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Joint Diseases and
Related Surgery
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Original Article · Open access

Clinical and radiological outcomes of direct anterior versus posterolateral total hip arthroplasty in ankylosing spondylitis: A propensity-matched study

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Xingshan Wang

Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China

ORCID: 0000-0002-0476-7968

Shaoyi Guo

Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China

ORCID: 0000-0003-1288-0888

Dazhao Chen

Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China

ORCID: 0009-0009-5279-562X

Yixin Zhou

Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China

ORCID: 0000-0002-9682-0577

Tao Bian

Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China

ORCID: 0000-0003-1600-077X

Siliang Man

Department of Rheumatology and Immunology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China

ORCID: 0000-0003-2109-1063

Liang Zhang

Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China

ORCID: 0000-0001-7337-2735

Abstract

Objectives: This study aims to compare the clinical and radiological outcomes of the direct anterior approach (DAA) and the traditional posterior-lateral approach (PLA) for total hip arthroplasty (THA) in patients with ankylosing spondylitis (AS).

Patients and methods: Between July 2001 and May 2024, a total of 137 patients (117 males, 20 females; mean age: 40.21±13.28 years; range, 17 to 73 years) with AS who underwent THA using the DAA or PLA were retrospectively analyzed. Using propensity score-matching, we retrospectively analyzed data on 164 hips with AS for which THA was performed, with 41 and 123 hips in the DAA and PLA groups, respectively. Preoperative baseline characteristics, surgical data, clinical and radiological outcomes at follow-up were collected and compared between the two groups.

Results: The mean follow-up was 68.05±38.09 months. There were no significant intergroup differences in terms of surgical data, postoperative complications, clinical scores, or patient satisfaction (p > 0.05). Compared to the PLA group, the DAA group had a significantly higher rate of achieving hip flexion over 90° (82.93% vs. 60.98%, p = 0.010), with fewer patients in the group reporting difficulty with putting on socks (p = 0.003). The DAA group exhibited a smaller acetabular anteversion (17.10±6.60° vs. 20.68±8.73°, p = 0.031), with a higher proportion of acetabular components positioned within the Lewinnek safe zone (82.93% vs. 60.16%, p = 0.008).

Conclusion: Although both surgical approaches are effective for managing hip involvement in ankylosing spondylitis undergoing THA, the DAA may offer functional benefits and improved prosthetic alignment. These advantages support its consideration as a favorable surgical option in appropriately selected patients,

# Xingshan Wang and Shaoyi Guo contributed equally to this manuscript and should be considered co-first authors

Declarations

Author Contributions

Y.Z., L.Z.: Idea; X.W., Y.Z.: Design; Y.Z.: Control; D.C., T.B.: Data collection; S.G.: Analysis; S.M., T.B.: Literature review; X.W., S.G.: Writing; Y.Z., S.M.: Crtitical review.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

AI Disclosure

The authors declare that artificial intelligence (AI) tools were not used, or were used solely for language editing, and had no role in data analysis, interpretation, or the formulation of conclusions. All scientific content, data interpretation, and conclusions are the sole responsibility of the authors. The authors further confirm that AI tools were not used to generate, fabricate, or ‘hallucinate’ references, and that all references have been carefully verified for accuracy.

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