Abstract：Objective To evaluate the accuracy and safety of single plane-guided osteotomy with double Kirschner needle in rigid and ankylosis hip arthroplasty. Methods From January 2008 to June 2022, total hip arthroplasty was used in the treatment of ankylosing spondylitis (AS) in 12 cases (24 hips) with hip rigidity and 23 cases (36 hips) with hip rigidity in Jiangsu Provincal Corps Hospital of Chinese People’s Armed Police Force. The posterolateral approach was performed. During the first osteotomy of the femoral neck, two 2.5 mm Kirschner needles were inserted into the femoral neck, lateral to the greater trochanter, 1.5~ 2.0 cm above the lesser trochanter, and the angle of the plane of Kirschner needles parallel to the acetabulum was adjusted by fluoroscopy to avoid damage to the anterior wall of the acetabulum. The first osteotomy was completed by cutting the neck of the femur along the lower edge of the Kirschner needle without affecting the work of the swinging saw. Hip ankylosis and stiffness were divided into two subgroups according to the boundary of ESR value of 30 mm/h. Hip flexion angle, adduction and abduction angle, residual hip flexion deformity and Harris function score before and after surgery were analyzed. The postoperative hip flexion angle, adduction and abduction angle, residual hip flexion deformity and Harris function score before and after surgery were analyzed. Results Intraoperative precise osteotomy was completed without anterior and posterior wall injuries of acetabulum. All patients were followed up for an average of 63.8 months (range, 50-86 months). The postoperative Harris score was higher than that before surgery (P<0.05), and the range of hip motion was improved (P<0.05). There were 6 cases of heterotopic ossification, including 4 cases of BrookerⅠand 2 caes of BrookerII which were asymptomatic and untreated. At the last follow-up, there was no loosening of the acetabular cup. Conclusions Single plane-guided osteotomy with double Kirschner needle is an effective method for ankylosis and rigid hip arthroplasty, which is simple to operate and can avoid the injuries of the anterior wall of the acetabulum and the complications related to the osteotomy of the greater trochanter.
王长峰, 杨乐, 李亮, 沈光银. 双克氏针单平面导向截骨法在僵硬、强直髋关节置换术中的应用[J]. 武警医学, 2023, 34(11): 971-976.
WANG Changfeng, YANG Le, LI Liang, SHEN Guangyin. Application of single plane-guided osteotomy with double Kirschner needle in rigid and ankylosis hip arthroplasty. Med. J. Chin. Peop. Armed Poli. Forc., 2023, 34(11): 971-976.
Xu L, Sun Q, Jiang S, et al. Changes in gene expression profiles of the hip joint ligament of patients with ankylosing spondylitis revealed by DNA chip[J].Clin Rheumatol, 2012, 31(10):1479-1491.
[3]
MacKay K, Brophy S, Mack C,et al. The development and validation of a radiographic grading system for the hip in ankylosing spondylitis: the Bath ankylosing spondylitis radiology hip index[J]. J Rheumatol,2000,27(12):2866-2872.
Gordon A B, McMulkin M L, Tompkins B, et al. Gait findings in the adolescent subject with a stiff hip[J]. J Pediatr Orthop, 2013,33(2):139-144.
[6]
Feng D X, Zhang K, Zhang Y M,et al.Bilaterally primary cementless total hip arthroplasty for severe hip ankylosis with ankylosingspondylitis[J].Orthop Surg,2016,8(3):352-359.
[7]
Bangjian H, Peijian T, Ju L,et al.Bilateral synchronous total hip arthroplasty for ankylosed hips[J]. Int Orthop, 2012,36:697-701.
[8]
Harris W H. Traumatic arthritis of the hip after dislocation and acetabular fractures:treatment by mold arthroplasty. An end resuh study using a new method of result evaluation[J].J Bone Joint Surg Am,1969,51 (4):737-755.
[9]
Brooker A F, Bowerman J W, Robinson R A,et al. Ectopic ossification following total hip replacement. Incidence and a method of classification[J]. J Bone Joint Surg Am,1973,55(8):1629-1632.
Lin D, Charalambous A, Hanna S A. Bilateral total hip arthroplasty in ankylosing spondylitis: a systematic review[J]. EFORT Open Rev,2019, 4:476-481.
[13]
Chai W, Kong X, Yang M, et al. Robot-assisted total hip arthroplasty for arthrodesed hips[J]. Ther Clin Risk Manag,2020,4(16):357-368.
[14]
Li L, Fu J, Xu C,et al. Fourth generation ceramic on ceramic tha in patients with ankylosing spondylitis: a minimum 10 year follow-up[J]. Orthop Surg,2022,14(5):860-867.
Bhan S, Eachempati K K, Malhotra R. Primary cementless total hip arthroplasty for bony ankylosis in patients with ankylosing spondylitis[J].J Arthroplasty, 2008, 23(6):859-866.
[17]
Wu H, Cheng W D, Jing J. Total hip arthroplasty by direct anterior approach in the lateral position for the treatment of ankylosed hips[J]. Eur J Orthop Surg Traumatol, 2020, 30(6): 993-1001.
[18]
Tamaki T, Oinuma K, Miura Y, et al. Total hip arthroplasty through a direct anterior approach for fused hips[J]. Hip Int, 2015, 25(6): 549-552.
Jacob M K, Reddy P K, Kuruvilla R S, et al. Functional and clinical outcome with modified lateral approach total hip arthroplasty in stiff hips with ankylosing spondylitis[J]. World J Orthop,2022,13(8):714-724.
van der Weijden M A, Claushuis T A, Nazari T, et al. High prevalence of low bone mineral density in patients within 10 years of onset of ankylosing spondylitis: a systematic review[J]. Clin Rheumatol, 2012,31(11):1529-1535.
[24]
Wang W, Huang G, Huang T, et al. Bilaterally primary cementless total hip arthroplasty in patients with ankylosing spondylitis[J]. BMC Musculoskelet Disord, 2014, 15: 344.
[25]
Bhan S, Eachempati K K, Malhotra R .Primary cementless total hip arthroplasty for bony ankylosis in patients with ankylosing spondylitis[J]. J Arthroplasty,2008,23:859-866.
[26]
Kim Y H, Oh S H, Kim J S, et al. Total hip arthroplasty for the treatment of osseous ankylosed hips[J]. Clin Orthop Relat Res,2003,414:136-148.
[27]
Hamadouche M, Kerboull L, Meunier A, et al. Total hip arthroplasty for the treatment of ankylosed hips: a five to twenty-one-year follow-up study[J]. J Bone Joint Surg Am,2001, 83:992-998.
[28]
Kim Y L, Shin S I, Nam K W,et al. Total hip arthroplasty for bilaterally ankylosed hips[J]. J Arthroplasty,2007, 22:1037-1041.
[29]
Feng D X, Zhang K, Zhang Y M, et al. Bilaterally primary cementless total hip arthroplasty for severe hip ankylosis with ankylosing spondylitis[J]. Orthop Surg, 2016,8(3):352-359.
Chai W, Kong X, Yang M, et al. Robot-assisted total hip arthroplasty for arthrodesed hips[J]. Ther Clin Risk Manag,2020,4(16):357-368.
[32]
Kilgus D J, Namba R S, Gorek J E, et al. Total hip replacement for patients who have ankylosing spondylitis: the importance of formation of heterotopic bone and of the durability of fixation of cemented components[J]. J Bone Joint Surg Am, 1990, 72: 834-839.
[33]
Oommen A T, Hariharan T D, Chandy V J, et al. Total hip arthroplasty in fused hips with spine stiffness in ankylosing spondylitis[J]. World J Orthop, 2021,12(12):970-982.
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