Abstract: Objective The ankylosing spondylitis (AS) with the hip joint involvement will lead to a poor prognosis.The early intervention in time can improve the prognosis of patients.The purpose of this paper is to explore the clinical and radiographic features of AS with hip joint lesions,and the influence of different intervention on prognosis of patients,and improve the understanding of the AS with hip joint lesions. Methods Total 220 cases of AS with hip joint lesions (group A) and 182 cases of AP without hip joint lesions (group B) were studied to compare the clinical signs and symptoms,laboratory indexes,imaging findings and treatment effect. Results The patients in group A had an earlier onset age[(21.97±21.97) years vs.(26.60±9.97) years,P<0.001)],longer time for clinical definite[(5.75±4.27) years vs.(3.84±3.60) years,P<0.001)],more juvenile-onset cases (44.5% vs.20.88%,P<0.001),more cases with hip joint starting symptoms (41.36% vs.28.02%,P<0.05) when compared with group B;The level of C-reactive protein[(30.36±25.52) mg/L vs.(22.58 ±18.83) mg/L,P<0.01],and sacroiliac joint CT grading (level Ⅲ:91 vs.56 cases,P<0.01;level Ⅳ:42 vs.24 cases,P<0.01) in group A were higher than those in group B.The patients in the two groups treated with tumor necrosis factor (TNF)-alpha blockers combined hip joint injection of sodium hyaluronate had a better prognosis by 1 year follow-up. Conclusion AS patients with the hip joint involvement often presented more initial hip joint symptoms,earlier onset age,longer time for diagnosis.Strong inflammatory reaction may be the main risk factor of AS hip involvement.The early application of TNF alpha blockers combined with hip injection of sodium hyaluronate can obviously relieve symptoms and improve the function of hip joint,and could be protection factor of AS with hip joint lesions.