Arthroscopic Treatment of Painful Hip in Associated with Ankylosing Spondylitis

Jung-Bum Lee; Deuk-Soo Hwang; Chan Kang; Bo-Gun Kim

doi:10.4055/jkoa.2010.45.1.59

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Lee, Hwang, Kang, and Kim: Arthroscopic Treatment of Painful Hip in Associated with Ankylosing Spondylitis

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2010; 45(1): 59-64.

Published online: 28 February 2010

DOI: https://doi.org/10.4055/jkoa.2010.45.1.59

Arthroscopic Treatment of Painful Hip in Associated with Ankylosing Spondylitis

Jung-Bum Lee, M.D., Deuk-Soo Hwang, M.D., Chan Kang, M.D., Bo-Gun Kim, M.D.

Department of Orthopedic Surgery, Chungnam National University College of Medicine, Daejeon, Korea.

Correspondence to: Deuk-Soo Hwang, M.D. Department of Orthopedic Surgery, Chungnam National University College of Medicine, #33 Munhwa-ro, Jung-gu, Daejeon 301-721, Korea. TEL: +82-42-280-7350, FAX: +82-42-252-7098, dshwang@cnu.ac.kr

Received 1 October 2009 Accepted 27 November 2009

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To examine clinical outcomes of patients who have undergone arthroscopic treatment for hip pain in patients with ankylosing spondylitis.

Materials and Methods

Between April 2003 and May 2008, 9 early ankylosing spondylitis patients with hip pain who underwent hip arthroscopic treatment were analyzed retrospectively. Arthroscopic synovectomy was performed on all the patients and a spur resection was performed simultaneously on any patient showing osteophytes or spurs on their radiograph. The clinical results were assessed using the pain score and Harris hip score.

Results

All the patients showed normal to early arthritic changes except for 1 case in a hip simple radiograph and showed synovial hyperplasia in the arthroscopic findings. Seven patients showed specific spike-shaped spurs on the femoral head-neck junction. According to the pain score, the scores were 0.8 before surgery, 2.6 at 6 months postoperatively and 2.8 at the final follow-up. According to the Harris hip score, the scores were 47.4 before surgery, 87 at 6 months postoperatively and 91 at the final follow-up.

Conclusion

Arthroscopic synovectomy and spur resection is a useful treatment for young adults with ankylosing spondylitis.

Keywords: hip, ankylosing spondylitis, synovitis, arthroscopic synovectomy, arthroscopic spur resection

Figures and Tables

Figure 1

Preoperative simple radiographs AP, lateral and MDCT of 24 year-old female's hip who complained right hip pain for several months and later was diagnosed as ankylosing spondylitis. Simple radiograph (A) shows spike-shaped spur on femoral head-neck junction on left hip. MDCT view (B) shows more prominent spur on right femoral head and neck junction.

Figure 2

This picture shows arthroscopic finding of synovial hyperplasia.

Figure 3

These pictures show preoperative simple radiograph AP (A) and postoperative simple radiographs AP (B) of a 20 year-old male's hip who complained right hip pain for several years and was diagnosed as ankylosing spondylitis.

Table 1

Diagnosis Criteria of Ankylosing Spondylitis (Modified New York Criteria^* (1984))

^*Criterion 4 plus any one of the other three criteria is sufficient for a diagnosis of definite AS.

Table 2

Demographic of Patients with Ankylosing Spondylitis

^*Tönnis grade.

Table 3

Clinical Data on All Patients

References

1. Eberhardt K, Fex E, Johnsson K, Geborek P. Hip involvement in early rheumatoid arthritis. Ann Rheum Dis. 1995. 54:45–48.

2. Law LA, Haftel HM. Shoulder, knee, and hip pain as initial symptoms of juvenile ankylosing spondylitis: a case report. J Orthop Sports Phys Ther. 1998. 27:167–172.

3. Tönnis D. Congenital dysplasia and dislocation of the hip in children and adults. 1987. NewYork: Springer;167.

4. Outrbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg Br. 1961. 43:752–757.

5. Khan MA, van der Linden SM. A wider spectrum of spondyloarthropathies. Semin Arthritis Rheum. 1990. 20:107–113.

6. Amor B, Santos RS, Nahal R, Listrat V, Dougados M. Predictive factors for the long term outcome of spondyloarthropathies. J Rheumatol. 1994. 21:1883–1887.

7. Boutry N, Khalil C, Jaspart M, Marie-Hélène V, Demondion X, Cotten A. Imaging of the hip in patients with rheumatic disorders. Eur J Radiol. 2007. 63:49–58.

8. Jäger M, Wild A, Westhoff B, Krauspe R. Femoroacetabular impingement caused by a femoral osseous head-neck bump deformity: clinical, radiological, and experimental results. J Orthop Sci. 2004. 9:256–263.

9. Pfirrmann CW, Mengiardi B, Dora C, Kalberer F, Zanetti M, Hodler J. Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients. Radiology. 2006. 240:778–785.

10. Krebs VE. The role of hip arthroscopy in the treatment of synovial disorders and loose bodies. Clin Orthop Relat Res. 2003. 406:48–59.

11. Braun J, Khan MA, Sieper J. Enthesitis and ankylosis in spondyloarthropathy: what is the target of the immune response? Ann Rheum Dis. 2000. 59:985–994.

12. McGonagle D, Gibbon W, Emery P. Classification of inflammatory arthritis by enthesitis. Lancet. 1998. 352:1137–1140.

13. Ide T, Akamatsu N, Nakajima I. Arthroscopic surgery of the hip joint. Arthroscopy. 1991. 7:204–211.

14. Witwity T, Uhlmann RD, Fischer J. Arthroscopic management of chondromatosis of the hip joint. Arthroscopy. 1988. 4:55–56.

15. Janssens X, Van Meirhaeghe J, Verdonk R, Verjans P, Cuvelier C, Veys EM. Diagnostic arthroscopy of the hip joint in pigmented villonodular synovitis. Arthroscopy. 1987. 3:283–287.

16. McGinty JB. Arthroscopic removal of loose bodies. Orthop Clin North Am. 1982. 13:313–328.

17. Ochi T, Iwase R, Kimura T, et al. Effect of synovectomy on the course of rheumatoid arthritis. J Rheumatol. 1991. 18:1794–1798.

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