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 Abstract Introduction: Knee dislocation has potential for complex injury to blood vessels nerves and ligaments. It requires prompt diagnosis and treatment. Radiological assessments aid in guiding appropriate orthopedic and surgical interventions. This study aims to assess the treatment outcomes of knee dislocations. Materials & Methods: A cross-sectional study of patients admitted to an orthopedic center within 4 years with knee dislocation was conducted. Demographic data, initial treatments, correlated injuries, pain severity, and post-surgery outcomes were collected. The initial management which was with external fixation or bracing were conquered. Statistical analysis was performed using SPSS v25. Results & Discussion: Sixty-two patients (11 female, 51 male) were enrolled. Motor vehicle accident, car accident, and falls were common causes. Co-occurring injuries included ligamentous, vascular, and nerve injuries, with the first one being predominant. The initial treatments were by either bracing or external fixation. No re-dislocation was reported in the external fixator group, while 5 occurred in the bracing group. Pain severity scores were lower in the external fixator group at 1 and 3 months post-surgery. Time to return to work and duration of rehabilitation were, non-significantly, shorter in brace treatment group. Conclusion: Both brace and external fixator show promise as initial knee dislocation treatments, offering distinct benefits. Definitive conclusions warrant comprehensive clinical trials.

Abstract Abstract Performing total knee arthroplasty (TKA) in patients with extra-articular deformities presents complex and significant surgical challenges that can have both direct and indirect impacts on treatment outcomes. These deformities often require more meticulous planning and tailored surgical strategies to maintain biomechanical alignment of the joint and ensure optimal patient function. Among these strategies are intra-articular corrections and extra-articular osteotomies, with the choice depending on the specific characteristics of the patient and the severity of the deformity. In this context, advanced technologies such as computer-assisted surgery and robotic systems have emerged as innovative tools that enhance accuracy in surgical planning and execution, minimize the risk of surgical errors, and facilitate improved clinical outcomes. This article provides a comprehensive review of current best practices and emerging trends in managing TKA for patients with extra-articular deformities, while also emphasizing the importance of multidisciplinary preoperative planning, advanced imaging assessment, and patient-specific risk evaluation. It further discusses structured decision-making algorithms to guide the selection of appropriate corrective techniques, with careful attention to soft-tissue balance, implant positioning, and long-term stability. Collectively, these considerations aim to optimize functional outcomes, reduce complications, and improve implant longevity in this challenging patient population.

Abstract Abstract
Introduction: The patella has an important role in knee extension and shock absorption. This retrospective study assessed factors influencing surgical outcomes of patellar fractures over ten years at a single center.
Methods: A descriptive-correlational design was applied to patellar fracture cases treated at a university center over a decade. Patients were stratified into follow-ups of <5 or ≥5 years. Data included demographics, medical history, functional outcomes (Koo’s and WOMAC indices), pain, range of motion, and osteoarthritis severity (Kallgren/Lawrence classification). Census sampling was used. Analyses were performed in SPSS, with visualizations in Excel and GraphPad Prism.
Results: Among 53 patients (mean age 60.45 ± 16.00; 90.6% male), 62.3% had <5-year and 37.7% had ≥5-years follow-up. Follow-up duration did not correlate with outcomes. Treatment complications significantly correlated with degenerative arthritis. Functional scores were higher (p < 0.05) and pain scores lower (p < 0.05) in patients without complications.
Conclusion: Patellar fracture surgery yielded favorable mid-term outcomes, with complications linked to poorer function and higher pain. Reoperation rates were low, supporting surgical efficacy.

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:
Introduction: Anemia is one of the most important and vital cases in internal medicine and surgery, and due to its important effects and complications on complete physical health and surgeries, in order to reduce the severity and frequency of anemia by recognizing the factors affecting its occurrence, the relationship between preoperative hemoglobin level and moderate to severe postoperative anemia in patients with complete knee replacement was performed in Imam Khomeini Hospital in Urmia.
Materials and methods: In this cross-sectional analytical study, with the aim of investigating the relationship between preoperative hemoglobin level and moderate to severe postoperative anemia in patients with total knee replacement, after obtaining the code of ethics from the ethics and research committee of Urmia University of Medical Sciences, the researcher referred to the archives of Imam Khomeini Hospital in Urmia and studied the files of 242 patients who underwent total knee replacement surgery in Imam Khomeini Hospital in Urmia.. Finally, the collected data were entered into SPSS 27 software with appropriate coding and analyzed based on the objectives of the study.
Findings: Of the total patients, 204 (84.3%) were female and 38 (15.7%) were male. The mean age of the patients was 66.69 years (age range 37 to 84 years) and the mean body mass index of the patients was 29.03 kg/m2 (body mass index range was 20 to 44 kg/m2). Considering the diagnosis of anemia on the second day after surgery, the best positive point in identifying high-risk patients for hemoglobin before surgery was 13.15 mg/dl (sensitivity and specificity of 73.6% and 72.6%, respectively).
Conclusion: Both preoperative and postoperative hemoglobin levels act as vital diagnostic markers in TKA, influencing not only immediate surgical outcomes, but also cure rates and longer-term complications.

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 There has been significant on-going debate on doing bilateral TKA either under a single anesthesia or staging the surgery (replacement on the contralateral knee within maximum of one year following the first knee) ⁽¹⁾. There are proponents of both techniques.
{The term staggered TKA refers to replacement on the same period of hospitalization, but not on a single anesthesia ⁽²⁾ and there is not much literature support for that).
Around 30% of patients who undergo unilateral TKA have enough symptoms -both in terms of pain and functional impairments, to require contralateral replacement within 10 years ⁽³⁾.
The controversy of simultaneous versus staged bilateral TKA can be looked at in 4 different categories:

Which technique would be more economic and what is the cost-effectiveness?
Functional achievements: which one has better functional outcome?
Complications, morbidity and mortality rate: which one is safer?
What percentage of patients and for how long after first TKA, would not need contralateral TKA?

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 Introduction: Knee osteoarthritis is one of the most common causes of joint pain and destruction in people over forty years old. This research has investigated the effect of using a drain on Fe, TIBC, and Hb levels in knee joint replacement surgery in a 6-months period, as a prospective cohort study. Materials & Methods: All patients who were candidates for knee joint replacement in one hospital, were included in a prospective study. The grouping of patients included those who had post-operative drain (45 patients)and the ones with no drain (45 cases). and the control group were those who did not undergo drainage after the intervention. Fe, TIBC, and Hb levels were compared 3 months post-surgery. Results & Discussion: A total of 21 men and 69 women were in the case and control groups. The average age in the case group was 67.67 years and in the control group was 68.96. The confounding variables considered in this study, including age, gender, and underlying diseases (including hypertension, diabetes, and hypothyroidism) were examined in both groups, and there was no significant difference between the group with and without a drain; Therefore, the difference between the two groups in this study was caused by the blood indices. However, the ferritin level of preoperative patients was different in the two groups. The most important blood index that was significant in all analyzes was hemoglobin changes before and after the operation. Also, significant changes in TIBC were present. Conclusion: Drain use in knee replacement surgery results in less HB drop. Good blood loss strajedy can lower the drop in TIBC in 3 months follow-up.

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: Anterior cruciate ligament (ACL) reconstruction is a commonly performed procedure to restore the stability of the knee. However, there is still no consensus on the optimal approach for determining the position of the tibial and femoral tunnels. In this study, we aimed to evaluate the effect of endobutton positioning on the clinical outcomes of the patients who underwent ACL reconstruction.
Methods: We evaluated 100 adult patients who underwent single-bundle ACL reconstruction surgery at our institution. The patients were categorized based on the position of the femoral endobutton observed in lateral and AP radiographs. We investigated the relationship between the position of the femoral endobutton in lateral and AP radiographs and the clinical outcomes of range of motion (ROM), Pivot Shift examination, and knee function scores at the 6-month follow-up.
Results: The Intermediate group had the largest number of patients, but there were no significant differences in the clinical examination results and knee function among these groups. Although the majority of individuals fell into the <39% group, there were no significant differences in clinical outcomes and knee function across these groups.
Conclusion: In conclusion, our study found no significant relationship between the position of the femoral endobutton as determined by radiography and the clinical examination results and knee function. These findings suggest that further research is needed to better understand the optimal approach for determining the position of the tibial and femoral tunnels and the appropriate grip for ACL reconstruction.

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 Introduction: Anterior cruciate ligament (ACL) rupture disrupts knee stability and increases the risk of subsequent meniscal injury and degenerative joint disease. (ACL) reconstruction is one of the most common orthopedic surgeries. This study was conducted with the aim of investigating the effect of pre-operative and post-operative physiotherapy of ACL reconstruction with hamstring autograft on the success rate of surgery based on the eight parameters of Lysholm knee scoring scale (LKS) one year after the operation.
Method: In this descriptive-analytical study 140 patients underwent ACL reconstruction surgery with hamstring autograft after cruciate ligament rupture in Imam Khomeini Hospital of Ahvaz between 2020 and 2024. The relationship between the number of pre-operative and post-operative physiotherapy sessions and the starting time of post-operative physiotherapy with (LKS) one year after the operation was analyzed using SPSS version 22 software.
Results: In this study 112 men and 28 women were examined. There was no significant relationship between the (LKS) score and the number of pre-operative and post-operative physiotherapy sessions, but the (LKS) score was higher in patients who had 1 to 10 pre-operative physiotherapy sessions and in patients who had less than 10 post-operative physiotherapy sessions. Also the patients who started their physiotherapy in the first week after the operation had much better results.
Conclusion: Although the number of physiotherapy sessions before and after the operation of ACL reconstruction with hamstring autograft does not have a clear effect on the results of the operation but the patients who did physiotherapy before the operation compared to the patients who had no experience of physiotherapy before the operation and also patients who started their physiotherapy sooner after the operation had better results.

Abstract Introduction: Anterior cruciate ligament is one of the most important knee ligaments. This ligament is one of the ligaments that is damaged during vigorous activity. The purpose of this study was comparative evaluation of reconstructive surgery and physiotherapy in patients.
Material and methods: Sixty-three subjects were enrolled in this cross-sectional study which referred to Imam Reza Hospital since 1391 to 1398. 32 patients underwent reconstructive surgery and 31 underwent physiotherapy treatment. The IKDC questionnaire was filled out and collected data was entered into SPSS 21 And were analyzed by two-way ANOVA and BONEFERRONI supplementary tests.
Results: The results showed that both treatment and occupation were effective and reconstructive surgery had a higher score than physiotherapy. Also in the jobs, the score of the soldiers was significantly lower than the rest of the jobs and there were no significant differences between the three freelancer’s jobs, military personnel and athletes.
Conclusion: According to the findings, both the type of treatment chosen and the type of occupation were effective in patient’s follow up. In fact, according to the study, people undergoing reconstructive surgery had more pain than the physiotherapy group. But in spite of the pain, they were more able to perform higher performance and function and achieve higher scores.

Abstract Introduction:
Genu varum is a type of knee deformity. In this deformity lower limb mechanical axis, moves inward to the knee centre. In genu varum mechanical axis usually lies through the medial of the knee joint. In this deformity, the patient's lower limbs become bow shape. One of the best techniques for genu varum correction is high tibial osteotomy that this procedure can change some index include posterior tibial slope (PTS), and insall-salvati index (ISI).
Method:
Our study was a cross-sectional study performed on patients with genu varum before and after a step cut of the high tibia osteotomy. The method of examining the posterior tibia slope was that before and after the high tibia osteotomy by Step Cut-MCL sparing method, a simple radiographic image in true lateral view (True lateral) was taken from the knee of patients. The significance level of P Value <0.05 was considered.
Result:
In this study 21 patients ( 11 male and 10 female ) were enrolled. Mean age was 36.19 ± 10.17 year-old. Mean PTS pre operation was 11.48 ± 1.94 degrees and post operation was 11.48 ± 2.15 degrees.
Conclusion:
In our study, PTS increased after HTO that this increase was not statistically significant difference between men and women. In addition, we showed that this increase did not have significant relationship with age and BMI. In the present study, Insall-Salvati index showed no significant difference before and after the treatment.

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: Acquiring knowledge about anatomic and geometric measurement of bone is among the most vital parameters in knee arthroplasty and has a significant effect on the subsequent outcomes. The aim of this study is to obtain anthropometric measurements of the distal femur of adult Sudanese Population and to compare the results with other populations.
Methods: This descriptive study conducted at Alamal hospital in Khartoum, Sudan, between Sep. 2020 and Feb. 2021, included all adult patients attending the radiology clinic for CT scan with normal knees. The Femoral medio-lateral (ML) and anteroposterior (AP) dimensions of the distal femora were measured. The collected data was analysed using statistical package for social science (SPSS).
Results: 385 adult Sudanese were studied. The mean age was 59.1±18.5 years (Range 20-86 years). 69.9% were male and 30.1% female. 45% were left knees and 55% right. The mean ML diameter was 76.6±6.0mm (rang 66.7-88.2mm), and the mean of AP was 45.640±4.9 mm (range 37.2-54mm). The anthropometric measurements of the distal femur of Sudanese people fall between Greek and Korean.
Conclusion: There were differences in mean ML and AP dimensions between the Sudanese population and other ethnic groups which should be kept in mind when designing Total Knee Arthroplasty implants.
 
 
 

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 Introduction: Knee arthroplasty is one of the most successful orthopedic surgeries, and many studies have been done on Eproch and the timing of surgery, but few studies have been performed on the outcomes and complications of knee arthroplasty and its comparison 48 hours later. Therefore, we decided to conduct a study to determine the clinical outcomes and complications of two knee joint replacements and to compare them within 48 hours.

Methods: This study was a cohort study, the first group consisted of patients undergoing concurrent arthroplasty and the second group were patients undergoing 48 knee arthroplasty within 48 hours then postoperative complications, duration Time of hospitalization, clinical outcome two weeks after surgery, one month after surgery and three months after surgery were evaluated.
Result: None of the criteria evaluated by lysholm questionnaire were significantly different in the studied patients. Postoperative complications were also evaluated in both case and control groups, with no significant difference in either group. (P> 0.05).
Discussion: Overall, there was no significant difference in pain rate, knee function, and surgical complications during the study after both treatments.

Abstract Introduction: Deep vein thrombosis (DVT) is accompanied by adverse effects after surgery and the prevalence of this complication is unknown following knee replacement surgery in patients with a history of chemotherapy. Therefore, the present study aimed to investigate the frequency of DVT after knee replacement surgery in patients with a history of chemotherapy.
Methods: This descriptive-analytical study was performed on 189 candidates for knee replacement surgery who had a history of chemotherapy during 36 months ending in March 2016 and referred to Shohada and Imam Reza hospitals affiliated to Tabriz University of Medical Sciences, Tabriz, Iran. After surgery, patients were evaluated for the incidence of DVT and the factors, influecing it based on the instrument of determining DVT and Doppler ultrasound. Statistical analysis was completed by Spearman’s correlation and regression tests.
Results: The mean standard deviation of DVT score was 43.49 ± 6.66, which indicates that after knee replacement surgery, patients with a history of chemotherapy are at high risk for DVT. The prevalence of DVT was 25.92% (N=49) and the number of chemotherapy sessions (P=0.001) correlated with the occurrence of DVT.
Conclusion: The prevalence of DVT following knee replacement surgery in people with a history of chemotherapy is above the normal mean reported in the literature. Consequently, further therapeutic and preventive measures are required.

Abstract Introduction: According to the literature, cardiovascular diseases are highly prevalent globally, while there is an increased risk of cardiovascular-related death in osteoarthritic patients. Therefore, the present study intended to investigate the cardiovascular risk factor prevalence in osteoarthritic patients.
Methods: This cross-sectional, descriptive study was performed at the orthopedics clinics of the Guilan University of Medical Sciences in 2017. The inclusion criteria were the 40-75-year-old patients who were selected using the convenience sampling method. They were diagnosed with osteoarthritis, and gave informed consent for participation. The study data included demographics, cardiovascular risk factors, medical history, and anthropometric measurements. After a qualitative analysis, the data were analyzed using the SPSS software version 16.
Results: A total of 100 patients with knee osteoarthritis, including 79 female and 21 male patients with the mean age of 53.9±11.9 years, were included in the study. The prevalence of diabetes, hypertension, obesity, metabolic syndrome, and smoking in the participants was 31%, 33%, 45%, 51%, and 9%, respectively. 12% reported a history of previous heart attacks. Moreover, the prevalence of diabetes, obesity, hypertension, and metabolic syndrome was higher in women than men. Also, the mean age of the male patients was significantly higher than women (P = 0.03).
Conclusion: Given the high prevalence of cardiovascular risk factors in osteoarthritis patients, it is essential to notice the early cardiovascular disease detection in patients with knee osteoarthritis, especially in female patients.

Abstract Introduction: The most common cause of knee pain is knee osteoarthritis, many surgical and non-surgical treatments have been proposed but the preferred treatment remains unknown. One of the non-surgical treatments was PRP (plasma reach platate) injection in these patients. Various studies have shown the improvement of the effect of PRP injection with substances such as calcium gluconate, so the aim of this study was to evaluate the effectof PRP with and without calcium gluconate on the clinical results of intra-articular injection of this substance in patients with knee osteoarthritis.
Methods: This was a cohort study in which patients were divided into two groups: PRP injection and PRP injection with calcium gluconate. The results of the study were evaluated by KOOS questionnaire and pain by VAS. A significance level of 0.05 was considered.
Result: Generally, during the study, the pain level in patients after receiving both treatments significantly decreased during the six-month period, while the pain in the case group significantly decreased. (P Value <0.05).
Discussion: From the results of this study, it can be concluded that simultaneous injection of PRP and calcium gluconate can further improve the results of injection.