Ankylosing Spondylitis Patients Have Lower Risk of Dislocation Following Total Hip Arthroplasty Compared with Patients Undergoing Lumbar Spinal Fusion Surgery

Abstract

Haitao Guan,1,2,* Chi Xu,2,* Jun Fu,2,* Xue Yang,2 Yingze Zhang,3 Jiying Chen2 1School of Medicine, Nankai University, Tianjin, People’s Republic of China; 2Department of Orthopedic Surgery, Chinese PLA General Hospital, Beijing, People’s Republic of China; 3Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jiying Chen, Department of Orthopedic Surgery, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, People’s Republic of China, Email [email protected] Yingze Zhang, Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei, People’s Republic of China, Email [email protected]: Patients undergoing lumbar spinal fusion (LSF) surgery and patients with ankylosing spondylitis (AS) have concomitant pathology of hip and lumbosacral spine. The purpose of our study is to compare the dislocation rate following total hip arthroplasty (THA) between patients with LSF and AS and reveal the differences of lumbar fusion secondary to LSF and AS.Patients and methods: Fifty-nine patients (73 hips) were included in Group LSF and every patient was matched with two patients in Group AS. Follow-ups were conducted for information of surgical prognosis and dislocation events following THA. Multiple anatomic parameters were measured on preoperative and postoperative radiological images.Results: The dislocation rate of patients in Group AS (0.68%) was obviously lower than that of patients in Group LSF (4.11%) and the hazard ratio of dislocation events following THA reached 6.1. Considering the low calculated power (1-β, 0.24), we supposed insufficient statistical evidence (p=0.118) could be attributed to small sample size. Postoperative hip flexion range of motion (ROM) in Group AS (102.1°± 24.5°) was significantly lower than that in Group LSF (117.4°± 14.2°) (p< 0.0005). Postoperative flexion ROM of lumbar was also significantly lower in Group AS (p< 0.001). There was no significant difference between two groups concerning postoperative acetabular inclination (p=0.988) and anteversion (p=0.25). However, patients in Group AS had a significantly lower sacral slope (p=0.025) and higher pelvic tilt (p< 0.0005) than patients in Group LSF after THA.Conclusion: Patients with AS have a lower risk of dislocation after THA compared with patients undergoing LSF. The lower risk is significantly relevant to severer stiffness and lower mobility along the spine–pelvis-–hip axis in AS patients after THA. Acetabular orientation has no significant effect on the difference of dislocation rate between patients with LSF and AS.Keywords: ankylosing spondylitis, lumbar spinal fusion, total hip arthroplasty, dislocation, range of motion

Keywords

• ankylosing spondylitis
• lumbar spinal fusion
• total hip arthroplasty
• dislocation
• range of motion