The Hip in Ankylosing Spondylitis

Ankylosing Spondylitis (AS) is a condition most commonly affects young males. It is known to cause stiffness in spine and hip joints. Importance of hip involvement in AS has been recognised as a commonly disabling problem, whereas involvement of other joints like shoulder is less frequent and less severe. In contrast to the classical changes of AS in the spine the changes in hip does not lead to formation of new bones, but it results in an erosive disease, which destroys the joint. These changes start occurring fairly early on in life, and total hip replacement is often the therapy of choice in this difficult clinical situation.

 

In the early stages, ankylosing spondylitis is  likely to cause:

  • pain in the lower back in the early morning which eases through the day or with exercise
  • pain in the sacroiliac joints (the joints where the base of your spine meets your pelvis), in the buttocks or the backs of your thighs.
  • Hip involvement usually comes on gradually, and although the pain often is felt in the groin area, it can sometimes be felt in other areas of the body, such as the knees or the front of the thigh

 

In advanced stages

  • Lower back and neck stiffness resulting in bending and twisting of torso and neck
  • Fusion of hips(Hip Ankylosis)

 

In the past, surgical fusion of the hip was performed to reduce the pain but at the cost of losing movement at the hip joint. Numerous studies now have however proven that total hip replacement in hip ankylosis is the most favourable line of treatment. It provides patient with pain relief , near normal movement of the hip joint and perfectly normal walking pattern.

 

At Udai Omni, total hip replacement for a fused or ankylosed hip has a long history of over ten years. To date, we have had a 100% success rate with no failures. This is a technically demanding procedure but if done well, the results are extremely gratifying as one can see in the example seen below:

 

Case Review:

A 33 year old software engineer came to us in 2009 with a fused right hip that resulted in a very awkward gait. He was obviously very conscious of his disability that affected his social life as well as his work. He had been to see many orthopaedic surgeons but could never get the confidence that he would walk normally again. During my annual visit to Udai Omni hospital from the UK, this young man consulted me and agreed to get his surgery done by me. Within six weeks, he could walk independently without a limp and eventually got back to his passion of swimming.

Video of patient swimming!

 

Dr. Udai Prakash

MBBS, FRCS (Eng), FRCS (Edin), FRCS (Tr & Orth) UK

Director, Consultant Orthopaedic Surgeon. Chief Joint Replacement & Trauma Surgeon

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