Retrospective Cohort Study
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World J Orthop. Aug 18, 2022; 13(8): 714-724
Published online Aug 18, 2022. doi: 10.5312/wjo.v13.i8.714
Functional and clinical outcome with modified lateral approach total hip arthroplasty in stiff hips with ankylosing spondylitis
Mathew Kiran Jacob, Pavan Kumar Reddy, Roncy Savio Kuruvilla, Chandy Viruthapadavil John, Pradeep Mathew Poonnoose, Anil Thomas Oommen
Mathew Kiran Jacob, Pavan Kumar Reddy, Roncy Savio Kuruvilla, Chandy Viruthapadavil John, Pradeep Mathew Poonnoose, Anil Thomas Oommen, Unit 2, Department of Orthopaedics, Christian Medical College Hospital, Vellore 632004, India
Author contributions: Jacob MK contributed to data collection, analysis, and figure preparation; Reddy PK, Kuruvilla RS, and Chandy VJ contributed to the figure preparation, manuscript writing, and literature review; Poonnoose PM provided input for the manuscript writing and literature review; Oommen AT contributed to concepts, manuscript preparation, figure preparation, and literature review.
Institutional review board statement: The study was approved by the Institutional Review Board, Office of Research, Christian Medical College, approval No. 11164 dated 06.02.2018.
Conflict-of-interest statement: The authors have no conflicts of interest to declare that are relevant to the content of this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Anil Thomas Oommen, DNB, MNAMS, MS, Full Professor, Unit 2, Department of Orthopaedics, Christian Medical College Hospital, Scudder Road, Vellore 632004, India. lillyanil@cmcvellore.ac.in
Received: December 27, 2021
Peer-review started: December 27, 2021
First decision: April 12, 2022
Revised: April 24, 2022
Accepted: July 26, 2022
Article in press: July 26, 2022
Published online: August 18, 2022
Processing time: 232 Days and 2.1 Hours
Abstract
BACKGROUND

Ankylosing spondylitis at total hip arthroplasty (THA) has significant hip stiffness with flexion deformity, restricted mobility, and function. Range of movement (ROM) improvement with good functional outcome is seen following THA in these hips. The modified Hardinge approach without abductor compromise is helpful in these stiff hips with associated flexion deformity.

AIM

To assess improvement in ROM and functional outcomes with a modified lateral approach THA in ankylosing spondylitis with stiff hips.

METHODS

A total of 69 hips that underwent THA with a modified Hardinge approach in 40 patients were evaluated at a mean follow-up of 38.33 mo. All individuals ambulated with weight-bearing as tolerated and ROM exercises from the 1st postoperative day. Modified Harris hip score and ROM were assessed during follow-up. Quality of life assessments using the 36-item and 12-item short form health surveys were done along with clinical and functional outcomes at follow-up. SPSS 22.0 was used for statistical analysis. The correlation of ROM and functional score change was performed using Pearson’s correlation coefficient.

RESULTS

Sixty-nine hips with a significant decrease in ROM preoperatively with 32 clinically fused hips showed significant improvement in flexion range. The mean flexion in 69 hips improved from 29.35 ± 31.38 degrees to 102.17 ± 10.48 degrees. The mean difference of 72.82 with a P value < 0.0001 was significant. In total, 45 out of 69 hips had flexion deformity, with 13 hips having a deformity above 30 degrees. The flexion during the follow-up was below 90 degrees in 3 hips. Eleven hips had flexion of 90 degrees at follow-up, while the remaining 55 hips had flexion above 100 degrees. Modified Harris hip score improved from 17.03 ± 6.02 to 90.66 ± 7.23 (P value < 0.0001). The 36-item short form health survey at the follow-up indicated health status in 40 patients as excellent in 11, very good in 20, good in 5, fair in 3, and poor in 1. The mean mental health score was 84.10 ± 11.58. Pain relief was good in all 69 hips. Altogether, 28/40 patients (70%) had no pain, 9 patients (22%) had occasional pain, and 3 patients (8%) had mild to moderate pain with unusual activity. Heterotopic ossification was seen in 21 hips with Brooker class 1 in 14 hips.

CONCLUSION

Modified Hardinge approach THA in ankylosing spondylitis with stiff hips with flexion deformity significantly improved ROM, Harris hip score, and quality of life indicated by the 36-item and 12-item short form health surveys.

Keywords: Ankylosing Spondylitis, Stiff, flexion deformity, Harris hip score, Hip range of movement, 36-item short form health survey score, Total hip arthroplasty modified Hardinge approach

Core Tip: Ankylosing spondylitis is characterized by significant hip stiffness with mobility restriction and decreased quality of life. Range of movement is reduced with coexistent flexion deformity. Total hip arthroplasty improves mobility by enhancing the quality of life. The modified Hardinge approach leaves the posterior two-thirds of the abductors intact. This approach is helpful in these hips with flexion deformity with good clinical and functional outcomes. Range of movement, Harris hip score, and quality of life indicated by the 36-item short form health survey score have shown promising results.