RESUMO
Background: Intra-articular and periarticular distal femur fractures with pre-existing osteoporosis (OP) and osteoarthritis (OA) pose a significant challenge to ambulatory patients because of the higher chances of implant failure and severe disability of OA. To reduce OA-related morbidity, we advocate simultaneous total knee arthroplasty (TKA) with fracture fixation instead of fracture fixation alone using computer-assisted navigation to achieve proper ligament balance, restoration of the mechanical axis, and component alignment. Case Report: A case series of four patients (male - 2 and females - 2) with periarticular fractures of the distal femur with severe OA and OP were primarily fixed with different modalities such as distal femur locking plates, cannulated-cancellous screw, and Herbert screw followed by computer navigation-assisted cruciate retaining TKA. All patients had Kellgren Lawrence grade ≥3 OA and underwent bilateral TKA. All patients were aggressively treated for OP using pulsed PTH therapy. Patients were found to have a faster recovery with the initiation of early partial weight bearing with crutches postoperatively in all patients, followed by unassisted weight bearing once radiological union was seen. Conclusion: Based on satisfactory quality evidence and navigation-assisted cruciate-retaining TKA appears to be a useful treatment option for distal femoral fractures with pre-existing OA and OP. This is cost-effective and is associated with the least morbidity and excellent patient satisfaction.
RESUMO
Introduction: Total hip arthroplasty (THA) is a common procedure used to treat various hip conditions. However, patients with ochronotic arthropathy, a rare genetic disorder characterized by the abnormal accumulation of homogentisic acid, are at a higher risk of post-surgical dislocation and instability due to poor bone quality and joint degeneration. Case Report: This case study features a 52-year-old male patient diagnosed with ochronotic arthropathy who underwent bilateral THA with the use of a dual mobility cup (DMC). Ochronotic arthropathy had caused significant joint degeneration and stiffness, leading to considerable functional impairment. Conclusion: The application of a DMC in THA for patients with ochronotic arthropathy has shown promising outcomes. The DMC offers increased range of motion and improved stability, effectively reducing the risk of post-surgical dislocation and implant failure. This case study highlights the potential of DMC as a viable solution for addressing the challenges posed by poor bone quality in patients with ochronotic arthropathy undergoing THA.
