45 year old Coxa Vara with secondary OA

 

ISOLATED PATELLAR LOOSENING AT 2 YEARS POST knee repalcement

immediate postop 

2 year postop

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immediate postop

 2 years post

Could not understand the cause of early patella loosening at 3 years post op. The surgical notes  and video were reviewed to look for intra-op issues and found none. No history of falls. History of intensive physio and opposite foot surgey cannot clearly explain the cause.

Intraop, the patella appeared A concave thin shell 6 mm thick at its deepest point and 10mm thick at its thickest point at the edges.

Gull wing osteotomy, Trabecular metal patella augment, allograft are the options. we decided to go for Rebarr patellar technique  as descibed  using  maxillofacial cortical screw as seen below and cemented a patella over it. at 3 months she is still good

McPherson EJ, Sherif SM, Dipane MV, Arshi A. Patellar Rebar Augmentation in Revision Total Knee Arthroplasty. J Arthroplasty. 2021 Feb;36(2):670-675. doi: 10.1016/j.arth.2020.08.057. Epub 2020 Sep 1. PMID: 32951925.

 

BILATERAL Dysplastic hips treated corail ddh stem and COC bearings 32 mm

 

DDH in an young hypermobile patient with pain

 Chasing the good medial bone with a posterior vector one could get a 48 mm cup and  28 COC bearing and an srom stem . she prsented at 6 weeks psot op with a dislocated hip without any symptoms oer episode at home. she  was ofcourse NWB but even then the without a  notable incidentthis was worrying. she had hyperlaxity in elbows and knee and was an avid dancer pre pain

Intraop the femoral version was changed to neutral or a touch retro  to remove the perceived impingement  at 3 month month surprisingly no abductor lurch and improvement in pelvic tilt

45 yr old neuropathic knee with pain and instabilty

The options of arthrodesis, wait and watch and rotating hinge was discussed. RHK had the best published results  however an 80 percent survival at 15 years was mentioned. An attempt elsewhere at regenerative medicine was attempted elsewhere which was surprising