Oommen Anil Thomas, Hariharan Triplicane Dwarakanathan, Kandagaddala Madhavi, Chandy Viruthipadavil John, Poonnoose Pradeep Mathew, Shankar A Arun
Department of Orthopaedics, Unit II, Christian Medical College Hospital, Vellore, Tamil Nadu, India.
Department of Radiology, Christian Medical College Hospital, Vellore, Tamil Nadu, India.
Arthroplast Today. 2022 Jun 25;16:182-191. doi: 10.1016/j.artd.2022.05.006. eCollection 2022 Aug.
Fused hips with spine stiffness in ankylosing spondylitis (AS) reduce spinopelvic mobility. We aimed to assess spinopelvic mobility pattern and acetabular anteversion in AS after total hip arthroplasty (THA).
Ninety-four stiff hips in 58 AS individuals (mean age: 37.05) who underwent THA between 2012 and 2018 with a modified lateral approach were included. Twenty-three hips were fused, and 71 hips had mean flexion of 37.67°. Pelvic tilt, pelvic inclination, sacral slope (SS), and lumbar lordosis were correlated with THA, and functional outcomes were assessed at 34.6-month mean follow-up.
Thirty-seven had a stuck sitting pattern with stuck standing seen in 4 individuals. SS standing before and after THA were 25.08° and 27.30°. SS sitting was 8.99° compared to 16.80°. SS from sitting to standing was reduced (17.7°) in 17 individuals. Spine stiffness in extension was seen in 4 out of 37. Mean acetabular inclination after THA was 42.67°, and acetabular anteversion was 17.48°. Flexion after THA improved to mean 98.47°. Changes in SS from sitting to standing were correlated with THA (r-value: 0.93, -value: .0001). The Harris Hip Score improved from 25.31 to 82.39 (-value <.05), and the mean 12-item Short Form Survey at review was 52.18 and 59.55 (physical and mental components). The mean Western Ontario and Mc Master Universities Arthritis Index score was 17.56.
Spinopelvic mobility change was <10° after THA in AS, stuck sitting was seen in 37 of 58 (63.8%), and stuck standing was seen in 4 of 58 (6.9%), including spine stiffness in flexion or extension. Acetabular anteversion assessed was 17.48° (standard deviation: 4.41), with significant functional improvement.
Level 4.
强直性脊柱炎（AS）中髋关节融合伴脊柱僵硬会降低脊柱骨盆活动度。我们旨在评估全髋关节置换术（THA）后AS患者的脊柱骨盆活动模式及髋臼前倾角。
纳入2012年至2018年间采用改良外侧入路接受THA的58例AS患者（平均年龄：37.05岁）的94个僵硬髋关节。其中23个髋关节已融合，71个髋关节平均屈曲度为37.67°。将骨盆倾斜度、骨盆倾斜角、骶骨斜率（SS）和腰椎前凸与THA进行相关性分析，并在平均34.6个月的随访期评估功能结果。
37例患者存在坐立受限模式，4例患者存在站立受限。THA前后站立位的SS分别为25.08°和27.30°。坐位的SS为8.99°，而之前为16.80°。17例患者从坐位到站立位的SS降低（17.7°）。37例中有4例存在脊柱伸展僵硬。THA后平均髋臼倾斜角为42.67°，髋臼前倾角为17.48°。THA后屈曲度改善至平均98.47°。从坐位到站立位的SS变化与THA相关（r值：0.93，P值：.0001）。Harris髋关节评分从25.31提高到82.39（P值<.05），复查时12项简短形式调查问卷的平均身体和精神成分得分分别为52.18和59.55。西安大略和麦克马斯特大学骨关节炎指数平均评分为17.56。
AS患者THA后脊柱骨盆活动度变化<10°，58例中有37例（63.8%）存在坐立受限，58例中有4例（6.9%）存在站立受限，包括屈曲或伸展时的脊柱僵硬。评估的髋臼前倾角为17.48°（标准差：4.41），功能有显著改善。
4级。
