Two stage Revision TKR with RHK and Stem Extender and Metallic Augment

62 years gentleman presented to us with infected Right TKR which was performed 1 year ago elsewhere.

A 2 stage revision TKR was planned. In the first stage primary prosthesis was removed, thorough debridement was done and customized, mobile antibiotic cement spacer was placed in situ. Antibiotics were given for a total of 6 weeks till the infection was eradicated. 8 weeks later 2nd stage revision TKR done with RHK (Rotating Hinge Knee) and Stem Extender and Metallic Augment ( Distal and Posterior Femur Augments / Wedges).

Patient is comfortable and walking pain free with full weight bearing with no sign suggestive of recurrence of infection.

Revision TKR in the scenario of infection is challenging. At our center we have successfully managed many such cases.

Revision Total Knee Replacement With Megaprosthesis

39 male gentleman presented to us with infection of left side knee. He had a history of proximal tibial tumour (osteosarcoma) which was treated by tumor resection and endoprosthesis 1 year back. He was in severe pain and was unable to bear weight on left side lower limb. Managing Infected Knee Replacement is a challenge and very few centres in India are managing these cases.

We at our centre follow 2 stage protocol for treatment of these case. In 1st stage the implants are removed and thorough debridement is done to clear of all the infection and antibiotic spacer are put for 3 months to clear the residual infection.

In 2nd Stage the antibiotic spacer are removed and revision Total Knee Implants are put. Patient can walk from 2nd post op day after this surgery. After surgery our patient is comfortable and walking independently. There are no signs of residual infection.

revision-total-knee-repllacement-t-k-r-of-deepak-agarwal- by Dr Shekhar Agarwal

Acatabular Fracture to THR

56 years old gentleman from Allahabad, sustained polytrauma 3 ½ months back with neglected fracture acetabulum left.

On examination hip was dislocated and femoral head was deformed. We planned uncemented Total Hip Replacement for the patient. THR in fracture acetabulum is challenging due to distorted anatomy and deficient bone stock. We reconstructed acetabulum with femoral head anatomy and used specialized continuum cup. Postoperatively patient is comfortable and walking with the help of walker.


PFN to Bipolar

75 years old overweight gentleman who sustained intertrochanteric fracture femur left and underwent surgery with Zimmer Natural Nail (Long PFN) with uneventful post-op period. However he develops implant failure, after about 5 months of surgery he was unable to walk. He was again planned for surgery in the form of Implant removal and Bipolar (Hemireplacement) of hip. Postoperatively patient is comfortable and walking with the help of walker.


Re-Revision Total Hip replacement

74 year old female is a follow–up case of recurrent dislocation post THR Left which was managed by dual mobility acetabular cup in October 2016. At 6 months she presented to us again with re-dislocation of the Acetabular cup and fracture acetabulum. Managing recurrent dislocation along with bone loss is a challenging problem.

In this case we did Re-Revision Total Hip replacement with reinforcement with cage. Postoperatively patient is comfortable and walking with the help of walker.