2024-03-29T09:32:42Z
https://abjs.mums.ac.ir/?_action=export&rf=summon&issue=1387
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2018
6
3
What´s New in Orthopedic Surgery for People with Hemophilia
E. Carlos
RODRIGUEZ-MERCHAN
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.
Hemophilia
Orthopedic surgery
New developments
2018
05
01
157
160
https://abjs.mums.ac.ir/article_10733_92f5e6358cddee283b5621242ece9321.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2018
6
3
Hip Surgery in Quiescent or Active Tubercular Hip Arthritis; Is Reactivation Risk Really a Matter
Ali
Parsa
Maryam
Mirzaie
Mohammad H.
Ebrahimzadeh
Ali
Birjandinejad
Abdolreza
Malek
Alireza
Mousavian
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.
Active
Hip
Quiescent
Reactivation
Surgery
Tuberculosis
2018
05
01
169
175
https://abjs.mums.ac.ir/article_10734_fe1ac3ce22e996f0efea1642757450b8.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2018
6
3
The clinical Outcome of One-stage High Tibial Osteotomy and Anterior Cruciate Ligament Reconstruction. A Current Concept Systematic and Comprehensive Review
Michael
Alexander Malahias
Omid
Shahpari
Maria
Kyriaki Kaseta
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. Level of evidence: II
Combined HTO ACL reconstruction
One-stage high tibial osteotomy and anterior cruciate ligament reconstruction
Simultaneous HTO ACL reconstruction
Systematic review
2018
05
01
161
168
https://abjs.mums.ac.ir/article_10732_f745e492df9c568fa3943276ab8649d9.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2018
6
3
Titanium Elastic Nails Versus Spica Cast in Pediatric Femoral Shaft Fractures: A Systematic Review and Meta-analysis of 1012 Patients
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
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<0.001) and coronal angulations (SMD -0.66, 95% CI [-1.00 to -0.31], P<0.001) favored TEN fixation in management of femoral fractures younger than 16 years. The reported length of hospital stay was not consistent across studies. The overall risk ratio of malalignment (RR=0.39, 95% CI [0.27 to 0.57], P<0.001) favored the TEN as well as walking independently. Based on our analysis, TEN treatment is superior to traction and hip spica for femoral fractures in patients younger than 16 years old. Conclusion: Based on our analysis we recommend the use of TEN fixation in management of pediatric femoral fractures in patients younger than 16 years. Level of evidence: II
Femoral fractures
Flexible nails
Spica cast
Titanium elastic nails
2018
05
01
176
188
https://abjs.mums.ac.ir/article_10292_b14484ca64e794845056959f6f61344d.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2018
6
3
A Novel Suture Button Construct for Acute Ankle Syndesmotic Injuries; A Prospective Clinical and Radiological Analysis.
Mohamed A.
Imam
James
Holton
Abdel
Hassan
Ahmed
Matthana
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
Suture button
Ankle
Syndesmosis
Injury
2018
05
01
189
195
https://abjs.mums.ac.ir/article_10309_c9d42075a89d633a7ed236878335632d.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2018
6
3
Multimodal Pain Management Protocol Versus Patient Controlled Narcotic Analgesia for Postoperative Pain Control after Shoulder Arthroplasty
Thema
Nicholson
Mitchell
Maltenfort
Charles
Getz
Mark
Lazarus
Gerald
Williams
Surena
Namdari
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<0.001). Of patients in the TLC group, 88% utilized breakthrough narcotics. VAS pain was significantly higher in the “Traditional group” at 16 hours (4.1 +/- 2.9 vs 3.2 +/- 2.7, P=0.020) and 24 hours (4.8 +/- 2.7 vs 3.7 +/- 2.6, P=0.004). 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. Level of evidence: III
Arthroplasties
Multimodal pain management
Pain management
Pain-postoperative
Shoulder Arthroplasty
2018
05
01
196
202
https://abjs.mums.ac.ir/article_10296_ffc526b74bbae319fd5eadefe5bca8c8.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2018
6
3
Arthroscopic Partial Meniscectomy for Painful Degenerative Meniscal Tears in the Presence of Knee Osteoarthritis in Patients Older than 50 Years of Age: Predictors of an Early (1 to 5 Years) Total Knee Replacement
E. Carlos
Rodriquez-Merchan
Jose
Garcia-Ramos
Norma
Padilla-Eguiluz
Enrique
Gomez-Barrena
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. Level of evidence: IV
Arthroscopic partial meniscectomy
Degenerative meniscal tear
Failure
knee
Total knee replacement
2018
05
01
203
211
https://abjs.mums.ac.ir/article_10287_c6f3c84844900bb98a2b0aa11bde3651.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2018
6
3
Results of Open Bankart Surgery for Recurrent Anterior Shoulder Dislocation with Glenoid Bone Defect and Concomitant Hill-Sachs Lesion
Morteza
Nakhaie Amroodi
Davod
Jafari
Ali Asghar
Kousari
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. Level of evidence: IV
Hill-sachs lesion
Glenoid bone defect
Open Bankart surgery
Recurrent shoulder dislocation
2018
05
01
212
218
https://abjs.mums.ac.ir/article_10286_0b28cf261f097e1347182b6fd780fba3.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2018
6
3
High Serum Alpha-2-Macroglobulin Level in Patients with Osteonecrosis of the Femoral Head
Zari
Naderi Ghale-Noie
Mohammad
Hassani
Amir R.
Kachooei
Mohammad A.
Kerachian
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. Level of evidence: II
Alpha-2-macroglobulin
Avascular necrosis of femoral head
Femur
Osteonecrosis
2018
05
01
219
224
https://abjs.mums.ac.ir/article_10280_14372147a556ba2581f034a97c923ff3.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2018
6
3
Bilateral Arm-Abduction Shoulder Radiography to Determine the Involvement of the Scapulothoracic Motion in Frozen Shoulder
Fei
Wu
Amir R.
Kachooei
Mohammad H.
Ebrahimzadeh
Farshid
Bagheri
Ehsan
Hakimi
Babak
Shojaie
Ara
Nazarian
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. Level of evidence: I
Center equator distance
Frozen shoulder
Radiography
Scapulohumeral angle
Scapulothoracic
2018
05
01
225
232
https://abjs.mums.ac.ir/article_10735_501cdb2f97421cc889e0c99f46855995.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2018
6
3
Validation of the Persian Version of the American Orthopedic Foot and Ankle Society Score (AOFAS) Questionnaire
Sayyed-Hadi
Sayyed-Hosseinian
Golnaz
Ghayyem Hassankhani
Farshid
Bagheri
Farshid
Bagheri
Niloofar
Alavi
Babak
Shojaie
Alireza
Mousavian
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<0.001). The reliability of testing the objective subscales was calculated by using Kappa, which indicated acceptable values. Pearson correlation coefficient between AOFAS and SF-36 was 0.415 (P=0.008). In addition, floor and ceiling effects were calculated 1.9% and 7.5% respectively. Conclusion: In our study, Persian translation of AOFAS demonstrated acceptable validity and reliability with no need to be culturally adapted. Level of evidence: II
AOFAS
Persian
Translation
Validation
2018
05
01
233
239
https://abjs.mums.ac.ir/article_10736_8b86d5c58ade8d49de3d274bcc727a56.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2018
6
3
Ilizarov Stump Lenthening Can Aggravate Phantom Limb Pain – a Case Report
Konstantin
Igorevich Novikov
Koushik
Subramanyam
Sergey V.
Kolesnikov
Oleg K.
Chegurov
Elina S.
Kolesnikova
Abhishek V.
Mundargi
Ilizarov is an accepted technique for lengthening short amputation stumps to improve prosthetic function andrehabilitation. 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 desiredlength was achieved. This report alerts the possibility of aggravation of PLP following stump lengthening and discussesits management.Level of evidence: V
Above knee amputation
Amputee rehabilitation
Ilizarov
Phantom limb pain
Stump lengthening
2018
05
01
240
242
https://abjs.mums.ac.ir/article_10295_147cb3807ab7b9a4f946ee184812d4ed.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2018
6
3
Simultaneous Quadruple Joint Replacement (QJR) in Disabling Juvenile Rheumatoid Arthritis – a Case Report with Review of Literature
Rajesh
Malhotra
Deepak
Gautam
Bhavuk
Garg
Anjan
Trikha
We wish to present a case of 47-year-old patient with Juvenile Rheumatoid Arthritis and ankylosis of both hips and bothknees treated by bilateral hip and knee arthroplasty in a single anaesthesia i.e. Quadruple joint replacement in singlesitting. He was back on his feet from his bed-ridden state within the fortnight following surgery. He has been followedup for four years and has been performing his activities of daily living independently. We discuss the preoperativeplanning, surgical details and post-operative rehabilitation and unique challenges pertaining to this case.Level of evidence: IV
Bilateral hip and knee arthroplasty
Juvenile rheumatoid arthritis
Simultaneous quadruple joint replacement
2018
05
01
243
247
https://abjs.mums.ac.ir/article_10276_79c64f26b02d1f5c2459900a02207003.pdf