Influence of hip replacement on spinal-pelvic sagittal balance of patients with hip ankylosis and spinal kyphosis
Objective To observe the effect of hip replacement on spinal-pelvic sagittal balance of ankylosing spondylitis patients with hip ankylosis accompanied by mild to moderate spinal kyphosis,and to explore its safety.Methods From February 2021 to May 2023,12 patients(23 hips)with ankylosing spondylitis and hip ankylosis accompanied by mild to moderate kyphosis were performed hip replacement and were followed up in Henan Provincial People's Hospital.The occurrence of prosthetic disorders,dislocation,and ectopic ossification during follow-up,as well as the relief of lower back pain and knee pain were recorded.The visual analogue scale score,hip Harris score,SF-36 score,activity of diseased hip,and spinal-pelvic sagittal balance parameters were compared before surgery and at the latest follow-up.Results(1)All 12 surgeries were successfully performed,and the prostheses were placed according to the presurgical pelvic retroversion degree.The surgery lasted for(321.25±69.12)min,and the intrasurgical blood loss was(529.17±253.57)mL.One week postsurgically,the hip X-ray showed a good positioning of the prosthesis.During a follow-up of(10.91±1.89)months,no prosthetic disorders,dislocation,or ectopic ossification occurred.At the latest follow-up,lower back pain and knee pain were significantly alleviated.(2)The visual analogue scale score was lower at the latest follow-up(1.33±1.21)than that before surgery(6.17±1.94)(t=5.175,P＜0.001),the Harris score and SF-36 score were higher at the latest follow-up(90.09±9.46,79.24±11.89)than those before surgery(32.08±20.93,20.50±13.23)(t=-6.191,P＜0.001;t=-8.090,P＜0.001).The hip flexion[(95.17±8.38)°],extension[(11.67±4.68)°],adduction[(13.17±2.14)°],abduction[(36.50±6.89)°],internal rotation[(11.17±3.06)°],and external rotation[(35.50±3.94)°]at the latest follow-up were all greater than those before surgery[(18.00±10.86)°,(2.95±2.50)°,(6.67±3.39)°,(8.33±5.57)°,(4.00±3.29)°,(5.17±4.79)°](t=-25.874,-3.841,-8.510.-8.431,-6.468,-9.941,all P values＜0.05).The chin-brow vertical[(6.6±5.3)°],pelvic incidence minus lumbar lordosis match[(17.0±12.4)°],and sagittal vertical axis[(150.0±141.4)mm]at the latest follow-up were all smaller than those before surgery[(13.3±6.0)°,(28.5±14.6)°,(272.0±186.9)mm](t=4.250,P=0.008;t=3.136,P=0.026;t=4.029,P=0.010),and the global kyphosis,thoracic kyphosis,thoracolumbar kyphosis,lumbar lordosis,pelvic tilt,pelvic incidence and sacral slope did not change significantly at the latest follow-up(P＞0.05).Conclusion Hip replacement can keep spinal-pelvic sagittal balance,reduce pain,improve life quality,and is quite safe for ankylosing spondylitis patients with hip ankylosis accompanied by mild to moderate spinal kyphosis.
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