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Case Reports
. 2023 Oct 16;11(29):7179-7186.
doi: 10.12998/wjcc.v11.i29.7179.

Use of Ilizarov technique for bilateral knees flexion contracture in Juvenile-onset ankylosing spondylitis: A case report

Li-Wei Xia  1 , Cheng Xu  2 , Jian-Han Huang  3
Affiliations
Case Reports

Use of Ilizarov technique for bilateral knees flexion contracture in Juvenile-onset ankylosing spondylitis: A case report

Li-Wei Xia et al. World J Clin Cases. .

Abstract

Background: Ankylosing spondylitis (AS) is a chronic rheumatic disease that primarily affects the spine and the sacroiliac and peripheral joints. Juvenile-onset AS (JoAS) patients will likely present with peripheral joint symptoms. Knee flexion contracture (KFC) and hip flexion contracture (HFC) are common in these patients due to subchondral bone inflammation. The Ilizarov technique is the most commonly used technique for treating KFC. However, its use to treat JoAS-associated KFC has not been reported.

Case summary: This report presents a case study of a 31-year-old male patient with a squatting gait due to severe bilateral KFC and HFC. The patient had a normal walking pattern until the age of eight, after which he experienced knee and hip pain, leading to the gradual development of KFC and HFC. The patient's primary complaint was an inability to walk upright. The patient was diagnosed with JoAS and underwent hip dissection and release, limited soft tissue release of the hamstring, and gradual traction using the Ilizarov method. Ultimately, the patient was able to walk upright.

Conclusion: The incidence of squatting gait due to KFC in individuals diagnosed with JoAS was low. Utilizing the Ilizarov technique has proven to be a secure and effective method for managing KFC in JoAS patients. Although the Ilizarov technique cannot substitute for total knee arthroplasty (TKA), its application can delay the need for primary TKA in JoAS patients and alleviate the intricacy and potential complications associated with the procedure.

Keywords: Case report; Ilizarov ring external fixator; Juvenile-onset ankylosing spondylitis; Knee flexion contracture; Squatting gait; Total knee arthroplasty.

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
Preoperative squatting gait. A: Frontal view; B: Lateral view; C: Posterior view.
Figure 2
Figure 2
Range of motion of bilateral knees. A: Range of motion of right knee was 75°-135°; B: Range of motion of left knee was 55°-135°.
Figure 3
Figure 3
Radiographic changes in the spine, hip joints and sacroiliac joints. A and B: Plain radiographies of spine showed bamboo spine; C and D: Plain radiography of pelvis and computed tomography scan of pelvis showed sacroiliac joint fusion; E: Computed tomography scan of hips revealed osteoarthritic changes.
Figure 4
Figure 4
Radiographic changes in the knee joints and feet. A and B: X-rays of the knees revealed osteophytes and bilateral knee flexion contracture; C and D: Plain radiography of ankles showed narrowing of ankle joints space and ankylosing tarsitis.
Figure 5
Figure 5
Postoperative X-rays of the bilateral knee joints. A: The right knee; B: The left knee.
Figure 6
Figure 6
Clinical images before removal of bilateral lower limb ring external fixators. A: Standing with ring external fixator; B: Showing almost full extension of bilateral knees.
Figure 7
Figure 7
Images after removal of bilateral lower limb ring external fixators. A and B: Lateral X-rays of bilateral knees; C: Standing up and walking with a walker.
Figure 8
Figure 8
Clinical photographs of the patient after removal of the long-legged brace (12 mo after the operation). A: Frontal view; B: Lateral view; C: Posterior view.
See this image and copyright information in PMC

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