Robotic arm-assisted arthroplasty was introduced in 2006 and has expanded its applications into unicompartmental knee, total knee, and total hip replacement. The first case of a revision surgery from conventional unicompartmental to total knee arthroplasty with the utilization of the robotic arm-assisted MAKO system is presented. An 87-year-old female presented with deteriorating left knee pain due to failure of medial unicompartmental knee arthroplasty at the outpatient clinic. The patient was advised to undergo revision surgery. Through medial parapatellar arthrotomy, the joint was exposed. With the use of the MAKO system, the estimated depth of the medial plateau according to CT planning was found to be 10 mm more distal than the lateral. The resection line of the remaining plateau was placed deliberately 2 mm more distal in order to achieve satisfactory replacement of the bony gap of the medial tibial condyle by a 10 mm augment. The patient had an uneventful recovery. A plethora of additional applications in the future, such as total shoulder or reverse total shoulder arthroplasty, megaprosthesis placement in oncological patients, and total hip or knee revision surgeries, may improve patient-related outcomes.
Patient: Male, 42-year-old Final Diagnosis: Bilateral quadriceps tendon re-rupture Symptoms: Disability • pain Medication: — Clinical Procedure: — Specialty: Orthopedics and Traumatology Objective: Unusual clinical course Background: Bilateral simultaneous quadriceps tendon rupture is a relatively rare injury, more commonly seen in patients older than 50 years and is usually associated with underlying metabolic or inflammatory diseases. Case Report: We report the case of an otherwise healthy, 42-year-old man who sustained a bilateral, quadriceps tendon rupture while he was trying to pound a branch of an olive tree into the ground. On clinical examination, a defect in both proximal patella poles was found on palpation, with complete discontinuity of the extensor apparatus. A meticulous surgical repair was performed using 3 bone anchors with an uneventful postoperative rehabilitation. A biopsy specimen taken at surgery showed evidence of chronic inflammation. He had a second episode while walking fast on the beach 3.5 months postoperatively, and presented again with bilateral quadriceps rupture. He was successfully managed with bilateral allograft reconstructions, showing a very good outcome at 18 months of follow-up. Our systematic literature review covering a 20-year period (2000–2020) revealed 10 articles on bilateral quadriceps ruptures in 14 healthy patients without comorbidities. All these injuries occurred in males, with a mean age of 56.8 years, during walking, descending stairs, or participating in recreational sports; the functional outcome was good to excellent in most cases, without any reported re-ruptures. To the best of our knowledge, no similar case has been reported in the literature. Conclusions: Bilateral quadriceps tendons rupture is a rare injury, especially in young patients without associated comorbidities. The risk of recurrence is low, but when it occurs, more complex techniques of reconstruction are needed.
Introduction: 2 years after the SARS-CoV-2 outbreak which is responsible for the COVID-19 pandemic, the clinical presentations remain unclear and unpredictable. The disease can present with a heterogeneous clinical course and a wide spectrum of clinical manifestations which can cause various complications from different systems, including musculoskeletal. Case Report: The case of a young, fit, and healthy female patient with severe onset of hip pain which started only shortly after being tested positive for COVID-19 infection is presented in this study. There is no history of rheumatologic disease. Clinical assessment did not show any signs of erythema at the hip region, however, on palpation, there was significant tenderness at the anterior aspect of the left hip joint. The patient was unable to bare weight on this hip and could not straight leg raise, and the rotation of the hip was severely restricted due to underlying pain. The nasopharyngeal swabs for SARS-Vo2 were performed and came back positive. The CRP was 205 (μοναδα μετρησης ) and plain anteroposterior radiograph of the pelvis did not show abnormalities. A diagnostic aspiration under sedation in theaters was offered; the culture and enrichment were negative for infection. Since the symptoms were not improving with conservative measures, an open washout of the joint cavity was performed in theatres. The microbiologists guided on the antibiotic treatment and adequate analgesia was prescribed. Symptoms settled very soon after the open procedure and the requirements for analgesics were reduced to minimal use. The following couple of days, the pain, range of movement, and mobility significantly improved, and the patient returned within 2 weeks back to her normal activities. The rheumatologists organized a complete screening which ruled out elements of seronegative disease. In the final, 6-month follow-up, the patient was totally symptom free, and the blood markers were entirely unremarkable. Conclusion: This is the first case of COVID-19-related, hip arthritis recorded worldwide, in a patient without any predisposing factors. Clinical suspicion is the key for early diagnosis and treatment for every COVID-19-positive patient with musculoskeletal symptoms, even for the patients with no history of autoimmune diseases. Viral-related arthritis remains a diagnosis of exclusion and underlies the importance to perform all the test to rule out other possible inflammatory arthritis. Our experience showed that early irrigation of the joint cavity is related with efficient symptoms relief, less requirement for analgesia, less time in hospital, and quicker return to daily activities. Keywords: COVID, arthritis, acute, hip
Introduction Failure after operative treatment of complex proximal humeral fractures (PHF) can prove challenging even for experienced surgeons. Reverse shoulder arthroplasty (RSA) seems to offer a satisfactory revision procedure with good clinical outcomes. Materials and Methods We present a case series of 14 patients, who were treated during a 3.5 years period (from 01/2016 until 06/2019). They all underwent revision surgery with RSA for failed operative treatment of PHF. Their mean age was 68 years (range, 51-84 years). 2 patients (14.3%) had been primarily treated with open reduction and internal fixation (ORIF), 5 patients (35.7%) with hemiarthroplasty, 3 patients (21.4%) with closed reduction and percutaneous fixation and 4 patients (28.6%) with transosseous suture fixation (TSF). We evaluated their absolute Constant score (CS), Visual Analogue Scale (VAS) score, and Range of Motion at their final follow-up, and we made a full clinical and radiological assessment to detect any postoperative complications. Results The mean absolute CS, VAS score, active anterior elevation, active abduction significantly improved compared with the preoperative status. Less significant difference was found in external rotation when comparing with the preoperative status ( P = .0304). No significant differences were found when comparing RSA for different failed primary techniques ( P > .05). No complications were detected following the revision surgeries of all patients. Conclusion RSA is an appropriate treatment as a revision technique for failed primary surgical treatment of PHFs. Though challenging it can offer good clinical results and pain relief.
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