Hip replacement for ankylosing spondylitis yields good long-term results

מתוך medicontext.co.il
WESTPORT, CT (Reuters Health) – Long-term outcomes of total hip arthroplasty (THA) in patients with ankylosing spondylitis are excellent, according to a report in the August issue of The Journal of Rheumatology.

"Our data suggest that the majority of THA last longer than 14 years with high patient satisfaction," write Dr. Andrei Calin and colleagues from the Royal National Hospital for Rheumatic Diseases in Bath, UK.

Early-onset ankylosing spondylitis (AS) brings a greater likelihood of hip arthropathy, the authors explain, but many orthopedic surgeons advocate postponement of total hip arthroplasty out of concern for mechanical failure of the prosthesis in these relatively young patients.

The authors used a self-administered questionnaire to examine the perceptions of 166 patients (mean age, 53.7 years) an average of 14 years after their first hip arthroplasty. One hundred nine (66%) of the patients had had bilateral hip replacements.

Overall results were quite good, the authors report, with none/mild pain reported for 83% of the procedures, 52% good/very good movement, and 58% high/very high success. Results were similar for patients undergoing bilateral and unilateral THA.

Fewer THA patients (42%) than control patients (64%) (p < 0.001) were employed. "However," the researchers write, "this is not surprising, given that we have shown that patients with hip involvement have more severe spinal disease and thus are more likely to be incapacitated."

Nine out of ten original joints continued to function beyond 10 years, the results indicate, and joint survival after 20 years was still 65% for original THAs and 61% for revisions. Most joint failures occurred within the first 7 years.

"Clearly," the authors conclude, "young, relatively mobile patients with AS who receive a THA cope very well, in contrast to oft-quoted concerns from orthopedic surgeons regarding young potential THA recipients."

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