Uncemented total hip arthroplasty (THA) with large size femoral heads have shown greater advantage with good stability, range of motion and decreased dislocation rate in ankylosing spondylitis (AS). Meticulous planning is needed to address the unique surgical challenges in such patients with fused hip and spinal deformity.
Materials and Methods
Thirty fivefused hip joints in twenty-five AS patients who underwent uncemented THA (April 2014 to December 2016) were included in our prospective study and were followed up for a minimum period of 36 months. Pain relief, functional improvement and patient satisfaction were statistically assessed using “Visual Analogue Score” (VAS), “Harris Hip Score” (HHS) and “AJRI 10-Point Satisfaction Score” (A10PSS), respectively.
The overall mean preoperative VAS improved from 6.9 ± 1.5 to 1.5 ± 1, HHS improved from 50.0 ± 12 to 88.4 ± 7.8 and A10PSS improved from 2.2 ± 1.2 to 7.6 ± 0.8. Our study results were significant with zero dislocation and good functional score in comparison to the other available studies in literature. First subdivision study in AS patients with bilateral THA performed better than unilateral THA. Second subdivision study showed no significant statistical difference in terms of VAS, HHS, A10PSS and dislocation rate in relation to femoral head size between 32 mm, 36 mm and 40 mm.
Uncemented THA with large size femoral head equal or greater than 32 mm provides better stability and good functional outcome with less dislocation rate in comparison to older studies of literature with femoral head size less than 32 mm.
Level of Evidence
A Level II study. (Data collected from the ongoing prospective study) (https://www.spine.org/Documents/LevelsofEvidenceFinal.pdf).
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Dean, L. E., Jones, G. T., MacDonald, A. G., Downham, C., Sturrock, R. D., & Macfarlane, G. J. (2013). Global prevalence of ankylosing spondylitis. Rheumatology,53(4), 650–657.
Braun, J., & Sieper, J. (2007). Ankylosing spondylitis. The Lancet,369(9570), 1379–1390.
Vander Cruyssen, B., Muñoz-Gomariz, E., Font, P., Mulero, J., de Vlam, K., BoonenA, V.-M., et al. (2009). Hip involvement in ankylosing spondylitis: epidemiology and risk factors associated with hip replacement surgery. Rheumatology,49(1), 73–81.
Woodward, L. J., & Kam, P. C. A. (2009). Ankylosing spondylitis: recent developments and anaesthetic implications. Anaesthesia,64(5), 540–548.
Tang, W. M., & Chiu, K. Y. (2000). Primary total hip arthroplasty in patients with ankylosing spondylitis. The Journal of Arthroplasty,15(1), 52–58.
Mahesh, B. H., Jayaswal, A., & Bhan, S. (2008). Fracture dislocation of the spine after total hip arthroplasty in a patient with ankylosing spondylitis with early pseudoarthrosis. The Spine Journal,8(3), 529–533.
Zheng, G. Q., Zhang, Y. G., Chen, J. Y., & Wang, Y. (2014). Decision making regarding spinal osteotomy and total hip replacement for ankylosing spondylitis. The Bone and Joint Journal,96-B(3), 360–365.
Bose, V. C., & Baruah, B. D. (2010). Resurfacing arthroplasty of the hip for avascular necrosis of the femoral head. The Journal of bone and joint surgery British,92-B(7), 922–928.
Bhan, S., Eachempati, K. K., & Malhotra, R. (2008). Primary cementless total hip arthroplasty for bony ankylosis in patients with ankylosing spondylitis. The Journal of Arthroplasty,23(6), 859–866.
Archbold, H. A. P., Mockford, B., Molloy, D., McConway, J., Ogonda, L., & Beverland, D. (2006). The transverse acetabular ligament: an aid to orientation of the acetabular component during primary total hip replacement. The Journal of bone and joint surgery British,88(7), 883–886.
Phan, D., Bederman, S. S., & Schwarzkopf, R. (2015). The influence of sagittal spinal deformity on anteversion of the acetabular component in total hip arthroplasty. The Bone and Joint Journal,97-B(8), 1017–1023.
Johnson, E. W. (2001). Visual Analog Scale (VAS). American Journal of Physical Medicine and Rehabilitation,80(10), 717.
Harris, W. H. (1969). Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. Journal of Bone and Joint Surgery. American Volume,51(4), 737–755.
Quraishi, M. K., Badsha, H., Khan, B., Shahzeb, M., Hegde, S., Mofti, A., et al. (2018). Interethnic Variations and Clinical Features of Spondyloarthropathies in a Middle Eastern Country. The Open Rheumatology Journal,12(1), 10–18.
Lin, D., Charalambous, A., & Hanna, S. A. (2019). Bilateral total hip arthroplasty in ankylosing spondylitis: a systematic review. EFORT Open Reviews,4(7), 476–481.
De Martino, I., D’Apolito, R., Soranoglou, V. G., Poultsides, L. A., Sculco, P. K., & Sculco, T. P. (2017). Dislocation following total hip arthroplasty using dual mobility acetabular components. Bone and Joint Journal,99-B(1 Supple A), 18–24.
Saglam, Y., Ozturk, I., Cakmak, M. F., Ozdemir, M., & Yazicioglu, O. (2016). Total hip arthroplasty in patients with ankylosing spondylitis: Midterm radiologic and functional results. Acta orthopaedica et traumatologica turcica,50(4), 443–447.
Bangjian, H., Peijian, T., & Ju, L. (2011). Bilateral synchronous total hip arthroplasty for ankylosed hips. International Orthopaedics,36(4), 697–701. https://doi.org/10.1007/s00264-011-1313-8.
Li, J., Xu, W., Xu, L., & Liang, Z. (2009). Hip resurfacing arthroplasty for ankylosing spondylitis. The Journal of Arthroplasty,24(8), 1285–1291.
Baba, T., Shitoto, K., Kaneko, K., Inoue, H., Nozawa, M., & Maruyama, Y. (2010). Total hip arthroplasty in Japanese patients with ankylosing spondylitis. European Journal of Orthopaedic Surgery and Traumatology,20(8), 613–618.
Xu, J., Zeng, M., Xie, J., Wen, T., & Hu, Y. (2017). Cementless total hip arthroplasty in patients with ankylosing spondylitis. Medicine,96(4), e5813. https://doi.org/10.1097/md.0000000000005813.
Wang, W., Huang, G., Huang, T., & Wu, R. (2014). Bilaterally primary cementless total hip arthroplasty in patients with ankylosing spondylitis. BMC Musculoskeletal Disorders,15(1), 344.
Ye, C., Liu, R., Sun, C., Lin, J., Li, H., Re, H., et al. (2014). Cementless bilateral synchronous total hip arthroplasty in ankylosing spondylitis with hip ankylosis. International Orthopaedics,38(12), 2473–2476.
Acker, A., Fischer, J. F., Aminian, K., Lécureux, E., & Jolles, B. M. (2017). Total hip arthroplasty using a cementless dual mobility cup provides increased stability and favorable gait parameters at five years follow-up. Orthopaedics and Traumatology: Surgery and Research,103(1), 21–25.
Huang, X. G., & Zeng, B. (2018). Total hip arthroplasty for the treatment of bony ankylosis in patients with ankylosing spondylitis. ZhongguoGu Shang,31(12), 1104–1107.
Grip, H., Nilsson, K. G., Häger, C. K., Lundström, R., & Öhberg, F. (2019). Does the femoral head size in hip arthroplasty influence lower body movements during squats, gait and stair walking? A clinical pilot study based on wearable motion sensors. Sensors,19(14), 3240.
Dietz, M. J., Moushmoush, O., Samora, W. P., Kish, V. L., & Hamlin, B. R. (2019). The effect of increasing femoral head size on the force required for dislocation. Surgical Technology International,35, 426–429.
Tsikandylakis, G., Mohaddes, M., Cnudde, P., Eskelinen, A., Kärrholm, J., & Rolfson, O. (2018). Head size in primary total hip arthroplasty. EFORT Open Reviews,3(5), 225–231.
Holtzman, J., Saleh, K., & Kane, R. (2002). Effect of baseline functional status and pain on outcomes of total hip arthroplasty. The Journal of Bone and Joint Surgery-American,84(11), 1942–1948.
Dabir, S., Ramanath, S., Shah, H., Rudramurthy, M., & Patil, S. S. (2015). Surgical technique and outcome of uncemented THR using HA coated stems in fused and deformed hips due to ankylosing spondylitis. Hip International: The Journal of Clinical and Experimental Research on Hip Pathology and Therapy,25(2), 142–145.
Dr. Palanivel C, Professor, SPM Department, JIPMER, Puducherry. firstname.lastname@example.org.
Miss. Lavanya Chandrasekar Physician Assistant, Asian Joint Reconstruction Institute @ SIMS Hospitals, Chennai, Tamil Nadu, India.
No specific financial support was received for this study.
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical standard statement
The study was approved by SIMS Institutional Review Board.
Informed consent from patients was obtained.
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Kanniyan, K., Patil, S., Kumar, P.S.A. et al. Does the Femoral Head Size Influence Outcomes After Uncemented Total Hip Arthroplasty for Fused Hips? A Prospective Study in Ankylosing Spondylitis. JOIO (2020). https://doi.org/10.1007/s43465-020-00210-7
- Ankylosing spondylitis
- Fused hip joint
- Femoral head size
- Uncemented total hip arthroplasty
- Visual analog score
- Harris hip score
- AJRI 10-point satisfaction score
- Transverse acetabular ligament
- Spinal deformity