Clinical efficacy of multiple arthroplasties in treatment for severe ankylosing spondylitis

doi:10.3877/cma.j.issn.1674-134X.2023.03.003

Abstract

Abstract:

Objective

To investigate the clinical effectiveness of multiple joint arthroplasty in the treatment of patients with severe ankylosing spondylitis.

Methods

A retrospective analysis was conducted on 18 patients at the Department of Orthopedics of the Second People's Hospital of Shenzhen between January 2015 and December 2020. Inclusion criteria: patients of severe AS with dysfunction of hip and knee underwent primary total knee and hip replacements; patients followed postoperative rehabilitation training according to the instruction and had complete medical records. The patients who were lost to follow up or followed up less than three months were excluded. A total of 40 hip and/or knee replacements were performed based on the patient's condition. The preoperative and postoperative joint functional scores and postoperative complications of the patients were recorded. The efficacy of surgery and improvement of the quality of life were evaluated.The t test was used to compare the functional improvement before and after surgery.

Results

All the patients had an average follow-up time of (31±12) months. The HSS knee score was (33±4) before the surgery, and was improved to (67±5) at one year after the surgery; the difference was statistically significant (t=20.638, P<0.05). The Harris hip score was (16±5) before the surgery, and was improved to (59±7) at one year after surgery; the difference was statistically significant (t=37.181, P<0.05). The mobility of knee and hip improved after the surgery(t=18.096、48.908, both P<0.001). None of the patients had experienced any complications such as joint dislocation, infection, or fracture.

Conclusions

Total knee and hip replacements are an effective treatment for lower limb joint disease in patients with ankylosing spondylitis. It effectively relieves joint pain, improves joint function, and improves quality of life and satisfaction of patients.

Key words: Spondylitis, ankylosing, Osteoarthritis, Arthroplasty

Jiaji Yue, Hongxi Shang, Min Hao, Wei Xie, Wei Sun, Anqing Liu. Clinical efficacy of multiple arthroplasties in treatment for severe ankylosing spondylitis[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(03): 311-317.

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https://zhgjwkzz.cma-cmc.com.cn/EN/Y2023/V17/I03/311

Figures/Tables 5

Table 1 Basic information of severe AS patients enrolled in this study

性别Gender	例数Case number	年龄(岁)Age	病程(年)Course of disease(year)	BMI(kg/m²)	随访时间(月)Follow-up period	生活状态Living status		受教育水平Education
性别Gender	例数Case number	年龄(岁)Age	病程(年)Course of disease(year)	BMI(kg/m²)	随访时间(月)Follow-up period	独立Independent	与家庭成员With family	初中及以下Junior high school and below	高中或中专Senior high school	大专及以上College or above
男性	12	42.1±8.0	14.5±7.1	18.7±2.3	28.9±15.7	5	7	6	3	3
女性	6	43.8±6.7	14.0±5.9	18.5±2.3	32.5±10.2	3	3	4	2	0
统计值		t＝0.459	t＝0.149	t＝0.150	t＝0.504	χ²＝0.106		χ²＝1.149
P值		>0.05	>0.05	>0.05	>0.05	>0.05		>0.05

Table 2 Functional evaluation of AS patients before and after operation

时间Time	HSS-TJAES	HSS评分	Harris评分	膝关节ROM(°)Knee ROM	髋关节ROM(°)Hip ROM
术前Before surgery	40±8	33±4	16±5	18±6	0
术后1年One year after surgery	77±7	67±5	59±7	79±9	117±13
t值	12.899	20.638	37.181	18.096	48.908
P值	<0.001	<0.001	<0.001	<0.001	<0.001

Figure 1 Radiographic images of pelvis of the typical patientNote: Left picture is lower positionX-ray image of pelvis, right picture is three-dimensional reconstruction in CT images of pelvis, showingthat the left hip joint wasin external rotation and flexional rigidity position, and the right hip joint was in adductional and flexional rigidity position

Figure 2 The anteroposterior and lateral views of X-ray of bilateral knee joints. A is radiograph of left knee, showing that left knee was in a flexional rigidity position of 90°；the right knee was in a flexional rigidity position of 70°

Figure 3 Anteroposterior view of full-length X-ray of lower extremities，showing that after bilateral knee and hip replacements, the prostheses were in good position

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