Iranian Journal of Orthopedic Surgery

Abstract One of the common complications after total knee replacement surgery is pain and instability in the patellofemoral joint, which significantly impacts patients' quality of life. Statistics show that 8–12% of revision knee replacement surgeries are due to issues related to the patellofemoral joint. A critical concern during surgery is patellar maltracking, which is frequently observed. This condition occurs when the patella does not move along its proper path, leading to functional problems and pain. Various methods have been introduced to evaluate and correct patellar maltracking. This review article addresses different aspects of this issue, including: Definition of patellofemoral maltracking, factors affecting patellar tracking, intraoperative evaluation of patellar tracking, the concept of Perfect Patellar Tracking, Surgical methods to correct patellar maltracking. This article aims to provide a comprehensive perspective on the importance of proper correction of patellar tracking to improve surgical outcomes and patients’ satisfaction.

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 Abstract
Corticosteroids are widely used medications with increasing prevalence in clinical practice. In autoimmune and rheumatological diseases, the use of corticosteroids in both pulsed and long-term manners is very common. Due to the COVID-19 pandemic, their consumption increased. However, long-term use is associated with several adverse effects on the musculoskeletal system, including osteoporosis, an elevated risk of fracture, avascular necrosis, hypocalcemia, hypovitaminosis D, and impaired bone growth in children. Corticosteroid-induced osteoporosis is the most common form of secondary osteoporosis. Several factors, such as age, time of use, family history of osteoporosis, previous fractures, and calcium intake, contribute to its prevalence. Corticosteroids exert their effects by disrupting the balance between the activity of osteoblasts and osteoclasts. These medications also disturb the calcium metabolism by altering intestinal calcium absorption and renal calcium excretion. To minimize these side effects, corticosteroid therapy should be limited whenever possible. Also, supplementing with calcium and vitamin D, incorporating breaks of at least three months between corticosteroid courses, and considering alternative therapies, especially in pediatric patients, can help mitigate the potential risks.

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.

Abstract Introduction: Knee pain is one of the most common musculoskeletal complaints in children and adolescents. There are relatively wide differential diagnoses for knee monoarthritis in children. One of the causes of knee pain and swelling is the discoid meniscus which as the most common congenital anomaly of the knee, can have a wide range of symptoms such as pain, swelling, limited range of motion, and mechanical symptoms including clicking, snapping, popping, and locking of the knee. Therefore, it is necessary to accurately understand this disease and distinguish it from other diseases that show these symptoms. The purpose of this study is to introduce a disease with chronic knee pain and swelling with the diagnosis of discoid meniscus to show that a strong clinical view is necessary to be able to diagnose this disease in children, especially in cases that occur at a younger age.
Case presentation : The patient is a 6-year-old girl who presented with pain, swelling, and limited range of motion in the left knee since 4 years ago, and during this period, she was treated with the diagnosis of Juvenile Rheumatoid arthritis(JRA). Due to the lack of response to treatment and after more examination and consultation with the knee surgeon, the discoid meniscus was diagnosed as her real disease discoid meniscus was diagnosed as his real disease. The patient underwent arthroscopic saucerization and lateral meniscus repair.
conclusion: According to this study, discoid meniscus should be considered as an important, rare differential diagnosis in children presenting with knee pain and swelling.

Abstract Background: To improve the education of orthopaedic residents and enhance patient care in the Iran's healthcare system, it is necessary to gather information about the current status of scientific, practical, and research-based education for residents.
Methods: The research project initially focused on examining the executive curriculum in 14 centers affiliated with 6 different medical universities. Subsequently, an investigation was conducted into human resources, infrastructure, operating room facilities, educational and research outcomes, as well as the regular implementation of practical examinations to evaluate the performance of residents during their residency years. All the aforementioned aspects were covered using a comprehensive questionnaire, which was distributed via the "Formafzar.com" website as a link to the heads of departments in these centers by the Iranian Orthopaedic Association. The relationship between facilities and equipment and passing the future specialized orthopaedic board examination was also evaluated.
Results: Among the examined centers, only 20% adhered to the criteria of Iran educational curriculum in all aspects of human resources, education, and research.
Conclusion: a regular evaluation of teaching methods used by international centers and the national curriculum is necessary for orthopaedic training centers in Iran. Additionally, regulatory systems should monitor the training process of orthopaedic residents to standardize services, equipment, and educational programs in the country.
 
 

Abstract Introduction: The risk of femoral neck fracture increases in the End Stage Renal Disease (ESRD) patients who underge hemodialysis. The aim of this study was to describe our experience with the treatment of femoral neck fracture in this particular group of patients.
Method: In a retrospective study, between January 2010 to December 2015, there were 16 displaced femoral neck fracture in 12 haemodialytic ESRD patient. All patients underwent total hip arthroplasty via direct anterior approach (three cementless and 9 cemented). No closed suction drain was used. Follow up regime was at 3,6 and 12 month and annually thereafter.
Result: All patients were satisfied with the results of total hip arthroplasty. At the time of the final follow-up of 22 months (2-47) months, all the hips in the 12 haemodialytic patients functioned well without any loosening, and with a Harris hip score (HHS) of 90(82–100). Of those patients who received cementless components: one patient showed loosening of femoral component on the right and then left hip one year after surgery. He underwent revision of femoral component to a cemented one. The other complications include one greater trochanteric fracture, one intraoperative distal femoral fracture, one postoperative hematoma formation and one superficial surgical site infection.
Conclusion: In this small series, relatively high complication rate is observable in cases of ESRD with femoral neck fracture treated by hip Arthroplasty. The use of cemented femoral sterns is preferred and extra caution is advised to avoid fracture in such osteoporotic bones.

Abstract Abstract
Total hip Arthroplasty (THA) is an advanced surgical modality, which reduces hip pain resulting from destruction or degenerative change. THA may be associated with complications, such as instability. Instability is the second common reason for revision surgery. The etiology of instability can be factors like prosthetic malposition, impingement, and low soft tissue tension around the hip and also polyethylene wear. In this paper, we will review the common causes of instability following THA in various phases, and suggest the strategies to prevent instability following THA.