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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (6): 1089-1095. doi: 10.19723/j.issn.1671-167X.2025.06.011

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A long-term review for radiographic parameters of hips in axial spondyloarthritis patients with end-stage hip involvement: A 24-year trend analysis from a single high-volume tertiary center

Xinfeng WU1, Siliang MAN2, Dazhao CHEN3, Yong HUA4, Xijie WEN5, Yingyue DING2, Liang ZHANG3,*(), Xiujuan HOU6,*()   

  1. 1. Department of Spine Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
    2. Department of Rheumatology and Immunology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
    3. Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
    4. Department of Orthopedics, Gaotang County Hospital of Traditional Chinese Medicine, Liaocheng 252800, Shandong, China
    5. Department of Orthopedics, Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine of Hebei Province, Cangzhou 061000, Hebei, China
    6. Department of Rheumatology and Immunology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
  • Received:2025-08-12 Online:2025-12-18 Published:2025-10-28
  • Contact: Liang ZHANG, Xiujuan HOU

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Abstract:

Objective: To evaluate the characteristics and their change trends of major radiographic parameters of hips in axial spondyloarthritis (axSpA) patients with end-stage hip involvement from a single high-volume tertiary center over a 24-year period. Methods: Between 2001 and 2024, the radiographic trends of hips in axSpA patients with end-stage hip involvement were retrospectively reviewed. These radiographic parameters included bony ankylosis, acetabular protrusio, dislocation, obturator foramen ratio (OFR), canal flare index (CFI) and neck shaft angle (NSA). The baseline demographic, disease-related and laboratory parameters before surgery were also collected. Trend analyses over the study period were assessed using the Jonkheere-Terpstra trend test or the Cochran-Armitage trend test for clinical and radiographic parameters. All the joints were divided into the 2001-2012 group and 2013-2024 group according to the year of surgery, and the intergroup comparisons were conducted to further elucidate temporal changes. Results: The overall incidence of bony ankylosis, acetabular protrusio and dislocation before operation were 40.2%, 14.8% and 9.8%, respectively. The median value of OFR, CFI and NSA were 1.5 (1.2, 1.7), 3.2 (2.6, 3.8) and 141.0° (135.0°, 148.0°), respectively. Notably, only the value of OFR demonstrated increasing trend (P=0.001) among these radiographic parameters of hip, although some clinical parameters demonstrated increasing trend [hemoglobin (Hb) (P < 0.001), albumin (ALB) (P < 0.001), short form 12-item health survey (SF-12) physical component summary (PCS) (P=0.005), Harris hip score (HHS) (P=0.003)] or decreasing trend [erythrocyte sedimentation rate (ESR) (P < 0.001), C-reactive protein (CRP) (P < 0.001), Bath ankylosing spondylitis disease activity index (BASDAI) (P=0.013), Bath ankylosing spondylitis functional index (BASFI) (P < 0.001)]. The results of intergroup comparisons between 2001-2012 inpatient group (n=421) and 2013-2024 inpatient group (n=577) showed that no significant differences were found for these radiographic parameters of hip, although some clinical parameters were significantly different, including gender (P=0.004), body mass index (BMI) (P=0.002), age at disease onset (P < 0.001) and HHS (P < 0.001). Conclusion: The radiographic parameters of hip in axSpA patients with end-stage hip involvement did not show a trend of improvement over time, despite observed improvements in disease activity control and functional status. This dissociation between clinical improvement and persistent structural damage presents considerable technical challenges for subsequent surgical reconstruction with total hip arthroplasty.

Key words: Ankylosing spondylitis, Hip joint, Radiographic parameters, Total hip arthroplasty

CLC Number: 

  • R593.23

Figure 1

Illustration of the radiographic parameter measurements"

Table 1

Comparison of clinical and radiographic parameters between the 2001-2012 inpatient group and the 2013-2024 inpatient group (calculated by number of hip joints)"

Items Total 2001-2012 inpatient group 2013-2024 inpatient group Statistic P value
Gender χ2=8.40 0.004
    Male 866 (86.8) 350 (83.1) 516 (89.4)
    Female 132 (13.3) 71 (16.9) 61 (10.6)
BMI/(kg/m2) 23.0 (19.6, 26.0) 22.2 (19.1, 25.3) 23.5 (20.2, 26.2) Z=-3.04 0.002
Surgical side χ2=0.07 0.796
    Left 512 (51.3) 218 (51.8) 294 (51.0)
    Right 486 (48.7) 203 (48.2) 283 (49.1)
Age at onset/years 21.0 (16.0, 23.0) 19.0 (16.0, 23.0) 21.0 (18.0, 24.0) Z=-3.58 < 0.001
Age at diagnoses/years 29.0 (22.0, 38.0) 28.00 (21.0, 37.0) 29.0 (22.0, 39.0) Z=-1.93 0.054
Age at surgery/years 40.0 (31.0, 50.0) 38.0 (29.0, 50.0) 41.0 (32.0, 50.0) Z=-1.71 0.087
Diagnostic delay/years 8.0 (4.0, 16.0) 8.0 (4.0, 15.0) 8.0 (4.0, 16.0) Z=-0.62 0.537
Treatment interval/years 19.0 (12.0, 28.0) 19.0 (12.0, 28.0) 20.0 (12.0, 27.0) Z=-0.62 0.534
RDCI 0 (0, 0) 0 (0, 0) 0 (0, 0) Z=-0.26 0.794
HLA-B27 positive (hips) 908 (91.0) 383 (91.0) 525 (91.0) χ2=0.00 0.994
Hb/(g/L) 134.0 (118.0, 145.0) 135.0 (118.0, 146.0) 134.0 (118.0, 145.0) Z=-0.38 0.707
ESR/(mm/h) 22.0 (11.0, 40.0) 23.0 (11.0, 41.0) 22.0 (10.0, 39.0) Z=-0.98 0.326
CRP/(mg/L) 12.6 (5.4, 28.7) 14.8 (6.2, 31.0) 12.2 (5.3, 26.1) Z=-1.87 0.062
ALB/(g/L) 42.4 (39.3, 45.4) 42.2 (39.3, 45.2) 42.5 (39.4, 45.7) Z=-0.38 0.700
BASDAI 3.9 (2.9, 5.1) 3.8 (2.9, 5.0) 3.9 (2.9, 5.1) Z=-0.48 0.634
BASFI 57.0 (45.0, 74.0) 59.5 (45.8, 75.0) 56.0 (45.0, 72.0) Z=-1.38 0.166
HHS 36.0 (25.0, 44.0) 34.0 (23.0, 41.0) 37.0 (25.0, 45.0) Z=-4.08 < 0.001
SF-12 MCS 43.0 (38.4, 48.8) 43.0 (38.2, 48.9) 43.2 (38.5, 48.7) Z=-0.80 0.424
SF-12 PCS 33.4 (25.6, 38.7) 33.9 (25.6, 38.7) 33.1 (26.0, 38.7) Z=-0.43 0.671
Bony ankyloses (hips) 401 (40.2) 167 (39.7) 234 (40.6) χ2=0.08 0.778
Protrusion (hips) 148 (14.8) 61 (14.5) 87 (15.1) χ2=0.07 0.796
Dislocation (hips) 98 (9.8) 46 (10.9) 52 (9.0) χ2=1.01 0.316
OFR 1.5 (1.2, 1.7) 1.5 (1.2, 1.7) 1.5 (1.2, 1.8) Z=-1.28 0.201
CFI 3.2 (2.6, 3.8) 3.2 (2.6, 3.8) 3.2 (2.6, 3.8) Z=-0.15 0.882
NSA/(°) 141.0 (135.0, 148.0) 141.0 (135.0, 148.0) 141.0 (134.0, 148.0) Z=-0.08 0.939

Figure 2

Trend analysis of radiographic parameters OFR, obturator foramen ratio; CFI, canal flare index; NSA, neck shaft angle."

Figure 3

Trend analysis of laboratory test results and disease-related parameters Hb, hemoglobin; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; ALB, albumin; PCS, physical component summary; HHS, Harris hip score; BASDAI, Bath ankylosing spondylitis disease activity index; BASFI, Bath ankylosing spondylitis functional index."

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