Iranian Journal of Orthopedic Surgery

Abstract Abstract Introduction: Spine disorders are one of the common causes of referral to orthopedic clinics and reasons for orthopedic surgeries. Lumbar spinal surgery helps reduce pain and improve function in patients with certain degenerative conditions. In this paper we investigated the causes of revision spine surgery. Materials & Methods: In a retrospective cohort study the patients who had undergone revision spinal surgery within one year in a teaching hospital were evaluated -in accordance with diagnosis and clinical criteria. The patients were randomly selected and screened, and demographic information (including age, gender, underlying disease, and body mass index (BMI)) was collected through a data collection form using patients’ records. The clinical features including diagnosis of spine disease, type of previous surgery, number of fusions, history of spine surgery, Roussouly classification, and T-score, and also radiographic parameters such as sagittal vertical angle (SVA), pelvic incidence (PI), lumbar lordosis (LL), PI-LL mismatch, sacral slope (SS) and pelvic tilt (PT) were collected and included in the checklist. Results & Discussion: The most common cause of original spine surgery was spinal canal stenosis, which was present in 37 patients (92.5%). The most common surgery was discectomy followed by spinal fusion _ performed in 30 (75%) and 27 patients (67.5%) respectively. 25 patients (62.5%) had a history of only one surgery. According to the Roussouly classification, 30 patients (75%) had SS <35 °, and 10 patients (25%) had SS> 35 °. The mean BMI was 28.28. 2.60 kg / m2. The mean T-score in bone densitometry was -1.86 ± 1.06. The mean size of SVA was 7.12 ± 2.19 cm; the mean PI angle was 52.12 ± 10.80 °; the mean LL angle was 23.42 ± 15.56 °; the mean size of the difference between PI and LL angles was 29.25 ± 15.30 °, the mean SS angle was 27.85 ± 10.69 °, and the mean PT angle was 23.62 ± 7.62 °. SVA size was abnormal in 35 patients (87.5%), PI in 14 patients (35%), the difference between PI and LL in 35 patients (87.5%), SS in 34 patients (85%), and PT in 29 patients (72.5%) was abnormal. There was a significant difference in SVA, PI, PI-LL mismatch, SS, and PT between normal and abnormal groups (P-value <0.001). The patient factors such as old age, previous medical conditions, high BMI, osteopenia, and intraoperative factors, including failure to correct lumbar lordosis, sagittal balance, and correction of angles in primary surgery, showed increased risk for revision spine surgery. Conclusion: Osteopenia and osteoporosis, failure in reconstituting lumbar lordosis and proper sagittal balance are common reasons leading to revision spine surgery.

Abstract   Introduction: Infection is a major orthopedic concern, particularly following knee replacement. Postoperative infection poses significant risks, and in trauma patients with open wounds, it can lead to severe complications. Managing these infections often requires prolonged antibiotic therapy, extended hospitalization, and, in many cases, revision surgery for joint replacement or repeated debridement in osteomyelitis—resulting in serious patient morbidity. Given the high rate of self-administered antibiotics and negative culture tests in joint infections, this study compares molecular (PCR) and culture methods for detecting microbial agents in osteomyelitis and septic arthritis. Materials & Methods: In this cross-sectional study, 100 samples from patients with joint infections and osteomyelitis at a Hospital were analyzed using microbial culture and PCR. Demographic data (age, gender), comorbidities, and clinical signs (fever, chills, swelling, discharge, pain, limited mobility) were extracted from medical records. Data were analyzed using SPSS22. Results & Discussion: Among 100 samples, 80 tested positive via PCR, while 55 were culture-positive. Conversely, 20% were PCR-negative and 45% culture-negative. A statistically significant difference existed between the two methods in detection rates (P < 0.04). The patient factors such as old age, previous medical conditions, high BMI, osteopenia, and intraoperative factors, including failure to correct lumbar lordosis, sagittal balance, and correction of angles in primary surgery, showed increased risk for revision spine surgery. Conclusion: PCR is faster and more accurate than culture for diagnosing osteomyelitis and septic arthritis, enabling earlier treatment intervention.

Abstract Introduction: Hip osteoarthritis is a common condition affecting 10–15% of individuals over 60 years old, leading to significant pain and discomfort. Low back pain is also highly prevalent among the elderly. The hip-spine syndrome describes the relationship between spinal pain, hip disorders, and symptomatic changes following hip reconstruction surgeries, particularly total hip arthroplasty (THA). The impact of THA on the biomechanical structure of the spine and pelvis remains unclear. This study investigates changes in clinical and radiological sagittal spinal alignment parameters following THA. Materials & Methods: This study included 15 patients who underwent THA at one hospital. Radiographic  parameters (Sacral Slope, lumbar lordosis, and S1-L1 distance) and clinical parameters, including low back pain (PSFS questionnaire), daily activity level (PSEQ questionnaire), and hip flexion range of motion, were assessed before and three months after surgery. Results & Discussion: Radiological changes after THA were not statistically significant. However, there was a significant reduction in low back pain (5.01±1.1-, P<0.001). An improvement in activity level (23.47±7.1, P<0.001), and an increase in hip flexion range of motion (38.66±19.62, P<0.001). Additionally, higher BMI was associated with a lower improvement in activity level (P=0.047). Conclusion: THA leads to reduced low back pain, improved activity level, and increased hip flexion range of motion. However, these changes are not correlated with radiological sagittal alignment parameters.

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 Introduction: Elbow fractures are common in both pediatric and adult populations, and accurate diagnosis is crucial for proper treatment. While radiography is the standard method, alternative imaging techniques such as ultrasound are increasingly explored, especially when radiographic imaging is not ideal. This study evaluated the diagnostic accuracy of ultrasound in detecting elbow fractures, comparing it with radiography and computed tomography (CT) as reference standards. Materials & Methods: Forty patients with suspected elbow fractures underwent imaging using ultrasound, radiography, and CT. Results from all three methods were compared to assess sensitivity, specificity, and agreement between ultrasound and the reference standards. Results & Discussion: The mean patient age was 15.5 years (range: 4–49), with 72.5% male (n=29). Supracondylar fractures were most common in patients under 18, while radial head fractures predominated in those over 18. Ultrasound showed good diagnostic performance, with 88.9% sensitivity, 87% specificity, and a kappa value of 0.73 compared to radiography. Against CT, ultrasound demonstrated 94.8% sensitivity and 89.7% specificity. Conclusion: Ultrasound is an accurate, non-invasive, and cost-effective alternative to radiography and CT for diagnosing elbow fractures, especially in emergency or resource-limited settings. Its strong diagnostic performance, particularly in children, supports its use as a reliable tool. Further studies with larger samples and follow-up are recommended.

Abstract Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity causing physical/psychological burdens. Optimal preoperative planning enhances appearance while preserving spinal function. Corrective surgery restores spinal mobility and balance. In dual-curve cases, selective fusion corrects one curve, inducing spontaneous correction of the other—preserving spinal motion and attracting surgical interest. However, limited adoption persists due to insufficient data. This study evaluates selective thoracolumbar/lumbar fusion, detailing surgical outcomes and complications to guide surgeons in procedure selection. Evidence confirms selective thoracic fusion is effective and safe for AIS, offering significant correction, improved quality of life, and fewer complications versus extensive approaches. Future research should refine patient criteria and assess long-term effects.

Abstract Lower limb malalignment around the knee may be a risk factor of knee osteoarthritis (OA) progression. A surgical treatment method for preventing OA progression is osteotomy and one of the rare side effects of this surgery is injury to the arteries. We present three cases, two men (24 and 42 years old) and one woman (15 years old) who were diagnosed with lower limb malalignment and received high tibial or distal femoral osteotomies and were complicated with arterial injury. Delay in diagnosis of the injury varied from about an hour to about one month after surgery.

Abstract Nanotechnology is currently recognized as a technology with vast application potential across multiple fields, particularly in medicine. Nanomaterials and nanostructures, owing to their ultra-microscopic dimensions, high surface area, and unique physicochemical properties, are increasingly employed in orthopedic surgeries. These materials, due to their distinctive features in interacting with living tissues, are considered key components in prostheses and medical devices, and they have led to significant advancements in bone tissue engineering, the design of implantable materials, and diagnostic as well as therapeutic processes. In this study, various databases including ISI Web of Science, PubMed, SID, Scholar, Scopus, and ScienceDirect were utilized. The keywords applied consisted of nanohydroxyapatite, bone defect repair, prosthesis, clinical evaluation, and fracture healing. The use of biocompatible nanomaterials in orthopedic prostheses—particularly due to their ability to stimulate cellular growth, regenerate damaged tissues, and improve cellular microenvironmental properties—has had a profound impact on enhancing orthopedic therapies. These technologies have successfully facilitated bone repair processes. This article has been prepared to provide a deeper understanding of the application of hydroxyapatite at the nanoscale and its potential therapeutic objectives in orthopedic surgeries.