Anaspure Omkar, Newsom Andrew, Patel Shiv, Baumann Anthony N, Eachempati Krishna K, Smith Weston, Sheth Neil P
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA.
J Orthop. 2025 Mar 17;69:86-95. doi: 10.1016/j.jor.2025.03.037. eCollection 2025 Nov.
This study sought to identify key postoperative complications and clinical outcomes in patients with Ankylosing Spondylitis (AS) undergoing total hip arthroplasty (THA).
This systematic review evaluated postoperative complications and clinical outcomes in this population by querying PubMed, Embase, and CINAHL, up till June 19th, 2024.
Nineteen observational studies (n = 2003; 81.72 % male; mean age 38.95 ± 10.08 years; mean follow-up 76 ± 22.10 months) were included. Surgical approaches were posterolateral (n = 11 studies), Watson-Jones anterior (n = 1 study), and minimally invasive 2-incision (n = 1 study). Complications included infection (n = 65; 5.14 %), heterotopic ossification (n = 51; 4.03 %), prosthetic joint noise (n = 24; 1.90 %), perioperative fracture (n = 18; 1.42 %), improper implant placement (n = 14; 1.11 %), re-infection (n = 11; 0.87 %), and implant loosening (n = 8; 0.63 %). Hip dislocation occurred in 2.64 % (n = 22) of patients across 8 studies, and 4.06 % (n = 21) of patients required revision THA in six studies for various reasons, such as leg length discrepancy, joint loosening, or instability. HO was reported in 11 studies (n = 880), affecting 15.11 % (n = 133/880) of patients. All four studies assessing range of motion (ROM) found significant improvement after THA.
Observed trends suggest a noticeable occurrence of complications, such as joint dislocation and HO, following THA in patients with AS. While postoperative improvements in ROM and patient outcomes were reported, these qualitative findings warrant further investigation to confirm their significance. We recommend increased awareness and the exploration of strategies to minimize the risk of complications for high-risk patients with history of HO and other preexisting comorbidities to prevent progression of the complication profile seen in patients with AS.
本研究旨在确定强直性脊柱炎（AS）患者行全髋关节置换术（THA）后的关键术后并发症及临床结局。
本系统评价通过检索截至2024年6月19日的PubMed、Embase和CINAHL数据库，评估该人群的术后并发症及临床结局。
纳入了19项观察性研究（n = 2003；男性占81.72%；平均年龄38.95±10.08岁；平均随访76±22.10个月）。手术入路包括后外侧（n = 11项研究）、沃森-琼斯前入路（n = 1项研究）和微创双切口入路（n = 1项研究）。并发症包括感染（n = 65；5.14%）、异位骨化（n = 51；4.03%）、人工关节异响（n = 24；1.90%）、围手术期骨折（n = 18；1.42%）、假体植入位置不当（n = 14；1.11%）、再次感染（n = 11；0.87%）和假体松动（n = 8；0.63%）。8项研究中的2.64%（n = 22）患者发生髋关节脱位，6项研究中有4.06%（n = 21）患者因各种原因（如肢体长度差异、关节松动或不稳定）需要翻修THA。11项研究（n = 880）报告了异位骨化，影响了15.11%（n = 133/880）的患者。所有四项评估活动范围（ROM）的研究均发现THA术后有显著改善。
观察到的趋势表明，AS患者行THA后，关节脱位和异位骨化等并发症的发生率较高。虽然报告了术后ROM及患者结局有所改善，但这些定性结果仍需进一步研究以证实其意义。我们建议提高认识，并探索策略以降低有异位骨化病史和其他并存合并症的高危患者的并发症风险，以防止AS患者出现更复杂的并发症情况。
