MOM METASUL 23 YEARS POSTOP RT

 

 23 YEARS POST RT HIP REPLACEMENT WITH MOM HIP ANDS 10 YEARS POST LT HIP COC , NOW CAME WITH PAIN LT HIP.  NO SYMPTOMS WITH 28 MM METASUL HIP MOM WITH POLYETHLENE SANDWICH IN 23 YEARS. THE IMPLANT WAS WITHDRAWN WHEN SULZER ORTHOPEDICS CLOSED DOWN. AWAITING CO AND CR LEVELS MRI IS NORMAL. 

 DISTAL TIP OF LT HIP WAS HOT OF BONE SCAN

Atypical femoral fracture Lt femur

Sudden onset thigh pain? Fall reported as intermedius tear. 

20 days later comes with Atypical sub trochanteric fracture, not on bisphosphonates. 

Intraop biopsies were normal.

 

ACI Vs UNI in 54 year uni-compartmental arthritis

 We debated about ACI vs Unicompartment replacement. Weighing the options the patient opted for ACI. 

Did not do HTO as there was grade 2 wear in lateral compartment which was small lesion

lt is 9 month standing postop xray with increased joint space after ACI

 

Post ACI  9 months

 Cartilage growth even a bit hypertrophic in the medial femur justifying joint preservation. . i could be questioned about unloading the compartment  and lets see how long it lasts

unstable periprosthetic fracture post TKR in an octogenarian caregiver

 one week old injury awaiting fixation. Decided to do a distal femoral replacement so that he can full wt bear and been the caregiver  he is for his wife, at six weeks he is back taking care of his wife. adv metabolic consult for osteoporosis

 

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

 

Stage 3 ulnocarpal impingement 

 

ARTHROSCOPIC RESECTION OF THE DISTAL ULNA THROUGH THE DEBRIDED CENTRAL TEAR ROTATING THE WRIST TO MOVE THE BURR IMPROVED THE IMPINGEMENT SYMPTOMS

POSTOP PICS 

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

Instabilty post TKR due to MCL injury

Repeated falls 5 monthspost TKR with mcl laxity and mild recuravtum n a Mobile bearing knee.

Delayd  Progreesive ligamentous laxity of MCL  has been reported with LCS knees in th e past. Was the falls the issue or the ligament the initial trigger is unknown. There was also a hint of ? malrotation with no stiffness

Gross mcl laxity is best adddrssed by a good RHK joint to get 20 to 30 years. Varus/valgus constraints do better with LCL injuries and is less predictable with mcl injuries including repair in TKR

 

Malunited childhood proximal femoral fracture with SUFE and OAhip and valgus knee,anke and degenerate spine

 Type 2 valgus degenerate  spine with painful malunited proximal femur with old SCFE hip,

Lt.  hip was replaced  4 years ago. CT  revealed an eccentric canal at the malunion. 

Planned  and executed plan B with a drill sleeve and k wire  inserted centrally under imaging and end cutting reamers used to get central and by pass the  deformity and a cemented  polished stem  and mobilised . 

Awaiting the valgus knee and ankle correction at 3 months