Conversion of bilateral hip and knee ankylosis to total joint replacements

Karva, A; Board, Tim; Porter, Martyn

doi:10.1302/0301-620x.90b5.19937

Cited by 5 publications

(7 citation statements)

References 42 publications

(53 reference statements)

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“…Another case was reported in 2008: a 25-year-old female with severe ankylosis of her hips and knees secondary to rheumatoid arthritis, and her function was severely limited. She underwent staged bilateral THR, followed by a staged bilateral TKR, the functional outcome was excellent in that case as well 7 .…”

Section: Discussionmentioning

confidence: 81%

Ankylosis of the hips and knees due to sickle cell disease

Elayan

Hamdan

2012

F1000Res

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This is a case report of a 29-year-old Saudi male with sickle cell disease (SCD) with severe stiffness of his joints, mainly both knees and hips, secondary to complications of SCD. He was severely crippled: unable to sit, stand or walk, and was bedridden for 8 years when he was presented to us. Radiographs showed fusion of both knees and hips. There was no evidence of active osteomyelitis by Gallium scan. The patient’s hemoglobin S decreased to levels below 30% by exchange transfusion. Bilateral total hip replacement, as well as unilateral total knee replacement, was carried out to improve his level of function. There is only one reported case of such severe and multiple joint complications in a single patient suffering from SCD.The increased life expectancy that medical advances have offered to the sickle-cell patients has led to the appearance of sickle-cell-related complications, which were previously only seen rarely. These complications were successfully managed and the patient was able to move and transfer using a wheel chair.

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Section: Discussionmentioning

confidence: 81%

Ankylosis of the hips and knees due to sickle cell disease

Elayan

Hamdan

2012

F1000Res

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“…According to the literature, arthritic changes become evident on average after 2-to 3 decades after hip fusion. 3,8,9 Conversion from fusion to hip replacement alone may relieve some stress put on the knee joint and consecutively-the pain, at least to some extent. Nonetheless, it is not curative, as it is unlikely it will influence the natural progression of the degenerative changes in the knee joint.…”

Section: Discussionmentioning

confidence: 99%

“…rheumatoid arthritis or juvenile arthritis), infectious or septic arthritis, or trauma (such as a proximal femoral fracture). [2][3][4] Some patients do adapt to a lack of motion of the hip joint and may report optimal function for a long period -however, it is not without compromises. Many of them face significant limitations in activities of daily living, such as putting on shoes, climbing stairs, and driving a car, and report that their condition also affects their sexual life -all of which contribute to a generally lower quality of life.…”

Section: Introductionmentioning

confidence: 99%

“…After 20-30 years, most of them tend to complain about pain in the lumbar spine, contralateral hip, and ipsilateral knee, which is true even for those who have had their hip fused in an optimal position. 3 Degenerative changes in the ipsilateral knee following hip fusion are estimated to appear in up to half of the patients. 5 Knee arthritis in these cases is a result of abnormal gait pattern, which results in overloading of the ipsilateral limb during a stance phase when the knee com-pensates increased pelvic rotation and lack of motion in the hip.…”

Section: Introductionmentioning

confidence: 99%

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Hip fusion takedown with total knee and hip arthroplasty in a patient with end-stage chronic kidney disease – a case report and narrative literature review

2022

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Hip fusion takedown and conversion to [total hip replacement (THR)] is a technically demanding procedure related to a high risk of complications, however, in selected patients, it might be required before performing [total knee arthroplasty (TKA)]. Currently, there is no standard of care, and each case has to be considered individually. We describe a case of a 70-year-old male with left hip ankylosis and debilitating pain in the ipsilateral knee. We describe the justification and technical issues related to the management of this case, and the difficulties associated with performing those in a dialyzed patient. Based on our experience and available literature, we conclude that the patient has to be informed of possible complications and outcomes. Even the presence of serious comorbidity does not necessarily preclude such a procedure if the patient is in good condition and the successful outcome is highly probable.

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“…Karva et al [7] reported the case of a 25-year-old patient with juvenile rheumatoid arthritis and ankylosis of both hips and both knees treated by staged bilateral hip and knee arthroplasty over 6 months. At 18 months follow up, the ranges of movement achieved at the hip and knee were comparable to those reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

Total Joint Replacements in Hip and Knee Ankylosed in Gross Flexion: Case Report

Kumar¹

2017

MOJCR

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The patient is a 38-year-old lady who was diagnosed with juvenile idiopathic arthritis at the age of 13yrs but did not take proper treatment and ended up being wheelchair bound. Her disability progressed gradually over the 25 years and on presentation to us, she had serious functional limitation and poor personal hygiene. Because of the deformity and stiffness of all major joints of lower limb, her ambulation was limited to crawling and in bed mobilization, severely jeopardizing her social life. Her upper limb joints were less severely affected.On clinical examination, her general condition was average. Both the hips were fixed in around 90 degrees of flexion and external rotation with right hip fixed in adduction and left hip in abduction. Also the, knees were fixed in 110 degrees of flexion with no movement possible and her ankles and feet were also deformed. (Figure 1) She had Z deformity of both her hands but her shoulder, elbows and spine were relatively normal. Muscles of upper and lower limbs appeared wasted with quadriceps atrophy being most prominent. Skin was atrophic and stretched out, especially over the joints. She was not on any medication currently but had history of steroid intake for long.Further investigations included blood workup including inflammatory markers ESR and CRP which were normal, suggesting inactivity of the disease. Radiographs of the knee and hip joints showed bony ankylosis (Figure 2-4) with arthritis of ankle, wrist and shoulder joints and generalized osteopenia. As a part of preanaesthetic checkup chest x-ray and echocardiogram were done and found to be normal.Patient had come to us with expectations of having painless, mobile joints and ability to ambulate without support. As multiple joints were ankylosed in unacceptable position, arthrodesis or girdlestone arthroplasty were not options. We gave her the option of total hip and total knee replacement but warned her about possible complications in this unique case. Patient was hopeless and was convinced that her condition could not get any worse so much so that she was ready to take the risk.Because knee surgery requires deep flexion at hip , we decided to replace hips first. Patient was given general anesthesia, put in lateral position, and operated using posterior approach. Because head was not dislocatable, in situ neck osteotomy had to be done and then acetabulum was reamed through the ankylosed head taking care of the acetabular walls and positioning. Extensive soft tissue releases were required to correct the deformities and a primary non-constrained uncemented implant was used (Stryker). (Figure 5) Owing to the osteoporotic bone, there was undisplaced spiral fracture of right proximal femur which was taken care of using cerclage wires. Adductor tenotomy was done postoperatively as the tendons standout only after taking down the ankylosis.

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Conversion of bilateral hip and knee ankylosis to total joint replacements

Abstract: We present a 25-year-old patient with juvenile rheumatoid arthritis and ankylosis of both hips and both knees treated by staged bilateral hip and knee arthroplasty. She was followed up for 18 months. We discuss the pre-operative planning, surgical details and post-operative rehabilitation.

Cited by 5 publications

References 42 publications

Ankylosis of the hips and knees due to sickle cell disease

Ankylosis of the hips and knees due to sickle cell disease

Hip fusion takedown with total knee and hip arthroplasty in a patient with end-stage chronic kidney disease – a case report and narrative literature review

Total Joint Replacements in Hip and Knee Ankylosed in Gross Flexion: Case Report

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