Total elbow arthroplasty is a relatively rare procedure compared with total knee or total hip arthroplasty. Total elbow arthroplasty for bony ankylosis is even rarer, and the results are often unsatisfactory. We report a patient who gained good mobility of the elbow after total elbow arthroplasty for the treatment of fractured arthrodesis site with which the patient had lived with for 12 years.
Ankylosis ; Arthrodesis* ; Arthroplasty* ; Arthroplasty, Replacement, Hip ; Elbow* ; Humans ; Knee

OBJECTIVE: Hip and knee joint replacement procedures are an effective therapeutic intervention in treating severe joint disorders. Its use has been increasingly performed worldwide, including the Philippines, with its techniques constantly evolving and the science behind it improving. This study aims to describe the demographics, clinical profiles, and outcomes of arthroplasty patients by the Arthroplasty Service, Department of Orthopedics, University of the Philippines – Philippine General Hospital (UP-PGH). METHODS: The study is a descriptive and retrospective review of patients who underwent joint replacement procedures, both primary and revision arthroplasty, from January 2012 to December 2018. Patient demographics and clinical data of patients who underwent total joint arthroplasty at the UP-PGH were collected and evaluated. RESULTS: Data from 279 patients with 306 primary joint replacement procedures were analyzed. There were 195 total hip arthroplasty procedures (THAs) and 111 total knee arthroplasty procedures (TKAs) done. The mean age for THA patients was 55.6 years old, with more females (68.2%) with the left hip being more commonly affected (54.9%). The most common indication for THA was an untreated femoral neck fracture (23.1%) followed by avascular necrosis (20.5%). Cementless fixation was the most commonly used technique (61.5%). Meanwhile, the mean age for TKA was 64.5 years old, with the majority having degenerative osteoarthritis, and using cemented TKA fixation for all knees. A total of 37 revision arthroplasty cases were performed, with 34 in the hip and three in the knee, with infection being the most common overall indication (53%). CONCLUSION: The demographics, clinical profiles, and outcomes of the UP-PGH Arthroplasty Service are comparable to other centers internationally, and further emphasizes the satisfactory outcomes of these procedures. Meanwhile, suggested explanations for the subtle differences are discussed in this study.
Arthroplasty, Replacement, Knee ; Arthroplasty, Replacement, Hip

Humans ; Arthroplasty, Replacement, Hip ; Arthroplasty, Replacement, Knee

Total ankle replacement has been performed for treatment of end stage arthritis of the ankle, hopefully being an alternative to ankle arthrodesis. However, due to its high failure rates, earlier versions of ankle replacements were not regarded as successful procedures. The latest design has shown increasingly positive results. Total joint replacement of the ankle itself is still regarded as a demanding procedure and much more challenging than that of the hip and knee in many aspects. Several studies, however, have pointed out that it is becoming the viable, accepted alternative for arthrodesis with advanced implants, appropriate patient selection, and proper training experience of procedures. Compared with arthrodesis, it shows equal or better outcomes in pain relief, range of motion, and patient's satisfaction. We are attempting to review its biomechanical characteristics, implant design, indications, complications, clinical outcomes, and survival rate.
Ankle ; Arthritis ; Arthrodesis ; Arthroplasty* ; Arthroplasty, Replacement, Ankle* ; Hip ; Joints ; Knee ; Patient Selection ; Range of Motion, Articular ; Survival Rate

Management of bed-ridden patients with polyarticular rheumatoid arthritis poses a considerable challenge to the orthopedic surgeon. Five such illustrative cases are presented. Case 1, a 46 year old woman, previously had Knowles pinning and fibular graft done for a neck fracture of the right hip with avascular necrosis. With a new subcapital fracture and pinns, total hip arthroplasty was done. Due to osteoporosis and anatomical distorsion surgery, the stem of the prosthesis protruded through the femoral shaft. At two year follow-up, although confined to house, the stem was unloosened and she was free of pain, while she had developed painful avascular necrosis on the opposite side. Case 2, a 49 year old woman, had had bilateral total hip arthroplasty, one with and the other without trochanteric osteotomy, for avascular necrosis. She was free of symptoms except for pain due to trochanteric nonunion. After two years, re-wiring solved the problem. Case 3, a 48 year old female,had had multiple joint pain for 17 years, including the crippling both knees with flexion deformity of 90 and 50 degrees. Bilateral total knee arthroplasty was done with subsidence of pain and gain in motion. Case 4, a 52 year old woman, had multiple joint pain and stiffness for 13 years, being bed-ridden for the last two years. A case of classical rheumatoid arthritis, she had flexion contracture of both knees of 90 snd 95 degrees and an equinus deformity of the right ankle. Her hands and wrists were stiff and elbows and shoulders were also involved. Posterior capsulotomy was followed by bilateral total knee arthroplasty and a total ankle on the right. Postoperative course was complicated by delayed wound healing and subluxation. She was made ambulatory with a walker with Lofstrand crutches and a whole body suspension. Case 5, a 14 year old girl with classical juvenile rheumatoid arthritis, was bed-ridden since the age of seven. She had flexion deformity of both knees of 130/110 and also af both hips. Ankles, wrists, elbows and shoulders were also involved. On each knee, posterior capsulotomy and synovectomy, bone shortening and supracondylarosteotomy and hamstring transfer were done, followed by grsdusl extension by skeletal traction and cast wedging. The hospital course was prolonged because of peroneal palsy and pressure sore of tbe heel on the left and skin necrosis of the lateral wound of the right knee. Hwoever, the child went home ambulating with a bilateral long leg brace and crutches with a Lof-strand platform on the right.
Ankle ; Arthralgia ; Arthritis, Juvenile ; Arthritis, Rheumatoid ; Arthroplasty, Replacement, Hip ; Arthroplasty, Replacement, Knee ; Braces ; Child ; Congenital Abnormalities ; Contracture ; Crutches ; Elbow ; Equinus Deformity ; Female ; Femur ; Follow-Up Studies ; Hand ; Heel ; Hip ; Humans ; Knee ; Leg ; Neck ; Necrosis ; Orthopedics ; Osteoporosis ; Osteotomy ; Paralysis ; Posterior Capsulotomy ; Pressure Ulcer ; Prostheses and Implants ; Shoulder ; Skin ; Traction ; Transplants ; Walkers ; Wound Healing ; Wounds and Injuries ; Wrist

PURPOSE: To compare the outcomes of navigation-assisted total knee replacement conducted by a skilled surgeon and novice surgeon, as well as to evaluate the usefulness of the navigation assistance to a novice surgeon. MATERIALS AND METHODS: We retrospectively made a comparison between 60 total knee replacement surgeries conducted by skilled surgeon and 60 total knee replacement surgeries by a novice surgeon during the 2015. Scanograms were taken both preoperatively and at 3-month postoperatively to measure the accuracy of bone cutting and alignment. As for external rotation of the femur, we checked the values of the distal femur surgical epicondyle axis, and the posterior condyle axis displaced by the navigator after bone registration for both novice and skilled groups. For postoperative functional examination, Knee Society Score (KSS) were evaluated at 1-year follow-up. RESULTS: Forty-nine knees in the skilled group, and 51 knees in the novice group achieved coronal axis alignment of hip knee ankle values of 0°±3°. The mean external rotation degree of the femoral epicondyle axis against the posterior condyle axis, measured by the navigator, was 3.8°±2.9° in skilled group, and 1.2°±3.0° in novice group. When regarding femoral epicondyle axis, which showed a more internal rotation than the posterior condylar axis as an outlier, six cases were outlier in skilled group, while, 18 cases were outlier in novice group. After revising external rotation value of femoral implants comparing values navigation displaced and values using 3° external rotation manual jig against femoral posterior condylar axis, the skilled group showed 0 case of outlier and the novice group showed 10 cases of outlier. The mean KSS knee assessed at 1 year postoperatively was 83.2±6.8 in skilled group, and 83.1±7.0 in novice group, with no statistically significant difference. CONCLUSION: Navigation provides advantages to novice surgeon to achieve stabilized coronal plane axis, as well as accurate resection of the femur and tibia. However, the navigation does not provide any advantages in achieving the aimed amount of femoral external rotation to novice surgeons.
Ankle ; Arthroplasty, Replacement, Knee* ; Femur ; Follow-Up Studies ; Hip ; Knee ; Retrospective Studies ; Surgeons ; Tibia

PURPOSE: The objective was to evaluate the relationship between side-to-side differences of lateral femoral bowing and varus knee deformity based on two-dimensional (2D) assessment in unilateral total knee arthroplasty (TKA). MATERIALS AND METHODS: A total of 143 patients with varus knee osteoarthritis who underwent unilateral TKA were enrolled. We evaluated the side-to-side differences of the frontal lower limb alignment by assessing lateral femoral bowing, anatomical medial distal femoral angle, and anatomical medial proximal tibial angle (aMPTA). RESULTS: The average values of all anatomical indices were significantly different between the operated side and the non-operated side (p < 0.05). The side-to-side difference in hip knee ankle (HKA) angle had a statistically significant correlation with that in lateral femoral bowing (intraclass correlation coefficient, 0.259; p=0.002) and that in aMPTA. Linear regression analysis showed 0.199° of side-to-side difference in lateral femoral bowing was associated with 1° of side-to-side difference in bilateral HKA angle. CONCLUSIONS: The side-to-side difference in lateral femoral bowing showed a tendency to increase in proportion to varus knee deformity based on 2D assessment in unilateral TKA patients.
Ankle ; Arthroplasty, Replacement, Knee ; Congenital Abnormalities ; Femur ; Hip ; Humans ; Knee ; Linear Models ; Lower Extremity ; Osteoarthritis ; Osteoarthritis, Knee

Periprosthetic joint infections are a major cause of morbidity and mortality following total joint arthroplasty. Two-stage arthroplasty, with the use of an antibiotic cement spacer, is an effective means of managing periperiprosthetic joint infections. There is a lack of data relating to the management, prognosis, and clinical outcomes associated with multiple peri-prosthetic joint infections. Here, we present a case report of a patient successfully treated for three synchronic peri-prosthetic joint infections of both knees and a single hip.
Arthroplasty ; Arthroplasty, Replacement, Hip ; Arthroplasty, Replacement, Knee ; Hip ; Humans ; Joints ; Knee ; Mortality ; Prognosis

Catastrophic failure of stemmed components in arthroplasty is an uncommon but a serious complication. Stem fractures and techniques for addressing these have been described following hip arthroplasty but much less so following total knee arthroplasty (TKA). We review three cases of catastrophic failure of the stem in rotating hinge revision TKA prostheses. We discuss the possible mechanism of failure and review the current literature addressing this topic. Metaphyseal support needs to be optimized in order to minimize load transfer to the stem and to the junction (and the risk of fracture) if a modular component is used. When constrained components are used, radiographs need to be carefully assessed for signs of proximal loosening. Nonmodular stems are also an option in this situation.
Arthroplasty ; Arthroplasty, Replacement, Knee* ; Hip ; Knee ; Prostheses and Implants

Hypobaric spinal anesthesia for fifty patients(spinal group) undergoing total hip replacement were compared with general anesthesia(general group) in respect to intraoperative blood loss, changes of blood pressures, postoperative analgesics, etc. Furthermore, the technical aspects were evaluated for hypobaric spinal anesthesia in the lateral position when 1% tetracaine in distilled water (epinephrine 1: 200,000) was administered. The lowest blood pressure parameters were significantly lower in the spinal group(29%) than in the general group(22%). The amount of blood loss in the spinal group was less than that in the general group even though there was no difference in blood replacement between groups. The time period before analgesic use longer in the spinal group(4.1 hours)than the general group(2.7 hours). The most common complication in either group was urinary retention(50% in the spinal and 44% in the general) in which urinary catheterization was necessary. In the general group, thirty-six per cent of the patients had mild fever in the first or second postoperative day which were not consistently related to pulmonary complications. For spinal anesthesia, 5 or 6 mg of 1%-tetracaine in distilled water mixed to 1: 200,000 epinephrine was used. The spinal puncture was performed by a 22G needle on the L2-3 or L3-4 in- tervertebral space with lateral aproach in the position of the operation. Injection speed was controlled to 1 ml/sec in all patients. Sensory levels were reached to T7-8 and T9-10 in the non-dependent and dependent side, respectively. Motor funetion on knee and ankle was lost in the non-dependent side, but not in the dependent side. There were some intraoperative complaintments including positional discomfort on hip rest and shoulder bar. However, there was no remarkable problem in hypobaric spinal anesthesia intraoperatively. The results of our study indicate that hypobaric spinal anesthesia in lateral decubitus position is a recommendable anesthetic technique for total hip replacement surgery.
Analgesics ; Anesthesia ; Anesthesia, Spinal* ; Ankle ; Arthroplasty, Replacement, Hip* ; Blood Pressure ; Epinephrine ; Fever ; Hip ; Humans ; Knee ; Needles ; Shoulder ; Spinal Puncture ; Tetracaine ; Urinary Catheterization ; Urinary Catheters ; Water