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Ankylosis – Causes, Symptoms and Treatment

Ankylosis refers to the complete stiffening of a joint due to bony or fibrous fusion of the joint surfaces. It can result from inflammation, injury, or chronic disease.

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Things worth knowing about "Ankylosis"

Ankylosis refers to the complete stiffening of a joint due to bony or fibrous fusion of the joint surfaces. It can result from inflammation, injury, or chronic disease.

What is Ankylosis?

Ankylosis is the complete or near-complete loss of movement in a joint, caused by the fusion of the joint surfaces. This fusion can occur through bone formation (bony ankylosis) or through the formation of scar and connective tissue (fibrous ankylosis). In principle, any joint in the body can be affected.

Causes

Ankylosis can develop due to a variety of underlying conditions:

Chronic inflammatory diseases: Conditions such as ankylosing spondylitis (Bechterew disease) or rheumatoid arthritis cause progressive joint destruction and subsequent fusion.
Infections: Bacterial joint infections (septic arthritis), if left untreated, can lead to ankylosis.
Trauma: Severe injuries or fractures near a joint can result in scarring and stiffening.
Postoperative changes: Certain surgical procedures may inadvertently lead to joint stiffening.
Degenerative diseases: Advanced osteoarthritis can also contribute to ankylosis.
Congenital causes: In rare cases, ankylosis may be present from birth.

Symptoms

The symptoms of ankylosis depend on which joint is affected and the severity of the condition:

Significantly reduced or completely absent range of motion in the affected joint
Pain, especially in early stages when inflammation is still active
Stiffness, particularly in the morning or after prolonged periods of rest
Joint deformity or misalignment
Muscle wasting (atrophy) around the affected joint due to disuse

Diagnosis

The diagnosis of ankylosis is established through a combination of clinical assessment and imaging studies:

Clinical examination: Assessment of joint mobility and tenderness by a healthcare professional.
X-ray: Reveals bony changes and fusion of joint surfaces.
Magnetic resonance imaging (MRI): Allows early detection of inflammation and soft tissue changes.
Computed tomography (CT): Provides detailed images of bony structures.
Laboratory tests: Blood tests to identify inflammatory markers or genetic markers such as HLA-B27 in cases of suspected ankylosing spondylitis.

Treatment

Treatment of ankylosis depends on the underlying cause, the joint involved, and the stage of the condition. The main goals are to relieve pain, preserve function, and prevent further progression.

Conservative Treatment

Physiotherapy and exercise: Regular physical therapy to maintain mobility and strengthen surrounding muscles.
Medication: Anti-inflammatory drugs (NSAIDs), corticosteroids, or biologics for inflammatory underlying conditions.
Heat and cold therapy: To relieve pain and stiffness.

Surgical Treatment

Joint replacement (arthroplasty/endoprosthesis): Implanting an artificial joint to restore function in severely affected joints.
Osteotomy: Surgical correction of deformity by cutting and realigning the bone.
Arthroplasty: Surgical reconstruction of the joint to restore movement.

References

Braun J, Sieper J. Ankylosing spondylitis. Lancet. 2007;369(9570):1379-1390.
World Health Organization (WHO). Musculoskeletal conditions. Available at: https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions
Firestein GS et al. Kelley and Firestein's Textbook of Rheumatology. 10th ed. Elsevier; 2017.

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