Total Hip Arthroplasty On Patients With Ankylosing Spondylitis

By analysising the effect of the total hip arthroplasty on patients withankylosing spondylitis and explaining something important should be taken care of inthe period of the operation. In order to instruct the clinical therapy of the ankylosingspondylitis. Methods: From 1985.1 to 2001.3, 22 total hip replacements were done in 15patients with ankylosing spondylitis. All diagnoses of these patients coincidence theNew York criterion revised in 1984. There are 14 male, 1 female, from 21 to 53 yearsold, averaged 35.3, the course is 3 to 20 years, averaged 10.4 years. 9 hips werecompletely ankylosed. Among them one patient had a 30°flexion contracture on theleft hip, and the arc of flexion-extension is from 30°to 60°. 6 hips had more than 30° flexion contracture deformity. 10 hips had severe pain, NSAIDs were needed torelieve the pain in the all year. We preview the data of these patients, evaluate theeffects of the total hip replacement and analysis the announcements which should bepaid attention to before, in and after the operation, conferred to the internal andexternal literature. Results:The improvement of total range of motion is from preoperative mean 20° to postoperative mean 150°. The deformity were corrected well. There are noflexion deformity postoperatively. Pain relief is obvious. Preoperatively, 10 hips hadsevere pain, NSAIDs were needed to relieve the pain in the all year. Postoperatively, 4hips had moderate pain only after long-time standing or walking, and resting will ·64·吉林大学硕士学位论文relieve the pain. 1 hip had pain at rest but no drug is needed. Only when being tired,NSAIDs were needed to relieve the pain. The mean improvement of Harris hip scoreis 43.5 points. The arc of flexion-extension decreased 20° in 1 hip at the most recentfollow-up. 1 hip concurred late deep infection five years after the operation and theprothesis had to be removed. 1 patient with severe osteoporosis concurred femurfracture at the distal end of the prothesis because of light trauma. 1 hip were definitelyloose according to the radiographic and clinical evaluation, but the patient couldn'thave the revision operation because of the economical reason and continue walkingfor one year then disconnected with us. 2 hips were loose according to theradiographic evaluation but they had no clinical symptoms and couldn't be diagnosedclinical loosening. Conclusion: Total hip replacement is effective for the patients with ankylosingspondylitis. But because the characteristic of ankylosing spondylitis oneself isdifferent from that of osteoarthritis, and other diseases which need to have total hipreplacement, both operation and treatment during perioperation have their owncharacteristic and corresponding complications. We should perform effectivemeasures to prevent the complications. Preoperatively, respiratory and cardiovascular system must be evaluated correctly.ESR and symptom of active phase must be checked, only when neither of them ispresent, the operation can be performed. Otherwise, systemic internal medicinetherapy must be accepted first. Antibiotics were injected before both 30 minutes and one day to prevent ·65·吉林大学硕士学位论文infection. If the operation needs a long time, another dosage should be offeredaccording to the half life of drug. Adrenal cortical hormane were offered from threedays before to three days after operation according to the dosage used before and thetime on which the hormane were used. If the blood pressure descent obviouslywithout much blood loss, adrenal insufficiency should be thinked over and hormanedosage should be added. The patients had a Poker spine, and their supraspinal ligments and interspinalligments are calcified, puncture is difficult if undergoing epidural anesthesia, sosomeone think general anesthesia should be performed. But in regard to pat...