Archives of Bone and Joint Surgery
Volume:11 Issue: 12, Dec 2023

Based on WHO data, as of June 2022, there were 532.2 million confirmed COVID-19 cases globally.In the initial phase of the COVID -19 pandemic, patients experiencing critical illness marked by severe respiratorydistress were commonly subjected to corticosteroid treatment. Regrettably, the administration of exogenouscorticosteroids stands as the prevailing cause of ONFH. In the current narrative review, we aim to evaluate if activescreening should be utilized to diagnose post-COVID-19 ONFH in its early stages.

The databases for PubMed, CINAHL, and Science Direct were systematically queried in March 2022.The search terms were as follows: “COVID-19”, “severe acute respiratory syndrome”, “coronavirus”, “systemicsteroid”, “corticosteroid”, “femoral head osteonecrosis”, “avascular necrosis”, or “steroid therapy.” The includedstudies for review were all required to be peer-reviewed studies in the English language with Reported complicationslinked to steroid therapy in COVID-19 patients or potential connections to the development of ONFH in individualsrecovering from the novel coronavirus have been documented.

Systemic corticosteroids were frequently employed in managing critically ill COVID-19 patients. The CDCreports up to June 2022 showed more than 4.8 million COVID-19 hospitalizations in the US, with approximately overone million patients receiving steroids. In a study of ONFH after infection with COVID-19, all patients had bilateralinvolvement. The average duration from the initiation of corticosteroid treatment to the onset of symptoms was 132.8days.

In summary, a distinct correlation exists between the administration of steroids to individuals with COVID19 and the subsequent risk of ONFH. Moreover, an elevated dosage and prolonged duration of steroid therapy inCOVID-19 patients are associated with an increased likelihood of developing ONFH. Therefore, active screening forhigh-risk patients, that may have received systemic corticosteroid treatment during a COVID-19 illness, may bereasonable. Level of evidence: IV

As COVID-19 will not be the last pandemic, understanding our historical response allowsus to predict and improve our current practices in preparation for the next pandemic. Following theremoval of the elective surgery suspension at the onset of the COVID-19 pandemic, it is unclear whethersports medicine surgery volume has returned to pre-pandemic levels as well as whether the backlogfrom the original suspension was addressed. The purpose of this study to observe the monthly changesin volume and backlog of knee and shoulder sports surgery one year since the original suspension. National all-payer data was utilized to identify patients undergoing knee and shoulder sports proceduresfrom January 2017 to April 2021. Descriptive analysis was utilized to report the monthly changes in surgeries. Alinear forecast analysis using historical data was utilized to determine the expected volume. This was compared tothe observed case volume. The difference in expected and observed volume was utilized to calculate the estimatedchange in backlog. From March to May 2020, there was a persistent decrease in the observed shoulder and knee sportsvolume when compared to the expected volume. By June 2020, all knee and shoulder sports volume reached theexpected volume. By April 2021, the estimated backlog for shoulder and knee procedures had increased by 49.8%(26,412 total cases) and 19.0% (26,412 total cases), respectively, with respect to the original calculated backlogfrom March to May 2020. Within four months, the sudden decrease in volume for knee and shoulder sports procedures hadreturned to pre-pandemic levels; however, the original backlog in cases has continually increased one year followingthe suspension. Additionally, the backlog is significantly higher for knee when compared to shoulder surgeries. Level of evidence: IV

The increasing number of total hip arthroplasties (THA) has led to increased patientdemands and expectations, making it crucial to assess patients' ability to "forget" their implants in dailylife. This study aimed to determine the reliability and validity of a Persian version of the Forgotten JointScore (P-FJS) in THA patients.

The questionnaire was translated bidirectionally with the permission of the questionnaire designer. Datawere collected from 2018 to 2020 and included 142 patients who had undergone THA by the same surgeon at leastone year ago. Participants completed the FJS questionnaire twice within a one-week interval, and the validity,reliability, and feasibility of the questionnaires were assessed using statistical tests on the HHS and OHS formscompleted by all participants.

In 142 patients (52.1% male) with a mean age of 65 ± 0.5 years who answered the questionnaires, P-FJScorrelated strongly with OHS and HHS. The internal consistency (α = 0.91) and reproducibility of the questionnairewere excellent. None of the floor and ceiling effects were detected.

The P-FJS questionnaire in the THA is considered a legitimate, repeatable, and self-administeredsurvey that can be compared to its English-language counterpart. In addition, it is noteworthy that this version doesnot show any floor or ceiling effects. Level of evidence: III

Dislocation rate of total hip arthroplasty (THA) can be as high as 20% for patients withfracture neck of femur, which is a disastrous complication in these vulnerable patients. Numeroustechniques, including bipolar arthroplasty and constrained liner, have been adopted to minimize therisk of dislocation. We aimed to evaluate the role of dual mobility Cups in treating patients with fracturesof the femoral neck with high risk of postoperative dislocation due to neuromuscular instabilitydisorders. A prospective cohort study was conducted (place is blinded as asked during submission), between 2016and 2019, with a post-operative follow up period of two years. We included skeletally mature patients with femoralneck fractures having neuromuscular disorders and cognitive dysfunction who are candidates for THA above 60years. Patients were then followed up clinically and radiographically at the clinic using Harris Hip Score (HHS) andx-rays at six weeks, six months, one year and two years postoperatively. Twenty patients (20 hips) with femoral neck fractures with high risk of postoperative dislocation due toneuromuscular instability disorders undergoing dual mobility cup were included. The mean age of patients was 70.5±6.42 years. There is highly significant difference between HHS preoperatively and postoperatively (six weeks, sixmonths and one, two years) p<0.001.Infection occurred in one case (5 %), sciatic nerve injury occurred in one case(5%), and none of the patients had postoperative dislocation. Dual mobility cup is effective in preventing early dislocation in patients suffered from fracture neck offemur with muscle weakness due to neurologic disorders. Level of evidence: IV

The most critical step in the calculation of final limb length discrepancy (LLD) is estimatingthe length of the short limb after skeletal maturity(Sm). Paley's multiplier method is a fast, convenientmethod for calculating Sm and LLD after skeletal maturity; nonetheless, the calculation of the processof Sm and LLD in acquired type cases is complex in contrast to congenital type in this method.Notwithstanding. The multiplier method uses a variable called "growth inhibition" for the calculationprocess in acquired type LLD; however, its mathematical proof has not been published yet. The presentstudy aims to find out whether there is an alternative way to estimate the length of Sm and LLD inskeletal maturity without using growth inhibition (GI) and its com plex calculation process in acquiredtype LLD. We used trigonometric equations to prove the GI concept and conducted proportionality analysis tocalculate the length of short limbs and LLD in skeletal maturity without using GI. Based on the results, the following proportionality can estimate the length of the short limb in skeletalmaturity. (ΔLm/ΔL = ΔSm/ΔS) The GI concept can be proved trigonometrically; nonetheless, its numerical value is not necessary forestimating the length of the short limb in skeletal maturity. Instead, a simple proportionality analysis serves thepurpose of calculation. Level of evidence: II

Quantitative biomechanical tests, along with physical assessment, may be useful tounderstand kinematics associated with graft types in anterior cruciate ligament surgery, particularly inindividuals aiming for a safe return to sport.

Sixty male soccer players in three groups participated in this study. Three equal groups of healthy, autotransplanted and allotransplanted participants, matched for age, gender, activity level and functional status, landedwith one foot on a force plate. Their kinematic information was recorded by the motion analyzer and used to describecoordination the variability by measuring coupling angles using vector coding.

The coordination variability of the allograft group in the surgical limb was significantly greater than that ofthe healthy group at least 9 months after the reconstructive surgery of the ACL and at the stage of return to sports,(F (6, 35) = 2.79, p = 0.025; Wilk's Λ = 0.676, partial η2 = 0.32). The coordination pattern in the surgical and healthylimbs of the surgical groups also differed from that of the healthy people, which was more pronounced in the allograftgroup, (F (6, 35) = 2.61, p = 0.034; Wilk's Λ = 0.690, partial η2 = 0.31).

These results show that the allograft group has a different coordination variability at return to sportthan the healthy group, so they may need more time for excessive training and competition. Level of evidence: II

The present study aimed to determine the prevalence of low bone mineral density (BMD)and low bone mineral content (BMC) as chronic complications of juvenile systemic lupus erythematosus(JSLE) and identify the associated variables and patient characteristics to investigate the relationshipbetween BMD and influential factors. This cross-sectional study enrolled 54 patients with JSLE, including 38 females and 16 males. The BMDand BMC were assessed by dual-energy X-ray absorptiometry in the hip (femoral neck) and the lumbar spine. LowBMD was considered a Z-score < -2. The study investigated the association of BMC and Z-score with the currentdaily dose of corticosteroids, the daily dose of corticosteroids at disease onset, the duration of disease, the durationof steroid treatment, the time from the onset of symptoms to diagnosis, and renal involvement. The prevalence of low BMD in the lumbar spine and the femoral neck was 14.8% and 18.5%, respectively;the reduction of BMD was more significant in the femoral neck compared to the lumbar spine. Osteoporosis wasdetected in one patient. The multiple linear regression analysis found a significant association between a higherdaily corticosteroid dose and lower BMC of the femoral neck and the lumbar spine. In addition, patients receivinghigher doses of corticosteroids at disease onset showed better follow-up bone mineral densitometry results. Based on the findings of this study, JSLE more affects the femoral neck than the lumbar spine. Patientsreceiving a more robust treatment with higher doses of corticosteroids at disease onset (to control the inflammatoryprocesses) showed better spinal BMC results. A higher dose of daily corticosteroid treatment during assessmentwas identified as a risk factor for low BMD. Level of evidence: IV

A 41-year-old man underwent Total Knee Arthroplasty with NexGen Legacy Constrained Condylar Knee(LCCK) system to treat his nonunion of distal femur, stiff knee, and malunion of tibia plateau. Thetreatment involved femoral and tibial stems and PS polyethylene. As a result, his knee range of motionimproved, and he no longer experienced pain. After two years, he resumed work without any signs ofloosening or stiffness. Level of evidence: IV

Low back pain is one of the most common pathologies worldwide. When conservative treatment fails toyield good results, surgery is the recommended approach. Despite spinal fusion, some patientscontinue to experience persistent low back pain. This is where a series of studies come into play todetect the source of treatment failure. The use of bone scintigraphy with SPECT (single -photonemission computed tomography) in combination with computed tomography (CT) has greatly improvedthe anatomical localization of abnormalities found in SPECT. While pseudoarthrosis is a significantcause of spinal fusion failure, in recent years, it has been observed that certain low-virulence pathogensare also implicated in persistent low back pain. This is the focus of our s tudy, in which we identifiedtwo patients with persistent low back pain after surgery, both of whom tested positive for chronic low -grade infection using SPECT/CT. Level of evidence: IV

We read with great interest the article "Closing-Wedge and Opening-Wedge High Tibial Osteotomy as Successful Treatments of Symptomatic Medial Osteoarthritis of the Knee: A Randomized Controlled Trial" by Mohammadreza Safdari et al [1]. We appreciate the authors' efforts to describe the efficacy of high tibial osteotomy as a treatment for medial osteoarthritis of the knee. However, we had several concerns about the study results and believe that the authors' responses may help to address them.

We read with great interest the article “Trans-Table Intraoperative Fluoroscopic Technique for Obtaining a True Lateral View of the Proximal Femur in the Lateral Decubitus Position” by Pisoudeh, K et al [1]. We acknowledge the authors' efforts to elucidate the effectiveness of trans-table intraoperative fluoroscopy as a technique for obtaining a true lateral view in the management of proximal femoral fractures. However, we had several concerns about the study results and believe that the authors' responses may help to address them.