77 year old lady in severe pain in her knee. She had a previous open lateral meniscectomy at age 20, and a further open procedure for 'problems with her knee cap' 30 years ago.
On examination she has a clinical valgus deformity, and an elevated BMI.
There are no contraindications to joint arthroplasty.
Drop any thoughts into the comments section.
If so, which 3 fundamental problems will you identify as risk factors in your exposure and approach in this case given the history?
If so how can your approach help in preventing that problem with patella mal-tracking?
The radiographs are of a 62-year-old male, otherwise fit and well, who presents with worsening pain and stiffness in the joint. This is now increasingly limiting his day-to-day activities; including both his keen hobby of golf, and his work as a train conductor.
He reports having always ‘been a little bow-legged’ but was pain free until about 5 years ago. Physiotherapy and analgesia have failed to improve his symptoms. He takes no regular medication.
Clinical examination demonstrates pain and crepitus through the arc of motion, with marked laxity on varus stressing. The medial soft tissues are tight, and the patella tends to track medially. He is keen on a definitive surgical solution.
During trial implantation the knee is tight medially in both flexion and extension. Assume that a medial parapatellar approach has been undertaken.
Following correction of this medial tightness, repeat trial demonstrates that the knee is now loose in both flexion and extension.
This is a 68 year old man has significant pain in his knee and has failed conservative treatment. He has no significant co-morbities.
On examination there is varus deformity with fixed flexion. Neurovascular examination is normal.
Questions to consider
Planning- What problems do you foresee and how are you going to manage it?
Exposure – anything different/ special required.
Equipment- What sort of equipment (type of implant) would you need and be prepared for?
Balancing- the Knee-- Any challenges?
Please do post your thoughts about these cases in the comments section below.
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