The Impact of Preoperative Inflammatory Activity in Patients with Ankylosing Spondylitis on Postoperative Joint...

The relationship between preoperative inflammatory activity and postoperative functional outcomes following total hip arthroplasty (THA) in patients with ankylosing spondylitis (AS) has not been fully elucidated. This study aimed to evaluate the predictive value of preoperative inflammatory markers for postoperative functional outcomes in patients with AS undergoing THA.

Employed a retrospective research method. A total of 541 AS patients (739 hips) who underwent primary THA between 2003 and 2019 were analyzed. Preoperative inflammatory markers, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), fibrinogen (FIB), and D-dimer (D-D), were measured. Functional outcomes were assessed using the Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Harris Hip Score (HHS).

Patients with higher baseline ESR levels experienced greater functional improvement postoperatively. Specifically, a higher baseline ESR was associated with an increased probability of BASFI improvement, with an adjusted relative risk of 0.72 per unit increase in ln(ESR). Clinically meaningful improvements were observed, with BASFI decreasing by an average of 18.5 points and HHS increasing by 46.2 points, both exceeding minimal clinically important differences.

These findings suggest that elevated preoperative inflammatory markers, particularly ESR, are not contraindications for THA in AS patients. Instead, they may indicate a greater capacity for postoperative functional recovery. The study supports a proactive surgical approach in appropriately selected AS patients, emphasizing the need for individualized assessment and consideration of systemic inflammation as a potential marker of postoperative improvement rather than a barrier to surgical intervention. These insights could refine surgical decision-making and optimize timing for THA in AS patients.