The choice of prosthesis is mainly based on the comprehensive consideration of the patient’s age factor and bone quality. Patients with ankylosing spondylitis often have varying degrees of osteoporosis in the proximal femur and acetabulum due to abnormal bone metabolism, as well as due to joint pain, contracture, and low activity, and there is still disagreement as to whether to use a cemented fixed-type prosthesis or a biologically fixed prosthesis prosthesis in artificial total hip arthroplasty. Cemented prostheses fix the prosthesis by internal locking and volumetric tamponade. Biological prostheses rely mainly on microporous techniques with bone tissue growth to fix the prosthesis. Both actions require good bone quality and sufficiently hard cancellous bone. Therefore, the ideal fixation for patients with osteoporosis, poor bone quality, and shorter survival is simply a matter of relatively good results using improved bone cement technology. Most patients with advanced ankylosing spondylitis are young, have a high demand for postoperative activity, and may face revision surgery later on. The use of an uncemented prosthesis for the initial replacement leaves a relatively large amount of bone for possible secondary surgery later on, leaving the best possible foundation for future prosthetic revisions. Ankylosing spondylitis late hip osteoarthritis young patients with active bone proliferation, new bone can grow more into the artificial joint prosthesis surface micropores, and within them to heal each other, and to achieve long-term stability of the prosthesis. Advances in biologic prosthesis design, especially with various coatings and metal microporous surface artificial total hip joints with multi-site weight-bearing and closely matching characteristics, also make its initial fixation more reliable than previous prostheses, and its near-medium-term efficacy is also satisfactory. In our group of relatively young 22 cases (29 hips), we used a non-cemented prosthesis to treat ankylosing spondylitis with hip ankylosis, and no loosening or displacement of the prosthesis occurred in the follow-up period of 18-47 months, and its long-term follow-up results need to be further observed. However, cemented fixation may be more appropriate for older patients with severe osteoporosis.