revision

Management Bone Defects

AORI / Andersen Orthopedic Research Institute

 

T Tibial  F Femoral

 

1.  Contained Metaphyseal Defect

 

2.  Damaged Metaphyseal

A.  One Condyle

B.  Both Condyles

 

3.  Deficient Metaphysis +/- collaterals +/- extensor mechanism

 

1.  Contained Metaphyseal defect 

 

Fractures

Intraoperative Fractures

 

1.  Shaft fracture from IM rod

 

TKR Femoral Shaft Fracture IM Rod

 

2.  Posterior condylar fracture

 

Management

- assess stability

- ORIF if needed

 

Stiffness

 

Incidence

 

10%

 

Requirements

 

70 swing phase

80o climb up stairs

90o climb down stairs + sit down in chair

100o low chair

 

NHx

 

Stiffness usually subsides at 6-8/52

- generally improves out to 3/12

- slow improvement for up to next 9/12

 

Background

IncidenceRevision ACL Ruptured Graft MRI BPTB Allograft

 

Up to 8% patients with ACL reconstruction will have recurrent instability and graft failure

- increased with surgical inexperience

 

Graft can

 

1.  Be inadequate from the start

- inadequate tension

- poor tunnel placement

 

Revision Stabilisation

Causes for failure

 

1.  Patient factors

 

A.  Recurrent Trauma

- contact athletes higher risk

 

B.  MDI / Ligamentous Laxity / Voluntary dislocaters

 

C.  Poor rehabilitation

- poor motivation

- too rapid

- patients rarely get stiff, better to go very slow

 

2.  Surgeon Factors

 

A.  Unrecognised bony defect