مجله جراحی استخوان و مفاصل ایران
سال سیزدهم شماره 1 (پیاپی 50، زمستان 1393)

Femoral neck anteversion is usually measured on the 2-dimensional (2D) images on CT slices. The 3D method uses 3-dimensional model of the femur reconstructed from CT scan images. The aim of this study was to compare these two methods of measurement of femoral ante-version. In a retrospective study، CT scans of 40 patients (6 men، 34 women) of a teaching hospital in Tehran-Iran were included. Both methods use the same anatomical landmarks، i. e. center of femoral head، femoral neck axis and posterior apex of the femoral condyles. In the 3D method، anteversion angle was measured on a plane perpendicular to the anatomical axis of femur. Whereas in the 2D method the measurement is performed on CT scan slices. Mean anteversion was found to be 9. 8 for the 2D and 16. 11 for the 3D method. Bland-Altman plot shows that the difference between the two methods is significant. This difference between 2D ad 3D measurement of femoral anteversion may be depend on the level of the selected CT slices، patients positioning during CT examination، and the impact of the deformity. The 3D method eliminates obvious sources of error، namely identifying landmarks and individual orientation of femur. Due to the lack of any gold standard there is a need to further review and study the measurement of this angle.

Knee osteoarthritis is a common etiology of disability in older age group. There are evidences suggesting that varus or valgus deformity can be from distal of femur، proximal of tibia or because of ligamentous laxity. Osteotomy in incorrect location may create zigzag deformity and may contribute to increase risk of osteoarthritis. The objective of this study was to find the correct location of deformity in genuevarum or genuevalgum. We studied 40 patients with knee deformity at a mean age of 27. 4 years (19-38)، prospectively. Standing 3-point view radiographs were obtained on each patient، and the limb axis was determined. The data on limb malalignment was analyzed statistically. In 94. 5% of cases the location of varus deformity was proximal of tibia and in 5. 5% in distal of femur، the best location of osteotomy. Our study also revealed multiple factors contributing to varus deformity، i. e. distal femur in 67. 5%of cases، proximal tibia deformity in 92. 5% of cases and ligamentous laxity in 77. 5%. Varus knee deformity can be from proximal tibia، distal femur or knee laxity. Before any corrective surgery one must clarify location of deformity

Post-operative pain control is an important issue in orthopaedics. Narcotics do not properly control pain and may have many complications. The non-steroidal anti-inflammatory drugs can، however، play an important role in postoperative pain management. This study evaluates the effect of intra-articular Ketorolac injection on pain control after knee arthroscopy. In a randomized double blind clinical trial study، 60 age and sex-matched patients of around 45 years of age were divided into two groups of 30. Tirthy mg of intra-articular ketorolac in one group and 30 millimeters of saline in the control group were injected at the end of arthroscopic knee surgery. The postoperative pain control and need for other pain medications were compared between the two groups. In the Ketorolac group the pain at 4 hours and 8 hours after surgery was significantly lower than the control group. At 12، and 24 hours after surgery، no significant difference in severity of pain was observed. The need for the use of opioid drugs was not significantly different between the two groups. The Sleep disturbance of 42. 8% in the Ketorolac and 57. 1% in the saline group was not significantly different. Intra-articular ketorolac is effective in pain reduction only in the first few hours after knee arthroscopy، and does not reduce the need for other analgesics.

One of the common operations for lower limb mal-alignment below 50 years of age is proximal tibial osteotomy. In the open wedge technique، the superficial medial collateral ligament (MCL) usually needs to be released. This study seeks to evaluate the results of open wedge high tibial osteotomy with or without releasing MCL. In a prospective clinical trial، 59 patients with symptomatic genu varum between 16-50 years of age who were candidates of tibial osteotomy were divided into open wedge surgery with (30 patients، 40 knees) or without MCL release (29 patients، 36 knees). The outcome was studied comparing the stability in valgus، pattelar height slope of tibial plateau، and also the knee score (KSS) in a 17. 4 months (3-24 months) follow-up. The patients from MCL preserving group، with mean age of 26. 7±9 improved their scores of 53. 5±15. 2 to 81. 9±13. 4. The cases from MCL-releasing group with mean age of 25. 5±8. 4 improved the score of 52. 4±14. 6 to 65. 4+17. 8. The rates of surgical complication and valgus instability were lower in MCL preserving ones، but tibial slope remained unchanged in either group. Both techniques lead to an improvement in the KSS score; however it was more significant in MCL preserving group with lower complication and without valgus instability.

Osteoarthritis (OA) is a degenerative disease of the joints. The asporin (ASPN) gene encodes a cartilage extracellular protein belonging to the small leucine-rich proteoglycan family. Polymorphisms in the aspartic acid (D) repeat are associated with OA susceptibility. The D14 allele is associated with increased OA susceptibility in the Japanese and the Han Chinese but is not an important factor in OA etiology among Caucasians، though the D15 allele is a risk factor for the Greek population. In this study، the effect of ASPN on Iranian with knee OA is investigated. 100 knee OA patients (72 female، 28 male) in a training hospital in Tehran، Iran were compared with 100 controls with no sign of OA، and the allelic association of the D-repeat polymorphism was studied in two groups. There were some minor differences in the frequencies of the D14 and D15 alleles between patient and control groups. These differences were، however، significant only for females. In Iranian females، D15 allele was significantly associated with KOA (p=. 045)، and D14 allele was significantly protective from KOA (p=. 032). D15 allele could be considered a risk allele only for women (p=. 045، OR=1. 73، 95% CI=1. 01-2. 94) in the Iranian population. This association is in part similar to that finding for the Greek population.

Aseptic loosening in total hip arthroplasty (THA) is among the common reasons for failure and the need for revision surgery. There is no general consensus among the orthopaedic surgeons as to the true reason for this pathology. Some consider this a purely mechanical failure، related to the long-standing forces applied to the joint، causing fatigue failure، while others consider it purely biological response of the body to the particulate debris resulting from the wear in polyethylene or other components of the THA causing linear osteolysis. A combined pathology is probably a more logical explanation، i. e. osteolysis weakening the prosthetic bone in-growth، making it more susceptible to shear، and rotational forces and eventually causing the loosening. Here in، an overview of pathophysiology، prevention، diagnosis and treatment of hip aseptic loosening has been presented.

In clinical photography a patient with a disease or a problem is presented. The aim of clinical photography is to provide accurate and precise information; and the disease or problem is the main subject of the photography. The art of photography helps doctors and surgeons in education، scientific presentations، scientific publications، patient counseling، discussion among colleagues، and evaluation of pre and post treatments، treatment planning and medico-legal works. Acknowledge of some useful points help to a better implication of the art of photography in everyday practice.