IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2020 | Volume:18 | Issue:2 (69)|Papers Count:5

Background: Venous thromboembolism (VTE) increases patientchr('39')s morbidity and mortality after orthopedic surgeries, and as such, prophylaxis is a routine practice after total joint replacement. Although there are many effective and safe prophylactic agents, clinical results are suboptimal. The aim of this study was to compare clinical and ultrasonographic results for the use of low molecule weight heparin (LMWH) and Rivaroxaban in patients undergoing total knee replacement. Methods: In a prospective cross-sectional study 325 patients were enrolled in receiving Enoxaparin or Rivaroxaban as thromboprophylaxis in their total knee replacement surgery. They had pre and post-operative doppler ultrasonography for diagnosis of thromboembolism. They were followed for a minimum of two years. The status and occurrence of VTE was evaluated. Patients were compared in terms of gender, body mass index (BMI), smoking, diabetes mellitus (DM) and previous VTE history. Results: The 325 eligible patients provided a sample of 130 (40%) male and 195 (60%) female. The average patient age (SD) was 63. 2 (14. 3). A total of 40 (12. 3%) patients (27 on LMWH, and 13 on Rivaroxaban), had DVT at the lower extremity. 15 (4. 6 %) patients-11from LMWH and 4 from Rivaroxaban group had pulmonary embolism (PE). 5 patients (1. 5%)-4 on LMWH, 1 on Rivaroxaban-had cerebrovascular thromboembolism. The incidence of thromboembolism was found to be similar in both prophylactic regimes. On the other hand, 2 patients (0. 6%) had spontaneous retroperitoneal bleeding from LMWH group. The PE patients had history of DVT. DVT occurred in patients with risk factors of obesity, diabetes or smoking. Conclusion: There was no difference between the use of rivaroxaban and enoxaparin for thromboembolic prophylaxis in total knee replacement in terms of occurrence of venous thrombosis and PE. Long-term thromboembolic prophylactic is preferred in cases with smoking, diabetes and obesity. Patients with previous venous thromboembolism are at a high risk for pulmonary and cerebrovascular embolism. Progressive hematocrit drop should alert the surgeon towards spontaneous retroperitoneal bleeding in the patients taking enoxaparin for thromboprophylaxis after total knee replacement surgery.

Introduction: Medial open wedge high tibial osteotomy is effective for the treatment of medial compartment osteoarthritis of the knee. Beside the advantages of MOWHTO several studies reported that MOWHTO had adversely affect like patella baja and increased patellofemoral contact pressure in the patellofemoral joint. There are various factors that could affect the progression of the patellofemoral osteoarthritis. Pressure distribution due to underlying varus deformities has a major influence on the onset and development of osteoarthritis in the knee joint. Therefore, several surgical therapies aiming to relief pressure in the medial compartment of the knee joint are applicable. Methods: The present study was a retrospective case series study on all patients with symptomatic osteoarthritis of the knee medial compartment with a deformed varus field requiring correction of deformities who referred to Imam Khomeini Hospital in Ahwaz in 2016-2018. At the last follow-up session, assessment of the patella changes based on Insall and Blackburn indices, pre and postoperative radiological measurements include the Mechanical Axis Deviation (MAD). Results: A total of 49 knees recruited. 52. 6% of patients were male. The mean age of patients was 26. 55± 5. 876 years and the mean body mass index of patients was 25. 05± 2. 903 kg/m2. None of the knees showed signs of revision surgery. Intra-articular fracture did not occur in any of the patients after surgery. The mean score of VAS increased significantly after surgery (P <0. 05). Patellar changes before and after surgery were not statistically significant based on Insall and Blackburn indices (P >0. 05). The mean pre-and postoperative measurements was (− 8. 90° ± 3. 07° to 0. 2° ± 2. 780° ) (− varus; +valgus) for the MAD Conclusion: Based on the results the proper correction in MAD was obtained and no significant change in patellofemoral joint biomechanics was seen.

Background: Reconstruction of anterior cruciate ligament (ACL) injuries using arthroscopic single-bundle method is a common procedure with a success rate of 83% to 95%. Some studies have shown that the transportal method for drilling the femoral tunnel results in a higher success rate than transtibial approach. Other studies show equal rate of success in both approaches. The aim of this study was to investigate which one of the two methods has nearest biomechanics to the original ACL and better outcome for patients. Methods: This study was a cross sectional (prospective) follow up. The clinical results of the ACL reconstruction in military patients with pure ACL rupture were evaluated and followed up. In one group 26 ACL reconstruction was done using the transportal (TP) technique and in the other group 20 ligaments were reconstructed using the transtibial (TT) method. Results: At the final follow-up, eight patients (40%) in the TT group and five cases (19. 23%) in the TP group had a positive pivot test. Three patients (15%) in the TT group and nine patients (34. 61%) in the TP group had a positive Lachman test. There was no statistically significant difference in the pivot test (P=0. 06) and Lachman test (P=0. 35) between the two groups. Mean Lysholm scores were 92. 8 ± 2. 5 and 93. 2 ± 2. 8 in the TT and the TP groups, respectively (P = 0. 51). The averages of the graft angle were 68. 7 ± 2. 9 and 43. 6 ± 4. 1 in TT and the TP groups, respectively (p = 0. 001). Any correlation between the graft angle and the patients’ concurrence (Lysholm score) after surgery (P>0. 05) and any correlation between the graft angle and the instability testes (P>0. 05) were not observed between the two groups. Conclusion: No significant clinical difference was found between the two techniques. No significant clinical differences were found between two techniques and therefore, both of them can create good results.

Introduction: This study aimed to investigate the risk factors and the effectiveness of calcium and vitamin D intake in controlling the progression of osteoporosis. Methods: This was a retrospective medical records study of the patients with osteoporosis, assessed from 2014 to 2018 in the bone density measurement center of Imam Khomeini Hospital in Ahvaz. Patients with a T-score of less than-2. 5 and patients with at least two repeat tests in their medical records were included. After collecting patient information, the correlation between osteoporosis and positive or negative history of underlying disease or family history was evaluated. The effectiveness of calcium and vitamin D in controlling the progression of osteoporosis in those patients was also assessed. Results: 16% of patients had a positive family history and 51% of patients had an underlying disease that was not significantly associated with osteoporosis. Decreased bone density in the spine area and femoral neck was significantly lower in people without basal calcium deficiency disease (P = 0. 04). Changes in bone density between patients with and without underlying disease receiving calcium-D supplementation were significantly different (P = 0. 02) so that in people with underlying disease, the decrease in bone density was significantly higher. There was no significant difference in changes in bone density in the spine and femoral neck between patients with and without the underlying disease who had not received calcium-D supplementation (P = 0. 64). Conclusion: Based on the results of the present study, there was no significant correlation between low densitometry measurements and osteoporosis in those with underlying problems like old age, nutritional factors, lifestyle and inactivity, smoking, menopause in women and low testosterone levels in men. It is important to pay attention to other risk factors in this population of patients. Calcium-D supplementation had shown a meaningful efficacy in patients without underlying disease, but this efficacy was not observed in patients with underlying disease.