Post-traumatic Arthritic Stiff Knee in a Malunited Distal Femur Fracture Treated with Total Knee Arthroplasty - A Case Report.

Introduction: Post-traumatic knee arthritis is defined as any structural osteochondral damage to the knee after an injury. About 12% cases of symptomatic osteoarthritis of the knee mainly due to post-traumatic arthritis. Primary total knee arthroplasty in a post-traumatic arthritic stiff knee with a malunited distal femur fracture is a technically difficult procedure due to secondary deformity, poor bone quality, bone loss, ligament incompetence, tissue adhesion, and stiffness. Case Report: A 65-year-old male presented with chief complaints of pain and stiffness in the left knee for 15 years. On inspection no scar, sinuses, and dilated veins on palpation, tenderness was present over both the medial and lateral joint lines. Radiographs of the left knee in anteroposterior and lateral views were taken, which showed united distal femur fracture with Grade 4 Kellegren Lawrence knee arthritis. Due to severe knee stiffness and with the patient demanding early mobilization and functional knee ROM, total knee arthroplasty with intra-articular and extra-articular adhesion release was planned for the patient. Conclusion: In cases of post-traumatic arthritis with severe stiffness, total knee arthroplasty is a viable option in providing good pain relief with excellent functional improvement; however, the procedure is technically more demanding.

Primary Total Hip Replacement in a Case of Unilateral Hypo Plastic Proximal Femur - A Case Report.

INTRODUCTION: Primary total hip replacement in hypo plastic proximal femur is difficult due to the presence of a small canal, soft- tissue contracture, fragility of bone, and poor femoral cement mantle when used. Intraoperatively, there could be occurrence of fracture of the femur, inadequate fit, and fill with cement less femoral component.It is found unilaterally in cases of osteonecrosis of femoral head, post- traumatic, and in sequelae of childhood septic arthritis. CASE REPORT: A 45-year- old male patient presented to the OPD with complaints of pain in the left hip and difficulty in walking since for 4 years. The patient had a history of fever and swelling over the left hip in childhood with no treatment taken for the same. X-ray of pelvis with both hips showed deformed femoral head, short neck, narrow femoral canal (Grade 1 Dorr), and arthritic changes in acetabulum. We managed with total hip replacement using Wagner cone stem. Postoperatively, the patient is having good range of motion and having no difficulty in walking and weight- bearing. Functional outcome is good as per Harris hip score. CONCLUSION: Total hip replacement in hypo plastic femur with arthritis is always a challenging problem. It requires surgical expertise and proper implant selection and pre-operative planning, which prevents intraoperative and post-operative complications. Wagner cone stem is a very good option in managing this type of patients.

The Neck of Femur Fracture in an Elderly Patient with Schizophrenia and Parkinsonism Managed with Dual Mobility Total Hip Replacement- A Rare Case Report.

Introduction: Neck of femur fractures is the most common fractures in elderly people as they present with osteoporosis. There is a higher chance of proximal femur fracture in a schizophrenic patient as there is a loss of bone mineral density due to a drug-induced increase in the level of prolactin and immobility. Patients with Parkinson's disease were at higher risk for the development of hip fractures due to gait disturbances and instability. Case Report: A 63-year-old male patient presented with complaints of the right arm pain, swelling, deformity of the right arm, and difficulty in extending the wrist for 3 days. The patient had a history of falls and trauma to the left arm at home. X-ray right arm showed distal one-third spiral humerus fracture for which intramedullary nailing was done. X-ray of the pelvis with both hips showed right neck of femur fracture with associated greater trochanter (GT) fracture. We managed with total hip replacement using a dual mobility cup and tension band wiring for GT fracture. Postoperatively, the patient has a good range of motion at the hip. The functional outcome is good as per Harris's hip score. Conclusion: Neck femur fractures in elderly patients with associated comorbidities such as schizophrenia and parkinsonism are best managed with total hip replacement using a dual mobility cup. It avoids the risk of dislocation in high-risk patients and prevents secondary procedures. Careful clinical and radiological examination of the pelvis is very essential even in asymptomatic patients with a history of trauma to prevent delayed diagnosis of these types of fractures in patients with schizophrenia and parkinsonism.