Posted: Jan 7 2024 #(C102328)

Ankylosing Spondylitis with Disabling fixed deformities of Bilateral hips and knees

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HPI

He was well till 8 years back when he started having pain in his lower back, hips, and knees. This was associated with morning stiffness. He started developing stiffness of joints gradually leading to current severity. He had been wheelchair-bound for the last 4 years with worsening deformities. He had been unemployed since finishing high school. He was dependent on his carers for ADLs and personal hygiene.

PMH

Anklylosing Spondylitis

Bilateral hips fixed in 60 degrees flexion and 30 degrees external rotation. Right hip fixed in 20 degrees abduction and left hip in 10 degrees adduction. Bilateral knees: Generalized joint line tenderness ROM 60-90 degrees Coronal plane deformity could not be assessed. Distal neurovascular status intact Spine - No tenderness; fused.

Poll

1 of 1

1. How would your prefer the sequence of surgeries?

All 4 joints in single stage

16%

1/6

Both hips in first stage and knees in second stage

33%

2/6

Both knees in first stage and hips in second stage

0/6

Ipsilateral hip and knee in first stage and the other side in next stage

33%

2/6

One joint at one time

16%

1/6

Intra-procedure P1

How would your prefer the sequence of surgeries?

Ipsilateral hip and knee in first stage and the other side in next stage

What would be your preferred time interval between the two stages?

2-3 weeks

What would be your preferred surgical approach for hips for this patient

Posterior

Post-procedure P2

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