22 years post bilateral revision in a spondyloepiphyseal dysplasia

This was a bil revision done in 2002 for failed bil MOP surface replacament with MOP. came with groin pain and pain on wt bearing . bone scans were normal. no cysts but  superior poly wear  ( enduron poly)was close to Metal on metal articulation. hence revision was planned. surprisingly the cemented cup on the rt showed hardly any wear

Revision was planned to change poly and head. Unfortunately JNJ has with drawn the  implants  so new poly liner and ceramic head  was unavailable.

 Plan A . was to cement a cemented cup after roughening the inner surface  of the cup and change the head

Plan b. If femoral taper was damaged to go for a full revision.

 as taper was not damaged a cup was cemented after roughening with a carbide disc and burr and metal head was changed

 

MYSTERY WRIST

 Presents 3 months after a twisting injury preventing a bike from falling.

.Pain after splinting by a doc in Mumbai. one week after injury. clinically gross limitations of all movement. .scaphoid tenderness. Watsons test not possible due to pain. 

 Xray lt wrist shows ? absent proximal  pole of scaphoid. 

 on top of all this patient blames the doc who splinted him and told that nothing can be done and to come back when it becomes painful.  

Ulnar deviated Xray reveals the mystery. Watch the dead vertical scaphoid 

Pt had a SL dissociation with a distal radial fracture and a bony avulsion of the ligament. explained the option of scope arthrolysis and scapholunate reduction and  repair/ recon of SL. Pt wants surgery here and physio in Mumbai so asked him to go to mumbai surgeon as post op physio is important and as it is his symptoms are vague( no pain) and blames doc for his predicament. One can only treat patient with symptoms and who wants to improvement. So stuck to identifying the problem and  suggesting solutions for him to take a call

 

ULNO CARPAL IMPINGEMENT WITH CENTRAL TEAR OF TFCC TREATED WITH A SCOPIC WAFER PROCEDURE

 

POSTOP PICS ON THE LT 

22 years after bil revision hip in a spondyloepiphyseal dysplasia

Painful lt hip( groin )

 negative  bone scan

 stress shielding. metal head starting to impinge in this  reg poly over 28 MOP bearing

Plan.A Cementing a new poly liner and change of COCR  head in short supply as implant being discontinued

 Plan B  is full revision

. 

 

rheumatoid elbow post elbow replacement

 

 ROM  30 to 100@ 4 weeks active flexion and passive extension to protect triceps repair till 6 weeks