RESUMEN
Purpose: The use of a TomoFix plate can be a challenge in Asian population who inherently have smaller tibial bones. This study aims to find out the normal proximal tibial morphometric measurements in Indian population and to compare the Medial Anterior Radius of Curvature (MAROC) of proximal tibia with the Proximal Part Radius of Curvature (PPROC) of the available TomoFix plates, to estimate conformity of the fit between them. Methods: Retrospective Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) based proximal tibial measurements were performed on 824 knees, 664 females and 160 males (604 patients). The mean MAROC, mean MAROC in males and mean MAROC in females were compared to the PPROC of TomoFix plates. Results: The radiological measurements revealed a mean AP length of 45.22 ± 3.79 mm, mean ML width of 69.04 ± 5.01 mm and mean MAROC of 21.88 ± 2.11 mm. The mean MAROC in males was 24.07 ± 2.1 mm, whereas in females it was 21.35 ± 1.75 mm. The mean MAROC, mean MAROC in males and mean MAROC in females when compared to the PPROC of Standard TomoFix plate (38 mm), Small TomoFix and Anatomical TomoFix plates (30 mm) showed a significant difference (p < 0.01), indicating that the radius of curvature of the plate does not match the radius of curvature of the anteromedial tibial plateau. Conclusion: The TomoFix plates, including Small (Asian Version) and Anatomical plates, are relatively large for the Indian population. Our study may help the implant to designers develop a plate that will better suit the Indian population, improving results and reducing hardware-related complications of MOWHTO.
RESUMEN
Introduction: Revision total hip arthroplasty requires meticulous planning and execution to achieve the desired outcome. Pelvic vessel injury following total hip arthroplasty is rare, but a well-known and serious complication, having a very high morbidity (15%) and mortality (7%). This case demonstrates the rare occurrence of acetabular screw abutment to the external iliac vessels, which if removed during revision hip surgery without releasing the adhesions around it, will lead to avulsion injury of the vessels and a catastrophic event. Case Report: We present this challenging and unique case of a 64-year-old female patient where the acetabular component screw was found to be adherent to the external iliac vessels, with vascular injury imminent. During revision surgery, the iliac vessels were first released free of all adhesions with the intrapelvis screw using an ilioinguinal incision and retroperitoneal approach. The prosthesis was removed using a posterior approach to the hip joint. Definitive surgery was performed after 2 weeks. Conclusion: Surgeons should be cognizant of the possibility of an avulsion vascular injury in revision cases having intrapelvic screws or implants. The proximity of such an implant with the intrapelvic vasculature must be confirmed preoperatively. Management should be individualized. Dual approach and staged procedure help in a favorable outcome. Vascular injury, revision total hip arthroplasty, screw abutting iliac vessel, external iliac vessel, computed tomographic angiography.