Clin Orthop Surg.  2017 Sep;9(3):263-269. 10.4055/cios.2017.9.3.263.

Comparison of Outcomes of Total Hip Arthroplasty between Patients with Ankylosing Spondylitis and Avascular Necrosis of the Femoral Head

Affiliations
  • 1Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea. tryoon@chonnam.ac.kr

Abstract

BACKGROUND
The objective of this study was to compare clinical and radiological outcomes of total hip arthroplasty (THA) between ankylosing spondylitis (AS) of the hip joint and avascular necrosis (AVN) of the femoral head.
METHODS
Thirty patients (30 hips) underwent cementless THA for AS between 2003 and 2012. They were compared to 30 patients (30 hips) who underwent the same procedure for AVN of the femoral head. Each group was matched for age and gender, and both groups had similar preoperative demographic characteristics. All cases were followed for minimum 4 postoperative years. Clinical evaluation was based on operation time, intraoperative blood loss, quantity of postoperative drainage, Harris Hip Score (HHS), and range of motion (ROM). Radiological results were evaluated by acetabular cup anteversion and inclination, femoral stem orientation, pre- and postoperative leg length discrepancy, and postoperative complications.
RESULTS
The operation time was significantly longer in the AS group (120.2 ± 26.2 min) than in the AVN group (79.5 ± 11.1 min). The volume of postoperative drainage was significantly greater in the AS group (764.5 ± 355.4 mL vs. 510.5 ± 195.6 mL). Preoperative HHS was lower in the AS group (55.6 ± 13.8 vs. 59.2 ± 2.8). Similarly, postoperative HHS was significantly lower in the AS group (92.8 ± 2.7 vs. 97.4 ± 2.6). The arc of ROM was improved from 146.5°± 13.2° preoperatively to 254.7°± 17.2° postoperatively in the AS group and from 182.6°± 15.5° to 260.4°± 13.7° in the AVN group. Implant position and postoperative leg length discrepancy were not different between the groups. However, three cases of heterotopic ossification was observed in the AS group, whereas only 1 case was found in the AVN group. One deep infection and one aseptic stem loosening were found in the AS group, whereas none was observed in the AVN group.
CONCLUSIONS
Cementless THA showed satisfactory clinical and radiological results in both groups, despite the longer operation time, larger blood loss volume, and lower HHS score of the AS group. Our findings suggest that cementless THA is an effective and reliable treatment for both AS and AVN.

Keyword

Ankylosing spondylitis; Total hip arthroplasty; Avascular necrosis

MeSH Terms

Adult
*Arthroplasty, Replacement, Hip/methods
Female
Femur Head Necrosis/diagnostic imaging/*surgery
Hip Joint/diagnostic imaging
Humans
Male
Middle Aged
Operative Time
Ossification, Heterotopic/diagnostic imaging/surgery
Radiography
Spondylitis, Ankylosing/diagnostic imaging/*surgery
Treatment Outcome
Young Adult

Figure

  • Fig. 1 Radiographs of a patient with ankylosing spondylitis who underwent primary cementless total hip arthroplasty. (A) Preoperative radiograph. (B) One-year postoperative radiograph. (C) Three-year postoperative radiograph.

  • Fig. 2 Radiographs of a patient with avascular necrosis of the femoral head who underwent primary cementless total hip arthroplasty. (A) Preoperative radiograph. (B) One-year postoperative radiograph. (C) Three-year postoperative radiograph.

  • Fig. 3 Radiographs of a patient with ankylosing spondylitis who presented with heterotopic ossification (A) Preoperative radiograph. (B) One-year postoperative radiograph. (C) Three-year postoperative radiograph. Heterotopic ossification of Brooker grade III was observed around the right hip joint.


Cited by  1 articles

Korean treatment recommendations for patients with axial spondyloarthritis
Mi Ryoung Seo, Jina Yeo, Jun Won Park, Yeon-Ah Lee, Ju Ho Lee, Eun Ha Kang, Seon Mi Ji, Seong-Ryul Kwon, Seong-Kyu Kim, Tae-Jong Kim, Tae-Hwan Kim, Hye Won Kim, Min-Chan Park, Kichul Shin, Sang-Hoon Lee, Eun Young Lee, Hoon Suk Cha, Seung Cheol Shim, Youngim Yoon, Seung Ho Lee, Jun Hong Lim, Han Joo Baek
J Rheum Dis. 2023;30(3):151-169.    doi: 10.4078/jrd.2023.0025.


Reference

1. Joshi AB, Markovic L, Hardinge K, Murphy JC. Conversion of a fused hip to total hip arthroplasty. J Bone Joint Surg Am. 2002; 84(8):1335–1341. PMID: 12177262.
2. Thilak J, Panakkal JJ, Kim TY, Goodman SM, Lee SS, Salvati EA. Risk factors of heterotopic ossification following total hip arthroplasty in patients with ankylosing spondylitis. J Arthroplasty. 2015; 30(12):2304–2307. PMID: 26154570.
Article
3. Yu MC, Jo YJ, Kim GI, Jeon YS, Lee YH, Ha JH. Conversion total hip arthroplasty in bony ankylosis of the hip joint. J Korean Hip Soc. 2003; 15(1):1–9.
4. Wang W, Huang G, Huang T, Wu R. Bilaterally primary cementless total hip arthroplasty in patients with ankylosing spondylitis. BMC Musculoskelet Disord. 2014; 15:344. PMID: 25306112.
Article
5. Edwards DS, Barbur SA, Bull AM, Stranks GJ. Posterior mini-incision total hip arthroplasty controls the extent of post-operative formation of heterotopic ossification. Eur J Orthop Surg Traumatol. 2015; 25(6):1051–1055. PMID: 25953634.
Article
6. Downing MR, Knox D, Gibson P, Reid DM, Potter A, Ashcroft GP. Impact of trochanteric heterotopic ossification on measurement of femoral bone density following cemented total hip replacement. J Orthop Res. 2008; 26(10):1334–1339. PMID: 18404740.
Article
7. Higo T, Mawatari M, Shigematsu M, Hotokebuchi T. The incidence of heterotopic ossification after cementless total hip arthroplasty. J Arthroplasty. 2006; 21(6):852–856. PMID: 16950038.
Article
8. Yoon TR, Bae BH, Choi MS. A modified two-incision minimally invasive total hip arthroplasty: technique and shortterm results. Hip Int. 2006; 16(Suppl 4):28–34. PMID: 19219826.
Article
9. Harris WH. 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. J Bone Joint Surg Am. 1969; 51(4):737–755. PMID: 5783851.
10. Choi IY, Kim YH, Roh WI, Cho WJ. Cementless total hip arthroplasty in bony ankylosed hip. J Korean Orthop Assoc. 2003; 38(7):710–715.
Article
11. Tang WM, Chiu KY. Primary total hip arthroplasty in patients with ankylosing spondylitis. J Arthroplasty. 2000; 15(1):52–58. PMID: 10654462.
Article
12. Kim YM, Kim HJ, Rhyu KH, Oh HC, Lim CK, Park KW. Total hip arthroplasty in bony fused hip. J Korean Orthop Assoc. 2000; 35(6):873–878.
Article
13. Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement: incidence and a method of classification. J Bone Joint Surg Am. 1973; 55(8):1629–1632. PMID: 4217797.
14. Ye C, Liu R, Sun C, et al. Cementless bilateral synchronous total hip arthroplasty in ankylosing spondylitis with hip ankylosis. Int Orthop. 2014; 38(12):2473–2476. PMID: 25030965.
Article
15. Bhan S, Eachempati KK, Malhotra R. Primary cementless total hip arthroplasty for bony ankylosis in patients with ankylosing spondylitis. J Arthroplasty. 2008; 23(6):859–866. PMID: 18722294.
Article
16. Gu M, Zhang Z, Kang Y, et al. Roles of sagittal anatomical parameters of the pelvis in primary total hip replacement for patients with ankylosing spondylitis. J Arthroplasty. 2015; 30(12):2219–2223. PMID: 26164560.
Article
17. Goodman SM, Zhu R, Figgie MP, Huang WT, Mandl LA. Short-term total hip replacement outcomes in ankylosing spondylitis. J Clin Rheumatol. 2014; 20(7):363–368. PMID: 25275762.
Article
18. Weng HK, Wu PK, Chen CF, et al. Total hip arthroplasty for patients who have ankylosing spondylitis: is postoperative irradiation required for prophylaxis of heterotopic ossification? J Arthroplasty. 2015; 30(10):1752–1756. PMID: 25980776.
Article
19. Zhu Y, Zhang F, Chen W, Zhang Q, Liu S, Zhang Y. Incidence and risk factors for heterotopic ossification after total hip arthroplasty: a meta-analysis. Arch Orthop Trauma Surg. 2015; 135(9):1307–1314. PMID: 26155968.
Article
20. Spinarelli A, Patella V, Petrera M, Abate A, Pesce V, Patella S. Heterotopic ossification after total hip arthroplasty: our experience. Musculoskelet Surg. 2011; 95(1):1–5. PMID: 21210261.
Article
21. Okano K, Aoyagi K, Osaki M, Motokawa S, Matsumoto T. Bone mineral density is not related to heterotopic ossification after total hip arthroplasty. Int Orthop. 2012; 36(6):1163–1166. PMID: 22190061.
Article
22. Kilgus DJ, Namba RS, Gorek JE, Cracchiolo A 3rd, Amstutz HC. Total hip replacement for patients who have ankylosing spondylitis: the importance of the formation of heterotopic bone and of the durability of fixation of cemented components. J Bone Joint Surg Am. 1990; 72(6):834–839. PMID: 2114407.
Article
23. Hug KT, Alton TB, Gee AO. Classifications in brief: Brooker classification of heterotopic ossification after total hip arthroplasty. Clin Orthop Relat Res. 2015; 473(6):2154–2157. PMID: 25427427.
24. Rama KR, Vendittoli PA, Ganapathi M, Borgmann R, Roy A, Lavigne M. Heterotopic ossification after surface replacement arthroplasty and total hip arthroplasty: a randomized study. J Arthroplasty. 2009; 24(2):256–262. PMID: 18534415.
Full Text Links
  • CIOS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr