Journal of Research in Orthopedic Science
Volume:1 Issue: 4, Nov 2014

Blood loss following total knee arthroplasty (TKA) is a challenging issue faced by orthopedic surgeons. Determination of risk factors for significant blood loss is a significant step toward blood management. The aim of this study was to determine factors predicting intraoperative blood loss, postoperative drainage, and need to blood transfusion in patients undergoing TKA. Patients and In a prospective study, 96 consecutive patients who underwent primary cemented TKA were included. Intraoperative blood loss, postoperative blood drainage, and hemoglobin (Hb) drop were measured and analyzed in terms of age, sex, body mass index, and tourniquet closure time. The mean age of patients was 68.4 ± 5.6 years (range, 52-75). Mean intraoperative blood loss and postoperative drainage were 147.1 ± 97.4 mL and 494.4 ± 188.1 mL, respectively. Based on a regression model, males and obese patients had significantly higher intraoperative blood loss (P < 0.05). Additionally, male sex and older age were significantly associated with more severe drop in Hb on the first postoperative day; however, there was no predictor of need for transfusion in regression analysis. Male sex and obesity were the risk factor for intraoperative blood loss while the elderly and male patients experienced more severe postoperative bleeding.

Patients with cervical disc herniation (CDH) may present axial neck pain, radiculopathy, myelopathy separately or all these outcomes together. This study aimed to evaluate the prevalence and severity of preoperative disabilities in Iranian patients with radiculopathy from CDH and compared these patients with those from other countries. Patients and In this retrospective study, medical records (including demographic characteristics, preoperative clinical presentations, and neck disability index score (NDI)) of the 93 patients (42 female, 51 male) with a mean age of 42.7 ± 9.5 (ranged; 23-71 years old) who had underwent surgery due to radiculopathy from cervical disc herniation between March 2009 and December 2013 in our orthopedic department were studied. Chi-square, Mann-Whitney, and Kruskal-Wallis tests were used to compare and correlate the variables. The most common symptoms of our patients included pain (95.7%) and paresthesia (79.6%), while a positive Spurling test was the most common sign (68.8%). The mean NDI in our patients was 47.30% ± 12.81% (ranged; 28-66%) and the most common type of disability was severe disability. We could not find any significant correlation between NDI and sex, age, level or number of herniated discs but as the patient’s age increased, the probability of multilevel disc involvement also increased. Iranian patients with CDH usually consented to surgery while they had severe disability. In comparison with developed countries, it seems that Iranian patients with CDH present too late to be treated effectively.

Polydactyly is the most common congenital anomaly of the forefoot. It can be isolated or associated with established genetic syndromes. We presented a rare preaxial (medial) polydactyly of the foot. Because our patient reached maturity (24 years old), detailed bony anatomy of the forefoot could be evaluated. Radiographic examination showed a widened navicular bone, fusion of the first cuneiform with the first metatarsal, fusion of phalanges of the first ray, articulation of the second cuneiform with the second and third metatarsal, and cuboid with the fourth and the fifth ray. The first ray disarticulation was performed from the naviculocuneiform joint. Operation result was excellent according to published protocols. According to the Watanabe classification, our case was a tarsal medial (preaxial) foot polydactyly.

Intraosseous ganglions (IOGs) of the lunate bone are a rare cause of chronic wrist pain. Traditional treatment by open curettage and bone grafting can lead to ongoing pain and stiffness of the wrist. In this study, an arthroscopically assisted minimally invasive technique of debridement without grafting of the lunate IOG was presented. Patients and In a prospective study, eight patients with symptomatic lunate intraosseous ganglions were treated with an arthroscopically assisted curettage technique without bone grafting in seven of them. At the preoperative examination and the last follow-up, wrist flexion/extension range of motion, the Mayo Wrist Performance Score, the Quick-Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) score and the visual analog scale (VAS) were calculated. At final follow-up recurrence, patients’ general satisfaction, return to work and complications were assessed. The mean age of patients was 37 ± 8 years. The mean duration of symptoms and follow-up were 12 ± 4 and 28 ± 17 months, respectively. The mean pretreatment wrist flexion-extension arc of motion was 151 ± 46, and 174 ± 9 at the last follow-up, which was not significantly different (P = 0.23). All patients had statistically significant improvements in the Mayo functional wrist score (P < 0.01), Quick-DASH score (P < 0.01) and VAS score (P < 0.01). Arthroscopic debridement of intraosseous ganglions of the Lunate bone without bone grafting could improve wrist functional outcomes with fewer complications.

Massive blood loss is one of the most important concerns in scoliosis surgery. There are some factors suggested to predict the massive blood loss in patients with adolescent idiopathic scoliosis (AIS), however, their predictive value remained unclear. The current study aimed to investigate whether preoperative variables can predict perioperative massive blood loss in patients with AIS.Patients and There were 60 patients with AIS who underwent surgical treatment in the current retrospective study. Posterior spinal fusion (PSF) was performed on 36 patients and PSF and anterior spinal fusion (ASF) for the other 24. Estimated blood loss (EBL) was calculated intraoperative. The correlation between preoperative radiographic and demographic variables with EBL was investigated. Among the variables, only AVB-R ratio positively correlated with the amount of intraoperative blood transfusion (r = 0.28; P = 0.03). Also, preoperative lateral rib hump positively correlated with blood loss in the PSF group (r = 0.39; P < 0.05). Also, the classification of the scoliosis did not affect the amount of blood loss and the number of transfused units. The preoperative lateral rib hump is an important factor positively correlated with the EBL.

Genu valgum deformity is defined as a mechanical axis deviation (MAD) lateral to the knee joint center. In this situation the lateral compartment of the knee is overloaded. Corrective osteotomies are recommended to realign the lower extremity. This study was designed to evaluate the lateral distal femoral biplanar open wedge corrective osteotomy results in patients with genu valgum. Patients and This is a case-series study on seven patients. All patients had genu valgum deformity and medial thrust or pain in the lateral compartment. Lateral biplanar distal femoral open wedge osteotomy was used as corrective osteotomy. Radiological findings and union time at the osteotomy site of the operated patients was determined. All patients were female. The mean age was 25.14 ± 4.74. The mean follow up time for these patients was 8.28 ± 6.96 months. The mean preoperative mechanical alignment was 8.71 ± 2.21 while the post-operative was 1.42 ± 0.53. The mean wedge size used for osteotomy was 8.71 ± 2.21 mm. The mean union time was 9.71 ± 2.56 weeks. Stability and early union without using bone graft at the osteotomy site, rapid rehabilitation and weight bearing of patients with genu valgum are the advantages of biplanar lateral distal femoral open wedge osteotomy.