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Revision of Prominent Implant
In ten procedures on five patients, complications from
prominent implant were among the indications for sur-
gery. In eight of these cases, sequelae were caused by
prominent femoral or tibial intramedullary (IM) rods,
and two cases involved prominent plates. Implant prom-
inence developed as a result of a change in limb length
following a fracture or osteotomy, or as the result of an
implant migration. Prominent implants impinged on
adjacent structures, limiting range of motion and causing
stiffness and pain.
In all cases, the procedures successfully reduced
implant prominence and alleviated the associated symp-
toms. However, in two cases involving two patients,
continued migration of the implant caused the promi-
nence to recur, requiring a second revision to correct the
impingement.
Figure 48.3 illustrates the revision of a prominent
Bailey-Dubow rod in the distal femur of a patient that
had undergone multiple previous procedures involv-
ing the implantation of corrective implant. The patient
had a Bailey-Dubow rod implanted several years earlier
due to a history of multiple fractures. Following a supra-
condylar osteotomy to correct a femoral deformity, the
distal tip of the rod became more prominent and began
to impinge on the patella, preventing full flexion of the
knee. During the revision, the rod was advanced proxi-
mally into the subchondral bone, eliminating the promi-
nence and restoring full range of motion at the knee.
effects of OI. Limb deformities, joint malalignment,
chronic non-unions of fractures and implant impinge-
ment were the main causes of functional impairment
and discomfort. Despite the fact that baseline capacity
was often reduced, patients requested surgery in order to
restore at least partial function and relieve pain.
Twelve patients had pain in lower extremities and dif-
ficulty with ambulation related to injuries that were being
addressed in 21 cases. Five had discomfort in, or impaired
use of, an upper limb representing six cases. Two of the
patients had both upper and lower limb impairment.
In 15 of 21 procedures involving lower limbs, there was
improvement in ambulation during the timeframe of
follow-up. All six cases involving upper limbs resulted in
improved weight bearing and decreased discomfort.
In 24 of 26 cases, relief of pain or discomfort was
an indication for surgery. In almost all cases, patients
reported partial or significant relief of pain related to
problems addressed during surgery. Most patients had
multiple sequelae related to OI, and these factors lim-
ited more complete functional improvement and pain
relief. When there was persistent pain following a
procedure, the most common causes were prominent
implant and chronic non-unions of osteotomies.
Figure 48.4 illustrates the reconstruction of a left tibia
with severe anterior bowing and valgus deformity, as
well as internal rotation of the tibia and external rotation
of the femur. The patient had an intramedullary Bailey-
Dubow rod implanted during a previous procedure that
had since become prominent distally, causing pain and
decreased range of motion in the left ankle. Due to the
deformity, pain and stiffness, the patient had impaired
mobility and decreased tolerance for weight bearing.
A reconstruction of the left leg was performed, including
midshaft and supramalleolar osteotomies of the tibia to
Chronic Pain and Functional Impairment
All patients had varying degrees of functional impair-
ment as well as pain or stiffness as a result of skeletal
FIGURE 48.4 Reconstruction of tibia with osteotomies, revision of intramedullary rod and tibial allograft: (A) preoperative lateral view; (B)
postoperative lateral view; (C) preoperative AP view; (D) postoperative AP view.
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