Two-Stage Treatment for Ankylosing Spondylitis With Severe Hip Contracture

Ankylosing spondylitis is a progressive inflammatory disease that often involves the hip, causing deformities and dysfunction. Total hip arthroplasty (THA) may be used, but contracture of the hip joint in ankylosing spondylitis makes THA technically difficult and leads to poor efficacy. This retrospective study describes a novel 2-stage surgical treatment for ankylosing spondylitis of the hip and evaluates its efficacy relative to THA alone. Patients with ankylosing spondylitis and severe hip flexion contracture treated between 2011 and 2017 were assigned to either an experimental group or an age-matched control group (n=12 each) based on receiving, respectively, soft tissue release of the hip joint, femoral osteotomy, and supracondylar bone traction (stage I) and THA (stage II) or THA only. Clinical and radiological data included preoperative, postoperative, and follow-up Harris Hip Score and visual analog scale score, hip range of motion, femoral nerve injury, and heterotopic ossification. Both groups had significant corrections after surgery. At the final follow-up, the experimental group had significantly higher Harris Hip Scores and range of motion in extension compared with the control group, significantly more reduction in visual analog scale score, and no femoral nerve injury. The novel 2-stage surgery for patients with ankylosing spondylitis and severe hip flexion contracture is effective for restoring hip function and improving patients' quality of life, having fewer complications than traditional THA alone. [Orthopedics. 2019; 42(6):e502-e506.].