Iranian Journal of Orthopedic Surgery

Abstract Abstract:

Meniscal tears are one of the most common knee injuries, and effective repair techniques are crucial for maintaining long-term knee function and preventing degenerative changes. Among various repair methods, the vertical mattress sutures are frequently utilized. Here we present a technique that we believe provides the strongest fixation for longitudinal meniscal tears.
Abstract:

Meniscal tears are one of the most common knee injuries, and effective repair techniques are crucial for maintaining long-term knee function and preventing degenerative changes. Among various repair methods, the vertical mattress sutures are frequently utilized. Here we present a technique that we believe provides the strongest fixation for longitudinal meniscal tears.
Abstract:

Meniscal tears are one of the most common knee injuries, and effective repair techniques are crucial for maintaining long-term knee function and preventing degenerative changes. Among various repair methods, the vertical mattress sutures are frequently utilized. Here we present a technique that we believe provides the strongest fixation for longitudinal meniscal tears.

Abstract Abstract Introduction: Success in knee joint replacement surgery depends on various factors, one of which is the correct technique and avoidance of technical errors. This, in turn, requires the use of precise orthopedic instruments and tools. Over time, orthopedic tools may experience wear and corrosion, negatively impacting the clinical outcomes of joint replacement. In this study, we compare the clinical results of two groups of patients operated on with new and used sets, and we examine the effect of wear in this group of patients. Materials & Methods: Two groups of patients who underwent knee arthroplasty using new and used sets from the same company were compared in terms of range of motion and Oxford scoring. The new and used instrument sets were also compared visually to identify differences in the shape of the instruments. Results & Discussion: The average extension in the worn group was 7 degrees, while in the new set group, it was 2 degrees. The flexion in the worn set group was 115 degrees, and in the new set group, it was 120 degrees. Statistical calculations showed a significant difference between the two groups in both parameters, with a p-value > 0.05. Regarding the VAS pain scoring, patients in the new set group reported a pain score of 2.5, while the worn set group reported a score of 3. In the examination of the instrument, the diameter of the jig cutting guides for the distal femur was 4 millimeters and for the tibia was 3 millimeters. This measurement in the new set was 2 millimeters. Conclusion: Bone cutting jigs can undergo mechanical wear and lose their initial accuracy. This loss of accuracy negatively impacts clinical outcomes.

Abstract Background and purpose: Despite its effectiveness as a therapeutic intervention, Total Knee Arthroplasty (TKA) is sometimes followed by joint infection as a serious postoperative complication. That is why this study aimed to investigate the effect of modified irrigation on the frequency of knee joint infection following TKA.

Methods: In this descriptive, cross-sectional study, 1201 patients undergoing TKA in private medical centers in Ardabil were investigated. For the selection of the patients to be included in the study, census sampling method was used. The information about each of the patients including their age, sex, education level, underlying diseases with or without infection, the type of infection, and laboratory test results (including WBC, hemoglobin, ESR, creatinine, blood sugar, platelet count, urea, and PMN) was obtained via checking their medical records, asking their treating doctor, and getting information from the patients themselves. The obtained data were analyzed using SPSS Software.

Findings: Out of the total number of patients, 586 (48.8%) were female and 615 (51.2%) were male. The mean age of the patients was 64.8±6.1 years. Acute or chronic deep infections were not observed in any of the patients following the surgery. In 2 of the patients, late hematogenous infection in the respiratory and urinary systems was detected. Non-purulent wound drainage was observed to be released from the surgical site in 11 patients. Also, lack of full closure of wound was observed in 4 of the patients under investigation. Fistula, however, was not observed in any of the patients. 
Conclusion: As the result of using modified irrigation method after TKA, no occurrences of joint infection (acute or chronic) or fistula were observed. This method was only found to be associated with late hematogenous infection and other non-infectious complications such as non-purulent wound drainage and lack of full closure of wounds.

Abstract Background: The tourniquet commonly uses in knee replacement surgery, but there is no consensus on the release time of the tourniquet. The aim of this study was the evaluation of tourniquet release time, on postoperative hemoglobin level in knee arthroplasty patients.
Material and Methods: During one year, patients undergoing complete knee arthroplasty were randomly divided into two groups according to the inclusion criteria, the early release tourniquet group (opening tourniquet after cementation) and the late release tourniquet group (opening tourniquet after wound dressing). Hemoglobin levels were measured and compared at preoperative, 24 hours and one week after surgery. Also, Duration of surgery, blood transfusion requirements and early wound complications were evaluated in two groups.
Results: The mean duration of surgery was 82 ± 11.2 minutes in the early release group and 73 ± 14 minutes in the late release group (P <0.001). Decrease of hemoglobin level at 24 hours and one week after surgery was 1.8±0.82 and 1.1±0.71 respectively in the first group, and 1.4 ±0.94 and 0.6 ±0.82 in the second group. In this study, the requirements for blood transfusion was more in the early release of the tourniquet group (4 cases in the first group and 2 cases in the second group), but this difference was not significant.
Conclusion: Late tourniquet release after wound dressing can reduce surgery time and reduction of hemoglobin level in total knee arthroplasty.

Abstract Background:
Total knee arthroplasty (TKA) is one of the most common orthopedic surgeries in the world. The use of tourniquet is recommended by some surgeons around the world. However, the evidence of its usefulness in replacing the knee is still uncertain. In the present study, we assessed the effect of using tourniquet in reducing bleeding during and after operation and the amount of transfusion requirement in TKA surgery.
Methods and Materials:
Patients referred to Imam Reza and Tabriz universal hospitals for TKA surgery in case of absence of hemorrhagic diseases and non-use of anticoagulants were included in this study. In this study, 8 (25.8%) males and 23 (74.2%) females were present with an average age of 63.6 ± 7.86 with a minimum age of 52 years and a maximum age of 81 years. Patients' Randomization applied considering balanced mean age and body mass index (BMI). In the first group after the patient's preparation and induction of anesthesia, the tourniquet was considered and surgery was performed and the tourniquet was released immediately after the cement was inserted. In the second group after the patient's preparation and induction of anesthesia, tourniquet was not used until cementation and after that again deflated. All surgical procedures were performed by the same and experienced surgical team using spinal epidural anesthesia. The standard surgical procedure was considered by surgeons.
Results:
23 (74.2%) patients did not need blood transfusion, and 8 (25.8%) patients needed transfusion. The average duration of surgery was 75.81 ± 26.3 minutes with a minimum duration of 30 minutes and a maximum of 125 minutes. The mean preoperative HB level was 12.66 ± 1.67, which was 11.09 ± 1.62 after surgery.
Conclusion:
In conclusion, the use of tourniquet in patients undergoing TKA surgery reduces the duration of surgery but does not significantly affect hemoglobin maintenance after surgery. In other words, the use of tourniquet does not have an effect on reducing the need for blood transfusion.
 

Abstract Background: Post-operative pain control is an important issue in orthopaedics. Narcotics do not properly control pain and may have many complications. The non-steroidal anti-inflammatory drugs can, however, play an important role in postoperative pain management.  This study evaluates the effect of intra-articular Ketorolac injection on pain control after knee arthroscopy.  Methods: In a randomized double blind clinical trial study, 60 age and sex-matched patients of around 45 years of age were divided into two groups of 30.  Tirthy mg of intra-articular ketorolac in one group and 30 millimeters of saline in the control group were injected at the end of arthroscopic knee surgery.  The postoperative pain control and need for other pain medications were compared between the two groups. Results:  In the Ketorolac group the pain at 4 hours and 8 hours after surgery was significantly lower than   the control group. At   12, and 24 hours after surgery, no significant difference in severity of pain was observed. The need for the use of opioid drugs was not significantly different between the two groups. The Sleep disturbance of 42.8% in the Ketorolac and 57.1% in the saline group was not significantly different. Conclusions: Intra-articular ketorolac is effective in pain reduction only in the first few hours after knee arthroscopy, and does not reduce the need for other analgesics.