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Case report
Surgical strategies in management of ankylosed bilateral hips and knees in crouched posture
  1. Sathish Muthu1,2,
  2. Girinivasan Chellamuthu2,3,
  3. Thiruvengita Prasad Gopalswamy2,4 and
  4. Velmurugan Kandasamy2,5
  1. 1Government Hospital, Velayuthampalayam, Karur, Tamil Nadu, India
  2. 2Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
  3. 3Department of Orthopaedic Surgery, Ganga Medical Centre and Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, India
  4. 4Prasad Ortho Care, Chennai, Tamil Nadu, India
  5. 5Department of Paediatric Orthopaedic Surgery, Institute of Child Health, Chennai, Tamil Nadu, India
  1. Correspondence to Dr Sathish Muthu; drsathishmuthu{at}


A 26-year-old wheelchair-bound man was brought to our institute with progressive painful deformity of both lower limbs involving bilateral hip and knee for the past 5 years. The patient was wheelchair-bound for the past 18 months. He was only able to crawl to meet his locomotor demands. On examination, the patient was in a crouched posture with mild kyphosis at the thoracolumbar region and ankylosis of bilateral hip and knee in an unfavourable position. Radiological and serological evaluation diagnosed him to be a case of neglected ankylosing spondylosis. We planned for arthroplasty of the bilateral hip and knee for correcting his posture and to regain his locomotor ability. The severity of the deformity mandated extensive releases and the handling of neurovascular structures. Hence, a holistic treatment plan with various surgical strategies was devised to manage his deformities. The patient made a good recovery and regained his locomotor ability without any major complications at a 2-year follow-up.

  • hip prosthesis implantation
  • orthopaedics
  • physiotherapy (rehabilitation)
  • anklosing spondylitis
  • osteoarthritis

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  • Contributors SM: resources, supervision, validation, visualisation, writing original drafts and reviewing drafts. GC: investigations, methodology, review and editing of draft. TP: conceptualisation, data curation, formal analysis, investigations and methodology. VK: conceptualisation, data curation, formal analysis, investigations, methodology, administration, resources and supervision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.