For the first hip replacement surgery, ankylosing spondylitis is a relatively difficult surgery, because the patient’s hip joint is restricted for a long time and the joint is ankylosed, which makes the surgical exposure more difficult. These patients need early postoperative exercises to avoid adhesions in order to recover the hip function as soon as possible, which has a great impact on the healing of the muscle repair part during surgery. Most of these patients have a significant impact on the external rotation or abduction function of the hip joint after surgery. Minimally invasive hip replacement is a challenge for ankylosing spondylitis, but in my experience, this type of patient is the best indication for small incision surgery, and with proper management, the patient’s functional recovery is faster than with conventional surgery, and the operative time is shortened and the bleeding is significantly reduced. Since no muscles are damaged, there is no restriction of hip movement after surgery. This greatly shortens the hospital stay and postoperative recovery time.