فهرست مطالب

  • Volume:5 Issue:4, 2018
  • تاریخ انتشار: 1397/08/07
  • تعداد عناوین: 7
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  • James P Waddell , Mehdi Moayedfar , *, Mahmoud Jabalameli Page 1
    Background
    There is no consensus regarding the effect of the type of deformities (valgus or varus) on the functional outcome of total knee arthroplasty (TKA). We aimed to compare the TKA outcome in varus and valgus patients to find whether different angulations of the knee could affect the functional outcome of the TKA.
    Methods
    In total, 55 valgus and 53 varus osteoarthritic knees with matched age, gender, BMI, tibiofemoral angle, comorbidities, type of prosthesis, and follow-up duration were included in the study. The mean follow-up of patients was 4.5 ± 1.7 years. The knee society score (KSS) was calculated for each knee at the latest follow-up. In addition, the western Ontario and McMaster Universities arthritis index (WOMAC) was assessed for each patient several times during the study in order to monitor the course of treatment.
    Results
    The total KSS was significantly higher in varus knees than in valgus knees, with the values of 82.80 ± 10.16 versus 78.61 ± 10.7, respectively (P = 0.023). Varus patients had a significantly better preoperative WOMAC index than valgus patients (with a score of 51.2 ± 4.05 vs. 42.21 ± 4.12) (P = 0.012). At the final follow-up, varus patients still had superior WOMAC although this difference was not statistically significant (P = 0.722). Interestingly, the WOMAC change in the first and final evaluations was significantly different in the two study groups, with 22.06 in varus and 30.14 in valgus patients (P < 0.001).
    Conclusions
    According to our results, the type of deformity could affect the long-term TKA outcome. In this regard, valgus patients would benefit more than varus patients from this surgery
    Keywords: Varus, Valgus, Total Knee Arthroplasty, Outcome
  • Bijan Valiollahi , *, Mostafa Salariyeh Page 2
  • Mehdi Moghtadaei , , Majid Abedi , * , Ali Yeganeh , Hooman Yahyazadeh , Nima Hossienzadeh , Javad Moeini , Kimia Haghighifard Page 3
    Background
    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.
    Methods
    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.
    Results
    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.
    Conclusions
    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
    Keywords: Anterior Cruciate Ligament Reconstruction, Femoral Tunnel Angle, Tibial Tunnel Angle, Graft Inclination Angle
  • Hooman Shariatzadeh , Davod Jafari , Farid Najd Mazhar , Roozbeh Taghavi , *, Hamidreza Dehghani Page 4
    Background
    Several procedures have been described for the management of post-traumatic disorders of the distal radioulnar joint (DRUJ). Amongst them, Sauve-Kapandji (SK) procedure has shown promising results; yet, it is not infallible. Here, we evaluated the radiologic and clinical outcomes of the SK procedure in eight patients with post-traumatic disorders of DRJU.
    Methods
    In a retrospective study, patients with post-traumatic derangement of the DRUJ that underwent the SK procedure were included. The radiologic outcomes were evaluated using the assessment of union, ulnar variation, and radial deviation. The forearm range of motion and Mayo Modified Wrist Score (MMWS) were used for the clinical evaluation of the outcomes. The grip strength of the injured hand was compared with the grip strength of contralateral hand.
    Results
    The mean extension, flexion, supination, and pronation of the patients were 67.5°, 65°, 77.5°, and 78.1°, respectively. The mean ulnar and radial deviations were 20.6° and 17.5°, respectively. The mean grip strength was 45.6 ± 14.1 Ib for the injured hand and 75.4 ± 30 Ib for the non-injured hand (P = 0.012). The mean MMWS was 83.8 ± 5.2. Based on the MMWS, the functional outcome was categorized as excellent in two patients, good in five patients, and fair in one patient. At the last follow-up, radiologic union was observed in all the patients but one. No other complications were recorded.
    Conclusions
    The SK procedure could result in acceptable radiologic and functional outcomes for the management of post-traumatic DRUJ problems. However, it might compromise some indices of the forearm such as grip strength
    Keywords: Sauve-Kapandji Procedure, Distal Radioulnar Joint, Fracture, Outcome
  • Amir Sobhani Eraghi , Mohsen Motalebi , *, Siavash Sarreshtehdari Page 5
     
    Background
    Orthopedic procedures on areas of the body where tourniquet application is not possible, such as the shoulder, is usually accompanied by significant bleeding in addition to a higher need for blood transfusion. Therefore, packed cell units are generally reserved prior to these kinds of procedures, however, not all of those are transfused during surgery. The waste of unused blood units takes a lot of money, time, and energy of the blood bank staff. In this study, we evaluated the average blood units reserved and consumed for elective shoulder surgeries to determine the C/T ratio (crossmatch/transfusion).
    Methods
    In this cross-sectional study, all recorded cases of elective shoulder surgeries between 2015 and 2017 were investigated through our hospital blood bank registry. The number of reserved blood units and transfused blood units (packed cell) for each surgical operation were recorded in the checklist. Finally, the average number of reserved and consumed blood units were determined using the SPSS v.16 software.
    Results
    In this work, 157 patients with a mean age of 36 ± 19.6 years were studied, of which 66.9% were male. The average number of reserved blood units was 1.5 ± 0.586 and the mean number of injected blood units were 0.216 ± 0.672. In addition, the average number of injected blood units in the men's group was significantly higher; this difference was statistically significant.
    Conclusions
    Considering the ratio of reserved blood units to the injected ones, this ratio, on shoulder surgeries at our hospital in Tehran, was within the normal range
    Keywords: Packed Cell, Shoulder Operations, Reserved, Cross Match
  • Ali Yeganeh , Mehdi Moghtadaei , Hosein Farahini , Ehsan Shekarchizadeh , * Page 6
    Background
    Management of acetabular bone defects, especially massive ones, is a challenging issue for surgeons during total hip arthroplasty (THA). Inadequate bone coverage can lead to weakness of acetabular component fixation and instability, and finally, failure of surgery. In recent decades, different techniques and methods have been reported in literature to manage these defects according to their size and location. However, the routine use of many of these new methods is impossible in the majority of patients because of existing financial limitations. The aim of the present study was to evaluate the clinical and radiographic outcomes of THA with acetabular defect reconstruction using shelf-autograft.
    Methods
    This study was designed and conducted in two phases of retrospective and prospective. Between 2012 and 2017, 423 THA surgeries were performed in two hospitals by senior surgeon. A total of 38 THA procedures using shelf autograft were performed. The short-term clinical and radiological results were evaluated in the present study.
    Results
    The mean coverage angle by graft was 45.5 ± 7.3% (range: 33 - 72%) and horizontal coverage percentage by graft was 79.3 ± 12.8% (range: 54 - 100%). After a mean follow-up of 26 months (range: 12 - 56 months), no evidence of instability was found in any of these hips. Considering loosening and revision as an end-point, the survival rate was 100%. The patients’ mean Harris hip score (HHS) improved from a mean of 35.50 ± 9.11 preoperatively to 95.10 ± 4.71 at the last follow-up. Rigid fixation of graft to host bone, medial insertion of acetabular cementless cup, and avoidance of lateral or high hip center were found to result in excellent THA with shelf graft outcomes.
    Conclusions
    Despite the development of more advanced methods to manage acetabular defects during total hip replacement, using shelf-graft is a valuable and accessible strategy for hip surgeons, and by the use of suitable techniques, we can expect excellent outcomes even in massive defects
    Keywords: Shelf Graft, Shelf Autograft, Total Hip Arthroplasty, Total Hip Replacement, Acetabular Defect, Primary Total Hip Arthroplasty, Harris Hip Score, THA
  • Mahmoud Jabalameli , Majid Abedi , * , Mehran Radi , Hooman Yahyazadeh , Seyed Jalil Hamidi Page 7
    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
    Keywords: Knee Extensor Mechanism, Bilateral Patellar Tendon Rupture, Trauma