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Management of hip involvement in ankylosing spondylitis

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Abstract

Ankylosing spondylitis (AS) is an inflammatory rheumatologic disease characterized by inflammation and progressive structural damage of the affected joints. Hip involvement often results in severe deformities and significant impairment on function. Although, tremendous progress has been made in conservative management for AS, effective prevention strategies for hip involvement and long-term need for total hip arthroplasty (THA) remain indefinite. When hip involvement has progressed to intractable pain and disability, THA is still the most effective treatment strategy to relieve pain and restore function. However, certain AS-specific problems regarding “preoperative preparation,” “intraoperative difficulties,” “perioperative pharmacological management,” “postoperative physiotherapy,” “operation benefits,” and “operation complications” need more concern and further discussion.

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References

  1. Cooksey R, Brophy S, Husain MJ, Irvine E, Davies H, Siebert S (2012) The information needs of people living with ankylosing spondylitis: a questionnaire survey. BMC Musculoskelet Disord 13:243

    Article  PubMed  Google Scholar 

  2. Gensler LS, Ward MM, Reveille JD, Learch TJ, Weisman MH, Davis JJ (2008) Clinical, radiographic and functional differences between juvenile-onset and adult-onset ankylosing spondylitis: results from the PSOAS cohort. Ann Rheum Dis 67:233–7

    Article  CAS  PubMed  Google Scholar 

  3. Ibn YY, Amine B, Laatiris A, Hajjaj-Hassouni N (2012) Gender and disease features in Moroccan patients with ankylosing spondylitis. Clin Rheumatol 31:293–7

    Article  Google Scholar 

  4. Hamdi W, Alaya Z, Ghannouchi MM, Haouel M, Kchir MM (2012) Associated risk factors with worse functional prognosis and hip replacement surgery in ankylosing spondylitis. Joint Bone Spine 79:94–6

    Article  PubMed  Google Scholar 

  5. Kobelt G, Andlin-Sobocki P, Maksymowych WP (2006) Costs and quality of life of patients with ankylosing spondylitis in Canada. J Rheumatol 33:289–95

    PubMed  Google Scholar 

  6. Kjeken I, Bo I, Ronningen A, Spada C, Mowinckel P, Hagen KB, Dagfinrud H (2013) A three-week multidisciplinary in-patient rehabilitation programme had positive long-term effects in patients with ankylosing spondylitis: Randomized controlled trial. J Rehabil Med 45:260–7

    Article  PubMed  Google Scholar 

  7. Ince G, Sarpel T, Durgun B, Erdogan S (2006) Effects of a multimodal exercise program for people with ankylosing spondylitis. Phys Ther 86:924–35

    PubMed  Google Scholar 

  8. Heikkila S, Viitanen JV, Kautiainen H, Kauppi M (2000) Sensitivity to change of mobility tests; effect of short term intensive physiotherapy and exercise on spinal, hip, and shoulder measurements in spondyloarthropathy. J Rheumatol 27:1251–6

    CAS  PubMed  Google Scholar 

  9. Yigit S, Sahin Z, Demir SE, Aytac DH (2013) Home-based exercise therapy in ankylosing spondylitis: short-term prospective study in patients receiving tumor necrosis factor alpha inhibitors. Rheumatol Int 33:71–7

    Article  CAS  PubMed  Google Scholar 

  10. Passalent LA (2011) Physiotherapy for ankylosing spondylitis: evidence and application. Curr Opin Rheumatol 23:142–7

    Article  PubMed  Google Scholar 

  11. Ozgocmen S, Akgul O, Altay Z, Altindag O, Baysal O, Calis M, Capkin E, Cevik R, Durmus B, Gur A, Kamanli A, Karkucak M, Madenci E, Melikoglu MA, Nas K, Senel K, Ugur M (2012) Expert opinion and key recommendations for the physical therapy and rehabilitation of patients with ankylosing spondylitis. Int J Rheum Dis 15:229–38

    Article  PubMed  Google Scholar 

  12. Braun J, van der Horst-Bruinsma IE, Huang F, Burgos-Vargas R, Vlahos B, Koenig AS, Freundlich B (2011) Clinical efficacy and safety of etanercept versus sulfasalazine in patients with ankylosing spondylitis: a randomized, double-blind trial. Arthritis Rheum 63:1543–51

    Article  CAS  PubMed  Google Scholar 

  13. Chen J, Veras MM, Liu C, Lin J (2013) Methotrexate for ankylosing spondylitis. Cochrane Database Syst Rev 2, CD004524

    PubMed  Google Scholar 

  14. Wanders A, Heijde D, Landewe R, Behier JM, Calin A, Olivieri I, Zeidler H, Dougados M (2005) Nonsteroidal antiinflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis: a randomized clinical trial. Arthritis Rheum 52:1756–65

    Article  CAS  PubMed  Google Scholar 

  15. Poddubnyy D, Rudwaleit M, Haibel H, Listing J, Marker-Hermann E, Zeidler H, Braun J, Sieper J (2012) Effect of non-steroidal anti-inflammatory drugs on radiographic spinal progression in patients with axial spondyloarthritis: results from the German Spondyloarthritis Inception Cohort. Ann Rheum Dis 71:1616–22

    Article  CAS  PubMed  Google Scholar 

  16. Kroon F, Landewe R, Dougados M, van der Heijde D (2012) Continuous NSAID use reverts the effects of inflammation on radiographic progression in patients with ankylosing spondylitis. Ann Rheum Dis 71:1623–9

    Article  CAS  PubMed  Google Scholar 

  17. Conaghan PG (2012) A turbulent decade for NSAIDs: update on current concepts of classification, epidemiology, comparative efficacy, and toxicity. Rheumatol Int 32:1491–502

    Article  CAS  PubMed  Google Scholar 

  18. Wang D, Ma L, Wu D (2011) Efficacy of etanercept in ankylosing spondylitis hip lesions. Joint Bone Spine 78:531–2

    Article  PubMed  Google Scholar 

  19. Lian F, Yang X, Liang L, Xu H, Zhan Z, Qiu Q, Ye Y (2012) Treatment efficacy of etanercept and MTX combination therapy for ankylosing spondylitis hip joint lesion in Chinese population. Rheumatol Int 32:1663–7

    Article  CAS  PubMed  Google Scholar 

  20. van der Heijde D, Landewe R, Einstein S, Ory P, Vosse D, Ni L, Lin SL, Tsuji W, Davis JJ (2008) Radiographic progression of ankylosing spondylitis after up to two years of treatment with etanercept. Arthritis Rheum 58:1324–31

    Article  PubMed  Google Scholar 

  21. van der Heijde D, Landewe R, Baraliakos X, Houben H, van Tubergen A, Williamson P, Xu W, Baker D, Goldstein N, Braun J (2008) Radiographic findings following two years of infliximab therapy in patients with ankylosing spondylitis. Arthritis Rheum 58:3063–70

    Article  PubMed  Google Scholar 

  22. van der Heijde D, Salonen D, Weissman BN, Landewe R, Maksymowych WP, Kupper H, Ballal S, Gibson E, Wong R (2009) Assessment of radiographic progression in the spines of patients with ankylosing spondylitis treated with adalimumab for up to 2 years. Arthritis Res Ther 11:R127

    Article  PubMed  Google Scholar 

  23. Zochling J, van der Heijde D, Burgos-Vargas R, Collantes E, Davis JJ, Dijkmans B, Dougados M, Geher P, Inman RD, Khan MA, Kvien TK, Leirisalo-Repo M, Olivieri I, Pavelka K, Sieper J, Stucki G, Sturrock RD, van der Linden S, Wendling D, Bohm H, van Royen BJ, Braun J (2006) ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 65:442–52

    Article  CAS  PubMed  Google Scholar 

  24. Backhaus M, Citak M, Kalicke T, Sobottke R, Russe O, Meindl R, Muhr G, Frangen TM (2011) Spine fractures in patients with ankylosing spondylitis: an analysis of 129 fractures after surgical treatment. Orthopade 40(917–20):922–4

    Google Scholar 

  25. Wulf H (1996) Epidural anaesthesia and spinal haematoma. Can J Anaesth 43:1260–71

    Article  CAS  PubMed  Google Scholar 

  26. Batra YK, Sharma A, Rajeev S (2006) Total spinal anaesthesia following epidural test dose in an ankylosing spondylitic patient with anticipated difficult airway undergoing total hip replacement. Eur J Anaesthesiol 23:897–8

    Article  CAS  PubMed  Google Scholar 

  27. Bhan S, Eachempati KK, Malhotra R (2008) Primary cementless total hip arthroplasty for bony ankylosis in patients with ankylosing spondylitis. J Arthroplast 23:859–66

    Article  Google Scholar 

  28. Bangjian H, Peijian T, Ju L (2012) Bilateral synchronous total hip arthroplasty for ankylosed hips. Int Orthop 36:697–701

    Article  PubMed  Google Scholar 

  29. Tang WM, Chiu KY (2000) Primary total hip arthroplasty in patients with ankylosing spondylitis. J Arthroplast 15:52–8

    Article  CAS  Google Scholar 

  30. Williams E, Taylor AR, Arden GP, Edwards DH (1977) Arthroplasty of the hip in ankylosing spondylitis. J Bone Joint Surg Br 59-B:393–7

    CAS  PubMed  Google Scholar 

  31. Baldursson H, Brattstrom H, Olsson T (1977) Total hip replacement in ankylosing spondylitis. Acta Orthop Scand 48:499–507

    Article  CAS  PubMed  Google Scholar 

  32. Finsterbush A, Amir D, Vatashki E, Husseini N (1988) Joint surgery in severe ankylosing spondylitis. Acta Orthop Scand 59:491–6

    Article  CAS  PubMed  Google Scholar 

  33. Sweeney S, Gupta R, Taylor G, Calin A (2001) Total hip arthroplasty in ankylosing spondylitis: outcome in 340 patients. J Rheumatol 28:1862–6

    CAS  PubMed  Google Scholar 

  34. Calin A, Elswood J (1989) The outcome of 138 total hip replacements and 12 revisions in ankylosing spondylitis: high success rate after a mean followup of 7.5 years. J Rheumatol 16:955–8

    CAS  PubMed  Google Scholar 

  35. Bisla RS, Ranawat CS, Inglis AE (1976) Total hip replacement in patients with ankylosing spondylitis with involvement of the hip. J Bone Joint Surg Am 58:233–8

    CAS  PubMed  Google Scholar 

  36. Joshi AB, Markovic L, Hardinge K, Murphy JC (2002) Total hip arthroplasty in ankylosing spondylitis: an analysis of 181 hips. J Arthroplast 17:427–33

    Article  Google Scholar 

  37. Sandri A, Regis D, Marino MA, Perandini S, Bonetti I, Toso M (2012) Deep external pudendal artery injury after percutaneous adductor tenotomy during THA in ankylosing spondylitis. Orthopedics 35:e566–9

    Article  PubMed  Google Scholar 

  38. Brinker MR, Rosenberg AG, Kull L, Cox DD (1996) Primary noncemented total hip arthroplasty in patients with ankylosing spondylitis. Clinical and radiographic results at an average follow-up period of 6 years. J Arthroplast 11:802–12

    Article  CAS  Google Scholar 

  39. Sochart DH, Porter ML (1997) Long-term results of total hip replacement in young patients who had ankylosing spondylitis. Eighteen to thirty-year results with survivorship analysis. J Bone Joint Surg Am 79:1181–9

    CAS  PubMed  Google Scholar 

  40. DeLee J, Ferrari A, Charnley J (1976) Ectopic bone formation following low friction arthroplasty of the hip. Clin Orthop Relat Res 53–9

  41. Wilde AH, Collins HR, Mackenzie AH (1972) Reankylosis of the hip joint in ankylosing spondylitis after total hip replacement. Arthritis Rheum 15:493–6

    Article  CAS  PubMed  Google Scholar 

  42. Tani Y, Nishioka J, Inoue K, Hukuda S, Tsujimoto M (1998) Relation between ectopic ossification after total hip arthroplasty and activity of general inflammation in patients with ankylosing spondylitis. Ann Rheum Dis 57:634

    Article  CAS  PubMed  Google Scholar 

  43. Kubiak EN, Moskovich R, Errico TJ, Di Cesare PE (2005) Orthopaedic management of ankylosing spondylitis. J Am Acad Orthop Surg 13:267–78

    PubMed  Google Scholar 

  44. Shih LY, Chen TH, Lo WH, Yang DJ (1995) Total hip arthroplasty in patients with ankylosing spondylitis: longterm followup. J Rheumatol 22:1704–9

    CAS  PubMed  Google Scholar 

  45. Busti AJ, Hooper JS, Amaya CJ, Kazi S (2005) Effects of perioperative antiinflammatory and immunomodulating therapy on surgical wound healing. Pharmacotherapy 25:1566–91

    Article  CAS  PubMed  Google Scholar 

  46. Radzikowska B (2000) Rheumatological considerations in the qualification of rheumatoid patients for surgical treatment and principles for pre- and post-operative management. Ortop Traumatol Rehabil 2:83–6

    CAS  PubMed  Google Scholar 

  47. Goh L, Jewell T, Laversuch C, Samanta A (2012) Should anti-TNF therapy be discontinued in rheumatoid arthritis patients undergoing elective orthopaedic surgery? A systematic review of the evidence. Rheumatol Int 32:5–13

    Article  CAS  PubMed  Google Scholar 

  48. Kawakami K, Ikari K, Kawamura K, Tsukahara S, Iwamoto T, Yano K, Sakuma Y, Tokita A, Momohara S (2010) Complications and features after joint surgery in rheumatoid arthritis patients treated with tumour necrosis factor-alpha blockers: perioperative interruption of tumour necrosis factor-alpha blockers decreases complications? Rheumatol (Oxford) 49:341–7

    Article  CAS  Google Scholar 

  49. Saag KG, Teng GG, Patkar NM, Anuntiyo J, Finney C, Curtis JR, Paulus HE, Mudano A, Pisu M, Elkins-Melton M, Outman R, Allison JJ, Suarez AM, Bridges SJ, Chatham WW, Hochberg M, MacLean C, Mikuls T, Moreland LW, O'Dell J, Turkiewicz AM, Furst DE (2008) American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum 59:762–84

    Article  CAS  PubMed  Google Scholar 

  50. Ledingham J, Deighton C (2005) Update on the British Society for Rheumatology guidelines for prescribing TNFalpha blockers in adults with rheumatoid arthritis (update of previous guidelines of April 2001). Rheumatol (Oxford) 44:157–63

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, 510515, China

    Mingqiang Guan, Jian Wang, Liang Zhao, Jun Xiao, Zhihan Li & Zhanjun Shi

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  1. Mingqiang Guan
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  2. Jian Wang
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Correspondence to Zhanjun Shi.

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Guan, M., Wang, J., Zhao, L. et al. Management of hip involvement in ankylosing spondylitis. Clin Rheumatol 32, 1115–1120 (2013). https://doi.org/10.1007/s10067-013-2278-3

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