Patient Overview

A 66-year-old woman had been dealing with knee pain for the past 10 years, which worsened significantly over the last two years. Despite trying various treatments, including painkillers, Ayurvedic remedies, joint injections, and exercise, she only experienced temporary relief. After a thorough examination and discussion with her and her family, the decision was made to perform a total knee replacement.

Surgical Details

• Surgical Approach: The surgery was done using the Minimally Invasive Sub-Vastus Approach, which avoids cutting through major muscles, resulting in a quicker recovery, less pain, and minimal scarring.
• Duration: The procedure was completed in 1 hour.
• Post-Surgery: The patient started walking with a walker on the same day of surgery and was discharged on Day 3. She experienced no complications, and ICU care was not required.

Recovery Process

• At-Home Physiotherapy: Physiotherapy continued at home, and by Day 5, the patient was walking independently without support, demonstrating excellent confidence in her recovery.
• Suture Removal: Sutures were removed on Day 14.
• Full Recovery: Within two weeks, the patient returned to her normal life without any assistance, pain-free.

Conclusion

This case shows how a minimally invasive total knee replacement can offer significant improvements in quality of life, with fast recovery and lasting relief from chronic knee pain.

Hashtags

#KneeReplacement #MinimallyInvasiveSurgery #Orthopedics #FastRecovery #PainRelief

Case Overview

A 40-year-old male patient sustained a significant injury after falling from a height of 12 feet. Fortunately, there were no signs of head, chest, abdomen, or spinal injuries. However, the patient was diagnosed with a floating knee, a severe injury involving fractures in both the femur and tibia.

The Injury Breakdown

1. Fracture 1: Left Segmental Femur Fracture

• Subtrochanteric fracture with a butterfly fragment: This is a fracture in the upper part of the femur near the hip. A butterfly fragment refers to a wedge-shaped fragment that often complicates the healing process.
• Extra-articular distal femur fracture: A break near the knee joint, but without affecting the joint surface.

2. Fracture 2: Left Segmental Tibia Fracture

• Proximal third tibia fracture: This is a fracture in the upper third of the tibia, the major bone in the lower leg.
• Midshaft tibia fracture: A break in the middle portion of the tibia.

Surgical Approach: Goals and Challenges

Goals:

The surgical team had three main goals for this procedure:

1. Anatomical Reduction: Ensuring the bones are perfectly aligned to heal properly.
2. Appropriate Stability: Achieving sufficient stability for the bones to heal while maintaining movement and weight-bearing functions.
3. Respect Fracture Biology: Protecting the natural healing capacity of the bone and soft tissue by minimizing excessive handling or disruption of the blood supply.

Sequence of Fixation:

1. Long Proximal Femoral Nail (PFN): The patient was positioned laterally to insert a long PFN, a type of intramedullary nail used for stabilizing femur fractures.
2. Supine Position for DFLP and Tibial Plate: After stabilizing the femur, the patient was turned into a supine position to work on the distal femur and tibia. The Distal Femur Locking Plate (DFLP) was inserted using a lateral approach, with careful attention to anatomical reduction of the distal femur segment.
3. Tibial Fixation with MIPPO Hockey Plate: The initial plan was to insert a nail into the tibia. However, the proximal tibia fragment was misaligning into recurvatum (backward bending) and varus (inward angulation). To counter this, the team opted for a Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO) Hockey Plate, which is ideal for stabilizing fractures while minimizing soft tissue disruption.

Duration:

This complex surgery lasted for approximately 4 hours, involving meticulous planning and execution to ensure the best possible outcome.

Conclusion

This case illustrates the intricacies involved in treating a floating knee injury. Achieving anatomical reduction, proper stabilization, and preserving the natural biology of the fracture site are all critical factors in a successful outcome. The decision to use a combination of PFN, DFLP, and MIPPO plates demonstrates the complexity of trauma surgeries and the expertise required to handle such cases.

Key Hashtags

#ComplexTrauma #FloatingKnee #FemurFracture #TibiaFracture #OrthopedicSurgery

Patient Background

A 76-year-old female had been suffering from severe bilateral knee pain for the past 12 years. The chronic pain was impacting her mobility and quality of life, making daily activities increasingly difficult. After a thorough examination and detailed counseling with the patient and her family, the medical team recommended a total knee replacement for both knees in a single procedure.

Decision for Surgery

Given the patient’s long-standing knee pain and limited mobility, total knee replacement was deemed the best course of action. This procedure would not only alleviate the pain but also restore her ability to walk and perform routine activities comfortably. The patient and her family were well-informed about the process, risks, and recovery expectations before moving forward.

Preoperative Care

The patient was admitted one day prior to the surgery for preoperative evaluations and preparation. After ensuring she was in optimal condition, the surgical team proceeded with the scheduled bilateral total knee replacement the following day.

Surgical Procedure: Minimally Invasive Sub-Vastus Approach

The surgical team used a Minimally Invasive Sub-Vastus Approach, which is particularly advantageous for knee replacement surgeries. This technique avoids cutting through major muscles, leading to:

• Faster Recovery: Muscle-sparing techniques allow patients to regain mobility quicker.
• Reduced Postoperative Pain: Less trauma to muscles means less pain after surgery.
• Minimized Scarring: The incision is smaller, resulting in a shorter and less noticeable scar.

The surgery took a total of 2.5 hours, during which both knees were successfully replaced.

Immediate Postoperative Recovery

The patient’s recovery was smooth and complication-free. She was:

• Shifted directly to her room, without requiring admission to the ICU, reflecting the minimally invasive nature and low risk of complications with the chosen surgical approach.
• Walking on the same day of surgery: With the aid of a walker, she was able to stand and take steps just hours after the procedure.

Postoperative Care and Discharge

The patient was discharged on Day 3, after demonstrating stable progress. She continued to receive physiotherapy at home, which focused on regaining strength and movement in the knees. Impressively, by the third day after surgery, she was walking independently without any support and showing remarkable confidence in her movements.

Follow-Up and Full Recovery

• Sutures were removed on Day 14, marking another significant milestone in her recovery.
• Within two weeks, the patient returned to her normal life without the need for any assistance, enjoying pain-free movement for the first time in over a decade.

Conclusion

This case highlights the life-changing benefits of bilateral total knee replacement using a minimally invasive, muscle-sparing approach. The patient’s swift recovery, early mobility, and return to normal life demonstrate how modern surgical techniques can significantly improve the outcomes for elderly patients.

If you’re suffering from chronic knee pain and wondering if knee replacement is right for you, consult our orthopedic specialists to explore your options.

Key Hashtags

#KneeReplacement #MinimallyInvasiveSurgery #OrthopedicSurgery #BilateralKneeReplacement #SeniorHealth