Effectiveness of combined anteversion angle technique in total hip arthroplasty for treatment of ankylosing spondylitis affecting hip joint_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Yuan ¹ , PEI Fang ¹ , WAN Feng ² , WANG Zexuan ¹ , LIU Xiaolei ³ ,  GUO Kaijin ¹

1. Department of Joint Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221000, P. R. China;
2. Department of Sports Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221000, P. R. China;
3. Department of Spine Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221000, P. R. China;

Corresponding author：

GUO Kaijin, Email: xzgkj@sina.com

Keywords：

Combined anteversion angle technique; total hip arthroplasty; ankylosing spondylitis

DOI：

10.7507/1002-1892.202310087

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Objective To explore the effectiveness of the combined anteversion angle technique in total hip arthroplasty (THA) for treating ankylosing spondylitis (AS) affecting the hip joint. Methods A retrospective analysis was conducted on the clinical data of 73 patients with AS affecting the hip joint who underwent THA between August 2018 and August 2021. According to whether the combined anteversion angle technique was used in THA, the patients were divided into study group (37 cases, combined anteversion angle technique was used in THA) and control group (36 cases, traditional THA). There was no significant difference in baseline data such as gender, age, body mass index, disease duration, preoperative Harris score, range of motion (ROM), acetabular anteversion angle, acetabular abduction angle, femoral anteversion angle, and combined anteversion angle between the two groups (P>0.05). The operation time, hospital stay, and complications of the two groups were recorded and compared. The Harris score and hip ROM were compared between the two groups before operation, at 1, 3, 6, 12 months after operation, and at last follow-up. The acetabular component anteversion angle, femoral component anteversion angle, acetabular component abduction angle, and component combined anteversion angle were measured postoperatively. Results The operation time in the study group was significantly shorter than that in the control group (P<0.05), and there was no significant difference in hospital stay between the two groups (P>0.05). There was no intraoperative complication such as acetabular and proximal femoral fractures, neurovascular injuries in both groups, and the incisions healed by first intention. All patients were followed up 2-3 years, with an average of 2.4 years; there was no significant difference in the follow-up time between the two groups (P>0.05). During the follow-up period, there was no complication such as hip dislocation, wound infection, delayed wound healing, deep venous thrombosis, and hip dislocation in both groups. The hip Harris score and ROM of the two groups gradually increased with time after operation, and the differences were significant when compared with those before operation (P<0.05); the above two indicators of the study group were significantly better than those of the control group at each time point after operation (P<0.05). Extensive bone ingrowth on the surface of the components could be observed in the anteroposterior X-ray films of the hip joint of the two groups at 12 months after operation, and the acetabular components was stable without femoral stem subsidence, osteolysis around the components, and heterotopic ossification. At last follow-up, the acetabular component anteversion angle, femoral component anteversion angle, and component combined anteversion angle in the study group were significantly superior to those in the control group (P<0.05), except that there was no significant difference in the acetabular component abduction angle between the two groups (P>0.05). Conclusion For patients with AS affecting the hip joint, the use of the combined anteversion angle technique during THA effectively promotes the recovery of hip joint function and enhances the postoperative quality of life of patients when compared to traditional THA.

Citation： WANG Yuan, PEI Fang, WAN Feng, WANG Zexuan, LIU Xiaolei, GUO Kaijin. Effectiveness of combined anteversion angle technique in total hip arthroplasty for treatment of ankylosing spondylitis affecting hip joint. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(1): 15-21. doi: 10.7507/1002-1892.202310087 Copy

1.	Zhu W, He X, Cheng K, et al. Ankylosing spondylitis: etiology, pathogenesis, and treatments. Bone Res, 2019, 7: 22.
2.	Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet, 2017, 390(10089): 73-84.
3.	Ungprasert P, Chaikijurajai T, Wijarnpreecha K, et al. Clinical characteristics and resource utilization of 19, 130 hospitalizations of patients with ankylosing spondylitis in United States: National Inpatient Sample 2018. Joint Bone Spine, 2022, 89(3): 105313.
4.	Gautam D, Malhotra R. Total hip arthroplasty in ankylosing spondylitis with extension contracture of hips. J Arthroplasty, 2019, 34(1): 71-76.
5.	隋善勇. 生物型全髋关节置换治疗强直性脊柱炎累及髋关节. 中华关节外科杂志 (电子版), 2020, 14(4): 423-428.
6.	Yan L, Ge L, Dong S, et al. Evaluation of comparative efficacy and safety of surgical approaches for total hip arthroplasty: A systematic review and network meta-analysis. JAMA Netw Open, 2023, 6(1): e2253942.
7.	Jin Z, Wang L, Qin J, et al. Direct anterior approach versus posterolateral approach for total hip arthroplasty in the treatment of femoral neck fractures in elderly patients: a meta-analysis and systematic review. Ann Med, 2023, 55(1): 1378-1392.
8.	Hu Z, Zhong R, Zhao D, et al. Staged osteotomy in lateral position for the treatment of severe kyphotic deformity secondary to ankylosing spondylitis: a retrospective study. J Orthop Surg Res, 2023, 18(1): 417.
9.	吴迪, 贾其余, 胡联英, 等. 人工智能三维术前规划在全髋关节置换术中的临床应用. 实用骨科杂志, 2023, 29(3): 202-207.
10.	Wooster BM, Kennedy NI, Dugdale EM, et al. Contemporary outcomes of primary total hip arthroplasty in patients with inflammatory arthritis. Bone Joint J, 2023, 105-B(7): 768-774.
11.	Torkington MS, Davison MJ, Wheelwright EF, et al. Bone penetration of intravenous flucloxacillin and gentamicin as antibiotic prophylaxis during total hip and knee arthroplasty. Bone Joint J, 2017, 99-B(3): 358-364.
12.	Porter SB, White LJ, Osagiede O, et al. Tranexamic acid administration is not associated with an increase in complications in high-risk patients undergoing primary total knee or total hip arthroplasty: A retrospective case-control study of 38, 220 patients. J Arthroplasty, 2020, 35(1): 45-51.
13.	Leta TH, Fenstad AM, Lygre SHL, et al. The use of antibiotic-loaded bone cement and systemic antibiotic prophylactic use in 2, 971, 357 primary total knee arthroplasties from 2010 to 2020: an international register-based observational study among countries in Africa, Europe, North America, and Oceania. Acta Orthop, 2023, 94: 416-425.
14.	Dorr LD, Callaghan JJ. Death of the lewinnek “safe zone”. J Arthroplasty, 2019, 34(1): 1-2.
15.	Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg (Am), 1978, 60(2): 217-220.
16.	Fortier LM, Rockov ZA, Chen AF, et al. Activity recommendations after total hip and total knee arthroplasty. J Bone Joint Surg (Am), 2021, 103(5): 446-455.
17.	刘德琳, 徐卫东, 张宸, 等. 人工全髋关节置换术治疗强直性脊柱炎. 协和医学杂志, 2017, 8(4): 251-257.
18.	Zhang W, Li D, Xu J, et al. Reliability and validity of the functional combined anteversion measurement method using standing lateral radiography after total hip arthroplasty. Ann Transl Med, 2023, 11(5): 196.
19.	李珂, 李恒, 孙凤龙, 等. 强直性脊柱炎髋关节影像学特征的初步研究. 中国修复重建外科杂志, 2017, 31(3): 290-294.
20.	Łęgosz P, Otworowski M, Sibilska A, et al. Heterotopic ossification: A challenging complication of total hip arthroplasty: Risk factors, diagnosis, prophylaxis, and treatment. Biomed Res Int, 2019, 2019: 3860142.
21.	唐浩, 王思远, 郭邵逸, 等. 患者个性化安全区指导下全髋关节置换术后脱位翻修1例报道. 中华骨与关节外科杂志, 2023, 16(7): 634-639.
22.	Hermansen LL, Viberg B, Hansen L, et al. “True” cumulative incidence of and risk factors for hip dislocation within 2 years after primary total hip arthroplasty due to osteoarthritis: A nationwide population-based study from the danish hip arthroplasty register. J Bone Joint Surg (Am), 2021, 103(4): 295-302.
23.	李少朋. 联合前倾角技术在初次非骨水泥型全髋关节置换术中的疗效分析. 吉林: 吉林大学, 2020.
24.	Sariali E, Boukhelifa N, Catonne Y, et al. Comparison of three-dimensional planning-assisted and conventional acetabular cup positioning in total hip arthroplasty: A randomized controlled trial. J Bone Joint Surg (Am), 2016, 98(2): 108-116.
25.	周柏臻, 林绍仪, 崔基浩, 等. 联合前倾角技术结合导针定位器对提高全髋关节置换术髋臼假体植入精准度的研究. 中国现代药物应用, 2022, 16(7): 44-46.
26.	翟志凯, 张国梁. 计算机辅助技术在骨科手术中的应用进展. 机器人外科学杂志 (中英文), 2021, 2(6): 485-491.
27.	Dimitriou D, Zindel C, Winkler E, et al. A novel method for evaluating combined component anteversion in total hip arthroplasty on cross-table lateral hip radiographs. Arch Orthop Trauma Surg, 2023, 143(9): 5977-5984.
28.	刘勇, 孙俊英, 王涛, 等. 全髋关节置换术治疗强直性脊柱炎累及髋关节的疗效观察. 中国修复重建外科杂志, 2017, 31(1): 25-30.
29.	黄小刚, 曾斌. 全髋关节置换治疗强直性脊柱炎髋关节骨性强直. 中国骨伤, 2018, 31(12): 1104-1107.
30.	Mitsutake R, Tanino H, Ito H. The effect of range of motion simulated with a patient-specific three-dimensional simulation analysis on dislocation after total hip arthroplasty. Hip Int, 2023, 33(2): 313-322.
31.	Loppini M, Gambaro FM, Nelissen RGHH, et al. Large variation in timing of follow-up visits after hip replacement: a review of the literature. EFORT Open Rev, 2022, 7(3): 200-205.
32.	Nakashima Y, Hirata M, Akiyama M, et al. Combined anteversion technique reduced the dislocation in cementless total hip arthroplasty. Int Orthop, 2014, 38(1): 27-32.

1. Zhu W, He X, Cheng K, et al. Ankylosing spondylitis: etiology, pathogenesis, and treatments. Bone Res, 2019, 7: 22.
2. Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet, 2017, 390(10089): 73-84.
3. Ungprasert P, Chaikijurajai T, Wijarnpreecha K, et al. Clinical characteristics and resource utilization of 19, 130 hospitalizations of patients with ankylosing spondylitis in United States: National Inpatient Sample 2018. Joint Bone Spine, 2022, 89(3): 105313.
4. Gautam D, Malhotra R. Total hip arthroplasty in ankylosing spondylitis with extension contracture of hips. J Arthroplasty, 2019, 34(1): 71-76.
5. 隋善勇. 生物型全髋关节置换治疗强直性脊柱炎累及髋关节. 中华关节外科杂志 (电子版), 2020, 14(4): 423-428.
6. Yan L, Ge L, Dong S, et al. Evaluation of comparative efficacy and safety of surgical approaches for total hip arthroplasty: A systematic review and network meta-analysis. JAMA Netw Open, 2023, 6(1): e2253942.
7. Jin Z, Wang L, Qin J, et al. Direct anterior approach versus posterolateral approach for total hip arthroplasty in the treatment of femoral neck fractures in elderly patients: a meta-analysis and systematic review. Ann Med, 2023, 55(1): 1378-1392.
8. Hu Z, Zhong R, Zhao D, et al. Staged osteotomy in lateral position for the treatment of severe kyphotic deformity secondary to ankylosing spondylitis: a retrospective study. J Orthop Surg Res, 2023, 18(1): 417.
9. 吴迪, 贾其余, 胡联英, 等. 人工智能三维术前规划在全髋关节置换术中的临床应用. 实用骨科杂志, 2023, 29(3): 202-207.
10. Wooster BM, Kennedy NI, Dugdale EM, et al. Contemporary outcomes of primary total hip arthroplasty in patients with inflammatory arthritis. Bone Joint J, 2023, 105-B(7): 768-774.
11. Torkington MS, Davison MJ, Wheelwright EF, et al. Bone penetration of intravenous flucloxacillin and gentamicin as antibiotic prophylaxis during total hip and knee arthroplasty. Bone Joint J, 2017, 99-B(3): 358-364.
12. Porter SB, White LJ, Osagiede O, et al. Tranexamic acid administration is not associated with an increase in complications in high-risk patients undergoing primary total knee or total hip arthroplasty: A retrospective case-control study of 38, 220 patients. J Arthroplasty, 2020, 35(1): 45-51.
13. Leta TH, Fenstad AM, Lygre SHL, et al. The use of antibiotic-loaded bone cement and systemic antibiotic prophylactic use in 2, 971, 357 primary total knee arthroplasties from 2010 to 2020: an international register-based observational study among countries in Africa, Europe, North America, and Oceania. Acta Orthop, 2023, 94: 416-425.
14. Dorr LD, Callaghan JJ. Death of the lewinnek “safe zone”. J Arthroplasty, 2019, 34(1): 1-2.
15. Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg (Am), 1978, 60(2): 217-220.
16. Fortier LM, Rockov ZA, Chen AF, et al. Activity recommendations after total hip and total knee arthroplasty. J Bone Joint Surg (Am), 2021, 103(5): 446-455.
17. 刘德琳, 徐卫东, 张宸, 等. 人工全髋关节置换术治疗强直性脊柱炎. 协和医学杂志, 2017, 8(4): 251-257.
18. Zhang W, Li D, Xu J, et al. Reliability and validity of the functional combined anteversion measurement method using standing lateral radiography after total hip arthroplasty. Ann Transl Med, 2023, 11(5): 196.
19. 李珂, 李恒, 孙凤龙, 等. 强直性脊柱炎髋关节影像学特征的初步研究. 中国修复重建外科杂志, 2017, 31(3): 290-294.
20. Łęgosz P, Otworowski M, Sibilska A, et al. Heterotopic ossification: A challenging complication of total hip arthroplasty: Risk factors, diagnosis, prophylaxis, and treatment. Biomed Res Int, 2019, 2019: 3860142.
21. 唐浩, 王思远, 郭邵逸, 等. 患者个性化安全区指导下全髋关节置换术后脱位翻修1例报道. 中华骨与关节外科杂志, 2023, 16(7): 634-639.
22. Hermansen LL, Viberg B, Hansen L, et al. “True” cumulative incidence of and risk factors for hip dislocation within 2 years after primary total hip arthroplasty due to osteoarthritis: A nationwide population-based study from the danish hip arthroplasty register. J Bone Joint Surg (Am), 2021, 103(4): 295-302.
23. 李少朋. 联合前倾角技术在初次非骨水泥型全髋关节置换术中的疗效分析. 吉林: 吉林大学, 2020.
24. Sariali E, Boukhelifa N, Catonne Y, et al. Comparison of three-dimensional planning-assisted and conventional acetabular cup positioning in total hip arthroplasty: A randomized controlled trial. J Bone Joint Surg (Am), 2016, 98(2): 108-116.
25. 周柏臻, 林绍仪, 崔基浩, 等. 联合前倾角技术结合导针定位器对提高全髋关节置换术髋臼假体植入精准度的研究. 中国现代药物应用, 2022, 16(7): 44-46.
26. 翟志凯, 张国梁. 计算机辅助技术在骨科手术中的应用进展. 机器人外科学杂志 (中英文), 2021, 2(6): 485-491.
27. Dimitriou D, Zindel C, Winkler E, et al. A novel method for evaluating combined component anteversion in total hip arthroplasty on cross-table lateral hip radiographs. Arch Orthop Trauma Surg, 2023, 143(9): 5977-5984.
28. 刘勇, 孙俊英, 王涛, 等. 全髋关节置换术治疗强直性脊柱炎累及髋关节的疗效观察. 中国修复重建外科杂志, 2017, 31(1): 25-30.
29. 黄小刚, 曾斌. 全髋关节置换治疗强直性脊柱炎髋关节骨性强直. 中国骨伤, 2018, 31(12): 1104-1107.
30. Mitsutake R, Tanino H, Ito H. The effect of range of motion simulated with a patient-specific three-dimensional simulation analysis on dislocation after total hip arthroplasty. Hip Int, 2023, 33(2): 313-322.
31. Loppini M, Gambaro FM, Nelissen RGHH, et al. Large variation in timing of follow-up visits after hip replacement: a review of the literature. EFORT Open Rev, 2022, 7(3): 200-205.
32. Nakashima Y, Hirata M, Akiyama M, et al. Combined anteversion technique reduced the dislocation in cementless total hip arthroplasty. Int Orthop, 2014, 38(1): 27-32.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of combined anteversion angle technique in total hip arthroplasty for treatment of ankylosing spondylitis affecting hip joint

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