Imaging features of hip joint in patients with ankylosing spondylitis undergoing total hip arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Ke ¹ , LI Heng ^2△ , SUN Fenglong ¹ , LI Xiang ² , ZHANG Qingmeng ² , XU Chi ² , SONG Xinggui ² ,  CHEN Jiying ²

1. Department of Orthopedics, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, 100144, P.R.China;
2. Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China;

Corresponding author：

CHEN Jiying, Email: chenjiying_301@163.com

Keywords：

Ankylosing spondylitis; CT three-dimensional reconstruction; imaging features; total hip arthroplasty

DOI：

10.7507/1002-1892.201610088

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Objective To study the imaging features of the hip joint by measuring the imaging parameters of spine, pelvis, and hip joint before and after total hip arthroplasty (THA) in patients with ankylosing spondylitis (AS) undergoing THA so as to provide reference for selection of operation methods and prosthesis. Methods Between January and July 2015, 38 patients (56 hips) with AS underwent primary THA as AS group, and 36 patients (45 hips) with osteonecrosis of the femoral head underwent THA as control group. There was no significant difference in side (χ²=1.14,P=0.95). The acetabular abduction angle (ABA), acetabular anteversion angle (AVA), center collum diaphyseal (CCD), offset, height from rotation center to lesser trochanter (HRCLT), femoral intertrochanteric distance (FID) were measured by CT three-dimensional morphology. The canal flare index (CFI), cortical thickness index (CTI), pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) were measured by X-ray film before operation. The AVA, ABA, and the filling ratio were measured on the postoperative X-ray film. Results There was no significant difference in preoperative AVA and ABA and postoperative ABA between 2 groups (P>0.05), but significant difference was found in postoperative AVA (t=6.71,P=0.00). The mean PI, SS, and PT in AS group were 48.37° (range, 41-58°), 5.64°(range, 2-11°), and 12.85° (range, 5-26°), respectively. There was significant difference in CCD, CFI, and CTI between 2 groups (t=3.63,P=0.04;t=5.12,P=0.02;t=3.91,P=0.04), but offset, HRCLT, and FID all showed no significant difference (t=0.41,P=0.36;t=0.33,P=0.56;t=0.59,P=0.12). On the basis of the Noble classification, medullary cavity of the femur was rated as chimney type, ordinary type, and champagne flute type in 32, 18, and 6 hips of AS group, and in 4, 28, and 13 hips of control group respectively. Filling ratio of distal segment in AS group was significantly lower than that in control group (t=5.64,P=0.02), but there was no significant difference in the filling ratio of middle and proximal segments between 2 groups (t=0.29,P=0.61;t=0.55,P=0.13). Conclusion Compared with patients having osteonecrosis of the femeral head, there is no significant difference in preoperative AVA and ABA, but postoperative AVA significantly increase in patients with AS. Because AS patients have mainly chimney type medullary cavity of the femur, the filling ratio of middle and distal segment is lower when tapered stems are used, and the filling ratio of anatomic stems is higher.

Citation： LI Ke, LI Heng, SUN Fenglong, LI Xiang, ZHANG Qingmeng, XU Chi, SONG Xinggui, CHEN Jiying. Imaging features of hip joint in patients with ankylosing spondylitis undergoing total hip arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(3): 290-294. doi: 10.7507/1002-1892.201610088 Copy

1.	李珂, 张庆猛, 李恒, 等. 强直性脊柱炎与非炎性髋关节疾病行人工全髋关节置换术的围手术期炎症指标比较. 中国修复重建外科杂志, 2015, 29(10): 1199-1203.
2.	Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet, 2007, 370(9597): 1508-1519.
3.	Ye C, Liu R, Sun J,et al. Cementless bilateral synchronous total hip arthroplasty in ankylosing spondylitis with hip ankylosis. Int Orthop, 2014, 38(12): 2473-2476.
4.	Gondusky JS, Pinkos KA, Choi L,et al. Simultaneous bilateral anterior approach total hip arthroplasty. Orthopedics, 2015, 38(7): e611-615.
5.	Rakow A, Simon P, Perka C. Hip arthroplasty in the presence of proximal femoral deformity. Orthopade, 2015, 44(7): 510-522.
6.	Hafez MA, Ragheb G, Hamed A,et al. Digital templating for THA: a simple computer-assisted application for complex hip arthritis cases. Biomed Tech (Berl), 2016, 61(5): 519-524.
7.	Rubin PJ, Leyvraz PF, Aubaniac JM,et al. The morphology of the proximal femur. A three-dimensional radiographic analysis. J Bone Joint Surg (Br), 1992, 74(1): 28-32.
8.	Tang WM, Chiu KY. Primary total hip arthroplastyin patients with ankylosing spondylitis. J Arthroplasty, 2000, 15(1): 52-58.
9.	Moll JM, Wright V. New York clinical criteria for ankylosing spondylitis. A statistical evaluation. Ann Rheum Dis, 1973, 32(4): 354-363.
10.	Olmedo-Garcia N, Lopez-Prats F, Agullo A,et al. A comparative study of the accuracy of Ranawat’s and Pierchon’s methods to determine the centre of rotation in bilateral coxopathy. Skeletal Radiol, 2000, 29(11): 652-655.
11.	Noble PC, Alexander JW, Lindahl LJ,et al. The anatomic basis of femoral component design. Clin Orthop Relat Res, 1988, (235): 148-165.
12.	Sah AP, Thornhill TS, LeBoff MS,et al. Correlation of plain radiographic indices of the hip with quantitative bone mineral density. Osteoporos Int, 2007, 18(8): 1119-1126.
13.	Vaz G, Roussouly P, Berthonnaud E,et al. Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J, 2002, 11(1): 80-87.
14.	Kim YH, Kim V. Uncemented porous-coated anatomic total hip replacement. Results at six years in a consecutive series. J Bone Joint Surg (Br), 1993, 75(1): 6-13.
15.	Teloken MA, Bisset G, Hozack WJ,et al. Ten to fifteen-year follow-up after total hip arthroplasty with a tapered cobalt-chromium femoral component (tri-lock) inserted without cement. J Bone Joint Surg (Am), 2002, 84-A(12): 2140-2144.
16.	范新成, 刘峰, 魏开斌, 等. 多层螺旋 CT 三维重建测量髋臼外展角及前倾角的实验研究. 中华临床医师杂志(电子版), 2014, 8(3): 122-126.
17.	Lewinnek GE, Lewis JL, Tarr R,et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg (Am), 1978, 60(2): 217-220.
18.	Baumgärtner R, Heeren N, Quast D,et al. Is the cortical thickness index a valid parameter to assess bone mineral density in geriatric patients with hip fractures? Arch Orthop Trauma Surg, 2015, 135(6): 805-810.
19.	张仕凯, 孙俊英, 田家祥, 等. 生物型人工全髋关节置换术治疗青年强直性脊柱炎髋关节病变的中期疗效. 中国修复重建外科杂志, 2013, 27(2): 243-244.
20.	Lacko M, Schreierová D, Čellár R,et al. Bone remodelling in the proximal femur after uncemented total hip arthroplasty in patients with osteoporosis. Acta Chir Orthop Traumatol Cech, 2015, 82(6): 430-436.
21.	刘宏伟, 顾卫东, 孙俊英. 应用矩形截面锥形股骨假体行人工全髋关节置换的中期疗效. 中国修复重建外科杂志, 2013, 27(5): 594-598.

1. 李珂, 张庆猛, 李恒, 等. 强直性脊柱炎与非炎性髋关节疾病行人工全髋关节置换术的围手术期炎症指标比较. 中国修复重建外科杂志, 2015, 29(10): 1199-1203.
2. Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet, 2007, 370(9597): 1508-1519.
3. Ye C, Liu R, Sun J,et al. Cementless bilateral synchronous total hip arthroplasty in ankylosing spondylitis with hip ankylosis. Int Orthop, 2014, 38(12): 2473-2476.
4. Gondusky JS, Pinkos KA, Choi L,et al. Simultaneous bilateral anterior approach total hip arthroplasty. Orthopedics, 2015, 38(7): e611-615.
5. Rakow A, Simon P, Perka C. Hip arthroplasty in the presence of proximal femoral deformity. Orthopade, 2015, 44(7): 510-522.
6. Hafez MA, Ragheb G, Hamed A,et al. Digital templating for THA: a simple computer-assisted application for complex hip arthritis cases. Biomed Tech (Berl), 2016, 61(5): 519-524.
7. Rubin PJ, Leyvraz PF, Aubaniac JM,et al. The morphology of the proximal femur. A three-dimensional radiographic analysis. J Bone Joint Surg (Br), 1992, 74(1): 28-32.
8. Tang WM, Chiu KY. Primary total hip arthroplastyin patients with ankylosing spondylitis. J Arthroplasty, 2000, 15(1): 52-58.
9. Moll JM, Wright V. New York clinical criteria for ankylosing spondylitis. A statistical evaluation. Ann Rheum Dis, 1973, 32(4): 354-363.
10. Olmedo-Garcia N, Lopez-Prats F, Agullo A,et al. A comparative study of the accuracy of Ranawat’s and Pierchon’s methods to determine the centre of rotation in bilateral coxopathy. Skeletal Radiol, 2000, 29(11): 652-655.
11. Noble PC, Alexander JW, Lindahl LJ,et al. The anatomic basis of femoral component design. Clin Orthop Relat Res, 1988, (235): 148-165.
12. Sah AP, Thornhill TS, LeBoff MS,et al. Correlation of plain radiographic indices of the hip with quantitative bone mineral density. Osteoporos Int, 2007, 18(8): 1119-1126.
13. Vaz G, Roussouly P, Berthonnaud E,et al. Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J, 2002, 11(1): 80-87.
14. Kim YH, Kim V. Uncemented porous-coated anatomic total hip replacement. Results at six years in a consecutive series. J Bone Joint Surg (Br), 1993, 75(1): 6-13.
15. Teloken MA, Bisset G, Hozack WJ,et al. Ten to fifteen-year follow-up after total hip arthroplasty with a tapered cobalt-chromium femoral component (tri-lock) inserted without cement. J Bone Joint Surg (Am), 2002, 84-A(12): 2140-2144.
16. 范新成, 刘峰, 魏开斌, 等. 多层螺旋 CT 三维重建测量髋臼外展角及前倾角的实验研究. 中华临床医师杂志(电子版), 2014, 8(3): 122-126.
17. Lewinnek GE, Lewis JL, Tarr R,et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg (Am), 1978, 60(2): 217-220.
18. Baumgärtner R, Heeren N, Quast D,et al. Is the cortical thickness index a valid parameter to assess bone mineral density in geriatric patients with hip fractures? Arch Orthop Trauma Surg, 2015, 135(6): 805-810.
19. 张仕凯, 孙俊英, 田家祥, 等. 生物型人工全髋关节置换术治疗青年强直性脊柱炎髋关节病变的中期疗效. 中国修复重建外科杂志, 2013, 27(2): 243-244.
20. Lacko M, Schreierová D, Čellár R,et al. Bone remodelling in the proximal femur after uncemented total hip arthroplasty in patients with osteoporosis. Acta Chir Orthop Traumatol Cech, 2015, 82(6): 430-436.
21. 刘宏伟, 顾卫东, 孙俊英. 应用矩形截面锥形股骨假体行人工全髋关节置换的中期疗效. 中国修复重建外科杂志, 2013, 27(5): 594-598.

Chinese Journal of Reparative and Reconstructive Surgery

Imaging features of hip joint in patients with ankylosing spondylitis undergoing total hip arthroplasty

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