Post Traumatic Secondary Osteoarthritis – Mangled Limb. TKR with PSI
2Rappaport Faculty of Medicine, Technion Institute of Technology, Israel
Patient: 58 y, male, work accident, fall from height, 2015 (6 y ago), crutch ambulation, pain clinic, cannabis medical permit.
Pathology: Bilateral comminuted Fx of distal femur Rt. - Open with complete ruptured patella tendon. contralateral closed comminuted # distal femur.
Treatment: ORIF with NCB plate + multiple headless screws Rt. Distal femur and patella tendon reattachment through patella drill holes. ORIF with NCB plate Lt. femur.
X-Ray 2021: Post traumatic advanced Rt. Knee Osteoarthritis:
Rx: Sever Patella Baja, large “Pellegrini Stiede Type” medial ossification, Multiple screws distal femur- through plate & independent (Acutrak), obliterated medullary canal, full union, good coronal alignment, sagittal distal femur deformity.
Physical exam: Rt. Knee: Hockey stick lateral surgical incision. Extension lag – Negative.
Stiffness: ROM; -5 to 80 degrees, painful.
Treatment: Primary TKR – Patient Specific Implants (PSI) – “Signature” preplanning.
Deep dish rotating platform Vanguard ROCC Zimmer- Biomet. Minimal “on demand” hardware removal.
Surgical approach: Midline Incision (cross distal arm previous scar), Adhsiolysis, Q-Snip, Patella resection arthroplasty.
Implantation: PSI jigs, standard technique
Rehabilitation: First 7 days – knee immobilizer + continuous Block. Early CPM – from day 7 POD. FWB.