Does the Femoral Head Size Influence Outcomes After Uncemented Total Hip Arthroplasty for Fused Hips? A Prospective Stud
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ORIGINAL ARTICLE
Does the Femoral Head Size Influence Outcomes After Uncemented Total Hip Arthroplasty for Fused Hips? A Prospective Study in Ankylosing Spondylitis Kanniyan Kalaivanan1 · Shantanu Patil2 · P. S. Ashok Kumar1 · P. Suryanarayan1 · Vijay C. Bose1 Received: 9 April 2020 / Accepted: 21 July 2020 / Published online: 2 August 2020 © Indian Orthopaedics Association 2020
Abstract Background Uncemented total hip arthroplasty (THA) with large size femoral heads have shown greater advantage with good stability, range of motion and decreased dislocation rate in ankylosing spondylitis (AS). Meticulous planning is needed to address the unique surgical challenges in such patients with fused hip and spinal deformity. Materials and Methods Thirty fivefused hip joints in twenty-five AS patients who underwent uncemented THA (April 2014 to December 2016) were included in our prospective study and were followed up for a minimum period of 36 months. Pain relief, functional improvement and patient satisfaction were statistically assessed using “Visual Analogue Score” (VAS), “Harris Hip Score” (HHS) and “AJRI 10-Point Satisfaction Score” (A10PSS), respectively. Results The overall mean preoperative VAS improved from 6.9 ± 1.5 to 1.5 ± 1, HHS improved from 50.0 ± 12 to 88.4 ± 7.8 and A10PSS improved from 2.2 ± 1.2 to 7.6 ± 0.8. Our study results were significant with zero dislocation and good functional score in comparison to the other available studies in literature. First subdivision study in AS patients with bilateral THA performed better than unilateral THA. Second subdivision study showed no significant statistical difference in terms of VAS, HHS, A10PSS and dislocation rate in relation to femoral head size between 32 mm, 36 mm and 40 mm. Conclusion Uncemented THA with large size femoral head equal or greater than 32 mm provides better stability and good functional outcome with less dislocation rate in comparison to older studies of literature with femoral head size less than 32 mm. Level of Evidence A Level II study. (Data collected from the ongoing prospective study) (https://www.spine.org/Docum ents/LevelsofEvidenceFinal.pdf). Keywords Ankylosing spondylitis · Fused hip joint · Femoral head size · Dislocation · Uncemented total hip arthroplasty · Visual analog score · Harris hip score · AJRI 10-point satisfaction score · Transverse acetabular ligament · Spinal deformity
Introduction Ankylosing spondylitis (AS) is a general inflammatory rheumatic disorder which impacts the axial skeleton, leading to a very characteristic inflammatory back pain, which may result into the structural changes and functional impairments with a subsequent decline in the quality of life scores. Recently, * Kanniyan Kalaivanan [email protected] 1
Asian Joint Reconstruction Institute (AJRI), SIMS Hospitals, Chennai, Tamil Nadu, India
Translational Medicine and Research, SRM Medical College, SRM IST, Kattankulathur, Tamil Nadu, India
2
developed imaging techniques and therapeutic options have substantially changed
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