Total Knee Arthroplasty in Patients with Ipsilateral Fused Hip: A Technical Note

We report the surgical technique used to perform posterior-stabilized total knee arthroplasty (TKA) in two patients with a well positioned and functional hip arthrodesis. Intraoperatively, the operating table was placed in an increased Trendelenburg position. Episodically, we flexed the foot of the table by 90degrees to allow maximal knee flexion to facilitate exposure and bone cuts. We opted to resect the patella and tibia first to enable exposure, given the stiffness of the arthritic knee. One patient's medical condition prohibited complex conversion total hip arthroplasty (THA) prior to the TKA. The other patient's scarred soft tissues around the hip, due to chronic infection and multiple operations, made THA risky. The final outcome provided satisfactory results at a minimum of 2 years postoperatively. TKA can be successfully performed with adjustments of table position and modification of the sequence of surgical steps in patients with ipsilateral hip fusion.

A Case of Acute Typhlitis Complicating Drug-induced Agranulocytosis / 대한내과학회지

Increasingly aggressive chemotherapy regimens, advances in transplantation technology, and the acquired immunodeficiency syndrome have resulted in a growing number of immunocompromised patients. Infections are a major cause of morbidity and mortality in this population. One of the most ominous complications is the development of typhlitis in this immunocompromised patients. Treatment of this process is controversial, and no consensus has emerged. We report a case of typhlitis who complicated agranulocytosis after exposure to drugs to treat "flu" like illness and recovered completely after two operations of appendectomy and ileocolectomy. Reviewing articles and this case, the favorable outcome seemed to be related to following three factors recognition of the acute surgical abdomen by abdominal CT scan, a prompt return of normal circulating white cells by the use of Granulocyte Colony Stimulating Factor and discontinuation of causative drugs, and an appropriately timed surgical intervention.