Total Knee Arthroplasty in Patients with Ipsilateral Hip Fusion: Technical Notes and Literature Review

Numerous studies report the success and outcomes of the total knee arthroplasty (TKA); however, few papers present patients with knee osteoarthritis and ipsilateral hip fusion. One controversy when treating patients requiring a TKA with prior ipsilateral hip fusion is whether to first perform a total hip arthroplasty (THA) of the fused hip, followed by the ipsilateral TKA, or to proceed with the TKA without replacing the hip; studies suggest that the position of the fused hip is a key factor when making this therapeutical decision. In addition, performing a TKA in patients with an ipsilateral fused hip may require modifications to the surgical technique generated by the lack of joint mobility in the hip. We identified 12 studies encompassing 30 patients with hip fusion and ipsilateral TKA in current orthopedic literature, but only six offered insights on patient positioning on the operating table during surgery. This study aims to review the current literature on patients with knee osteoarthritis and prior ipsilateral hip fusion and to present some technical considerations when performing a TKA on a 75-year-old patient with hip ankylosis who underwent a total ipsilateral knee arthroplasty in our clinic.

[Colonic Crohn's disease, the total form]

A rectocolic localisation of the Crohn disease, total form-ulcero-granulomatous rectocolitis, which started an a colitic chronic syndrome with secondary anemia, is described. The radiological investigation shows aspects characteristic of the ulcero-granulomatous colitis (disappearance of the haustra coli and a relative stenosis of the sigmoid) (fig. 1 and 2). The biopsy from the superior mucous membrane of the rectum disclose an inflammatory chronic granulomatous process. A temporary derivative right subangulocolic transverse-right paraumbilical anus is performed (Iliescu). The biopsy from the colic wall at the level of the derivative anus shows the same inflammatory granulomatous chronic process. A medical treatment with salazopyrine and cortisone is carried ou for 6 months. Favourable course. Reexamined radiologically, the patient shows a quasi-complete stenosis of the left colic border and of the transverse up to the derivative anus (fig. 3 and 4). After one year of medical treatment, the problem will be contemplated of the eventual reestablishment of the transit by shunting only to the right colon and the superior rectum, the only areas spared for the moment by the cicatricial stenosis (fig. 5). The coding of the medical and surgical treatment in the extensive forms of the colic Crohn disease is discussed in the light of the world medical literature.