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

@1

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

 

Z shaped MCL tear /MCL tear is not always onesided

Z shaped MCL tear associated with  PCL and medial meniscal root tear
 root tear

16 years post revision with alumina ceramic on poly THR

has some pain Rt thigh . bloods normal/ bone scan below. waiting for a 3 month review to repaet bloods and clinical assesment.lass="separator" style="clear: both;">

74 year gentle man with periprosthetic fracture 2 years post fracture

had 3 attempts at union surgically with 2 scars. Decided to do distal femoral repalcement to get him back to his feet after 2 tears. nil infection. the risk of skin issues was discussed and had plastic backup which luckily was not needed .