Department of Orthopedics, West China Hospital, Sichuan University, #37 Guoxue Road, 610041, Chengdu, People's Republic of China.
Department of Orthopedics, Chongqing General Hospital, University of Chinese Academy of Sciences, 400014, Chongqing, China.
BMC Musculoskelet Disord. 2021 Mar 24;22(1):302. doi: 10.1186/s12891-021-04142-7.
Bilateral osseous ankylosed hips secondary to ankylosis spondylitis (AS) are relatively rare but impact the quality of life hugely. Cementless total hip arthroplasty (THA) for bilateral osseous ankylosed hips with AS is a challenging procedure. No previous literature compares the clinical outcomes of synchronous and sequential bilateral THA for these special patients.
23 patients (46 hips) were retrospectively analyzed and divided into bilateral THA synchronously (group A) and sequentially (group B). The clinical measurement, radiological assessments, and complications were compared. Independent sample T test was used for data analysis.
Harris Hip Scores (HHS) improved greatly for both groups (P = 0.58) as well as the range of motion (P = 0.64). But group B can realize shorter time (3.6 ± 1.2 days) to walk for the first time postoperatively (P = 0.02). Group A needed more blood transfusions (P = 0.028). For group A, no statistical difference was found in the bilateral inclination of cup (IC) (P = 0.48) and femoral offset (FO) (P = 0.07). For group B, no statistical difference was observed in bilateral IC (P = 0.37) but in bilateral FO (P = 0.04). Group A showed the fewer difference of bilateral IC (P = 0.02), while comparative measurements were found for two groups in the difference of bilateral FO (P = 0.78) and leg length discrepancy (P = 0.83). For both groups, the total hospital expense for each patient was similar and almost all patients were very satisfied with the outcomes. For group A, one patient encountered femoral fracture intraoperatively and another patient encountered hip dislocation and delay union of wound. 3 hips from group A and 3 hips from group B encountered heterotopic ossification.
Our retrospective research demonstrated that cementless bilateral THA was a reliable treatment for osseous ankylosed hip due to AS. Synchronous and sequential bilateral THA can realize similarly satisfactory clinical outcomes and radiographic evaluation.
强直性脊柱炎（AS）导致的双侧骨性强直髋相对少见，但严重影响生活质量。对于双侧骨性强直髋 AS 患者，施行非骨水泥全髋关节置换术（THA）是一个具有挑战性的手术。既往文献尚未比较同期和序贯双侧 THA 治疗此类特殊患者的临床效果。
回顾性分析 23 例（46 髋）患者，分为同期双侧 THA（A 组）和序贯双侧 THA（B 组）。比较两组的临床测量、影像学评估和并发症。采用独立样本 T 检验进行数据分析。
两组的 Harris 髋关节评分（HHS）均显著提高（P=0.58），活动范围也明显改善（P=0.64）。但 B 组术后首次下地行走的时间更短（3.6±1.2 天，P=0.02）。A 组需要更多的输血（P=0.028）。对于 A 组，双侧髋臼倾斜角（IC）（P=0.48）和股骨偏心距（FO）（P=0.07）无统计学差异。对于 B 组，双侧 IC 无统计学差异（P=0.37），但双侧 FO 有统计学差异（P=0.04）。A 组双侧 IC 的差异较小（P=0.02），而两组间双侧 FO 差异（P=0.78）和下肢长度差异（P=0.83）的比较测量值相似。两组患者的每位患者的总住院费用相似，几乎所有患者对治疗结果都非常满意。A 组有 1 例患者术中发生股骨干骨折，另 1 例患者发生髋关节脱位和伤口延迟愈合。A 组 3 髋和 B 组 3 髋发生异位骨化。
本回顾性研究表明，非骨水泥双侧 THA 是治疗 AS 导致的骨性强直髋的可靠方法。同期和序贯双侧 THA 可实现相似的满意的临床效果和影像学评估。
