Summary of key studies of total hip arthroplasty in patients with ankylosed hips
| Study | Patients | Surgical approach | Outcomes |
|---|---|---|---|
| Present study | 47 patients (76 hips) with spontaneous ankylosis. | A combined anterolateral and posterolateral approach via a lateral incision. Mean follow-up was 5.5 years. | Harris hip score improved from 53 to 88 points postoperatively. The outcome was excellent to good in 88.37% of cases. Femoral prosthesis subsidence occurred in 3 hips. The maximum subsidence was 2 mm. No treatment was required as there were no symptoms related to the subsidence. Heterotopic ossification occurred in 6 hips. |
| Bhan et al.16 | Retrospective review of 54 patients (92 hips) who underwent cementless THA for bony ankylosis due to ankylosing spondylitis. | Posterior approach. Mean follow-up was 8.5 years. | Harris hip scores improved from 49.5 to 82.6. Complications included pain (n = 10), anterior dislocation (n = 4), sciatic nerve palsy (n = 1), revision arthroplasty due to aseptic loosening (n = 13). |
| Kim et al.18 | 12 patients with bilateral anyklosis (24 hips). | All surgeries performed by a single surgeon via the standard transtrochanteric approach. | Harris hip scores increased from 55.4 to 82.3. Complications included osteolysis (n = 3) and loosening (n = 2), and 11 cups were outside the safe ranges of Lewinnek. |
| Abdel-Aal et al.19 | 12 patients (15 hips) with surgically (n = 5) and spontaneously fused hips (n = 7). | Hardinge approach. | Harris hip scores in all patients improved from 42 preoperatively to 76 postoperatively. Complications included femoral artery injury due to Hofmann retractors in front of the acetabulum, 1 failed THA. |
| Joshi et al.5 | 103 patients underwent 181 THAs for ankylosing spondylitis. | Either direct lateral approach via trochanteric osteotomy or the Hardinge approach. All patients received cemented low-friction THAs. | No Harris hip scores were reported. Instead, authors indicated that 96% of hips had an excellent (low) pain score and 29.25 of the hips had normal or near-normal function. |
| Rutz et al.20 | 22 patients (22 ankylosed hips) secondary to posttraumatic osteoarthritis, coxitis, hip dysplasia and primary osteoarthritis. | 19 conversions were via a lateral approach and 3 were via an anterolateral approach; 20 patients were available at a mean follow-up of 13.2 years. | Harris hips scores postoperatively were 84.9 (presurgical scores were not cited). Complications occurred in 30% of patients and included transient apraxia of the femoral nerve, a lesion of the sciatic nerve, 2 deep infections, and aseptic loosening of 2 femoral stems. |
| Hamadouche et al.21 | 45 patients (45 hips) underwent THA for treatment of spontaneous ankylosis (n = 20) and postoperative ankylosis (n = 35). Cases of ankylosing spondylitis and fibrous ankylosis were excluded. | Lateral approach with a standard trochanteric osteotomy. | Merle d’Aubigné hip scores increased from 11.3 points preoperatively to 16.5 points at the time of last follow-up. Satisfactory hip function was achieved in 41 (91%) patients. Complications included deep vein thrombosis (n = 2), common peroneal nerve palsy (n = 1), and periprosthetic and inguinal abscess 1 year postoperatively (n = 1). |
| Rajaratnam et al.22 | 15 patients (16 hips) undergoing cementless THA to treat spontaneous ankylosis (including ankylosing spondylitis) or surgical arthrodesis. | Hardinge approach in 5 patients and the remaining 10 patients had a posterior approach with an enhanced posterior repair. Median follow-up was 10.75 years. | Harris hip scores improved from 70 to 83 and Merle d’Aubigné hip scores had a score of 4.8 for pain, 3.9 for mobility, and 4.4 for function. The overall Merle d’Aubigné hip score postoperatively was a mean of 13. Aseptic loosing requiring acetabular cup revision occurred in one patient, and deep vein thrombosis occurred in another. |
| Bangjian et al.23 | 12 patients with bilateral ankylosed hip joints (24 hips) caused by late ankylosing spondylitis. | The most appropriate approach depending on patient anatomy and the incision was via the posterolateral approach. Mean follow-up was 4.2 years. | All hip joint function improved, and flexion deformity was corrected. Flexion ranges were 75–105° (mean 84.4°) and extension ranges were 10° to 20° (mean, 18.7°). Harris hip scores ranged from 15.21 points preoperatively to 86.25 points postoperatively. No patient experienced hip pain postoperatively, and preoperative knee and lower back pain were clearly relieved postoperatively. |
THA = total hip arthroplasty.