Introduction

Recurrent dislocation after hip arthroplasty is a difficult problem. The purpose of the present study was to evaluate the results with the use of a constrained cup for treatment for instability after hip arthroplasty.

TKA (Total Knee Arthroplasty) is a successful operation. Soft tissue problems with TKA are difficult to treat. Flap surgery is successful in treating this problem and salvaging the prostheses. We present results of flap surgery for complicated TKAs over a ten year period, performed by a single surgeon.

Between 1996 and 2005, 31 patients (32 knees) underwent flap surgeries for TKAs. Four of these procedures were done prophylactically in patients with previous knee surgeries. Gastrocnemius, medial fasciocutaneous and anterior compartment flaps were used either solely or in combination based on the size of the defect. The data was collected retrospectively from case-notes and correspondence from the treating orthopaedic surgeons. All the knees included in the study had a minimum follow up of 6 months.

The patients were aged between 50 and 94 years. Indication for primary TKA was osteoarthritis in 26 patients and rheumatoid arthritis in 5. The index orthopaedic surgery was a primary knee arthroplasty in 14 and revision in 13. The average duration between the TKA and flap surgery was 11 weeks (range 1 – 52). Gastrocnemius was the most commonly used local flap (17 cases). Anterior compartment flap was used in 5 cases and in the rest combination of flaps was used. Coagulase -ve Staph. aureus was the most commonly isolated organism from the perioperative wound swabs. Successful soft tissue cover was achieved in 29 of 32 knees (92%). Overall, TKA was salvaged in 23 of 32 knees (72%) and 3 knees (9.7%) underwent arthrodesis. Three (9.7%) patients had above knee amputation, two of these had post op MRSA infection. We could not use a functional knee scoring system due to inadequate information available.

We conclude local flap surgery is a viable and successful procedure for providing soft tissue cover for complicated TKAs with good results.

Introduction and aims: Soft tissue defects after total knee arthroplasty (TKA) are difficult problems to treat. Flap surgery has been successful in salvaging the prostheses. We present results of flap surgery for exposed TKAs over a 10 year period performed by single surgeon.

Material and Methods: Between 1996 and 2005, 31 patients (32 knees) underwent flap surgeries for TKAs. Four of these procedures were done prophylactically in patients with previous knee surgeries. Gastrocnemius, medial fasciocutaneous and anterior compartment flaps were used either solely or in combination based on the size of the defect. The data was collected retrospectively from case-notes and correspondence from the treating orthopaedic surgeons.

Results: The patients were aged between 50 and 94 years. Indication for primary TKA was osteoarthritis in 25 patients and rheumatoid arthritis in 5. Coagulase negative Staph. aureus was the most commonly isolated organism. In patients using steroids, 4 of 6 (71.4%) knees had good or satisfactory outcome compared to 22 of 24 (91.7%) knees in patients not on steroids. Smoking did not influence the outcome of flap surgery . The average duration between the TKA and flap surgery was 11 weeks (range 1 – 52). Successful soft tissue cover was achieved in 30 of 32 knees (94%). Overall, TKA was salvaged in 20 of 28 knees (71.4%) knees, 3 knees (9.7%) underwent arthrodesis and above knee amputation was performed in 4 (12.4%). The information gathered from case notes and orthopaedic surgeons was insufficient to use a knee score for evaluating the functional outcome of the procedure.

Conclusion: Local flap surgery for providing soft tissue cover for exposed TKA is a viable and successful procedure with good results.

Claw toes are treated by a variety of soft tissue and bony proceduresbased on the severity of the deformity. We evaluated the results of Stainsby procedure for claw toes. This is a retrospective analysis of the results of Stainsby procedure for claw toes of the foot done by a single surgeon over a 10 year period. All patients who had claw toes,secondary to Rheumatoid and Non rheumatoid causes and treated by this procedure were included in the study. All the patients operated between Jan 1995 -Dec 2004 and who had minimum follow-up of 6 months after surgery were included in the study. Follow up evaluation was by clinical examination, review of case notes and telephone conversation.

42 patients underwent this procedure of which 38 were available for evaluation. Average follow-up was 43.5 months (6–110months). 26 rheumatoid and 21 non-rheumatoid feet were evaluated based on the AOFAS score. The mean AOFAS score was 76.5. The scores for the Rheumatoid and Non-Rheumatoid groups were 81.5 and 72.6 respectively.81% were satisfied with the result of the operation and 83% would recommend this surgery for friends and relatives. Six patients had superficial infection, 2 had broken k-wires, 2 had DVT, and 2 had recurrence of deformity.

We conclude that Stainsby procedure for claw toes is a procedure which has good results in the long term and can be taken up as a procedure of choice for severe claw toes.

Claw toes are treated by a variety of soft tissue and bony proceduresbased on the severity of the deformity. We evaluated the results of Stainsby procedure for claw toes. This is a retrospective analysis of the results of Stainsby procedure for claw toes of the foot done by a single surgeon over a 10 year period. All patients who had claw toes, secondary to Rheumatoid and Non rheumatoid causes and treated by this procedure were included in the study. All the patients operated between Jan 1995 -Dec 2004 and who had minimum follow-up of 6 months after surgery were included in the study. Follow up evaluation was by clinical examination, review of case notes and telephone conversation.

42 patients underwent this procedure of which 38 were available for evaluation. Average follow-up was 43.5 months (6–110months). 26 rheumatoid and 21 non-rheumatoid feet were evaluated based on the AOFAS score. The mean AOFAS score was 76.5. The scores for the Rheumatoid and Non-Rheumatoid groups were 81.5 and 72.6 respectively.81% were satisfied with the result of the operation and 83% would recommend this surgery for friends and relatives. Six patients had superficial infection, 2 had broken k-wires, 2 had DVT, and 2 had recurrence of deformity.

We conclude that Stainsby procedure for claw toes is a procedure which has good results in the long term and can be taken up as a procedure of choice for severe claw toes.

Metachronous multifocal osteosarcoma (MFOS) is a rare form of osteosarcoma manifested by one or more new tumors developing after the initial treatment of primary osteosarcoma. We present a 61 year old Asian male who was referred with 10 week history of pain and discomfort around his left shoulder and low back pain. In 1968, he received radiotherapy followed by disarticulation of left hip for an osteosarcoma of lower end of left femur complicated with pathological fracture. He did not show any clinical features suggestive of recurrence of disease since then until he presented again in February 2005. CT scan of left scapula has revealed extensive osteosarcoma of lower part of scapula, involving subscapularis and infraspinatus muscles. An MRI scan of whole spine has shown evidence of multiple lesions in sacrum, ilium and acetabulum. A core biopsy from scapula has confirmed the histological diagnosis as high grade osteoblastic osteosarcoma. Slides from 1968 were reviewed in the context of recent recurrence and were consistent with features of intermediate grade fibroblastic osteosarcoma. He is currently undergoing chemotherapy prior to planning definitive treatment as there is evidence in the literature that MFOS is a potentially curable condition.