60 years old lady known diabetic and hypertensive underwent partial hip replacement for fracture neck of femur in 2012 elsewhere. Patient had continuous pain on walking and was unable to walk without walker after this operation. With these symptoms she presented to us in 2013 and on examination loosening of the prosthesis was diagnosed and total hip replacement was done after removing the old implant.
Patient was walking normally for about 3 years post operatively when she again started with gradually increasing pain in hip region and inability to bear weight on affected limb. X ray showed the acetabular component had migrated in the pelvis with large defect in the acetabular floor.
She was again taken for surgery and acetabular revision was done using large trabecular metal cup. Patient is relieved of the earlier symptoms post operatively and started ambulating on second post operative day.
70 year old female known case of diabetes and hypertension had underwent bilateral total knee replacement 11 years ago (elsewhere). Recently she had history of 2 episodes of dislocation of left knee 2 months apart following minor trauma. Both dislocations were managed in hospital elsewhere. She came to our OPD with complaints of instability left knee joint and pain. On clinical examination knee was unstable more so in flexion. Patient was planned for revision total knee replacement left side. Rotating hinge knee prosthesis was used after removing the previous implant. Patient is asymptomatic and is normally bearing weight on the left leg.
60 year old female known case of Rheumatoid Arthritis had a history of left hip painfor which surface replacement was done in 2005 and totalhip replacement (THR) in 2013 (elsewhere). From last 1 year patient again has pain in left hip and is not able to bear weight on left leg. With these complains patient presented to us and on clinical examination there was significant shortening of left leg and x-rays showed the acetabular cup migration into the pelvis (protrusio).Revision total hip replacement was done and special implants were used to augment the defect in acetabulum. Patient was walking with walker support on second post operative day, she is relieved of pain and has regained limb length.
62 year old gentleman had undergone total knee replacement in 2011 for arthritis of both knees (operated elsewhere). Following this surgery patient had persistent pain, inability to bear wt. On right leg and fever. Multiple surgeries were done with no relief and patient also noticed loss of extension of knee post operatively. Repair of extensor mechanism and a two staged revision knee replacement was done in Chicago but none of the symptoms improved.
With these symptoms patient presented to our OPD and investigations were done which suggested patient had persistent infection of right. Knee joint and extensor mechanism failure. Patient was planned for a two staged procedure and it was explained to the patient. In the first stage the implant was removed and extensor mechanism was repaired and an antibiotic impregnated cement spacer was used to fill the defect.
After 4 months when markers of infection were normal patient was taken for a second stage procedure and special knee replacement implants were imported to overcome the bony defect left after revision procedure. Patient was walking with walker on second post-operative day; he is relieved of the earlier pain and is extending the knee normally.
61 year old female had history of trauma right hip region in 2011 . She was diagnosed as fracture of right hip region and was managed elsewhere with internal fixation with a nail. Following this surgery patient was unable to walk without walker support and was not able to bear weight on the affected leg because of pain.
With these complaints patient presented to our hospital. X ray showed that her fracture had not united and the nail had broken inside the bone. Implant removal and total hip replacement was done and patient was mobilised on the second post operative day.