Total knee arthroplasty in patients with ankylosing spondylitis

SummaryAnkylosing spondylitis is a chronic disease of insidious onset startingusually in males between ages of 10 and 40 years. Ankylosing spondylitis isthree times more frequent in men than in women. It commonly involves thesacroiliac and lower spinal joints and less frequently other large joints such asthe hips, knees and ankles as well as the entheses. The etiology may be a crossreactionby antibodies for certain bacteria in individuals with the HLA-B27gene. The basic pathologic lesion of ankylosing spondylitis occurs at theentheses, which are sites of attachment to bone of ligaments, tendons, and jointcapsules. Typically, bilateral and symmetric changes in the three compartmentsof the knee (medial femorotibial, lateral femorotibial, patellofemoralcompartments) include effusions, osteoporosis, and joint space narrowing.Additional manifestations are marginal erosions, subchondral cysts, and juxtaarticularperiostitis. Intra-articular bone fusion also is reported.Common symptoms of Ankylosing Spondylitis start out as recurrentlower back pain in the lumbar and sacroiliac areas for longer than three monthswith swelling around the sacroiliac joints . although it can start in the peripheraljoints in the form of swelling of joints causing a stiff, painful movement whichis especially worse during periods of inactivity. In approximately 30 per cent ofpatients with ankylosing spondylitis of long duration, radiographic abnormalitiesappear in the knees. MRI was able to detect inflammatory and destructivechanges of the joints in spondylitis. accurate diagnosis depends on clinical andradiologic investigations.