Table of ContentsView AllTable of ContentsPurpose of AS SurgeryTypes of Surgery for ASBefore SurgeryAt the HospitalDuring SurgeryAfter SurgeryRecoveryComplications and Risks
Table of ContentsView All
View All
Table of Contents
Purpose of AS Surgery
Types of Surgery for AS
Before Surgery
At the Hospital
During Surgery
After Surgery
Recovery
Complications and Risks
Most people withankylosing spondylitis(AS), a type of chronic inflammatory arthritis, don’t require surgery. A procedure is typically only recommended if spine or joint damage becomes severe enough that it causes intense daily pain or restricts mobility and theability to perform daily tasks.
This may happen when non-surgical treatments likephysical therapyand medications that ease inflammation and help reduce joint degeneration and deformity are not given, fail, or are started late.
The type of surgery recommended—be it a joint replacement or spine surgery—depends on the case.
This article will explore joint replacement surgeries and spine surgeries for ankylosing spondylitis, common preparation instructions, risks, and the recovery process.
Ankylosing spondylitis can affect the body in a few ways, each of which may prompt the need for surgery.
Repair or Replace an Affected Joint
AS causes jointinflammationthat typically begins with thesacroiliac (SI) joints, which are located on either side of the lower back between the base of the spine and pelvis.
Surgery to repair or either partially or completely replace the affected joint may be done to:
Correct Spine Issues
As ankylosing spondylitis progresses, it often affects thefacet joints, which are located in the back of the spinal column. People have two facet joints between each pair of vertebrae, which are the small bones forming the backbone.
Degeneration and fusion (joining) of the facet joints and vertebrae impairs mobility because facet joints provide much of the bending and twisting ability of the spine.
If facet joints are severely affected, a C-shape rounding of the back known askyphosismay occur. This may affect portions of the lower (lumbar), middle or upper (thoracic), or top of spine at the neck (cervical).
A person with kyphosis may no longer be able to stand up straight and may be forced to look downward.
Facet joint damage can also put pressure on the spinal cord and nerves, causing pain, numbness, weakness, loss of coordination, and tingling in the arms and legs.
Surgery can:
RecapAS is an inflammatory arthritis that primarily affects the pelvis and spine. Most people with AS never have surgery, but it’s an option when AS leads to severe pain, spinal deformities, or joint problems.
Recap
AS is an inflammatory arthritis that primarily affects the pelvis and spine. Most people with AS never have surgery, but it’s an option when AS leads to severe pain, spinal deformities, or joint problems.
There are several types of procedures that can be performed to repair spine deformity and joint damage in people with ankylosing spondylitis.
The type of surgery recommended will depend on each person’s individual situation and symptoms.
Hip Replacement
People with AS frequently develop damage in the tissues and joints of the hips. In fact, it’s estimated that about 40% of people with AS have some hip involvement and up to 30% have joint damage.
Hip replacement surgerycan be helpful for severe damage that restricts mobility and compromises quality of life. This procedure involves removing part of the joint and replacing it with a metal, plastic, or ceramic device called a prosthesis to help improve mobility and reduce pain.
Research on outcomes for people with ankylosing spondylitis who have hip replacements is still somewhat limited, however.
A 2019 review of four small studies that included a total of 114 cases of bilateral (both sides) total hip replacements in patients with AS suggests that this surgery is an effective treatment for advanced hip damage and improves hip function.
That said, the authors noted that debate still exists on which surgical methods and type of prosthesis may be best to use in patients with AS. The authors caution that each patient’s individual factors should be considered when planning for surgery to help reduce risk of complications.
Other Joint Replacements
People who have other types of joint damage from AS may consider other types of joint replacement, including repairs to shoulder and knee joints.
Much like hip surgery, replacement surgery for a knee or shoulder joint usually involves replacing cartilage and bone surfaces with man-made materials, including plastic and metal.
Hip, shoulder, and knee replacements are a common choice for people who live with severe pain and limited mobility from ankylosing spondylitis.
Osteotomy of the Spine
Osteotomyis surgery to cut and reshape bone. There are a variety of osteotomy surgeries that may be done to help realign and straighten the spine in people with ankylosing spondylitis.
Studies have found that osteotomy surgeries are typically successful for kyphosis in patients with AS. They are able to look straight ahead when walking and lie on their backs again after the procedure.
However, spine surgeries do come with risks.
A study of more than 400 people with AS who had osteotomy surgery found that complications occurred in about 7% of one-level osteotomies, which are performed in one location of the spine, and in 24% of two-level osteotomies, which are performed in two places on the spine for more severe kyphosis cases.
The most common complications were lower back pain and leaking ofcerebrospinal fluid (CSF), which surrounds and cushions the spinal cord. There were no deaths or cases complete paralysis reported.
Because of this, it is a good idea to find an orthopedic surgeon who specializes in correcting this type of deformity.
How an Osteotomy Procedure Can Treat Arthritis
Spinal Fusion Instrumentation
Aspinal fusion instrumentationis when a surgeon fuses two or more vertebrae together using special hardware, including screws and rods.
This may be done to stabilize the spine. It may be done after an osteotomy if bones become damaged or if there was significant bone removal.
After this surgery, the joints that are fused will not have movement or be as flexible as before, which unfortunately is a trade-off to spine stability.
Laminectomy
Surgeries that take pressure off the spinal cord and nerves are called decompression surgeries.Laminectomyis one such procedure commonly performed on people with AS.
This procedure involves removing part of the vertebral bone called thelamina—the flattened part of the arch that forms the roof of the spinal canal (the channel that covers the spinal cord and nerves). Muscles in the area are pushed aside as well.
By doing this, pressure is taken off the spine and compression of the nerve roots is eliminated.
When done as part of a stabilization and fusion procedure, the spine is more easily accessible so that grafts, screws, and/or rods can be placed.
The procedure is minimally invasive, takes a couple of hours, and requires a small incision in the back.
RecapJoint replacements, which are the most common surgeries in those with AS, involve removing parts of a joint and replacing them with a prosthesis.Spine surgeries for AS typically involve removing parts of bone to either relieve pressure on nerves or to help realign the spine. In some cases, screws and rods are used to hold vertebrae together after a procedure.
Joint replacements, which are the most common surgeries in those with AS, involve removing parts of a joint and replacing them with a prosthesis.Spine surgeries for AS typically involve removing parts of bone to either relieve pressure on nerves or to help realign the spine. In some cases, screws and rods are used to hold vertebrae together after a procedure.
Joint replacements, which are the most common surgeries in those with AS, involve removing parts of a joint and replacing them with a prosthesis.
Spine surgeries for AS typically involve removing parts of bone to either relieve pressure on nerves or to help realign the spine. In some cases, screws and rods are used to hold vertebrae together after a procedure.
Having surgery for AS can help to relieve pain and allow you to live a fuller, more active life.
Planning ahead for surgery and recovery will help ensure a successful outcome.
Educate Yourself
Take the time to educate yourself about what to expect before, during, and after surgery. Talk to a healthcare provider and ask questions about concerns.
Here are somequestions patients may want to ask:
Make sure to speak up about anything confusing or any worries regarding surgery, hospital stay, recovery, or pain management.
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Gather Medical and Personal Information
During the weeks before surgery, patients will be asked about insurance coverage, medical history, and legal arrangements.
It might be a good idea to put together a list of personal and medical information to speed up the process to avoid pulling the same information together over and over.
The list of information should include the following:
Physical Preparations
Getting the body in good physical shape before surgery helps to lessen the potential for complications and may shorten recovery.
For example:
Planning for the Return Home
Joint replacement and spine surgeries are major surgeries and a patient will need several weeks to recover.
To make recovery easier, take time to make home more comfortable and safer.
Consider these preparations for returning home:
If living alone, will have little or no help, or have a disability, it may make sense to instead consider staying at a specialized rehabilitation center after leaving the hospital and through recovery. Ask the surgeon’s office for recommendations.
Surgery Preparations
Make sure to follow through on any instructions given prior to surgery. These may include:
What to Do if You Have a Cold or Get Sick Before Your Surgery
Last-Minute Preparations
The day before surgery will be a busy time filled with last-minute preparations. The surgery team may recommend:
Ask a friend or family member to help out with anything else needed before the procedure. Recovery will be a lot quicker if one has what they need and asks for help.
Upon arrival at the hospital, patients will be checked in, and given a gown, cap, and socks to change into. Patients will also be assigned a secure place to keep belongings.
Once changed, patients will meet with the preoperative nurse who will prepare them for the procedure. Patients will then read and sign surgical and anesthesia consent forms.
The procedure will be explained, blood work (if needed) will be taken, and an IV (access to a vein) started. Patients can ask any remaining questions they have at this time.
The anesthesiologist and surgeon may also speak with the patient, explain their roles, and answer any additional questions.
Patients will then be taken to the operating room, placed in the right position for the procedure, and given blankets and/or pillows to make them more comfortable.
They will be hooked up to machines to measure heart rate, breathing, blood pressure, andblood oxygen.
The anesthesiologist will likely talk about theanesthesia, how it will be administered, side effects, and what to expect. The anesthesiologist will likely will be given general anesthesia to put the patient to sleep.
The surgeon will then arrive and perform the procedure.
RecapBefore surgery, patients will need time to prepare themselves, both physically and psychologically. Ask questions whenever so that the steps of the surgery are understood and options can be properly evaluated. Arrange for someone to provide a ride home from the hospital and for a caregiver to stay over for the first few days after surgery.
Before surgery, patients will need time to prepare themselves, both physically and psychologically. Ask questions whenever so that the steps of the surgery are understood and options can be properly evaluated. Arrange for someone to provide a ride home from the hospital and for a caregiver to stay over for the first few days after surgery.
Minimally invasive joint replacement and spinal surgeries are good options for many people with ankylosing spondylitis. With minimally invasive procedures, incisions are smaller, which may lead to less blood loss and pain.
This also reduces the risk of complications and may shorten the hospital stay, reduce scarring, and speed healing.
The healthcare provider cuts alongside the side of the hip and moves the muscles on top of the thighbone to expose the hip joint.
The ball of the joint is removed with a saw, and an artificial joint is attached to the thighbone either with cement or other material. The healthcare provider will then remove any damaged cartilage and attach the replacement socket to the hipbone.
The new part of the thighbone is inserted in the socket of the hip, the muscles are reattached, and the incision is closed.
Spine Surgery
The surgeon makes an incision over the spine and exposes the bones of the spinal column.
Screws are often inserted in the vertebrae above and below the bone.
Depending on the nature of the spine surgery, the surgeon may cut and remove or realign parts of the lamina and facet joints.
Next, the spine may be realigned. The surgeon will manipulate the spine to a new position, using implants to help determine the needed correction.
For spinal fusion surgery, the surgeon may apply bone grafts (transplanted bone) to permanently connect bones, which is crucial for long-term spine stability.
Once the vertebrae are realigned, rods are placed into the screws added at the start of the surgery. This is done to help hold the vertebrae in place so they can heal in the new position.
Finally, the incision is closed in layers and the wound dressed with a gauze bandage.
RecapJoint replacement and spine surgeries are often minimally invasive to reduce the risk of complications and speed healing. General anesthesia is typically used to put patients in a sleep-like state for surgery.
Joint replacement and spine surgeries are often minimally invasive to reduce the risk of complications and speed healing. General anesthesia is typically used to put patients in a sleep-like state for surgery.
Patient stays in the recovery room depend on the extent of the procedure they underwent, how it went, personal health, and how patients feel in the aftermath.
Monitors will be checking heart rate, breathing, blood pressure, and blood oxygen levels.
Once alert, patients might be offered a snack or drink, and when oral fluids are tolerable, the IV may be removed.
Once able to go home, patients will be given instructions about activity, medication, hygiene, comfort measures in pain management, and medical equipment the surgeon has ordered.
Once home, patients will need to make an appointment for a follow-up postoperative visit with the surgeon.
Recovery After Surgery
Both spinal surgery and joint replacement surgery may respond better with physical therapy (PT) afterward. PT can be an important part of helping patients to heal and also plays a role in the successes and gains of AS surgery.
A program may involve strengthening, conditioning, and stretching to offer patients the most positive outcomes.
Patients can also take prescribed pain medications to make the process easier and less painful.
Also consider joining a digital or in-person support group, such as those offered through theSpondylitis Association of America,to connect with other individuals or families of loved ones with the condition. It may help patients feel more supported and offer a chance to share experiences and resources.
RecapHow long patients stay in the hospital after surgery will depend on the nature of the surgery and how they are feeling afterward. During recovery, physical therapy can be a key part of healing and regaining mobility.
How long patients stay in the hospital after surgery will depend on the nature of the surgery and how they are feeling afterward. During recovery, physical therapy can be a key part of healing and regaining mobility.
Surgeons do everything to avoid and manage potential problems that may arise during or after surgery. Most joint replacement surgeries and spine surgeries don’t have major complications.
However, the reality is that all surgeries—whether major or minor—generally do come with risks, including:
Spine surgeries carry the same risks as other orthopedic surgeries, but they also carry additional risks.
One 2015 study that looked at 95 patients who underwent spine surgery found that just over a quarter of them experienced complications. The most common complication was infection at the surgical site.
Risks associated with spinal surgery may include:
When to Call a Doctor
Call a healthcare provider or go to the local emergency room if experiencing any of the following symptoms:
RecapMost joint replacement and spine surgeries don’t have major complications, but all surgeries come with risks of complications, such as infection or blood clots. Seek medical attention if any sudden swelling, pain, difficulty breathing, or signs of infection occur after surgery.
Most joint replacement and spine surgeries don’t have major complications, but all surgeries come with risks of complications, such as infection or blood clots. Seek medical attention if any sudden swelling, pain, difficulty breathing, or signs of infection occur after surgery.
Summary
The type of surgery that’s recommended will vary based on an individual’s AS symptoms and how it affects their spine or joints. Risks also vary based on the type of surgery and individual health conditions.
Hip and other joint replacement surgeries can improve mobility and reduce pain.
Spine surgery may involve a laminectomy to take pressure off nerve roots for pain relief or an osteotomy to help realign a curved spine.
9 Best Exercises for Ankylosing Spondylitis
11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Nayak NR, Pisapia JM, Abdullah KG, Schuster JM.Minimally invasive surgery for traumatic fractures in ankylosing spinal diseases.Global Spine J. 2015;5(4):266-273. doi:10.1055/s-0034-1397341Xin Z, Zheng G, Huang P, Zhang X, Wang Y.Clinical results and surgery tactics of spinal osteotomy for ankylosing spondylitis kyphosis: experience of 428 patients.J Orthop Surg Res. 2019;14(1):330. doi:10.1186/s13018-019-1371-yWard MM.Increased rates of both knee and hip arthroplasties in older patients with ankylosing spondylitis.J Rheumatol. 2019;46(1):31-37. doi:10.3899/jrheum.171316American Academy of Orthopaedic Surgeons.Total joint replacement.Lin D, Charalambous A, Hanna SA.Bilateral total hip arthroplasty in ankylosing spondylitis: a systematic review.EFORT Open Reviews. 2019;4(7):476-481. doi:10.1302/2058-5241.4.180047American Academy of Orthopaedic Surgeons.Spinal fusion.National Library of Medicine: MedlinePlus.Laminectomy.American Academy of Orthopaedic Surgeons.Get in shape for surgery.Rustagi T, Drazin D, Oner C, et al.Fractures in spinal ankylosing disorders: a narrative review of disease and injury types, treatment techniques, and outcomes.J Orthop Trauma. 2017;31(Suppl 4):S57-S74. doi:10.1097/BOT.0000000000000953American Academy of Orthopaedic Surgeons.Spine rehabilitation exercises.Reis RC, Oliveira MF de, Rotta JM, Botelho RV.Risk of complications in spine surgery: a prospective study.Open Orthop J. 2015;9(1):20-25. doi:10.2174/1874325001509010020
11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Nayak NR, Pisapia JM, Abdullah KG, Schuster JM.Minimally invasive surgery for traumatic fractures in ankylosing spinal diseases.Global Spine J. 2015;5(4):266-273. doi:10.1055/s-0034-1397341Xin Z, Zheng G, Huang P, Zhang X, Wang Y.Clinical results and surgery tactics of spinal osteotomy for ankylosing spondylitis kyphosis: experience of 428 patients.J Orthop Surg Res. 2019;14(1):330. doi:10.1186/s13018-019-1371-yWard MM.Increased rates of both knee and hip arthroplasties in older patients with ankylosing spondylitis.J Rheumatol. 2019;46(1):31-37. doi:10.3899/jrheum.171316American Academy of Orthopaedic Surgeons.Total joint replacement.Lin D, Charalambous A, Hanna SA.Bilateral total hip arthroplasty in ankylosing spondylitis: a systematic review.EFORT Open Reviews. 2019;4(7):476-481. doi:10.1302/2058-5241.4.180047American Academy of Orthopaedic Surgeons.Spinal fusion.National Library of Medicine: MedlinePlus.Laminectomy.American Academy of Orthopaedic Surgeons.Get in shape for surgery.Rustagi T, Drazin D, Oner C, et al.Fractures in spinal ankylosing disorders: a narrative review of disease and injury types, treatment techniques, and outcomes.J Orthop Trauma. 2017;31(Suppl 4):S57-S74. doi:10.1097/BOT.0000000000000953American Academy of Orthopaedic Surgeons.Spine rehabilitation exercises.Reis RC, Oliveira MF de, Rotta JM, Botelho RV.Risk of complications in spine surgery: a prospective study.Open Orthop J. 2015;9(1):20-25. doi:10.2174/1874325001509010020
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Nayak NR, Pisapia JM, Abdullah KG, Schuster JM.Minimally invasive surgery for traumatic fractures in ankylosing spinal diseases.Global Spine J. 2015;5(4):266-273. doi:10.1055/s-0034-1397341Xin Z, Zheng G, Huang P, Zhang X, Wang Y.Clinical results and surgery tactics of spinal osteotomy for ankylosing spondylitis kyphosis: experience of 428 patients.J Orthop Surg Res. 2019;14(1):330. doi:10.1186/s13018-019-1371-yWard MM.Increased rates of both knee and hip arthroplasties in older patients with ankylosing spondylitis.J Rheumatol. 2019;46(1):31-37. doi:10.3899/jrheum.171316American Academy of Orthopaedic Surgeons.Total joint replacement.Lin D, Charalambous A, Hanna SA.Bilateral total hip arthroplasty in ankylosing spondylitis: a systematic review.EFORT Open Reviews. 2019;4(7):476-481. doi:10.1302/2058-5241.4.180047American Academy of Orthopaedic Surgeons.Spinal fusion.National Library of Medicine: MedlinePlus.Laminectomy.American Academy of Orthopaedic Surgeons.Get in shape for surgery.Rustagi T, Drazin D, Oner C, et al.Fractures in spinal ankylosing disorders: a narrative review of disease and injury types, treatment techniques, and outcomes.J Orthop Trauma. 2017;31(Suppl 4):S57-S74. doi:10.1097/BOT.0000000000000953American Academy of Orthopaedic Surgeons.Spine rehabilitation exercises.Reis RC, Oliveira MF de, Rotta JM, Botelho RV.Risk of complications in spine surgery: a prospective study.Open Orthop J. 2015;9(1):20-25. doi:10.2174/1874325001509010020
Nayak NR, Pisapia JM, Abdullah KG, Schuster JM.Minimally invasive surgery for traumatic fractures in ankylosing spinal diseases.Global Spine J. 2015;5(4):266-273. doi:10.1055/s-0034-1397341
Xin Z, Zheng G, Huang P, Zhang X, Wang Y.Clinical results and surgery tactics of spinal osteotomy for ankylosing spondylitis kyphosis: experience of 428 patients.J Orthop Surg Res. 2019;14(1):330. doi:10.1186/s13018-019-1371-y
Ward MM.Increased rates of both knee and hip arthroplasties in older patients with ankylosing spondylitis.J Rheumatol. 2019;46(1):31-37. doi:10.3899/jrheum.171316
American Academy of Orthopaedic Surgeons.Total joint replacement.
Lin D, Charalambous A, Hanna SA.Bilateral total hip arthroplasty in ankylosing spondylitis: a systematic review.EFORT Open Reviews. 2019;4(7):476-481. doi:10.1302/2058-5241.4.180047
American Academy of Orthopaedic Surgeons.Spinal fusion.
National Library of Medicine: MedlinePlus.Laminectomy.
American Academy of Orthopaedic Surgeons.Get in shape for surgery.
Rustagi T, Drazin D, Oner C, et al.Fractures in spinal ankylosing disorders: a narrative review of disease and injury types, treatment techniques, and outcomes.J Orthop Trauma. 2017;31(Suppl 4):S57-S74. doi:10.1097/BOT.0000000000000953
American Academy of Orthopaedic Surgeons.Spine rehabilitation exercises.
Reis RC, Oliveira MF de, Rotta JM, Botelho RV.Risk of complications in spine surgery: a prospective study.Open Orthop J. 2015;9(1):20-25. doi:10.2174/1874325001509010020
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