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Diagnosed as tibial spine. Done with screw fixed inside. No flexion is possible. Knee feels stiff. Suggestions?

DOCTOR OF THE MONTH - Jul 2013
Jul 2013
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Orthopaedic Surgeon, Joint Replacement
Practicing since : 1996
Answered : 2148 Questions
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good mg,
i met with an accident and diagnoised as tibial spine injury on the right knee in the year 2003. For that ACL had done with screw fixed inside. Puss had come from the place where the surgery were undergone. Again switches were removed and cleaned the place after 2 days interval. After one months of removal of plaster of paris i tried to flex with the help of physiotherapist but the excercise was in vain. Later i approached to the XXXXXXX ortho where i calcaneal traction was done , was advised to wait to control the infection and the screw inside the knee had removed with the x-y quadriceps procedure. even after the surgery, no flexion was possible with severe work-ups. again i visited he told that flexion is not possibe since the ligaments and things around knee are severely damaged and the knee is very stiff- must go for ilazarav ring fixation to fix the knee joints. i did so...my knee is not flexed a little now.... With regard to this, my question is there any way to make my knee flexed, if no is there any future advancement to make the knee flexed..? Moreover the diameter of thigh part is getting somehow thin
Posted Mon, 12 Aug 2013 in Bones, Muscles and Joints
 
 
Answered by Dr. K. Naga Ravi Prasad 36 minutes later
Hi, thanks for getting back to me.

This is just to let you know that Total knee arthroplasty (TKR) is generally reserved for people older than 50 years of age. But there is no hard and fast rule.

A well performed TKR will last for 15-20 years.

The cost of this surgery will be around 1.5 - 2 lakhs with conventional implants .

If there is damage to the COLLATERAL LIGAMENTS in the knee joint, then the conventional implants won't work and HINGED KNEE PROSTHESIS has to be used which costs much more.

There are so many complications related to TKR and its not possible to mention all of them here. But the important complications are INFECTION and DVT (deep vein thrombosis -means formation of blood clots in the veins). All the complications will not occur in each and every patient.

I just understand why your treating doctor told you that TKR is not possible in you.

Please send me the scanned copies of xrays, doctor prescriptions, surgical notes summary and any relevant material concerned. I will just go through them and offer you a reasonable solution to your problem.

Regards
Above answer was peer-reviewed by
 
Follow-up: Diagnosed as tibial spine. Done with screw fixed inside. No flexion is possible. Knee feels stiff. Suggestions? 23 hours later
Thanks sir,

i am very hopeful now after getting your positive response as i have the chance to get back to the normality... thanks once again sir...

during 2003 after i met with an accident. Imediately i was admitted in Mahatma XXXXXXX Medical and Reserach Institute, puducherry. the Chief ortho was DR.M.N XXXXXXX

DIAGONISED: as "AVULSION INJURY TIBIAL TUBERCL...@(NOT READABLE) @ RIGHT KNEE.

OPERATIVE FINDINGS: screw fixation of tibial injury ACL done on 28/08/2003

RECOMMEDED: remove the plaster of paris after 15 days.

though puss came out from the place where surgery was made out of fear i moved to MIOT, chennai. Thereat he diagonised

POST TRAUMATIC STIFFNESS OF RIGHT KNEE WITH INFECTION FOLLOWING IMPLANT SURGERY
S/P AVULSION FRACTURE OF RIGHT TIBIAL SPINE
IMPLANT SURGERY DONE ELSEWHERE IN PUDUCHERRY (SEP.3RD)

TREATMENT GIVEN: Calcaneal pin traction applied right side on 18.10.2003
Arthrolysis right knee with quadricepts V-Y plasty on 04.11.2003

and was discharged on 31.01.2004 and advised to do physio regularly.

After no effect aftermath regular physio i was again moved to the same hospital on 19.01.2004.

DIAGONSIS: IMPLANT FAILURE RIGHT KNEE WITH FLEXION DEFORMITY

TREATMENT GIVEN: ILAZAROV RING FIXATION APPLICATION RIGHT KNEE DONE ON 20TH XXXXXXX 2004 FOR CORRECTION OF THE FLEXION DEFORMITY
POST OPERATIVELY DISTRACTON WAS STARTED FROM 21ST XXXXXXX 2004
THE CORRECTION OBTAINED WAS SATISFACTORY. (I was asked the doctor whether flexion could possible for that the doctor said no its not possible and i again asked is knee replacement procedure would give back the normal, he said no., sir)

ADVICED: Care of the pin tract site, distraction as advised, gentle active right ankle and toe mobilization excercises, full weight bearing crutch walking right lower limb, elevation of right limb at rest, review after 2 weeks.

I was discharged on 31.04.2004

III VISIT TO SAME HOSPITAL TO REMOVAL OF EXTERNAL FIXATION AND TUBE CAST APPLICATION DONE ON 14.02.2004; post operative period was uneventful.

ADVISED: care of the pop cast; gentle active right ankle and toe mobilisation, straight leg raising excersies, ..

This was the history of mine as given by the hospital concerned....

regards,

XXXXX

(i have a doubt that if any things which around the knee is damaged, the total knee replacement would give good result?)
 
 
Answered by Dr. K. Naga Ravi Prasad 51 minutes later
Hi XXXXX, thanks for getting back.

Infact, all the details that you have provided are dating back 2003 & 2004. Let me know the present status of your knee joint -
* Is there any evidence of infection in the knee joint right now? either in the form of swelling, pain over knee, local rise of temparature in the knee etc.
* Are you still having the tube cast on your leg?
* Are you able to walk normally with full weight bearing on the knee?
* Can you make your knee straight ( full extension )?
* How much of knee flexion you have (knee bending)? please mention in degrees like 20%,30% etc
* Any other medicines that you are taking now

There are a few things in your past treatment that are making me confused.
* For a post traumatic knee stiffness with infection, generally a calcaneal pin traction will suffice.
* Assuming that there is no response to calcaneal pin traction, an arthrolysis of knee and V-Y Quadriceps plasty was done to give you good range of movement in the knee. This should have given you a reasonably functioning knee joint.
* I just don't understand the logic of applying Ilizarov fixator only to correct the flexion deformity. Clarity is needed in this aspect.
* Again one more contradictory treatment aspect - why after removing the Ilizarov fixator, your leg was kept in a tube cast.

The very purpose of all the treatments you have received is to regain flexion (bending) of the knee. So once the leg is immobilised in a tube cast, this purpose is lost and once again stiffness of the knee results.

Your entire treatment is Enigmatic.

My answer to your last point - For proper functioning of Total knee replacement (TKR) surgery, the integrity of the quadriceps muscle and the collateral ligaments should be intact. Even if the collateral ligaments are damaged, TKR can still be done using HINGED KNEE PROSTHESIS. Generally in complicated cases like you, the success rates will be around 80%. Also, a TKR done in a stiff knee may give a maximum knee flexion of upto 70 degrees.

Please provide me the answers for above questions.

Regards
Above answer was peer-reviewed by
 
Follow-up: Diagnosed as tibial spine. Done with screw fixed inside. No flexion is possible. Knee feels stiff. Suggestions? 25 hours later
Thanks for your feedback as soon as i sent..

adverting to your question putforth, i do hereby furnish my reply as follows,

1.. I am not feeling any swelling over the knee and any rise in temperature. often it pains if i sleep abdomen and knee laying on the ground.

2. i dont have any foreign body in my knee. x-rays after surgery reveals it.

3..yes i am able to walk normally with full weight bearing on the knee. if i strain for a long time it pains.

4..actually my right leg is in 20-30 degree flexion FIXED now. i am not able to flex to a single degree. (it was advised by the doctor to make easy to walk little fixed bend in the knee is needed, so it has fixed the knee like that)

5..i dont take any medicine now. after the surgery i havent been taking any medicine for this..

i dont know what is tube cast.

regards
XXXXX

 
 
Answered by Dr. K. Naga Ravi Prasad 1 hour later
Hi XXXXX, nice to hear from you.

If you are able to walk normally bearing full weight on the knee then don't think of going for TKR now. Let the natural knee serve you as long as it can.

As per your description, you have got a FIXED FLEXION DEFORMITY of knee, the result of ANKYLOSIS in the knee which could be possibly due to infection.

Anyway, you can reach me on XXXXXXX whenever you feel like.

Keep going. Good luck
Above answer was peer-reviewed by
 
Follow-up: Diagnosed as tibial spine. Done with screw fixed inside. No flexion is possible. Knee feels stiff. Suggestions? 2 hours later
thanks sir,

Thanks for your feedback.

and very thanks for your opinion and advice.

sir, actually i thought i would go for surgery after 45 years of age if it is possible. let me know my thought come true after 45. or in future, will there be any advancement in respect of surgery for my case?

i am ver kind of u once again, sir

regards
XXXXX
 
 
Answered by Dr. K. Naga Ravi Prasad 8 minutes later
Hi XXXXX, Science and technology is advancing so rapidly in these days.

So who knows, miraculous surgeries & techniques may spring out in future that may work wonders in the field of orthopedics.

BE POSITIVE AND DON'T LOSE HOPE.

Have a great day
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