2021 Otto Aufranc Award: A simple Hip-Spine Classification for total hip arthroplasty : validation and a large multicentre series.

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Abstract

[Indexed for MEDLINE] 14. J Arthroplasty. 2021 Jul;36(7S):S282-S289. doi: 10.1016/j.arth.2021.01.054. Epub 2021 Jan 23. Primary Total Hip Arthroplasty in Patients With Ankylosing Spondylitis. Bukowski BR(1), Clark NJ(1), Taunton MJ(1), Freedman BA(1), Berry DJ(1), Abdel MP(1). Author information: (1)Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN. BACKGROUND: Ankylosing spondylitis (AS) is a common inflammatory spondyloarthropathy with hip involvement in 40% of patients. With the renewed interest in the hip-spine interplay, this study aimed to define long-term outcomes of primary total hip arthroplasty (THA) in the setting of AS. METHODS: We identified 309 hips (219 patients) with AS treated with primary THA from 1969 to 2018. Mean age was 49 years, 80% were males, and mean body mass index was 28 kg/m2. Cumulative incidences of any revision, reoperation, and dislocation were calculated utilizing a competing risk analysis. Harris Hip Scores and complications were also reported. Mean follow-up was 16 years. RESULTS: The cumulative incidence of any revision after primary THA was 2.3% at 5 years and 17.5% at 20 years. The most common reasons for revision (n = 73) were aseptic loosening (41%), osteolysis/polyethylene (PE) wear (30%, all with conventional PE), and femoral component fracture (8%). The cumulative incidence of dislocation was 1.9% at 5 years and 2.9% at 20 years. Younger age was associated with increased risk of revision (hazard ratio (HR) = 1.3, P < .01) and reoperation (HR = 1.2, P < .01), but not dislocation (HR = 0.7, P = .1). Twenty-eight hips (9%) experienced a postoperative complication not requiring reoperation. The mean Harris Hip Score improved from 51 to 76 after THA (P < .001). CONCLUSION: In this series of 309 primary THAs in patients with AS, the 20-year cumulative incidence of any revision after primary THA was 17.5%. Aseptic loosening, osteolysis/PE wear, and femoral component fracture were the most common reasons for revision. Notably, the cumulative incidence of dislocation at 20 years was only 2.9%. LEVEL OF EVIDENCE: Level IV. Copyright © 2021 Elsevier Inc. All rights reserved. DOI: 10.1016/j.arth.2021.01.054