os with an arse

Middle aged arab male with pain on walking during swing phase of gait and walking down hill of 4 years duration. No gain with conservative treatment.

O/E. Tenderness on the posterior lateral aspect of ankle with minimal pain on Inv/eversion. Pain on plantar flexion and exteranl rotation.

Any options

We did ahind foot scopy as taught by Dr. Van Djik http://www.ankleplatform.com/. The course is rated 10/10. The portals on a horizontal line from tip of the fibula on either side of the Tendoachilles. The posterolateral portal after split and spread technique is aimed towards the first webspace and hit the bone. The posteromedial portal goes perpendicular to the scope in the PL portal and walk on the scope till you reach tip[ and debride the soft tissue till you expose the os , ankle joint and subtalar joint. The os was removed piece meal with a burr, grabber and finally an osteotome to be flush with the posterior tibia. The FHL shown in the pic protects the n/v bundle. stay posterior to it. The relief of symptoms were magical.

This was presented in the Cochin orthopedic meeting By Dr. Rajesh Subash our latest arthroscopy fellow

Do we fix it with Locking compression plates, Intramedullary nail or replace with a rotating hinge

65 yr old lady 3 months after after ORIF done elsewhere for a peroprosthetic fracture post TKR. Please comment on options

A middle aged haemophilaic with pain and mild medial lateral instabilty(Dr. Kapoors patient) with corrected factors at present awaiting knee replacement.

My suggestions are to use metaphyseal sleeves and a rotating platformTC3 RP knee as the primary choice with a rotating hinge back up if unstable

Knee Replacement in wind swept deformity

The xrays of a patient with a wind swept deformity is presented here. The deformity is complex and uncommon combination to have a varus (towards midline) and valgus (away from midline) in the same patient. I have used a rotating platform knee design in the varus knee and posterior stabilised design in the valgus knee to optimise function and longievity of implant in this case. Her knee society score at five years followup is still within the ninety percentile.

First blog on Knee Replacement!

I am orthopedic surgeon practicising the past 27 years in the United Kingdom and India with special interests in joint replacement and sports surgery. This blog is essentially made to discuss and use my experience and views for the benifit of patients, surgeons and ofcourse to recieve your comments and suggestions in dealing with complex primary and revision joint surgery.