Midterm follow-up outcomes of total hip arthroplasty in treatment for patients with juvenile-onset ankylosing spondylitis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Liang ¹ , MAN Siliang ² , LI Hongchao ² , BIAN Tao ¹ , GUO Shaoyi ¹ ,  ZHOU Yixin ¹

1. Department of Orthopedics, Beijing Jishuitan Hospital (Fourth Clinical College of Peking University), Beijing, 100035, P. R. China;
2. Department of Rheumatology, Beijing Jishuitan Hospital (Fourth Clinical College of Peking University), Beijing, 100035, P. R. China;

Corresponding author：

ZHOU Yixin, Email: orthoyixin@yahoo.com

Keywords：

Ankylosing spondylitis; juvenile-onset; adult onset; total hip arthroplasty

DOI：

10.7507/1002-1892.202111062

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Objective To assess the midterm follow-up outcomes of total hip arthroplasty (THA) for the treatment of patients with juvenile-onset ankylosing spondylitis (JAS). Methods The clinical data of 81 patients (127 hips) with JAS (age≤16 years, JAS group) and 267 patients (391 hips) with adult onset ankylosing spondylitis (AAS) (age>16 years, AAS group) between January 2004 and March 2018 were retrospectively analysed. The baseline demographics, clinical, radiographic, and laboratory parameters were collected. Before operation and at last follow-up, the overall disease activity [Bath ankylosing spondylitis disease activity index (BASDAI)] and function status [Bath ankylosing spondylitis functional index (BASFI)], hip subjective score [Harris hip score (HHS)] and objective score [12-item short form health survey (SF-12), including physical component score (PCS) and mental component score (MCS)], and patient satisfaction for THA were reviewed. The major orthopedic complications, including periprosthetic infection, dislocation, periprosthetic fractures, and poor incision healing, were also recorded during the follow-up period. Results The comparison of preoperative baseline parameters showed that the body mass, body mass index, age of onset, age of surgery, disease duration, and the proportion of combined smoking history in the JAS group were significantly lower than those in the AAS group (P<0.05), the proportion of bilateral surgeries, proportion of uveitis, proportion of combined family history, C-reactive protein, albumin, and preoperative BASFI were significantly higher than those in the AAS group (P<0.05). Both groups were followed up. The follow-up time in the JAS group was 29-199 months, with an average of 113 months; in the AAS group was 35-199 months, with an average of 98 months. Incisions in both groups healed by first intention. During the follow-up period, there were 1 case of periprosthetic fracture, 1 case of dislocation, and 1 case of ceramic fragmentation in the JAS group, 1 case of periprosthetic infection and 6 cases of periprosthetic fracture in the AAS group. There was no significant difference in the incidence of complications between the two groups (P>0.05). At last follow-up, the BASDAI, BASFI, SF-12 MCS, SF-12 PCS, and HHS score of the two groups were significantly improved when compared with those before operation (P<0.05); but there was no significan difference in the difference of the above parameters before and after operation and the patient satisfaction between the two groups (P>0.05). Conclusion The midterm follow-up outcomes of THA for the treatment of JAS patients were reliable. A low age at disease onset did not exert a significant negative effect on THA reconstruction for the treatment of ankylosing spondylitis.

Citation： ZHANG Liang, MAN Siliang, LI Hongchao, BIAN Tao, GUO Shaoyi, ZHOU Yixin. Midterm follow-up outcomes of total hip arthroplasty in treatment for patients with juvenile-onset ankylosing spondylitis. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(5): 548-554. doi: 10.7507/1002-1892.202111062 Copy

1.	Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet, 2017, 390(10089): 73-84.
2.	中华医学会风湿病学分会. 强直性脊柱炎诊断及治疗指南. 中华风湿病学杂志, 2010, 14(8): 557-559.
3.	Colbert RA. Classification of juvenile spondyloarthritis: Enthesitis-related arthritis and beyond. Nat Rev Rheumatol, 2010, 6(8): 477-485.
4.	Chen HA, Chen CH, Liao HT, et al. Clinical, functional, and radiographic differences among juvenile-onset, adult-onset, and late-onset ankylosing spondylitis. J Rheumatol, 2012, 39(5): 1013-1018.
5.	Jadon DR, Shaddick G, Jobling A, et al. Clinical outcomes and progression to orthopedic surgery in juvenile- versus adult-onset ankylosing spondylitis. Arthritis Care Res (Hoboken), 2015, 67(5): 651-657.
6.	Jadon DR, Ramanan AV, Sengupta R. Juvenile versus adult-onset ankylosing spondylitis-clinical, radiographic, and social outcomes. a systematic review. J Rheumatol, 2013, 40(11): 1797-1805.
7.	魏士雄, 黎苏佳, 刘毅. 幼年特发性关节炎成人后的临床特点及生物制剂治疗. 北京大学学报 (医学版), 2020, 52(6): 1014-1022.
8.	Li HG, Wang DM, Shen FC, et al. Risk factors for progression of juvenile-onset non-radiographic axial spondyloarthritis to juvenile-onset ankylosing spondylitis: a nested case-control study. RMD Open, 2021, 7(3): e001867. doi: 10.1136/rmdopen-2021-001867.
9.	Schnaser EA, Browne JA, Padgett DE, et al. Perioperative complications in patients with inflammatory arthropathy undergoing total hip arthroplasty. J Arthroplasty, 2016, 31(10): 2286-2290.
10.	Swarup I, Lee YY, Christoph EI, et al. Implant survival and patient-reported outcomes after total hip arthroplasty in young patients with juvenile idiopathic arthritis. J Arthroplasty, 2015, 30(3): 398-402.
11.	Daurka JS, Malik AK, Robin DA, et al. The results of uncemented total hip replacement in children with juvenile idiopathic arthritis at ten years. J Bone Joint Surg (Br), 2012, 94(12): 1618-1624.
12.	Jolles BM, Bogoch ER. Juvenile arthritis patients report favorable subjective outcomes of hip arthroplasty despite poor standard outcome scores. J Arthroplasty, 2012, 27(9): 1622-1628.
13.	Cruz-Pardos A, García-Rey E, García-Cimbrelo E, et al. Alumina-on-alumina THA in patients with juvenile idiopathic arthritis: a 5-year followup study. Clin Orthop Relat Res, 2012, 470(5): 1421-1430.
14.	Malviya A, Walker LC, Avery P, et al. The long-term outcome of hip replacement in adults with juvenile idiopathic arthritis: the influence of steroids and methotrexate. J Bone Joint Surg (Br), 2011, 93(4): 443-448.
15.	张亮, 徐辉, 郭晓忠, 等. 人工全髋关节置换术治疗强直性脊柱炎的中期疗效. 中国修复重建外科杂志, 2014, 28(1): 1-6.
16.	van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum, 1984, 27(4): 361-368.
17.	Garrett S, Jenkinson T, Kennedy LG, et al. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol, 1994, 21(12): 2286-2291.
18.	Calin A, Garrette S, Whitelock H, et al. A new approach to defining functional ability in ankylosing spondylitis: the Bath Ankylosing Spondylitis Functional Index. J Rheumatol, 1994, 21(12): 2281-2285.
19.	Sotelo-Garza A, Charnley J. The results of Charnley arthroplasty of hip performed for protrusio acetabuli. Clin Orthop Relat Res, 1978, (132): 12-18.
20.	吕明, 张金庆, 王兴山, 等. 直接前入路髋关节置换术及其早期临床疗效. 北京大学学报 (医学版), 2017, 49(2): 206-213.
21.	Balevic SJ, Becker ML, Gonzalez D, et al. Low etanercept concentrations in children with obesity and juvenile idiopathic arthritis. J Pediatr Pharmacol Ther, 2021, 26(8): 809-814.

1. Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet, 2017, 390(10089): 73-84.
2. 中华医学会风湿病学分会. 强直性脊柱炎诊断及治疗指南. 中华风湿病学杂志, 2010, 14(8): 557-559.
3. Colbert RA. Classification of juvenile spondyloarthritis: Enthesitis-related arthritis and beyond. Nat Rev Rheumatol, 2010, 6(8): 477-485.
4. Chen HA, Chen CH, Liao HT, et al. Clinical, functional, and radiographic differences among juvenile-onset, adult-onset, and late-onset ankylosing spondylitis. J Rheumatol, 2012, 39(5): 1013-1018.
5. Jadon DR, Shaddick G, Jobling A, et al. Clinical outcomes and progression to orthopedic surgery in juvenile- versus adult-onset ankylosing spondylitis. Arthritis Care Res (Hoboken), 2015, 67(5): 651-657.
6. Jadon DR, Ramanan AV, Sengupta R. Juvenile versus adult-onset ankylosing spondylitis-clinical, radiographic, and social outcomes. a systematic review. J Rheumatol, 2013, 40(11): 1797-1805.
7. 魏士雄, 黎苏佳, 刘毅. 幼年特发性关节炎成人后的临床特点及生物制剂治疗. 北京大学学报 (医学版), 2020, 52(6): 1014-1022.
8. Li HG, Wang DM, Shen FC, et al. Risk factors for progression of juvenile-onset non-radiographic axial spondyloarthritis to juvenile-onset ankylosing spondylitis: a nested case-control study. RMD Open, 2021, 7(3): e001867. doi: 10.1136/rmdopen-2021-001867.
9. Schnaser EA, Browne JA, Padgett DE, et al. Perioperative complications in patients with inflammatory arthropathy undergoing total hip arthroplasty. J Arthroplasty, 2016, 31(10): 2286-2290.
10. Swarup I, Lee YY, Christoph EI, et al. Implant survival and patient-reported outcomes after total hip arthroplasty in young patients with juvenile idiopathic arthritis. J Arthroplasty, 2015, 30(3): 398-402.
11. Daurka JS, Malik AK, Robin DA, et al. The results of uncemented total hip replacement in children with juvenile idiopathic arthritis at ten years. J Bone Joint Surg (Br), 2012, 94(12): 1618-1624.
12. Jolles BM, Bogoch ER. Juvenile arthritis patients report favorable subjective outcomes of hip arthroplasty despite poor standard outcome scores. J Arthroplasty, 2012, 27(9): 1622-1628.
13. Cruz-Pardos A, García-Rey E, García-Cimbrelo E, et al. Alumina-on-alumina THA in patients with juvenile idiopathic arthritis: a 5-year followup study. Clin Orthop Relat Res, 2012, 470(5): 1421-1430.
14. Malviya A, Walker LC, Avery P, et al. The long-term outcome of hip replacement in adults with juvenile idiopathic arthritis: the influence of steroids and methotrexate. J Bone Joint Surg (Br), 2011, 93(4): 443-448.
15. 张亮, 徐辉, 郭晓忠, 等. 人工全髋关节置换术治疗强直性脊柱炎的中期疗效. 中国修复重建外科杂志, 2014, 28(1): 1-6.
16. van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum, 1984, 27(4): 361-368.
17. Garrett S, Jenkinson T, Kennedy LG, et al. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol, 1994, 21(12): 2286-2291.
18. Calin A, Garrette S, Whitelock H, et al. A new approach to defining functional ability in ankylosing spondylitis: the Bath Ankylosing Spondylitis Functional Index. J Rheumatol, 1994, 21(12): 2281-2285.
19. Sotelo-Garza A, Charnley J. The results of Charnley arthroplasty of hip performed for protrusio acetabuli. Clin Orthop Relat Res, 1978, (132): 12-18.
20. 吕明, 张金庆, 王兴山, 等. 直接前入路髋关节置换术及其早期临床疗效. 北京大学学报 (医学版), 2017, 49(2): 206-213.
21. Balevic SJ, Becker ML, Gonzalez D, et al. Low etanercept concentrations in children with obesity and juvenile idiopathic arthritis. J Pediatr Pharmacol Ther, 2021, 26(8): 809-814.

Chinese Journal of Reparative and Reconstructive Surgery

Midterm follow-up outcomes of total hip arthroplasty in treatment for patients with juvenile-onset ankylosing spondylitis

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