mylesclough at shaw
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Apr 9, 2008, 9:05 PM
Post #1 of 1
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[Orthopod] Re: Bilat hip and knee pain
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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
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> >
> <Hip.jpg><Knee.jpg>
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