مجله جراحی استخوان و مفاصل ایران
سال نوزدهم شماره 2 (پیاپی 73، بهار 1400)

The aim of this study was to evaluate the effect of various factors on the prognosis of elderly patients with hip fractures to make it easier for physicians and patients to choose the type of surgical or non-surgical treatment with more accurate prognosis.

This epidemiological study was performed on patients older than 65 years who presented with a diagnosis of hip fracture within one year. Independent variables including sex, age of the patient, concomitant diseases, time elapsed from fracture to surgery and type of anesthesia were evaluated for Bartel score, postoperative mortality and type of treatment.

The mean age of the study population (163 people) was 7.7 ± 78.7- with the age range of 65-97 which included 91 women (55.8%) and 72 men (44.2%). The highest number of our patients was in the age range of 76 to 85 years (48%). The number of deaths in patients who did not undergo surgery in the first month after the fracture was 3 (1 11.5) in femoral neck fractures and 3 (5 11.5) in intracentric fractures. In the next eleven months of follow-up, Mir had one patient (8 3.8) in femoral neck fractures and three patients (11.5 ٪) in intracentric fractures.

In this study, the age of patients was an important determinant of mortality, so that mortality has increased with age, but the type of gender is not effective in increasing mortality.

Elevated free radical generation in inflamed joints and impaired antioxidant system has been implicated in rheumatoid arthritis (RA). Evidence suggests that exercise improves the symptoms of rheumatoid arthritis, although the mechanism is not well understood. The aim of this study was to investigate the effect of swimming training on the glutathione antioxidant system and oxidative changes induced by rheumatoid arthritis in rats.

8-week-old female Wistar rats were distributed within three groups (n=10 in each): a normal control group (C), a rheumatoid arthritis control group (RA+C), and a rheumatoid arthritis swimming training group (RA+EX). At nine weeks-of-age, rheumatoid arthritis was induced by injection of complete Freundchr('39')s adjuvant (20mg/kg) into the tail of Wistar rats. The degree of arthritis was assessed by macroscopic assessments such as walking ability, skin redness, and swelling in the joints. The RA+EX rats were conditioned to swim for the 4-week period (~20-60 min/day), whereas the C and RA+C remained sedentary in their cages. 48 hours after the last training session, a venous sample was collected to determine metabolic parameters, including glutathione peroxidase, glutathione reductase and lipid peroxidation products (malondialdehyde).The variance analysis test and the Tukey post-hoc test were applied to analyze the data (p < 0.05).

As predicted, rheumatoid arthritis significantly increased levels of malondialdehyde, and swimming training prevented this response (p < 0.05). Interestingly, glutathione peroxidase was significantly decreased in the RA+C group compared to the RA+EX and C groups (p < 0.05). In addition, the severity of rheumatoid arthritis clinical signs in RA+EX group was significantly lower than RA+C group. (p < 0.05).

Our findings suggest that swimming training may be useful in preventing the negative changes in glutathione antioxidant system and oxidative stress parameters related to rheumatoid arthritis.

Falling is one of the most common and serious health problems in the elderly. As a result of aging, chronic diseases, including joint diseases, increase in the elderly. The aim of this study was to investigate the prevalence of falls and its relationship with joint diseases in the elderly in Urmia.

This study is a cross-sectional (descriptive-analytical) study in which 200 elderly people were selected by random cluster sampling. Necessary information was collected using a two-part questionnaire including demographic information, joint diseases of the elderly and a history of falls in the elderly in the past year. Data were analyzed using chi-square and logistic regression tests in SPSS v.21 software.

The results of this study showed that the rate of falls in the elderly was 30%. Falling was statistically significantly associated with age, gender, marital status and joint disease. The results of logistic regression showed that the chance of falling of the elderly who had one of the joint and bone diseases such as osteoarthritis, osteoarthritis, osteoporosis, rheumatoid arthritis, gout ... was 6.2 times higher compared to healthy elderly (OR = 6.2 ).  

The findings of this study showed that the incidence of falls in the elderly in Iran is relatively high and in accordance with the effective factors obtained in falls in the elderly, including joint diseases, appropriate and effective preventive interventions should be performed.

The tourniquet commonly uses in knee replacement surgery, but there is no consensus on the release time of the tourniquet. The aim of this study was the evaluation of tourniquet release time, on postoperative hemoglobin level in knee arthroplasty patients.

During one year, patients undergoing complete knee arthroplasty were randomly divided into two groups according to the inclusion criteria, the early release tourniquet group (opening tourniquet after cementation) and the late release tourniquet group (opening tourniquet after wound dressing). Hemoglobin levels were measured and compared at preoperative, 24 hours and one week after surgery. Also, Duration of surgery, blood transfusion requirements and early wound complications were evaluated in two groups.

The mean duration of surgery was 82 ± 11.2 minutes in the early release group and 73 ± 14 minutes in the late release group (P <0.001). Decrease of hemoglobin level at 24 hours and one week after surgery was 1.8±0.82 and 1.1±0.71 respectively in the first group, and 1.4 ±0.94 and 0.6 ±0.82 in the second group. In this study, the requirements for blood transfusion was more in the early release of the tourniquet group (4 cases in the first group and 2 cases in the second group), but this difference was not significant.

Late tourniquet release after wound dressing can reduce surgery time and reduction of hemoglobin level in total knee arthroplasty.

Knee arthroplasty is one of the most successful orthopedic surgeries, and many studies have been done on Eproch and the timing of surgery, but few studies have been performed on the outcomes and complications of knee arthroplasty and its comparison 48 hours later. Therefore, we decided to conduct a study to determine the clinical outcomes and complications of two knee joint replacements and to compare them within 48 hours.

This study was a cohort study, the first group consisted of patients undergoing concurrent arthroplasty and the second group were patients undergoing 48 knee arthroplasty within 48 hours then postoperative complications, duration Time of hospitalization, clinical outcome two weeks after surgery, one month after surgery and three months after surgery were evaluated.

None of the criteria evaluated by lysholm questionnaire were significantly different in the studied patients. Postoperative complications were also evaluated in both case and control groups, with no significant difference in either group. (P> 0.05).

Overall, there was no significant difference in pain rate, knee function, and surgical complications during the study after both treatments.

Preserving the biological structure of the initial nature of cancellous bone could prepare it for a proper scaffold for successful bone tissue engineering. Moreover, it is vital to eliminate the cells belonging to its bed to increase its biocompatibility and reduce their immunological responses.

In this study, Chemical methods were used for decellularization of three-dimensional scaffolds made from spongy calfchr('39')s pelvic bone. For this purpose, the bone samples which were cut from calf pelvis bone were degreased, and then their cells were removed through chemical (sodium dodecyl sulfate (SDS) and TritonX-100 with different concentrations) method. The samples were characterized by hematoxylin and eosin staining, trichrome staining, and optical and scanning electron microscope. In the end, to ensure the absence of toxic substances in the scaffold, a cell toxicity test was conducted.

The results show that the decellularized samples with TritonX-100 of 2% and combining solution of 3% TritonX-100 and 4% SDS respectively (T3S4) can substitute for damaged cancellous bone tissue. The results indicated that calf pelvic spongy bone tissue, as a xenograft that has undergone decellularization with SDS and Triton x-100 chemical solutions, can produce an appropriate scaffold for bone tissue engineering. The natural bone tissue with preservation of collagen fibers and the presence of porosity in its structure can provide a suitable environment for tissue regeneration..

The results suggested that T3S4-acellular bone tissue can be further evaluated as a natural scaffold suitable for using in bone tissue engineering and restorative medicine.