Severe Heterotopic ossification bilateral hip

40 yr old HO post head injury  and femoral head fracture with grade 4 Brooker HO and a non healing posterior wound post previous  attempt at excision.

 

 Pre operative  Radiation on the day of surgery was done to reduce  recurrence stimulan with antibiotic and an acetabular  cement spacer  inserted and wound closed with VAC to eliminate dead space was done. Standard 6 weeks 2 bactericidal antibiotic and antibiotic free 6 week window was done before  a constrained liner and THR was done again with VAC. The second time intra op cultures are awaited. the rt hip has a jog of painless movement at present. 

Should meniscal root lesions add a different grading to SCHENK MILKI GRADING

RTA  leading  to ACL, PCL LCL,PLRI - Anterior root lateral meniscus  with posterior dislocation of meniscus  and radial tear medial meniscus. Did one stage MLKI recon and meniscus repair. one stage reconstruction started with anterior root reduction and repair with radial medal meniscal tear repair followed by acl pcl  reconstruction and Lateral Recon as per Kim's technique. Has stable painless knee at 1 year with loss of last 10 degrees flexion and loss of hyperextension which was present on his normal knee.  The patellar fracture was treated conservative and flexion X-rays showed no displacement. The root avulsion and radial tear adds a dimension to tge results. Believe meniscal healing is also better but stiffness may be higher.

Should we add meniscal injuries to the Schenck classification to help stratify the results.

 

1 year postop X-rays

 

Short and conical stems - do they have a role

The role of short cone grit blasted prosthesis  in primary have been proven. In revision going short and thick has few published  series but has something to think about to preserve the bone for further revisions

Here  the distal hole has been bypassed by 2.7 cm but not fitting and is conical

 

Patellat tendon avulsion in 12 year post tkr after a fall

Managed with percutanoeus quads to tibia by pass with neoligament with full function at 6 weeks.Using hamstring in the 90s caused ext lag  and decreased strength. started with inquinal hernia mesh for ext tendon dysfunction in early 2000 and finally we have a simpler reproducible  solution for there extraarticular injuries

 

18 years post revision of a hemiarthroplasty

Cemented c stem and MOP bearings with nil symptoms to date.  Cementing a stem in a loose uncemented Austin Moore  could be an  issue if all th cancellous bone is abraded off  with no cancellous bone to anchor 

 

Surprisingly no sinkage or major poly wear

The cement bone interface has been static to date