Journal of Research in Orthopedic Science
Volume:3 Issue: 3, Aug 2016

Context: There is a need to find if patients with poorly controlled diabetes, immunosuppression, or autoimmune disease require different perioperative antibiotic prophylaxis. There is also a need to determine if antibiotic prophylaxis should be different for primary cases, revision cases, hip arthroplasty and knee arthroplasty. The best antibiotic prophylaxis to choose in patients with colonization by carbapenem resistant enterobacteriaceae or multi-drug resistant (MDR)-Acinetobacter spp needs to be determined.
Evidence Acquisition: Delegates in workgroup 3 of the consensus meeting on PJI reviewed English literature for relevant articles. 30 of 221 articles were relevant to the 4 following questions regarding perioperative antibiotic prophylaxis to prevent PJI.
There is no need to use different antibiotic prophylaxis for patients with poorly controlled diabetes, immunosuppression, or autoimmune disease than routine antibiotic prophylaxis. Perioperative antibiotic prophylaxis should be the same for primary and uninfected revision arthroplasty. Perioperative antibiotic prophylaxis should be the same for hips and knees arthroplasties. There is insufficient data to recommend expanded antibiotic prophylaxis in patients known to be colonized or recently infected with multi-drug resistant pathogens.
Based on evidences in the literature and consensus of expert delegates from consensus meeting recommendations for type of antibiotic prophylaxis in patients with poorly controlled diabetes, immunosuppression, or autoimmune disease, primary and uninfected revision arthroplasty, hip or knee arthroplasties and patients known to be colonized or recently infected with multi-drug resistant pathogens were provided.

It is generally accepted that total knee arthroplasty (TKA) after high tibial osteotomy (HTO) is technically more difficult; however, there is still disagreement whether the subsequent arthroplasty is compromised.
The current case series study aimed to assess patients treated by knee arthroplasty after a previous high tibial osteotomy and to determine the influence of this osteotomy on the clinical and radiologic outcomes of subsequent arthroplasty.
Up to April 2013, twenty-three patients with a history of twenty-five proximal tibial osteotomies prior to TKA were identified and compared with a matched group who underwent primary TKA in Shafa Orthopedic Hospital, Tehran, Iran. Demographic parameters of patients, surgical details, the knee range of motion (ROM), and American functional knee society (AKS) scores before and after TKA were recorded in the HTO and control groups. Weight bearing alignment radiographs were taken preoperatively and at the last follow-up. At the latest visit, patients’ satisfaction was recorded.
After an average of 49 months follow-up, all patients in the HTO and control groups were satisfied with their current level of function. In the HTO group, the rectus snip had to be used for better exposure in eight cases. There was no statistically significant difference between the two groups in postoperative knee ROM, mechanical leg alignment and mean functional knee society score, but the mean of operation time in the HTO group was significantly longer than that of the TKA time in the control group.
Although knee arthroplasty after HTO is technically more challenging than a primary procedure, the results of clinical scores, postoperative ROM and radiological evaluation in the study subjects were comparable with those of the primary TKA in mid-term follow-up. Rectus snip is a safe procedure in such difficult cases for better exposure.

The relationship between negative ulnar variance and Kienböck’s disease is unknown and does not justify all of the cases. The present study planed the hypothesis that maybe the pressure from distal structures to the lunate bone plays a role in the etiology.
The current study aimed to investigate the possibility of a relationship between an increased length of the third metacarpal and the capitate with Kienböck’s disease .
The study compared the wrist posteroanterior (PA) X-ray images of 105 healthy individuals with those of 91 patients with Kienböck’s disease . Meticulous measurement criteria were defined in the present study to measure the third metacarpal and the capitate lengths. These lengths along with ulnar variance were measured on each X-ray. The Lichtman classification was used for staging. A new index, named capitate-index, was defined due to the linear relationship between the capitate and the third metacarpal lengths.
Comparing the two groups, no meaningful difference was observed between the capitate and third metacarpal bone lengths in patients and the control group. Also, there was no significant difference in the capitate-index (capitate length/3rd metacarpal length) between the groups. Furthermore, no differences were observed comparing the patients with ulnar variance ≧ 0 and patients with ulnar variance Based on the above-mentioned findings, the existence of a relationship between the third metacarpal and the capitate lengths and the Kienböck’s disease is unlikely.

Bone grafting is a common surgical technique to augment bone regeneration in orthopedic surgery. Autologous bone graft harvesting is the reliable treatment option and iliac crest is the most common harvesting site for healing bone fractures. However, the results of iliac crest bone graft harvesting are associated with morbidity and a number of complications.
The aim of this study was to assess donor site complications of scaphoid nonunion, to find clinical outcomes and the impact of iliac crest bone graft on age, gender, pain, numbness, itching, nerve injury and scar appearance of patients.
In a prospective review of 61 cases of iliac crest bone graft procedures at the Shafa hospital from 2013 to 2014, complications including pain, infection, hematoma, stress fracture, hypertrophic scars, numbness area and itching were assessed clinically.
Pain identified as the most common complication. The most common complications following postoperative pain at the donor site that reduced after six weeks were: numbness 3.27%, unsatisfactory scar appearance 3.27% and itching discomfort 1.63%.
Harvesting of iliac crest bone graft can be the ideal way to prepare graft procedures required surgery scaphoid nonunion fractures with minimal complications. Nevertheless, with an adequate preoperative planning and appropriate surgical technique, the prevalence of these complications can be reduced.

Ultrasonic bone-cutting devices (UBC) are new cutting tools and have low frequency ultrasonic blade. There is limited data on the safety and effectiveness of using ultrasonic bone-cutting devices in the treatment of adult spinal deformities (ASD).
This Retrospective review of prospectively collected data was designed to determine if the use of an ultrasonic bone-cutting device is safe in the adult spinal deformity population and to compare its effectiveness in blood loss reduction by using a comparison group from a prospective multicenter database of adult spinal deformity patients.
Nineteen consecutive surgical ASD cases in which the UBC was used were compared with 19 propensity-matched cases from a prospective ASD database in which conventional bone cutting instruments were used. The two groups were matched based on age, ASA, and number of levels fused posteriorly. The need for blood transfusion, volume of blood transfusion if required, estimated blood loss (EBL), and total operating time were compared between the two groups. Data were analyzed using non-parametric Mann-Whitney U test and Spearman’s Correlation test (P There was no statistically significant difference in any measured parameter between the two groups. While the EBL difference between the two groups (925 mL in the study group vs. 1628 mL in the control group) was not statistically significant (P = 0.142), the 703 mL difference is clinically relevant. In addition, no complications directly related to the use of the UBC were reported.
The use of an ultrasonic bone-cutting device was shown to be safe and effective in the surgical treatment of ASD. It resulted in a 43% reduction in EBL, which was clinically relevant and statistically non-significant, without the addition of any complications. We did not identify statistical differences in transfusion rates, EBL, or operative time, which may be due to our small sample size.

Primary Non-Hodgkin’s lymphoma (NHL) of the bone is a rare condition. Calcaneus is also an uncommon site for this kind of lymphoma.
We hereby present a case of primary non-Hodgkin’s lymphoma of the calcaneus, which was diagnosed and treated at our hospital. The patient had a minor twisting trauma of his ankle but symptoms were present for one year after trauma. The patient complained from instability and swelling of his ankle. After paraclinic assessments, a pathologic lesion was detected in his calcaneus, so incisional biopsy was done and the pathology diagnosis was a large B-cell non-Hodgkin’s lymphoma. Bone marrow assessment was negative for the disease. The patient was treated by chemotherapy and radiotherapy and currently the disease is in remission and patient is doing his previous full activity without any important complication.
Lymphoma is a rare condition in the foot region but we suggest to be more wise for chronic, uncommon symptoms after minor injuries, as lymphoma of the bone can present mysterious and nonspecific symptoms as was seen in this patient. It may be better to do more assessments to prevent delayed diagnosis of such rare conditions. These rare cases may have atypical imaging and clinical appearance, which can lead to misdiagnosis.

Brucellosis is a zoonotic infectious disease with worldwide distribution, especially in the south and central American countries, the Middle-East and the Mediterranean areas. Knee prosthesis infection due to Brucella spp. is very rare with the first case reported in 1991 and the ninth case reported in 2010.
Here is reported a case of a 68-year-old female patient, referring to Shafa Orthopedic hospital, Tehran, Iran, complaining about a discharge from right total knee arthroplasty. All of the knee joint aspirations and laboratory tests were negative for infection. Initially, no clear reason was found for this painful operated knee and it was decided to revise it; however, intra-operative samples were positive for Brucella melitensis. Unfortunately, serum indicators of Brucellosis (Wright, Coombs Wright and 2-mercaptoethanol (2ME) tests) had not been checked in the preoperative evaluations. After six months of antibiotic therapy for brucellosis, a second stage revision surgery was performed successfully.
Prosthetic infection by Brucella species is very uncommon, this is the tenth case of total knee prosthesis infection with Brucella spp. reported in the literature but all orthopedic surgeons, especially those who work in the endemic areas, should evaluate a suspected joint for brucellosis.