Physical Therapy and Surgery

Abstract

Physical therapy and orthopedic surgery are important components in the treatment of ankylosing spondylitis (AS). Supervised physical therapy is more effective that individual or unsupervised exercise in improving symptoms, but controlled trials suggest than combined inpatient and outpatient therapy provides the greatest improvement. Recommendations for exercise are universal, but the best types and sequence of therapies are not known. Total hip replacement is the surgery most commonly performed for AS, with good long-term implant survival. Heterotopic ossification may occur no more frequently after hip replacement in patients with AS than in patients with other diseases. Corrective spinal surgery is rarely performed and requires specialized centers and experienced surgeons.

Rehabilitation and surgical management of ankylosing spondylitis

“…The survival of the prostheses is about 90 % at 10 years, declining to 65 % after 20 years. Nearly 1 % of the THR replacements can fail, and some of them need a revision in the first 5-10 years for aseptic loosening [34].…”

Unanswered questions in the management of axial spondyloarthritis: an opinion piece

“…While the nature of these interventions prevents double-blind, placebo-controlled studies, the available clinical trials of physical therapy in AS are not standardized and mostly not well designed. There are very few comparative studies on the efficacy of well-defined physiotherapy interventions and those that exist lack adequate information on exercise frequency (or the "dose" of physical therapy) [28,29].…”