bijuben at yahoo
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Apr 17, 2008, 7:01 PM
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[Orthopod] Bilat hip and knee pain
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As suggested by Dr. Myles Clough and his colleagues we are still in search of a "taker in a big city" for the patient. We have many "buses" out of here but not many "willing destinations". Will keep you all posted about the case.
Dr. Biju Benjamin
--- On Thu, 4/10/08, Myles Clough <mylesclough@shaw.ca> wrote:
> From: Myles Clough <mylesclough@shaw.ca>
> Subject: [Orthopod] Re: Bilat hip and knee pain
> To: orthopod@googlegroups.com
> Date: Thursday, April 10, 2008, 9:35 AM
> I showed this case to some colleagues and garnered some
> additional
> ideas.
> Number one suggestion was a bus ticket to the big city!
> If you have top of the line equipment and experience a
> one-stage
> operation like I (and Dr Desai) suggest might be the way to
> go.
> However, if your resources are more limited, a two stage
> procedure
> might be better and has the advantages that a) you can back
> out b)
> you can use more standard components.
> At the first operation do a posterior approach and resect
> the femoral
> head; then take down the osteotomy and insert a standard
> reamed
> intramedullary rod, locked proximally ( and distally if you
> think it
> is needed). Bone graft depending on how good the contact is
> at the
> osteotomy site. Now you have a Girdlestone arthroplasty
> which is
> probably better than what she has now - if you never get to
> do the
> second stage.
> After 6-8 weeks there should be good callus formation; now
> you can
> extract the rod and do a more or less conventional total
> hip
> replacement with a long stem. Posterior approach is
> suggested because
> it may be easier to insert the IM rod through that
> approach, but it
> would not be impossible to use a straight lateral approach
> and either
> one should give you access to take down the osteotomy.
> Could we see laterals? The left side looks as though the
> osteotomy
> has healed with a good deal of AP offset.
> Would anyone use mini components and leave the osteotomy
> alone?
> Resurfacing arthroplasty?
> Myles Clough MD FRCSC
> Orthopaedic Surgeon, Retired
> Kamloops, BC
> mylesclough@shaw.ca
> Clinical Instructor, University of British Columbia
> Associate Editor, Orthogate www.orthogate.org
> Editor, Orthopaedic Web Links (OWL)
> www.orthopaedicweblinks.com
>
>
>
>
> On 9-Apr-08, at 4:34 AM, Biju Benjamin wrote:
>
> > Dear colleagues,
> > The Xrays attached are of a lady who presented
> > with bilateral hip and knee pain. She is 54 years of
> > age and about 4.5 feet in height. On examination she
> > had fixed flexion deformity of both hips of about 30
> > degrees with no further movement. She has bilateral
> > knee valgus. The range of movements at the knees is
> > about 10 to 60 degrees. While she is ambulating, it is
> > with severe pain and limp.
> > In the past she has had bilateral hip surgery
> > (proximal femoral ostetomy when she was 17 years old
> > for a possible hip subluxation). No old records are
> > available.
> > Her immediate problem is the knee pain. What could be
> > best done for her? X-rays are attached. Looking
> > forward to all of your valued opinion.
> > Dr. Biju Benjamin
> >
> >
> > __________________________________________________
> > Do You Yahoo!?
> > Tired of spam? Yahoo! Mail has the best spam
> protection around
> > http://mail.yahoo.com
> > >
> > <Hip.jpg><Knee.jpg>
>
>
>
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