{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T20:10:01Z","timestamp":1756325401980,"version":"3.44.0"},"reference-count":20,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,10,5]]},"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1136\/bcr-2020-236043","type":"journal-article","created":{"date-parts":[[2020,10,30]],"date-time":"2020-10-30T17:10:43Z","timestamp":1604077843000},"page":"e236043","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Surgical strategies in management of ankylosed bilateral hips and knees in crouched posture"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7143-4354","authenticated-orcid":false,"given":"Sathish","family":"Muthu","sequence":"first","affiliation":[{"name":"Government Hospital, Velayuthampalayam, Karur, Tamil Nadu, India"},{"name":"Orthopaedic Research Group, Coimbatore, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Girinivasan","family":"Chellamuthu","sequence":"additional","affiliation":[{"name":"Orthopaedic Research Group, Coimbatore, Tamil Nadu, India"},{"name":"Department of Orthopaedic Surgery, Ganga Medical Centre and Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thiruvengita Prasad","family":"Gopalswamy","sequence":"additional","affiliation":[{"name":"Orthopaedic Research Group, Coimbatore, Tamil Nadu, India"},{"name":"Prasad Ortho Care, Chennai, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Velmurugan","family":"Kandasamy","sequence":"additional","affiliation":[{"name":"Orthopaedic Research Group, Coimbatore, Tamil Nadu, India"},{"name":"Department of Paediatric Orthopaedic Surgery, Institute of Child Health, Chennai, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,10,30]]},"reference":[{"key":"2025082712410335000_13.10.e236043.1","first-page":"2230","article-title":"Geriatric trauma: the role of immediate arthroplasty","volume":"95","author":"Schmidt","year":"2013","journal-title":"J Bone Joint Surg Am"},{"key":"2025082712410335000_13.10.e236043.2","doi-asserted-by":"publisher","DOI":"10.3928\/01477447-20120426-25"},{"key":"2025082712410335000_13.10.e236043.3","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/S0883-5403(86)80019-5","article-title":"Bilateral hip and knee arthroplasty","volume":"1","author":"Grauer","year":"1986","journal-title":"J Arthroplasty"},{"key":"2025082712410335000_13.10.e236043.4","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-200002000-00017"},{"key":"2025082712410335000_13.10.e236043.5","doi-asserted-by":"crossref","DOI":"10.1097\/00003086-197811000-00018","article-title":"Bilateral total hip and knee replacement in adults with rheumatoid arthritis","volume":"137","author":"Jergesen","year":"1978","journal-title":"Clin Orthop"},{"key":"2025082712410335000_13.10.e236043.6","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1302\/0301-620X.90B5.19937","article-title":"Conversion of bilateral hip and knee Ankylosis to total joint replacements","volume":"90","author":"Karva","year":"2008","journal-title":"J Bone Joint Surg Br"},{"key":"2025082712410335000_13.10.e236043.7","first-page":"207","article-title":"Total joint replacements in hip and knee ankylosed in gross flexion: case report","volume":"7","author":"Anand","year":"2017","journal-title":"MOJ Clin Med Case Rep"},{"key":"2025082712410335000_13.10.e236043.8","first-page":"371","article-title":"The lower extremity functional scale (LEFS): scale development, measurement properties, and clinical application. 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