HPI - THA after femoral neck fracture, pain following start of mobilization 5 days after surgery. No subsidence of the stem after WB
How would you treat this intraoperative peri-prosthetic fracture?
HPI - Female 78 years old, with a left TKA revised 3 years ago, tripped on a small stair and fell on her opperated left knee.
How would you treat
HPI - Progressive pain and deformity of knee
Reconstruction of medial tibial defect
HPI - 13 months ago insidious onset of left hip pain which progressively become worse. Sudden deterioration after a sickle cell crisis. Now left hip is Ficat stage III. He started feeling discomfort with his right hip about two months ago. Now right hip is Ficat stage IIA (Precollapse stage)
What is the best combination of bearing surfaces for left THA
HPI - History of injury right knee joint 15 yes back .Treated conservatively .Now presenting with pain on walking
Should TKR be done as a single stage or two staged procedure
HPI - Patient with bilateral knee osteotomy 10 years ago.
Now with knee OA.
How would you treat this patient?
HPI - Active male.
Sustained fracture neck femur right hip in Nov 2014 for which optd at another center with Uncemented Bipolar HRA utilizing posterior approach.
Post op had persistent and increasing pain and stiffness right hip and painful weight bearing..
Jan 2015 - Evaluated for the above ...Healed surgical wound .. local temp increased painful movement .... Radiographs s/o progressive heterotopic ossification around hip ... Bone scan +ve for infected prosthesis, ESR and CRP positive. TLC WNL. Alkaline phosphatase - 100.
Underwent Hip aspiration under fluoroscopic guidance .. No pus/ fluid aspirated.
Feb 2015 - Underwent Removal of prosthesis and Debridement with excision of heterotopic mass which was obstructing implant removal. Intra op no pus or any abnormal fluid. Intra op cultures negative
Post op skeletal Traction applied.. indl was totally non compliant with skeletal traction .. surgical wound healed .. Post op given Tab ofloxacin and rifampicin for 06 weeks
Which approach to hip has the maximum risk for heterotopic ossification
HPI - Pain B/L knee joint.left more than right
What should be the treatment plan
HPI - Fall from standing height
How would you treat this injury?
HPI - Pt had fusion hip 10 yrs back
Has pain rt hip for 2 mths
What is the best treatment option
HPI - 2013/10 Bipolar-hemiarthroplasty d/t
2014/09 ORIF c cable grip d/t periprosthetic fx
2014/10/7 CRP was elevated(8~10mg/dl).
2014/10/24 wound problem(redness, pus)
10/31 cable grip removal & antibead insertion
-> Pus was seen lateral aspect of
We considered focal infection due to
We did not expose and irrigate intra-
After latest surgery, CRP elevation(8~10mg/dl) was continued using 1st cephalosporin. After changing 3st cephalosporin, recently two weeks CRP was decreased (1~2mg/dl, above normal)
How would you treat this patient at this time?
HPI - a 75 YO, Female patient, presented to our ER Dept. complaining of painful arm and inability to move her shoulder.
How would you classify this fracture?
HPI - 74 yr old Asthmatic and Diabetic had a fall in the bathroom yesterday and is unable to walk despite using a walker
HPI - 70 yr old very active, Hypertensive with Coronary Artery Disease, had a fall at home and could not bear weight on the right lower limb associated with severe pain. Had an Austin Moore prosthesis implanted for a fracture neck of Femur 8 years ago.
How would you classify this fracture as per the Vancouver classification?
HPI - Over the past five years the patient noticed that her left knee was progressively swollen, became painful and experienced difficulties in ambulating independently. She started using a stick for support and was asking for regular analgesia.
HPI - Patient has a history of a fall after a twisting injury while walking.
Accorrding to the Vancouver Classification - What type of periprosthetic fracture is this
HPI - Patient had hip trauma 35 yrs back .no record available
Will flexion deformity 20 degree will correct with physio or release needed
HPI - Since several months ago, the patient feels dull pain in her left groin area, especially after exercise and some clicking sensation when rotating her left lower limb. Most of the time the patient is asymptomatic
What are your treatment options for this young patient
HPI - 71 y/o female with a 2 year history of right knee pain. Symptoms have gotten severely worse within the last six months
What is the best treatment option here?
HPI - falling from the last stair,hip replacement since 2002,treatment of the femoral pseudarthosis since 2011
HPI - Left hip pain for 14 years with draining sinus tract.
HPI - Hx of RTA 8 years ago, had Surgery around the left hip, pt remained symptomatic and had another surgery on the hip in other center 5 years ago.(No Medical record or X-rays were available with the pt.
Pt presented with left thigh pain, limping, quadricep waisting, limited Abduction.
What would be your next step in management of this patient?
HPI - Patient slip off,(minor trauma)
Anamensis: 1988 THA( posttraumatic AVN of the femoral head)
1999 revision hip arthroplasty(Wagner revision stem+cerclage) because of aseptic loosening
Problem: atrophic femoral cortex around stem!!
What treatment would you suggest ?
HPI - Operated 3 weeks ago for a peroprosthetic fracture of the femur (Vancouver C).
No weightbearing since the operation. Rx failure of the osteosynthesis.
What is the best treatment? (We do not have allograft)
HPI - 34 y o male 20 years post both distal femur fracture operated many times. Now, complain of inability to sit on floor or use Indian toilet. he is not in pain.
what type of procedure will you do for him
HPI - Patient developed pain left hip joint 2years back. After investigation he was diagnosed as having cystic lesion in the femoral head and neck with a pathologic fracture. He underwent ORIF as well as placement of a nonvascularized fibular allograft. The patient continues to have pain now.
Repeat MRI shows increase in the lytic lesion in head and neck with decrease in joint space and involvement of acetabulum.
HPI - 3 weeks after hemi for displaced femoral neck fracture, patient returns to clinic with click in hip. Has bilateral BKA's but previously ambulatory with prosthesis. Has been "crawling" around nursing home as current prostheses don't fit. Denies new injury. Wants to return home and walk again with prostheses. Has had stump wound problems recently but skin healing and prostheses being made.
HPI - pain bilateral knee joint ,right knee joint pain more severe than left.Had arthoscopic partial medial menisectomy and lavage about 3years back which gave temporary releif for about 6 months. also had intra articular hylaurinic acid injection, pain in right knee joint has increased severely
How would you treat this patient's right knee?
HPI - Now is in my theater with this intermaterial fracture. What do you think abaut?
What is the treatament you would choice?
HPI - Gradual increase in pain since 8 years
what is the most appropriate treatment
HPI - 60 year old male, household ambulator previously, confined to the bed for past 2 years, complained of pain in his right hip when he sat on a chair.
How would you manage this patient ?
HPI - pain in both knees since years.2 surgeries done for rt knee.2years ago he had a TKR done in his home country which failed miserably.following that he was walking with crutches.6 mths ago he had another surgery which involved removal of implant with spacer.
no details of any of the surgeries.now he has come to us.
What would be your next step in treatment for this patient?
HPI - 60 years old man. Non smoker. Index injury May 2011. Hit by a collapsing tree
ORIF lat tibial plateau through lateral hockey stick approach. Synthetic bone graft/blocks used as significant lateral depression.
Removal of metalwork January 2013.
Ambulatory with a stick.
What is the best reconstruction options
HPI - Patient had surgery two weeks prior. Now there is discharge of pus from the wound.
HPI - Pain left hip joint since six month.
Inability to bear weight since 6 month.
Gradual increase in pain and deformity since 6months
Patient has been on ATT for past 4months but erosionof hip joint and resorbtion of femoral head has gradually increased
What should be the treatment plan
HPI - since a year patinet has noticed he has started limping and associated pain whichh is increasing on walking
HPI - patient had a MVA 10 years ago.the set up he was did not have a proper teriary hospital and he was treated conservatively. for over 3 years he had draining sinuses from his femur lower third.
patient has limitations but going about his life with limitations.patient wants to know whether intervention will improve his quality of life or he continue as he is
HPI - Tkr left knee done on 1/03/13
Watery clear yellow colour discharge from 5th post op day from middle of wound.
No fever, redness,swelling
Discharge has decreased
Culture senstivity negative
ESR 45 CRP NEGATIVE
What should be further plan
HPI - Patient is a 40 year old female who sustained injury to her left hip about one year back while she was climbing a ladder and slipped off . Now she presented to us with severe pain on walking, limp and difficulty i squatting,sitting cross legged to carryout her daily routine activities, and is unable to walk distances more than 100 meters in one stretch.No history suggestive of fever or constitutional symptoms.
How would you like to manage this case?
If THA is your choice does this patient require special implants?
How would you like to manage this case?
HPI - Road side accident on 23/6/11 ,communited fracture proximal end femur.
DHS done on23/6/11
Bone grafting done on12/8/11
Had fever for 9 months post op.
DHS removal was done on 8/6/12
Fever subsided after that
What is the appropriate time of surgery (already 8 months post implant removal)
HPI - pain in the knkee steadily increasin severity
conseravtive treatment.or arthroscopic washout and biopsy follwed later by TKA
HPI - pain in both knees increasing severity over the years.patient able to walk but requires nsaids often
conserevative or coversion to tka
HPI - on and off pain in the rt hip since many years .no h/o any trauma.
THR or conservative treatment and thr only when symptoms increase
HPI - 52 year old rheumatoid patient with worsening left knee pain. Previous TKA approximately 15 years ago. Denies any fevers, chills, systemic signs of infection, or trauma. Local orthopaedic surgeon has given patient a brace that has improved pain, but has noticed worsening in last 12 months.
How would you treat this RA patient with worsening left knee pain after a well functioning TKA
HPI - 11 months since onset.
best modalitiy of treatment for avn when canal is narrow and patient non affording.
HPI - 70 year old female fell 7 days after undergoing primary total hip arthroplasty. Greater trochanter fractured during index surgery, repair was attempted. Transferred for definitive management. Hip was placed through Watson Jones approach, and abductors were destroyed.
What is your preferred technique for damaged abductor/trocahnteric management?
HPI - Fell from standing height in the home. Deformity and can't bear weight through leg.
How would you treat this periprosthetic fracture?
HPI - s/p nonsyncopal fall, with L hip pain and limb shortening. Sent from OSH for evaluation.
What would you do with this case?
HPI - femoral head resection for tbc septic arhritis and head collapse. antitbc drug threapy for 1 year. repeated debridmans. the joint is clear now. confirmed with 3 aspirations culture and asid fast organism
HPI - c/o on off pain over lt hip, diff in cross leg sitting & squatting. H/o pain for 3 yrs treated by anti TB drugs for 8 months now pain reduced taken biopsy 2 yrs back
Assuming serum labs and joint aspiration confirm eradication of infection, how would you treat this patient?