issues

Perthes

Issues

 

Femur

 

Multiplanar deformity

- worsend by previous surgery

- may require osteotomy

 

Acetabulum

 

Dysplasia often present

- not as severe as in DDH

 

LLD

 

Can be significant

 

Abductors

 

Have been short for long time

- difficult to restore length

Median & Ulna Nerve

IssuesMedian and ulna nerve injury

 

Extremely difficult

- goals of rehab must be realistic

- limited number of donors

- static procedures more prominent

- fusions, tenodesis and capsulodeses must be used

 

Goals

 

1.  Thumb Opposition

 

EIP to APB and EPL 

Cemented

THR Cemented Femur

Goals in femoral cementing

 

Optimize cement-bone interface

Cement mantle free of defects

Minimum 2 mm thickness

Femoral component centred in cement mantle

 

Survival

 

Swedish Joint Registry

 

Reflection All Poly / Spectron 92% 10 year

 

Revision Shoulder Arthroplasty

Issues

 

Rule out infection

Assess rotator cuff / bone stock preoperatively

Approach

- difficult / scarring +++

- very difficult to restore any loss of ROM

Removal of prosthesis

Glenoid

- may not be able to revise

Humeral component

- long stem

 

Investigations

 

Rule out infection

- CRP / ESR

- ultrasound or xray guided aspiration

Scoliosis

Epidemiology

 

Scoliosis 10 to 15 x more common in patients with spastic quadriplegia than spastic diplegia

 

Typically

- spastic quadriplegic patient

- long C shaped curve

- lumbar apex

- progressive past maturity

- pelvic obliquity / dislocated or subluxed hips

- can extend into cervical spine

- high risk of respiratory compromise

 

Issues

 

Sitting in wheelchair

Hygiene

Neuromuscular

Categories

 

Decreased tone

- Polio

- Down's syndrome

- spina bifida

 

Increased tone

- cerbral palsy

- Parkinson's

- CVA

 

Polio

 

Rare

- case reports only

 

Down's Syndrome

 

Acetabular dysplasia not uncommon in this group

 

Results

 

Arthrodesis Conversion

Indications

 

Severe LBP 

- most common indication

 

Ipsilateral knee pain

- less beneficial

 

Malposition

- especially abduction

 

Contraindications

 

Absent abductor mechanism

Flail

Active infection

Insufficient bone stock

 

Examination

 

LLD

 

Hemiplegia

Problems

 

1.  Lower limb

 

All walk

- Ankle > knee > hip

 

Ankle

- most require operations for ankles

 

LLD

- unilateral underdevelopment

- LLD 0-5cm (average 2cm)

 

2.  Lower limb

- one handedness

- decrease movement in swing

- astereogenesis

- usual upper limb contractures