Hip Replacement in Ankylosing Spondylitis Patients with Advanced Hip Involvement: Factors Associated with Bilateral Total Hip Arthroplasty

Abstract

Liangliang Li,1– 3 Jun Fu,2 Chi Xu,2 Ming Ni,2 Wei Chai,2 Libo Hao,2 Yonggang Zhou,2 Jiying Chen2 1Medical School of Chinese PLA, Beijing, People’s Republic of China; 2Department of Orthopedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China; 3Department of Orthopedics, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of ChinaCorrespondence: Jiying Chen; Libo HaoDepartment of Orthopedics, The First Medical Centre, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, People’s Republic of ChinaTel [phone]; Tel [phone]Fax [phone]Email [email protected]; [email protected]: This study aimed to compare the clinical data of ankylosing spondylitis (AS) patients who underwent unilateral and bilateral total hip arthroplasty (THA) due to advanced hip involvement. Furthermore, to determine the factors associated with bilateral THA.Methods: Utilizing a single-institution database, we selected 373 consecutive AS patients undergoing primary THA from 2012 to 2017 and compared the clinical characteristics and anti-tumor necrosis factor (TNF) therapy of the patients who underwent unilateral and bilateral THA. Logistic regression was used to identify factors associated with bilateral THA.Results: Bilateral THA was performed in 67.3% (n=251) of the patients. Male patients had a higher frequency of undergoing bilateral THA compared with female ones (P< 0.05). The proportion of the patients who had bilateral onset in hips, administration of TNF inhibitors, flexion contracture in the hip, and a BASRI-hip score of 4 was significantly higher in patients with bilateral THA than that with unilateral THA (P< 0.05). Patients with bilateral THA experienced longer disease duration than those with unilateral THA (P< 0.05). The results of the logistic regression showed that factors related to bilateral THA were bilateral onset in hips, administration of TNF inhibitors, a BASRI-hip score of 4, and an erythrocyte sedimentation rate (ESR) level (P< 0.05).Conclusion: Bilateral THA is more common in AS patients with advanced hip involvement. Bilateral onset in hips, a BASRI-hip score of 4, and a higher level of ESR are risk factors associated with bilateral THA, while anti-TNF therapy is a protective factor reducing the progression of hip involvement to bilateral THA.Keywords: ankylosing spondylitis, hip involvement, bilateral total hip arthroplasty, anti-TNF therapy

Keywords

• ankylosing spondylitis
• hip involvement
• bilateral total hip arthroplasty
• anti-tnf therapy