Indications of fiberoptic intubation in ankylosing spondylitis patients undergoing total hip arthroplasty

Background and Aims: This study aimed to report the indications and results of fiberoptic intubation (FOI) in patients with ankylosing spondylitis (AS) undergoing total hip arthroplasty (THA). Methods: This retrospective study analyzed the clinicoradiographic data of 191 THAs performed on patients with AS. Preoperative Mallampati score to grade difficulty of intubation, the Bath AS Radiology Index (BASRI) grade of cervical and lumbar spine disease severity, temporomandibular joint (TMJ) involvement, and type of hip joint involvement on plain hip X-rays were analyzed. Results: Out of 191 THAs, 129 (67.5%) were performed under routine spinal anesthesia and 13 (7%) under general anesthesia. In the remaining 49 THAs (25.5%) that were identified preoperatively as having difficult intubation with a FOI backup, 18 THAs (9.5%) required FOI. The mean age was significantly higher ( P = 0.02), a significantly higher ( P < 0.0001) percentage of patients had class III and IV Mallampati scores, grades 3 and 4 BASRI cervical and lumbar spine, a significantly higher ( P < 0.0001) percentage of patients had TMJ affection, and a significantly higher ( P = 0.03) percentage of patients had chondrolytic hip in the FOI group when compared to the non-FOI group. Multivariate analysis indicated that a higher BASRI cervical and lumbar spine grades, TMJ affection, and chondrolytic hips were the predictors for FOI. Conclusion: Awake FOI is a safe and reliable method to achieve airway access in patients with AS undergoing THA. Patients with higher BASRI cervical and lumbar spine grades, TMJ affection, and chondrolytic-type hip involvement may be an indication for FOI during THA.