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Hip replacement surgery in patients with ankylosing spondylitis
  1. Tone Wikene Nystad1,2,
  2. Ove Furnes2,3,
  3. Leif Ivar Havelin2,3,
  4. Arne Kristian Skredderstuen2,
  5. Stein Atle Lie2,4,
  6. Bjørg-Tilde Svanes Fevang1,5
  1. 1Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
  2. 2The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
  3. 3Department of Clinical Medicine, University of Bergen, Norway
  4. 4Department of Health, University Research Bergen, Norway
  5. 5Section for Rheumatology, Department of Clinical Science, University of Bergen, Norway
  1. Correspondence to Dr Tone Wikene Nystad, Department of Rheumatology, Haukeland University Hospital, Jonas Lies vei 65, Bergen 5021, Norway; tone.wikene.nystad{at}helse-bergen.no

Abstract

Objectives Although TNF-α inhibitors’ striking effect on clinical symptoms have revolutionised the treatment of ankylosing spondylitis (AS), no certain influence on the development of spinal ankylosis and joint destruction has been documented. We wished to investigate whether improved treatment has affected the use of hip arthroplasty surgery.

Methods Using the Norwegian Arthroplasty Register, we selected hip prosthesis procedures performed in patients with AS in 1988–2010 (n=534), and compared the trend in the number of procedures being performed annually in 1988–2002 versus 2003–2010. Patients with osteoarthritis (OA) (n=95094) were used as a control group.

Results The frequency of hip prosthesis surgery increased significantly in both groups up until 2002. In 2003–2010, although not statistically significant (p=0.087), there was a trend towards a reduced frequency in the AS group when compared with the expected continued increase as was seen among patients with OA. Mean age at surgery increased significantly (p<0.001) from 49.9 years to 56.4 years when comparing patients with AS up until and after 2002.

Conclusions TNF-α inhibitors were introduced to patients with AS in Norway in 2000–2003, and our findings suggest that they may have altered the prognosis by inhibiting or slowing large joint arthritis and thus reducing the need for hip replacement surgery.

  • Ankylosing Spondylitis
  • Anti-TNF
  • Arthritis
  • Treatment
  • Orthopedic Surgery

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