Journal of Research in Orthopedic Science
Volume:7 Issue: 1, Feb 2020

Management of patellar maltracking during primary TKA is of considerable importance. Lateral release, which is generally performed for this purpose, is associated with several complications. 

In this study, we aimed to evaluate the role of partial lateral facetectomy in tracking the patella in Total Knee Arthroplasty (TKA). 

In a retrospective study, the efficiency of partial lateral facetectomy of the patella in achieving proper tracking of the patella was evaluated in 116 patients who underwent unresurfaced patellar-retaining TKA. The radiographic outcome measures included the patellar tilt and patellar shift. The functional outcome was assessed with Kujala anterior knee pain scale. 

The Mean±SD age of the patients was 66.3±7.6 years. The mean follow-up of patients was ‎‎20.6±8.9 months. The Mean±SD patellar tilt was ‎‎10.5±7.2‎‎‏°‎‏ before the surgery and ‏‎4.4±5‎‎‏° after ‏the operation ‏‎ (‎P‎<‎‏0.001‏‎). ‎The Mean±SD preoperative patellar shift was ‏‎3.3±4.3‎‏ mm which improved to ‏‎-‎‎0.2±2.8°‎‏ after the surgery ‏‎(‎P‎<‎‏0.001‏‎). ‎The Mean±SD Kujala score of the patients was ‏‎74.6±7.1‎, ‎‏ ‏ranging ‎from 54 ‏to ‎‏89. ‎No complication was recorded during the follow‎-‎up period.

Partial lateral facetectomy of the patella provides an acceptable radiographic and ‎functional outcome in patients undergoing primary TKA. Therefore, it could be regarded as a ‎valuable alternative to lateral release in unresurfaced patellar-retaining TKA.‎

Management of chronic collateral ligament injury of the Metacarpophalangeal (MCP) joint, either its Ulnar Collateral Ligament (UCL) or Radial Collateral Ligament (RCL), is challenging. 

In this study, we report the outcome of ligament reconstruction procedure in the treatment of such injuries. 

In a retrospective study, the outcomes of static reconstruction surgery of the symptomatic chronic collateral ligament injury of the thumb MCP joint (five RCL and three UCL) were evaluated. We used palmaris longus tendon in four surgeries and flexor carpi radialis tendon in the remaining. The outcome measures included the thumb range of motion, the disabilities of the arm, shoulder, and hand (QuickDASH) questionnaire, pinch and grip strength, visual analog scale, and Kapandji opposition score.

Eight patients (6 males and 2 females) with the mean±SD age of 32±7.1 years were included in this study. The Mean±SD duration from the injury to surgery was 66.7±99.5 weeks. The Mean±SD follow-up of the patients was 4.88±1.35 years. The mean pinch and grip strength of the involved hand averaged 98.9% and 100% of the other hand, respectively. Postoperative pain was only noticed in two patients. The Mean±SD postoperative Kapandji opposition score was 9.4±0.7 (range: 8-10). The Mean±SD QuickDASH score was 12.9±1.9 (range: 11-17). The thumb range of motion was similar to the contralateral hand in all but one patient. All the operated joints were stable. A case of mild degenerative joint disease was the only observed postoperative complication.

Static reconstruction of chronic collateral ligament injury of the thumb MCP joint provides acceptable results, regardless of the time interval between the injury and surgery.

Vascular thromboembolism is one of the major concerns of orthopedic surgeons after hip or knee replacement surgery. Although many thromboprophylactic drugs have been introduced, there is still no consensus over their efficacy and safety. Therefore, this study aimed to compare the efficacy and safety of oral rivaroxaban and aspirin administration and enoxaparin injections in patients undergoing knee or hip replacement.

Determination and comparison of the side effect and efficacy of Rivaroxaban and Enoxaparin after total hip or knee arthroplasty.

A total of 231 patients undergoing knee or hip replacement surgery were included in the study. Of them, 31 patients were excluded due to missing the follow-up. Of the remaining 200 patients, 42 low-risk and 158 moderate- to high-risk patients were identified, according to Caprini risk assessment model. Then, they were divided into three groups: aspirin (42 patients), enoxaparin (78 patients), and rivaroxaban (80 patients). Severe hemorrhage (hemoglobin reduction of more than 2 g/dL or requiring blood transfusion) was assessed after the first dose of medication until discharge through daily hemoglobin testing. Frequency of other side effects such as wound complications (ecchymosis, hematoma, and wound infection) and gastrointestinal or skin problems was recorded and compared by daily examination during the hospital stay and then in the future visits to the clinic up to 6 months in each group. Follow up visits were performed at weeks 6, 12, and 24.

No cases of deep vein thrombosis or pulmonary thromboembolism were observed in any of the study groups. There was no significant difference between the two groups in the number of major bleeding cases (P=0.39). Ecchymosis around the wound was significantly higher in the rivaroxaban group than in the enoxaparin group (33.8% vs. 23%). However, this difference was not statistically significant (P=0.06).

The efficacy and safety of rivaroxaban and enoxaparin drugs are comparable. Although ecchymosis was seen after using rivaroxaban rather than enoxaparin, rivaroxaban is orally administered and costs less for the patient and the health system. So, its use as a thromboprophylactic drug of choice following hip and knee arthroplasty surgery is still recommended.

Femoral Neck Fracture (FNF) is prevalent in young people. It is mostly due to high-energy trauma and creates many challenges in surgical repair. A few patients with hip fractures can fully recover from the injury and act independently in their daily activities. In this study, we evaluated the results of FNF operation in patients younger than 60 years. 

This study was conducted to evaluate the outcome of femoral neck surgery in young patients and comparison the complications according to types of surgery ,age,delay and type of FNF fracture. 

This study was a retrospective-prospective descriptive and analytical study on patients 15 to 60 years old with FNF from 2013 to 2017. The surgical efficacy and its results were evaluated using the Harris Hip Scale (HHS). The obtained data were analyzed in SPSS version V. 24. 

The Mean±SD age of 53 study patients was 42.07±12.5 years. The Mean±SD femoral neck shortening was 7.05±5.42 mm, and the HHS score was 82.7±6.9. Avascular Necrosis (AVN) was seen in 10 (18.9%), malunion in 11 (20.8%), nonunion in 1 (1.9%)  and failure in 3 (5.7%) patients. Eight patients had reoperation procedures. The type of fracture, delay in surgery, type of operation, and the shortening of the femoral neck were predictive factors of postoperative complications (P<0.05). 

According to this study, reducing the delay for surgery, increasing anatomic reduction, and preventing the shortening of the femoral neck can improve the quality of life, reduce complications, and decrease the economic burden.

Patients with idiopathic scoliosis are exposed to repetitive x-ray for angle measurement. Therefore, the discovery or development of alternative techniques with less radiation has continuously been a major concern.

In this study, we compared the Cobb angles on supine Magnetic Resonance Imaging (MRI) with those on standing plain radiographs to figure out how precisely the supine MRI can show the real curve.  Consequently, the need for certain exposures throughout the management of idiopathic scoliosis might be eliminated. 

A total of 103 patients with idiopathic scoliosis were included in this prospective study. The standing radiographs and supine MRI were obtained with less than a 1-month time lag. One senior author assessed Cobb angles of the major curves were on both standing radiographs and MR images. All the eligible patients had already signed the consent for diagnostic imaging, including MRI. The individuals, who were not requested for x-ray and MRI, were excluded from this study.

The Mean±SD Cobb angle was 55.5±11.2°‎‏ on the standing plain radiographs and  44.5±10°‎‏ on MR images (P<0.001). The Mean±SD difference between the Cobb angles on the standing plain radiographs and MR images was 11±1.4°‎‏. A significant positive correlation was found between the Cobb angles calculated on plain radiographs and MRI (r=0.996, P<0.001). Accordingly, Cobb angles on MRI could be converted to Cobb angles on plain radiographs under the formula of MRI=0.9* XRAY-5.31 (absolute error of 5.31°‎‏).

Cobb angles on supine MRI correlates with measured ones on standing radiographs with an acceptable range of error and could be used as a valuable alternative for radiographic Cobb angle measurement.

Combined injuries of Mid-shaft clavicle fracture and Acromioclavicular (AC) joint dislocation are rare, and only a few cases have been reported. Several treatment options including surgical, conservative and hybrid approach have been described. Yet, there is no consensus regarding the optimal management approach for this injury.

Here we reported a case of Mid-shaft clavicle fracture with associated type IV AC joint dislocation in a 29-year-old male following a cycling accident.

Both parts of the injury were fixed surgically. Meanwhile, the patient did not follow the postoperative protocol and started the heavy sports activities one month after the surgery.

The patient showed up 6weeks after the surgery with slightly uncorrected AC joint. However, he was satisfied with the results and accordingly no intervention was done for the correction of the AC joint. 

Our case reveals the importance of adherence to the postoperative protocol in this combined and challenging injury and we recommend surgical fixation for such injury.

Alkaptonuria is a rare inborn metabolic disease, in which an enzymatic deficiency accumulates alkapton in different tissues, causing darkness and injury, especially in spine and large cartilages, called ochronosis. The urine darkness can be a key to early diagnosis in childhood, but some cases are missed until adulthood and gradual damage to cartilages causes disability and impairs the patients’ quality of life. Here, a 49-year old male patient is presented with a 2 week history of left knee pain and swelling, who underwent arthrotomy, and the macro- and microscopic evaluation revealed ochronosis, superimposed by septic arthritis. Diagnosis of this rare disease should be considered in differential diagnoses of common joint disorders, like septic arthritis and osteoarthritis, so that appropriate management of the disease can prevent further damages.