here sharing with you complicated cases that we encountered in our hospital & how we treated. all advices are always welcome

1. CASE NO. 1
63 YR OLD MALE ,H/O OLD MALUNITED
ACETABULAR # OPERATED FOR THR ELSEWHERE
WITH SIGNIFICANT INFECTION,PAIN.

2. ROTATEDCUP,LOOSEFEMORALPROSTHESIS

3. ..
STAGE 1 ;
• REMOVAL OF EXISTING IMPLANTS, ANTIBIOTIC MIX
CEMENT WITH CONTOURED K NAIL FEMUR AS A SPACER
• PT. IN BED FOR 3 MONTHS WITH SPECIFIC ANTIBIOTIC
COVER.
• AFTER HEMATOLOGICAL PARAMETERS LIKE ESR,CRP,TOTAL
COUNT WERE
CONSTANT FOR 2 WEEKS, DECIDED TO OPERATE.
• WE HAD NOTICED LARGE ACETABULUM WHICH WOULD
NEED
• AUGMENTATION

4. OPTIONS CONSIDERED
• ACETABULAR MESH,PLATE WITH BONE GRAFTS
• EXTRA LARGE ACETABULAR CUP WITH WEDGES
• ALLOGRAFT AUGMENTATION.
• FIRST 2 OPTIONS WERE EXPENSIVE SO DECIDED ON THE 3RD
• ALLOGRAFTS,PROCURED FROM TATA MEMORIAL HOSPITAL
WERE USED.

5. POSTOPX-RAY

6. CASE NO. 2
55 YR OLD NEGLECTED CONDYLAR # TIBIA
PRESENTED AFTER NEARLY 1 YEAR
SHE WAS NOT WALKING WITH SEVERE PAIN &
DEFORMITY.

7. ..

8. ..

9. ..
• PT. LOST FOR FOLLOWUP 3
MONTH POST OPERATIVELY .
• CAME WITH FIXED FLEXION
DEFORMITY,70 DEGREES,
POSTERIOR SUBLUXATION &
PAIN.

10. ..
X- RAY S/O UNITED OSTEOTOMY
POSTERIOR SUBLUXATION.

11. PROBLEMSFACED
• FIXED FLEXION DEFORMITY
• POSTERIOR SUBLUXATION
• SEVERE PAIN
sOLUTION
• SKELETAL TRACTION ABOVE
THE ANKLE
• TO OUR SURPRISE DEFORMITY
WAS CORRECTED OVER 3 WEEKS PERIOD

12. CONVERTEDTOTKRSUCCESSFULLY

13. OURTAKEONTHISCASE
• NEGLECTED CONDYLAR FRACTURES ESPECIALLY WITH
SUBLUXATION SUGGESTING SIGNIFICANT INTERNAL
DERANGEMENT COULD HAVE BEEN PRIMARILY
SUBJECTED TO TKR.
• MERE CORRECTION OF DEFORMITY BY THE 1ST
PROCEDURE WAS INADEQUATE YET MADE OUR
SUBSEQUENT TKR EASY.

14. THANK YOU