Holy Cross Orthopedic Institute, Holy Cross Health, Fort Lauderdale, FL, USA.
Hospital for Special Surgery, West Palm Beach, FL, USA.
Hip Int. 2024 Sep;34(5):602-607. doi: 10.1177/11207000241267706. Epub 2024 Aug 16.
Ankylosing spondylitis (AS) is an inflammatory spondyloarthropathy, often involving the spine and sacroiliac joints. Total hip arthroplasty (THA) has been shown to be effective in improving pain and function in patients with AS with hip involvement. However, extraskeletal manifestations and altered mechanics in those with AS leads to increased complications. Thus, the aims of this study were to assess the effects that AS has on medical and implant complications, falls, length of stay, and readmissions following THA.
A retrospective review of the Mariner private insurance claims database was conducted from 2010 to 2020. All cases of THA and those with AS were identified using Current Procedural Terminology, and International Classification of Disease 9 and 10 revision codes. Patients who underwent THA with a diagnosis of AS were matched to non-AS patients 1:5 based on demographic and comorbidity profiles. 90-day medical complications, falls, and readmission rates, as well as 2-year implant complications were compared between cohorts.
A total of 6509 AS patients were matched to 32,489 control patients. The AS group had significantly higher rates of myocardial infarction, cerebrovascular accident, deep vein thrombosis, pulmonary embolism, urinary tract infection, wound complications, acute kidney injury, pneumonia, sepsis, transfusions, and falls when compared to the control group. The AS group had significantly higher rates of prosthetic joint infection, dislocation, mechanical loosening, and periprosthetic fracture (all < 0.0001). Likewise, mean length of stay and readmissions were significantly greater in the AS group.
Ankylosing spondylitis in patients undergoing THA is associated with significant risk of medical and implant complications, as well as fall risk, length of stay, and readmission rates. These findings may allow orthopaedic surgeons to be more attentive in identifying those patients at risk and allow for more educated patient counseling and perioperative planning.
强直性脊柱炎（AS）是一种炎症性脊柱关节病，常累及脊柱和骶髂关节。全髋关节置换术（THA）已被证明能有效改善髋关节受累的 AS 患者的疼痛和功能。然而，AS 患者的骨骼外表现和力学改变导致并发症增加。因此，本研究旨在评估 AS 对 THA 后医疗和植入物并发症、跌倒、住院时间和再入院的影响。
对 2010 年至 2020 年期间的 Mariner 私人保险索赔数据库进行回顾性分析。使用当前程序术语（Current Procedural Terminology）和国际疾病分类第 9 版和第 10 版修订代码（International Classification of Disease 9 and 10 revision codes）识别所有接受 THA 和 AS 的病例。根据人口统计学和合并症特征，将接受 AS 诊断的 THA 患者与非 AS 患者 1:5 匹配。比较两组患者的 90 天内医疗并发症、跌倒和再入院率以及 2 年的植入物并发症。
共有 6509 例 AS 患者与 32489 例对照患者相匹配。与对照组相比，AS 组心肌梗死、脑血管意外、深静脉血栓形成、肺栓塞、尿路感染、伤口并发症、急性肾损伤、肺炎、败血症、输血和跌倒的发生率明显更高（均<0.0001）。同样，AS 组假体关节感染、脱位、机械松动和假体周围骨折的发生率也明显更高（均<0.0001）。此外，AS 组的平均住院时间和再入院率也明显更高。
接受 THA 的 AS 患者发生医疗和植入物并发症、跌倒风险、住院时间和再入院率的风险显著增加。这些发现可能使矫形外科医生能够更准确地识别出那些有风险的患者，并为患者提供更有针对性的咨询和围手术期计划。
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