Issue 01/April 2024

Precision in Practice: A Complex Case Successfully Handled by the Sterling Arthroplasty Team

By: Dr. Himanshu Mathur Dr. Pravin Nandwana

When a patient presented to the Outpatient department of Sterling Hospital, Gurukul in December 2023 and met our Senior Consultants - Dr. Himanshu Mathur and Dr. Pravin Nandwana, they had been suffering extensively for the last three years and were on the verge of a breakdown due to constant pain in their right knee and inability to walk even for a few meters. The patient had been involved in an accident in their native place, Chittor, about three years ago and had undergone surgery for plating in the right femur in Chittor.

However, since the day of the surgery, they hadn’t experienced a single pain-free day, and moreover, their knee had become stiff. After thorough clinical and radiological examination, it was determined by our consultants that they were suffering from non-union with hardware failure in the right femur fracture, along with a totally stiff knee with zero flexion at the right knee. X-ray and CT scan revealed non-union of the distal femur with two distal femur plates in situ (medial and lateral), with many broken screws seen on both plates. Tenderness was present at the fracture site with no flexion seen at the right knee, and a scar from the previous surgery was seen midline anteriorly.

After thorough counseling of the patient, it was determined that it was better to remove the plates and non-united fragments along with broken screws and implant a distal Rotating Hinged Knee Prosthesis along with fibrolysis to achieve flexion of the knee. It was quite a complex surgery but handled with utmost precision by our immensely experienced team of Dr. Himanshu Mathur and Dr. Pravin Nandwana. Intra-operatively, the knee was approached from the previous incision only, taking care to preserve the vascular outflow of the skin. Gradually, adhesions were removed, and screws, seen directly, were taken out. The fracture site was identified, and carefully the distal femur was removed. As the knee flexion improved greatly at this point in time, the lateral and medial plates along with broken screws were extracted using specialized instruments. The femur and tibial preparations were done, and the Rotating Hinged Knee Prosthesis was implanted successfully.

The incision was carefully sutured in layers. The very next day, the patient was made to stand and walk, and knee bending was started. At the three-month follow-up, the patient is greatly satisfied with total alleviation of pain in their right knee and is walking up to two kilometers without support. They are able to bend the knee up to 30-40 degrees, which greatly improves their day-to-day activities, and further improvement is expected in the coming weeks with physiotherapy. In conclusion, a very complex case was handled diligently by the Sterling Arthroplasty Team, leading to an extreme satisfaction level of the patient.

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