Iranian Journal of Orthopedic Surgery

Abstract Purpose: Correct axial positioning of the prosthetic knee components remains challenging. In the current study, the effects of the axial alignment of the components on patient satisfaction and functional outcomes after total knee arthroplasty (TKA) were investigated. It was investigated whether parallel axial axes of the components can affect the outcomes.
Methods: There were 89 TKA patients with correct coronal alignment investigated at least 1 year after the operation. Using CT scanning, the axial alignment of the components and prosthetic joint were evaluated. To measure the mismatch angle between two axes, the related CT images were superimposed. The criteria for the correct axial alignment of the prosthetic joint included: 1) correct axial alignment of the femoral component; 2) correct axial alignment of the tibial component; and 3) parallel rotational axes of the components. Patient satisfaction was measured using the visual analogue scale (VAS). Further, the Knee injury and Osteoarthritis Outcome Score (KOOS) was completed.
Results: The correct axial alignment of the femoral and tibial components was found in 80.9% and 67.4% of the patients, respectively. The correct axial alignment of the prosthetic joint was found in 35 patients (39.3%) and was not related to better KOOS and VAS scores. However, a mismatch >10° significantly decreased the KOOS and patient satisfaction (p<0.05).
Conclusions: The current study showed that a rotational mismatch > 10° between the axial axes of the prosthetic knee components is associated with poor functional outcomes and decreased satisfaction.

Abstract Background: Postoperative pain following total hip arthroplasty (THA) impacts patients' rehabilitation and quality of life. Although gabapentin has been widely used for pain control, its effectiveness in hip arthroplasty is not well established. The aim of our systematic review is to evaluate the effect of gabapentin on postoperative pain after THA.
Methods: A systematic search was conducted in three databases: MEDLINE, PsycINFO, and Embase, through OVID, using the keywords gabapentin, pain, and hip arthroplasty, with no restrictions on language or publication date. To evaluate the quality of the articles, the Cochrane Collaboration tool was used.
Results: Five studies, including 728 patients, were included in our systematic review. Gabapentin 600 mg was used in three and 1200 mg in two studies. The results of these studies showed that gabapentin had no significant effect on pain or morphine consumption after THA. Besides, gabapentin use was associated with side effects such as rash, nausea, headache, vomiting, and pruritus.
Conclusion: Gabapentin does not decrease pain or morphine consumption after THA. However, future studies with a larger sample size and longer follow-up period are required.
 
 

Abstract Background: One of the common reasons for referral to healthcare centers are orthopedic injuries which may occur due to spontaneous pathologic injuries, traffic accidents, workplace injuries, and during exercise. This study aimed to determine the frequency, types and causes of orthopedic injuries refering to Akhatr teaching hospital in Tehran.
Methods: In this study, records of all the patients presented to the emergency department of the Akhtar hospital in 2015 were reviewed. Data were collected by random completion of the "damage record questionnaire" by nurses. Data were analyzed using descriptive (frequency, mean and standard deviation) and inferential (Chi-square) statistics to evaluate the incidence rate of injuries and demographic characteristics of the participants and to compare the incidence rate of injuries in various body parts.
Results: Most injuries occurred in lower extremities, followed by upper extremities. In addition, there was a significant association between gender and cause of incidents (P<0.03). Moreover, a significant correlation was observed between gender and rate of injury in left (P<0.001) and right (P<0.049) lower extremities and also in the right (P<0.001) and left (P<0.001) upper extremities. Results demonstrated a higher rate of injury among men, compared to women. Furthermore, the ankle was the most commonly injured area in the lower extremities while the wrist was the most common area of injury in upper extremities.
Conclusion: According to our results, the main cause of orthopedic injuries in the emergency department was traffic accidents (drivers, car occupants, and pedestrians), and the majority of patients were in the age range of 20- 40 years.
 

Abstract Background: There are limited studies regarding the incidence of degenerative changes in asymptomatic adolescents. This study investigated the incidence of these changes in MRI and demographic factors affecting the presence of these changes.Methods: In a cross-sectional study, lumbar intervertebral disks of 84 asymptomatic adolescents aged between 12-18 years were evaluated using MRI in a educational training center in Tehran, Iran. The presence of degenerative changes in different levels was evaluated and demographic characteristics were compared between those with and without degenerative changes. The effects of these changes on mental and physical health were investigated using SF-36.Results: In total, 25.7% of disks were degenerated. The incidence of these changes was different in different levels. The incidence of degenerative changes was highest in L4-L5 level (45.2%) followed by L5-S1 (36.9%) and lowest in L1-L2 (5.9%). The mean of age of subjects with degenerative changes was significantly higher (p < /em>=.005). Gender and body mass index (BMI) had no effect on incidence of degenerative changes. The presence of these changes decreased the physical, mental and total score of SF-36 only at L3-L4 level, but not in other levels.Conclusions: The degenerative changes in lumbar disks occur at earlier ages and have no symptoms. These changes do not affect the quality of life. BMI has no role in development of degenerative changes in adolescents but increased age is associated with increased risk of disk degeneration.

Abstract Background: There are many cases with lumbar disk herniation in which asymptomatic lumbar canal stenosis will be diagnosed radiologically. In current study, we compared the outcomes of treating these patients with either laminectomy or laminotomy. Methods: In this randomized clinical trial, there were 40 patients with lumbar disk herniation and asymptomatic lumbar canal stenosis assigned to 2 groups: laminectomy and fenestration. The severity of pain and disability were determined utilizing visual analogue scale (VAS) and Oswestry disability index (ODI) both before and after the surgery and the scores were compared in each group and between the two groups. The outcome of surgery was also compared using Japanese Orthopaedic Association (JOA) scoring system in a one year follow-up. The surgical time, blood loss and duration of hospital stay were also compared. Results: Significant postoperative decrease in severity of pain and ODI were found in both groups (p < /i>