Functional and Clinical Outcome With Modified Lateral Approach Total Hip Arthroplasty in Stiff Hips With Ankylosing Spondylitis&nbsp;

doi:10.21203/rs.3.rs-154818/v1

Download PDF

Research article

Functional and Clinical Outcome With Modified Lateral Approach Total Hip Arthroplasty in Stiff Hips With Ankylosing Spondylitis

https://doi.org/10.21203/rs.3.rs-154818/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Background

Ankylosing spondylitis at THA have significant hip stiffness with flexion deformity and restricted function. ROM (range of movement) improvement with good functional outcome is seen following THA with modified lateral approach in these hips.

Methods

69hips who underwent THA with a modified Hardinge approach in 40patients were evaluated at a mean follow up of 38.33 months (0 to 83 months). Modified Harris hip score, ROM (range of movement), and SF 36 scores were used to assess clinical and functional improvement at review.

Results

69 hips with significant decrease in ROM preoperatively with 32 clinically fused hips showed significant improvement in the range of flexion. The mean flexion in 69 hips improved from 29.35 (SD 31.38) to 102.17 degrees (SD10.48). The mean difference of 72.82 with p Value <0.0001 was found to be significant. 45 /69 hips had fixed flexion deformity with 13 hips having a deformity above 30 degrees. The flexion at review was below 90 degrees in 3 hips. Eleven hips had flexion of 90 degrees at review while the remaining 55 hips had flexion above 100 degrees. Modified HHS improved from 17.03(SD 6.02) to 90.66 (SD7.23). SF 36 at review indicated health status in 40 patients as excellent in 11, very good in 20, fair in 3 and poor in 1. Mean mental health score was 84.10(SD11.58)

Conclusion

Our study suggests that modified lateral approach THA in AS with stiff hips achieves significant improvement in ROM, HHS and quality of life indicated by SF12 and SF36 scores. Modified lateral approach is useful especially in fused AS hips with flexion deformity.

Orthopedics

Ankylosing Spondylitis

Stiff

flexion deformity

HHS

Hip ROM

SF 36 Score

THA modified Hardinge approach

Ankylosing Spondylitis (AS) belongs to the spondyloarthropathy group of disorders affecting the young with by progressive stiffness of the spine and hip joints. 25–50% of patients have involvement of the hip joint[1]with bilateral hip disease seen in 50 to 90% of in AS[2–5]. Disability in these individuals is predominantly due to decreased movement resulting in stiffness restricting their activities. The hip involvement presents with varying degrees of stiffness with bony ankylosis seen in about 40% at THA (Total hip arthroplasty)[6]. Majority of these young patients have fixed deformities with loss of spinal mobility. THA improves the functional outcome in these patients with significant activity limitation and progressive stiffness in their spine and hips.

THA in these hips provide significant improvement in the range of movement and pain relief. This brings about marked improvement in function and mobility[4]. However the associated risks to be considered are ectopic bone formation, reduced range of movement(ROM)and re ankylosis after THA in AS[6].

Our aim was to assess the functional and clinical outcome in AS with stiff hips after THA with the modified lateral approach. ROM, functional outcome using the Modified Harris Hip Score (MHHS), SF-36 and SF 12 scores were calculated for assessment.

A retrospective analysis of clinically stiff hips with AS who underwent THA in our unit between 2012 to 2018 were included. The criteria for inclusion were individuals over 18 years of age diagnosed as AS with decreased ROM who had THA in our unit and had come for follow up more than 6 months after the procedure. Based on these criteria, 168 patients fulfilled the criteria for this study. 69 hips in 40 patients who could be assessed clinically during the study period were included in this study. 62 patients with AS were reviewed and 22 patients had to be excluded due to insufficient data. The remaining could not be available for a clinical evaluation during the study period. Data for the 40 patients were collected at clinical review. Information was also obtained from the medical records. Preoperative details regarding ROM, pain and other data regarding the hip joint involvement were collected and compared with the data obtained at clinical review. Data regarding medical management by the rheumatology department was also collected. Informed consent was obtained from all patients. Institutional Review Board approval was obtained for this study.

SURGICAL TECHNIQUE

All THAs were done by 2 of the senior authors. All 69 hips had varying degrees of stiffness with 32 clinically fused hips. 24 patients with bilateral hip arthritis had simultaneous bilateral THA in the same sitting. Five patients had staged THA for bilateral hip disease. 11 patients had THA for unilateral hip disease. The approach used for all our hips was the modified Hardinge lateral approach[7, 8]. The Malory modification with preservation of the posterior 2/3rd of the abductors is the approach routinely utilised in our unit for THAs without requirement for posterior or posterosuperior augmentation and reconstruction. The Malory modification essentially preserves the posterior 2/3rd of the gluteus medius rather than detaching the entire abductor in the classical Hardinge approach. The anterior 1/3rd was cut at the musculotendinous junction to enable effective repair at the end of the procedure. Templating was done preoperatively for all cases to assess the size of the acetabulum and femur. Lateral positioning for THA was challenging in the fused and stiff hips. Circumferential capsular release was done to enable mobilisation of the proximal femur and provide complete exposure of the acetabulum. The capsule in these stiff hips was opened antero lateral and released from the entire bony acetabular margin after dislocation. The capsular tissue was elevated and the thickened fibrotic tissue interfering with the acetabular preparation was excised. Femoral neck osteotomy was done insitu for 26 fused hips that could not be dislocated after defining the acetabular margins as well as the proximal femur with soft tissue release. Care was taken to support the limb on completion of the osteotomy to prevent additional propagation to the calcar region as well as the acetabular margins. Additional bony resection was done the neck cut to leave enough calcar for stable femoral component implantation. Acetabulum reaming was done only after defining the margins. Sequential reaming onto the resected neck and head was done after ensuring to avoid eccentric reaming and maintaining the anterior and posterior wall thickness. The medial wall was identified by the residual pulvinar and reaming continued gradually to obtain the best fit of the acetabular component.

The acetabulum was cementless in all our cases. Acetabular components in this series were Pinnacle (Depuy,USA)in 34, R3(Smith and Nephew ,USA)in 29, Trident(Stryker, USA )in 2 and Latitud ( Meril, India)in 4 hips. Screw fixation was used in 42 hips to augment fixation. The femur was prepared with the limb adducted and externally rotated to accommodate a cementless component in 61 hips while 8 hips required a cemented fixation for Dorr type C femur. Cementless femur components were Corail (Depuy, USA) in 30, Synergy (Smith and Nephew,USA)in 12, Polarstem(Smith and Nephew,USA)in 13, Latitud(Meril, India ) in 4 and Accolade(Stryker, USA) in 2 hips. The 8 cemented femoral implants were C stem(Depuy, USA) in 2, CPCS (Smith and Nephew,USA) in 4 and CPT (Zimmer, Warsaw,USA) in 2 hips. The head size was dependent on the acetabular component with mean head size 32.92 (28 mm in 9hips, 32 mm in 35hips, 36 mm in 25 hips). No constrained or dual mobility liners were used. Copious lavage with saline to remove all the bone debris was done prior to closure to reduce chances of heterotopic ossification. 2 hips with proximal femur split in the calcar region required wiring for additional stability. The calcar fracture was seen with the last broach size used. Fracture of the greater trochanter was seen at reduction in 1 hip which required stabilisation.

All patients were given parenteral antibiotics for 48 hours and ambulated with weight bearing as tolerated by the next day after surgery. DVT prophylaxis with aspirin was given for 6 weeks. The patients with stiff hips were initially encouraged prolonged sitting as soon as tolerated to ensure spinal posture and muscle balance and then mobilised actively as mobility restriction was significant prior to surgery. The patients were ambulated as soon as tolerated with support which was gradually weaned off after 6 weeks

The preoperative and follow up flexion and total range of motion (ROM)for each hip were compared. The ROM measurement were done with a goniometer. The total ROM for each hip was compared with the total ROM possible at last follow up. The improvement in flexion was compared for each hip. The SF 36 and SF 12 scores were calculated to assess the overall quality of life. Neuromuscular studies or MRI were not used to assess the hip abductors. The Modified Harris Hip score (HHS), ROM, SF 36 and SF 12 scores were used to assess the overall outcome in these patients. The xrays were evaluated for HO (heterotopic ossification) and presence of any radiolucent lines, lysis in the Charnley acetabular zones and the Gruen femur zones with relation to the implants.

The mean with SD based on the distribution of Harris Hip score, SF 12 and SF 36 score was analysed. The distribution of the HHS, SF 12 and SF 36 was tabulated for all patients. SPSS 22.0 was used for statistical analysis. P value < 0.05 was considered as statistical significance

There were 69 hips in 40 patients diagnosed as AS with stiff hips who underwent THA at our unit between January 2012 and December 2018 were included in this study. There were 36 males and 4 females with mean age of 36.6 years (range 24 to 58). 69 hips were studied as 24/40 patients (60%) underwent simultaneous bilateral THA.

RANGE OF MOTION

43 hips were found to have preoperative flexion less than 30 degrees(Figure 1). 45 /69 hips had fixed flexion deformity with 13 hips having a deformity above 30 degrees. 3 hips had preoperative flexion of 90 degrees and 2 hips had preoperative flexion of 100 degrees. 5 hips had External rotation deformity of 30 degrees. The remaining 64 hips had significant restriction of internal and external rotation. All hips had significant restriction of daily activity with arthritis. The mean preoperative total ROM in 69 hips improved from 45.29(SD 47.20) to mean 223.59 (SD 27.41). The mean flexion in 69 hips improved from 29.35 (SD 31.38) to 102.17 degrees (SD 10.48). The mean difference was 72.97 with p Value <0.0001 was found to be statistically significant. The total ROM in 32 clinically fused hips improved from mean 5.47degrees (SD 9.22) to 223.59 degrees (SD 23.33) at last review.

The flexion at review was below 90 degrees in 3 hips. Eleven hips had flexion of 90 degrees at review while the remaining 55 hips had flexion above 100 degrees.

The modified Harris hip score improved from 17.03(SD 6.02) to 90.66 (SD7.23) at review. This improvement was found to be statistically significant (p<0.001). 30/40 patients had a modified HHS >90 at review (Table 1)

PAIN SCORE

Pain scoring was done as part of the HHS assessment. All 40 patients had pain with restriction of movement for a mean 31.08 months(SD 36 ) prior to THA. Pain relief was good in all 69 hips. 28/40 (70%) had no pain while 9 patients (22%) had occasional pain without any compromise in activity. 3 patients (8%) had mild to moderate pain with unusual activity.

QUALITY OF LIFE-SF 36 SCORE AND GENERAL HEALTH

Short Form 36 or also known as SF-36 is to date, the most commonly used health-related quality-of-life measure in research and has been used to assess the health status in AS patients and comparing them with the normal individuals[9–11]. SF-36 focuses on eight domains with physical and mental components with outcome measures which indicates health related quality of life (HR QOL)[12]. The responses are assessed in all domains and the score is generated with higher scores indicating better health. This assessment has been used in the evaluation of patients after THA and TKA[12, 13]

The SF-36 measures eight scales: Physical Functioning (PF), Role limitations due to Physical health (RP), Bodily Pain (BP), General health (GH), Vitality (VT), Social functioning (SF), Role limitations due to emotional problems (RE), and Mental Health (MH). This assessment tool used extensively is a reliable detailed measure of overall physical and mental health The SF 36 questionnaire scores calculated at review in 40 patients indicated general health as excellent or very good in 31 out of 40 patients (Table 3). The mental health score of 84.10 (SD 11.58) along with all other sub scores favoured the assessment as a good overall outcome (Table 2)

SF 12

This Short Form Survey instrument used in outcome assessment is quicker with fewer details with 2 components. The mean Physical score PCS 12 in 40 patients was 45.22 (SD 8.94) and the mean Mental score MCS 12 measured 57.63(SD 5.18).

RADIOLOGY

Preoperative assessment included spine as well as hip anteroposterior and lateral views. The AP view was done in all hips for immediate postoperative assessment. All 69 hips at review showed implants with stable acetabular and femoral component. No radiolucent lines, lysis or implant loosening was seen in all the Charnley and Gruen zones. Heterotopic ossification (HO) was seen in 21 hips with Brooker class 1 in 14 hips, class 2 in 5 hips, and class 3 in 2 hips. (Figure 2,3,4,5)

COMPLICATIONS

There were no dislocations, or early infections in our series. One bilateral THA presented 73 months post op with symptoms suggestive of low grade infection. He had been on irregular medical treatment and was also diagnosed with chronic venous insufficiency secondary to perforator incompetence in his lower limbs. He underwent staged revision for his coagulase-negative Staphylococcus infection. There were no other early or delayed complications till last review.

Total hip arthroplasty is effective in relieving pain and improving function in ankylosing spondylitis. Five percent of AS patients have been reported to need hip replacement surgery and the overall rate of joint replacement surgery in AS has increased by 40%[14] .Previous studies have shown and established that this disease has a higher male to female ratio of about 2:1 to 3:1 and it was evident in our study also as 90% of our patients were males.

The most known indication of THA is stiffness and pain. Patients with stiff hips or bony ankylosis have significant, functional disabilities. THA brings about dramatic changes in function and quality of life in these young patients. The increased hip ROM and subsequent functional improvement in these individuals support THA in this condition.

Malory modification of the Harding approach is used routinely for THA in our unit. Lateral approach with trochanteric osteotomy has been described[3].There is lack of data regarding functional outcome following THA in AS with fused hips with this approach. There has been some concern regarding the approach in fused hips with AS with concern regarding the risk of damage to the weakened abductor and hence the posterior approach has been advocated[4]. The modified lateral approach preserves the posterior 2/3 rd of the abductor and is useful especially in the stiff hips with the flexion deformity as the anterior capsular release is facilitated by the approach itself. Flexion deformity in the 45 hips were successfully corrected with the extensive soft tissue release with the lateral approach. The insitu neck resection in 26 fused hips was done with particular attention to prevent damage to the posterior acetabular wall during osteotomy[4]. Femoral neck osteotomy could be challenging with the posterior approach especially in fused hips external rotation deformity. The choice of implant for the acetabulum was based on the bone quality at the time of preparation. Gradual sequential reaming with information obtained from preoperative templating aided in cementless fixation with optimum fit and bone stock utilisation in all 69 hips with additional screws when necessary.

Cemented femur was used in 8 Dorr C femurs and cementless components achieved stable fixation in the remaining 61 hips. Increased risk of of intra operative femur fracture would be high if uncemented fixation is attempted with larger sizes to achieve stable fixation in the larger canal with thin cortices.

The proximal femur required wiring in 2 hips for medial femur calcar split seen at preparation. Cementless implants in AS have found favour with long term survivorship in recent series[4] as opposed to cemented fixation which was advocated earlier[5].

The average follow up of patients in our series was 38.33 months with no evidence of clinical or radiological signs of implant loosening at last review. There were 21 hips with HO seen at review with no functional limitations. Our protocol was to use copious lavage before closure to remove bone debris and active mobilisation. The patients were re started on their DMARDS post operatively.

The mean flexion in 69 hips changed from 29.35 (SD 31.38) to 102.17 degrees (SD 10.48) indicating a mean improvement of 72.82. The ROM in 43 hips had flexion less than 30 degrees with 23 fused hips also recorded significant improvement in their flexion at follow up which was comparable to patients who had preoperative ROM more than 90 degrees. This significant improvement in ROM in the 69 hips resulted in considerable improvement on the hip function at follow up.

Modified HHS improved from 17.03(SD 6.02) to 90.66 (SD7.23) which was statistically significant (p < 0.001) as 30/40 patients had a modified HHS > 90 at review. This improvement in HHS is due to the significant increase in the activity levels achieved in these stiff hips.

92% of our patients in this series in this study have no pain or ignorable pain that did not compromise any activity. 8% had moderate pain with unusual activity rarely that required occasional analgesics for pain relief.

31 out of 40 patients showed excellent or good scores in SF-36 and SF 12 physical and mental components analysis. This was comparable with other quality of life analysis done in spondyloarthropathy[15]. The improvement in ROM with the HHS and SF 36 indicates and overall improvement in the hip joint function as well as quality of life. Data regarding functional outcome and health related QOL after THA in AS has been limited[4, 15].

The functional scores along with quality of life assessment has been reported in patients with AS[10]. The mental component did not show a significant change and mean physical component score was significantly lower in the study group[10, 16]. The SF 36 scores in this series did not have a preoperative value for comparison.

Reports suggest that quality of life in AS patients have significantly impaired quality of life with most of the domains affected in the SF 36 assessment.

SF 36 in our series done at the time of follow up and this indicated a significant improvement in the quality of life after total hip arthroplasty in this group of patients with AS. The general quality of life was seen in all the domains assessed indicating an overall although researching the short-and mid-term effects of THA in AS patients is acceptable; the number of cases may have been too small (69 THAs), good score in the physical and emotional quotient[17](Table 3)

The SF 36 scores which evaluates 8 domains used as a functional outcome measure has added value when used with the modified HHS and the ROM improvement in these stiff hips. SF 12 has a physical and mental component assessment and has lesser detail when compared to the SF 36. The SF 36 used to assess functional outcome in THA and TKA was found to have significant improvement following THA[12]. Our series took into consideration the improvement in ROM along with the modified HHS. The modified HHS allows for evaluation of the hip joints studied as the HHS allows for evaluation of the whole patient. The evaluation of the individual joint deformity, ROM especially in the bilateral THAs is possible with the modified HHS. These scores along with the SF 36 showed a significant overall improvement in these patients with stiff hips in AS.(Table 4)

The limitations in this study include relatively short duration of follow up and small number of patients that could be included in this series. The retrospective nature of this study is one of the main limitations. Five year follow up with radiological and clinical outcomes would have been ideal to study the various outcomes while our study’s average follow up was 38.33 months (range 6–83 months). We will continue to follow up on these patients to study the clinical, radiological and overall outcome. The risk of complications in THA with AS is associated with stiffness of the spine. The possibility of fractures, component loosening are few complications that could be seen on longer follow up[18].

THA with modified lateral approach in ankylosing Spondylitis with stiff hips have significant improvement in the range of movement, HHS, overall function and quality of life as indicated by functional outcome measures with SF12 and SF 36 scores.

THA Total Hip arthroplasty, AS Ankylosing Spondylitis, HHS Harris Hip Score

Ethics approval and Consent to participate: Office of Research Institutional Review Board, Christian Medical College, Vellore, India. IRB approval No 11164 dated 06.02.2018

Consent for publication: Informed consent obtained from all patients

Availability of data and materials: All data has been provided. Please contact author for additional data if required

Competing interests /Conflict of interest: The authors have no relevant financial or non-financial interests to disclose. The authors have no conflicts of interest to declare that are relevant to the content of this article.

Funding, Source of support: The study was partly funded by an institutional fluid research grant- no external grant. No external funding.

Authors' contributions:

ATO carried out study design and writing of the manuscript. MKJ, VJC confirmed the completeness and validity of the data. MKJ, VJC, HH, AS participated in data collection and analysis. ATO, PMP conceived of the study and participated in its study design and revision of the manuscript. The authors read and approved the final manuscript.

Authors' information:

Department of Orthopaedics , Unit 2, Christian Medical College Hospital, Vellore , South India 632004

Acknowledgements: We would like to acknowledge Dr. Jayaseelan, Ms. Ambily and Mr. Madhan from the department of Biostatistics for their expert advice and contribution during the entire process.

Burki V, Gossec L, Payet J, Durnez A, Elhai M, Fabreguet I, et al. Prevalence and characteristics of hip involvement in spondyloarthritis: a single-centre observational study of 275 patients. Clin Exp Rheumatol. 2012;30:481–6.
Tang WM, Chiu KY. Primary total hip arthroplasty in patients with ankylosing spondylitis. J Arthroplasty. 2000;15:52–8.
Hamadouche M, Kerboull L, Meunier A, Courpied JP, Kerboull M. Total hip arthroplasty for the treatment of ankylosed hips : a five to twenty-one-year follow-up study. J Bone Joint Surg Am. 2001;83:992–8.
Lin D, Charalambous A, Hanna SA. Bilateral total hip arthroplasty in ankylosing spondylitis: a systematic review. EFORT Open Rev. 2019;4:476–81.
Kubiak EN, Moskovich R, Errico TJ, Di Cesare PE. Orthopaedic management of ankylosing spondylitis. J Am Acad Orthop Surg. 2005;13:267–78.
Bhan S, Eachempati KK, Malhotra R. Primary cementless total hip arthroplasty for bony ankylosis in patients with ankylosing spondylitis. J Arthroplasty. 2008;23:859–66.
Frndak PA, Mallory TH, Lombardi AV. Translateral surgical approach to the hip. The abductor muscle “split.” Clin Orthop Relat Res. 1993;:135–41.
Mulliken BD, Rorabeck CH, Bourne RB, Nayak N. A modified direct lateral approach in total hip arthroplasty: a comprehensive review. J Arthroplasty. 1998;13:737–47.
Dagfinrud H, Mengshoel AM, Hagen KB, Loge JH, Kvien TK. Health status of patients with ankylosing spondylitis: a comparison with the general population. Ann Rheum Dis. 2004;63:1605–10.
Bahardoust M, Hajializade M, Amiri R, Mousazadeh F, Pisoudeh K. Evaluation of health-related quality of life after total hip arthroplasty: a case-control study in the Iranian population. BMC Musculoskelet Disord. 2019;20:46.
Yang X, Fan D, Xia Q, Wang M, Zhang X, Li X, et al. The health-related quality of life of ankylosing spondylitis patients assessed by SF-36: a systematic review and meta-analysis. Qual Life Res. 2016;25:2711–23.
Lindner M, Nosseir O, Keller-Pliessnig A, Teigelack P, Teufel M, Tagay S. Psychosocial predictors for outcome after total joint arthroplasty: a prospective comparison of hip and knee arthroplasty. BMC Musculoskelet Disord. 2018;19:159.
Mariconda M, Galasso O, Costa GG, Recano P, Cerbasi S. Quality of life and functionality after total hip arthroplasty: a long-term follow-up study. BMC Musculoskelet Disord. 2011;12:222.
Vander Cruyssen B, Muñoz-Gomariz E, Font P, Mulero J, de Vlam K, Boonen A, et al. Hip involvement in ankylosing spondylitis: epidemiology and risk factors associated with hip replacement surgery. Rheumatology (Oxford). 2010;49:73–81.
Rohde G, Berg KH, Pripp AH, Prøven A, Haugeberg G. No deterioration in health-related quality of life in patients with axial spondyloarthritis followed for 5 years in ordinary outpatient clinics in the biological treatment era. Qual Life Res. 2020;29:99–107.
Rojanasopondist P, Galea VP, Connelly JW, Matuszak SJ, Rolfson O, Bragdon CR, et al. What Preoperative Factors are Associated With Not Achieving a Minimum Clinically Important Difference After THA? Findings from an International Multicenter Study. Clin Orthop Relat Res. 2019;477:1301–12.
Neuprez A, Neuprez AH, Kaux J-F, Kurth W, Daniel C, Thirion T, et al. Total joint replacement improves pain, functional quality of life, and health utilities in patients with late-stage knee and hip osteoarthritis for up to 5 years. Clin Rheumatol. 2020;39:861–71.
Blizzard DJ, Penrose CT, Sheets CZ, Seyler TM, Bolognesi MP, Brown CR. Ankylosing Spondylitis Increases Perioperative and Postoperative Complications After Total Hip Arthroplasty. J Arthroplasty. 2017;32:2474–9.

TABLE 1 COMPARSION OF PREOP AND REVIEW FLEXION, ROM AND HHS

Movement	pre op	review	Mean diff (95 % CI)	P value
flexion	29.35	102.17	65.76 ±71.37	< 0.0001
ROM TOTAL	45.29	220.65	132.97 ±171.855	< 0.0001
ROM SCORE	1.71	4.95	3.33 ±3.178	< 0.0001
MHHS	17.03	90.66	53.84 ±72.164	< 0.0001

Table 2 Distribution of general health status and SF 36 - 40 patients

General Health Status	Poor	1	2.5
	Fair	3	7.5
	Good	5	12.5
	Very Good	20	50.0
	Excellent	11	27.5

SF-36 Scores

SF-36 Scores
Mental Health (MH)	(n=40)	84.10 ±11.58
Role limitations due to emotional problems (RE)	(n=40)	94.17 ± 19.81
Social functioning (SF)	(n=40)	86.25 ± 16.70
Energy fatigue/Vitality (VT)	(n=40)	71.87 ± 16.63
General Health (GH)	(n=40)	63.12 ± 24.22
Bodily Pain (BP)	(n=40)	80.00 ± 19.23
Physical Functioning (PF)	(n=40)	69.63 ± 18.58
Role limitations due to Physical Health (RP)	(n=40)	85.00 ± 33.87

TABLE 3 SF 36 SCORES COMPARED TO OTHER SERIES

SF-36 Scores	Our Series	Bahardoust et al 2012	Dagfinrud et al 2004	van Tubergen et al 2002
Mental Health (MH)	84.10 (11.58)	39.9(28.2)	70 (19)	65.5 (18.1)
Role limitations due to emotional problems (RE)	94.17 (19.81)	79.1 (19.2)	66 (42)	68.5 (41.3)
Social functioning (SF)	86.25 (16.70)	28.5 (29.2)	70 (27)	64.6 (24.6)
Energy fatigue/Vitality (VT)	71.87 (16.63)	56.2 (21.4)	43 (23)	42.6 (16.5)
General Health (GH)	63.12 (24.22)	42.1 (26.3)	51 (24)	42.8 (20.2)
Bodily Pain (BP)	80.00 (19.23)	48.2 (28.4)	44 (22)	48.3 (19.2)
Physical Functioning (PF)	69.63 (18.58)	28.3 (11.1)	71 (23)	55.8 (23.4)
Role limitations due to Physical Health (RP)	85.00 (33.87)	31.2 (12.6)	44 (41)	35.6 (38.1)

TABLE 4 Comparison of parameters with other series

Study (Year)	Patients (Hips)	Follow up in Months	Pain Relief%	Final MHHS	ROM Score/ Mean Flexion	Approach	Complications ( %)
Bisla (1976)	23 (34)	42.5	91	NS	ROM-3	NS	5.88
Resnick (1976)	11 (21)	36	NS	NS	NS	NS	0
Williams ((1977)	56 (99)	36	NS	NS	NS	NS	10
Baldurson (1977)	10 (18)	45.6	94	NS	Flexion-90	NS	0
Shanahan (1982)	12 (16)	89	94	NS	NS	NS	6.25
Finsterbush (1988)	23 (35)	90	NS	NS	Flexion-86	NS	14.28
Walker (1991)	19 (29)	58	97	NS	ROM-4	NS	0
Gualtieri (1992)	39 (73)	90	89	NS	NS	NS	0
Brinker (1996)	12 (20)	75	90	89.1	ROM-4	Posterior, Lateral	0
Sochart (1997)	24 (43)	276	100	NS	ROM-4	NS	27.9
Lehtimaki (2001)	54 (76)	240	NS	NS	NS	NS	3.94
Joshi (2002)	103 (181)	120	96	NS	NS	Lateral, Hardinge	10.5
Kim (2007)	12 (24)	132	NS	82.3	NS	Lateral	12.5
Bhan (2008)	54 (92)	102	62	82.6	ROM-4	Posterior	14
Li (2009)	24 (39)	36	NS	91	ROM-4	Posterolateral	2.5
Tang (2000)	58 (95)	135.4	94	88.8	ROM-4.2	Posterior	20
Bangjian (2012)	12 (24)	50.4	100	86.25	Flexion-84	Posterolateral	0
Malhotra (2012)	23 (32)	42	NS	87.1	ROM-4	Posterior	4.7
Siavashi (2014)	77 (NA)	12	NS	88.22	ROM-5	Posterior, Lateral	20.8
Xu ( 2017)	54 (81)	42	NS	86.1	Flexion-82.5	Posterolateral	0
Our Series	40 (69)	38.33	92	90.67	Flexion- 102.1739, ROM-4.9514	Modified Hardinge	1.4

Download PDF

Version 1

posted

You are reading this latest preprint version

Functional and Clinical Outcome With Modified Lateral Approach Total Hip Arthroplasty in Stiff Hips With Ankylosing Spondylitis

Status:

Version 1

Abstract

Figures

Background

Methods

SURGICAL TECHNIQUE

Results

Discussion

Conclusion

Abbreviations

Declarations

References

Tables

Status:

Version 1