November 21, 2007
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Bilateral THA improves pain, function in patients with bilateral hip ankylosis

At final follow-up, the average Harris Hip Score had improved to 82.3 points from 55.4 points preoperatively, and 10 patients could walk unsupported.

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Performing bilateral total hip arthroplasty can improve pain and function in patients with bilateral hip ankylosis, a retrospective study shows.

Young Lae Kim, MD, and colleagues in Seoul, South Korea, reviewed outcomes for 12 patients at an average age of 36 years with bilateral hip ankylosis that were converted to total hip arthroplasty (THA). They published their results in the Journal of Arthroplasty.

Investigators defined hip ankylosis as a total loss of hip motion on physical exam.

Of the 12 patients — all men — six had bilateral bony ankylosis, two had bilateral fibrous ankylosis and four had bony ankylosis and fibrous ankylosis one on side each. The ankylosis had persisted for an average of 11 years before patients were converted to THA, according to the study.

"The indication for surgery was progressive disabling pain in the low back or knee, loss of function caused by immobility or malposition of both hips, severe limping and walking disability. All patients had two or three of these problems," the authors noted.

One patient underwent same-day bilateral THA. The surgeon performed sequential procedures in the other 11 patients, with an average interval of 19 days between operations.

The surgeon implanted a cementless acetabular cup in all cases, a cemented stem in nine hips and a cementless stem in 15 hips. No patient received NSAIDs postoperatively to prevent heterotopic ossification, according to the study.

"Patients were usually allowed to walk with support after 5 days, and full weightbearing was permitted after 10 weeks," the authors noted.

At 11-years mean follow-up, the average Harris Hip Score had improved to 82.3 points from 55.4 points preoperatively, and 10 patients could walk without using support, they reported.

Low back pain was eliminated in three of seven patients who had the pain preoperatively, "and the other four had residual low back pain that was more tolerable than preoperative pain," the authors reported.

In addition, six of eight patients with preoperative knee pain showed improvements. One patient with persistent knee pain received a total knee arthroplasty (TKA), and the other is awaiting TKA.

"All patients were subjectively satisfied with bilateral conversion of their arthrodesis to THA," the authors stated.

"Overall cup malposition, whether in anteversion or inclination, was observed in 11 (46%) of the 24 hips. Of 10 hips with ankylosing spondylitis, five had a malpositioned cup, and of 14 hips with non-ankylosing spondylitis, six had a malpositioned cup," they wrote. "No difference was observed between these two groups in cup malposition frequency."

At final follow-up, there were no loose stems and no patients experienced either postoperative dislocation or trochanteric nonunion, according to the study.

"[The] overall clinical result was considered good, as reflected by a final average Harris Hip Score of 82.3 points," the authors wrote.

"Final ranges of motion were less satisfactory than those achieved by THA overall, and most patients had limping because of abductor weakness, but patient subjective satisfactions were excellent," they reported.

For more information:

  • Kim YL, Shin SI, Nam KW, et al. Total hip arthroplasty for bilateral ankylosed hips. J Arthroplasty. 2007;22:1037-1041.