67 yrs old lady who had undergone revision total knee replacement (rotating hinge knee) 1 year ago fell at home and sustained a Periprosthetic fracture around tibial stem.
The tibial component was well fixed and therefore we chose to fix the fracture. This was done by using 2 plates to achieve good fixation as seen in the post operative x-rays. She will have to ambulate with protective weight bearing until the fracture unites.
77 years old gentleman underwent Left Knee replacement 4 years ago. He presented with severe pain and swelling in knee. Infection markers were highly raised and pus was aspirated from the knee. We were unable to grow any organism. Treatment of infected total knee replacement is highly challenging as it is very difficult to eradicate infection in these cases.
We did 2 stage revision total knee replacement. In first stage all the previous implants were removed and thorough debridement was done. Mobile antibiotic cement spacer was used so that the patient can remain mobile during the 1st stage. Broad spectrum antibiotics were given for 6 weeks. After 3 months the infection markers returned to normal and we proceeded for 2nd stage surgery.
Rotating hinge knee implants were used to substitute the deficient collateral ligaments. Post-operative X-Ray show rotating hinge knee prosthesis. Patient is recovering well from this extensive surgery
66 years old lady presented with pain, limp and inability to bear full weight over left lower limb for the past 1 year.
Patient had history of surgical intervention done elsewhere in view of proximal femur fracture 1 year back. Fracture was fixed with short PFN A2. Surgical site has been healed with primary intention and has no sign of infection. Her blood investigations were also come to be within normal limits.
Present X-Ray showing non union fracture proximal femur with Failed PFN in situ.
Thus planned for PFN removal and conversion to UNCEMENTED (DUAL MOBILITY) THR with long stem to bypass the distal screw.
Post op showing well press fit uncemented Total Hip Replacement (THR) with dual mobility cup to enhance the stability. These cases are challenging due to presence of ununited fracture in proximal femur and needs extra care for stability. We routinely do these cases with good outcomes using special dual mobility cup concept.
Now patient is happy, walking comfortably with support.
57 year old gentleman came to us with complaints of pain in right hip region and inability to walk and bear weight over right lower limb. Patient had past history of trauma to right hip region in the form of fracture acetabulum for which patient underwent primary fixation and Total Hip Replacement elsewhere in 2018. Subsequently patient developed dislocation of right Total Hip Replacement (THR) and underwent revision of acetabulum constrained component at our institute. Patient developed surgical site infection and re-dislocation of previously done hip and came to us for further management.
Pre-op X-Ray pelvis with both hip joints showed dislocated hip with implant in situ
Patient planned for meticulous debridement and definite management for recurrent dislocation of hip. These complex cases required appropriate surgical planning and special surgical instrumentation. Because of previously done multiple surgeries leads to laxity of soft tissues and increases the risk of infection.
This patient underwent thorough surgical site debridement to wash out the infection and one stage re-revision Total Hip Replacement (THR) was done using cemented constrained acetabulum. The femoral stem was also revised to a cemented stem.
77 year old gentleman had underwent Right total knee replacement in 2017 elsewhere in view of secondary Osteoarthritis (post tubercular). Subsequently patient developed surgical site infection after 3 months of the index procedure and came to us with no relief in symptoms.
We have done 1st stage debridement and cemented mobile spacer was inserted in 2019. After 2 months of subsidence of infection, 2nd stage specialized revision implant (rotating hinge knee) was done. At follow up – Patient is asymptomatic and walking with support.