Ankylosing spondylitis is a systemic disease characterized by chronic inflammation of the medial joints, the cause of which is unknown and is generally thought to be related to autoimmune abnormalities caused by genetic and environmental factors. The high incidence age is 20-30 years, and the number of male patients is two to three times higher than that of female patients. The spine is the main site of involvement, often leading to extensive ossification of the spinal ligaments and resulting in bony ankylosis. The hip joint is the most commonly involved extremity joint, with a reported 28% involvement rate and a specific (juvenile) form of ankylosing spondylitis involving the hip joint in up to 46.7% of cases. 94% of hip symptoms present within 5 years of onset and are characterized by pain and limited motion, with 40% of patients eventually developing joint ankylosis. In patients with severe disease, the ankylosis can extend from the entire spine to the sacroiliac and hip joints, but the incidence of shoulder and knee involvement is relatively low, and other extremity joints are rarely involved. Patients with ankylosing spondylitis involving the hip joint should first be treated with medications, such as nonsteroidal anti-inflammatory and analgesic drugs, salbutamol and biological agents such as TNF-α antagonists. If these drugs do not control the progression of the disease, if hip pain persists and worsens progressively, or if hip ankylosis occurs, which seriously affects daily life, such as the inability to stand and walk, the inability to sit down with simultaneous ankylosis of both hips, and the inability to perform personal hygiene problems on their own, then surgical treatment should be considered. Therefore, not all patients with ankylosing spondylitis involving the hip joint need surgery. Currently, the preferred surgical treatment is total hip replacement. Although the surgery is relatively difficult and complicated, with the current more mature prosthesis design and surgical techniques, the majority of patients can achieve good medium to long-term results.