ABSTRACT
Total knee arthroplasty [TKA] is a satisfactory procedure regarding functional outcome and pain relief. The ever increasing number of total knee arthroplasties and expanding indications have led to a high number of revisions. The principles of revision arthroplasty are to understand the cause of failure, adequate surgical exposure, restoration of limb alignment, achieving appropriate soft tissue balance, correct implant alignment, restoration of joint line and a good range of motion. The literature on revision TKA is diverse and is not conclusive in many aspects. The results of revision surgery are not as good as the primary TKA with main causes being increased polyethylene wear, aseptic loosening, malalignment of components, instability, extensor mechanism problems, infection and stiffness. Revision knee Arthroplasty is not a repeat primary Arthroplasty but it is a technically and economically demanding procedure and its successful performance requires thorough preoperative planning, adherence to the principles of revision knee arthroplasty, availability of diverse implant options and adequate bone graft
Subject(s)
Humans , Arthroplasty, Replacement, Knee/methods , Reoperation , Knee/surgeryABSTRACT
To present the early results of pelvic osteotomies performed for repair of exstrophy bladder. Five cases of exstrophy bladder were treated with closure following bilateral iliac osteotomies. Three patients underwent closure of pubic symphysis diastasis by use of external fixator, one by screws and cerclage wires, and one by use of K-wires and suture. The patients were followed up by the pediatric urologist and orthopedic surgeon. All patients achieved a closure of diastasis and a tension free repair after the index surgery. The average follow-up was 3.6 years with range of 4 months to 6 years. All osteotomies healed within two months and had closure of the diastasis, except one which had a partial failure with loss of 50% correction. No patient had any wound dehiscence or breakdown of the bladder repair. Preoperative mean diastasis of symphysis pubis was 6 cm [range; 4.5 cm to 7 cm] and post operative mean diastasis was 3.5 cm with the range of 2.5 cm to 4 cm at 12 months follow up. All patients achieved urinary continence post operatively and were passing urine per-urethra with satisfactory urinary control as followed-up with the pediatric urologists. Bilateral iliac osteotomies and use of external fixator in our series was found to be helpful in achieving a tension free closure and preventing dehiscence of the repair