hooman yahyazadeh

Total joint arthroplasty (TJA) of the lower extremities is a successful surgical procedure for end-stage degeneration and is gaining increasing popularity worldwide. Preexisting neurological conditions have been a significant challenge for arthroplasty surgeons for a long time, and they have avoided performing TJA in these patients. Parkinson’s disease (PD), an age-related neurodegenerative disorder, is prevalent and associated with a higher likelihood of gait imbalance, falling, and osteoarthritis (OA). The number of patients with PD who experience hip and knee OA is increasing. As a result, some of these individuals may need to undergo total hip or knee arthroplasty (THA/TKA) to alleviate symptoms and improve their function. Patients with PD present a remarkable set of challenges for surgeons owing to increased muscle tone, higher fracture risk, and ligament instability. Currently, limited information is available regarding the outcomes and effectiveness of these procedures in PD patients. The lack of data is a concern because it prevents surgeons from making informed decisions regarding the use of TJA in this patient population. This study aims to summarize the recent literature regarding total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures in patients with PD to help surgeons in this challenging setting and improve their knowledge of potential complications and outcomes in this complex background.

Bucket-handle meniscus tears are a common yet severe knee injury, often associated with anterior cruciate ligament (ACL) damage. While isolated bucket-handle tears (BHT) are well-documented, simultaneous medial and lateral BHTs are rare, particularly in chronic ACL-deficient knees. The term "triple posterior cruciate ligament (PCL) sign" arises due to the lack of overlap between the two BHTs in the coronal plane while positioned in the intercondylar notch, preventing them from aligning within the same sagittal plan.

In this report, we present a case of triple PCL sign on magnetic resonance imaging (MRI) in a patient with bilateral lateral and medial bucket handle tears and associated chronic ACL rupture. The patient underwent diagnostic and therapeutic arthroscopy, which confirmed bimeniscal bucket handle tears ‎and their fragments’ entrapment in the intercondylar notch, along with ACL rupture‎. 

This report highlights the diagnostic importance of the triple PCL sign because it is observed in patients with both compartment meniscus tears adjunct to ACL rupture. It also raises awareness of the need to pay more attention to this sign in patients presented with ACL rupture ‏symptoms because it is crucial for preoperative planning.

Total knee arthroplasty (TKA) is an effective surgical procedure for alleviating pain and improving function in patients with severe knee osteoarthritis. However, significant intraoperative blood loss is a common concern, often necessitating blood transfusions and increasing the risk of complications. A tourniquet during TKA is a widely accepted technique to reduce blood loss and improve implant fixation, but it may lead to postoperative pain and restricted range of motion (ROM). 

This randomized clinical trial aimed to compare intraoperative blood loss, postoperative ROM, and pain in patients undergoing TKA with and without a tourniquet.

A total of 34 patients were randomized into two groups: 18 patients in the tourniquet group (TG) and 16 in the non-tourniquet group (NTG). Intraoperative blood loss, postoperative hemoglobin levels, ROM, thigh pain, and straight leg raise (SLR) were measured at multiple intervals postoperatively. 

The results showed that the TG group had significantly lower intraoperative blood loss (236.11 mL vs 531.25 mL, P<0.001) and higher postoperative hemoglobin levels than the NTG group. However, the TG group experienced significantly lower ROM on the first and second postoperative days (P<0.001) and reported greater thigh pain. By six months postoperatively, the two groups had no significant difference in ROM.

Using a tourniquet in TKA significantly reduces intraoperative blood loss but is associated with increased immediate postoperative pain and reduced early ROM. However, these adverse effects do not persist long-term. Individualized patient care and strategies to optimize tourniquet use are recommended to balance these outcomes.

Neglected knee dislocations are rare. There is no agreement on the best treatment for these injuries. In this report, we present a case of old knee dislocation treated with open reduction and proximal tibial traction pin. After open reduction and extensive soft-tissue release, the complete reduction was not achieved. Therefore, we used a proximal tibial traction pin to gradually obtain a complete reduction via ‎traction weight change.‎ We did no ligamentous repair. One year after the operation, the patient had an acceptable radiographic reduction and satisfactory clinical outcomes. We recommend the proximal tibial traction pin as a valuable alternative in the treatment of neglected ‎knee dislocation. In addition to its promising outcomes, the traction pin is much less expensive than the already-used devices. Moreover, the introduced procedure makes the future conversion to total knee arthroplasty (TKA) more feasible, which is considered a significant concern in such ‎patients.

Cognitive-behavioral therapy (CBT) is acknowledged as an efficient therapeutic modality in fibromyalgia. However, its effect on the oxidative balance of fibromyalgia patients has not been investigated.

We investigated whether CBT intervention could influence serum markers of oxidative balance.

Forty fibromyalgia patients were randomly assigned to either the intervention (CBT) or control (waiting list) group. For the intervention group, traditional face-to-face CBT was performed for 20 sessions over two months. Sixteen patients in the CBT group and 17 patients in the control group completed the study. Outcomes were the serum total oxidant status (TOS) and total antioxidant capacity (TAC) that were assessed before the intervention and at the end of the intervention by an oxidation-reduction colorimetric assay. Within-group and between-group analyses were performed using theWilcoxon signed-rank test and Mann–Whitney U test, respectively.

Baseline characteristics showed no significant difference between the participants of the two groups. At the end of the study, mean TOS significantly reduced in the case group (P < 0.001) but not in the control group (P = 0.61), and mean TAC showed no significant change in the case and control groups (P = 0.1 and P = 0.09, respectively). The mean change in TOS was 0.43 ± 0.3 mM in the CBT group and 0.03 ± 0.2 mM in the control group (P < 0.001). The mean change in TAC was 0.015 ± 0.03 mM in the CBT group and 0.01 ± 0.02 mM in the control group (P = 0.57).

Cognitive-behavioral therapy improves the oxidative balance of fibromyalgia patients. Our results further support the benefits of CBT implication in the treatment of fibromyalgia.

Semi-constrained implants are developed to reduce the detrimental impact of constrained implants in patients with complex primary total knee arthroplasty (TKA). However, the outcomes of TKA using semi-constrained implants are mainly unknown. 

This study aims to report the short-term outcomes and complications of primary TKA in patients managed with a semi-constrained implant. 

Twenty-three patients (33 knees) who underwent TKA with semi-constrained implants were included in this study. The outcomes of patients were evaluated radiographically and clinically. Clinical evaluation was performed using the knee society score (KSS) and oxford knee score (OKS) at 6 and 12 months. The subjective satisfaction of the patients was also evaluated at 6 and 12 months using yes/no questions. Postoperative complications were inspected through the patient’s medical records.

The study population included six men and 17 women with a mean age of 70.7±7.6 years. The mean follow-up of the patients was 12.5±4.8 months. The average postoperative ‎tibiofemoral alignment was 0.26±1.1º of valgus (ranging from 3º of valgus to 2º of varus). The mean KSS of the patients were 93.8±8.1 and 94.7±8.3 at 6 and 12 months, respectively. The mean OKS of the patients were 43.6±3.7 and 44.1±3.8 at 6 and 12 months, respectively. All patients were satisfied with the surgery at 6 and 12 months. No postoperative complications were recorded during the follow-up period. 

The use of a semi-constrained prosthesis is safe and effective as a primary implant in TKA ‎patients having severe deformity or ligamentous laxity.

Many surgeons avoid performing unicompartmental knee arthroplasty (UKA) due to various concerns. Cohort studies showing the satisfactory outcomes of UKA can convince surgeons to use this technique. In this study, we report the mid-term outcomes of UKA in a series of patients with medial compartment knee osteoarthritis. Seventeen patients with unicompartmental degenerative joint disease of the knee that underwent UKA and were available for final evaluation were included. The mean age of the patients was 63 ± 5.1 years. The mean follow-up of the patients was 37.2 ± 18.3 months. The outcome measures were the Oxford Knee Score (OKS), Knee Society Score (KSS) for knee score and knee function, Knee injury and Osteoarthritis Outcome Score (KOOS), knee range of motion (ROM), and satisfaction rate on a 5-point Likert scale. In the last follow-up visit, the mean of OKS and knee score section of the KSS were 44.6 ± 3.2 and 83.8 ± 2.1, respectively. The mean knee function section of the KSS was measured at 98.2 ± 7.2. The mean KOOS score and the mean knee ROM were 84 ± 9.4 and 134.4 ± 7º, respectively. The mean VAS for pain was 8.9 ± 1.1 (range 8-10) before the operation and 1.2 ± 0.8 (range 0-2) at the last follow-up. All the patients were very satisfied (n=14) or satisfied (n=3) with the results. No postoperative complication or reoperation was recorded during the follow-up. Unicompartmental knee arthroplasty provides satisfactory outcomes and a high survival rate, at least in mid-term follow-up. These findings suggest increased use of UKA in future workups. Level of evidence: IV

Anatomic distal femoral plates locking compression plate (LCP) are generally used for the fixation of distal femoral fractures. However, they are not suitable for periprosthetic femoral fracture after total knee arthroplasty (TKA), mainly owing to the impingement with prosthesis.

In this case series, we report the outcome of proximal tibial LCP fixation in the treatment of periprosthetic femoral fracture after TKA.

Twelve patients with a periprosthetic femoral fracture who underwent surgical treatment were included. According to Su et al. classification, all fractures were type II, originating from the femoral component with proximal extending. Fractures were managed with open reduction and plate fixation. The plate choice was either a long low-profile proximal tibial LCP (n=9) or a short anatomic distal femoral LCP (n=3).

The study population included one male and 11 females with a mean age of 74.5±9.3 years and a mean follow-up of 2.8±1.3 years. Union of fracture was observed in all fractures that were fixed with a long locking plate during a mean period of 3.1±2.1 months. Fixation failed in all three patients who were managed with a short plate. These patients underwent revision surgery with a long low-profile proximal tibial LCP. In one of them, the fixation failed again and finally fixed with tumor prosthesis. The other two fractures were united with no complications.

Long low-profile proximal tibial LCP omits the problem of impingement by prosthesis, which is caused by short anatomic distal femoral LCP in the treatment of periprosthetic femoral fractures above the prosthesis. However, future large-scale comparative studies are required before we can recommend it for routine implications in these fractures.

Although infections following arthroscopic surgery of cruciate ligament and meniscus are uncommon,they have potentially serious consequences for the graft and articular cartilage. This study aimed to investigatethe efficacy of correct sampling and appropriate media, especially resin-containing media, for the detection ofinfections in patients receiving antibiotics under suspicion of joint infection after arthroscopic anterior cruciateligament (ACL) and meniscal surgery. In such cases, proper sampling and the use of suitable culture media thatcause the neutralization of antibiotics are very effective in isolating microorganisms from the patient samples andpositive cultures. In total, 10 patients who had received antibiotics with suspected knee infection after arthroscopic ACLand meniscal surgery were identified after referral to surgeons during a period of 10 months and investigated in thisstudy. The sample collection, culture on various media (i.e., resin-containing culture media), microbiological tests,and antibiotic susceptibility tests were performed in this study. The amplification of the mecA gene using PCR assaywas accomplished for methicillin-resistant staphylococcus strains. This study was conducted on 10 patients who underwent arthroscopic procedures and had receivedantibiotics. Overall, joint fluid and tissue culture were positive in 60% of the patients. The resin-containing mediarevealed a trend toward increased detection of bacteria. Coagulase-negative staphylococcus strains were the mostfrequently isolated bacteria in arthroscopic ACL surgery infections. Out of five methicillin-resistant staphylococcusstrains, four strains were found that were resistant to cefoxitin and positive-mecA designated as methicillin-resistantstrains. Except for one case, the rest of the staphylococcal strains were resistant to methicillin but susceptible tovancomycin. Despite uncommon and low percentage of infections after arthroscopic ACL and meniscal surgery,the results of our study showed that correct sampling, appropriate cultures, especially aerobic and anaerobic resincontainingmedia, and microbiological testing remained useful and valuable for diagnosing bacterial infections.Level of evidence: II

Traumatic bilateral patellar tendon rupture (BPTR) is a rare injury with low levels of clinical suspicion, especially in young adults. Since early diagnosis of the BPTR is the cornerstone of a successful management, BPTR reports are valuable as they raise awareness of the careful clinical and radiologic workout in similar cases. Here, we present a case of BPTR in a 34-year-old male following a motorcycle accident. At the emergency department, the necessary examinations including clinical, physical, and radiologic tests were performed and BPTR was diagnosed accordingly. The patient underwent reconstruction surgery the day after the injury. At the last follow-up, the patient was able to perform active straight leg raise with 130° flexion and no extension lag. The superior results of BPTR reconstruction in this report further emphasize the importance of early diagnosis and repair of BPTR. Active straight leg raise test is necessary to perform for all patients with a history of an eccentric load of the knee extensor mechanism, and if positive, extensor mechanism rupture should be strongly suspected

Anterior cruciate ligament reconstruction (ACLR) surgery is frequently used to manage anterior cruciate ligament (ACL) tear. The non-anatomic positioning of the graft may cause graft failure. This study aimed at evaluating the association of the ACLR outcome with factors affecting the anatomic positioning of the graft, including the tibial tunnel, femoral tunnel, and graft inclination angles. A total of 37 patients, who had undergone ACLR surgery, were included in this retrospective study. All surgeries were performed by the transportal arthroscopic reconstruction technique. The tibial and femoral tunnel angles were evaluated on both anteroposterior (AP) and lateral radiographs. Graft inclination angle was evaluated on AP radiograph. Outcome measures included: International Knee Documentation Committee (IKDC), the Lachman and the pivot shift test, and KT-1000 arthrometer score. The mean age of the patients was 30.1 ± 9.4 years. The ACLR surgery was successful in 36 (97.3%) patients and failed in one patient (2.7%). No significant association was found between the femoral/tibial tunnel angles and outcome measures on both AP and lateral view. A negative significant correlation was found between the IKDC score and the graft inclination angle (P = 0.049, r = -0.326), indicating that with graft angle between 20° and 36°, the more horizontal graft was associated with better IKDC score. According to the results, graft inclination angle, yet not femoral/tibial tunnel angles, were associated with the outcome of the ACLR surgery However, further studies are required to address ‎the inconsistent results of different investigations

The degree of patient’s suffering in association with radiological evidence of osteoarthritis (OA) determines the time point of surgery. Thus, a more clear understanding of the association between clinical and radiological symptoms of OA is necessary.
Here we aim to evaluate how clinical and radiographic symptoms of patients are associated with each other in an Iranian Knee OA population.
In a cross - sectional study, patients with knee OA were recruited. The diagnosis of OA was made using the criteria of American College of Rheumatology (ACR) Classification. Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) was used as an indicator of self-reported disability. The Kellgren - Lawrence index was used for OA grading.
A total of 96 OA patients, including 77 females and 19 males, with a mean age of 53.27 ± 10 years, were included. The OA was graded as I, II, III, and IV in 28, 35, 19, and 14 patients, respectively. The mean WOMAC score was 55.2 ± 20.5, ranging from 6.3 to 100. The WOMAC score was not significantly correlated with the grade of OA (p = 0.1, r = - 0.188). When we stratified the patients based on their gender, a strong correlation was observed between WOMAC scores and OA grade in male patients (p Self - reported disability is associated with radiographic symptoms in male patients with knee OA, but not in females. Hence, the orthopedic surgeons should consider this discrepancy in their decision - making process to decide appropriately about the choice of therapy.

Quadriceps tendon ruptures (QTR) are uncommon injuries of knee extensor mechanism. Although immediate repair is necessary to re-establish knee extensor continuity, favorable outcome of QTR reconstruction even several years after injury is reported.
The outcome of acute and chronic QTR is rarely investigated. The current study aimed at evaluating the objective and subjective measures of outcome following the surgery of acute and chronic QTR.
A total of 6 QTR injuries, 3 acute and 3 chronic cases, in subjects with the mean age of 31.66 ± 12.7 years and mean follow-up of 4.3 ± 2.5 years were retrospectively evaluated. Pre- and post-operative subjective measures including international knee documentation committee (IKDC), modified Cincinnati knee scores, and objective measures including range of motion (ROM) and extension lag were used to evaluate the outcomes.
ROM improvement was 36.6° in acute and 33.3° in chronic injuries. Extension lag improvement was 28.3° in acute and 26.7° in chronic injuries. IKDC improvement was 72.8 in acute and 62.4 in chronic injuries. Improvement of modified Cincinnati was 72.6 in acute and 64.7 in chronic injuries. No post-operative complications were observed in the studied series, while all cases re-established their pre-operative activity level.
According to the current study results, delayed repair of QTR injury adversely affected the outcome of surgery. Meanwhile, surgical reconstruction of chronic QTR is still warranted regarding the considerable post-surgical improvement of the outcome measures.

There is significant evidence of hip and knee kinematic influence on each other. In some studies, hip restricted range of motion is a risk factor of anterior cruciate ligament (ACL) tear. This study was designed to compare hip range of motion in physical examination between non-contact ACL injured patients with normal population. Patients and One hundred and forty patients with arthroscopically confirmed primary ACL ruptures were evaluated to assess their hip range of motion; these findings were compared with a control group of 100 patients with non ACL injury. All parameters of hip range of motion (internal rotation, abduction and adduction) except external rotation were decreased significantly in ACL injured group compared with control group. Patients with sum of internal and external rotation lower than 80° had an increased odds ratio of having ACL injuries (OR = 2.64; 95% CI, 1.4 to 4.7). There was an association between non-contact ACL rupture and decreased hip range of motions including internal rotation, abduction and adduction as well as sum of internal and external rotation. Therefore, it may be possible to use hip physical exam finding as a predictor of ACL rupture.

Platelet-rich plasma (PRP) is plasma of enriched platelets with high concentration of platelet granules and growth factors. The platelet growth factors have a great potential of wound and connective tissue healing used to treat cartilage lesions and retarding the progression of knee osteoarthritis. This study was designed to evaluate PRP injection results in knee osteoarthritis. Patients and This was a case-series study of 39 patients and all of them had three injections of PRP for the involved knee (every two weeks) and they were followed up at two weeks, two months and six months post-injection of PRP. All included patients filled the WOMAC (western Ontario and Mcmaster universities arthritis index) standardized and translated to our national language and culture. We analyzed the collected scores of before initiation of PRP injections, the second week, the second month and the sixth month after injections into the knees. Thirty-nine patients with a mean age of 55.24 ± 9.27 years (ranged 40 to 83) were evaluated in this study. Six patients (15.4%) were male and 33 patients (84.6%) female. There were significant differences in WOMAC score of patients in two months and six months after injection of PRP compared to before injection. PRP had a great clinical improvement in short-term follow-up for early stages of knee osteoarthritis.

Distal femur wedge osteotomies for varus or valgus alignment of the lower extremity could be done in either uniplanar or biplanar fashion.Union time and stability of the osteotomy site has been considered important in this anatomic region. In this study, clinical and radiographic findings of biplane distal femur osteotomy were reported. Clinical, functional, and radiological findings of eight patients (10 knees)underwent biplane distal femur osteotomy were evaluated. Visual analogue score (VAS) and Lysholm-Tegner knee score were used for the assessment of pain and function before and three months after surgery. In this study, eight patients were included. All patients were female. The mean age was 28±6.3. The mean pre-operativemechanical anglewas 8.7±2.2˚and the post-operativeangle was 1.4±0.53˚ in patients with valgus alignment whileit was 7.0±1.0˚preoperatively and 0.66±1.2˚ postoperatively in patients with varus alignment. The mean lateral distal femoral angle (LDFA)was 85±8.0˚ before surgery and was 88±1.3˚ after surgery. According to Lysholm- Tegner knee score, in the post-operative visit, sixknees were good and four were excellent. The mean union time was 9.2±2.3 weeks. Biplane distal femur osteotomy is a reliable technique that creates larger surfaces and more stability at the osteotomy site with further rapid union.

Intraosseous ganglia (IG) are solitary, osteolytic lesion juxta-articular in the epiphyses of long bones. The origin of articular cysts is controversial and is not recognized well. From 2006 to 2011 in Shafa Orthopedic Hospital we identified 7 cases with final diagnosis of intraosseous ganglion cyst in medial condyle of tibia. We surveyed their medical documents and images and after final visit described the pattern of presentation, radiologic feature, treatment and their outcome after treatment. Of 7 patients, 6 were female and 1 was male. All had chief complaint of posteromedial knee palpable identified to be sub pes anserine bursa. There were two evidence of moderate degenerative joint disease (DJD) in the knee joint. We found conduit between the cysts beneath or near the pes anserine and the ganglion cysts in the medial condyle of the tibia in all of the cases. After surgery, patients became symptoms free, and there was no evidence of recurrence in 25 months mean follow up. IGs of medial condyle of tibia are usually associated with soft- tissue component. Considering the strength of cortex and resistance of bone trabeculation of medial condyle of tibia, it is more likely that the primary lesion originates in the bone and then will spread to the adjacent soft-tissue.

Ewing’s sarcoma is a malignant small cell neoplasm of long bones and pelvis during the first or second decades of life. The involvement of phalangeal bones is extremely rare. We report a Ewing’s sarcoma of proximal phalanx of the second finger of a young man.

Primary aneurysmal bone cyst (ABC) in the hands is rare. It occurs more commonly in metacarpal bones and involvement of carpal bones is very uncommon. We report the third case of ABC in the capitate, its clinical presentation, imaging findings and treatment.

Asthma is a common condition in general medical practice, and it accounts for about 1% of all ambulatory hospital visits. Nowadays, hospitalization rates for asthma have actually been increased in some demographic subgroups despite recent advances in treatment. Understanding the underlying factors that contribute to hospitalization and especially duration of the hospitalization of asthmatics could help elucidate the recent rise in morbidity and also reduce the high demand on health care systems of the disease. The aim of this study was to evaluate factors affecting the duration of hospitalization for Iranian patients with asthma. This study was conducted on 55 asthmatic patients (diagnosis of asthma was in accordance with the criteria of the American Thoracic Society). The study was performed on patients hospitalized in Rasoul-e-Akram hospital in Tehran, Iran during the period 2005-2006. During hospitalization, the patients’ most common complaints were recorded as the symptoms and signs of the medical condition, results of physical examinations, spirometry, arterial blood gas analysis (ABG), and ICU admission. There were 18(32.7%) male and 37(67.3%) female patients with a mean age of 54.96 (SD=17.54) years. The mean duration of hospitalization was 8.31(SD=4.69) days that ranged between 2 and 23 days. The mean baseline arterial PH (p=0.039, RPearso = -0.362), baseline arterial [HCO3] (p=0.042, RPearson = 0.361), changes of FEV1 after bronchodilator (p=0.041, RPearson= -0.363) and patient''s age (p=0.002, RPearson=0.0433) were determined as factors affecting duration of hospitalization. Our results showed that more attention needs to be given to the findings of arterial blood gas and spirometry which can potentially affect the duration of hospitalization of asthmatic patients.

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, and is an important health economic problem. Since 1960, there has been an increase in mortality associated with COPD, especially in men. Acute exacerbations form a major component of the socioeconomic burden of COPD which mainly results in long-term hospitalization. Despite the high number of COPD-related hospitalizations, relatively little is known about the mortality rate and related determinants of patients hospitalized for this acute deterioration in the clinical course of COPD. The aim of this study was to evaluate the factors affecting duration of hospitalization in Iranian patients with COPD. This cross-sectional study was performed on 68 COPD patients who were hospitalized in Rasool-e-Akram hospital in Tehran, Iran for the period 2005-2006. During hospitalization, patients’ chief complaint, symptoms and signs, results of physical examinations,spirometry, arterial blood gas (ABG) and ICU admission were recorded. Data were analyzed using Independent T-test, One Way ANOVAand Correlation tests. The patients were 41(60.3%) males and 27(39.7%) females with the mean age of 69.7(SD=13.52) years. The mean duration of hospitalization was 11.82(SD=5.49) days and 3(4.4%) patients died. The family history of pulmonary disease (P=0.018), habitual snoring (P=0.031), and mean baseline arterial PaO2 (P=0.010, r= -0.361) were determined as factors affecting duration of hospitalization. On the other hand, other factors such as smoking (P=0.992), patient’s gender (P=0.735) and spirometric indices did not significantly associate with duration of hospitalization. The fact that people hospitalized with COPD have a subsequently increased risk of death compared with those not hospitalized suggests the former are an atrisk group and shows the importance of factors affecting duration of hospitalization. Our results show that more attention must be paid on habitual snoring and low arterial pO2 which may have potential effects on duration of hospitalization in COPD patients.