Arthroscopic PLRI reconstruction

While preparing for a talk on PLRI, I was shown ( By Dr. Biju my colleague) a Chinese article in arthroscopy July issue where in they did a arthroscopic PLRI reconstruction. The description appears doable using a trans- septal portal. Has any body tried it do date.

Total knee replacement after High tibial osteotomy is sometimes challenging, Prior incisions, meta-diaphyseal deformity, interfering hardware, Patella Baja add to the problems. Here is an example of a 20 degree valgus following an HTO 5 years back. any suggestions or comments please.

Here are the postop pics with a metaphyseal osteotomy. Only the interfering screws were removed. Prior lateral skin incision were extended proximally in the midline from the junction of the lateral transverse arm and vertical arm with nil skin problems.

DO WE CALL THIS ORTHOPEDICS

Finally after all the comments. Lets show you what happened. The patient is financially challenged and has INR 10,000. We collected around and decided to revise the the worn out acetabulum as that was causing more pain. Our plan was to remove the bipolar and remove the distal broken stem through a knee arthrotomy and punch it out through the intercondylar notch with an oats recipient instrument induced access. Unfortunately we found some clear fluid from the hip and therefore did not want to contaminate the knee. While waiting for the frozen section, cell count and g stain we did a femorotomy and removed the distal implant. As the femorotomy reached the diaphyseal flare we had to choose a locking stem in this case Reef(HA coated) with ceramic on ceramic bearings . she is mobilising with a single stick now and now wants revision of the dislocated hip which possibly could be done with a primary stem with a large bearing. I would be glad if there are any takers for doing the same as she is broke. She would about 200000 for HARD ON HARD LARGE BEARING THR.The first surgeon who is an orthopedic hospital owner apparently has washed his hands off and lives a semiretired life comfortably.
Points for discussion.
1. Rule out an metabolic cause in a 36 yr old female with bilateral # nof.
2.Adequate fixation of neck of femur. DHS is easy with a derotation screw. A gamma nail may be more indicated in elderly.
3. No role for hemi arthroplasty in young active patients even if financially challenged.
4. Does IMC need to debar and penalise the criminal who did this?
jacob

36 yr old female auxillary nurse sustained what appears a bilateral # neck of femur ( ?metabolic cause) had the following set of surgeries done free by I believe an orthopedic surgeon. The final xrays before revision is on the left and what serial xrays available are below. your comments on what was done and what to do?

ACL Reconstuction.

Over the past 10 yrs there is a rising no of Cruciate ligament injuries at a ratio of 10:1 ACL/PCL ratio. May be the awareness is increasing in Gods own country or the vaidyans are being left out, Even the Vaidyans are asking for MRI before referring or treating the same. The changes in technique in my practise has been double bundle reconstruction when young,sporty and affordable and single bundle reconstruction with the femoral tunnel being at 10'o'clock to better control rotations. AM on tibia and PL on femur. As far as fixation goes we do endobutton with aperture screw on femur and intrafix on tibia. At one year followup we have not seen any functional difference between the two.

My take on bioscrew at both are 1. On the femoral side i end up damaging part of the graft occasionally and on 2 occasion my entire graft pulled out of the femoral tunnel on tensioning before tibial fixation. This has not happened yet with a suspensory fixation like enobutton or transfix.

profound venting by an orthopod

How objective are we when we counsel our patients with regards to options of treatment. The bias one has as we get older, technology availabilty, expertise, ignorance, financial and other benefits cloud ones Lt. frontal lobe.

The way out would be objective independent audits published by the department for the patient to compare the local results with the best international to make a choice. The science editors in the newspapers follow what the advertising company tells them without an indepedent check. The not so recent advert about key hole knee replacement is an example where even The Hindu Newspaper printed the same. The nexus between service providers and customers (MRI, CT scans, lab tests and commission paid to doctors for referral) are compromising the quality of care.

Orthopedic training to pass the exams are akin to entrance coaching( The license to cut). No lateral or objective thinking. The examiners both young and old still want students to mug up all those lines(Chinnies) and tests like Thomas and Bryants triangle etc which has no relevance today. The discussions on objective management are short and swift. Medical colleges both Govt. and private are not being objective to improve and inspire future doctors. If we do not give the best inspired training we ourselves will be the geriatric guniea pig in time.

Relicensing was talked about some time back. At least mandatory seminars to qualify. Not just holiday trips for chilling, wife's shopping etc.. Lectures given from text books which are ancient as atharavveda. Lecturers selected for their age and contacts,marketing potential and not for quality. Conferences to market, advertise and now to make money as one's primary trade is less renumerative or is it multi tasking. Where are we heading?

Jake

36 yr old rt handed male fell down after "ethanol" use on a monsoon weekend. Sustained an undisplaced scaphoid. Postop xrays at 2 months when he is left free of pop. Back to work driving himself. There was communition at the radial and volar border. The xrays out of pop which will be uploaded in due course as the xrays are with the patient. You don't need to removed the screws and if you need to due to infection etc god help us