Rising numbers of elderly parents living alone need an aggreesive metabolic management of osteoporosis. we are seeing an epidemic of insufficiency and periprosthetic fractures thsi fortnight. Better methods other than BMD measurements are needed to control bone and muscle loss. Do we need to routinely use bone resorption markers as the BMDs dont match the porosis when do the Bone cuts in TKR. Quick stable fixations as seen above are needed in these patients to get them back on there feet soon div class="separator" style="clear: both;">

Meniscal Transplant -Post menisectomy medial in a 24 yr old

Dislocation in a post stroke patient one montg postop

posterior impingement and anterior disloccation wad the cause. as he was a post strone one month, a constained luner or dual mobikty was the choice. A constrained option was chosen after discussion with the family. was pleasant surprised to see ingrowth in cup at 6 weeks. /a>

Does sagital alignment have a role

Dislocation in Thr post fracture neck of femur

Dislocation post THR in elderly is an issue which can be avoided by using larger head diameter, Tighter soft tissue with correct verical and horizontal offset. Good soft tissue repair is possible and may be avoid southern approaches The case below had stem sinkage causing lax soft tissue and retroverted acetabulum. A cemented stem to correct the vertical and horizontal offset and constriained liner was used as the posterior soft tissue were deficienct and patient was elderly.

Proximal bone loss in distal loading stem rt srom was revised due metal ions going up after 14 years. rt side was coc

one stage bil thr in ddh

lt hip had an abductor lurch 3 month postbil THR . Both were done with a hardinge approach, COC bearings with cone prosthesis as 2 offset options were available. The lurch on the lt persisited, pt has history or surgery on lt side for ddh as an infant and now has trochnateric overgrowth. . Should I consider distalising the trochanter to reduce jt forces

THR is stiff spine - Stuck Sitting

Case of stiff spine in an outlet view  suggesting a stuck sitting position. To avoid anterior dislocation a neutral version and closed cup with a nonmodular dual mobilty cup was chosen

 

popliteomeniscal fascicle repair

patient felt a lateral pop. Figure of four test was -ve. felt unstable with lachmanb1A and negative pivot shift. Lateral meniscus had a small bucket handle tear and lax anterior meniscopopliteal fascicle. could subluxe lateral meniscus by 50 percent at the anterior part of pop hiatus and less posteriorly

Knee replacement Malunited T Tibial plateau

At 75 we opted to retain the plate and avoid stems

 

Painful DDH in a pt with Prior Limb lengthening done

 

Postop the limb was perceived to be long

The postop Pelvic tilt was suggested as the IT band being pulled due to the lentgening

3 month wt bearing xray showed a corrected LLD

Was caught out by un noticed limb lengthening done as a kid Happy to see her today standing on operated leg with no limb at 6 months without an abductor lurch( modified Hardinge approach) She is off to canada for studies and our entire team wishes her well

Proximal bone loss in art distal loading solution stem compared with proximal loading distal fitting srom MOM on lt side

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Paget’s disease with bowed femur 12 degrees Varus and 12 degrees flexed

The options of navigated and robotic replacement were offered. Settled for a simpler local custom made distal cutting jig , followed by gap method for a Varus valgus stabilised knee 

 

  

  

Revascularisation of acl allograft