Moshe Weisbort

Fracture of the Central Polyethylene Tibial Spine in Posterior Stabilized Total Knee Arthroplasty

Between 1993 and 1998, 332 I-BII (Insall Burstein II) prostheses were implanted in our department. We studied 5 cases of tibial polyethylene spine fractures. The fractures occurred 3 to 5 years following the surgery. All cases with fractures had mild medial laxity that was noted on follow-up of 2 to 3 years following arthroplasty. One also developed mild hyperextension. All the patients had a revision surgery. In 2 cases, the polyethylene was changed to a thicker one, together with medial reinforcement. Three cases were revised to a rotating hinge prosthesis.

Pectoralis major rupture in elderly patients: A clinical study of 13 patients

The purpose of this study was to analyze and describe circumstances and clinical aspects of pectoralis major rupture in elderly patients compared with younger patients. Eleven patients were nursing home residents and two were community residents. All had severe pain with a large pectoral ecchymosis extending to the lateral chest wall and arm. Twelve patients experienced substantial blood loss (average, 2.3 g/dL hemoglobin), which resulted in hemodynamic decompensation in two of the patients, necessitating a blood transfusion. The most probable mechanism of injury was indirect, caused by a brisk tearing movement applied to stiff, atrophic muscle during commonly used nursing procedures for transferring, positioning, and dressing the patients. The authors suspect this injury to be more common than reported. Although surgical repair is not required in the elderly, a proper diagnosis is imperative because the injury has a severe clinical impact necessitating care and followup.

Fracture of the greater trochanter during hip replacement: a retrospective analysis of 21/372 cases.

We reviewed retrospectively 373 total hip replacements operated on using a lateral approach with the patient in a supine position. We found 21 iatrogenic fractures of the greater trochanter, all in women. 15 cases were diagnosed during the operation and were treated with wire fixation. 6 fractures were diagnosed on radiographs during the first 3 months following the operation. 2 of these 6 cases presented in association with dislocation of the prosthesis; 1 after 6 weeks and 1 after 2 months. Displaced nonunion occurred in 2 cases, 5 healed with minimal displacement and 14 with no displacement. 8 patients limped slightly at follow-up after mean 4 (1-7) years and 4 had some pain over the lateral thigh.

Fracture of the hip after knee arthroplasty--an unusual case with pain in the knee.

(2001). Fracture of the hip after knee arthroplasty--an unusual case with pain in the knee. Acta Orthopaedica Scandinavica: Vol. 72, No. 2, pp. 194-195.

Semimembranosus tendonitis after total knee arthroplasty: good outcome after surgery in 6 patients.

More than 700 total knee arthroplasties were performed in our Department between 1992–2000. 6 patients developed pain on the postero-medial aspect of the knee, within 1 year of surgery. The pain increased during walking and especially on rising from a chair. All patients were women with good knee motion and good alignment of the implanted prosthesis. We found no signs of low-grade infection. Injection of 1% Xylocaine relieved pain for a short time in all patients. They were all treated with excision of the reflected portion of the semimembranosus tendon which was not cut during the arthroplasty. Pain was completely relieved in 5 cases and improvement occurred in 1.

Medial unicompartmental replacement for tricompartmental disease in the elderly

Between 1993 and 1998, we performed 18 unicompartmental arthroplasties of the knee, all on the medial side, in a selected group consisting of 18 elderly patients aged 74-81 (mean 77.2), with severe arthrosis mainly in the medial compartment and mild arthrosis in the lateral compartment and the patellar articular surface mostly covered with articular cartilage. The patients were mainly housebound due to relatively advanced age and severe pain. Unicompartmental arthroplasty was chosen for this group because of a quicker and easier rehabilitation. Two patients had had a high tibial osteotomy 7 and 10 years ago. The average follow up was 5.5 years ranging in age from 5 to 8 years. The average initial American Knee Society Knee Score was 52, ranging from 28 to 70 which improved at follow up to 83 (range 60-92). All prostheses used were Allegretto (Sulzer). The operation was done through short medial arthrotomy. The purpose of this study is to report our results in these low demand patients and although the follow-up was only 5-8 years, the results are promising.

INTRA-ARTICULAR TIBIAL PLATEAU STRESS FRACTURE ASSOCIATED WITH OSTEOARTHROSIS AND VALGUS KNEE DEFORMITY

Severe valgus deformity of the knee secondary to osteoarthritis can predispose to stress fracture of the lateral tibial plateau. Described herein is a case of severe valgus knee deformity that was complicated by an intra-articular tibial plateau stress fracture and treated by a fully constrained Guepar hinge prosthesis with a satisfactory end result. The etiology and mechanism of this complication are discussed, with emphasis on the diagnostic process.

Modified lateral approach for knee arthroplasty in a fixed valgus knee--the medial quadriceps snip

The lateral approach to the knee first mentioned by Cameron and Fedorkow (1982) was developed by Keblish (1991). Although valgus deformity can be successfully corrected via a medial approach (Krachkow et al. 1991), an advantage of the lateral approach is that it permits direct exposure of the contracted soft tissue in the lateral aspect of the knee. An extensive lateral release is much easier to perform. The lateral approach preserves the continuity of the medial side of the capsule with the insertion of the vastus medialis vascularity of the patella and corrects the external tibial rotation associated with the valgus knee. Patellofemoral problems may diminish with this approach

Fracture of the Greater Trochanter during Hip Replacement A Retrospective Analysis of 29/688 Cases

Nonunion of the greater trochanter occasionally occurs following trochanteric osteotomy [1] without major consequences. The information regarding the incidence and the consequences of unintended trochanteric fracture is limited. Specifically, it is not clear whether trochanteric non-union or long term trochanteric pain is consequences of such fractures. Trochanteric nonunion may also increase the risk of prosthesis dislocation [2]. Fracture of the greater trochanter rarely occurs after THR surgery without osteotomy [3]. In the current comparative study, the incidence and clinical relevance of iatrogenic greater trochanter fractures in connection with the lateral Hardinge approach [4] were analyzed depending on the patient’s position during the surgery in order to define whether the incidence varies depending on patient positioning.