211/1032. Percutaneous retrieval of a Wallstent from the pulmonary artery following stent migration from the iliac vein. Wallstents are being used increasingly in conjunction with balloon dilatation for treatment of iliac vein stenosis. Stent misplacement or migration is a complication of the procedure, and may be symptomatic and warrant repositioning or removal. We report the case of a patient whose iliac vein stenosis was managed with two overlapping Wallstents and was complicated by embolization of one stent into the right ventricle (RV) and the other to the pulmonary artery (PA). This article illustrates percutaneous endovascular removal of a migrated stent from the PA using a jugular and femoral approach. ( info) |
212/1032. Delayed fracture of the ceramic femoral head after trauma. There are various ways in which a total hip arthroplasty may fail catastrophically. Failure of the ceramic femoral head component is well known and described. It may fail because of trauma, but delayed fracture after trauma has not been described previously. This case report describes this phenomenon and postulates a possible mechanism for this failure. ( info) |
213/1032. Locking mechanism failure in the Harris-Galante porous acetabular component associated with recurrent hip dislocation. In this review of longitudinal studies of the Harris-Galante porous acetabular component, 20% of all revisions were caused by failure of the polyethylene liner locking mechanism. We report 2 cases of locking mechanism failure in the Harris-Galante porous acetabular component presenting with recurrent dislocation. Broken tines from the acetabular locking mechanism were found embedded into the polyethylene liners in both cases. In a 79-year-old woman with recurrent dislocation, the polyethylene liner and femoral head were replaced, and the acetabular component was revised. In a 74-year-old man with chronic recurrent dislocation, the polyethylene liner and femoral head were replaced, but the acetabular component was preserved. Appropriate treatment for locking mechanism failure with a well-fixed acetabular component depends on many factors, and further long-term data are needed. ( info) |
214/1032. Aseptic loosening of 2 rim-fix, hydroxyapatite-coated acetabular cups. Two cases of aseptic loosening in the 11th and 12th year of follow-up of the same acetabular component of a fully hydroxyapatite (HA)-coated total hip arthroplasty are presented. The acetabular cup was a rim-fix type, HA-coated, titanium hemispherical shell secured to the bony acetabulum with titanium screws at the peripheral polyethylene rim. The short-term and midterm results were good with HA-coated total hip arthroplasties, but further studies are needed to investigate whether the >10-year survival of these cups is as good as the survival of cemented ones. ( info) |
215/1032. Posterior femoral impingement causing polyethylene failure in total knee arthroplasty. Several reports in the literature describe dislocation and fractures of the meniscal bearings as a result of polyethylene failure after total knee arthroplasty. In this case of an asymptomatic patient with a clinically uneventful 7-year follow-up, who died a year later of an unrelated cause, we found impressive damage of the polyethylene components. This damage, at the posterior corner of the meniscal bearing elements, was caused by regrowth of the posterior femoral osteophytes. The primary osteophytes had been resected adequately during the arthroplasty. These osteophytes are related to a bone-polyethylene impingement that occurs at >110 degrees of knee flexion. The possible range of motion of an artificial joint, owing to its design, is less than the range of flexion sometimes reached clinically by the patient. This is a problem that should be solved by the industry in the near future. ( info) |
216/1032. A dislocation of the inner head in bipolar prosthesis with a self-centering system: a case report. We present a case of inner head dislocation 11 years after the replacement of a bipolar prosthesis with a self-centering system. An 84-year-old woman with osteoarthritis of the left hip underwent a replacement of the Bateman UPF-II bipolar prosthesis in 1987. She fell off a chair on April 19 1998, and felt a sudden sharp pain in the left hip. Roentgenograms revealed that the inner head was dislocated from the outer head. Moreover, on June 19, when she stood up from the floor, the dislocation recurred. On July 23, a revision surgery was carried out. When the outer head was removed from the acetabulum, the bearing insert was markedly worn by the impingement of the femoral stem neck. Because there was no evidence of loosening of the femoral stem, a cemented replacement of the acetabular component was performed. At a 2-year follow-up, she had mild hip pain, but had returned fully to daily living. Our review of current published studies reveals that most inner head dislocations occurred in osteoarthritic patients. Thus, the occurrence of dislocations may be more dependent on patient selection than on failure of the bipolar prosthesis itself. ( info) |
217/1032. Case challenges in knee surgery: what would you do? In an interactive case presentation session, the faculty discussed management of complex primary and revision knee arthroplasty issues. Principles discussed included: preoperative evaluation of the failed knee arthroplasty, intra-articular versus extra-articular deformity correction, ligamentous balancing, managing the unstable total knee arthroplasty, bone deficiency management, rotational positioning of prosthetic components, selection of articular constraint in the revision knee, and extensor mechanism balancing. ( info) |
218/1032. An unusual case of dysphagia: retained Groningen valve. A Groningen speaking valve was lodged in the oesophagus in a post-laryngectomy patient and was neglected for nine years. The patient presented with dysphagia. It was diagnosed and removed on rigid endoscopy. The procedure was complicated by a primary tear of the oesophagus, that was managed conservatively. The case has many interesting features, that are discussed below. ( info) |
219/1032. Progressive opacification of hydrophilic acrylic intraocular lenses in diabetic patients. Four patients with diabetes mellitus had cataract extraction with implantation of a hydrophilic acrylic intraocular lens (IOL) (ACRL-C160, Ophthalmed). The IOLs showed progressive and generalized opacification 10 to 20 months after implantation, decreasing visual acuity. All 4 IOLs were removed. By light microscopic examination, the IOL surfaces were wrinkled and encrusted with microspheres. Electron microscopy revealed the material to be crystalline in nature. Energy dispersive x-ray spectrum analysis showed that the deposits were mainly composed of calcium and phosphate. ( info) |
220/1032. Opacification of a hydrophilic acrylic intraocular lens with exacerbation of Behcet's uveitis. Behcet's disease is 1 of the most common causes of uveitis in the Eastern world. Its common ocular complications are uveitis, cataract, and obliteration of retinal vessels. phacoemulsification with intraocular lens (IOL) implantation in patients with Behcet's disease is known to be a safe procedure. We managed a patient with Behcet's disease who had aggravated uveitis and opacification of a hydrophilic acrylic IOL (ACRL-C160, Ophthalmed) 4 months after cataract surgery. Recalcitrant uveitis despite maximum tolerable medication and IOL opacification with vitreous opacity necessitated an IOL exchange and trans pars plana vitrectomy. After the procedure, the eye became quiescent. However, the visual acuity was 20/200 because of the obliteration of retinal vessels. ( info) |