Breakdown of spontaneous fused bilateral hip with heterotopic ossification to staged bilateral total hip arthroplasty through a direct lateral approach: A case report.

INTRODUCTION: Heterotopic ossification (HO) is the abnormal bone formation in soft tissue where bone normally does not exist. HO can occur secondary to musculoskeletal trauma, burns, spinal cord injury, or traumatic head injury. The treatment of HO ranges from simple medical treatment to advance surgical intervention; it is largely dependent on the amount of bone formation, the location, the limitation of motion, and the severity of the joint disease. PRESENTATION OF CASE: We present the case of a 26-year-old man who presented to an orthopedic clinic with pain in the lower back and both knees, which was not relieved by conservative treatment. The clinical examination revealed a loss of motion in both hips. Radiography of the pelvis showed bilateral fused hips and Brooker type IV HO in both hips. The patient underwent HO resection and converted the fused hip to total hip arthroplasty (THA) through a direct lateral approach. The patient was satisfied with the outcome of over 18 months of follow-up. DISCUSSION: A direct lateral approach, as what we performed, is a simple approach that can expose the acetabulum and proximal femur. The presence of intraoperative fluoroscopy can help identify HO's extension with less damage to the soft tissue and blood loss. CONCLUSION: The surgery appears to be a doable, effective, and safe procedure to treat fused bilateral hip with HO. This is the first study to report staged bilateral THA for HO through a direct lateral approach to the best of our knowledge.

Total Knee Arthroplasty Wrong Side Implant.

We report a unique wrong implant error during bilateral total knee replacement procedure in 72-year-old woman with bilateral knee osteoarthritis that failed conservative treatment. Patient has severe bilateral knee pain. Examination showed full range of motion. X-ray showed severe bilateral tricompartmental osteoarthritis. Patient underwent surgery in 2013; postoperative radiographs showed well-fixed femoral, tibial, and patellar components but right femoral implant was placed in the left knee. Postoperative examination showed painless full range of motion. One similar case report found describing wrong-site femoral component that ended with symptomatic. In our case, no complications were observed.

Neglected Bilateral Posterior Shoulder Fracture Dislocation in an Uncontrolled Seizure patient.

Posterior dislocation of the shoulder is a rare injury that occurs secondary to trauma and seizures. Diagnosis is often missed and treatment is challenging. Neglected posterior dislocation is associated with Hill-Sachs lesion which leads to locking of dislocation. Correct diagnosis is achieved by history taking, a physical examination and appropriate imaging. In neglected shoulder dislocation with uncontrolled seizure and humeral head defects of up to 45% the McLaughlin procedure shows excellent results at follow-up.