Case 1: Bilateral Varus Knees in a 68-Year-Old — Staged Total Knee Replacement
A 68-year-old retired teacher had Kellgren-Lawrence grade IV osteoarthritis in both knees with 18° varus deformity, walking barely 100 metres with support. After failed conservative care over two years, we planned staged bilateral TKR — right knee first, left six weeks later — safer than simultaneous bilateral surgery in her age group with controlled hypertension.
Management
Cemented posterior-stabilised TKR, adductor canal block + multimodal analgesia, walking day 1.
Outcome
At 6 months she walks 2 km daily and climbs stairs step-over-step — pain-free for the first time in a decade.
Case 2: Avascular Necrosis of the Hip in a 42-Year-Old — Uncemented Total Hip
A 42-year-old bank officer developed progressive groin pain; MRI showed Ficat stage III avascular necrosis of the femoral head with collapse — beyond the reach of head-preserving surgery. He had taken long-term steroids for a kidney condition, the classic culprit. An uncemented THR with a ceramic-on-highly-crosslinked-polyethylene bearing was chosen for longevity in a young patient.
Management
Uncemented THR, posterior approach, ceramic head on crosslinked polyethylene.
Outcome
Walking unaided at 3 weeks; back at his desk at 4 weeks; equal leg lengths.
Case 3: Fractured Neck of Femur at 78 — Why We Replaced Instead of Fixing
A 78-year-old woman presented a day after a fall with a displaced femoral-neck fracture. In this age group the blood supply to the head is unreliable after displacement — fixation fails in up to a third. We performed a cemented bipolar hemiarthroplasty within 48 hours, allowing immediate full weight-bearing.
Management
Cemented bipolar hemiarthroplasty via posterior approach; walking frame from day 1.
Outcome
Discharged day 4; independent walking with a stick at 6 weeks; osteoporosis treatment started.
Case 4: Failed Hip Screw with Cut-Out — Conversion to Total Hip Replacement
A 70-year-old man came 8 months after hip-fracture fixation elsewhere with worsening pain: the lag screw had cut out through the femoral head into the joint. Salvage required removing the implant and converting to a total hip replacement — technically demanding because of distorted anatomy, dead bone, and old screw tracks, using a long-stem femoral component.
Management
Implant removal + cemented long-stem THR with acetabular reconstruction.
Outcome
Pain relief was immediate; walking with a stick at 2 months.
Case 5: Rotator Cuff Arthropathy — Reverse Shoulder Replacement at 74
A 74-year-old woman could not lift her arm to comb her hair — pseudo-paralysis from a massive irreparable rotator cuff tear with secondary arthritis. A standard shoulder replacement fails without a cuff; the reverse geometry prosthesis medialises the centre of rotation so the deltoid alone can raise the arm.
Management
Reverse total shoulder arthroplasty, deltopectoral approach; sling 4 weeks with early passive motion.
Outcome
Active elevation improved from 40° to 140° by 6 months; she combs her hair with the operated arm.
Case 6: Medial Compartment Arthritis at 55 — Unicompartmental (Partial) Knee
A 55-year-old executive had isolated medial-compartment osteoarthritis: full range of motion, intact ACL, correctable deformity, and untouched lateral and patellofemoral compartments. He was an ideal candidate for a partial (unicompartmental) knee replacement — smaller incision, preserved cruciate ligaments, and a knee that feels more natural.
Management
Medial unicompartmental knee replacement, minimally invasive approach; same-day walking.
Outcome
Discharged in 48 hours; driving at 3 weeks; badminton (doubles) at 4 months.
Case 7: Rheumatoid Knees at 48 — Replacement in Inflammatory Arthritis
A 48-year-old woman with long-standing rheumatoid arthritis had a destroyed, valgus left knee despite good medical control. Rheumatoid patients bring special considerations: fragile bone, thin soft tissue, higher infection risk, and perioperative management of immunosuppressants — her biologic agent was paused around surgery per rheumatology advice.
Management
Cemented TKR with valgus release; biologic withheld one dosing cycle; strict asepsis protocol.
Outcome
No infection; walking unaided at 6 weeks; deformity fully corrected.
Case 8: Post-Traumatic Arthritis After Tibial Plateau Fracture — Complex Primary TKR
A 58-year-old man developed painful arthritis five years after a tibial plateau fracture fixed with plates. His TKR was complicated by retained hardware, scarred soft tissue, and a bone defect under the medial plateau — managed with staged hardware removal, then TKR using a stemmed tibial component and metal augment.
Management
Two-stage: plate removal, then TKR with tibial stem + 5 mm medial augment.
Outcome
Stable, well-aligned knee; 0–115° motion at 6 months.
Case 9: Infected TKR — Two-Stage Revision That Saved the Knee
A 66-year-old diabetic presented with a swollen, discharging knee 18 months after TKR elsewhere. Aspiration grew Staphylococcus aureus: chronic periprosthetic joint infection. Cure requires removing everything: stage one explanted the implant and placed an antibiotic-cement spacer; six weeks of IV antibiotics followed; stage two re-implanted a revision prosthesis once infection markers normalised.
Management
Two-stage revision: explant + articulating antibiotic spacer → 6 weeks culture-directed antibiotics → revision TKR.
Outcome
Infection-free at 2-year follow-up; walking with a stick.
Case 10: Simultaneous Arthritis of Hip and Knee — Which Joint First?
A 71-year-old had severe arthritis in the right hip and the right knee. When both joints of one limb need replacement, we almost always replace the hip first: hip pain refers to the knee (and can even mimic knee arthritis), hip replacement rehabilitates faster, and a stiff painful hip ruins knee rehab. His knee symptoms improved noticeably after the THR — the knee was replaced four months later.
Management
THR first; TKR at 4 months.
Outcome
Independent, pain-free walking at 8 months from the first surgery.
Explore More Cases
This series is part of the OrthoChronicles Surgical Case Library — 50 real-world cases across trauma, joint replacement, spine, paediatric and sports orthopaedics.