Instabilty post TKR due to MCL injury

Repeated falls 5 monthspost TKR with mcl laxity and mild recuravtum n a Mobile bearing knee.

Delayd  Progreesive ligamentous laxity of MCL  has been reported with LCS knees in th e past. Was the falls the issue or the ligament the initial trigger is unknown. There was also a hint of ? malrotation with no stiffness

Gross mcl laxity is best adddrssed by a good RHK joint to get 20 to 30 years. Varus/valgus constraints do better with LCL injuries and is less predictable with mcl injuries including repair in TKR

 

Malunited childhood proximal femoral fracture with SUFE and OAhip and valgus knee,anke and degenerate spine

 Type 2 valgus degenerate  spine with painful malunited proximal femur with old SCFE hip,

Lt.  hip was replaced  4 years ago. CT  revealed an eccentric canal at the malunion. 

Planned  and executed plan B with a drill sleeve and k wire  inserted centrally under imaging and end cutting reamers used to get central and by pass the  deformity and a cemented  polished stem  and mobilised . 

Awaiting the valgus knee and ankle correction at 3 months

 

Periarticular fracture of femur and patella i

 RTA in a pt with  10 year old conservative  treated  tibial fracture with osteopenia

 Attempted fixation by surgeon revealed no hold for  femoral fragments to mobilise, hence early salvage was decided to get him back to  autorickshaw  driving. Distal femoral replacment with circlage wiring of patella and prophylactic stimulan was inserted as the second opening of  type 1 open fracture was done. Started  wt bearing and mobilisation immediately aiming to get him back to work

6 MONTH OLD ACL/PCL AND OPEN MCL INJURY IN A 28 YEAR

ALLEGED RTA WITH THE ABOVE INJURY ONLY THE OPEN MCL WAS REPAIRED IN THIS YOUNG PERSON WHO PRESENTED WITH A STIFF KNEE ROM 0 TO 30. COMPLETE ACL, MCL GRADE 3 ABD PCL GRADE 3. THE MCL COULD HAVE FAILED AS THE PCL WS NOT RECONSTRUCTED.

Keinbocks disease (Begg and Bains grade 1). lunate chondral damage by intact radio-lunate fossa

OPTION S OF LIMITED FUSION VS PRC DISCUSSED. IN VIEW OF LT HAND AND BEING A CASHIER PRC WAS OPTED FOR BY THE PATIENT,. 5 MONTHS POST OP not happy with the result inspite of good rom and improved grip from preop.

8 months old patellar tendon avulsion . Use of neoligament to by pass quads to tibia to obtain active extension

The patella could be mobilised only by 1. 6 cm. use of synthetic mesh helped in immediate mobilisation effecting a Quads to tibia bypass.

ACL reconstruction 5 years failure

Anterio-superior femoral tunnel leading to failure. Tibial tunnel was 18 mm so 2 stage revision with 1st stage grafting

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20 years post acetabular fracture

Only interfering screws were removed. Intraop frozen sections and cultures were negative. Global and acetabular offset increased by 5 mm. Will this help in abductor efficiency or lurch/ pain time will tell. Usually they take an year to be happy if offset is increased

Recurrant dislocation of Rt THR in a 55 year old lady- one year post thr for secondary osteoarthritis due to AVN

the poly (Bubble) is sen on the lateral aspect of the ilium as a ring. Even a dual mobility cannot salvage this vertical cup

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