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Case: A 61-year-old woman with an asymptomatic hip presented acutely with a swollen lower limb 15 years after a metal bearing surface total hip replacement (THR). A large intrapelvic pseudotumor was discovered compressing her femoral and iliac vessels. Collaboration between an orthopaedic and vascular surgeon led to a 2-stage surgical procedure with resection of the pseudotumor, followed by revision of the THR implant 3 months later., Conclusion: This case demonstrates the importance of long-term follow-up of patients with metal bearing surface implants, early recognition of an unusual presentation of a common problem, and the utility of collaboration between orthopaedic and vascular surgeons., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/B475)., (Copyright © 2021 by The Journal of Bone and Joint Surgery, Incorporated.)

The optimal surgical construct for lumbar fusion remains controversial. The posterior lumbar interbody fusion (PLIF) operation offers advantages including total nuclear disc excision, restoration of disc-space height, root decompression, limited muscle retraction and injury, and solid mechanical arthrodesis. Major disadvantages have included graft displacement, neurologic injury and nonunion. The use of posterior fixation as an adjunct to PLIF reduces the probability of these complications and increases the chances of fusion. This study examines 35 patients who underwent PLIF and facet-screw fixation. Indications for surgery included disabling low-back pain with discographic/MRI-demonstrated disc derrangement, recurrent disc herniation, and failed inter-transverse process fusions. Follow-up ranged from 6 to 18 months. There were no patients with significant neurologic injury or functional root loss. One patient developed graft displacement and failure of fixation (laminar fracture in markedly obese patient). Three patients had subcutaneous hematomas (no surgical treatment required). None of the cases required blood replacement. The authors have concluded that the addition of facet fixation/fusion to the PLIF operation substantially reduces the complication rate of the procedure.

The five ligaments studied act with a symphonic harmony to provide stability to the knee. The SMCL was of major importance in medial knee stability. The other ligament which provided the most dramatic contribution to knee stability was the PC. It was the only ligament which when sectioned resulted in a significant posterior anterior drawer instability and on three occasions produced a jerk test.