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Botanlioglu H. 1, Kaynak G. 1, Ozsahin K. 2, Caliskan G. 2, Guven M. F. 1, Erdogan F. 1, Bilsel N. 1
1 Department of Orthopaedics and Traumatology Cerrahpasa Faculty of Medicine Istanbul University, Kocamustafapasa Istanbul, Turkey;
2 Department of Physical Therapy and Rehabilitation, Istanbul University Cerrahpasa Faculty of Medicine Kocamustafapasa, Istanbul, Turkey
Aim: The purpose of our study was to evaluate preoperative and postoperative functional results (and its effect on the posture of the body) of patients who had diagnosis of ankylosing spondylitis (AS) and had total hip arthroplasty because of hip flexion contracture and coxarthrosis, bilateral sacroiliac joint fusion, vertebra involvement, related to AS.
Methods: Thirteen patients were evaluated who had total hip arthroplasty (THA) because of hip joint ankylosis related to AS, and whose operations were performed by the same surgeon. All patients have bilateral sacroiliac joint ankylosis, hip joint flexion deformity, hip and vertebra ankylosis. The mean hip flexion contracture was 45° degrees. Patients’ functional evaluation was made by preoperatively and postoperatively Harris hip score, Bath Ankylosing Spondylitis Functional Index (BASFI) and Jergesen’s functional evaluation.
Results: Totally THA was performed on 22 hip joints, on 9 patient bilateral THA and on 4 patients unilateral THA were performed. Mean follow-up time was 73.6 months (min: 24, max: 240 months). Preoperative mean Harris hip score was 30.77(range from 12 to 38; SD: ±8.7), Jergesen score was 27.7 (range from 8 to 44; SD: ±11.1) and BASFI was 8.2 (range from 7.2 to 9.6; SD: ±0.74); postoperatively on patients’ last controls Harris hip score was 71.15 (range from 52 to 77; SD: ±8,89), Jergesen score was 74.85 (range from 58 to 80; SD: ±7.63) and BASFI was 3,91 (range from 2.4 to 6.3; SD: ±1.25) found. Between preoperatively and postoperatively calculated BASFI and Jergesen functional evaluation scores were found statistically significant (P<0.001). Mean occiput-wall distance preoperatively was found 21.77 (range from 19 to 25; SD: ±1.83), postoperatively 12.77 (range from 11 to 15; SD: ±1.42); (P<0.001). Mean thoracic kyphosis degree was 70.46° (range from 65 to 75).
Conclusion: THA provides a better functional outcome by increasing daily activities, in the AS patients with coxarthrosis accompanied by flexion contracture, bilateral sacroiliac fusion and vertebral joint involvement. At the same time, THA fixes patient’s posture and looking straight. Fixing hip flexion contractures in AS patients’ sagittal balance without needing vertebral osteotomy is possible with THA.