IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2008 | Volume:6 | Issue:2 (22)|Papers Count:10

Background: Avascular necrosis (AVN) of femoral head, with resultant joint destruction, is a common disabling disease of fourth and fifth decades of life. Metal-on-metal resurfacing is a relatively newer treatment modality for this disease. The aim of this study is to compare the result of resurfacing for osteonecrosis with that of resurfacing for other causes.Methods: Twenty eight patients with stage III or IV (Ficat & Arlet) osteonecrosis who underwent metal-onmetal hip resurfacing were compared with 24 cases of grade IV or V (Croft’s) osteoarthritis (OA) who had undergone the same kind of arthroplasty during a 2 year period in Akhtar hospital in Tehran. These cases were matched in terms of gender and age, and were assessed by Harris hip score with 41(±22) months follow-up.Results: The AVN cases had 30.86 (±7.5) and OA cases 47.88 (±12.6) years at surgery. Three patients from each of the above groups had sustained complications of either femoral neck or acetabular cup fracture and had required revision surgery. The average Harris hip score was 94(±7.2) in AVN and 91.2(±9.4) in OA group. The collective hip range of motion was 216(±6.2) in AVN and 196±(5.6) in AO patients. Conclusions: Metal-on-metal hip resurfacing gives similar satisfactory results in avascular necrosis and in osteoarthritis of hip joint in short-term, with no statistically significant difference.

Background: The association between wound drainage and subsequent periprosthetic infection is well known. However, the most appropriate treatment of wound drainage is not well understood.Methods: We retrospectively reviewed the records of 10325 patients (11785 procedures), among whom 300 patients (2.9%) developed persistent (greater than 48 hours postoperatively) wound drainage. Wound drainage stopped spontaneously between 2 and 4 days in 217 patients treated with local wound care and oral antibiotics. The remaining 83 patients (28%) underwent further surgery.Results: A single débridement resulted in cessation of drainage without subsequent infection in 63 of 83 patients (76%), whereas 20 (24%) patients continued to drain and underwent additional treatment (repeat débridement, resection arthroplasty, or long-term antibiotics). Timing of surgery and the presence of malnutrition predicted failure of the first débridement. There were no differences between the success and failure groups with regard to all other examined parameters, including demographic or surgical factors.Conclusions: We found patients who underwent débridement at a mean of 5 days following the onset of drainage were more likely to be infection free at one year postoperatively compared to patients who underwent debridement at a delayed time (mean, 10 days). Our data confirmed that malnourished patients (serum transferrin less than 200 mg/dL, serum albumin less than 3.5 g/dL, or total than 1500/mm3) undergoing total joint arthroplasty are lymphocyte count less more likely to develop deep infection and require further treatment after irrigation and débridement. Based on these findings, we recommend early (within 7 days) surgery for persistent wound drainage in general, and particularly for those with malnutrition.

Background: Myofascial trigger point is a tender point within a palpable taut band of skeletal muscle, with or without referred pain. The purpose of this study is to compare maximal isometric strength of upper, middle and lower trapezius muscles in healthy individuals with cases of myofascial trigger point syndromes.Methods: In a case-control study, 15 myofascial trigger points-syndrome patients (mean age of 22.53 years) and 15 healthy persons (mean age of 22.46 years) were compared. Muscle strength of upper, middle and lower trapezius was measured with a digital myometer.Results: The persons with latent trigger points demonstrated a significantly lower isometric strength in upper trapezius muscles (p<0.05) compared to healthy individuals. There wasn’t significant difference in middle and lower trapezius strength between the two groups (p>0.05).Conclusions: Latent myofascial trigger points are pain free neuromuscular lesions that are associated with decreased muscular contractile efficiency.

Background: Nativization is modification of the components of a system in accordance with the needs of a society without altering its original function. We hypothesized that an index that incorporates Iranian society native specifications would be more sensitive in measurement of hip and knee osteoarthritis severity in comparison to common international indices.Methods: Thirty patients with primary osteoarthritis of hip or knee that underwent total joint arthroplasty and fulfilled the criteria were enrolled. Patients were studied using WOMAC, Lequesne, Modified Doyle index, nativized WOMAC index and patient and interviewer global assessment preoperatively and also 6 weeks, 3 months and 6 months post-operatively. "50 feet walking time" and knee range of motion were also studied. The results were analyzed using parametric and nonparametric tests and Pearson coefficient of correlation.Results: The nativized index improved from mean 118 (99-136) pre-operatively to 53.4 (41-68) at 6 weeks post-operatively and 31.5 (23-44) at 6 months. WOMAC and Lequesne improved from mean pre-operative values of 75.6 (55-92) and 18.6 (11-24) to 18.8(17-24) and 6.6 (3-11) at 6 months. Doyle index also improved significantly. Interviewer and patient global assessment improved from mean pre-operative value of 3.4 and 3.9 respectively to 1.5 and 1.9 at 6 weeks and 0.7 and 0.8 at 6 months post-operatively respectively. The most sensitive indices were nativized WOMAC and Lequesne indices.Conclusions: Nativized WOMAC index in knee and hip osteoarthritis demonstrates the severity of symptoms with more sensitivity than other common international indices.

Background: Osteoarthritis is a relatively common ailment of human beings. The aim of this study is to compare the short-term effects of oral non-steroid anti-inflammatory medications with intra-articular injections of Hyaluronic Acid or Methyl Prednisolone acetate.Methods: In a clinical trial study, 40 female patients with moderate or severe knee osteoarthritis received Hyaluronic Acid intra-articular injections. They were compared with 16 cases who had intra-articular Prednisolone injection and 36 female patients who received non-steroid anti-inflammatory oral medication. The results were evaluated in 6 and 24 weeks by Visual Analogue Scale and Western Ontario & McMaster Universities (WOMAC) functional score. Results: Pain relief in 6 and 24 weeks post injection were 4.9 and 4.7 for Hyaluronic Acid, and 1.5 and 1.6 for Prednisolone. The figures for oral non-steroidal anti-inflammatory medication were 5.2 and 4.9 respectively. Subjective patient’s satisfaction was expressed in 28 (70%) of Hyaluronic Acid group and 16 (100%) of Prednisolone group.Conclusions: After 6 and 24 weeks following intra-articular steroid injection in female patients with knee osteoarthritis, pain relief and subjective patient satisfaction is more favorable compared to intra-articular Hyaluronic Acid injection. These two are both more effective than oral anti-inflammatories. This statement does not include the potential side-effects of intra-articular steroid injection in long-term.

Corticosteroids can be used in orthopaedic patients in either local or systemic ways. These drugs have some complications that are seen in both local and systemic usage. In this study we report a case of ankle joint destruction due to repeated local corticosteroid injection.