فهرست مطالب

Archives of Bone and Joint Surgery  - Volume:6 Issue:3, 2018
  • Volume:6 Issue:3, 2018
  • تاریخ انتشار: 1397/02/30
  • تعداد عناوین: 13
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  • E. Carlos Rodriguez-Merchan * Pages 157-160
    Modern orthopedic surgery can improve the musculoskeletal problems of people with hemophilia. The most commonly affected joints are the knees, the ankles and the elbows. The most common orthopedic procedures that PWH undergo are the following: RS, arthroscopic synovectomy, arthroscopic joint debridement, ankle arthrodesis, total joint arthroplasty and removal of pseudotumors. Every surgical procedure must be performed with adequate clotting factor coverage, following the indications of the hematologist in charge. For PWH, routine pharmacological thromboprophylaxis is not indicated. In patients with inhibitors (acquired antibodies against the deficient coagulation factor) and for the surgical removal of pseudotumors, local fibrin glue is advised. The mean infection rate with TKA in PWH is 7%. Intraarticular TXA is advised to control surgical bleeding. LIA is also recommended to control postoperative pain after TKA.
    Keywords: Hemophilia, Orthopedic surgery, New developments
  • Michael Alexander Malahias, Omid Shahpari *, Maria Kyriaki Kaseta Pages 161-168
    Background
    Patients with an anterior cruciate ligament-deficient varus-angulated knee may need not only an isolated high tibial osteotomy (HTO), but also an additional anterior cruciate ligament reconstruction (ACLR). A number of prospective clinical trials have been published considering the combination of HTO and ACL reconstruction. Our aim was to investigate whether one-stage combined HTO and ACL reconstruction is an effective, well-established technique with long-term results in the treatment of varus-angu lated knees with ACL deficiency.
    Methods
    A systematic review was conducted by two independent reviewers by searching the MEDLINE/PubMed and the Cochrane Database of Systematic Reviews. These databases were queried with the term ‘combined high tibial osteotomy anterior cruciate ligament reconstruction’ and ‘simultaneous high tibial osteotomy anterior cruciate ligament reconstruction’.
    Results
    From the initial 41 studies we finally chose and assessed 6 studies were eligible according to our inclusion-exclusion criteria. The vast majority of the patients were treated with hamstrings autograft (85.6% of the patients), whereas a small minority had a patellar Bone-to-Bone autograft (12.8% of the patients) and 3 patients received a patellar allograft. High tibial open wedge osteotomy was performed in 116 patients (57.4%) and closed wedge in 86 patients (42.6%). The mean pre-operative angle of the patients included in our review was 6.6º varus, while the mean final post-operative angle was found to be 1.3º valgus. All 6 studies illustrated improved post-operative IKDC with the use of one-stage HTO and ACLR, whereas the reoperation rate was very low.
    Conclusion
    Despite the lack of high quality studies, it seems that one-stage HTO and ACLR is a safe and effective procedure for treatment of patients suffering from symptomatic varus osteoarthritis in combination with anterior knee instability.
    Keywords: Combined HTO ACL reconstruction, One, stage high tibial osteotomy, anterior cruciate ligament reconstruction, Simultaneous HTO ACL reconstruction, Systematic review
  • Ali Parsa *, Maryam Mirzaie, Mohammad H. Ebrahimzadeh, Ali Birjandinejad, Abdolreza Malek, Alireza Mousavian Pages 169-175
    About 15 % of all musculoskeletal tuberculosis (TB) have hip involvement. Early anti-tubercular drug therapy and other conservative treatment including short-term traction and mobilization programs could prevent hip joint destruction. Reactivation of TB accounts for a significant of active TB incidence, especially in the developed countries with a low TB prevalence. The risk of TB activation for population with the latent form of disease is about 5-10%. According to the existing literature surgery in tubercular hip arthritis would be safe once sufficient debridement and precise anti tubercular chemotherapy has been done.
    Keywords: Active, Hip, Quiescent, Reactivation, Surgery, Tuberculosis
  • Mohamed A. Imam *, Ahmed S. Negida, Ahmed Elgebaly, Amr Hussein, Lukas Ernstbrunner, Saqib Javed, Joshua Jacob, Mark Churchill, Paul Trikha, Kevin Newman, David Elliott, Arshad Khaleel Pages 176-188
    Background
    There is a general consensus on the management of femoral fractures in children younger than two years and adolescents older than sixteen years. The best treatment for patients younger than sixteen years of age is still debatable. Titanium Elastic Nails (TEN), is widely used with some evidence, nonetheless, we undertook a systematic meta-analysis to assess the efficacy of TEN compared to Spica cast for the management of femoral shaft fracture in children aged between 2 to 16 years old.
    Methods
    A computer literature search of PubMed, Scopus, Web of Science, CINAHL and Cochrane Central was conducted using relevant keywords. We included clinical trials and observational studies that compared TEN versus Spica cast; Records were screened for eligible studies and data were extracted and synthesized using Review Manager version 5.3 for Windows. Our search found 573 unique articles. After screening the abstract and relevant full text, 12 studies with a total of 1012 patients were suitab le for the final analysis
    Results
    In terms terms of union (in weeks), the reported effect sizes favoured the TEN group in two included studies only. Moreover, the overall standardized mean difference in sagittal (SMD -0.48, 95% CI [-0.70 to -0.26], P
    Conclusion
    Based on our analysis we recommend the use of TEN fixation in management of pediatric femoral fractures in patients younger than 16 years.
    Keywords: Femoral fractures, Flexible nails, Spica cast, Titanium elastic nails
  • Mohamed A. Imam, James Holton *, Abdel Hassan, Ahmed Matthana Pages 189-195
    Background
    The importance of the syndesmosis in ankle stability is well recognized. Numerous means of fixation have been described for syndesmotic injuries including the suture button technique. Significant cost limits the use the commercially available options. We, therefore, designed a cheap and readily available alternative construct. We aim to assess the results of using a novel suture-button construct in treatment of syndesmotic ankle injuries.
    Methods
    Fifty-two patients (34 males and 18 females) fulfilled our inclusion/exclusion criteria. Five patients were lost to follow-up. The remaining 47 patients were successfully followed up for a minimum of 24 months. The pre and post-surgery American Orthopedic Foot and Ankle Society scores (AOFAS) together with reported complications and post-operative radiological analysis were assessed. In this innovative construct, we utilized polyester braided surgical sutures jointly with double mini two- holed plates, a No.2 polygalactin 910 suture, a 4 mm drill bit, together with a 15 cm long suture needle with slotted end. This technique was supported with the use of the image intensifier.
    Results
    The AOFAS score improved significantly from a mean of 32.4 to 94.2 (P˂0.004). Radiologically, the medial clear space (MCS), tibio-fibular clear space (TFCS) (P=0.05) and tibio-fibular overlap (TFO) measurements showed a significant improvement postoperatively (P=0.02). Patients reported good satisfaction rates with a 96% success rate (95% CI: 94.0% to 99.3%).
    Conclusion
    We have observed that this low cost suture button construct is a simple, safe and cost effective treatment option for acute syndesmotic injuries.
    Level of evidence: IV
    Keywords: Suture button, Ankle, Syndesmosis, Injury
  • Thema Nicholson, Mitchell Maltenfort, Charles Getz, Mark Lazarus, Gerald Williams, Surena Namdari Pages 196-202
    Background
    Our institution’s traditional pain management strategy after shoulder arthroplasty has involved the utilization of postoperative patient-controlled narcotic analgesia. More recently, we have implemented a protocol (TLC) that utilizes a multimodal approach. The purpose of this study was to determine whether this change has improved pain control and decreased narcotic utilization.
    Methods
    Patients undergoing primary total shoulder or reverse arthroplasty were retrospectively studied. All patients underwent interscalene brachial plexus blockade. “Traditional” patients were provided a patient-controlled analgesic pump postoperatively. TLC patients were given preoperative and postoperative multimodal, non-narcotic analgesic medications and breakthrough narcotics. Morphine equivalent units (MEU) consumed and Visual Analog Scale (VAS) scores for pain (0, 8, 16, and 24 hours) were considered.
    Results
    There were 108 patients in each group. Total postoperative narcotic consumption in the first 24 postoperative hours was 38.5 81.1 MEU in the “Traditional group” compared to 59.3 59.1 MEU in the TLC group (P
    Conclusion
    Those treated with the TLC protocol had greater narcotic utilization but better VAS pain scores at 24 hours after surgery. Both groups experienced rebound pain. While the TLC protocol led to an improved pain experience, further modification of the currently protocol may be necessary to reduce overall narcotic utilization.
    Keywords: Arthroplasties, Multimodal pain management, Pain management, Pain, postoperative, Shoulder arthroplasty
  • E. Carlos Rodriguez-Merchan *, Jose Garcia-Ramos, Norma G. Padilla-Eguiluz, Enrique Gomez-Barrena Pages 203-211
    Background
    The role of arthroscopic partial meniscectomy (APM) for painful degenerative meniscal tears (PDMT) is currently controversial.
    To define the rate of early (1 to 5 years) conversion to total knee replacement (TKR) and their predictors after APM for PDMT in patients with knee osteoarthritis and more than 50 years of age.
    Methods
    Retrospective cohort study of patients more than 50 years of age with the diagnosis of PDMT, treated by means of APM. Patients were classified in two groups: Patients that required an early (between 1 and 5 years after APM) TKR (TKR group) after its failure and patients that did not require a TKR (non-TKR group). Patient demographics, general characteristics, Kellgren & Lawrence (KL) classification, Outerbridge classification, and other characteristics were analyzed. Postoperative variables were also analyzed: pain, use of walking aids and use of intra-articular injections (hyaluronic acid or corticosteroids) at 3, 6, and 12 months of follow-up.
    Results
    A total of 356 patients (356 APMs) were included. Forty-nine patients (13.7%) required an early (1.8 years on average) TKR and 307 did not. The main predictor of early TKR was the grade of the KL classification. After APM, the presence of pain and the need of walking aids also were predictors of an early TKR.
    Conclusion
    In patients older than 50 years with PDMT, APM should be cautiously indicated in case of KL grade of 1 or more. Postoperative pain and prolonged need of walking aids were also predictors of an early (mean 1.8 years) TKR.
    Keywords: Arthroscopic partial meniscectomy, Degenerative meniscal tear, Failure, Knee, Total knee replacement
  • Morteza Nakhaie Amroodi, Davod Jafari, Ali Asghar Kousari * Pages 212-218
    Background
    Open Bankart surgery is the main treatment procedure in patients with recurrent anterior shoulder dislocation, especially in cases with glenoid bone defect. The goal of this study was to determine the outcomes after open Bankart surgery in cases of recurrent anterior shoulder dislocation with glenoid bone defects and concomitant Hill-Sachs lesions.
    Methods
    Between 2006 and 2010, 89 patients with recurrent anterior shoulder dislocation and concomitant glenoid bone defects (10-30%) and Hill-Sachs lesions undergoing open Bankart surgery were reviewed. The mean follow-up after surgery was 7 years (5.5-9.5 years). The recurrence rate as well as the degree of shoulder pain and daily activity level was determined subjectively based on the visual analogue scale (VAS) and activity daily living scale (ADLs). Shoulder range of motion (ROM) in abduction and external rotation was compared with contralateral side; and finally, the American shoulder and elbow score (ASES) and constant-Murley score (CMS) were calculated.
    Results
    Over 7 years of follow-up, a total of 15 patients (16.8%) undergoing surgery were found to have instability (3 patients (3.3%) with dislocation and 12 patients with (13.4%) subluxation). Patients with postsurgical instability had significantly larger glenoid bone defects (P=0.0001) and Hill-Sachs lesions (P=0.019) compared to those without instability. The mean loss of forward flexion compared with the normal contralateral side was 4º while the mean loss of external rotation between both sides was 5º. At the final visit, the average VAS was 0.4 (out of 10); ADL was 28.97 (range: 25-30); ASES was 96.1(range: 78.3-100); and the mean CMS value was 93.9(range: 82-100).
    Conclusion
    Open Bankart surgery with anteroinferior capsular shift for recurrent anterior shoulder dislocation with up to 30% glenoid bone defect and Hill-Sachs lesion provided desirable results in terms of shoulder function and recurrence rate. Bankart surgery is a successful and practical option in these patients and can be considered as an alternative to other procedures.
    Keywords: Hill, sachs lesion, Glenoid bone defect, Open Bankart surgery, Recurrent shoulder dislocation
  • Zari Naderi Ghale-Noie, Mohammad Hassani, Amir R. Kachooei, Mohammad A. Kerachian * Pages 219-224
    Background
    Diagnosis of osteonecrosis of the femoral head (ONFH) is complicated due to the lack of reliable serum biomarkers. Up-regulation of alpha-2-macroglobulin (A2M) gene has been reported in glucocorticoid-induced ANFH rat model. This study aimed to investigate whether the serum level of alpha-2-macroglobulin (A2M) can be used for ONFH diagnosis.
    Methods
    Serum protein capillary electrophoresis was performed on the sera of 36 ONFH patients. Also, human enzyme-linked immunosorbent assay was performed to evaluate the serum levels of A2M.
    Results
    Alpha-2 subunit level, composed of alpha-2-macroglobulin, ceruloplasmin and 2-2 haptoglobin phenotype, was increased significantly as compared to healthy subjects (P=0.0001). Moreover, ELISA assay confirmed significant elevation in the A2M (P=0.037).
    Conclusion
    Our findings suggest that avascular necrotic femur head presumably directly or indirectly elevates A2M in the bloodstream. Thus, serum level of A2M might be used as a reliable diagnostic tool in clinical practice.
    Keywords: Alpha, 2, macroglobulin, Avascular necrosis of femoral head, Femur, Osteonecrosis
  • Fei Wu, Amir R. Kachooei *, Mohammad H. Ebrahimzadeh, Farshid Bagheri, Ehsan Hakimi, Babak Shojaie, Ara Nazarian Pages 225-232
    Background
    We hypothesize that there is no difference in the motion of the scapula with respect to the thoracic wall (scapulothoracic interface) between the affected versus non-affected shoulder on 0° and 90° standard arm abduction radiography.
    Methods
    We enrolled 30 patients with the diagnosis of unilateral frozen shoulder after ruling out of other pathologies. Bilateral standard shoulder radiography was done in two position of 0° and 90° of arm abduction. Non-affected side was used as a control group.
    Results
    The mean scapulothoracic angle of the affected side was significantly larger than the non-affected side in both 0° and 90°of abduction in spite that the scapulohumeral angles were comparable in 0°, indicating potential alteration in scapular positioning.
    Conclusion
    Scapulothoracic motion and position can be affected in frozen shoulder along with other areas. All treatment modalities should be applied to this area as well if substantial difference was detected between the two sides.
    Keywords: Center equator distance, Frozen shoulder, Radiography, Scapulohumeral angle, Scapulothoracic
  • Sayyed-Hadi Sayyed-Hosseinian, Golnaz Ghayyem Hassankhani *, Farshid Bagheri, Niloofar Alavi, Babak Shojaie, Alireza Mousavian Pages 233-239
    Background
    American Orthopedic Foot and Ankle Society Score (AOFAS) is a reliable and reproducible measurement tool which is commonly used for the assessment of foot and ankle conditions. In this study we aimed to translate and assess the psychometric properties of the Persian version of AOFAS questionnaire.
    Methods
    In this study, we enrolled 53 patients with ankle and hindfoot conditions. Our study was conducted according to five staged cross-cultural adaption steps including translation, synthesis, back translation, expert committee review, and pretesting. After that reliability of the subjective parts calculated by Cronbach’s alpha and the intraclass correlation coefficient (ICC) and the reliability of the objective items estimated using Cohen’s kappa test. Also, construct validity was assessed by testing the Persian AOFAS against the SF-36 questionnaire.
    Results
    Chronbach’s alpha coefficient was 0.696, which was considered acceptable. Furthermore, the test-retest reliability measured by using the ICC for the subjective subscales was 0.853 (P
    Conclusion
    In our study, Persian translation of AOFAS demonstrated acceptable validity and reliability with no need to be culturally adapted.
    Keywords: AOFAS, Persian, Translation, Validation
  • Konstantin Igorevich Novikov, Koushik Subramanyam *, Sergey V. Kolesnikov, Oleg K. Chegurov, Elina S. Kolesnikova, Abhishek V. Mundargi Pages 240-242
    Ilizarov is an accepted technique for lengthening short amputation stumps to improve prosthetic function and rehabilitation. The relation of stump lengthening and phantom limb pain (PLP) has not been reported in literature. We present here a case report of a transfemoral amputee who had a flare up of PLP following stump lengthening. He responded well to a combination of pharmacological therapy and soft tissue manipulative techniques and desired length was achieved. This report alerts the possibility of aggravation of PLP following stump lengthening and discusses its management.
    Keywords: Above knee amputation, Amputee rehabilitation, Ilizarov, Phantom limb pain, Stump lengthening
  • Rajesh Malhotra, Deepak Gautam *, Bhavuk Garg, Anjan Trikha Pages 243-274
    We wish to present a case of 47-year-old patient with Juvenile Rheumatoid Arthritis and ankylosis of both hips and both knees treated by bilateral hip and knee arthroplasty in a single anaesthesia i.e. Quadruple joint replacement in single sitting. He was back on his feet from his bed-ridden state within the fortnight following surgery. He has been followed up for four years and has been performing his activities of daily living independently. We discuss the preoperative planning, surgical details and post-operative rehabilitation and unique challenges pertaining to this case.
    Keywords: Bilateral hip, knee arthroplasty, Juvenile rheumatoid arthritis, Simultaneous quadruple joint replacement