alireza moharrami

The request for total knee arthroplasties (TKA) is increasingly being raised and imposes an enormous burden on the healthcare system. Most subjects represent symptomatic concomitant low back pain (LBP) at baseline, interfering with functional outcomes with little or no improvement in mental health following TKA. Orthopedics should notify the patients suffering from concomitant LBP about the like hood of unfavorable recovery. The authors describe the functional outcomes and satisfaction following TKA in patients suffering from concomitant LBP.

Radial head and neck fractures are one of the common fractures of the elbow in adult patients. There are controversial in treatment of nondisplaced head and neck fracture. However, nonoperative treatment remain as a choice treatment of nondisplaced radial head fracture without motion block.

Case Report: 

we presented a 23 years-old patient who had bilateral nondisplaced radial head fracture. The Patients was managed with conservative treatment and early elbow range of motion. Finally, the patient had full range of motion without any pain in his both elbows.

Nonoperative treatment with early range of motion remain as a treatment for bilateral nondisplaced radial head fracture with acceptable outcome.

The current study aims to evaluate the potential role of extracorporeal shock wave therapy (ESWT) on functional status, physical disability, and pain in patients suffering from low back pain (LBP). ESWT may provide superior therapeutic outcomes in reducing pain and ameliorating the patient's functional status regarding LBP.

Kienbock disease (KD) was described by Robert Kienbock in 1910 as osteomalacia of the lunate. A century has passed since the first description of KD, and numerous theories, classifications, and treatments have been published for achieving the best outcomes for this disease, but the treatments remain controversial among surgeons. Various classifications have been proposed for KD based on radiography, MRI, arthroscopy, and morphology from 1947 to 2017. Recently, the pioneers of KD (Lichtman and Bain) proposed a new classification based on all the previous classification (radiographic, MRI, and Arthroscopy). This classification seems to be the best evaluation method and treatment for KD. We recommend using this new classification for assessment of Kienbock disease.

We aimed to assess the most effective route for Tranexamic acid (TXA) administration among Intraarticular (IA), Intravenous (IV), and combined IA/IV for Total Knee Arthroplasty (TKA) surgeries. A double-blinded clinical trial was run on 147 TKA candidates. Blood loss and hemoglobin (Hb) drop were evaluated using the Gross and Nadler formula in three matched case groups administered TXA during the TKA through IV, IA, or combined IA/IV route. Tourniquet was used on all operations for controlling intraoperative blood loss. No drainage catheter was used for the cases.  The combined group showed an average blood loss of 630±252 ml, which was significantly lower than that in the IV group (878±268 ml, P<0.01) and the IA group (774±288 ml, P=0.03). Furthermore, the mean Hb and hematocrit drop were significantly lower in the combined group, compared to the other two groups, 48 and 72 h postoperatively (P<0.05). The combined IA/IV route had a 28% and 19% reduction of blood loss, compared to the IV or IA methods, respectively. Therefore, using TXA via the combined IA/IV route may be more effective for reducing perioperative blood loss following TKA surgery using a tourniquet without drain placement. Level of evidence: I

Avascular necrosis of the femoral head typically occurs in the young population. Core decompression in the precollapse stage provides pain relief and preservation of the femoral head. The results of core decompression vary considerably despite the early diagnosis. Clinicians concur that primary treatment should focus on preserving the natural surface of the joint. This study investigated the predictive risk factors of failure in femoral head decompression. We retrospectively reviewed 135 patients and 207 hips (77 male (127 hips) and 58 female (80 hips)) who underwent core decompression (mean age: 34.7 years [age range: 21-71]) from April 2010 to December 2017. All patients were followed by a mean of 57 months. All hips were in the precollapse stage (Ficat I, II).  A total of 207 hips were treated with core decompression surgery, and the overall success rate was 58%. The higher grade of Kerboul, Ficat, ARCO classifications, multifocal avascular necrosis of the femoral head, smoking, opium, and corticosteroids were significantly associated with a higher failure rate after core decompression in univariate analysis. In multivariate logistic regression analysis, the Kerboul and Ficat classifications, alcohol consumption, and multifocal avascular necrosis of the femoral head were significantly correlated with core decompression failure. The most common predictive factors in core decompression failure were Ficat II, Kerboul stage 3, multifocal avascular necrosis of the femoral head, and alcohol consumption.  In conclusion, we had an overall 58 % success rate in core decompression of femoral head avascular necrosis. Based on the results of this study, imaging evaluation and imaging-based classifications are the most valuable predictor factors for the success of core decompression. Consistent with previous reports, corticosteroid was not a significant predictor of core decompression failure.Level of evidence: III

Total knee arthroplasty (TKA) has been known as a definitive treatment for advanced knee osteoarthritis. Both intramedullary (IM) and extramedullary (EM) tibial guides have been used to restore the desired extremity alignment. However, controversy exists regarding the superiority of either technique We aimed to compare the functional outcomes and accuracy of IM and EM tibial guides in providing neutral alignment after TKA. In a randomized, double-blinded clinical trial, we studied 98 patients undergoing primary TKA in two groups of IM and EM. We measured the medial proximal tibial angle (MPTA), varus angle (VA), and joint-line convergence angle with normal ranges of 90°±3°, 0-2°, and 0±3°, respectively, on a three-joint alignment view after three months. We also assessed the functional outcomes at the last follow-up. Finally, we compared these outcomes between the two groups.  Eighty-four patients (IM=42, EM=42) were included in the final analysis (16 males, 68 females, mean age: 63.9±8.6 years, mean follow-up: 13±2.9 months). The mean postoperative (post-op) alignment angles showed no significant difference, although MPTA outliers were significantly more frequent in the EM group (26.2% vs. 9.5% in IM, P=0.04). None of the functional outcomes showed a significant difference between the two groups. However, the mean increase in knee range of motion (ROM) was significantly higher in the knees with VAs within ±3° of neutral than those outside this range (30.8 vs. 27.4, respectively, P=0.039). We conclude that both techniques were not different regarding the mean alignment angles and functional outcomes. However, fewer MPTA outliers can be seen with the IM technique. A post-op mechanical axis within ±3° of neutral can result in a more ROM increase after one year.  Level of evidence: I

Dehiscence of the wound is an infrequent complication following total knee arthroplasty (TKA); numerous risk factors are responsible for this. This study aims to represent a case who underwent TKA, was infected with coronavirus disease-2019 (COVID-19) soon afterward, took corticosteroid as an immunosuppressive agent to resolve COVID-19 symptoms, and presented with wound dehiscence with minor trauma in early postoperative follow-ups.

Case Report: 

A 62-year-old man underwent TKA, and soon after discharge from the hospital, he was hospitalized with COVID-19. A corticosteroid was started for the patient, and a traumatic impaction occurred on his operated knee after he fell in the hospital. As a result, wound dehiscence was performed on the operated knee.

Numerous risk factors such as diabetes mellitus and corticosteroid consumption are implicated as known risk factors for wound dehiscence after TKA, which must be followed precisely to prevent the unfortunate development of such complications. Postoperative care must be considered in patients at risk for wound dehiscence. In the presented case, wound management was fulfilled with proper timing of irrigation and debridement without any prosthesis component exchange.

Intertrochanteric (IT) fractures are responsible for almost half of the fractures in the elderly. The financial burdens of IT fractures are considerable, not only because of their influence on morbidity and mortality but also because they might lead to functional limitation, alleviated quality of life, and a limited possibility to work. There are several methods of fixations for IT fractures, such as cephalomedullary nailing, dynamic hip screw (DHS), proximal femur plate, and external fixator. Most of the patients with this fracture were unsuitable for anesthesia and surgical procedure. The external fixator is a fast, non-invasive, and bloodless method for fixation which would be performed with light sedation. In the present study, we reviewed recent literature regarding external fixators for IT fractures.

Arthroscopy procedures for the knee are excellent and tend to be outpatient procedures. Pain control after arthroscopic surgery is an important aspect of patient satisfaction and quicker return to daily activities following surgery. The objective of this article was to review the current literature regarding pain management after knee arthroscopy using intra-articular (IA) injections. Our goal in this article is to review the drugs that have been suggested in various articles for IA injections following knee arthroscopy to control pain. In conclusion, the current evidence suggests that combining IA lidocaine and morphine with tranexamic acid (TXA), in addition to ketorolac, is effective for pain relief after arthroscopic knee surgery.

Slipped capital femoral epiphysis (SCFE) is the most common hip disorder affecting the adolescent population, usually between 10 and 15 years old, with some multifactorial etiologies may include obesity, trauma, and some endocrinal causes. We reported a 10‑year‑old boy who presented with unilateral SCFE following intertrochanteric fracture, which was fixed by dynamic compression plate 1 year before the SCFE. The SCFE fixed by a 6.5 mm cannulated screw. In the 1‑year postoperative follow‑up, the patient achieved the union and the physis did not displace. The patient had not any pain and his gait and function were normal in both sides.

Transolecranon fracture is an unstable intra-articular injury in the elbow caused by high-energy trauma. Here, we introduce a medial humerus plate for severely comminuted transolecranon fracture.

 This article presents the case of a 29-year-old man who had a severely comminuted transolecranon fracture due to a motorcycle accident. A dorsal longitudinal approach was used in order to reach the fracture site. An olecranon anatomical plate and a medial humerus plate were applied for fixation, a new treatment method. The range of motion (ROM) was complete at a two-month follow-up, and the Mayo Elbow Performance Score (MEPS) was obtained 100 with no signs of complications.

Despite the several methods available for fixing transolecranon fractures, using the medial humerus plate, especially in severe comminution, can yield acceptable results. It should be considered in future studies to prove its efficacy in this type of fracture.

During an open fracture, the barrier of skin that protects the bones is breached, and the unprotected bones are exposed to the environment, resulting in contamination that leads to hematoma formation. It is often found that open fractures are associated with a high rate of morbidity and infection. In spite of the lack of evidence supporting negative pressure wound therapy (NPWT), open fractures may benefit from it. An increasing number of studies have demonstrated that it can be used to treat open fractures and open complex wounds after failure of arthroplasty or spinal surgery. Based on the recent studies and evidence, we reviewed the role of the NPWT in the open fracture in the present study.

This study aimed to present a rare case of a failed dynamic hip screw (DHS) used for fixation of intertrochanteric fracture sliding into the pelvis and to review the most common causes of DHS failure in order to prevent this from happening in the future.

 A 68-year-old woman was referred to the orthopedics clinic with left hip pain and limping from 6 months ago. In our evaluation, she had DHS failure and intrapelvic protrusion.

There have been several  aspects  of the previously described  DHS failure. We performed a two-stage total hip arthroplasty (THA) for the patient with a good one-year follow-up in the present case.

The spine, pelvis, and hip are three anatomic structures that tightly interact to create spinopelvic mobility and harmony. Orthopaedic surgeons, both spine and hip specialists, must have a complete awareness of this concept. Recently, the literature has placed great emphasis on paying attention to these parameters in the preoperative planning of the total hip arthroplasty (THA). We could distinguish between balanced and unbalanced pelvis and spine with spinopelvic parameters and therefore, we could diagnose the spinopelvic stiffness that is important in preventing complications following THA. This review briefly introduces the importance of spinopelvic parameters and their critical role in THA outcome. Treatment algorithms are also provided based on the most recent studies.

Total Joint Arthroplasty (TJA) is a major surgery performed for patients who suffer from severe joint destruction. It is so important to reduce the blood loss in the TJA surgery to decrease the infection rate, falling, and other complications following the surgery. Many methods could reduce blood loss, such as mechanical methods and chemical methods. Tranexamic acid (TXA) is a chemical method to reduce blood loss in surgery. There are numerous methods of administration of TXA in the literature, such as intravenous (IV), intra-articular, and a combination of intra-articular and -venous methods. In the present review article, we review the studies that compared the efficacy of each method of the TXA administration.

Femoroacetabular impingement (FAI) could cause early osteoarthritis in patients. It is important to diagnosis this condition in the early stages to avoid osteoarthritis. The radiological x-ray is one of the main methods to diagnose FAI. There are many radiological signs which help orthopedic surgeons to diagnose FAI in the pelvic x-ray. Recent studies revealed many new signs for diagnosis and in the present concept article, we try to review all the radiological signs of the FAI in the pelvic and hip x-ray.