Ankylosing spondylitis affects young men pre dominantly. The earliest manifestations are low back pain and gradually the disease results in hip pain stiffness and involvement of other joints. The spine is most commonly affected and can result in fixed deformities.
The diagnostic tests for ankylosing spondylitis consist of blood tests, x rays of the lumbar spine and other involved joints.
Hip involvement starts early. The permanent solution is Hip replacement.
Hip resufacing is possible in the early stages of the disease. However with totally fused joints, Hip replacement is the only option.
Since most patients are young, cementless hip replacements are preferred. Long lasting bearings like metal on metal, ceramic on ceramic, ceramic on cross linked poly are preferred.

Avascular necrosis is the most common cause of hip pain in the young and middle aged population. The most common reason is idiopathic or unknown. Other causes include steroid intake, blood disorders, fractures of the neck of femur, alcoholism.
The disease is very common in the age group 20 to 50.
Treatment options are
1) Non surgical- This has a poor rate of cure.
2) Surgical- Surgical treatments can be further divided into joint replacement or non joint replacement. Non joint replacement measures are core decompression and regenerative therapy with bone forming stem cells. This modality of treatment is relatively new and is available in India at a modest cost.
Joint Replacement- This consists of hip resurfacing, BHR, Birmingham mid head resection (BMHR),Short stem hip replacements, Birmingham mid head resection and total hip replacement with an uncemented or cementless prosthesis.
The bearings used need to be long lasting and devoid of side effects. Metal on metal bearings are used in Hip resurfacing and BMHR.
Ceramic on ceramic or ceramic on metal or ceramic on poly bearings can be used with short stem and total hip replacements. Ceramic on ceramic bearings result in the least amount of wear. Metal bearings can produce some amount of wear particles.
Most procedures mentioned above are bone preserving operations with the exception of a total hip replacement.
We have been performing short stem hip replacements with the Proxima hip since the last 5 years.