Iranian Journal of Orthopedic Surgery

Abstract Abstract
Total Knee Arthroplasty (TKA) is a surgery performed to treat patients with advanced knee osteoarthritis. Currently, about 95.3% of knee arthroplasties are performed using the cemented technique. Since the introduction of Polymethylmethacrylate (PMMA) cement, it has played a primary role in arthroplasty. Cementless fixation may lead to better survival rates in selected patients, while cemented TKA is believed to have lower infection rates. With the increasing number of TKAs, improving cementing techniques is essential to reduce primary TKA failure and avoid revision surgeries. A narrative review was conducted by searching the MEDLINE database from 2000 to 2024 to investigate the most appropriate cementing techniques in knee replacement. Recent studies have identified several factors affecting the results of cement placement in TKA, such as cement penetration depth, cementing technique, and cement viscosity. Preparing the bone surfaces before cementing is essential to ensure adequate cement penetration. Bone surfaces must be thoroughly dried before cementing. For optimal cement penetration, sclerotic surfaces should undergo drilling. Poor cementing technique is associated with loosening of the prosthesis leading to early or late joint replacement failure. Therefore, it is essential to use an accurate cementing method at the time of TKA to avoid aseptic loosening and, early failure of TKA.

Abstract Introduction: Radioactive synoviorthesis, used as a local treatment for hemophilic arthropathy, causes the ablation of sub-synovial vessels. Previous studies have indicated that this procedure is effective in reducing the frequency of hemarthrosis in patients with recurrent episodes. However, it remains unclear how long this effect lasts and whether it has any impact on radiologic changes.
Aim: To assess the impact of follow-up duration after synoviorthesis on the incidence of hemarthrosis, as well as the extent of clinical and radiological involvement of the joint.
Methods: Synoviorthesis using 32P was performed once on 56 target joints in 56 patients. Thirty cases (29 males and one female) with an average age of 15.7 years (SD: 6.1) and a follow-up duration of 21.8 months ( 3–36 months) were compared to 26 males with an average age of 17.8 years (SD: 8.4) and an average follow-up duration of 43.6 months (38–102 months).
Results: The average reduction in the rate of hemarthrosis was 56.4% in the ≤36-month follow-up group (p<0.05) and 35.9% in the >36-month follow-up group (p<0.05).
Although there was greater improvement in the ≤36-month group, the difference was not statistically significant. Additionally mean improvement in clinical grade (Fernandez-Palazzi) was 0.56 (SE: 0.21) in ≤36-month group (p<0.05) and 0.65 (SE: 0.28) in the >36-month group (p<0.05), with the slightly better results in the ≤36-month group also not being statistically significant. The mean increase in radiographic grade (Arnold-Hilgartner) was 0.25 (SE: 0.15) in the ≤36-month group and 0.78 (SE: 0.14) in the >36-month follow-up group, and this difference was statistically significant.
Conclusion: The beneficial effects of 32P synoviorthesis on clinical involvement in hemophilic arthropathy persist over time. Despite an initial reduction in its effectiveness, longer follow-up demonstrated that synoviorthesis remains durable procedure. However, this treatment modality was unable to halt the radiologic progression of joint degeneration

Abstract Sickle cell disease (SCD), often leads to skeletal complications such as avascular necrosis (AVN) of the femoral head, osteoporosis, fractures, and infections. Despite joint-preserving surgeries, many SCD patients require total hip arthroplasty (THA). However, THA carries significant risks for these patients, including hypoxia and vascular. This case report describes a 29-year-old female with SCD who presented with recurrent hip pain after a previous surgery was canceled due to a sickle cell crisis. Physical examination revealed restricted hip motion, and imaging confirmed AVN of the right femoral head. After a thorough hematology consultation, uncemented THA was performed. The surgery was uneventful, with minimal blood loss and no need for transfusion. The patient recovered well and was stable at her first follow-up. THA is common in SCD patients due to the high incidence of femoral head osteonecrosis, but they face higher risks of postoperative complications. Therefore, careful preoperative planning and coordination among surgical, anesthetic, and hematology teams are crucial for optimizing outcomes.