55 years old lady came to us with complaints of pain in right hip with shortening of 5 cm. She had a hip replacement 40 years back which had failed. She was barely managing with a walking stick till now. She had severe pain for the last 6 months. We performed Total Hip Replacement. The acetabulum bone was inadequate which had to be supported with a special implant called Mueller’s Ring into which a poly cup was cemented. The shortening was also corrected and she now has a pain free stable hip.
55 years old lady came to us with complaints of left hip pain and difficulty in bearing weight on left lower limb for the past 3 months. She underwent hip replacement surgery (THR) in 1995 followed by revision THR (2000 & 2008) elsewhere. On Clinical examination there were no signs of infection. There was shortening of 4 cm on left side.
Infection markers were negative. Preoperative x ray showed aseptic loosening of both acetabular socket and femoral stem. There was huge defect in acetabulum.
We further evaluated this case with CT scan which showed large anterior and superior bone defect while the posterior bone stock was good. We also prepared a 3D model of acetabulum preoperatively to study the defect and procure all the implants as backup for filling the defect. This 3D model was made under the guidance of Dr Shekhar Agarwal and team.
3D printing is the latest technology in Orthopaedics where we can have actual 3D model of bone and plan our surgery accordingly. 3D model exactly replicates actual bone defects which helps the surgeon to plan the surgery.
At Sant Parmanand Hospital we have this facility of 3D printing that we use in cases of difficult surgeries. As per our preoperative planning we did revision Total Hip Replacement (THR). Allograft bone was used to fill the acetabular defect and Trabacular metal jumbo acetabular cup was used. Uncemented long stem Wagner femoral stem was used on the femur. Now patient is comfortable and walking with support.
77 years old obese gentleman who underwent bilateral knee replacement (left in 2016 and right in 2018) fell at home and sustained injury to right knee and right ankle 2 months ago. He was treated with plate osteosynthesis for fracture right distal tibia and knee injury was managed conservatively. Patient came to us with pain and instability of right knee. On clinical examination the knee was unstable and dislocatable. Pre operartive X-Ray was showed avulsion fracture of medial condyle of femur. At surgery the whole medial collateral ligament had avulsed along with the medial condyle making the knee unstable.
We repaired MCL avulsion using suture anchor and ethibond. Constrained spacer was used for additional stability . Post operative X-Ray shows perfectly balanced knee with suture anchor in situ. Patient is now able to bear full weight with the help of knee brace and we have allowed range of motion exercises.
66 years old gentleman underwent bilateral Total Knee Replacement (Right 12 years and left 5 years back ) done elsewhere.
He presented with complaints of instability, pain and difficulty in walking on the right knee. On Clinical examination there was effusion in right knee with instability. Infection markers were found to be normal and synovial fluid examination showed no evidence of infection. X-Ray was suggestive of aseptic loosening of tibia and femur.
We did revision Total Knee Replacement with Rotating Hinge knee. Both the femoral and tibial components were loose with extensive osteolysis of the femur and tibia. There was no clinical evidence of infection. Patient made satisfactory post-operative recovery.
55 years old gentleman underwent right partial knee replacement in 2019 for medial compartment osteoarthritis. Over the last 6 months he complained of pain instability and difficulty in walking. His X-Rays revealed subsidence and loosening of the tibial component (Picture).
Having ruled out infection he was taken up for surgery to convert this into total knee replacement. These cases require appropriate surgical planning to counter the tibial and femoral defect and meticulous balancing of flexion and extension gap. We routinely perform these procedure at our institute with excellent results. Post-operative X-Ray shows primary knee replacement implant with additional tibial stem. Patient is making satisfactory recovery after surgery.