ABSTRACT
INTRODUCTION: Recently, implant manufacturers have made modifications to currently available implants in an attempt to improve postoperative flexion. The Low Contact Stress (LCS) RPS (DePuy Orthopaedics Inc., Warsaw, IN, USA) is one such prosthesis which is a modification of the established LCS RP design. Satisfactory results have been obtained without patella resurfacing in the original LCS RP design. METHODS: We report on a single surgeon series showing an alarmingly high incidence of patellofemoral crepitus when this new prosthesis, LCS RPS, is used without patella resurfacing. In addition, the outcomes for this prosthesis from the Australian National Joint Replacement registry will be reported. These results show a high revision rate with most revisions being patella resurfacing for patellofemoral pain. RESULTS: Affected patients who elected to have a revision procedure underwent either an arthroscopic patellaplasty procedure or revision to resurface the patella. Both of these procedures resulted in satisfactory resolution of symptoms in the majority of patients. DISCUSSION: Potential causes for this complication are discussed. It is the recommendation of the authors that when using this prosthesis the patella is resurfaced.
Subject(s)
Arthroplasty, Replacement, Knee/instrumentation , Knee Prosthesis/adverse effects , Patellofemoral Joint/physiopathology , Postoperative Complications/etiology , Adult , Aged , Aged, 80 and over , Arthroplasty, Replacement, Knee/methods , Australia , Follow-Up Studies , Humans , Middle Aged , Outcome Assessment, Health Care , Patella/surgery , Patellofemoral Joint/surgery , Postoperative Complications/diagnosis , Postoperative Complications/surgery , Prosthesis Design , Range of Motion, Articular , Registries , Reoperation/statistics & numerical data , Retrospective StudiesABSTRACT
The Birmingham Mid-Head Resection (Smith & Nephew Ltd, Warwick, United Kingdom) arthroplasty is a new bone-conserving procedure that, like hip resurfacing, is used in younger, active patients. We present the case of a young man with Sotos syndrome (cerebral gigantism) with associated extraordinary stature (height, 2.16 m; weight, 157 kg) who underwent Birmingham Mid-Head Resection arthroplasty. The large stature of this patient required a custom manufactured prosthesis (a femoral head 68 mm in diameter with an acetabular cup 76 mm in diameter). We believe this to be the largest metal-on-metal resurfacing articulation and hip arthroplasty reported to date.
Subject(s)
Arthroplasty, Replacement, Hip/methods , Femur Head/surgery , Hip Dislocation/etiology , Hip Dislocation/surgery , Sotos Syndrome/complications , Adult , Arthroplasty, Replacement, Hip/instrumentation , Hip Joint/diagnostic imaging , Hip Joint/surgery , Hip Prosthesis , Humans , Male , Metals , Patient Satisfaction , Prosthesis Design , Radiography , Treatment OutcomeABSTRACT
We present the first reported case of a combined medial humeral condyle fracture with ipsilateral radial head dislocation. This injury was sustained by a 7-year-old girl following a fall on an outstretched hand. The operative technique is described. At 6-month follow-up, the patient had normal alignment of the limb and achieved full range of motion.
