hosein farahini

Application of fix-bearing-(FB) or mobile-bearing (MB) total knee arthroplasty (TKA) is an area of controversy. Introduction of mobile-bearing implants has become an appealing option for some surgeons leading to more favorable structural and weight-bearing outcomes in TKA; however, the beneficial long-term outcome is still unclear. This study was carried out to compare TKA outcomes by MB-versus FB implants with respect to long-term outcome. A total of 140 patients who met our inclusion criteria were enrolled in this retrospective cohort study from March 2015 to April 2016. They were divided into two groups of 85 patients with MB TKA and 55 subjects with FB TKA. The range of motion (ROM), knee injury and osteoarthritis outcomes score (KOOS), and patient satisfaction were compared between two groups. The ROM and KOOS scores were not significantly different between the two groups (P > 0.05). With regard to the patient’s satisfaction, there was no significant difference between the two groups (P > 0.05). According to our results in this retrospective cohort study, regarding the outcome of TKA by MB versus FB implants, we showed comparable mechanical and functional outcome.

Management of acetabular bone defects, especially massive ones, is a challenging issue for surgeons during total hip arthroplasty (THA). Inadequate bone coverage can lead to weakness of acetabular component fixation and instability, and finally, failure of surgery. In recent decades, different techniques and methods have been reported in literature to manage these defects according to their size and location. However, the routine use of many of these new methods is impossible in the majority of patients because of existing financial limitations. The aim of the present study was to evaluate the clinical and radiographic outcomes of THA with acetabular defect reconstruction using shelf-autograft.

This study was designed and conducted in two phases of retrospective and prospective. Between 2012 and 2017, 423 THA surgeries were performed in two hospitals by senior surgeon. A total of 38 THA procedures using shelf autograft were performed. The short-term clinical and radiological results were evaluated in the present study.

The mean coverage angle by graft was 45.5 ± 7.3% (range: 33 - 72%) and horizontal coverage percentage by graft was 79.3 ± 12.8% (range: 54 - 100%). After a mean follow-up of 26 months (range: 12 - 56 months), no evidence of instability was found in any of these hips. Considering loosening and revision as an end-point, the survival rate was 100%. The patients’ mean Harris hip score (HHS) improved from a mean of 35.50 ± 9.11 preoperatively to 95.10 ± 4.71 at the last follow-up. Rigid fixation of graft to host bone, medial insertion of acetabular cementless cup, and avoidance of lateral or high hip center were found to result in excellent THA with shelf graft outcomes.

Despite the development of more advanced methods to manage acetabular defects during total hip replacement, using shelf-graft is a valuable and accessible strategy for hip surgeons, and by the use of suitable techniques, we can expect excellent outcomes even in massive defects

During a total knee arthroplasty, it is common to make a distal femoral cut based on the femoral mechanical-anatomical angle (FMA), which in most patients is six degrees. However, in patients with a higher FMA, there is not yet a consensus between surgeons regarding the degree of the cutting angle.
The aim of this study is to assess the treatment outcomes of patients with a FMA of more than seven degrees who were treated by distal femoral cuts of six degrees during a total knee arthroplasty.
We retrospectively reviewed the clinical and radiological results of patients who were treated at our center by a conventional valgus cut of six degrees during a total knee arthroplasty and had a FMA of more than seven degrees. A knee society score (KSS) was completed for all patients during follow-up visits.
A total of 31 cases with knee osteoarthritis and a FMA of more than seven degrees were enrolled in this study. The cases consisted of 8 men and 23 women with an average age of 65.41 (range 46 - 77 years) (SD ± 7.61) years and a mean follow-up time of 11.51 months (range 3 - 24 months) (SD ± 6.08). The mean KSS was 148.51 (SD ± 7.43), (range 132 to 167), which is considered good. There was a statistically significant relationship between the lateral distal femoral angle (LDFA) and FMA. However, there was not a statistically significant correlation between LDFA and KSS.
Although the overall alignment of the lower extremity in our patients was in varus, this amount of varus does not prove to have an effect on the outcome.

The transfer of the tibialis posterior tendon to the dorsum of foot can restore the function of the paralyzed dorsiflexor muscles of the foot and ankle. In order to reduce the wound complication in the insertion site of tendon to bone by a plantar knop we used a new method of fixation by an absorbable screw inserted dorsally. we performed this operation on 15 patients in a 3 years period. All patients had drop foot deformity due to irreversible lesions of the peroneal nerve. The inclusion criteria was the peroneal nerve palsy that was not improved after 18 months even by using nerve releasing or nerve repairing. All patients were evaluated after 6 months for ankle function and wound complications. Of 15 patients one was excluded from study. At 6 month ten patients got excellent score (66%) and 4 good score (26%) further ankle function. There was no wound complication at insertion site. This simple modification for insertion site fixation had good result in restoring ankle function whiles eliminated the possibility of plantar pressure sores caused by fixation knop.

Subacromial impingement is a common cause of shoulder pain and many patients with this condition recover with conservative management. The most commonly used modalities of nonoperative treatment include activity modification, anti-inflammatory medication and subacromial injection of steroid and ultrasound and physical therapy programs. This study assessed the value of physiotherapy versus subacromial corticosteroid injection in patients with shoulder impingement syndrome (SIS). Seventy three patients with SIS enrolled in the study and treated through physiotherapy (n=37) and subacromial corticosteroid injection (n=36). Two follow-up sessions accomplished at the end of 4th week and 3rd month of treatment respectively. Corticosteroid injection caused dramatic improvement in the painful state (p<0.0001) and sleep dysfunction score (p=0.039) in the first follow-up. However, physiotherapy showed significantly better results regarding patients’ pain score (p=0.016) and their shoulder join range of motions (p=0.017 and p=0.029 for the abduction and extension, respectively) in their second follow-up. Our study results showed that subacromial corticosteroid injection primarily resulted in more improvement in the impingement symptoms. However, with the long-term follow-up the results were better for the physiotherapy. These results suggest that patients should not undergo surgery before having conservative treatment.