drmohandesai at hotmail
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Apr 9, 2008, 9:22 AM
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[Orthopod] Re: Bilat hip and knee pain
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She needs conversion of both the hips to THRs -followed by TKR.
Hips will have to be converted in this case since the success of the TKR is all about the alignment & soft tissue balance.
With the significantly deformed mechanical axis proximally it's v. difficult to obtain the knee alignment. Even if one gets it using navigation, later conversion to THR will again change the alignment.
It' s the conversion of her hipswhich is challenging since the morphology is altered due to pelvic support osteotomy.It needs reosteotomy to orient the medullary canal right with modular prosthesis like S-ROM which will allow one to alter the version as well as horizontal offset for the stability.
Knees are easier than her hips. Exposure can be difficult due to stiffness.sizes will have to be templated carefully preop to check the availability of the smaller sizes of components so that overhangs are prevented.
Having said all these things , I would like to mention that this needs the expertise of an experienced surgeon.
mohan desai
mumbai> Date: Wed, 9 Apr 2008 04:34:20 -0700> From: bijuben@yahoo.com> Subject: [Orthopod] Bilat hip and knee pain> To: orthopod@googlegroups.com> > 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 > _________________________________________________________________
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