PMC3955855_01
A, Lateral X ray of the knee shows radial multiple exostoses around the knee (thin white arrow). B, Anteroposterior X ray of the shoulder shows exostoses around the shoulder joint (thin white arrow).
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HME 12 years ago while he had hip trauma, and multiple exostoses around the knee, ankle and shoulder joints were found in the obtained X rays (Figure 1 A and B). He was diagnosed as AS 3 years ago due to low back pain (LBP) accompanied with significant morning stiffness that lasted about 1.5 h together with laboratory and radiological findings. He was diagnosed as AS based on New York criteria including clinical criteria; a) low back pain more than 3 months improved by exercise and not relieved by rest, b) limitation of lumbar spine motion in sagittal and frontal planes and limitation of chest expansion, and radiologic criteria of bilateral sacroiliitis grade 2 or more.
Reduction of the hip joint spaces and bilateral sacroiliitis. AP radiograph of the hip shows symmetrical narrowing of both hip joint spaces (black arrow), bilateral sacroiliac joint erosions and iliac side subchondral sclerosis (bilateral sacroiliitis, the arrows at the top).
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B). Both sacroiliac joints were fused completely and the joint spaces of both hips were narrowed (Figure 2).
Whole body bone scan revealsincreased uptake in the metaphysis of different long bones.
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A whole body bone scan showed increased activity in the metaphysis of multiple long bones that supported multiple exostoses (Figure 3).
Total hip replacement (arthroplasty)
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Bilateral total arthroplasty was performed (Figure 4).