Dislocated bipolar in an octegenarian household ambulator

The decision to do a bipolar is probably correct. the postoperative dislocation and repeated instabilty was surprising. May be a touch of decrease offset added to the instability. If these were a tripolar cup one could imagine an impingement between the neck and the large polyhead could contribute to instability.

intraop the patient had global instabilty due to possible  wrong stem versiosn and soft tissue laxity. we revised the stem with a cememt on cement smaller stem causing smaller offset and still having laxity. so intraop we decided to go for a constrained liner as she was low demand.  

The  final post op xrays with a the +3 head and constrained liner stabilised the hip. The cup is a touch too medial which could have been avoided.  the other option would have been a tripolar cup which could dislocate too due to impingement. The constrined liner could dissociate at the stem head junction if tested as well as wear more quickly

Oops! post acl recon

The patient feels that his knee is not right. He has a 3 degree ffd, full flexion

Femoral component loosening in a ha coated stem in one year

The questions asked were whether revise only the stem and secondly uncemented or cemented revision

My opinion is as follows

The femoral stem has major osteolysis,new bone formation, short duration of implantation and had problems during primary as seen by the circumferential ss wires. It is infected unless proved otherwise. One should aspirated, le test, and intraop frozen section. If you got a decent bug preop one could consider a one stage revision, otherwise be safe and do a 2 stage revision. My choice of stem will be srom and would revise both cup and stem if infected and would go for stem only if the lab is trusted and negative. You could use any modular or mono lock distal loading stem too.

revision

Patella in femur

This xray shown to me by ny colleague is again a pattern I have never seen before. the quads was torn and the distally rotated patella was foung inside the intercondylar fractured femur.