mylesclough at shaw
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Apr 9, 2008, 8:48 AM
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[Orthopod] Re: Bilat hip and knee pain
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I would have to wonder how much of her knee pain is referred from her
hip. I would inject some local anaesthetic into one or both hips to
shed some light on this aspect. An evaluation of her spine would also
be helpful.
Even if she still does have significant knee symptoms I would have to
assume that her primary problem is the hips. She should have
bilateral total hip replacements and with that might well be able to
manage her residual knee problems. The hip operation is a difficult
one because of the deformity caused by the previous osteotomies and I
personally would refer her to a team specializing in complex hip
problems. If I had to do the surgery in person I would do the
acetabulum first, then an osteotomy at the previous osteotomy site,
hold it temporarily with a plate(s) and clamps then prepare the femur
for a long stem fully coated cementless femoral component getting
most of the fixation below the osteotomy. To help plan the osteotomy
you might print the xrays onto paper and try various cuts. I did
wonder about a dome shaped osteotomy at the lower end of the
deformity, but I suspect there would be significant offset after that
so the cavities of the two fragments would not line up. A closing
wedge osteotomy would be simplest but would lose length and might
increase the instability of the arthroplasty. Obviously, careful
planning would be required. I would be most interested to hear the
opinions of others.
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!?
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> >
> <Hip.jpg><Knee.jpg>
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