Trochlear dysplasia in an 18 year old boy

18 year old engineering student presented with recurrent patellar dislocation and pain.

O/E

positive apprehension test. tuber sulcus angle of 10 degrees

xray- crossing sign and trochlear bump present

MRI showed a convex trochlea

Trochleoplasty was done to reshape the trochlea
After removing subchondral bone from the trochlea from proximal to disatal direction and collapsing the cartilage to ereshape the trochlea.

the final ic at 6 weeks during Chondron implantation for the patella

medial patellar facet chondral defect

grade 4 medial patella r defect 3 cm circumference in a 19 year old male student. Normal TT:TG diatance. MPFL intact. No history of injury.

cartilage mapping at 6 months. this was done in 2010 has good function till date 10 years followup.

ceramic on metal cleared by FDA

It was anounced that FDA approved ceramic on metal bearing by depuy for use recently. We have been using this bearing couple over the last 2 years with no untoward problems( 11 cases with 2 year follow up). Ever since J. fishers article in j of biomechanics(2004) suggesting decrease in metal debris as well as decrease chances of liner fracture, this was an option to look forward to.

Does this reduced metal debris cause problems

will this evolve to other new bearing Viz; ceramic on oxinium bearings.

anterior column fracture with posterior hemitransverse in an 82 year old male

anterior column is displaced with an essentilly undispalced hemitransverse fracture as described by letournel.

would you fix it or treat him conservatively

or fix and repalce it ?

He was advised PTH for severe porosis 2 years before> it was deferred by the patient due to percieved immediate cost.

This patient was advised antiresorptive therapy 2 years ago. He refused and paid the price. We fixed the posterior column and used a ganz cage to cement a cup.. the trochanrteric flip was used to improve exposure. A single screw was used to stabilse the anterior column thru the cage . He was mobilised on day 3 PWB. Awaiting for the six week review.

recurrant dislocation of patella.

16 year old girl with 3 episodes of patellar dislocation.

Apprehension test positive for lateral patellar subluxation

No clinical torsional abnormality.

normal xrays

MRI- show laterally subluxed patella mild trochlear hypoplasia. No chondral damage

CT Scan- 14 degree anteversion

TT_TG distnce 23 mm

Plan- MPFL reconstruction with tibial tubercle transfer(fulkerson)

thr in dysplastic hip post pprp

32 year old financially challenged girl with painful hip. She has a foot drop . grade 4+ hip abductors and flexors

problems1. dyspalstic acetabulum

coxa calga

narrow osteoporotic femoral canal.

TKR in a valgus knee with malunited shaft of femur

68 year old gentleman whose xrays below where sent to me for opinion.

Option 1. Ideal case for CAS

option 2. If CAS is not available what next? comments pleaase

poly wear 6 years post thr

this is my own patient done 6 years ago with metal on poly( CLS with sportono cup). 2 week history of thigh pain.
ESR, CRP and cbc are normal. Bone scan shown minimal uptake in the proximal femur( gruen 1 and 5).

Impending fracture post thr

68 year old sister with an aseptic loosening. How can one advise to continue walking innthis case? Are we waiting for the inevitable fracture of femur and posterior column.

Isn't it better to revise early once loosening occurs.

THR in non unon fracture acetabulum

Case sent by C . mahajan

67 year old with 2 year old malunited acetabular fracture planned for thr

problems.

1. Is the fracture united - if not in situ posterior column plating single or double.

2. Cavitatory defect with posteriosuperior migration. peripheral reaming to widen the acetabular mouth to fix a peropheral fitting cup and particulate grafting of the cavity. The union to could be assesd from the floor.

Implants. - keep larger cups as well as pinnacle revision cup back up in case.

Gages may not be needed.

Dr mahajan felt that the acetabulum was united and did an uncemented cup without screws. He was confident of the stabiilty. I would have been comfotable with screw at least 2 of them as well as posterior plates if there was any doubtof column union. I need to get his permission to upload the post op pics

jacob

Acetabular wear one year post bipolar replacement

66 year old female sustained a fracture neck of femur in dubai and was treated by a modular bipolar arthroplasty. She presented with groin pain one year postop.

Bone scan confirmed acetabular uptake suggesting acetabular wear.

Xray showed about 1.5 cm decreased femoral offset.

1. Did this contribute to her aceatbular wear?

2. Was bipolar indicated in a fracyure neck at 66 years( active female)

3. Is metal bipolar succesful in a porotic female

options please

93 year old female came to us 6 days post injury with a subtrochanteric fracture. She had chest infection which was treated with antibiotics.

Options

proximal femoral nailing either gama/ recon or PFM

would you consider a cemented long stem (calacar replacement) bipolar to mobiise immediately. we did worry about embolisation and cement induced hypotension. The children from US could wait only for a month and hence arthroplasty was decided.

We did a long stem bipolar, mobilised day 2 and home by 6th postop day. Unfortunately patient died at home during sleep 3 weeks postop.

? pe

Distal pole scaphoid fracture with Greissler’s Grade III SL dissociation

•53 year old Female,Right Hand Dominant Doctor with H/O Fall 4 days back
•Pain and Tenderness right wrist
loacalised to radia side of wrist



Cine radography and scopy showed a conplete SL dissociation, distal pole fracture and a trapezoid fracture.

This was an unusual radial side combination injury .
We ignored the trapezoid injury and k wired the distal pole ro hamate and proximal pole to lunate to treat the scapholunate injury with some shaving of the adjoining surface SL joint to cause fibrous ankylosis . 6 weeks later the fracture united and was mobilised.

65 year old, 18 months post surface replacement in apatient for OA shoulder with cuff tear. She has a malunited shaft fracture 18 years old.

1.Was the choice coloured against a TSR due to the malunion

2. Was the cuff tear signifcant for TSR and Cap to fail....

3 Reverse shoulder would have been the option if the cuff was deficient?

The much hyped reverse shoulder has finally reached our shores. It took five years for depuy to consider bringing this implant to india. This is more difficult operation to do with a reported published complication rate as high as 25%. sHE IS 3 MONTHS NOW WITH 100 ABD,90DEGRESS FLEXION, 30 DEGREES EXT ROTATION.

Scapular notching, stress fractures, dislocation etc are reported. It is important to be tight unlike TSR where in 50% subuxation should be possible after closure for a well functioning TSR. TSR OR Shoulder capping is acceptable in the young active person as the reported rate of glenoid loosening is high at 10 years.

Sub troch nonunion for THR post shanz osteotomy

One year post subtrochanteric osteotomy and thr post shanz ostrotomy for DDH. Patient is 35 years old

jacob

The instability at the osteotomy site was posibly due to lack of stable fixation of the distal fragment,which was augmented by the plate. I feel this was insufficient and hence the non union.- ideally the stem should have been upsized. This was revised to a distal loading solution stem using an eto to remove the well ingrown Srom sleeve