Post-traumatic knee stiffness can present after injuries around the knee and surgery. Management is guided by the type of initial injury, amount of range-of-motion loss, time since injury, and cartilage status. Cases refractory to conservative management may conventionally be treated with manipulation under anesthesia (MUA), arthroscopic lysis of adhesions, or open quadricepsplasty. We describe our arthroscopic technique of lysis of adhesions with anterior interval release and intraoperative MUA, which has been shown to provide sustainable range-of-motion improvement in a subset of patients with severe knee arthrofibrosis. Although technically demanding, this technique benefits from being minimally invasive, allows for direct visualization of intra-articular structures, and allows all-round arthroscopic release of adhesions to improve patellar mobility and decrease the risk of fracture prior to MUA. A rigorous postoperative formal physical therapy protocol and patient compliance are imperative to achieve good outcomes.

Although ganglion cysts occur frequently, their presence in the lower extremities is rare and they seldom cause peripheral nerve compression. There are enumerable case reports of intraneural ganglion involvement with the common peroneal nerve and its branches, the sural nerve, and the posterior tibial nerve but extraneural ganglion sciatic and common peroneal nerve palsy cases are quite rare. Our case, a 26 years old female patient presented with right leg tingling and radiating pain followed up gradually with progressive right sided foot drop. MRI diagnosed the lesion as a ganglion cyst and the EMG/NCV confirmed the level of compression at the right fibular head. The patient was electively operated with standard lateral approach and the ganglion cyst engulfing the common peroneal nerve was excised. The cyst was traced to the base of its articular origin, excised and stalk ligated to prevent recurrence. At 1 year, there were no signs of recurrence and the patient was symptomatically free with no residual weakness. We, thus, report to you a rare cause of common peroneal nerve palsy-a proximal tibio-fibular joint "ganglion cyst"; a cause of foot drop which can be completely reversible if treated appropriately, its implications and thus, making its early diagnosis significant.

Background: Post-operative hip dislocation has been commonly associated with primary THA as a troublesome complication after posterior approach. Although several other risk factors have been implicated, techniques of capsular repair and closure have also been described. A new technique for repair of the capsule after posterior, minimally invasive, total hip arthroplasty is described. Methods: In Part A of this two-part study, 133 classic repairs of the capsule and external rotators to the greater trochanter (Group 1) were retrospectively compared to 144 capsular noose repairs (Group 2). After minimum 24-month follow up, dislocation was more common in Group 1 than in Group 2 (5.3% vs. 0.69%, p = 0.02). In Part B, 20 consecutive patients were tested intra-operatively for torque and internal rotation to dislocation using three capsular repair techniques. Results: The capsular noose repair provided greater resistance to dislocation than no repair (p < 0.01) and to simulated classic repair (p < 0.05). Conclusion: The capsular noose repair may reduce dislocation risk after posterior approach total hip arthroplasty. Highlights:

HighlightsA Tibial baseplate-Cone construct with proud tibial cones and without metallic augments has been described for AORI type 2B/3 tibial defects.The technique mainly involves that the host bone be prepared for the reception of the Cone with a high-speed burr. The Cone that would press-fit to obtain maximum axial stability but at the same time reconstitute the joint line to the closest native position without use of full-width augments/wedges.Morsellized allograft bone/demineralized bone matrix (DBX; Synthes Westchester Pennsylvania) used to fill in any minute voids between the host bone and the cone so as to make efforts for maximal host bone-cone contact area.Cementing all the tibial stems upto the diaphysis is advised.A stronger Tantalum cone-cement interdigitation around the stem due to a longer contact area between them because of exclusion of metallic augments seems a valid advantage.Also, the tibial tray baseplate sitting directly on the cone with interfingering cement could be another parallel boost to the construct stability over the base plate-augment interface with smooth metallic surfaces on both sides.The “Tibial base plate-cone without augments (BCCA)”type (Swanson’s technique) of a construct may offer a valid long term advantage over the Tibial base plate-Augment-Cone combination in massive tibial bone defects. Larger studies are expected to validate the proposed technique and its long-term advantage.

HighlightsIn conclusion, we have suggested some principles in treating patients with such a similar, difficult clinical presentation with Post-irradiation bilateral Primary THA loosening with an ipsilateral aseptic Paprosky Type IIB acetabular defect and a contralateral septic Type IIIB acetabular defect in a same patient.Careful attention must be given to a patient’s medical history, especially if they have been previously treated with radiation to their pelvis for prior malignancy. Although further clinical studies are needed in this patient population, cementless fixation, particularly with tantalum trabecular metal provide stable long-term fixation and should be preferred over cemented implants.In the face of an aseptic and contralateral septic loosening of THA components, careful staging of treatment is of utmost importance. Following initial management of the more urgent, septic hip with explant, antibiotic spacer implant, and continued intravenous antibiotic administration to eradicate infection, management of the contralateral aseptic hip can be addressed to better accommodate rehabilitation for the anticipated second-stage reconstruction.Surgical dissection of post-irradiated hips can be difficult due to extensive fibrosis, scarring, and vascular friability. It can lead to extensive bleeding while negotiating surgical planes. This can be particularly treacherous if this is associated with persistent infection. It is always advisable to keep a Vascular surgeon on standby in such cases where bleeding complications may occur intraoperatively.Although it is worthwhile to keep the Cup-cage/Triflange options in the surgical armamentarium in the case of severe bone loss (Paprosky Type IIIA and IIIB defects) the cup-in-cup technique (with augments and/or buttress’) is an option to achieve stable fixation and bridge to remaining native bone.Trabecular augments can be used for tiding over segmental acetabular defects in these Paprosky type IIIB, pelvic discontinuity cases. It can also serve as another cementless adjuvant to the construct with potential for ingrowth and osseointegration.Dual-mobility heads can serve additional benefit by providing a larger, more native sized head, a decreased chance of dislocation and higher range of motion.