Ankylosis is the immobility of the joint. Usually develops as a result of injuries and diseases, less often it is congenital. It can affect any joints – temporomandibular, extremities, spine. It is manifested by the lack of movement. In the case of fibrous fusion, pain may increase with exertion and attempts at movement. The diagnosis is made based on the results of an external examination, radiography and other imaging methods. The treatment is operative, it is possible to install the limb in an advantageous position, restore movements by arthroplasty or endoprosthetics.
Ankylosis is one of the most unfavorable outcomes of traumatic injuries and diseases of the joint. It can occur in any age period, the peak incidence occurs in middle and old age. Congenital form - ankylosis on the background of arthrogripposis are rarely detected. The lower extremities suffer more often than the upper ones, the first place in prevalence (almost 50% of the total number of cases) is occupied by ankylosis of the knee joint. The greatest clinical significance is the lesions of large and medium-sized joints of the extremities and widespread ankylosis of the vertebral joints in Bekhterev's disease.
Pathology is formed as a result of the fusion of articular surfaces during inflammation, tissue repair after damage or prolonged absence of movement. In practical traumatology and orthopedics , the following main causes of ankylosis are distinguished:
In some cases, ankylosis is formed with improper treatment of arthrogryposis, a congenital condition characterized by multiple contractures.
Movements in the joint are carried out by sliding the articular surfaces covered with cartilage relative to each other. The possibility of movement is provided by the elasticity of the capsule and the surrounding soft tissues. The normal configuration during movements is preserved due to strong inelastic ligaments that connect the bones together.
With ankylosis, one or two links suffer, on which the mobility of the joint depends. The most common options are complete or partial loss of cartilage, followed by fusion of articular surfaces and the proliferation of inelastic fibrous tissue inside or around the joint. Less often, the cartilages fuse together.
Taking into account the type of fusion , there are three variants of joint ankylosis:
The patient complains about the lack of movement in the joint. With fibrous fusion, pain syndrome is usually present, with bone ankylosis there is no pain. During external examination, the joint is in a fixed position, which can be both functionally advantageous (providing the greatest opportunity for movement or self-service) and functionally disadvantageous.
An advantageous position for the shoulder joint is considered to be a moderate retraction with a slight deviation in front and a turn outward. For an ankylosed elbow joint, the optimal condition is bending at a right angle. The hip joint is most functional in the position of slight flexion and retraction, the knee joint – slight flexion, the ankle joint - flexion at an angle slightly exceeding 90 °. All other provisions are considered as functionally unprofitable and in need of correction.
External changes in ankylosis can vary significantly - from gross deformities (sometimes in combination with shortening or curvature of the limb) to a local violation of the configuration of the joint. The symptoms of attempting passive movements depend on the type of fusion. With bone ankylosis, there are no movements and pains, with fibrous, rocking movements are determined, accompanied by increased pain.
The presence of ankylosis has a negative effect on the rest of the musculoskeletal system, since it violates the biomechanics of movements. A healthy limb constantly suffers from overload, so arthrosis and enthesopathy are more often formed in it. With ankylosis of the lower extremities, the load on the spine increases and becomes asymmetric, which leads to curvature, osteochondrosis, intervertebral hernias.
The diagnosis is made by an orthopedic surgeon based on the results of an external examination and data from visualization techniques. Laboratory tests are carried out to determine the inflammatory diseases that led to the formation of ankylosis. The survey plan includes the following procedures:
Any conservative measures in this condition are of auxiliary importance, are prescribed to eliminate the etiological factor, reduce pain syndrome, at the stage of preparation for surgery and in the postoperative period. The only effective way to correct ankylosis in the absolute majority of cases is surgical intervention.
It is mainly used for fibrotic ankylosis. To eliminate pain , patients are recommended:
With a small length of fibrous bridges, the return of mobility can sometimes be achieved using mechanotherapy.
The purpose of surgery for ankylosis is to restore the volume of movements or to bring the limb into a functionally advantageous position. The following techniques are used:
After the operation, standard rehabilitation measures are carried out – physical therapy, massage, physiotherapy are prescribed. In the process of physical therapy, patients restore old or master new motor stereotypes.
The prognosis for ankylosis is determined by the type of fusion, the severity of deformities in the joint area, the condition of muscles, tendons and ligaments, and other factors. After arthrodesis, the functional capabilities of the limb increase, partial or complete disability persists. After arthroplasty, there is usually a partial return of mobility, possibly the re-formation of ankylosis. After the endoprosthetics, the working capacity is restored.
Prevention of ankylosis consists in timely reposition of intra-articular fractures with accurate restoration of the configuration of the articular surface, early initiation of treatment of inflammatory diseases of the joints. Immobilization cannot be abused unnecessarily. With a high probability of ankylosis formation, the limb should be fixed in advance in the desired position with a plaster bandage.