SPINAL WEDGED OSTEOTOMY COMBINED WITH TOTAL HIP ARTHROPLASTY FOR KYPHOSIS AND SEVERE HIP FLEXTION CONTRACTURE CAUSED BY ANKYLOSING SPONDYLITIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 ZENGYong , HERui , LIQing , SHIHuayang , MAHongbing

Department of Orthopaedics, Chengdu Second People's Hospital, Chengdu Sichuan, 610017, P. R. China;

Corresponding?author：

ZENGYong, Email: zysh2929@163.com

Keywords：

Ankylosing spondylitis; Kyphosis; Spinal wedged osteotomy; Hip flexion contracture; Total hip arthroplasty

DOI：

10.7507/1002-1892.20140207

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Objective To evaluate the effectiveness of spinal wedged osteotomy and total hip arthroplasty (THA) for treatment of kyphosis and severe hip flexion contracture caused by ankylosing spondylitis (AS). Methods Between December 2008 and November 2011,25 patients (37 hips) with kyphosis and severe hip flexion contracture caused by AS were treated.There were 22 males and 3 females,aged 29-38 years (mean,35.6 years).The disease duration was 8-16 years (mean,13.2 years).Of them,18 cases had complete limitation of hip motion,and 16 cases had severe spine deformity (Cobb's angel ≥60°).All 25 cases underwent spinal wedged osteotomy at first,and then received THA after 8 weeks.The effectiveness was evaluated by Harris hip score,range of motion (ROM) of the hip,visual analogue scale (VAS) score,Cobb's angle,and information and data exchange system (IDES) criteria for aseptic loosening,respectively. Results The patients were followed up 12-14 months (mean,13 months).Spondylolisthesis (Ⅱ degree) occurred in 1 case spinal after wedged osteotomy,and was corrected after second operation.No vascular injury or spinal cord injury was observed.Bony fusion was obtained at osteotomy ends at 6 months after operation.The Cobb's angle was significantly corrected from (83.5±10.4)° preoperatively to (25.4±5.5)° (t=24.63,P=0.00) 12 months postoperatively.One case had traction injury of the femoral nerve after THA,and the muscle function recovered at 9 months after operation.According to IDES criteria,up-displacement of cup (<5 mm) was observed in 1 patient,who had no obvious clinical symptoms; periacetabular osteolysis occurred in 1 patient,with no displacement of cup.No obvious radiolucent was seen in 37 hips.The Harris hip score was significantly improved from (26.87±4.23) preoperatively to (85.92±6.04) (t=28.72,P=0.00) 3 months postoperatively; the VAS score was significantly decreased from (6.71±1.14) preoperatively to (2.31±0.82) (t=42.26,P=0.00) 3 months postoperatively; and the flexion-extension ROM of the hip was significantly improved to 60-100° (mean,72.0°) at post-operation,and the abduction ROM of the hip was improved to 20-40° (mean,28.7°). Conclusion Spinal wedged osteotomy combined with THA is an efficient treatment for kyphosis and severe hip flexion contracture caused by AS.

Citation： ZENGYong, HERui, LIQing, SHIHuayang, MAHongbing. SPINAL WEDGED OSTEOTOMY COMBINED WITH TOTAL HIP ARTHROPLASTY FOR KYPHOSIS AND SEVERE HIP FLEXTION CONTRACTURE CAUSED BY ANKYLOSING SPONDYLITIS. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(8): 942-946. doi: 10.7507/1002-1892.20140207 Copy

1.	Walker LG,Sledge CB.Total hip arthroplasty in ankylosing spondylitis.Clin Orthop Relat Res,1991,(262):198-204.
2.	Guan M,Wang J,Zhao L,et al.Management of hip involvement in ankylosing spondylitis.Clin Rheumatol,2013,32(8):1115-1120.
3.	Moshirfar A,Rand FF,Kebaish KM.Fixed sagittal plane deformity:causes,prevention,and treatment options.Seminars in Spine Surgery,2011,23(2):135-141.
4.	Kim KT,Park DH,Lee SH,et al.Partial pedicle subtraction osteotomy as an alternative option for spinal sagittal deformity correction.Spine (Phila Pa 1976),2013,38(14):1238-1243.
5.	李冬松,劉建國.人工髖關節置換術后假體無菌性松動的臨床及影像學評估.中華創傷骨科雜志,2005,7(4):376-379.
6.	Hamadouche M,Kerboull L,Meunier A,et al.Total hip arthroplasty for the treatment of ankylosed hips:a five to twenty-one-year follow-up study.J Bone Joint Surg (Am),2001,83-A(7):992-998.
7.	Joshi AB,Markovic L,Hardinge K,et al.Total hip arthroplasty in ankylosing spondylitis:an analysis of 181 hips.J Arthroplasty,2002,17(4):427-433.
8.	詹子睿,肖松生.強直性脊柱炎強直髖全髖關節置換術45例臨床分析.華西醫學,2010,25(5):877-879.
9.	Tang WM,Chiu KY.Primary total hip arthroplasty in patients with ankylosing spondylitis.J Arthroplasty,2000,15(1):52-58.
10.	Sotereanos NG,Miller MC,Smith B,et al.Using Inteaoperative pelvic landmarks for acetabular component placement in total hip arthroplasty.J Arthroplasty,2006,21(6):832-840.
11.	Wilson MJ,Whitehouse SL,Howell JR,et al.The results of acetabular impaction grafting in 129 primary cemented total hip arthroplasties.J Arthroplasty,2013,28(8):1394-1400.
12.	Zheng GQ,Zhang YG,Chen JY,et al.Decision making regarding spinal osteotomy and total hip replacement for ankylosing spondylitis:experience with 28 patients.Bone Joint J,2014,96-B(3):360-365.
13.	Rachid B,El Zorkany B,Youseif E,et al.Early diagnosis and treatment of ankylosing spondylitis in Africa and the Middle East.Clin Rheumatol,2012,31(11):1633-1639.
14.	Kebaish KM.Spinal sagittal plane deformities:etiology,evaluation,and management.Seminars in Spine Surgery,2009,21(1):41-48.
15.	Kuroiwa T,Yoshii T,Sakaki K,et al.Vertebral locking lesion following cervical spine fracture in ankylosing spondylitis.Orthopedics,2012,35(6):e1005-1008.
16.	Mehdian S,Arun R.A safe controlled instrumented reduction technique for cervical osteotomy in ankylosing spondylitis.Spine (Phila Pa 1976),2011,36(9):715-720.
17.	Kim KT,Jo DJ,Lee SH,et al.Does it need to perform anterior column support after Smith-Petersen osteotomy for ankylosing spondylitis.Eur Spine J,2012,21(5):985-991.
18.	Wang R,Wang Z,Ma Y,et al.Particle-induced osteolysis mediated by endoplasmic reticulum stress in prosthesis loosening.Biomaterials,2013,34(11):2611-2623.

1. Walker LG,Sledge CB.Total hip arthroplasty in ankylosing spondylitis.Clin Orthop Relat Res,1991,(262):198-204.
2. Guan M,Wang J,Zhao L,et al.Management of hip involvement in ankylosing spondylitis.Clin Rheumatol,2013,32(8):1115-1120.
3. Moshirfar A,Rand FF,Kebaish KM.Fixed sagittal plane deformity:causes,prevention,and treatment options.Seminars in Spine Surgery,2011,23(2):135-141.
4. Kim KT,Park DH,Lee SH,et al.Partial pedicle subtraction osteotomy as an alternative option for spinal sagittal deformity correction.Spine (Phila Pa 1976),2013,38(14):1238-1243.
5. 李冬松,劉建國.人工髖關節置換術后假體無菌性松動的臨床及影像學評估.中華創傷骨科雜志,2005,7(4):376-379.
6. Hamadouche M,Kerboull L,Meunier A,et al.Total hip arthroplasty for the treatment of ankylosed hips:a five to twenty-one-year follow-up study.J Bone Joint Surg (Am),2001,83-A(7):992-998.
7. Joshi AB,Markovic L,Hardinge K,et al.Total hip arthroplasty in ankylosing spondylitis:an analysis of 181 hips.J Arthroplasty,2002,17(4):427-433.
8. 詹子睿,肖松生.強直性脊柱炎強直髖全髖關節置換術45例臨床分析.華西醫學,2010,25(5):877-879.
9. Tang WM,Chiu KY.Primary total hip arthroplasty in patients with ankylosing spondylitis.J Arthroplasty,2000,15(1):52-58.
10. Sotereanos NG,Miller MC,Smith B,et al.Using Inteaoperative pelvic landmarks for acetabular component placement in total hip arthroplasty.J Arthroplasty,2006,21(6):832-840.
11. Wilson MJ,Whitehouse SL,Howell JR,et al.The results of acetabular impaction grafting in 129 primary cemented total hip arthroplasties.J Arthroplasty,2013,28(8):1394-1400.
12. Zheng GQ,Zhang YG,Chen JY,et al.Decision making regarding spinal osteotomy and total hip replacement for ankylosing spondylitis:experience with 28 patients.Bone Joint J,2014,96-B(3):360-365.
13. Rachid B,El Zorkany B,Youseif E,et al.Early diagnosis and treatment of ankylosing spondylitis in Africa and the Middle East.Clin Rheumatol,2012,31(11):1633-1639.
14. Kebaish KM.Spinal sagittal plane deformities:etiology,evaluation,and management.Seminars in Spine Surgery,2009,21(1):41-48.
15. Kuroiwa T,Yoshii T,Sakaki K,et al.Vertebral locking lesion following cervical spine fracture in ankylosing spondylitis.Orthopedics,2012,35(6):e1005-1008.
16. Mehdian S,Arun R.A safe controlled instrumented reduction technique for cervical osteotomy in ankylosing spondylitis.Spine (Phila Pa 1976),2011,36(9):715-720.
17. Kim KT,Jo DJ,Lee SH,et al.Does it need to perform anterior column support after Smith-Petersen osteotomy for ankylosing spondylitis.Eur Spine J,2012,21(5):985-991.
18. Wang R,Wang Z,Ma Y,et al.Particle-induced osteolysis mediated by endoplasmic reticulum stress in prosthesis loosening.Biomaterials,2013,34(11):2611-2623.

Chinese Journal of Reparative and Reconstructive Surgery

SPINAL WEDGED OSTEOTOMY COMBINED WITH TOTAL HIP ARTHROPLASTY FOR KYPHOSIS AND SEVERE HIP FLEXTION CONTRACTURE CAUSED BY ANKYLOSING SPONDYLITIS

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