Statin use in total joint arthroplasty: a systematic review.

Introduction: There has been increased interest in the use of Statins in total hip and knee arthroplasty (THA and TKA) patients to improve outcomes and reduce postoperative complications. This study was performed to systematically review the evidence on Statin use in total joint arthroplasty, specifically its benefits and complications. Methods: Adhering to the PRISMA guidelines, a systematic review of PubMed, Embase, Scopus, Web of Science, and the Cochrane database was performed to find studies reporting on the effects of Statin use on outcomes of THA and TKA. Two authors independently selected relevant papers to include. Results: A total of 18 papers were included in the final analysis. Most were retrospective studies, with heterogeneous patient selection and outcome measures. The evidence on the risks and benefits of Statin use on outcomes of total joint arthroplasty was very limited and heterogeneous. Studies were focusing on perioperative cardiac outcomes, clinical outcomes and complications, renal, pulmonary, and gastrointestinal outcomes. Due to the heterogeneity of reported data, a formal meta-analysis was not possible. Conclusions: There is some evidence in the literature suggesting that perioperative use of Statins, especially in Statin-naïve patients, may reduce cardiac (e.g. atrial fibrillation) and noncardiac (e.g. delirium) complications, while not increasing the risk of muscle or liver toxicity. The authors also found low levels of evidence that Statin use may reduce the long-term risk for revision surgery and osteolysis.

The process of social death in patients with hip fracture.

People with chronic disability and uncontrollable long-term complications following hip fracture have characterist.ics that may predispose them to social death. Continuous physical disability can have negative physical, psychological, and social consequences in these patients. To design care interventions for preventing and controlling social death, it is essential to identify the dimensions and characteristics of this process. Therefore, the present study aimed to explain the process of social death in hip fracture patients. In this study, which was conducted using a grounded theory approach, 20 patients were selected with maximum diversity and 9 professional and non-professional caregivers also through purposive sampling followed by theoretical sampling. Data were collected through semi-structured in-depth interviews, field notes, and observations. Data were analyzed using the approach proposed by Corbin and Strauss in stages including data analysis for concepts and their dimensions and characteristics, the context, process extraction, and integration of the categories. One core category and 16 main categories, which consisted of 55 subcategories and 212 primary concepts, were extracted. The results showed that the core process of social death in hip fracture is an intentional self-destruction for getting liberated from the conditions of the illness and the disrupted social life after the fracture, which ultimately leads to outcomes such as isolation-seeking and death ideations in these patients. The core category of liberating self-destruction reflects the close relationship between the context, process, and outcomes of social death. The process of social death is social, multidimensional, and complex. So far, no explanatory theory has been presented for this group of patients. Therefore, the results of this study can play an important role in designing helpful interventions for preventing, modifying, and changing the phenomenon of social death.

Investigating the correlation between hip abductor muscle strength and width in anteroposterior pelvic radiographs in hip revision candidates following previous total hip arthroplasty: a cross-sectional study.

The changes in strength of hip abductor muscles after total hip arthroplasty may depend on its anatomical parameters. In the present study the correlation between the strength of the hip abductor muscles before hip revision surgery and the diameter of the abductor muscles in the pelvic anterior posterior X-ray was investigated. Methods: This cross-sectional study included the patients underwent hip arthroplasty and were candidates for revision surgery. The diameter of the hip abductor muscles on the affected and unaffected sides were calculated based on plain radiography. Patients were also clinically examined and their abductor muscle strength on both sides were determined based on Medical Research Council Manual Muscle Testing scale. Results: A total of 51 patients were included in the study and after exiting 20 patients; finally 31 patients' data were analyzed. Based on results there was a significant correlation between the ratios of muscle strength and muscle diameter in affected side to unaffected side (r=0.517, P=0.003). As indicated in Table 3, such significant association was revealed in men (r=0.719, P=0.001), but not in women (r=-0.092, P=0.754). Also, this relationship was found to be significant in patients older than 60 years (r=0.529, P=0.011), not in the younger. Conclusion: In patients undergoing total hip arthroplasty revision surgery, there is a strong association between the ratio of strength and diameter of the abductor muscles in the affected side to the unaffected side especially in men and older ages.

Comparison of low-dose (162 mg) and high-dose (650 mg) Aspirin prophylaxis following total joint arthroplasty: a prospective cohort study.

Since Aspirin's adverse effects are dose-dependent, and evidence supporting the use of low-dose (LD) Aspirin in preventing venous thromboembolism (VTE) after total hip arthroplasty (THA) is weak, the authors do not know what the minimal effective dosage of Aspirin is to prevent VTE. This study aimed to compare the rates of 90-day symptomatic VTE following THA and total knee arthroplasty in healthy patients taking LD Aspirin vs. high-dose (HD) Aspirin for 6 weeks postoperatively. Materials and methods: A prospective cohort of patients with THA and total knee arthroplasty was conducted at two tertiary centres. Symptomatic VTE within 90 days of index arthroplasty was the primary outcome; gastrointestinal bleeding (GIB) and mortality were secondary outcomes. Results: The final analysis included 312 consecutive patients: 158 in the LD group and 154 in the HD group. Two groups were similar regarding preoperative data, including sex, age, BMI, smoking, diabetes mellitus, Hgb and platelet count, and type of surgery. The LD group had one deep vein thrombosis (0.6%), and the HD group had two (1.3%) (P=0.62). Neither group had PTE. Therefore, VTE rates are the same as deep vein thrombosis rates and similar between the groups (0.6% vs. 1.3%, P=0.62)Regarding GIB due to anticoagulant therapy, no patient in the LD group reported GIB, whereas two (1.3%) patients in the HD group reported GIB within 90 days of arthroplasty. GIB rates did not differ significantly between groups (P=0.24). Considering VTE + GIB combined, the HD groups showed a higher rate of complications (N=4, 2.6%) than the LD groups (N=1, 0.6%) but not statistically significant (P=0.21). Conclusions: Prophylactic administration of Aspirin with low doses (81 mg BID) and high doses (325 mg BID) for six weeks is equally effective at reducing VTE in total joint arthroplasty patients and had similar adverse effects. Level of Evidence: Therapeutic Level II.

Single High-Dose Systemic Methylprednisolone Administered Preoperatively Improves Pain Control and Sleep Quality After Total Hip Arthroplasty: A Double-Blind, Randomized Controlled Trial.

Background: This study was performed to evaluate the efficacy of preoperative high-dose methylprednisolone on pain levels and sleep quality following primary total hip arthroplasty. Material and methods: A double-blind, randomized controlled trial was performed in adults underdoing total hip arthroplasty. A computer-generated, permuted-block randomization scheme with a 1:1 ratio between the intervention (125 mg methylprednisolone) and control groups (normal saline) was utilized. Patients underwent a similar preoperative and postoperative protocol. Pain was assessed using the visual analog scale (VAS). Sleep quality was assessed at the 2-week postoperative visit using the Pittsburgh Sleep Quality Index (PSQI). Results: With a total of 70 patients, 35 patients were included in the intervention and placebo groups. Hospital stay was significantly shorter in the intervention group (1.5 ± 0.7 vs 2.0 ± 0.5 days, P = .03). Preoperative pain levels were similar between groups, while satisfactory pain control was achieved in a significantly larger number of patients in the intervention group (18 vs 8 patients, P = .009). The intervention group was significantly more likely to have a good sleep quality than the placebo groups (74% vs 31%, P = .001). No significant differences were found between preoperative and postoperative blood sugar levels. We did not observe any cases of early postoperative wound complication, infection, or deep vein thrombosis among our patients. Conclusion: In this randomized controlled trial, preoperative administration of 125 mg of methylprednisolone was found to improve pain control, as measured by VAS, 24 hours after surgery, and sleep quality, as measured by PSQI, 2 weeks following surgery.

Social death in patients: Concept analysis with an evolutionary approach.

Social death is an important concept that should be considered in a wide range of patients, especially in chronic diseases. Despite, there is still no clear and comprehensive definition of social death in medicine. The present study was thus conducted with Rodgers' evolutionary concept analysis method to identify the key features and provide a clear definition of social death in patients and understand its background and consequences. Considering the stages of concept analysis, an initial search was carried out in scientific databases (PubMed, Science Direct, Google Scholar, Magiran, and SID) without time limit until 2020. The search resulted in 400 articles in the first stage, which were screened according to the study objective and, all the items and points consistent with the concept's attributes, antecedents, consequences, associated concepts, alternative terms and definition were extracted. According to the results of different studies, the attributes of social death in patients can be classified into three main themes: The loss of social identity, loss of social relations (social isolation), and deficiencies related to the inefficiency of the body and various diseases. Generally, antecedents' social death in patients can be including; the factors related to the patient, Family neglect, Medical personnel's treatment of the patient as a corpse, Having no social situation. Also, there is little information available about the effect of social death on the patients themselves and their families, specialists, health care institutions and the society. Mankind's perception of social death is multidimensional and may have consequences such as bad death, disgraceful death deprivation of belonging to the society, financial vulnerability, removed or weakened legal support, stigma, and the loss of social identity. The proper understanding of social death in patients not only determines the role and importance of care in the process of incidence of this phenomenon, but also paves the way for designing an evidence-based care program for its prevention and control.

Evaluation of the Degenerative Changes of the Distal Intervertebral Discs after Internal Fixation Surgery in Adolescent Idiopathic Scoliosis.

STUDY DESIGN: Retrospective study. PURPOSE: Lumbar intervertebral disc degeneration is an important cause of low back pain. OVERVIEW OF LITERATURE: Spinal fusion is often reported to have a good course for adolescent idiopathic scoliosis (AIS). However, many studies have reported that adjacent segment degeneration is accelerated after lumbar spinal fusion. Radiography is a simple method used to evaluate the orientation of the vertebral column. magnetic resonance imaging (MRI) is the method most often used to specifically evaluate intervertebral disc degeneration. The Pfirrmann classification is a well-known method used to evaluate degenerative lumbar disease. After spinal fusion, an increase in stress, excess mobility, increased intra-disc pressure, and posterior displacement of the axis of motion have been observed in the adjacent segments. METHODS: we retrospectively secured and analyzed the data of 15 patients (four boys and 11 girls) with AIS who underwent a spinal fusion surgery. We studied the full-length view of the spine (anterior-posterior and lateral) from the X-ray and MRI obtained from all patients before surgery. Postoperatively, another full-length spine X-ray and lumbosacral MRI were obtained from all participants. Then, pelvic tilt, sacral slope, curve correction, and fused and free segments before and after surgery were calculated based on Xray studies. MRI images were used to estimate the degree to which intervertebral discs were degenerated using Pfirrmann grading system. Pfirrmann grade before and after surgery were compared with Wilcoxon signed rank test. While analyzing the contribution of potential risk factors for the post-spinal fusion Pfirrmann grade of disc degeneration, we used generalized linear models with robust standard error estimates to account for intraclass correlation that may have been present between discs of the same patient. RESULTS: The mean age of the participant was 14 years, and the mean curvature before and after surgery were 67.8 and 23.8, respectively (p<0.05). During the median follow-up of 5 years, the mean degree of the disc degeneration significantly increased in all patients after surgery (p<0.05) with a Pfirrmann grade of 1 and 2.8 in the L2-L3 before and after surgery, respectively. The corresponding figures at L3-L4, L4-L5, and L5-S1 levels were 1.28 and 2.43, 1.07 and 2.35, and 1 and 2.33, respectively. The lower was the number of free discs below the fusion level, the higher was the Pfirrmann grade of degeneration (p<0.001). Conversely, the higher was the number of the discs fused together, the higher was the Pfirrmann grade. CONCLUSIONS: we observed that the disc degeneration aggravated after spinal fusion for scoliosis. While the degree of degeneration as measured by Pfirrmann grade was directly correlated by the number of fused segments, it was negatively correlated with the number of discs that remained free below the lowermost level of the fusion.

A New Modified Method for Inserting Iliosacral Screw versus the Conventional Method.

STUDY DESIGN: Methodological study. PURPOSE: To our knowledge, this is the first study to introduce a new modified method for inserting iliosacral screws and to compare its results with those of a conventional method. OVERVIEW OF LITERATURE: Previous techniques, such as open reduction and internal fixation, are associated with perioperative hemorrhage, postoperative infection, and neurological deficits. Although percutaneous iliosacral screw insertion confers the advantage of being minimally invasive, leading to less blood loss and a low postoperative infection rate, it harbors the risk of screw malpositioning due to narrow sacral proportions and a high interindividual variability. METHODS: Nine cadaveric pelvises were included in this study, with one hemipelvis of each being assigned to the new modified method and the other to the conventional iliosacral screw insertion method. In the new modified method, the guidewire entry point was determined using a lateral sacral X-ray. To do so, we first identified the anterosuperior quadrant of the S1 body on one hemipelvis. The anterosuperior quadrant was further divided into four imaginary quadrants, and the guidewire was inserted into the posteroinferior quadrant. The guidewire trajectory was perpendicular to the sagittal plane so that the guidewire resembled a single point in the lateral sacral view. Guidewires were inserted into corresponding hemipelves using the conventional method as described in the literature. Subsequently, an axial computed tomography scan with 1-mm fine cuts was obtained, and sagittal and coronal views were reconstructed. The distance of the guidewire from the sacral canal, anterior sacral cortex, and first sacral foramen was measured in axial, sagittal, and coronal views. The minimum measurement among different views was defined as the safety index of the insertion methods. The conventional and new modified methods were then compared in terms of safety and duration of the procedure. RESULTS: The minimum distance of the guidewire from the S1 foramen and anterior sacral cortex was not significantly different between the two methods. However, the minimum distance between the guidewire and sacral canal was significantly greater in the new modified method than in the conventional method. The duration of guidewire insertion was significantly shorter in the new modified method than in the conventional method. CONCLUSIONS: This new modified method of iliosacral screw insertion could be safely and simply implemented while taking less surgical time than the conventional methods.

Iranian Joint Registry (Iranian National Hip and Knee Arthroplasty Registry).

Periodic evaluation and monitoring the health and economic outcome of joint replacement surgery is a common and popular process under the territory of joint registries in many countries. In this article we introduce the methodology used for the foundation of the National Iranian Joint Registry (IJR) with a joint collaboration of the Social Security Organization (SSO) and academic research departments considering the requirements of the Iran's Ministry of Health and Education.

A comparative study between multiple cannulated screws and dynamic hip screw for fixation of femoral neck fracture in adults.

PURPOSE: In younger adults with fractures of the femoral neck, anatomic reduction is compulsory and maintaining the reduction is crucial. Both cannulated screws and dynamic hip screw (DHS) have the capacity of compression in the fracture site but the strength for keeping reduction is not the same. The aim of this study was to compare the results with fixations of the femoral neck fractures with cannulated screws versus dynamic hip screw. METHODS: This is a randomized clinical trial study on 58 cases with a minimum of one year follow-up. Leg length discrepancy, Harris Hip Score, infection, avascular necrosis of femoral head, and union of the fracture site were evaluated. RESULTS: There were two failures in the first trimester in the cannulated screw group and three more failures in the second and third trimesters in this group. In the DHS group, there was no reduction and fixation failure in the follow-up period. There was no fixation failure (0 %) in Group B (DHS) but there were five fixation failures (18 %) in Group A (screw), and there is significant difference between the groups (p < 0.001). The rate of avascular necrosis was the same in both groups. CONCLUSIONS: It seems to us that in our practice the fixation of femoral neck fracture in young adults with the DHS is a better option compared with the osteosynthsis with multiple cannulated screws.

Subtrochanteric Fractures: Comparison of Proximal Femur Locking Plate and Intramedullary Locking Nail Fixation Outcome.

Fixation of subtrochanteric fracture, even for experienced surgeons, is a challenge. This fracture is most difficult to treat, and the incidence of complications in this type of fracture is higher. This study compared surgical results of two methods, proximal femur locking compression plate and intramedullary locking nail. This is an analytic study, performed on all patients with subtrochanteric fracture who were referred to the hospital during 3 years. They were treated with proximal femur locking plate or intramedullary locking nail. The postoperative complications were evaluated and recorded. Finally, the data were analyzed by SPSS software. Complications were studied in both groups. Neither treatment has statistically significant difference in complications, onset of complications incidence, and time of full-weight bearing. Although the Harris Hip Score among patients improved in both methods of treatment, there is no significant difference between the two groups. The results of subtrochanteric fracture fixation by intramedullary or locking plate were similar and had the same outcome.

Clinical outcomes of total hip arthroplasty in patients with ankylosed hip.

BACKGROUND: Hip ankylosis includes the limitation of hip motion and hip arthroplasty is the recommended treatment. This study aimed to evaluate the clinical and radiographic outcomes in the treatment of ankylosis of the hip joint by the Harris Hip Score (HHS). METHODS: This interventional study was performed on patients with ankylosis in one or both hip joints, who were referred to Sina Hospital, Tehran, Iran from 2011-13. Electromyogram and nerve conduction studies were taken from the hip abductor muscles before surgery and HHS was calculated. Type of surgery and prosthesis, osteotomy required for the neck and trochanteric region of the femur, periprosthetic fracture and the need to restore the acetabulum were studied in the patients. Postoperative complications such as infection and dislocation at 3, 6 and 12 months after surgery were examined and then the HHS was calculated. RESULTS: Six patients were excluded after six month and two patients were excluded after 12 month due to surgery complications. The mean HHS of patients before surgery was 48.53±6.28 and it progressed to 88.22±3.78 after 12 month (P<0.001). CONCLUSIONS: Total hip arthroplasty for patients with ankylosed hip can improve the range of joint motion, especially in the long-term follow-up. However, good results should be considered in the absence of pre- and post-operative complications.

Plantar fasciitis.

Heel pain, mostly caused by plantar fasciitis (PF), is a common complaint of many patients who requiring professional orthopedic care and are mostly suffering from chronic pain beneath their heels. The present article reviews studies done by preeminent practitioners related to the anatomy of plantar fasciitis and their histo-pathological features, factors associated with PF, clinical features, imaging studies, differential diagnoses, and diverse treatment modalities for treatment of PF, with special emphasis on non-surgical treatment. Anti-inflammatory agents, plantar stretching, and orthosis proved to have highest priority; corticosteroid injection, night splints and extracorporeal shock wave therapy were of next priority, in patients with PF. In patients resistant to the mentioned treatments surgical intervention should be considered.

Ochronosis of hip joint; a case report.

BACKGROUND: Ochronosis is connective tissue manifestation of Alkaptonuria. Joint involvement specially hip and knee destruction is seen. The cartilage is pigmented and destroyed. It is interested for both pathologists and orthopedic surgeons. CASE PRESENTATION: A 54 years old woman with hip fracture after simple falling is candidate for surgery, but, after skin and subcutaneous incision over deep fascia there was dark blue pigmentation which continues toward hip joint. After biopsy of soft tissues and bone, in another operation, we replace hip joint. CONCLUSION: In this case, besides of cartilage destruction of hip joint, there was a lythic lesion of neck of femur which causes pathologic fracture of hip joint. We planned Total hip replacement instead of bipolar for her because of cartilage damage of acetabulum.

The predictive value of extensor grip test for the effectiveness of treatment for tennis elbow.

OBJECTIVE: To compare the effectiveness of 5 different modalities, and determine the usefulness of recently proposed extensor grip test (EGT) in predicting the response to treatment. METHODS: In a randomized controlled clinical trial, 92 of 98 tennis elbow patients in Sina Hospital Tehran, Iran between 2006 and 2007 fulfilled the trial entry criteria. Among these patients 56 (60.9%) had positive EGT result. The stratified EGT result, were randomly allocated to 5 treatment groups: brace, physiotherapy, brace plus physiotherapy, injection, and injection plus physiotherapy. RESULTS: Patients with a positive EGT result had better response to treatments. Among them, injection plus physiotherapy was the most successful, then brace plus physiotherapy, physiotherapy, and brace injection was the worst treatment modality. Response to treatment was comparable in all groups between EGT positive and negative patients except bracing, in which positive EGT was correlated with a dramatic response to treatment. CONCLUSION: In all patients, injection plus physiotherapy and then brace plus physiotherapy is recommended, but in EGT negatives, bracing seems to be of no use. Injection alone is not recommended in either group.