Strategizing Simultaneous Spinal Osteotomy and Total Hip Replacement in Ankylosing Spondylitis
Chen Guo1, Yan Liang1, Zhenqi Zhu1
1Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, PR China.
Orthopaedic Surgery
|December 12, 2024
Summary
For ankylosing spondylitis (AS), hip replacement before spinal osteotomy can be advantageous, improving patient outcomes and potentially simplifying subsequent spinal surgery. This tailored approach enhances functional abilities and quality of life.
Area of Science:
- Orthopedics
- Rheumatology
- Surgical Sequencing
Background:
- Ankylosing spondylitis (AS) causes chronic inflammation, spinal fusion, and impaired mobility.
- The optimal surgical order for spinal osteotomy and total hip replacement (THR) in AS patients is debated.
Purpose of the Study:
- To investigate the optimal sequencing of spinal osteotomy and THR in adult patients with AS.
- To compare outcomes based on whether spinal osteotomy or THR is performed first.
Main Methods:
- Retrospective cohort study (2017-2021) of 14 AS patients undergoing both procedures.
- Radiographic (Global Cobb angle, pelvic parameters) and clinical (Harris hip score) outcome measures.
- Paired and independent sample t-tests for pre- and postoperative and group comparisons.
Main Results:
- Significant postoperative improvements in Global Cobb angle and Harris hip scores at 3 months.
- The 'Spine First' group showed greater pelvic parameter changes but longer operative times and blood loss.
- No major complications were reported in either group.
Conclusions:
- Performing total hip replacement before spinal osteotomy may be viable and advantageous in select AS patients.
- This sequence may reduce complications and facilitate subsequent spinal surgery.
- Surgical decisions should be individualized based on patient-specific needs and anatomy to improve function and quality of life.
