Rajiv Gandhi University of Health Sciences s40

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BENGALURU, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 Name of the candidate and address DR.VEERAGANDHAM KOTESHWARA (in block letters) PRASAD DEPARTMENT OF ORTHOPAEDICS ,VYDEHI INSTITUTE OF MEDICAL SCIENCES & RESEARCH CENTRE, WHITEFIELD , BANGALORE.

2 Name of the Institution VYDEHI INSTITUTE OF MEDICAL SCIENCES AND RESEARCH CENTRE BANGALORE - 66 3 Course of the study and subject M.S. ORTHOPAEDICS

4 Date of admission to course 3rd MAY, 2010. 5 Title of the topic STUDY OF TOTAL HIP REPLACEMENT IN ANKYLOSING SPONDYLITIS 6 Brief resume of the intended work

6.1 Need for the study

Ankylosing spondylitis is a auto immune disorder affecting the axial skeleton and hip joints,it occurs as a result of inflammatory process in the joints.

Patients with ankylosing spondylitis are usually young and more active and problems are related to function, posture and locomotion are more rather than pain

The current well accepted treatment for ankylosing spondylitis in hip is total hip replacement. Relief of pain in the neighbouring joints, improved mobility of the hips and correction of limb length discrepancy are the reasons most patients are satisfied with the results of this procedure.1

And studies indicated that patients suffering from ankylosing spondylitis who underwent total hip arthroplasty, significant benefit has obtained in posture and function so that these patients could be gainfully employed and with improved range of movements2.

The purpose of the study is to document clinical and radiological results following total hip replacement in terms of pain relief and improvement in function in patients with ankylosing spondylitis of hips3

In this study,I will be analyzing the technical difficulties associated with planning and executing total hip replacement in such patients, and the study includes both cemented and uncemented hip arthroplasty and longterm results. 6.2 Review of literature A study on 10 patients with ankylosing spondylitis who underwent total hip replacement showed satisfactory results over a period of 3.8years in terms of pain management and mobility1.

Another study involving 23 patients with 34 total hip replacements with similar complaints and a follow up of 42.5 months showed overall good results but in two2.

Similar study was done on 24 patients who underwent 43 total hip replacements with ankylosing spondylitis showed high success rate after a mean follow up of 22.5years3.

After few years a similar study was done and post op pain management and mobility were assessed and has shown satisfactory results4.

A study on severe ankylosing spondylitis on 20 cases with a mean follow up of 5 years who underwent total hip replacement have shown encouraging results5. 6.3 Objectives of the study

1) To study the efficacy of Total Hip Replacement in ankylosing spondylitis of hip in 20 cases.

2) To study the complications associated with this treatment modality.

7 Materials and Methods 7.1 Source of data The study will be conducted on patients who has ankylosing spondylitis of hip joints in Department of Orthopaedics,Vydehi institute of medical sciences and research centre, Whitefield, Bangalore. Sample size – 20. 7.2 Method of collection of data (including sampling procedure if any)

I will prospectively follow up 20 cases of Ankylosing spondylitis undergoing Total Hip Replacement during 18 month period in our hospital. Patients with ankylosing spondylitis are admitted and examined according to protocol both clinically and radiologically, and functional outcome is asseses by distribution of Harris hip scores both pre- operatively and post operatively. And the patients are reviewed with post op x-rays immediately after surgery,at the end of 6,12,24 weeks after the surgery

Inclusion criteria: 1.Patients of Ankylosing spondylitis with involvement of hip joints. 2.Patients in the age group of 15 to 75 yers. 3.Patients willing to give informed consent.

Exclusion criteria: 1.Patients of age less than 15 yrs. 2.Absolute contraindication is active infection of hipjoint

7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animal? If so, please describe briefly. 1. Routine blood and biochemistry 2. ECG 3. X-ray pelvis with hip joint - Anterior posterior view.. 4. C.T.scan and 3 D reconstruction if required. 5. HLA-B27 assay 6. Post op x.rays(immediate post op,,6,12,24 weeks)

7.4 Has ethical clearance been obtained from your institution in case of 7.3

Yes, copy enclosed

STATISTICS:The data will be analysed using percentage,mean and Harris Hip Score 8 References

1. Baldursson H, Brattstrom H, Olsson T: 1977 “Total hip replacement in ankylosing spondylitis”. Acta Orthop Scand 48:499-507,

2. Bisla, R. S.; Ranawat, C. S.; and Inglis, A. E.: 1976 “Total hip replacement in patients with ankylosing spondylitis” with involvement of the hip. J. Bone and Joint Surg. March; 58-A:233-23

3. David h. Sochart and Martyn l. Porter J 1997 Bone Joint Surg Am.; 79:1181-9.

4. Alex Flnsterbush', David Amir', Ellahu Vatashki2and Nejah Husseini'1988 Acta Orthopaedica, 59: 5, 491 — 496

5. James Wharkess “ Arthoplasty Ot Hip”, Chapter 7. in Terry and canale, Campbell’s orhtopeadics surgery USA: elstvier ;. 2009, 612 pp

6. Robert B.Duthie,Ed,Mercers Orthopaedic Surgery jaypee brothers,; 2006, 1306 pp 9 Signature of the candidate

10 Remarks of the guide Ankylosing spondylitis is a inflammatory disease involving fusion of hip joints with symptoms like pain and difficulty in movement,hence total hip replacement has shown satisfactory results in terms of relief in pain and movement 11 Name and designation of the guide (in block letters) Dr .SATISH KUMAR, M.B.B.S, 11.1 Guide M.S.Ortho PROFESSOR DEPARTMENT OF ORTHOPAEDICS VIMS & RC, BANGALORE

11.2 Signature

11.3 Co Guide

11.4 Signature

11.5 Head of the Department Dr. MURALIDHAR N. BSc, MBBS, MS,D-ortho PROFESSOR & HOD DEPARTMENT OF ORTHOPAEDICS VIMS & RC, BANGALORE 11.6 Signature

12 12.1 Remarks of the Principal

12.2 Signature

CERTIFICATE OF ETHICAL CLEARANCE This is to certify that Dr.Veeragandham Koteshwara Prasad is a post graduate MS Degree student in the department of Orthopaedics. He was admitted to this course during the academic year 2010. The Ethical

Committee has issued clearance to the subject "STUDY OF TOTAL HIP

REPLACEMENT IN ANKYLOSING SPONDYLITIS” to the candidate to carry his Dissertation work on the synopsis submitted by him.

Principal Ethical Committee Chairman