Recurrent posterior dislocation following primary posterior-stabilized total knee arthroplasty.
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In our series of 136 patients with primary total knee arthroplasty using posterior-stabilized prosthesis, a female patient with Parkinson disease developed posterior dislocation of the knee 9 months after surgery. Eventually, the dislocation became recurrent, occurring several times a day. The patient made the reposition always by herself. Two months after the first dislocation, we performed the revision of the polyethylene tibial insert and found wearing of the tibial insert's cam as an hitherto unreported cause of the mechanical instability of the total knee prosthesis. (+info)
The painful shoulder: part II. Acute and chronic disorders.
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Fractures of the humerus, scapula and clavicle usually result from a direct blow or a fall onto an outstretched hand. Most can be treated by immobilization. Dislocation of the humerus, strain or sprain of the acromioclavicular and sternoclavicular joints, and rotator cuff injury often can be managed conservatively. Recurrence is a problem with humerus dislocation, and surgical management may be indicated if conservative treatment fails. Rotator cuff tears are often hard to diagnose because of muscle atrophy that impairs the patient's ability to perform diagnostic maneuvers. Chronic shoulder problems usually fall into one of several categories, which include impingement syndrome, frozen shoulder and biceps tendonitis. Other causes of chronic shoulder pain are labral injury, osteoarthritis of the glenohumeral or acromioclavicular joint and, rarely, osteolysis of the distal clavicle. (+info)
C1-C2 rotary subluxation following posterior stabilization for congenital atlantoaxial dislocation.
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The authors report a rare complication of C1-C2 rotary subluxation in two children following posterior stabilization for congenital atlantoaxial dislocation (AAD). A patient, with mobile AAD, underwent Brook's C1-C2 fusion while the other, with fixed AAD, underwent transoral decompression followed by Jain's occipitocervical fusion. A pre-existing ligamentous laxity associated with an asymmetrical wire tightening or slippage of the wires due to rotation of the neck in the former, and the drilling of the C1-C2 lateral joints during the transoral procedure in the latter, could have contributed to the rotary subluxation. Both patients presented with persistent torticollis due to fusion in an asymmetrical position with dislocated facet joints. Rotary C1-C2 subluxation, when coexisting with anterior dislocation, has the potential to cause severe and occasionally fatal cord compression. Well defined criteria to diagnose this entity by conventional radiology exist, however, due to the overlap of anatomy, the condition is often overlooked. In the present study, three dimensional reconstruction images using helical computerized tomography were very useful in delineating the subluxation and in planning its surgical reduction and arthrodesis. (+info)
Volar plate arthroplasty of the thumb interphalangeal joint.
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The fibrocartilaginous volar plate of the thumb interphalangeal joint is anatomically quite similar to the volar plate of the digital proximal interphalangeal joint. Due to this similarity, Eaton's technique of volar plate arthroplasty may also be utilized in fracture-dislocations of the thumb interphalangeal joint. (+info)
A locked knee in extension: a complication of a degenerate knee with patella alta.
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We present a case of superior dislocation of the patella trapped by interlocked osteophytes. Unlike previous reports, in which the mechanism resulted from a blow to the inferior pole, it is postulated that increased load on the extensor mechanism, combined with patella alta and patellofemoral osteophytes, caused locking of the knee in extension. (+info)
A modular femoral implant for uncemented stem revision in THR.
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We present the early results of 142 uncemented femoral stem revisions using the modular MRP-Titan system. There were 70 cases with marked preoperative femoral bone defects (Paprosky type 2C and type 3); and bone grafts were used in 31 cases. At a mean follow-up of 2.3 years five cases were re-revised due to dislocation and two due to aseptic loosening. The mean Harris hip score improved from 37.4 preoperatively to 92.4. In 122 cases progressive bone regeneration on X-ray was seen; and no further osteolysis was observed. (+info)
The Wagner revision prosthesis consistently restores femoral bone structure.
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The short-term results are reported for 43 hip revision operations with the long-stemmed Wagner prosthesis. The patients were followed-up for an average of 25 months. The Charnley scores were; pain 5.2, movement 4.0 and walking 4.0. All patients except one showed abundant new bone formation. The stem subsided more than 20 mm in 5 patients and in 22 the subsidence was less than 5 mm. The major complication was dislocation, which occurred in 9 patients; 8 of these were reoperated and from then on remained stable. (+info)
The management of intracapsular fractures of the proximal femur.
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The optimum choice of treatment for an intracapsular fracture cannot be based purely on the radiological appearance of the fracture and on the age of the patient. Although these are the main considerations many other factors need to be evaluated for each individual patient. Figure 1 gives a flow diagram which helps to aid decision in treatment. The intracapsular fracture should not be thought of as the unsolved fracture. Internal fixation is indicated for selected fractures. Some require arthroplasty and for others either treatment can be used. The clinician must assess each of the individual risk factors for healing in each patient, and then decide if the risk of failure of internal fixation is high enough to justify replacing the femoral head with an arthroplasty. (+info)