Purpose of the study To evaluate the outcomes and complications using cemented megaprosthesis in elderly patients with distal femur nonunions (DFN). Materials and methods Between 2012 and 2016, 24 patients of DFN with an average age of 71.8 years (66-83) and an average 1.9(1-3) prior surgery was managed with distal femur replacement using cemented modular endoprosthesis. Outcomes were analysed on the following criteria: implant status, complications, knee range of motion, Knee Society Score (KSS) and Musculoskeletal Tumor Society (MSTS) score. Results All patients were extremely satisfied with their outcomes. At an average 22.1 months (10-43) follow-up, patients had an average 69.5°(40°-110°) knee flexion, an average KSS of 75.7 (63-88) and an average MSTS score of 19.3 (17-25). Four patients died at an average 21.3 months after surgery due to causes unrelated to the fracture. One patient (4.1%) had implantrelated complication; deep infection which required debridement and intravenous antibiotics. There were no late amputations or peri-operative deaths and no patient had aseptic loosening of components. Conclusion By permitting immediate full weight-bearing ambulation and with most patients returning to an acceptable functional status, cemented megaprosthesis is a viable and useful single-stage management option in elderly patients with DFN.
Purpose
Osteoarthritis of knees with varus deformity is associated with a compensatory valgus deformity of the hindfoot and a lateral loading foot pressure pattern. However, whether this abnormal loading pattern is corrected in total knee arthroplasty (TKA) is unclear.
Methods
The alignment and loading pattern of 91 consecutive patients (121 knees) undergoing TKA with pre‐operative varus more than 10° were evaluated prospectively with functional outcome scores, static conventional radiography and dynamic pedobarogaphy pre‐operatively and 1‐year post‐operatively. Outcomes assessed were Oxford Knee Scores, American Orthopaedic Foot and Ankle Scores, femorotibial mechanical angle, tibia–hindfoot angle, hindfoot valgus/varus index (VVI), foot line of pressure (LOP) laterality and peak pressure (PP) at both time points.
Results
Of 121 knees, 98 (81%) regained normal alignment of the knee and 114 (92%) of the hindfoot. Similarly, PP (p < 0.001), VVI (pre‐operative: − 0.29 ± 0.22, post‐operative: − 0.04 ± 0.23, p < 0.001) and LOP laterality (pre‐operative: 7% medial, post‐operative: 96% medial, p < 0.001) all medialised post‐operatively. All patients had improved functional outcomes at the knee (pre‐operative: 20 ± 2, post‐operative: 40 ± 2, p < 0.001) and ankle (pre‐operative: 59 ± 10, post‐operative: 89 ± 6, p < 0.001).
Conclusion
The present study shows, following the correction of knee varus with TKA, hindfoot alignment and foot loading pattern are both restored in the majority of patients. TKA offers both static and dynamic correction as seen in the hindfoot and loading pattern, respectively.
Level of evidence
Level III: prospective case–control study.
Floating hip injuries involving the acetabulum, femoral head, and the femoral shaft are a very rare presentation. A complex floating hip injury comprising of an ipsilateral acetabular fracture associated with a displaced femoral head fracture and a femoral shaft fracture following a high-velocity road traffic accident presented to us where all the fractures were addressed with internal fixation during the primary surgery. Postoperatively, the patient suffered a dislocation of the femoral head which eventually went on to avascular necrosis at 5 months from the initial presentation. Then, the patient underwent a total hip replacement with an acetabular reconstruction following which he went on to have a good functional outcome. Our experience in dealing with such a complex case shows that it is difficult to set a protocol for such injuries and they need to be addressed on a case-to-case basis depending on the complexity of the injury.
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