Case challenges in knee surgery: What would you do?,☆☆

https://doi.org/10.1054/arth.2002.32546Get rights and content

Abstract

In an interactive case presentation session, the faculty discussed management of complex primary and revision knee arthroplasty issues. Principles discussed included: preoperative evaluation of the failed knee arthroplasty, intra-articular versus extra-articular deformity correction, ligamentous balancing, managing the unstable total knee arthroplasty, bone deficiency management, rotational positioning of prosthetic components, selection of articular constraint in the revision knee, and extensor mechanism balancing. Copyright 2002, Elsevier Science (USA). All rights reserved.

Section snippets

Case presentation

A 48-year-old farmer presents with recalcitrant medial joint line pain of the left knee. He has had a prior arthroscopy and several intra-articular corticosteroid injections (Fig. 1).

. Case 1. Preoperative anteroposterior (A) and lateral (B) radiographs.

Dialogue

Hanssen: Dr. Romagnoli, what would you do?

Romagnoli: Was there a previous tibial fracture?

Hanssen: No, the patient did have a prior femoral shaft fracture and a proximal fibular fracture (Fig. 2).

. Case 1. Preoperative full-length standing (A) and

Case presentation

A 58-year-old man who had a TKA 18 months previously complains of knee instability but has excellent knee range of motion (Fig. 4).

. Case 2. Preoperative anteroposterior (A) and lateral (B) radiographs.

Dialogue

Hanssen: Dr. Maloney, what would you do?

Maloney: One should perform a good physical examination for collateral ligament and anteroposterior stability. Some of these patients have midflexion instability. In patients with posterior cruciate ligament insufficiency, hanging the leg over the table to

Case presentation

A 58-year-old man fell after a having a TKA and sustained a periprosthetic fracture of the distal femur. It has been fixed twice, and the patient presents because of persistent pain and motion at the nonunion site (Fig. 7).

. Case 3. Preoperative anteroposterior (A) and lateral (B) radiographs.

Dialogue

Hanssen: Dr. Kurosaka, what would you do?

Kurosaka: Well, this is a tough problem. What is the knee range of motion?

Hanssen: It is difficult to assess how much knee motion the patient has because of the

Case presentation

A 78-year-old woman weighing 100 lb. presents with progressive loss of ambulatory ability primarily as a result of left knee instability. She does not complain of severe pain (Fig. 9).

. Case 4. Preoperative anteroposterior (A) and lateral (B) radiographs.

Dialogue

Hanssen: Dr. Ranawat, what would you do?

Ranawat: First, we find out if she has Charcot's disease.

Hanssen: The neurologists have evaluated her and do not believe she has a Charcot joint because she does not have diabetes or other predisposing

References (2)

  • WP Dougherty et al.

    Total knee arthroplasty in neuropathic arthropathy

  • M Soudry et al.

    Total knee arthroplasty in Charcot and Charcot-like joints

    Clin Orthop

    (1986)

Cited by (2)

No benefits or funds were received in support of this study.

☆☆

Reprint requests: Arlen D. Hanssen, MD, Department of Orthopedics, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

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