Management of hip involvement in ankylosing spondylitis
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REVIEW ARTICLE
Management of hip involvement in ankylosing spondylitis Mingqiang Guan & Jian Wang & Liang Zhao & Jun Xiao & Zhihan Li & Zhanjun Shi
Received: 4 April 2013 / Accepted: 19 April 2013 # Clinical Rheumatology 2013
Abstract Ankylosing spondylitis (AS) is an inflammatory rheumatologic disease characterized by inflammation and progressive structural damage of the affected joints. Hip involvement often results in severe deformities and significant impairment on function. Although, tremendous progress has been made in conservative management for AS, effective prevention strategies for hip involvement and long-term need for total hip arthroplasty (THA) remain indefinite. When hip involvement has progressed to intractable pain and disability, THA is still the most effective treatment strategy to relieve pain and restore function. However, certain AS-specific problems regarding “preoperative preparation,” “intraoperative difficulties,” “perioperative pharmacological management,” “postoperative physiotherapy,” “operation benefits,” and “operation complications” need more concern and further discussion. Keywords Ankylosing spondylitis . Pharmacological management . Physiotherapy . Total hip arthroplasty
Introduction Ankylosing spondylitis (AS) is an inflammatory disease of unknown origin that often results in gradual ankylosis of the affected joints. The onset of AS often occurs at a relatively young age [1]. It is deemed that the younger the age at the onset, the greater is the likelihood of hip involvement [2]. Male, axial disease, and enthesitis are also regarded as risk factors of hip involvement and the need for total hip arthroplasty (THA) in AS [3, 4]. Hip involvement occurs in 25–50 % of patients with AS, and 47–90 % of patients M. Guan : J. Wang : L. Zhao : J. Xiao : Z. Li : Z. Shi (*) Department of Orthopaedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province 510515, China e-mail: [email protected]
who have such involvement have it bilaterally [3]. Hip joint involvement in AS often results in severe deformities and may also harm other activities related to spinal mobility. The combination of the stiff spine and hip can cause severe disability in the patients. In addition, hip involvement cannot only affect the patients in physical status but also in employability, psychosocial status, and comprehensive quality of life [5]. Till now, THA is still the standard operation for pain relief and function improvement to treat patients with AS. However, due to various reasons, every patient with THA at present has the potential of failure and the need for revision surgery. Therefore, waiting for THA is not an optimal treatment strategy for AS patients who are usually young and active. Conservative management strategies with definite effect to prevent hip involvement and the need for THA are expected. When hip involvement progresses to intractable pain or severe deformities, THA is the most recommended treatment strategy. However, THA for AS patients with stiff spine and i
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