Iranian Journal of Orthopedic Surgery

Abstract Knee osteoarthritis (KOA) is a common degenerative joint disease that mostly impacts adults over 5 years of age. Its prevalence is considerably higher in women, individuals with excess body weight and people with prior joint trauma. Current treatment strategies primarily focus on symptom control, which underscores the urgent need for more effective and disease-modifying therapies. Recent advances in both nonsurgical and surgical modalities have introduced promising regenerative options. Therapeutic modalities notably mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP) have demonstrated substantial potential in attenuating inflammatory responses and facilitating cartilage regeneration, particularly during the early pathological phases of knee osteoarthritis. Intra-articular hyaluronic acid (HA) injections provide only temporary symptomatic relief and show limited long-term efficacy. For advanced cases, surgical interventions including autologous chondrocyte implantation (ACI) and knee arthroplasty (TKA) remain viable options, with their associated risks and complications. Personalized treatment approaches based on disease severity, progression, and patient-specific factors are likely to yield optimal outcomes. Future directions in KOA management may include gene-edited MSCs, smart implants, and the integration of machine learning to enhance therapeutic precision and long-term success.

Abstract Background: Severe acetabular bone loss following total hip arthroplasty (THA) presents a complex reconstructive challenge. Traditional classification systems, such as Paprosky, may not fully capture the morphology of defects in the most extreme cases. Additionally, previous revision plans could not safely manage such cases.
Case Presentation: A 71-year-old man presented with pain and instability four years after a primary THA. Imaging revealed a massive acetabular defect with extensive osteolysis and metallosis, including complete loss of the posterior column, medial wall, posterior wall, inferior rim, and ischium, and only the anterior wall and column remained intact. The acetabular cup had also protruded into the pelvic cavity, approaching the bladder, and had migrated centrally. While the defect resembled a Paprosky type IIC pattern, it was markedly more severe and did not fit existing classifications. A complex two-stage reconstructive surgery was performed, involving elevation of the hip center by 2.5 to 3 cm and compensation for limb shortening through femoral stem lengthening using a long-stem prosthesis. After 2-step revision surgery, the patient experienced prosthetic dislocation, necessitating a third surgery. During this procedure, a bipolar cup was manually drilled to allow bone cement to pass through the holes for improved fixation. Additionally, bone cement was applied over the screw heads (positioned superior to the cup) to construct a scaffold that enhanced implant stability and reduced the risk of dislocation.
Discussion: This case may represent a novel subtype of acetabular bone defect not encompassed by current classification systems. Furthermore, the innovative approach of penetrating a bipolar cup and using cement augmentation over a screw framework presents a potential new strategy for achieving stable fixation in cases of severe bone loss.
Conclusion: This case underscores the need for updated classification systems to account for atypical acetabular defect patterns and demonstrates a novel fixation technique that may improve outcomes in revision THA involving extensive bone loss.
 

Abstract Abstract
Introduction: Postoperative bleeding is a major concern in total knee arthroplasty (TKA), often leading to complications such as anemia and increased demand for blood transfusion. Tranexamic acid (TXA), an antifibrinolytic agent, is used intravenously and topically to reduce surgical blood loss. This study aimed to compare the efficacy of three administration methods of TXA (intravenous, topical, and combined) in reducing bleeding among Iranian patients.
Materials & Methods: This double-blind randomized clinical trial (RCT) was conducted on 135 patients undergoing TKA, between February 2021 and June 2021. Patients were randomly assigned to three groups of 45 each: intravenous, topical, and combined. Demographic data, postoperative drainage volume, hemoglobin changes, and other clinical variables were analyzed using SPSS software.
Results & Discussion: The combined TXA group showed a statistically significant reduction in intraoperative bleeding (524.0 ± 150.5 mL) compared to the intravenous (665.6 ± 136.3 mL) and topical (740.2 ± 141.5 mL) groups (p<0.05). This group also experienced a smaller postoperative drop in hemoglobin. No significant differences were observed among the groups in terms of edema or knee circumference (p>0.05).
Conclusion: The combined administration of intravenous and topical TXA was more effective in reducing postoperative drainage volume and hemoglobin drop, compared to either method alone. These findings support the superiority of the combined approach and highlight the importance of TXA use in managing bleeding in orthopedic surgeries.

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: Supracondylar humerus fracture is the most common elbow fracture in children and accounts for about 16% of pediatric fractures. To maintain stability in the reduced segment in medial and lateral columns is an important treatment concept. The aim of this study was to compare two methods of proximal distal lateral pinning with medial and lateral cross pinning. Methods: In a cross-sectional study, 140 children (63 boys, 77 girls) with supracondylar humerus fracture were evaluated in a training center in Tabriz, Iran. The mean age was 5.04 years. The cases were divided into two groups (each 70 patients), matched for age, sex and type of fracture and were treated with two above methods. Complications and outcomes were copmpared. Results: Ulnar nerve lesion in the medial and lateral cross technique was 4.3%, and none in the group done by all lateral pin technique. The need for further surgery and loss of stability was 2.9% and 1.4% respectively with no statistical difference. Pin site infection around the pins was 4.3% and 12.9% percent respectivly. Cubius varus deformity rate was 2.9% in lateral cross pinning and 4/1% in medial lateral cross pinning. Conclusions: Proximal distal cross pinning technique for suprocondylar humerus fracture is comparable to medial and lateral cross pinning in terms of stability in maintaining a good reduction. The possibility of ulnar injury is negated in cross-lateral technique.