PMC5974687_01
A clinical photograph showing gross varus deformity of both knees.
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F1
A 78-year-old male presented to us with a history of progressive severe knee pain and deformities over the last 10 years (Fig. 1).
Hip-knee-ankle radiograph showing gross varus deformity of both knees with distortion of mechanical axis.
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F2
There was a gross distortion of mechanical axes on both the sides (Right: 157  and Left: 151 ) with lateral deviation of the mechanical axis (Right: 7.15 cm and Left: 8.45 cm) (Fig. 2).
(a) Right knee anteroposterior and lateral radiograph showing severe osteoarthritis (OA) changes and varus deformity. (b) Left knee anteroposterior and lateral radiograph showing severe OA changes and varus deformity.
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F3
T scores of -2.0 in the lumbar spine and -1.8 in the hip bones. The plain anteroposterior (AP) and lateral knee radiographs showed severe varus deformity, gross destruction in the medial tibiofemoral and patellofemoral compartments, lateral subluxation of the tibia, and large posterior osteophytes (Fig. 3).
Anteroposterior and lateral radiograph showing an ununited stress fracture medial malleolus.
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F4
Plain radiograph of the ankle showed an ununited fracture of the left medial malleolus with hypertrophic callus at the fracture site (Fig. 4).
Good correction of knee deformities after bilateral simultaneous total knee arthroplasty.
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F5
TKA components (Scorpio TS , Stryker) with tibial stem extenders were used (Fig. 5). The patient was started on thromboprophylaxis in the form of injection enoxaparin 0.4 mg subcutaneously once a day for 3 weeks and DVT stockings for 6 weeks.
Anteroposterior and lateral radiograph of the ankle depicting fixation of the medial malleolus fracture using two cancellous screws.
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F6
After the freshening up of the fracture ends, it was fixed using two 4 mm 60 mm cancellous screws (Fig. 6).
Anteroposterior radiograph showing a united stress fracture of medial malleolus with two cancellous screws in situ.
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F7
The stress fracture united uneventfully in 3 months (Fig. 7).
Post-operative hip-knee- ankle radiograph showing restoration of mechanical axis ofthe both sides.
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F8
Post-operative HKA radiograph showed restoration of mechanical axes (Right: 179  and Left: 178 ) on both the sides (Fig. 8).