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.
70 years old lady had total knee replacement on both sides 15 year back. Though she was carrying on well with her left side, her right knee started paining for last 1 year. Serial x-rays and blood test of the affected side showed non infected loosening of previously implanted components.
Revision total knee replacement was performed on left knee. Previous loose parts were removed and special new revision implants inserted. The patient was started on physiotherapy and is ambulated with walking frame.
JUNE, 2015 : 61 year old lady presented to us with infection of right side knee which underwent Total Knee Replacement 3 months back. She was in severe pain and was unable to bear weight on right side lower limb. Managing Infected Total Knee Replacement is a challenge and very few centers in India are managing these cases. We at our center 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.
APRIL, 2015 : HM 63 old lady Rheumatoid and hypertensive underwent Left Total knee replacement in October 2003 . One month later she sustained fracture supracondylar femur which was managed by open reduction and plating. She presented to us 2 year later with non union of the fracture and broken plate . Broken implant was removed and expandable supracondylar nailing was done . 5 yr later the nail broke and revision Total Knee Replacement(TKR) was done. Now the patient presented to us with fracture supracondylar femur with broken implant and dislocated knee.
Previously these patients remain bedridden as no further surgery could be done but with the development of better surgical skills and implants (Mega Prosthesis) we were able to operate this patient and make her mobile once again.
JAN, 2015 : SB 50 years old lady presented with pain and instability of right knee . Patient got right side knee replaced in 2009 at some other center. Patient developed infection of the right side knee in 2010 which was managed by aspiration and prolonged antibiotics. She had a history of fall 5 months back following which whenever she tried to walk the knee would give way. As a result the patient almost became bedridden for the last 5 months. This patient underwent Right Total Knee Replacement with special implant (Rotating Hinge Knee). With this special implant we have relieved her of pain as well as given her a good range of movement of the knee. Patient is comfortable in the post operative period.