{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T17:04:25Z","timestamp":1784307865648,"version":"3.55.0"},"reference-count":17,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Ankylosing spondylitis (AS) is a chronic immune\u2010mediated inflammatory arthropathy primarily affecting the axial skeleton but may involve peripheral joints, particularly the hips. Avascular necrosis (AVN) of the femoral head represents a severe, underrecognized complication whose pathogenesis in AS is multifactorial\u2014encompassing disease\u2010intrinsic inflammatory vasculopathy, iatrogenic glucocorticoid exposure, and, potentially, a prothrombotic state. We report the case of a 28\u2010year\u2010old HLA\u2010B27\u2013positive male with a decade\u2010long history of AS who presented with bilateral AVN of the femoral heads superimposed on secondary hip osteoarthritis, compounded by severe microcytic anemia (hemoglobin 6.5\u2009g\/dL) and a recent COVID\u201019 infection. The patient was initiated on infliximab (TNF inhibitor) for disease control and underwent staged bilateral total hip arthroplasty (left hip: March 2023; right hip: October 2024), achieving marked functional recovery. This case underscores the importance of prospective hip surveillance in AS, delineates the mechanistic nexus between systemic inflammation, corticosteroid use, and AVN, and highlights the perioperative considerations unique to biologic\u2010treated AS patients. A multidisciplinary rheumatology\u2010orthopedic approach is essential to optimize outcomes in this high\u2010complexity population.<\/jats:p>","DOI":"10.1002\/ccr3.72801","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T05:26:01Z","timestamp":1779859561000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Bilateral Avascular Necrosis of the Femoral Heads in Ankylosing Spondylitis Requiring Staged Total Hip Arthroplasty: A Case Report of Diagnostic and Therapeutic Challenges"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-8783-1453","authenticated-orcid":false,"given":"Syeda Simrah","family":"Shah","sequence":"first","affiliation":[{"name":"Dow Medical College  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5807-3033","authenticated-orcid":false,"given":"Muhammad","family":"Ahsan","sequence":"additional","affiliation":[{"name":"Jinnah Sindh Medical University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4545-913X","authenticated-orcid":false,"given":"Tehreem","family":"Farooq","sequence":"additional","affiliation":[{"name":"Dow Medical College  Karachi Pakistan"},{"name":"Shaheed Mohtarma Benazir Bhutto Medical College  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0883-1445","authenticated-orcid":false,"given":"Mirza Daniyal","family":"Baig","sequence":"additional","affiliation":[{"name":"Dow Medical College  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9879-6853","authenticated-orcid":false,"given":"Mirza Mohammad Ali","family":"Baig","sequence":"additional","affiliation":[{"name":"Islamic International Medical College Riphah International University  Rawalpindi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1366-2375","authenticated-orcid":false,"given":"Mohammed Hammad Jaber","family":"Amin","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Alzaiem Alazhari University  Khartoum Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197510232931701"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-210770"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9629(15)40414-8"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2011.151027"},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.7326\/M14-2470"},{"key":"e_1_2_15_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kep174"},{"key":"e_1_2_15_8_1","doi-asserted-by":"publisher","DOI":"10.1054\/arth.2002.32170"},{"key":"e_1_2_15_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l2178"},{"key":"e_1_2_15_10_1","doi-asserted-by":"publisher","DOI":"10.1302\/2058-5241.4.180036"},{"key":"e_1_2_15_11_1","unstructured":"UpToDate \u201cDiagnosis and Differential Diagnosis of Axial Spondyloarthritis (Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis) in Adults \u2013 UpToDate \u201d(2026) https:\/\/www.uptodate.com\/contents\/diagnosis\u2010and\u2010differential\u2010diagnosis\u2010of\u2010axial\u2010spondyloarthritis\u2010ankylosing\u2010spondylitis\u2010and\u2010nonradiographic\u2010axial\u2010spondyloarthritis\u2010in\u2010adults."},{"key":"e_1_2_15_12_1","doi-asserted-by":"publisher","DOI":"10.31689\/rmm.2020.27.1.55"},{"key":"e_1_2_15_13_1","doi-asserted-by":"publisher","DOI":"10.5312\/wjo.v2.i12.107"},{"issue":"9","key":"e_1_2_15_14_1","article-title":"Delayed Diagnosis of Ankylosing Spondylitis: A Missed Opportunity?","volume":"11","author":"Patel P.","year":"2019","journal-title":"Cureus"},{"issue":"1","key":"e_1_2_15_15_1","first-page":"27","article-title":"Total Hip Arthroplasty: Areview of Advances, Advantages and Limitations","volume":"8","author":"Liu X. W.","year":"2015","journal-title":"International Journal of Clinical and Experimental Medicine"},{"key":"e_1_2_15_16_1","doi-asserted-by":"publisher","DOI":"10.2147\/TCRM.S415564"},{"key":"e_1_2_15_17_1","doi-asserted-by":"publisher","DOI":"10.2174\/0115733971259997231012101534"},{"issue":"3","key":"e_1_2_15_18_1","first-page":"1003","article-title":"Unusual Occurrence of Avascular Necrosis With Bilateral Involvement and Ankylosing Spondylitis, Meningioma and Hodgkin Lymphoma","volume":"60","author":"Stoic\u0103nescu L. D.","year":"2019","journal-title":"Romanian Journal of Morphology and Embryology"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.72801","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccr3.72801","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.72801","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T16:19:59Z","timestamp":1784305199000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.72801"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,26]]},"references-count":17,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1002\/ccr3.72801"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.72801","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"value":"2050-0904","type":"print"},{"value":"2050-0904","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,26]]},"assertion":[{"value":"2026-04-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e72801"}}