Comparative analysis of the functional status of hip joints before total hip replacement in patients with ankylosing spondylitis, rheumatoid arthritis and coxarthrosis: preliminary data of a retrospective study

Approximately 2.7% of all total joint arthroplasties are performed on patients with inflammatory arthritis. Severe structural and functional changes of the hip joints (HJ) increase the risks of intra- and postoperative complications.

The aim of the study – to carry out a comparative analysis of the functional state of the hip joints before total hip arthroplasty (THA) in patients with ankylosing spondylitis (AS), rheumatoid arthritis (RA) and osteoarthritis (OA).

Materials and methods. A retrospective study included 170 patients diagnosed with AS who met the modified 1984 New York criteria. For comparative analysis, age-matched individuals with AS were selected from the cohort of RA (n=1604) and OA (n=1458) patients. The preliminary analysis included data on 68 patients with RA and 52 with secondary coxarthrosis (posttraumatic and due to HJ dysplasia). All patients underwent elective THA between 1998 and 2020. Among AS patients, men (80.6%) predominated. The mean age was 38.1±11.3 years, duration of disease from the onset of the first symptoms was 17.0±8.5 years, duration of HJ pain before THA was 7.4±4.8 years. The majority of patients with RA were women (83.8%). The mean age of the patients was 42.8±9.9 years. The mean duration of RA from disease onset to THA HJ was 15.9±8.6 years. The duration of HJ pain before surgical treatment was significantly (p<0.05) less than in AS – 5.7±2.3 years. Women (57.7%) were also predominant among patients with OA. Patients with OA at the time of THA HJ were significantly older than AS patients, their mean age was 45.3±8.4 years. The duration of pain in HJ was 6.8±5.3 years. Preoperative functional state of HJ was determined using the modified Harris scale.

Results and discussion. The mean total Harris scale score before surgical treatment in AS was significantly higher than in RA and lower than in OA: 38.0±15.4, 33.9±12.7, and 44.9±12.2, respectively. In most parameters of the Harris scale, patients with AS had similar indicators with RA patients. The following parameters of the Harris scale were significantly more frequently used in RA and were worse in comparison with AS: fixed adduction, fixed inward rotation, fixed flexion contracture, HJ flexion. Patients with AS were significantly more likely than those with OA to have more severe claudication, problems with distance walking, more frequent use of additional support, and more severe anatomical deformities on the Harris scale.

Conclusion. Assessment of function according to the Harris scale revealed a high degree of functional impairment of the HJ before THA in all the studied diseases. The average total score on the Harris scale before surgical treatment in AS was significantly higher than in RA and lower than in OA. According to the majority of parameters characterizing functional limitations in the HJ, AS patients had similar indices with RA patients.

A high degree of structural and functional changes in the HJ before surgical treatment may potentially increase the risks of postoperative complications, whereas better results can be expected with initially higher functional capabilities.

1. Borjon ED, Barba LDM, Juan VM, Jirjis MSG, Hazel HRC, Estrada JJG. 20-year experience in total primary hip arthroplasty in patients under 50 years with inflammatory rheumatic diseases: Functional results, complications and survival. J Orthop Res Ther. 2023;8:1286. doi: 10.29011/2575-8241.001286

2. Eskin NA (ed.), Andreeva TM, Ogryzko EV, Popova MM (compiled). Injuries, orthopedic morbidity, state of traumatological and orthopedic care for the population of Russia in 2018. Collection of the National Medical Research Center of Traumatology and Orthopedics named after N.N. Priorov. Moscow;2019 (In Russ.).

3. Ershov AS, Volokitina EA. Hip arthroplasty in patients with rheumatoid arthritis. Ural Medical Journal. 2022;21(2):26-37 (In Russ.). doi: 10.52420/2071-5943-2022-21-2-26-37

4. Mertelsmann-Voss C, Lyman S, Pan TJ, Goodman SM, Figgie MP, Mandl LA. US trends in rates of arthroplasty for inflammatory arthritis including rheumatoid arthritis, juvenile idiopathic arthritis, and spondyloarthritis. Arthritis Rheumatol. 2014;66(6):1432-1439. doi: 10.1002/art.38384

5. Abdelaal MS, Restrepo C, Sharkey PF. Global perspectives on arthroplasty of hip and knee joints. Orthop Clin North Am. 2020;51(2):169-176. doi: 10.1016/j.ocl.2019.11.003

6. Dempsey KE, Collins JE, Ghazinouri R, Alcantara L, Thornhill TS, Katz JN. Associations between preoperative functional status and functional outcomes of total joint replacement in the Dominican Republic. Rheumatology (Oxford). 2013; 52(10):1802-1808. doi: 10.1093/rheumatology/ket180

7. Simmen BR, Bogoch ER, Goldhahn J. Surgery insight: Orthopedic treatment options in rheumatoid arthritis. Nat Clin Pract Rheumatol. 2008;4(5):266-273. doi: 10.1038/ncprheum0767

8. Dubinin AO, Khramov AE, Dubinina TV, Ilinykh EV, Byalik EI. Intraoperative picture of hip joint lesion in ankylosing spondylitis: Data from a retrospective analysis. Nauchno-Prakticheskaya Revmatologia = Rheumatology Science and Practice. 2022;60(5):594-598 (In Russ.). doi: 10.47360/1995-4484-2022-594-598

9. Dubinin AO, Khramov AE, Dubinina TV, Ilinykh EV, Byalik EI. Analysis of the functional state of the hip joints before total hip replacement in patients with ankylosing spondylitis: Data from a retrospective study. Nauchno-Prakticheskaya Revmatologia = Rheumatology Science and Practice. 2023;61(5):618-623 (In Russ.). doi: 10.47360/1995-4484-2023-618-623

10. Wooster BM, Kennedy NI, Dugdale EM, Sierra RJ, Perry KI, Berry DJ, et al. Contemporary outcomes of primary total hip arthroplasty in patients with inflammatory arthritis. Bone Joint J. 2023;105-B(7):768-774. doi: 10.1302/0301-620X.105B7.BJJ-2023-0220.R1

11. Khlaboshchina VN, Karateev АЕ, Polishchuk ЕYu, Makarov МA. Total knee and hip replacement in rheumatoid arthritis: A current trend. Nauchno-Prakticheskaya Revmatologia = Rheumatology Science and Practice. 2024;62(2):227-236 (In Russ.). doi: 10.47360/1995-4484-2024-227-236

12. Jeong H, Eun YH, Kim IY, Kim H, Lee J, Koh EM, et al. Characteristics of hip involvement in patients with ankylosing spondylitis in Korea. Korean J Intern Med. 2017;32(1):158-164. doi: 10.3904/kjim.2015.229

13. Agafonova EM, Erdes SH. Relationship between different methods of visualization of hip joint lesions in patients with axial spondyloarthritis during a two-year observational study. Nauchno-Prakticheskaya Revmatologia = Rheumatology Science and Practice. 2022;60(1):38-44 (In Russ.). doi: 10.47360/1995-4484-2022-38-44

14. Schnaser EA, Browne JA, Padgett DE, Figgie MP, D’Apuzzo MR. Perioperative complications in patients with inflammatory arthropathy undergoing total hip arthroplasty. J Arthroplasty. 2016;31(10):2286-2290. doi: 10.1016/j.arth.2016.03.023

15. Morse KW, Su EP. Hip resurfacing arthroplasty for patients with inflammatory arthritis: A systematic review. Hip Int. 2018;28(1):11-17. doi: 10.5301/hipint.5000558

16. Ram GG, Thamodaran B, Ashok TR, Perumal S, Varthi VP. Analysis of functional and radiological outcome of total hip replacements in rheumatoid and osteoarthritis patients. Open J Rheumatol Autoimmun Dis. 2013;3:246-250. doi: 10.4236/ojra.2013.34038

17. Atalar H, Baymurat AC, Kaya İ, Tokgöz MA, Tolunay T, Arikan ŞM. Total hip arthroplasty in patients with coxarthrosis due to developmental dysplasia of the hip: Is fixation of the subtrochanteric osteotomy necessary? Jt Dis Relat Surg. 2023;34(3):605-612. doi: 10.52312/jdrs.2023.1091

18. Moharrami A, Mirghaderi SP, Marzban S, Moazen-Jamshidi SMM, Shakoor D, Mortazavi SMJ. Total hip arthroplasty via direct anterior approach for osteonecrosis; comparison with primary hip osteoarthritis in a mid term follow up. J Clin Orthop Trauma. 2022;34:102042. doi: 10.1016/j.jcot.2022.102042

19. Osawa Y, Seki T, Takegami Y, Kusano T, Makida K, Ishiguro N. Cementless total hip arthroplasty for osteonecrosis and osteoarthritis produce similar results at ten years follow-up when matched for age and gender. Int Orthop. 2018;42(7):1683-1688. doi: 10.1007/s00264-018-3987-7

20. Malhotra R, Kannan A, Kumar V, Nagaraj C, Marimuthu K, Khatri D. Hip resurfacing arthroplasty in inflammatory arthritis: A 3- to 5-year follow-up study. J Arthroplasty. 2012;27(1):15-20. doi: 10.1016/j.arth.2011.02.016