Takedown of a Fused or Stiff Hip in Ankylosing Spondylitis

Description

In this detailed surgical overview, Dr. Anoop Jhurani addresses the complexities involved in operating on a fused hip, particularly in patients with ankylosing spondylitis. He begins by emphasizing the importance of understanding the spinal influence on pelvic alignment, outlining how a fused spine can lead to significant changes in hip positioning. The case discussed involves a 50-year-old patient displaying fibrous ankylosis, with limited mobility in both hips, particularly a mere minimal movement on the left and essentially none on the right.



Jhurani carefully explains anatomical considerations, such as decreased lumbar lordosis and anterior pelvic tilt caused by the spine's flexion. He highlights the risks of anterior dislocation, which is a common complication in these cases, urging the need for accurate anteversion measurement during surgery. A graphics example is provided, showing how the obturator foramen's appearance in X-rays can indicate pelvic and spinal deformities.



During the surgical video segment, the intricate procedures are demonstrated, showcasing a posterior approach that accommodates in-situ osteotomy techniques. The importance of trial reductions and adjustments for cup positioning in the context of the patient's anatomical variances is meticulously underscored. As the procedure unfolds, viewers witness the skillful maneuvers required to navigate the fibrous tissues, osteophytes, and deformities while avoiding damage to surrounding structures.



Ultimately, Dr. Jhurani highlights the significance of trial cups for ensuring stability before final fixture implantation, reiterating the critical need for precise adjustments in anteversion to bolster surgical outcomes and prevent dislocations in these high-risk cases. His insightful commentary throughout serves as a guide not just for the procedural nuances, but also for understanding the broader implications of surgical interventions in patients suffering from complex spinal and hip conditions.

DOI: 10.1302/3114-230109

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