Tibia-hindfoot osteomusculocutaneous rotationplasty with calcaneopelvic arthrodesis for extensive loss of bone from the proximal part of the femur. A report of two cases.

We report a new technique to create an effective lower extremity weight-bearing stump for two patients who had extensive segmental loss of femoral bone proximal to the distal femoral condyles. One patient had previously had complete resection of the proximal part of the femur because of an infection following the insertion of a custom femoral replacement and hip arthroplasty prosthesis. The other patient had had débridement of the femur from the subcapital line to the femoral condyles because of post-traumatic osteomyelitis after failure of a reconstruction with a massive allograft. Both patients were managed with a tibia-hindfoot osteomusculocutaneous rotationplasty after transtarsal (Chopart) amputation, with calcaneopelvic arthrodesis to create stable fixation of the extremity to the pelvis; this fixation allowed flexion, extension, abduction, and adduction of the hip by means of the retained tibiotalar and subtalar joints. At the time of the latest follow-up (at thirty-three and forty-four months), both patients were bearing full weight, without pain, with the use of a standard above-the-knee-amputation prosthesis. We report this procedure as a useful alternative to disarticulation at the level of the hip in patients who have massive loss of femoral bone and destruction of the hip joint in association with scarred and previously infected soft tissues and are not considered to be candidates for other forms of limb-preservation reconstruction. The patient must be willing to accept the equivalent of a low above-the-knee amputation and recognize the potential value of a weight-bearing stump.

Total shoulder arthroplasty in patients with Parkinson's disease.

Treatment of orthopaedic problems in patients with Parkinson's disease can be problematic and include failure of fixation or prosthetic dislocation. A study was undertaken to assess the outcome of total shoulder arthroplasty in this patient group. Fifteen patients with Parkinson's disease underwent 16 unconstrained shoulder arthroplasties. Thirteen of the patients had mild to moderate Parkinson's disease according to the Hoehn and Yahr score. Average length of follow-up was 5.3 years, ranging from 1.2 to 15 years. After surgery, patients had significant relief of pain (p < 0.01); however, functional results were surprisingly poor. With the Neer result rating system four shoulders achieved excellent results, and two had satisfactory results. Ten patients had a change in joint position, mainly superior subluxation. Three patients required revision surgery, two for symptomatic subluxation and one for glenoid loosening. Older patients (> 65 years) did significantly worse, but this factor did not account for all the unsatisfactory outcomes. Duration of Parkinson's disease, Hoehn and Yahr score, Levodopa dose, and rigidity, arm swing, or rapid alternating movement scores were not found to be significant predictive factors. We conclude that despite successful pain relief, the functional results of total shoulder arthroplasty in patients with Parkinson's disease are poor, especially in patients older than 65 years of age, and complications are more frequent.