Li Guishan, director of the Department of Arthroplasty of Guizhou Huaxia Orthopaedic Hospital, saw a special patient who is suffering from bilateral knee pain for 11+ years, he came to the hospital with a bench to trek into the department, with severe deformity of both knees and great difficulty in walking. The radiographs suggested that the patient had old fracture (non-healing) of the left distal femur + old dislocation of the left knee + osteoarthrosis of the right knee. For further treatment, the patient sought help from the joint surgery department of Guizhou Huaxia Orthopaedic Hospital, hoping to receive knee surgery.
In response to the patient’s bilateral knee condition, Director Guishan Li’s team conducted a thorough consultation and studied the details of the surgery, and finally developed a complete and thorough surgical plan for the patient, then performed “bilateral” knee arthroplasty using the LDK “Hinged Knee Prosthesis” and “Modular Tumor Knee Prosthesis”, and the surgery went well.
Description:
Patient, female, 62 years old
Complaint:
Bilateral knee pain and limitation of movement for 11+ years.
Present medical history：
The patient had pain in both knees since about 11+ years ago without any clear cause, and gradually became limited in movement (the left side is more severe), but she did not care at that time and did not receive systematic treatment. She was unable to walk, limp when walking with crutches, squatting and walking up and down slopes, and other weight-bearing activities. The left knee dislocation deformity gradually worsened; the right knee gradually developed enlargement and flexion inversion deformity, which seriously affected daily life.
In the past year, the above symptoms worsened, and she was admitted to a local hospital for further treatment, and requested inpatient knee surgery.
Past history:
13+ years ago, a traumatic injury to the left knee caused deformity and pain and limited activity, and after self-treatment, the deformity, pain and activity of the left knee improved; in 13+ years, he underwent a free body removal of the left knee at a local hospital and was discharged clinically cured; for 8+ years, he had a history of intermittent black stool without formal treatment.
Specialized examinations:
The spinal physiological curvature became shallow, there was no pressure pain and percussion pain in the lumbosacral region, and the lumbar spine was movable in all directions.
The left lower extremity was shorter than the right lower extremity by about 6.0 cm; the right knee was enlarged and flexion deformed (inversion of about 30°); the left thigh was pseudo-articularly dislocated near the knee; the skin color and temperature of both knees were normal; about 8.0 cm of longitudinal old surgical scars were seen on the anterior side of the left knee, which healed well.
Both knees had significant peripatellar and total medial and lateral knee gap pressure pain, floating patella test (-), right drawer test (-), left drawer test (could not be examined normally), lateral stress test (+), McSweeney’s sign (+), patellar grinding test (+), negative right straight leg raise test, left straight leg raise test could not be performed; right knee movement was limited: right knee extension about -5°; right knee flexion about 70°; right knee internal rotation about 5°, external rotation about 5°.
Loss of extension, flexion, internal rotation and external rotation of the left knee; good sensation and blood flow in the distal part of both lower limbs; normal muscle tone in the right lower limb; muscle tone in the left lower limb could not be measured normally; good pulsation of the dorsalis pedis artery bilaterally.
Auxiliary examinations:
1, Bilateral knee osteoarthrosis
2, Old fracture of the distal left femur (non-healing)
3, Old dislocation of the left knee joint
4, Gastrointestinal bleeding?
Preoperative
Postoperative
Surgeon Introduction
Guishan LI
Director of Joint Surgery, Guizhou Huaxia Orthopaedic Hospital
Former Director of Orthopedic Department, 91st PLA Hospital
Master’s Degree, Associate Chief Physician
Standing member of the Third Professional Committee of Trauma and Repair of Guizhou Rehabilitation Medicine Association;
Member of Guiyang City Medical Accident Technical Appraisal Expert Pool
Specialties: artificial joint replacement surgery and revision surgery, sports medicine (arthroscopic surgery), surgical treatment of spinal injuries, complex fractures of extremities, soft tissue defects, and correction of extremity deformities, etc. He has special insight into the diagnosis and treatment of femoral head necrosis.
Post time: May-09-2023