SM Javad Mortazavi; Nima Bagheri; Amirreza Farhoud; Saeid Hadi Kalantar; Ehsan Ghadimi
Volume 8, Issue 4 , July 2020, , Pages 470-478
Abstract
Total knee arthroplasty is considered as the treatment of choice for those with end stage hemophilic arthropathy.Compared to other patients undergoing TKA, these patients have specific features such as bleeding tendency, youngerage, pre-operative restricted range of motion (ROM), altered anatomy, and ...
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Total knee arthroplasty is considered as the treatment of choice for those with end stage hemophilic arthropathy.Compared to other patients undergoing TKA, these patients have specific features such as bleeding tendency, youngerage, pre-operative restricted range of motion (ROM), altered anatomy, and increased complications. This narrativereview of literature is going to investigate several issues regarding the TKA in hemophilic patients including indications,perioperative factor replacement, surgical challenges, postoperative rehabilitation, outcomes, and complications.Level of evidence: I
Mehrdad Sadighi; SM Javad Mortazavi; Adel Ebrahimpour; Alireza Manafi-Rasi; Mohammad H. Ebrahimzadeh; Meisam Jafari KafiAbadi; Seyyed Saeed Khabiri; Saber Barazandeh Rad; Monireh Yaghoubi; Mohammadreza Chehrassan
Volume 8, Issue 3 , May 2020, , Pages 378-382
Abstract
Background: Surgery in the time of COVID-19 pandemic is a challenging issue while treatment of affected fracturepatients is inevitable. The present study summarizes the challenges that an orthopedic surgeon is confronting duringthe surgical treatment of fracture patients with concomitant COVID-19 infection.Methods: ...
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Background: Surgery in the time of COVID-19 pandemic is a challenging issue while treatment of affected fracturepatients is inevitable. The present study summarizes the challenges that an orthopedic surgeon is confronting duringthe surgical treatment of fracture patients with concomitant COVID-19 infection.Methods: Demographic and fracture related data of 13 fracture patients with concomitant COVID-19 infection whowere treated with surgery was collected from three trauma centers in Tehran and Kermanshah cities from 21, February2020 to April 3, 2020.Results: All patients were male with mean age of 38.6±19.5 years. Eight patients had high energy fracture and sevenpatients had multiple fractures and trauma. Wrist and hand were the common sites of fracture following hip and pelvis. Themean interval time period between the diagnosis of COVID-19 infection and surgery was 2.3±1.5 days. Before surgery, allpatients except one had been admitted to the corona dedicated wards, while two patients were admitted to the intensivecare unit (ICU). One of the ICU admitted patients died. All the 12 alive patients remained in home isolation after discharge.Conclusion: Fracture surgery in COVID-19 patients has many challenges such as lack of medical resources, delayof surgery, medial staff fear, and patient isolation. However, a multidisciplinary approach using all potential hospitalresources would lead to successful operation and acceptable outcome.Level of evidence: III
SM Javad Mortazavi; Mohammad Hossein Nabian
Volume 8, Issue 3 , May 2020, , Pages 323-324
Abstract
An enormous technological improvement in Ultrasonography devices has occurred during last decade, providing excellent soft-tissue contrast and high spatial resolution images. Nowadays, musculoskeletal ultrasonography is going to be a stethoscope in the hand of orthopedic surgeons for the diagnosis of ...
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An enormous technological improvement in Ultrasonography devices has occurred during last decade, providing excellent soft-tissue contrast and high spatial resolution images. Nowadays, musculoskeletal ultrasonography is going to be a stethoscope in the hand of orthopedic surgeons for the diagnosis of many musculoskeletal pathologies, as well as an accurate guide for therapeutic interventions. Therefore, it is wise for practicing orthopedic surgeons to learn musculoskeletal ultrasonography in collaboration with radiology colleagues as this would improve the patients' care .
SM Javad Mortazavi; Babak Sattartabar; Alireza Moharrami; seyed hadi Kalantar
Volume 8, Issue 3 , May 2020, , Pages 355-362
Abstract
Background: Total knee arthroplasty (TKA) can cause excessive blood loss requiring allogenic transfusions.Tranexamic acid (TXA) has been increasingly used for lowering blood loss. The present study aimed to comparethe efficacy of intravenous (IV) and intra-articular (IA) administrations of TXA in TKA ...
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Background: Total knee arthroplasty (TKA) can cause excessive blood loss requiring allogenic transfusions.Tranexamic acid (TXA) has been increasingly used for lowering blood loss. The present study aimed to comparethe efficacy of intravenous (IV) and intra-articular (IA) administrations of TXA in TKA patients who receive aspirin aschemoprophylaxis and uses no drain post-operative.Methods: In this prospective randomized clinical trial, 49 TKA patients were intravenously given 15 mg/kg dose ofTXA, and 49 patients intraarticularly received 15 mg/kg of TXA. Demographic information, pre-operative and postoperativehemoglobin values of the patients were used for assessing total perioperative blood loss by GOOD &NADLER formulae.Results: There was not any significant difference between the IV TXA and IA TXA groups concerning blood loss(P=0.102). However, the decrease in hemoglobin level at 48 hours post-operation compared to the preoperativelevel in the IV TXA group was significantly higher than that in the IA TXA group (-2.3 ±0.8 vs. -1.9 ±1.0 g/dL;P=0.038). No blood transfusion was needed, and the deep venous thrombosis and pulmonary embolization werenot observed in either of the groups (P>0.05).Conclusion: Our study showed that during TKA, the IA TXA is equally safe and effective as its IV infusion concerningdecreased blood loss and adverse effects. The use of TXA during TKA is safe for patients who receive less potentchemoprophylaxis agents such as aspirin.Level of evidence: I
Seyed Hadi Kalantar; Amir Reza Farhoud; S.M. Javad Mortazavi
Volume 8, Supplement 1 , April 2020, , Pages 235-241
Abstract
The COVID-19 disease is rapidly spreading around the world, affecting many countries and their healthcare systems.Like many other countries, Iran is struggling with the current situation. In this article, we aim to share our perspectiveson confronting obstacles mentioned above using appropriate hospital ...
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The COVID-19 disease is rapidly spreading around the world, affecting many countries and their healthcare systems.Like many other countries, Iran is struggling with the current situation. In this article, we aim to share our perspectiveson confronting obstacles mentioned above using appropriate hospital protocols during the COVID-19 crisis.We investigated and compared the number of referred patients to the emergency room, elective, and emergentorthopedic operations in our hospital, along with a number of residents and faculty participants in the morning reportsand virtual classes before and after the outbreak of COVID-19 in our hospital.The number of referred patients to the emergency room was significantly reduced; the number of orthopedic operationswas also decreased to almost zero in March 2020. Meanwhile, we managed to dismiss our residents and reducethe number of in-hospital morning reports and conferences. Instead, we designed virtual classes, and the number ofparticipants in our virtual classes grew to almost two-third of the whole participant. We also managed to fortify our virtualoffice system to reduce the number of in-hospital visits.Since our hospital had become a leading center for the treatment of COVID-19 patients, and the number of referredtrauma patients, elective, and trauma operations, along with educational activities, was reduced. There was also asignificant concern about the management of elective, trauma, and post-operative patients in this era. Orthopedicfaculty members needed to react to the current situation cautiously. We were able to manage the situation withconsideration of our educational path, along with the management of personal protective equipment (PPE), and theuse of communication technologies and specific protocols to overcome the obstacles mentioned above. Yet involvedour staff andWith orthopedic faculties active involvement at in-hospital activitie and establishment of hospital protocols consideringtechnological facilities and WHO guidelines, we can improve education, management of PPE, and both orthopedicelective and trauma patients.Level of evidence: IV
Mansour Abolghasemian; Mohammad H. Ebrahimzadeh; Mohammad Ali Enayatollahi; Keivan Honarmand; Amir R. Kachooei; Soheil Mehdipoor; Mohammad Javad Mortazavi; Alireza Mousavian; Ali Parsa; Gholam Ali Akasheh; Farshid Bagheri; Adel Ebrahimpour; Mohammad Fakoor; Roshanak Moradi; Mohammad Razi
Volume 8, Supplement 1 , April 2020, , Pages 209-217
Abstract
Iranian Orthopedic Community as a part of the national health system feels deeply responsible to take part in the battle against the new coronavirus (COVID-19) pandemic. Although we might not be considered the front-line defenders, we do have a key role in this challenge. As the crisis continues to grow ...
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Iranian Orthopedic Community as a part of the national health system feels deeply responsible to take part in the battle against the new coronavirus (COVID-19) pandemic. Although we might not be considered the front-line defenders, we do have a key role in this challenge. As the crisis continues to grow in Iran, the risk of contracting the virus increases with subsequent increase in the number of seriously ill and dying patients. The shortage of ventilators and personal protective equipment (PPE) is a main concern that may even worsen as the number grows. In response to the burden on the health system, the elective part of our practice has to be suspended for now so that the resources can be deployed to more critical patients. There is a social responsibility to preserve vital resources for those who are in greater need. Moreover, we follow the recommended social distancing by postponing elective surgeries which should help reduce further spread of this disease. The recommendations in this document are valid through the evolving period of the current pandemic. Future amendments and updates will be announced in line with the action plans of the Ministry of Health. Nonetheless in this crisis, we should be prepared to treat non-elective and trauma patients who are in need of emergency care. We should seek the best local solutions to continue the proper management for these trauma patients while preserving resources for the response to COVID-19. Furthermore, we need to plan for probable shortages in our resources including staff, spaces and supplies. The Iranian Orthopedic Association (IOA) supports shared decision-making policy in these extraordinary circumstances and acknowledges that non-operative management of many orthopedic injuries as well as reducing face-to-face follow-ups are a reasonable path.
Seyed Farshad Allameh; Nasim Khajavirad; Ali Labaf; Azim Mirzazadeh; Khosro Sageghniat; S.M. Javad Mortazavi; Ali Jafarian
Volume 8, Supplement 1 , April 2020, , Pages 277-280
Abstract
Coronavirus pandemic has been announced by World Health Organization Director General on March 11th, 2020.Imam Khomeini Hospital Complex, affiliated to Tehran University of Medical Sciences, was one the first referral hospitalsin the capital city of Tehran, I.R.Iran that entered the crisis and started ...
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Coronavirus pandemic has been announced by World Health Organization Director General on March 11th, 2020.Imam Khomeini Hospital Complex, affiliated to Tehran University of Medical Sciences, was one the first referral hospitalsin the capital city of Tehran, I.R.Iran that entered the crisis and started a serious battle with the disease. Thehospital had to change many routine operations to cope with the situation and during this journey, we used previouslyleadership principles and reached to some new experiences. As this is probably the most severe health-related crisis inIran in the past 100 years, we gathered our lessons learned in the first fifty days of epidemic from the leadership pointof view to share those with all colleagues worldwide. We know that leadership is of pivotal role in such a massive crisisand focused leadership experiences can help health care providers to manage the crisis while we are in the middle of it.Level of evidence: IV-V
Knee
Mohammad Razi; SM Javad Mortazavi
Volume 8, Issue 1 , January 2020, , Pages 1-4
Abstract
With increasing life expectancy, the demand for preservation of native articular cartilage is increasing to delay joint arthroplasties. In the knee, there are many different strategies to preserve the articular cartilage including but not limited to corrective osteotomies, chondral injury restoration, ...
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With increasing life expectancy, the demand for preservation of native articular cartilage is increasing to delay joint arthroplasties. In the knee, there are many different strategies to preserve the articular cartilage including but not limited to corrective osteotomies, chondral injury restoration, intraarticular injection of cells or growth factors(PRP). However, One of the most important strategies in knee preservation is meniscal preservation. It was highlighted again in the 4th international meeting The Meniscus held in Bologna late in January 2016. As the loss of the meniscus can be regarded as a pre-arthritic condition, a knee surgeon must save the meniscuses much as he or she can.
General Orthopedics
S. M. Javad Mortazavi; Alireza Moharrami; Hosein Shafiei; Mohammad H. Ebrahimzadeh; Mehdi Karimi
Volume 7, Issue 6 , November 2019, , Pages 561-565
Abstract
Avascular necrosis of the femoral head (AVNFH) is a leading cause of end-stage joint disease in the young populationthat can lead to total hip replacement in early life. There are various risk factors, including trauma, corticosteroids,thrombosis, hypertension, and alcohol. There is a growing number ...
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Avascular necrosis of the femoral head (AVNFH) is a leading cause of end-stage joint disease in the young populationthat can lead to total hip replacement in early life. There are various risk factors, including trauma, corticosteroids,thrombosis, hypertension, and alcohol. There is a growing number of patients with AVNFH and history of self-medicationwith herbal supplement used for weight gain in Iran. The present study aimed to demonstrate the prevalence rate ofusing unapproved weight gain supplements (UWGS) in patients with AVNFH.An observational and cross-sectional study was conducted to estimate the prevalence rate of using UWGSs in patientswith osteonecrosis at Imam Khomeini Hospital, Tehran, Iran, from January 2012 to 2018. The data were analyzed inSPSS software (version 24) through descriptive statistics and tests of means.Out of 207 patients with AVNFH, 115 cases were male. In total, 44 patients (20.95%) had a history of using UWGSs,and there had no other risk factors of osteonecrosis of FH.In conclusion, UWGSs can be a risk factor for AVNFH, and it is necessary to develop educational programs to alertyoung population about the side effects of these supplements.Level of evidence: III
Knee
Mohammad H. Kaseb; Seyed Mohammad J. Mortazavi; Mohammad Ayati Firoozabadi; Hesam Toofan
Volume 7, Issue 5 , September 2019, , Pages 441-444
Abstract
Background: Patellar crepitus after total knee arthroplasty (TKA) is not uncommon. The choice between patellarresurfacing or retention in TKA has remained controversial. Therefore, this randomized controlled trial aimed to evaluatethe impact of patellar resurfacing on the incidence of patellar crepitus. ...
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Background: Patellar crepitus after total knee arthroplasty (TKA) is not uncommon. The choice between patellarresurfacing or retention in TKA has remained controversial. Therefore, this randomized controlled trial aimed to evaluatethe impact of patellar resurfacing on the incidence of patellar crepitus. In addition, we compared the clinical outcomesand satisfaction between the patients who underwent patellar retention or resurfacing.Methods: A total of 63 patients randomly received patellar resurfacing or non-resurfacing TKA by one surgeon at ImamKhomeini Hospital Complex, Tehran University of Medical Sciences, Iran during May 2014-February 2017. Finally,29 patients in the resurfaced group and 44 subjects with retained patella were evaluated pre-op and in an averagefollow-up period of 8.68 months using the clinical Knee Society Score (KSS), functional KSS, and Knee injury andOsteoarthritis Outcome Score (KOOS).Results: Our findings demonstrated no significant difference between the two groups regarding the satisfactionof patients, KSS, and KOOS. It was shown that the latter scores improved in both groups in the follow-up period.Nonetheless, patellar crepitus was not statistically different between the two groups.Conclusion: According to the results of the present study, patellar resurfacing did not lead to decreased patellarcrepitus or enhanced clinical outcomes of TKA.Level of evidence: I
Knee
S.M. Javad Mortazavi; Ahmad Ramezanpoor Asl; Hamed Jafari; Hojjat Asgari; Mohamad H. Kaseb; Mohammad J. Dehghanifiroozabadi
Volume 7, Issue 5 , September 2019, , Pages 463-468
Abstract
Background: The purpose of this study was to introduce a technical tip for the preparation of tibial tunnel in a posteriorcruciate ligament (PCL) reconstruction to reduce the chance of popliteal artery injury and duration of the surgery.Methods: This study included 18 patients who underwent PCL reconstructions ...
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Background: The purpose of this study was to introduce a technical tip for the preparation of tibial tunnel in a posteriorcruciate ligament (PCL) reconstruction to reduce the chance of popliteal artery injury and duration of the surgery.Methods: This study included 18 patients who underwent PCL reconstructions at Imam Khomeini University Hospital,Tehran, Iran, between 2016 and 2017. In all patients, the PCL tibial aimer device was inserted from the anteromedialportal and its tip aimed 8-9 mm below shiny white fibers in PCL facet. Subsequently, the smooth guide pin was insertedfrom anteromedial tibial cortex and advanced just to the posterior cortex but not through it based on the measurementof tibial tunnel length. Thereafter, the reaming was done over the guide pin. As the pin was engaged in the posteriorcortex, it was assured that it would not run before the reamer to the popliteal fossa. The pin was removed when thereamer touched the posterior cortex, and the reaming continued until reamer’s head appeared in the PCL facet. Othersteps of standard arthroscopic PCL reconstruction were done in this study. All patients were subjected to computedtomography scans.Results: The mean age of the patients and the mean duration of surgery were 25±3 years and 95 min, respectively.There was no vascular injury, and the position of the tibial tunnel in all cases was accurate. Moreover, the meandistance between the centers of the tibial tunnel to champagne-glass drop-off of the posterior cortex of tibia wasobtained at 7.42 mm (range: 4.6-10.4 mm).Conclusion: This study showed that avoiding the penetration of posterior cortex of the tibia by means of the pin duringtibial tunnel preparation for PCL reconstruction is a safe, reproducible, and time-saving technique. This techniqueeliminates the need for fluoroscopy during the procedure.Level of evidence: IV
General Orthopedics
Hangama C. Fayaz; Raymond M. Smith; Mohammad H. Ebrahimzadeh; Hans-Christoph Pape; Javad Parvizi; Khaled J. Saleh; Jens-Peter Stahl; Johannes Zeichen; James F. Kellam; SM Javad Mortazavi; Ashok Rajgopal; Vivek Dahiya; Wolfgang Zinser; Leonid Reznik; Igor Shubnyakov; Marco Pecina; Jupiter B. Jesse
Volume 7, Issue 4 , July 2019, , Pages 384-396
Abstract
Background: To date, little has been published comparing the structure and requirements of orthopedic training programsacross multiple countries. The goal of this study was to summarize and compare the characteristics of orthopedic trainingprograms in the U.S.A., U.K., Canada, Australia, Germany, India, ...
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Background: To date, little has been published comparing the structure and requirements of orthopedic training programsacross multiple countries. The goal of this study was to summarize and compare the characteristics of orthopedic trainingprograms in the U.S.A., U.K., Canada, Australia, Germany, India, China, Saudi Arabia, Russia and Iran.Methods: We communicated with responders using a predetermined questionnaire regarding the national orthopedictraining program requirements in each respondent’s home country. Specific items of interest included the following: thestructure of the residency program, the time required to become an orthopedic surgeon, whether there is a log book,whether there is a final examination prior to becoming an orthopedic surgeon, the type and extent of faculty supervision,and the nature of national in-training written exams and assessment methods. Questionnaire data were augmented byreviewing each country’s publicly accessible residency training documents that are available on the web and visitingthe official website of the main orthopedic association of each country.Results: The syllabi consist of three elements: applied clinical knowledge, applied clinical skills, and professional andmanagement skills. The application of simulation techniques for both teaching and assessment are fundamental tomodern surgical education. The skill of today’s trainees predicts the quality of future orthopedic surgeons. The EuropeanBoard of Orthopaedics and Traumatology (EBOT) exam throughout the European Union countries should function asthe European board examination in orthopedics. We must standardize many educational procedures worldwide in thesame way we standardized patient safety.Conclusion: Considering the world’s cultural and political diversity, the world is nearly unified in regards to orthopedics.The procedures (structure of the residency programs, duration of the residency programs, selection procedures, using a logbook, continuous assessment and final examination) must be standardized worldwide, as implemented for patient safety.To achieve this goal, we must access and evaluate more information on the residency programs in different countries andtheir needs by questioning them regarding what they need and what we can do for them to make a difference.Level of evidence: III