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Abstract Background Hip involved secondary to ankylosis spondylitis (AS) had a huge influence on hip function. Cementless total hip arthroplasty (THA) can improve hip function. However, no previous study compared the outcomes of THA for AS patients with three different degrees of hip involvement. Methods The 195 hips were retrospectively analyzed and divided into non-ankylosed group (group A, 94 hips), fibrous ankylosed group (group B, 49 hips), and bony ankylosed group (group C, 52 hips). postoperative range of motion (ROM), harris hip scores (HHS), the short-form 12 health survey (SF-12), length of stay (LOS), cost, radiological assessments, and complications were compared. Results The follow-up time was (79.4 ± 29.5) months for group A, (80.6 ± 28.9) months for group B, and (79.1 ± 28.9) months for group C (P = 0.966). Group A had the best postoperative hip ROM (P

BackgroundTotal hip arthroplasty (THA) using the direct anterior approach (DAA) is becoming increasingly popular due to its potential benefits over the posterolateral approach (PLA). However, few studies have compared the efficacies of these two surgical approaches in hip fusion treatment. This study compared early clinical direct anterior and posterolateral THA outcomes in hip fusion treatment.MethodsHere, 127 hips (65 DAA, 62 PLA) were retrospectively evaluated. Early postoperative functional outcomes of DAA and PLA groups were assessed using Harris score and Oxford Hip Score (OHS) and standard anteroposterior hip radiographs. Surgical characteristics, perioperative results, and complications within 6 months postoperatively were recorded.ResultsThough baseline values were similar, Harris and OHS scores were better in the DAA group than in the PLA group at 1 and 3 months postoperatively. The average cup anteversion angle was significantly greater in the DAA group than in the PLA group (12.7° vs. 11.1°). More hips undergoing DAA were successfully orientated in both inclination and anteversion angles (46 vs. 32). Early postoperative hip function predictors were preoperative fused hip position, surgical approach, and range of motion. DAA was associated with reduced postoperative blood loss and shorter hospital stays. Furthermore, 14 vs. 8 complications occurred in the DAA vs. PLA group. Lateral femoral cutaneous nerve injuries were observed in eight hips (12.3%) of the DAA group.ConclusionFor fused or ankylosed hips, THA using DAA in the lateral decubitus position may result in excellent prosthesis positioning and faster postoperative recovery throughout early follow-up vs. PLA.

Background: Hip involved secondary to ankylosis spondylitis (AS) had a huge influence on hip function. Cementless total hip arthroplasty (THA) can improve hip function. However, no previous study compared the outcomes of THA for AS patients with three different degrees of hip involvement. Methods: The 195 hips were retrospectively analyzed and divided into non-ankylosed group (group A, 94 hips), fibrous ankylosed group (group B, 49 hips), and bony ankylosed group (group C, 52 hips). postoperative range of motion (ROM), harris hip scores (HHS), the short-form 12 health survey (SF-12), length of stay (LOS), cost, radiological assessments, and complications were compared. Results: The follow-up time was (79.4 ± 29.5) months for group A, (80.6 ± 28.9) months for group B, and (79.1 ± 28.9) months for group C (P = 0.966). Group A had the best postoperative hip ROM (P < 0.001), while group A and B can realize better HHS than group C (P < 0.001). The three groups had similar SF-12 postoperatively. For group A, LOS and cost for unilateral procedure were the least than that for group B and C (P = 0.003 and P = 0.001). Similar radiological assessments were achieved for three groups. 1 hip in group A encountered delay union of wound. 1 hip in group C encountered delay union of wound and dislocation and another patient encountered femoral fracture intraoperatively. 12 hips (12.8%) in group A, 6 hips (12.2%) in group B, and 6 hips (11.5%) in group C encountered asymptomatic heterotopic ossification (P = 0.977). Conclusion: For AS patients with hip involvement, THA can improve hip ROM and function. THA for the non-ankylosed hip can realize the better hip function and postoperative ROM than ankylosed hip. [ABSTRACT FROM AUTHOR]

Introduction: Fixed abduction and/or adduction deformities of the hip joint may cause pelvic obliquity with subsequent development of secondary lumbar scoliosis. However, the relationships between the magnitude of a fixed angle (either abduction or adduction) of the hip and the direction of pelvic tilt and lumbar scoliosis remain unclear. The purpose of this study was to investigate the coronal alignment of the lumbar spine and pelvis in patients with ankylosed hips. Methods: A total of 56 patients were analyzed, including 17 males and 39 females, with an average age of 65 years (range: 45 to 80 years). Regarding the coronal spinopelvic alignment, the following parameters were measured: the degree of lumbar scoliosis (LS; Cobb angle), pelvic obliquity (PO), and ankylosed hip angle (AHA). The PO and AHA were defined as the angle between the inter-teardrop line and a horizontal line, respectively, and the long axis of the femur on the side of the ankylosed hip. For each parameter, correlations between the parameters were evaluated using a regression analysis. A P value of

Hip fractures are the cause of significant morbidity and mortality, aggravated by the existence of an underlying hip pathology. The association of a pertrochanteric fracture with an ankylosed hip and acetabular protrusion is extremely rare. It has not been reported in the literature and the optimal management remains unknown. The surgical treatment indicated for trochanteric fractures allows patients to restore their autonomy quickly while avoiding complications. We present the case of a 45-year-old patient who was followed for multiple myeloma and treated with chemotherapy. Following a fall on the pelvis, we found a pertrochanteric fracture with an ankylosed hip and acetabular protrusion. The patient was treated with a PFNA nail based on some principles to improve stabilization, with good results. The combination of acetabular protrusion and hip ankylosis alters the biomechanics of this joint by displacing the center of rotation inward and decreasing abductor muscle tension while increasing the lever arm. Several surgical approaches have been reported on case reports with different results. No consensus has been reached for this entity because of its rarity and the absence of a large sample. The result reported for our patient could make cephalomedullary nailing a good option since it allows preservation of the gluteal musculature, early management of the patient and recovery of the pre-morbid state. The lack of consensus and the changes caused by this hip condition are a challenge for orthopedists. We treated our patient with a PFNA nail based on a few principles necessary to optimize stability with a satisfactory result. • We present an extremely rare case of a 45-year-old patient with a pertrochanteric fracture in an ankylosed hip with acetabular protrusion. • No cases have been reported in the literature and the optimal management remains unknown. • However, the lack of consensus and the changes caused by this hip condition are a challenge for orthopedists. [ABSTRACT FROM AUTHOR]

Introduction: Fused or Ankylosed hip is late complication of chronic inflammatory disorder with progressive changes in and around articular as well as periarticular structures with alteration in bio-force line of body which later lead to severe flexion deformity of joint. This not only results decreased movements of hip, it’s also increase pain around the hip, back and contralateral hip. Methods: Retrospectively, all patients aged 18 years or older undergoing THA between June 2006 to June 2012 were reviewed with selection criteria. The five ankylosed hips (three left and two right) with severe flexion deformities which ankylosed spontaneously were successfully converted to THA at time period of 2006 to June 2012. Range of Motion (ROM), Harris Hip Score and Flexion Deformity Angle at preoperative, postoperative and follow-up periods were used as evaluation. Results: Mean follow up is 42 months. Mean HHS increased from 21.6±4.97 to 81.8±4.02 points with one excellent, two good and two fair cases. The FDA is corrected to mean 8°±10.95 postoperatively and 4°±5.47 at final follow up from 81.6°±4.39 with two hips of 10° residual deformity. Hip ROM is improved as flexion 70° to 100°, adduction 10° to 20°, abduction 10° to 30°, internal rotation 5° to 10° and external rotation 2° to 50° from 0° activity. As complications, one hip had loose prosthesis, two had early postoperative dislocations, one had Deep Vein Thrombosis and one had femoral nerve palsy with quadriceps weakness. Conclusions: THA is an effective treatment for ankylosed hip with severe flexion deformity although complications are noted more than routine hip arthroplasties. Keywords: ankylosed hip; fused hip; severe flexion deformity; total hip arthroplasty. | PubMed

This study evaluated the results of the resection angulation osteotomy in post-septic ankylosis of hip. We performed the procedure in 19 patients, with average age of 26 years (range, 21-32 years) and followed patients postoperatively for an average of 43 months (range 20-65 months). The osteotomy united in all patients with an average union time of 16 weeks (range 12-22 weeks). Average painless movement postoperatively was: flexion, 114 degrees; extension, 18 degrees; abduction, 35 degrees; adduction , 21 degrees; external rotation, 23 degrees; and internal rotation, 22 degrees. All the patients except one were able to sit cross- legged on the floor, offer prayers and use squat-type toilets. We conclude that this procedure is a good treatment option in patients with post-septic ankylosis of the hip, who need an alternative to more sophisticated procedures like total hip arthroplasty.

Conversion to total hip arthroplasty (THA) from a fused hip is a challenging procedure because of the technical difficulties involved. Here we report the surgical procedure and the early clinical outcome of conversion THA from a fused hip through a direct anterior approach.~Introduction~Background~9 consecutive THAs following hip fusion were performed in 9 patients. Of these, 6 patients had undergone surgical hip fusion and 3 patients had nonsurgical fusion.~Methods~Methods~The mean time interval between fusion and THA was 29.7 years. The mean follow-up period was 5.2 years. All THAs were performed using a direct anterior approach on a standard surgical table. The mean operative time was 68.7 minutes. The mean intraoperative blood loss was 377 g. All acetabular components were placed within Lewinnek's safe zone. The mean Japanese Orthopaedic Hip Score significantly improved from 54.0 to 73.2. One early anterior dislocation occurred and was treated conservatively. No revision surgery was required.~Results~Results~The direct anterior approach allows for an accurate and less invasive implantation of the total hip components.~Conclusions~Conclusions [ABSTRACT FROM AUTHOR]

We evaluated 70 patients (71 hips) who underwent complex total hip arthroplasty (THA) through the combined anterior and posterior approach. Sixty-five patients (32 dislocated hips and 34 ankylosed hips) were followed-up at a minimum of 3 years (median, 6 years; range, 3–10 years). Seven patients (10.6%), who had transient paresthesia on the anterior thigh, recovered within 3 months. All patients had a good clinical outcome in terms of range of motion, pain and recovery of walking. At the latest follow-up, all prostheses had bone-ingrown stability without any detectable wear or osteolysis. The combined approach allows an excellent exposure of the acetabulum for accurate cup alignment, leg lengthening and mobilization of joint in complex THA without trochanteric osteotomy, excessive abductor release and femoral shortening osteotomy. [ABSTRACT FROM AUTHOR]

Background: An intracapsular femoral neck fracture is a common orthopaedic presentation and requires expedient fixation in a young adult. This case demonstrates how patient-specific factors, namely an ankylosed contralateral hip, can make a common operation challenging. Case Description: A 22-year-old man with osteogenesis imperfecta and multiple bony deformities was brought to A&E after being involved in a motor vehicle collision. Plain radiographs and clinical examination demonstrated a right intracapsular femoral neck fracture, ipsilateral femora vara and a contralateral ankylosed hip secondary to protrusio acetabuli. The intraoperative patient and fluoroscopic positioning were technically challenging. Clinical Relevance: Preoperative literature review revealed no operative strategy or case report describing how best to perform closed reduction and internal fixation of a femoral neck fracture with a co-existing contralateral ankylosed hip joint. We hope our experience will aid other surgeons who find themselves in a similar clinical scenario. We will present the difficulties faced and the adaptations made to our surgical technique which we utilised to achieve an anatomical fixation. [ABSTRACT FROM AUTHOR]

We report a rare case of a rigid spinal deformity with severe pelvic obliquity (PO) resulting from hip ankylosis caused by childhood tuberculosis (TB). A 66-year-old woman presented with left knee pain, chronic low back pain, and fatigability during walking. She presented with leg length discrepancy (LLD) due to an ankylosed right hip joint, severe PO, and secondary lumbar scoliosis. Total hip arthroplasty (THA) and adductor tendonectomy were performed prior to spine surgery, and posterior spinal correction and fusion were performed from T10 to the pelvis. Prior to spinal correction surgery, we predicted that it would be impossible to make the pelvis perfectly horizontal. Therefore, we positioned a prosthetic acetabular cup at a small inclination angle at the upper limit of anteversion; spinal correction and fusion were then performed. Her symptoms including fatigability during walking resolved and the sagittal spinal balance on standing improved dramatically. The preoperative and postoperative values of the thoracolumbar Cobb angle was 40° and 25°, lumbosacral Cobb angle was 60° and 14°, C7 plumb line shift was 24 and 0 mm, pelvic tilt was 15° and 19°, lumbar lordosis (LL) was 23° and 60°, pelvic incidence minus lumbar lordosis (PI-LL) was 38° and 1°, the sagittal vertical axis was 80 and 0 mm, and PO was 28° and 15°, respectively. We present a case of rigid spinal deformity accompanied by hip joint ankylosis and PO. Performing THA prior to spinal correction surgery is an alternative and feasible option for the treatment of this challenging pathology., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Iwai et al.)

Purpose: The purpose of this study was to report the long-term results of total hip arthroplasty (THA) for the treatment of ankylosed hip., Methods: Twenty-nine consecutive THAs were performed in 26 patients. The mean age of the patients at the time of the operation was 43.3 years (range, 19-69 years). We used cementless fixation in all hips and the mean duration of follow-up was 10.1 years (range, 4.5-20 years). Radiological evaluation of components, osteolysis, radiolucent lines and loosening were assessed. The Harris Hip Score (HHS), range of motion (ROM), limb-length discrepancy and walking capacity with or without any support were used preoperatively and at final follow-up for clinical evaluation. Survivorship analysis was conducted using the Kaplan-Meier method using second revision for any reason as the endpoint., Results: The mean HHS was 85.6 (range, 55-98) points and mean ROM was 110.5° for flexion. The mean limb-length discrepancy improved from 4.1 cm to 1.1 cm. Positive Trendelenburg sign was recorded in 31% of the patients and 24% of patients needed any support for walking postoperatively. We observed surgical complications related to abductor arm in 25% of the patients. Radiolucency on the acetabular side was seen on one or more zones in 15 patients (16 hips). One aseptic acetabular component loosening was observed. On the femoral side, 11 patients demonstrated non-progressive radiolucent lines and osteolysis around the stem was seen in four hips but there was no aseptic stem loosening. The Kaplan-Meier survival rate considering revision for any reason as the endpoint was 81.5%, for aseptic loosening 91.3%, for a worst-case scenario of 66.4% at 10 years., Conclusion: Cementless fixation showed good to excellent results at 10 years. Preoperative and postoperative abductor status of the patient is critical for patient satisfaction.

Objective: To assess the functional outcomes of patients undergoing total hip arthroplasty for ankylosing spondylitis (AS)., Methods: Between March, 2013 and May, 2016, 75 AS patients with ankylosed hip (involving 92 hips) underwent unilateral biological artificial total hip arthroplasty. The patients were followed up for 12-24 months and the changes in VAS score of the affected hip were evaluated. The changes in the range of motion (ROM) of hip, employment, BASFI and BASDAI score, and Harris score were analyzed after the operations., Results: Significant improvements in general joint mobility, clinical symptoms and hip joint functions were achieved in all the patients. The average VAS score was significant reduced from 6.51± 1.32 preoperatively to 2.47±0.38 after the operation. Significant improvements were also achieved after the operation in the average Harris hip score (from 22.51±3.32 to 89.17±2.52), the total ROM (from 0 to 171.50±30.30), and mean BASFI score (from 6.2±2.6 to 2.3±1.2; all P < 0.05). At the final follow up, 42 hips showed excellent outcomes, 38 hips had good outcomes, and 12 hips had acceptable outcomes, with a good outcome rate of 87%. By 6 and 12 months after the operation, 6 and 32 of the 75 patients returned to work. No neurovascular injuries, infections or dislocations was found in the patients during the follow-up; 1 patient had prosthesis loosening found by X-ray ordered for complaint of pain in the affected hip 4 months postoperatively. Five patients had heterotopic ossifications, including 3 grade Ⅰ hips and 2 grade Ⅱ hips according to the Brooker grading system., Conclusions: Biological artificial total hip arthroplasty is effective for treatment of ankylosing spondylitis with hip stiffness with good functional outcomes of the hip joint.