Iranian Journal of Orthopedic Surgery

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 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: This study was performed to evaluate the effect of lyophilized human platelet rich plasma powder (LhPRP) and omentum autograft on the bone healing properties in animal model which can further be utilized for different orthopedic or maxillofacial reconstructive surgeries.
Materials & Methods: Bone defects of 10 mm diameter were created in diaphysis of radius of 20 rabbits and then either left undisturbed (control group) or filled with one of the following materials: a piece of autogenous omentum, LhPRP, or concurrent use of LhPRP and omentum. Bone formation, union and remodeling, were evaluated at the 2nd, 4th, 6th and 8th weeks postoperatively by radiography, using bone healing criteria. On 56th postoperative day, the operated limbs were removed and further histopathological evaluations were carried out.
Results & Discussion: The results showed that LhPRP with or without omentum in bone regeneration in 10mm defects was significantly superior to control group (p<0.05).
Conclusion: LhPRP powder, alone or combined with autogenic omentum, provides increased bone regenerative properties in experimental bone defects in animal model after 56 days.
Keywords: Omentum, Lyophilization, Platelets, Bone regeneration, Rabbits.

Abstract Abstract Introduction: Legg-Calvé-Perthes disease (LCPD) is a prevalent pediatric orthopedic disorder characterized by avascular necrosis of the juvenile femoral head due to disrupted blood flow. Revascularization of the necrosed fragment can lead to femoral head deformation and reduced hip joint longevity. The incidence of LCPD varies geographically, with higher prevalence in northern Europe. This study investigates the correlation between solar irradiance and LCPD incidence. Materials & Methods: Incidence data for LCPD from 31 regions, reported per 100,000 children under 15 years, were retrieved from PubMed. Corresponding regional solar irradiance data were obtained from a geo-localization website and two open data sources. Pearson correlation coefficients were calculated to assess the relationship between latitude, solar irradiance, and LCPD incidence. Results & Discussion: A significant negative correlation was found between regional solar irradiance and LCPD incidence, while a significant positive correlation was observed between latitude and LCPD incidence. Conclusion: Evidence indicates: 1) a sharp increase in LCPD incidence at higher latitudes, 2) increased prevalence of vitamin D deficiency at higher latitudes due to reduced sun exposure, and 3) vitamin D deficiency can induce a hypercoagulable state. We propose the hypothesis that "Decreased vitamin D levels during the antenatal and/or early childhood periods are correlated with increased incidence of LCPD," warranting further clinical research for verification.

Abstract Abstract Introduction: Rotator cuff problems may account for up to 70% of shoulder pain as well as limitation of motion and function. Treatment for rotator cuff injuries and tears includes supportive care as the first line and surgical intervention as the second line. The aim of this study is to evaluate the impact of open rotator cuff repair on pain intensity and shoulder function in patients who are candidates for surgery. Materials & Methods: In a cross-sectional study, 37 patients who had undergone open shoulder surgery were studied with an average follow-up of 11 months (2-42 months). Age, gender, pain levels, tear size, duration of the tear, range of motion (ROM), and patient function were recorded in a checklist before surgery. Postoperative ROM and function were also documented. Pain levels were measured using the Visual Analog Scale (VAS), and function was assessed by the American Shoulder and Elbow Surgeons (ASES) score. The data obtained from the questionnaires and checklists were analyzed using SPSS v.26 software. Results & Discussion: The analysis of mean function, pain, abduction, and internal and external rotation of the shoulder before and after surgery showed improvement in all the cases, the clinical status of the patients improved (p < 0.05). shoulder function improved but did not reach a score of100, while the patients experienced a reduction in pain, but did not reach zero. there was an overall increase in range of motion, this increase was more pronounced in internal rotation and abduction movements. Conclusion: The results of this study suggests that, if conservative treatment fails and when there is no major contraindication for surgery, the patients should be offered, open rotator cuff repair in order to enhance quality of life.

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 Abstract The healing of bone fractures is a multifaceted process that ultimately leads to the creation of new bone tissue. A significant factor influencing this process is the mechanical environment present at the site of healing. Computational models that employ mechanobiological algorithms are capable of simulating the impact of mechanical stimuli on the differentiation of stem cells into various tissue types during the bone healing process. This paper provides a review of the domain of computational mechanobiology, particularly concerning bone healing, and evaluates the existing mechanobiological models. Furthermore, it discusses recent developments and the current challenges faced in this area. Recently, there has been a growing interest in integrating mechanobiological algorithms with a more comprehensive depiction of cellular and molecular events. A primary challenge in this domain is the validation of these models through their comparison with experimental data. Such models can enhance our understanding of the bone fracture healing process and improve the design of implants and treatment analyses. However, existing mechanobiological models are still in their early stages and require ongoing updates and refinements to keep pace with the continuous advancements in the field of stem cell mechanobiology.

Abstract Abstract Fracture fixation using plates has evolved over time. This progress is evident both in the types of devices used—such as the development of locking plates—and in the conceptual approach of orthopedic surgeons, including greater respect for soft tissue and minimal manipulation of it. In summary, locking plates function as internal fixators, where the plate acts as a rod and the screws play the role of Schanz pins. This structure, which functions as a solid, unified unit, is less dependent on bone quality, making it especially useful in the fixation of articular surface fractures and metaphyseal fractures, particularly when using minimally invasive approaches. Numerous advancements in the evolution of these plates—such as Variable Angle Plates and Locking Compression Plates (LCP)—offer surgeons significant intraoperative flexibility. Understanding concepts such as working length and screw density greatly assists surgeons in screw placement. Although there are no absolute contraindications for the use of locking plates, their use is not recommended for simple diaphyseal fractures. Through ongoing evaluation of design, biomechanics, and surgical concept comprehension, it is anticipated that newer and more advanced locking plates will be developed in the near future through the collaboration of orthopedic surgeons and engineers. This continuous improvement reflects the dynamic nature of orthopedic technology and surgical techniques in fracture management.