Midfoot dislocation
Appropriate treatment of the acute injury depicted is:
| (A) | Open reduction, internal fixation | |
| (B) | Traction | |
| (C) | Closed reduction and casting | |
| (D) | Primary midfoot arthro |
Tarsal Bones are the seven bones which form the tarsus – namely, CALCANEUS, TALUS, cuboid, navicular, and the internal, middle, and external cuneiforms (Ankle Bones / Cuboid Bone / Cuneiform Bones / Navicular Bone of Foot).
I just think of a quite recent total hip arthroplasty for bilateral spontaneous hip arthrodesis in maximum extension and adduction in a bamboo spine spondylarthritic young man.
I take this opportunity to review my experience of total hip arthroplasty (THA) after hip arthrodesis performed because of septic arthritis.
Revision total hip arthroplasty (THA) after hip arthrodesis is an uncommon and challenging operation : however subsequent to tuberculosis, I witness very impressive results I have in two cases of women, one 77 years old with arthrodesis 70 years earlier and another one 83 years old with very stiff hip from TB 45 years before and surgical bamboo spine from Hibbs procedure just after world war II.
The task would appear to be even more difficult if the arthrodesis is performed because of septic arthritis due to the theoretical risk of recurrent infection.
Women or men, left hip seems more often fused.
All of the patients have arthrodesis for sepsis: either subsequent to tuberculosis or subsequent to septic arthritis (Staphylococcus aureus ).
I examine the impact of the initial arthrodesis (surgical technique, position, leg length) on neighboring joints and indications for de-fusion.
Mean age is menopausis (range 32-83) and on average, the patients had a fixed hip for three and a half decades (range 7-70).
Revision surgery is performed via a posterolateral approach sometimes with trochanterotomy or via an anterolateral approach.
Implantation uses cemented implants, press fit implants, or hybrid implants (cemented cup and press fit stem).
Clinical assessment at last follow-up notes pain, walking capacity and joint motion.
Leg length discrepancy is measured and complications noted.
The position of the original arthrodesis was considered satisfactory (flexion 20̊, adduction 0-10̊, external rotation 0-20̊) for less than half of the hips.
Leg length discrepancy is 4 cm (2-8 cm).
Neighboring joints involved concerned the lumbar spine in most patients, the ipsilateral knee in a majority patients, as well as the contralateral knee and the contralateral hip.
The decision to remove the arthrodesis is based on functional needs related to lumbar pain, the homolateral or the controlateral knee, limping and leg length discrepancy, or an operation on the ipsilateral knee.
After surgery, 4 out of 5 hips are free of pain with improvement or relief (Hibbs fusion case) of the lumbar pain and pain of the homolateral knee and/or the contralateral knee.
One third of the patients walks without support but nearly all still have a limp.
Mean flexion is 75̊.
Leg length discrepancy is 2.5 cm on average and less than half of the patients has balanced limbs.
The postoperative period is uneventful for a majority of the patients (rare paresia of the common fibular nerve, rare femoral phlebitis, rare early infection).
Among late complications are noted: nonunions of the greater trochanter, recurrent ankylosis and loosenings.
Earlier history of infection does not appear to be a contraindication for implantation of a total hip arthroplasty after hip arthrodesis.
Despite the long recovery period and the modest gain in joint motion, 4 out of 5 patients are satisfied after endeavouring their blocked hip for 35 years on average.
Key words : Hip, ,
The incidence of non union following arthrodesis of painfully diseased joints in rheumatoid arthritis patients is not unusual.
