Calcaneal Osteosarcoma: A Rare Instance in Adolescent Patient.

Introduction: Calcaneal osteosarcoma is extremely uncommon, accounting for <1% of all osteosarcomas. They typically exhibit swelling and chronic heel pain and are frequently clinically misdiagnosed as traumatic or inflammatory process. Case Report: We report a case of a 19-year-old girl with calcaneal osteosarcoma who initially complained of heel pain that was refractory to analgesic medications over a period of 4 months. Conclusion: The case highlights the importance of early diagnosis and management of osteosarcoma in patients with chronic heel pain and also highlights the importance of considering osteosarcoma as a differential diagnosis in adolescents who present with chronic heel pain, despite the rarity of the condition.

Erosion and Failure of the Tibial Post after Posterior-stabilized Total Knee Replacement: A Case Report.

Introduction: Posterior-stabilized (PS) total knee arthroplasty (TKA) prostheses are characterized by an articulation between the polyethylene tibial post and the cam of the femoral component. Tibial post-fractures, traumatic and non-traumatic, are uncommon but catastrophic complications. We report a rare and unusual case of complete atraumatic erosion of the tibial post after PS-TKA. Case Report: We present a case of atraumatic tibial post-failure (complete erosion) in a 73-year-old female after primary TKA. The patient presented with chronic pain, effusion, and instability both in the coronal and sagittal plane over a period of 1 year. There were no signs of component loosening on plain radiography, no fractures, and revealed medial extension laxity on valgus stress views. During revision surgery, polyethylene insert retrieval revealed a completely eroded tibial post, without any obvious fracture. There was no fractured tibial post lying freely in the joint cavity. The patient was subsequently revised with a hinged component due to gross bi-planar instability. Conclusion: In a post-TKR (PS knee) patient with chronic pain and instability, one should consider tibial post-complications after ruling out infection. Chronic instability can cause progressive erosion of the tibial post, which can fail without an obvious fracture. Revision surgery with constrained implants may be needed to manage such cases.

Mid-resection Workflow for Robotic-assisted Total Knee Arthroplasty in a Stiff Knee.

Introduction: With the growing prevalence of robotic-assisted total knee arthroplasty (RATKA), the significance of effectively addressing complex deformities using this approach is gaining widespread recognition. This article underscores the importance of a novel mid-resection workflow specifically tailored for RATKA in cases with complex deformities. Case Report: A 58-year-old female patient diagnosed with severe osteoarthritis in both knees and a stiff left knee underwent RATKA utilizing a mid-resection workflow. The surgery resulted in favorable intraoperative stability and achieved a satisfactory range of motion. Follow-up at the 1-year post-operative mark demonstrated a range of movement of 110° and a positive functional outcome for the patient. Conclusion: Severe knee arthritis with flexion deformity represents a common condition encountered in surgical practice. The advent of RATKA has provided us with an opportunity to assess and establish the effectiveness of mid-resection workflow in managing such cases.

Is it worth the risk? Frailty transition and complications following robotic total knee arthroplasty: A retrospective observational study.

BACKGROUND: Frailty is an underutilized prognostic parameter in the geriatric population. Our study aimed to analyse the frailty incidence, its transition over 1 year and its influence on complication rate in patients undergoing elective robotic-assisted total knee arthroplasty (TKA). METHODS: This was a retrospective study wherein an accumulation of deficits model was used to evaluate frailty of 435 consecutive patients undergoing primary unilateral Mako-assisted cemented TKA between January 2020 and July 2021. Based upon the preoperative values, participants were divided into three groups; non-frail (FI < 0.11), vulnerable (0.11-0.20) and frail (FI > 0.20) states and were followed up for 1 year for change in frailty class, complications, re-admissions and mortality. RESULTS: A total of 435 patients were divided into three groups, non-frail (178), vulnerable (208) and frail (49). Improvement in mean frailty scores was seen in all three groups (P < 0.0001); 21.63% of the vulnerable and 48.97% of the frail participants improved by one frailty class. Multivariate analysis showed the co-relation of change in frailty index (ΔFI) with preoperative FI (r = 0.083) and Knee Society Score (KSS) (r = 0.742). The frail group had a significantly higher re-admission rate over 1 year. When compared with the vulnerable group, the frail group had a higher hazard ratio for readmission (3.12 vs. 0.96) and complications (1.62 vs. 1.26). CONCLUSION: Although frail individuals are at a higher risk for readmissions and perioperative complications, TKA significantly improves the mobility and frailty status of elderly individuals. With explained higher risk of complications, surgeons should not refrain from offering TKA to elderly frail individuals disabled with knee pain.