Knee Ankylosis Research Articles

Total Knee Arthroplasty in Patients Who Have Ankylosed Knees: A 10-Year Retrospective Study

BackgroundKnee ankylosis can result in major functional impairment, and surgical treatment of knee ankylosis is often regarded as a tremendous challenge due to technical difficulties such as difficult joint exposure and a high incidence of complications. The objective of this study was to review the results of preoperative and postoperative functional scores, range of motion (ROM), and complications of total knee arthroplasty (TKA) for the treatment of knee ankylosis. MethodsBetween January 2007 and January 2021, 19 patients (17 patients, 11 women, and 6 men) who had knee ankylosis underwent TKA. The mean age of the patients was 52 years (range, 31 to 71), and the mean follow-up period was 10.2 years (range, 3.1 to 13.9). The surgical procedure involved a TKA, performed via a medial parapatellar approach, a quadriceps snip, and a secondary osteotomy with soft tissue release. The postoperative clinical outcomes and complications were evaluated using a range of methods, including ROM assessment, Hospital for Special Surgery Knee Score, and visual analog scale scores. ResultsAt the final follow-up, the mean Hospital for Special Surgery Knee score improved significantly from the preoperative score of (33.6 ± 8.7) to (88.1 ± 5.2) (P < 0.001), ROM improved from (0 ± 0°) to (100.9 ± 14.1°) (P < 0.001), the visual analog scale score improved from a preoperative score of 0 to (1.0 ± 0.94) (P < 0.001), and radiographs showed no aseptic loosening of the knee. There were 8 knees (42.1%) that had postoperative complications. ConclusionsTotal knee arthroplasty (TKA) in patients who have ankylosing knees resulted in significant improvements in flexion and extension, mobility, and quality of life, despite a high incidence of complications such as skin necrosis.

Sequential surgery for the treatment of type I knee ankylosis: a series of 62 cases.

The lack of systematic classification and standard treatment principles for knee ankylosis prevents optimal treatments. This study explored treatments for type I (mild) knee joint ankylosis. This retrospective study analysed patients with knee joint ankylosis admitted from March 2013 to January 2018 who underwent sequential arthroscopic release. The 62 patients had 12-36 (average, 18) months of follow-up. Thirty-eight patients were released; of these, 18 were assisted by limited incision with partial quadriceps femoris expansion myotomy and released according to arthroscopy. Six patients underwent lengthening and release of the quadriceps femoris. All surgeries combined with full-course rehabilitation resulted in improved joint mobility. The range of motion (ROM) of the knee joint recovered to a range of 0° to 85°-140° (mean: 118.32 ± 9.42°) from the preoperative range of 30°-70° (mean: 45° ± 15.50°). The clinical effect was evaluated according to the Judet criteria at the final follow-up. The outcomes at the last follow-up (at least for 1 year) were excellent in 55 cases, good in six cases, and fair in one case. Sequential arthroscopic release, minimal selective invasion of limited incision of partial quadriceps femoris expansion myotomy, assisted by pie-crusting technique to release, or quadriceps femoris lengthening, and release surgery for type I knee joint ankylosis, accompanied by early rehabilitation training provided satisfactory results without significant complications.

A novel solution for the patient with knee ankylosing spondylitis: a case report

Link of Video Abstract: https://youtu.be/wskQdvBx0c0 Background: Knee ankylosis is a joint condition that causes functional limitation that becomes more severe when accompanied by pain. Arthroplasty is a complex and intricate reconstruction procedure that is more challenging when there is a structural limitation that requires a technique modification. In this report, we presented a rare case of a young patient with knee ankylosis and flexion contracture treated with arthroplasty. Case Presentation: A 20-year-old young woman came to the hospital with stiffness in her left knee, inability to sit well and crouch, and difficulty getting up from sitting. Based on the physical examination and X-ray of the left knee, the patient showed bone ankylosis on the femorotibial joint with a 100 flexion, which confirmed knee ankylosis. Arthroplasty was performed with a parapatellar medial approach. After eight months of supervision, the patient was able to perform an active flexion within 1050 and a full extension on the left knee. In our patient, arthroplasty brought a satisfying functional outcome and pain reduction, which was also supported by previous studies with the same procedure on ankylosis patients. Conclusion: Arthroplasty can be considered the main therapy option for joint deformities due to its more satisfying outcomes.

Ankylosis of knee joint in human skeletal remains from Istria, case report from St. Teodor (15th-18th centuries)

Objective: To present a case of knee joint ankylosis in human skeletal remains found in Istria, Croatia. Materials and methods: A fused knee joint was found at archeological site St Teodor. We analyzed the knee changes using macroscopic observation, using digital radiography and computed tomography. Results: Macroscopic analysis and both digital radiography and computed tomography imaging show knee ankylosis with cortical thickening. Conclusion: Knee ankylosis with cortical thickening suggests that the person still used the leg despite the disability.

The impaired nomad: A bioarchaeological study on an Early Iron Age case of knee ankylosis from the Jiaerkenjiaga Cemetery, Northwestern China

AbstractAbnormality of the knee joint due to diseases or injury would disable the patient's affected leg, lead to difficulty in locomotion and daily life, and in turn makes the patient demand special care from his/her family and community. In this study, we report a case of knee fusion from Jiaerkenjiaga Cemetery, northwestern China, from a male individual who died at the age between 35 and 45 years. Carbon dating of his bone sample shows that he died during 542–391 BCE. The phenomenon was examined through macroscopic observation, digital radiography, and CT scanning. Results demonstrate that the right femur and tibia were fused at the right knee, whilst the patella was fused to the lateral condyle of the right femur. Otherwise, there were no signs of fracture, neoplasm, or other pathological conditions. It was diagnosed as knee ankylosis. It was proposed that this abnormality was likely due to the rupture of the medial patellofemoral ligament and subsequent complication of patella dislocation and septic arthritis. Given the nomadic lifestyle of the Jiaerkenjiaga people, it is speculated that the right patellofemoral ligament of this individual was torn in an accident likely related to horse riding. The well‐remodelled nature of the new bone formation indicates that the injury might have happened years before his death. The impairment would have limited his ability to walk and ride unaided, so someone in his community must have provided him with long‐term care.

Tibial plateau fractures in a limited-resource setting: A prospective study of surgical techniques and outcome over three years

Introduction: Tibial plateau fractures form a wide spectrum of injuries accounting for 1.2% of all fractures and a prevalence of 10 cases per 100,000 inhabitants. Methodology: A prospective consecutive multicentre study from May 2018 to May 2021 was carried out in Yaounde. All consenting cases of tibial plateau fracture underwent surgical treatment while patients with pathologic fractures, previous knee osteoarthritis, medically unfit for surgery, and discharging against medical advice were excluded. Data was analysed with SPSS 26.0 and the level of significance set at p&lt;0.05. Results:Eighty-four (84) cases of tibial plateau fractures were sampled and 68 consented to surgery. The mean age was 42 ±13.6 years and sex ratio 2.4. Estimated prevalence was 2.2 cases per 100,000 inhabitants. Schatzker type II fractures were most represented (33.3%). The left leg was affected in 57.1%. Motorbike accidents were the main cause of injury (66.7%). Of the 68 operated, 63.3% by plating osteosynthesis, 32.4% by external fixation, and 4.4% by screws fixation. Tricortical iliac bone graft was realised in 4 cases. The minimum follow-up was 6 months, with a median of 18 months (5 to 37 months). Plating osteosynthesis (p&lt;0.001), operative time between 60 to 120 minutes (p&lt;0.02) and a good radiologic fracture healing (p&lt;0.04) were associated with a satisfactory outcome. Poor prognosis was seen with open fractures (p&lt;0.001), bridging external fixation (p&lt;0.001), and Schatzker VI fractures (p&lt;0.02). Complications included post-traumatic osteoarthritis (64.7%), post-traumatic osteomyelitis (29.4%), knee ankylosis (5.9%), and limb malalignment (30.9%). Conclusion:The prevalence of tibial plateau fractures remains lower than reported in literature but it is projected to rise. Plating remains a viable treatment option. A larger scale study will establish the burden of this entity in our context.

Ankylosis of a knee joint from Medieval London: Trauma, congenital anomaly or osteoarthritis?

ObjectiveTo explore the differential diagnoses of a fused left knee joint and the subsequent impairment. MaterialsAn adult female skeleton from the Medieval cemetery of St Mary Spital (London, England). MethodsWe employed digital radiography and macroscopic observation to record the changes observed throughout the skeleton. We also used the Index of Care to explore the subsequent impairment. ResultsA range of congenital and developmental conditions were identified throughout the axial skeleton, with changes to the spine, pelvis, arms and leg bones reflecting adaptation to the mobility impairment. ConclusionsIn all probability, the left knee reflects a case of congenital ankylosis with a differential diagnosis of subadult trauma. The female’s skeleton had adapted to the impairment. Their risk is likely to have been elevated because of climatic and pandemic events during this period. SignificanceFirst reported case of congenital knee ankylosis. LimitationsThe left knee joint was damaged during excavation. Suggestions for further researchAdditional imaging is advised.

The Leg Wound of King Philip II of Macedonia.

ObjectiveKing Philip II, the father of Alexander the Great, suffered a penetrating wound to the leg from a spear that left him severely handicapped. His skeletal remains represent the first and only case of an injury from ancient Greece that can be directly compared to its historical record. The objective of the study was to confirm the identity of the male occupant of Royal Tomb I in Vergina, Greece as Philip II of Macedonia by providing new evidence based on anatomical dissection and correlation with the historical description of the wounds.MethodsRadiographs and photographs of the leg in Royal Tomb I in Vergina were examined. Anatomical dissection of a cadaver with a reconstructed wound similar to Philip’s was also completed to identify associated soft-tissue injuries.ResultsThe left leg was penetrated by an object at the knee which resulted in joint diastasis, external rotation of the tibia, knee ankylosis, and formation of a granuloma around the related object. This caused massive trauma to the joint but spared the popliteal artery. This resulted in ligamentous injury as well as injury to the peroneal nerve and probably the tibial nerve, resulting in a complete palsy of those nerves.ConclusionThis evidence exactly matches the historical sources and shows conclusively that the leg and Tomb I belong to Philip II. The anatomic and archaeologic evidence also serve as independent verification of some of the historical record of that period, better enabling scholars to judge the reliability of various texts. Furthermore, it gives invaluable information about surgical practices in ancient Greece according to Hippocratic methods and their outcomes. Finally, this sheds new light on the occupants of Royal Tomb II including the fact that the armor recovered there may have belonged to Alexander the Great.

Management of knee ankylosis using ilizarov device

Knee ankylosis is a common complication of knee trauma and infection that poses a serious challenge to orthopaedic surgeons regularly in their practice. This study highlights the success of the use of Ilizarov device in the management of fibrous ankylosis of the knee. A 37-year-old nurse with a fibrous ankylosed knee that had a range of movement (ROM) of 0°–40° was successfully treated with Ilizarov device, indomethacin (analgesics) and physiotherapy. Her ROM of the affected right knee improved to 0°–140° and after a follow-up period became 0°–90°. She was very happy with the outcome. There was no associated knee pains afterwards. Ilizarov device, together with adequate analgesia and physiotherapy, can successfully treat knee ankylosis.

Physical therapy management in knee ankylosis -Case study-

Abstract Aim: The purpose of this paper is to present a complicated case of a 2.8 year-old child with knee synovitis of unknown etiology which complicated in a very short time by the appearance of an ankylosis. The removal of the cast after 3 weeks revealed stiffness in flexion of the affected knee. Neither physiotherapy nor attempts to mobilize under anesthesia, led to the expected results. Consequently, the patient was referred to a surgery service for the adherence removal by arthrotomy. During the following 5 months, new complications developed due to a double tibia and peroneal fracture. After the consolidation of the fractures, both the therapist and the recovery protocol were changed. Method: For one and a half years, the child followed two weekly recovery sessions consisting in physiotherapy and massage. At home the child did an exercise program under parental supervision and worn an orthosis. Results: At the end of the rehabilitation program we noticed the restoring the normal amplitude of all the lower limb joints, restoring the muscular strength of the lower limb, and normal course resumption. Conclusion: In addition to the need for a correct diagnosis of the disease, such cases also require an adequate recovery protocol, following the instructions given by the treating physician and to ensure continuity of the rehabilitation program (both in a recovery and home program), until the complete rehabilitation of the deficit.

Surgical Treatment of Neglected Traumatic Quadriceps Tendon Rupture with Knee Ankylosis.

Quadriceps tendon rupture is an uncommon injury. This disabling condition is the result of direct or indirect trauma. It requires surgical repair to avoid poor outcomes in cases of neglected or chronic rupture. In most acute cases, simple tendon suture or reinsertion is suitable for an extensor mechanism reconstruction of the knee joint. However, chronic lesions often require a tendon graft or flap reconstruction. We report a case of a 15-year-old male who was diagnosed with a chronic quadriceps rupture with a patellar superior pole fracture. We performed quadriceps reconstruction using tibialis anterior allograft tendon and additional screw fixation to reconstruct the extensor mechanism and recover knee joint range of motion to prevent a high-level functional restriction. The treatment was difficult and limited due to neglect for 9-months that led to ankylosis accompanied with nonunion of tibial fracture. Our surgical treatment using allograft tendon resulted in a very good outcome after 30 months of follow-up.

Spontaneous Knee Ankylosis through Heterotopic Ossification after Total Knee Arthroplasty.

This paper reports on a case of total ankylosis of the knee after a cruciate-sacrificing cemented total knee arthroplasty (TKA). An 82-year-old female patient previously underwent primary TKA for osteoarthritis twenty years ago in our institution. She had recovered uneventfully and returned to her regular activities. There was no history of postsurgical trauma; however, she progressively lost knee range of motion. Radiographs revealed severe bridging heterotopic ossification.

The lameness of King Philip II and Royal Tomb I at Vergina, Macedonia

King Philip II was the father of Alexander the Great. He suffered a notorious penetrating wound by a lance through his leg that was nearly fatal and left him lame in 339 B.C.E. (i.e., 3 y before his assassination in 336 B.C.E.). In 1977 and 1978 two male skeletons were excavated in the Royal Tombs II and I of Vergina, Greece, respectively. Tomb I also contained another adult (likely a female) and a newborn skeleton. The current view is that Philip II was buried in Tomb II. However, the male skeleton of Tomb II bears no lesions to his legs that would indicate lameness. We investigated the skeletal material of Tomb I with modern forensic techniques. The male individual in Tomb I displays a conspicuous case of knee ankylosis that is conclusive evidence of lameness. Right through the overgrowth of the knee, there is a hole. There are no obvious signs that are characteristic of infection and osteomyelitis. This evidence indicates that the injury was likely caused by a severe penetrating wound to the knee, which resulted in an active inflammatory process that stopped years before death. Standard anthropological age-estimation techniques based on dry bone, epiphyseal lines, and tooth analysis gave very wide age ranges for the male, centered around 45 y. The female would be around 18-y-old and the infant would be a newborn. It is concluded that King Philip II, his wife Cleopatra, and their newborn child are the occupants of Tomb I.

John Rhea Barton: the birth of osteotomy

Osteotomy is one of the most common surgical procedures performed everyday all over the world. This technique dates back to the first half of nineteenth century and to the fundamental contribution made by Pennsylvania Hospital surgeon John Rhea Barton (1794-1871), who can be considered the pioneer of modern osteotomies; this paper focuses on his life and career highlights with a description of the first corrective osteotomies for hip and knee ankylosis (documented in two fundamental papers whose original pictures are here reproduced). The success of osteotomy as a current surgical approach to treat several orthopaedic conditions is confirmation of the importance of this procedure in the orthopaedic discipline and prompted an investigation into the pioneering mind who introduced it.

Congenital bony fusion (absence) of the knee: A case report

Congenital knee ankylosis is a rare condition which might be accompanied with other abnormalities or not. To our knowledge, there is no report on true bony ankylosis of the knee. The only ones in the literature include fibrous knee ankylosis. Thus this seems to be the first presentation of true congenital bony fusion of the knee joint.

Akute traumatisch bedingte Exazerbation einer tuberkulösen Ankylose des Kniegelenks: Klinisches Management

With this manuscript we want to show a means of the clinical management in an advanced stage of tuberculous destruction of the knee in elderly, polymorbid patients with a high risk of undergoing surgery. We describe the case of a patient who suffered from a Mycobacterium bovis infection of the left knee that led to spontaneous ankylosis in her childhood. At the age of 87 years an acute exacerbation of the tuberculous osteoarthritis occurred due to a drop attack with a fracture in the region of the previous knee ankylosis. Considering the patient's age and general poor condition, it was our paramount goal to preserve her walking ability and to avoid that she becomes bedridden. After radical surgical debridement and resection of the ankylosis, we achieved macroscopically clean bone and soft tissue conditions. We performed palliative arthrodesis with a long intramedullary nail and a cement spacer. Additionally, the patient underwent a tuberculostatic therapy for 8 months. The acute inflammatory process could be stopped and the ability of the patient to walk could be preserved. Because of the increased incidence of tuberculosis in the industrialised countries during the past 20 years, it should be considered as a differential diagnosis in cases of unclear septic arthritis.

Total Arthroplasty in Ankylosed Knees: A Case Series

OBJECTIVETo present nine patients with ankylosis in their knees that were submitted to a total arthroplasty to lessen their pain and improve their functional limitation. For these patients, arthrodesis remained a possibility in the event of arthroplasty failure.INTRODUCTIONAnkylosis of the knee is a severe functional limitation that becomes worse when pain is present. Arthrodesis of the knee is a classical indication for such patients, since it resolves the pain; however, the severe functional limitation remains.METHODSIn the present study, we evaluated the clinical course of nine patients who underwent total arthroplasty of the knee, and were followed up for at least five years.RESULTSThe results demonstrate that all of the patients experienced a significant reduction in pain and some improvement in the degree of knee flexion and extension.CONCLUSIONBased on the latest follow-up, there has been no need to perform arthrodesis for any of our patients, showing that a total arthroplasty could be a option for treatment in knee ankylosis.

Conversion of bilateral hip and knee ankylosis to total joint replacements

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.

Huckstep Nail in the Treatment of a Femur Fracture

Purpose : To analyze the clinical and radiological results of Huckstep nailing in the treatment of acute femoral fractures and femoral nonunion, and to report the easy and non-fluoroscopic technique of targeting the locking screw holes by making double cortical windows. Materials and Methods : This study examined a total of fifteen femoral fractures treated with Huckstep nailing between January 1999 and January 2004. The fractures included six acute fractures (five closed and one open) and nine nonunions (four infective and five aseptic). The reoperative status, number of interventions, time to union and complications were analyzed. Ten male and 5 female patients with an average age of 42 years (range, 18-70) were followed up for a mean of 26 months (range, 16 months to 6.4 years). A new method of double cortical windows for targeting the screw holes were performed in seven cases without fluoroscopic aid. Results : Radiographic union was achieved after a mean of 15.3 weeks in those with an acute fracture and after a mean of 24.6 weeks in those with nonunion. One open fracture was fixed initially using a monofixator followed by Huckstep nail 4 weeks later when the open wound had healed. A bone graft was performed in two cases of nonunion, and Hydroxyapatite/Tricalcium phosphate granules were grafted in three cases of nonunion. Partial knee ankylosis resulted in 6 cases of nonunion at the final follow-up because the nonunion cases had undergone an average of 4.3 surgical procedures at other hospitals over an average of 11.8 months before performing Huckstep nailing. One acute case without proximal screw fixation resulted in dynamization and femoral shortening of 2 cm. Conclusion : Huckstep nailing provides stable fixation sufficient to enable early knee motion and weight bearing until the fracture heals in both acute fracture and nonunion. The new method of double cortical windows allows the easy targeting of screw holes without fluoroscopic aid.

Operative treatment of severe knee ankylosis with release and down-shift of musculus rectus femoris as well as united plasty of bilateral rotation retinacula and pedicle flaps

目的 探讨重度膝关节僵硬手术方式的改进,以提高手术效果,减少术后并发症. 方法 1999～2003年 11例重度膝关节僵硬患者采用膝关节周围及关节内松解后,股直肌起点松解下移、膝旁双侧旋转支持带腱瓣、双侧双蒂皮瓣、旋转皮瓣联合成形术手术治疗. 结果所有患者术后随访 10～ 35个月,平均 20个月.术前活动度 5°～ 20°,平均 15°;术后活动度 90°～ 120°,平均 100°,较术前平均增加 85°.无皮肤坏死、裂开、感染等并发症. 结论股直肌起点松解下移、膝旁双侧旋转支持带腱瓣、双侧双蒂皮瓣、旋转皮瓣联合成形术是治疗重度膝关节僵硬的有效方法,可有效防止术后再粘连、皮肤坏死、裂开、感染等并发症的发生,提高了手术效果。