Glenoid osteotomy with various tendon transfers for brachial plexus birth palsy: clinical outcomes.

BACKGROUND: Posterior shoulder dislocation is one of the disabling complications of brachial plexus birth injury (BPBI), and various treatment options including capsule and surrounding muscles release for open reduction, humeral derotational osteotomy, and tendon transfers have been recommended to manage it. In the present study, we aimed to determine the clinical outcome of open reduction with soft tissue release, tendon transfer, and glenoid osteotomy in patients with BPBI and posterior shoulder dislocation or subluxation. METHODS: From 2018 to 2020, 33 patients who underwent open reduction, glenoid osteotomy, and tendon transfer were included. The glenohumeral deformity was classified according to the Waters radiographic classification. Functional assessment was performed using the Mallet grading system before and at least 2 years after the surgery. RESULTS: The patients were monitored for 26.88 ± 5.47 months. Their average age was 27.5 ± 14 months. Significant improvement was seen in the overall Mallet score (from 13.5 to 18.91 points) and its segments including hand-to-mouth, hand-to-neck, global abduction, global external rotation, abduction range of motion (ROM), and external rotation ROM. Hand-to-back score and the presence of a Trumpet sign were significantly decreased in the postoperation phase (all P values < .001). The above-mentioned variables significantly changed for both infantile and noninfantile dislocations. CONCLUSION: Our study demonstrated that open reduction along with glenoid osteotomy improves retroversion, and muscle strengthening with different muscle transfers is an effective technique for BPBI.

Effect of joint immobilization using extension splint immediately after total knee arthroplasty on post-operative knee function and pain: a randomized clinical trial.

PURPOSE: Investigate the effect of semirigid extension bracing after total knee arthroplasty (TKA) on articular pain and function. METHODS: The present randomized clinical trial included 72 patients undergoing unilateral primary TKA. Patients in the case group received eight days of post-operative semirigid extension-locked knee bracing, whereas controls did not. The outcomes assessed preoperatively and on the first, ninth, 30th day, and one year post-operatively included the knee society score (KSS), functional KSS (FKSS), VAS pain score, amount of postoperative opiate painkiller usage (tablet oxycodone 5mg), and knee ROM. RESULTS: The case group had a significantly lower flexion ROM on postoperative day nine compared to the control group (95.3° vs. 100.8°, p=0.03), while it became significantly higher 1 month (114.1° vs. 104.7°, p=0.03) and one year post-operative (128.0° vs. 120.5°, p=0.002). Also, FKSS was significantly higher in the case group than in the controls in the one month post-operative assessment (37.0 vs. 32.6, p=0.009) but not in the one year post-operative assessment. The case group patients had a significantly lower pain than the controls on days one (5.8 vs. 7.2, p=0.02) and nine post-operative (4.1 vs. 5.2, p=0.048), but not at later assessments. The amount of one month post-operative opium (oxycodone) consumption was significantly lower in the brace group (12.4 vs. 14.1 tablets, p=0.03). The KSS were not significantly different between the groups after the surgery. CONCLUSION: Extension-locked splinting immediately after TKA is a noninvasive, non-pharmacological, and inexpensive intervention with possible promising effects on knee ROM, short-term functional improvement, and acute post-operative pain management.

Restoring femoral medial offset could reduce pelvic obliquity following primary total hip arthroplasty, an observational study.

BACKGROUND: Since femoral and horizontal offsets may be contributing factors to hip and pelvic balance, this study seeks to determine whether there is a correlation between pelvic obliquity (PO) after unilateral total hip arthroplasty (THA) and horizontal/vertical offset differences of the replaced and contralateral natural joints. METHODS: A cross-sectional study was performed on adult patients who underwent unilateral THA between 2017 and 2020. An expert orthopaedic resident measured PO angles and offset parameters. "Delta medial offset" is considered medial offset of the replaced hip minus the medial offset of the contralateral side. "Absolute delta medial offset" is considered the absolute value of the "Delta medial offset." RESULTS: Finally, 133 patients were included in the study with a mean (SD) age of 45.3 ± 14.8 years and 57.9% female. The PO values (median, IQR) changed from 3.2 (1.7-5.7) before THA to 3.0 (1.50-5.6) after THA, not significantly decreased (P = 0.31). The PO after THA is significantly correlated with PO before THA (correlation coefficient of 0.457, P < 0.001), the delta medial offset after THA (correlation coefficient of - 0.24, P = 0.006), and the absolute delta medial offset after THA (correlation coefficient of 0.284, P = 0.001). The amount of changes of delta medial offset, before and after surgery, was not significantly correlated to PO or PO changes after surgery. CONCLUSION: PO before the THA and medial offset discrepancy after THA are two important contributing factors for post-operative PO. Restoring the medial offset of the affected side and lowering the delta medial offset between the two sides can significantly decrease post-operative PO.

White matter abnormalities in paediatric obsessive-compulsive disorder: a systematic review of diffusion tensor imaging studies.

Microstructural alterations in white matter are evident in obsessive-compulsive disorder (OCD) both in adult and paediatric populations. Paediatric patients go through the process of maturation and thus may undergo different pathophysiology than adult OCD. Findings from studies in paediatric obsessive-compulsive disorder have been inconsistent, possibly due to their small sample size or heterogeneous populations. The aim of this review is to provide a comprehensive overview of white matter structures in paediatric obsessive-compulsive disorder and their correlation with clinical features. Based on PRISMA guidelines, we performed a systematic search on diffusion tensor imaging studies that reported fractional anisotropy, mean diffusivity, radial diffusivity, or axial diffusivity alterations between paediatric patients with obsessive-compulsive disorder and healthy controls using voxel-based analysis, or tract-based spatial statistics. We identified fifteen relevant studies. Most studies reported changes predominantly in the corpus callosum, cingulum, arcuate fasciculus, uncinate fasciculus, inferior longitudinal fasciculus, superior longitudinal fasciculus, inferior fronto-occipital fasciculus, corticospinal tract, forceps minor and major, and the cerebellum in paediatric obsessive-compulsive disorder. These alterations included increased and decreased fractional anisotropy and radial diffusivity, and increased mean and axial diffusivity in different white matter tracts. These changes were associated with obsessive-compulsive disorder symptoms. Moreover, specific genetic polymorphisms were linked with cerebellar white matter changes in paediatric obsessive-compulsive disorder. White matter changes are widespread in paediatric OCD patients. These changes are often associated with symptoms however there are controversies in the direction of changes in some tracts.

Predictors of Core Decompression Success in Patients with Femoral Head Avascular Necrosis.

Background: Avascular necrosis of the femoral head typically occurs in the young population. Core decompression in the precollapse stage provides pain relief and preservation of the femoral head. The results of core decompression vary considerably despite the early diagnosis. Clinicians concur that primary treatment should focus on preserving the natural surface of the joint. This study investigated the predictive risk factors of failure in femoral head decompression. Methods: We retrospectively reviewed 135 patients and 207 hips (77 male (127 hips) and 58 female (80 hips)) who underwent core decompression (mean age: 34.7 years [age range: 21-71]) from April 2010 to December 2017. All patients were followed by a mean of 57 months. All hips were in the precollapse stage (Ficat I, II). Results: A total of 207 hips were treated with core decompression surgery, and the overall success rate was 58%. The higher grade of Kerboul, Ficat, ARCO classifications, multifocal avascular necrosis of the femoral head, smoking, opium, and corticosteroids were significantly associated with a higher failure rate after core decompression in univariate analysis. In multivariate logistic regression analysis, the Kerboul and Ficat classifications, alcohol consumption, and multifocal avascular necrosis of the femoral head were significantly correlated with core decompression failure. The most common predictive factors in core decompression failure were Ficat II, Kerboul stage 3, multifocal avascular necrosis of the femoral head, and alcohol consumption. Conclusion: In conclusion, we had an overall 58 % success rate in core decompression of femoral head avascular necrosis. Based on the results of this study, imaging evaluation and imaging-based classifications are the most valuable predictor factors for the success of core decompression. Consistent with previous reports, corticosteroid was not a significant predictor of core decompression failure.

Simultaneous femoral head reduction osteotomy (FHRO) combined with periacetabular osteotomy (PAO) for the treatment of severe femoral head asphericity in Perthes disease.

BACKGROUND: The purpose of this study is to describe the midterm clinical and radiologic outcomes of concurrent femoral head reduction osteotomy (FHRO) and periacetabular osteotomy (PAO) in Legg-Calvé-Perthes disease (LCPD) patients with major aspherical femoral head deformities. METHODS: The study included four Perthes patients in Stage IV of Waldenstrom's classification with a mean age of 10.5 and severe femoral head asphericity. They were treated with a combination of FHRO + PAO and followed for at least 2 years. An evaluation of the radiological outcome of the surgery was carried out based on the lateral center to edge angle (LCEA), the anterior center to edge angle (ACEA), the Tönnis angle, the head sphericity index, the Stulberg classification, the extrusion index, and Shenton's line integrity. An evaluation of the clinical outcome was made by evaluating hip range of motion (ROM), Harris hip score (HHS), and Merle d'Aubigne´-Postel score. RESULTS: All radiographic measures improved; three patients were classified as Stulberg class II and one as class III. The LCEA, ACEA, and Tönnis angle improved by 29° (from 3° to 32°), 16° (from 14° to 30°), and - 10° (from 18° to 8°), respectively. The mean femoral head sphericity index and extrusion index improved by 12% (from 83 to 95%) and - 33% (from 40 to 7%). No disruption was observed in the postoperative Shenton's line. According to HHS, all patients have shown excellent hip function, which improved by 27 points (from 69 to 96). Moreover, the hip ROM was increased from 222° to 267°. The follow-up period did not reveal any serious postoperative complications, such as osteonecrosis or conversion to arthroplasty. CONCLUSIONS: Combined FHRO with PAO may improve the hip joint's morphology and function in patients with residual femoral head deformity and acetabular dysplasia due to LCPD. Despite being considered a complex and demanding hip surgery, these results suggest a more widespread implication of the salvage procedure.

Scientometric Analysis of the Top 50 Most-Cited Joint Arthroplasty Papers: Traditional vs Altmetric Measures.

Background: Alternative scientometric measures have introduced a novel view of the scientific literature. This study aimed to identify the top 50 most-cited recent articles in the field of knee and hip arthroplasty, characterize their traditional and alternative scientometric measures, and determine the relationship between traditional and alternative scientometric measures. Material and methods: The 50 most-cited articles with the term "arthroplasty" in the title that were published between 2015 and 2019 were retrieved from the Scopus database. Alternative scientometric parameters such as Altmetric Attention Score (AAS) from Altmetrics bookmarklet (Altmetrics.com) were retrieved. Scientometric variables such as journal impact factor, first author H-index, and keywords were also extracted. Results: The 50 most-cited papers accrued 7955 total citations, with a mean of 159.10 ± 56.4 citations per article. The overall mean AAS across the papers was 63.4 ± 164.8. The mean first author's H-index was 23.8 ± 18.9. Papers published in 2017 and 2018 had a significantly higher mean AAS than those published in 2015 and 2016 (35.1 vs 22.5, P = .009). Citation count was weakly correlated with the AAS (correlation coefficient = 0.379, P = .009). Also, AAS had significant correlations with the journal's impact factor (P < .001). Conclusion: We found that the AAS was highest in more recently published papers, while citation count had the opposite trend. The AAS was significantly correlated with the journal's impact factor and citation count, but the correlation is weak. This suggests that the alternative scientometric measures are complementary to, and not substitutes for, complement traditional measures such as citation count and impact factor.

Comparison of hook plate versus T-plate in the treatment of Neer type II distal clavicle fractures: a prospective matched comparative cohort study.

BACKGROUND: This study aimed to compare the clinical and radiological outcomes of distal clavicle fracture fixation with a hook plate versus the standard non-locking T-plate for unstable Neer type II fractures. METHODS: A prospective matched cohort study including two groups of hook plates and T-plates fixation was conducted in our two tertiary trauma centers. Patients with distal clavicle fractures Neer type II were assessed for union and the Constant-Murley score (CMS) at 1-, 3-, and 6-month follow-ups. Inadequate radiographic consolidation > 6 months after surgery was defined as non-union. Subscales of CMSpain, CMSactivities of daily living, CMSrange of motion (ROM), and CMSstrength were also compared between groups. According to recommendations, the implant was removed after union confirmation in the hook plate at a planned second surgery. RESULTS: Sixty consecutive patients were enrolled: 30 in the T-plate group and 30 in the hook plate group. CMS showed similar functional outcomes for T-plates and hook plates at all follow-ups (Month 6: 92.0 vs. 91.7, P = 0.45). However, on the month 1 follow-up, the T-plate group scored higher than the hook plate group for ROM and pain (CMSpain = 13.0 vs. 12.3, P = 0.03; CMSROM = 35.2 vs. 33.2, P = 0.002). Despite this, Pain, ROM, and other CMS domains were comparable between groups (P > 0.05). The mean time to union was 2.5 + 1.4 months for the T-plate group and 2.3 + 1.6 months for the hook plate group (P = 0.44). There was one fixation failure in each group and one periprosthetic fracture in the hook plate group (two revisions for the hook plates and one for T-plates, P = 1.00). Non-union and other complications were not observed. CONCLUSION: Both surgical approaches resulted in full recovery and good function. However, in the hook plate group ROM and pain scores were lower at 1 month. Standard non-locking T-plates are a viable alternative to hook plates with low cost and promising outcomes for treating displaced distal clavicle fractures.

Broken pin removal from hip joint using arthroscopic grasper - A technical note and review of literature.

Guidewire breakage during a surgical procedure is uncommon but still challenging for orthopedic surgeons. Due to the potential for harmful complications, surgeons prefer to remove broken wires near the joint surface or neurovascular bundle in the hip region. Due to the depth of the location, the retrieval procedure is arduous, time-consuming, and potentially dangerous. This study describes a case of a sub-capital femoral neck fracture that was fixed with a cannulated screw. However, three years later, the distal portion of the guidewire broke and migrated into the hip joint, where it became entrapped. This study describes a method for removing a broken wire from the hip region and a relevant literature review. In brief, initially, we untightened the screw and removed it. Afterward, the broken wire was reached by reaming in the direction of the screw. Ultimately, we advanced the arthroscopic grasper to the broken wire for removal under fluoroscopic guidance. The study's findings indicate that this method could provide a promising outcome with minimal complications.

Percutaneous sacroiliac screw fixation in a pediatric with unstable bilateral superior rami and sacral fracture-dislocation; a case report and review of the literature.

Complex pelvic ring injuries in childhood can be difficult to treat, and literature mentions several techniques for fixing SIJ fracture-dislocations. In accordance with the CAse REport (CARE) guidelines, this study describes a five-year-old boy with a complex pelvic ring fracture caused by a car accident: vertically unstable pelvic fracture consists of bilateral superior rami fractures and type I of Denis sacral fracture. Fixation was achieved by inserting a 6.5 mm major diameter cannulated screw with a 60 mm length and 16 thread into the SIJ at the level of S1. The pelvic inlet view corrected the anterior-posterior position, and the pelvic outlet view adjusted the superior-inferior position to determine a suitable sacral level. After three months, the SI joint has shown an anatomically fracture consolidation, and he could ambulate with full weight-bearing and full ROM with no pain. A 3-year follow-up showed promising results in radiological and functional terms. We conclude that percutaneous SI screw fixation using a cannulated screw is a suitable technique for pediatrics because it provides anatomic reductions and is minimally invasive. Children as young as five can be treated safely with SI screws for sacral fractures and SIJ injuries.

Incidence of Symptomatic COVID-19 in Unvaccinated Patients Within One Month After Elective Total Joint Arthroplasty: A Multicenter Study.

BACKGROUND: The safety of continuing total joint arthroplasty (TJA), as an elective procedure, during the pandemic is controversial. The present study aimed to investigate the incidence of symptomatic coronavirus disease 2019 (COVID-19) and its related risk factors in unvaccinated patients after TJA within 1 month after discharge in 2 large cities of our country. MATERIAL AND METHODS: The present prospective study included all the patients admitted to 3 hospitals, located in Tehran and Isfahan, 2 highly populated cities of Iran, from April 1, 2020, to April 1, 2021, for elective TJA. Urgent TJA (traumatic fractures) were excluded. The primary outcome was symptomatic COVID-19 within 1 month after discharge that was diagnosed using the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription polymerase chain reaction test. Afterward, the incidence of COVID-19 in the study population was compared with that in the general population to estimate the safety of elective TJA during the pandemic. RESULTS: From the 1007 patients undergoing TJA, 755 patients met the inclusion criteria. None of the patients was vaccinated against COVID-19. Among them, 18 patients (2.4%) developed symptomatic COVID-19 within 1 month after discharge. In the same time interval, the incidence of COVID-19 was 2.2% in the general population of these 2 cities, which was similar to the incidence reported in the study population. Of the patients who were positive for COVID-19, 4 patients were hospitalized, and 3 of them were admitted to an intensive care unit; however, no mortality was reported. CONCLUSION: The TJA will be a safe elective procedure for the patients during the pandemic if the preventive protocols are followed strictly.

Odontoid fracture complicating ankylosing spondylitis presenting with cervical canal stenosis and quadriparesis: A case report with 5-year follow-up and review of the literature.

INTRODUCTION AND IMPORTANCE: Spinal fractures, especially cervical fractures, are more common in patients with ankylosing spondylitis in comparison with unaffected patients. However, odontoid fractures are relatively rare in these patients. Also, neurological symptoms are not common in odontoid fractures due to the larger diameter of the spinal canal at this level. CASE PRESENTATION: Here, we presented a 41 year-old man known case of ankylosing spondylitis who develop odontoid fracture and severe cervical stenosis after falling trauma. Quadriparesis and positive Hoffman sign as well as significant thoracolumbar kyphosis were diagnosed in further investigation. Laminectomy and posterior fixation were executed primary and pedicular subtraction osteotomy was performed two years later to manage the kyphosis and sagittal imbalance. On the follow-up period of five years the patient was fully functional. CLINICAL DISCUSSION: There are a few cases of odontoid fractures complicating ankylosing spondylitis in the literature. Neurological symptoms are relatively uncommon in odontoid fractures; however, cases with AS can present with neck pain, weakness, and hyperreflexia when having unstable fractures. CONCLUSION: Although there is not any gold standard for the treatment of the odontoid fracture in AS, surgical intervention is preferred.

Anterior cruciate ligament injury and its postoperative outcomes are not associated with polymorphism in COL1A1 rs1107946 (G/T): a case-control study in the Middle East elite athletes.

BACKGROUND: It is unclear what role COL1A1 polymorphisms play in anterior cruciate ligament (ACL) injury pathophysiology. The present study investigated the relationship between COL1A1-1997 guanine (G)/thymine (T) (rs1107946) polymorphism and ACL injury. Moreover, the possible effect of this polymorphism on the postoperative outcomes of ACL reconstruction surgery was evaluated. METHODS: This prospective case-control study was performed on 200 young professional men with an ACL tear who underwent arthroscopic ACL reconstruction surgery. Moreover, 200 healthy athletes without a history of tendon or ligament injury who were matched with the case group were selected as the control group. DNA was extracted from the leukocytes of participants, and the desired allele was genotyped. Clinical outcomes were collected for the case group before and one year after surgery. RESULTS: The genotype distribution was in accordance with the Hardy-Weinberg principle. In the ACL injury group, the G allele frequency was non-significantly higher than the healthy controls, with an odds ratio [95% CI] of 1.08 [0.79-1.47] (P = 64). We did not find a significant difference between the genotype of individuals-GG, GT, and TT-in the case and control groups (P > 0.05). Clinical outcomes of the ACL tear group were significantly improved in terms of preoperative values. However, none of them were significantly different between the three genotypes (GG, GT, and TT). CONCLUSION: According to the findings of the present investigation, single-nucleotide polymorphism (SNP) at COL1A1 rs1107946 (G/T) was not a predisposing genetic factor for ACL injury in a young professional male athlete population in the Middle East. Furthermore, patients' responses to treatment were not different between distinct genotypes.

Complication of lengthening and the role of post-operative care, physical and psychological rehabilitation among fibula hemimelia.

There is a clear clinical need for efficient physiotherapy and rehabilitation programs during and after bone lengthening and reconstruction for gaining the optimal effect and also prevention or treatment of lengthening side effects. Pin tract infection is the most prevalent side effect during lengthening which could be prevented and treated initially via proper wound care. Muscle contractures are typically a consequence of the generated tension on the distracted muscle. It can be managed by physiotherapy initially and surgically in later severe stages. Furthermore, it is essential to avoid muscle contracture development, which is the demonstration of the imbalanced muscle appeals on the joint to inhibit the following subluxation. The knee is the furthermost affected joint by the aforementioned problem due to the inherent lack of ligamentous and bony stability. Joint stiffness is the other possible unfavorable effect of lengthening. It happens because of extensive muscle contractures or may possibly be attributed to rigidity of the joint following the amplified pressure on the joint surface during the process of lengthening. Physiotherapy and occupational therapy including endurance and strength exercise as well as stretching play an important role during the rehabilitation periods for the prevention and also the treatment of muscle contracture and the following deformity and also joint stiffness. Likewise, the effect of mental and physical rehabilitation programs should not be overlooked.

Femoral Stem Dislocation Caused by Trunnionosis Along with Adverse Local Tissue Reaction: A Case Report and a New Technique of Head to Cone Cementing.

In total hip replacement (THR), fretting and corrosion at the modular head-neck junction (trunnionosis) may cause adverse local tissue reaction (ALTR). In this report, we presented a 34 years woman with a history of THR eight years ago, presenting with acute pain and limping. The radiographic assessment revealed stem-head dislocation for which a revision hip surgery was planned. Surprisingly, we observed pseudotumor and tissue necrosis resulting from the body's reaction to cobalt-chromium alloy. The revision surgery entailed pseudotumor debridement and replacing the femoral head with a new metal head (size 36, long). Due to the separation of the femoral head on a stem, we fixed it on a stem using bone cement. The stem (Omnifit®, Stryker®) was well-fixed and retained to avoid fractures and infection risk. This technique revealed an acceptable outcome without recurrence of ALTR after a one-year follow-up. Our findings suggest that stem dislocation secondary to trunnionosis might be a long-term complication after THR with subsequent ALTR.

Evaluation of Crossover Sign in Pelvis Models Made with a Three-Dimensional Printer.

Introduction: Investigation of the crossover sign (COS) in different degrees of tilt in pelvises made by three-dimensional printing of CT scans among patients with normal hip versions was carried out. Methods: Radiology CT scans of 8 normal pelvises reconstructed in 3D and the effect of sequential tilting on the presence of the false-positive COS in 48 radiographs were investigated. Results: The COS was seen in 77% of the AP radiographs during tilt changes. The average distance between the tip of the coccyx and the symphysis pubis was 32.06 ± 10.99 mm. Also, COSs were present in all radiographs from 6 degrees tilt and above. Conclusion: Minor tilting of the pelvis can result in a false-positive crossover sign on AP plain radiographs.

Determining the accuracy of preoperative total hip replacement 2D templating using the mediCAD® software.

BACKGROUND: Templating is a preoperative planning procedure that improves the efficiency of the surgical process and reduces postoperative complications of total hip arthroplasty (THA) by improving the precision of prediction of prosthetic implant size. This study aimed to evaluate the accuracy of the preoperative cup and stem size digital 2D templating of THA with mediCAD® software and find the factors that influence the accuracy, such as indication for surgery, patients' demographics, implant brand, and the assessors' grade of education. METHODS: We retrospectively retrieved 420 patient template images of all patients who underwent THA between March 2018 and March 2021. Templating of all included images was processed using mediCAD® software a day before surgery by a newcomer physician to hip arthroplasty course (PGY-2 orthopedic resident or hip surgery fellow). Preoperative templating cup and stem sizes were compared with the actual inserted implant sizes. RESULT: After excluding ineligible patients, this study included 391 patients, 193 (49.4%) males and 198 (50.6%) females with a mean age of 43.3 ± 14.9. The average cup sizes predicted before and after surgery were 52.12 ± 14.28 and 52.21 ± 15.05 respectively, and the mean delta cup size (before and after surgery) was 2.79 ± 2.94. The delta stem size before and after surgery has a mean value of 1.53 ± 1.49. The acetabular cup components, measured within ± 0, ± 1, and ± 2 sizes, were 28.9%, 63.9%, 83.1% accurate, respectively. The femoral stem design component measured within ± 0, ± 1, and ± 2 sizes were 27.2%, 61.0%, 78.6% accurate, respectively. Wagner Cone® stem brand, DDH patients, and females showed significantly higher accuracy of stem size templating. Revision THA has the lowest accuracy in terms of cup size templating. The compression of accuracy rate between resident and fellow revealed no significant differences. Also, no significant difference was detected between the accuracy of templating performed in the first months with the second months of the arthroplasty course period. CONCLUSION: Our study showed that under mentioned condition, templating using mediCAD® has acceptable accuracy in predicting the sizes of femoral and acetabular components in THA patients. Digital software like mediCAD® remains favorable because of the short learning curve, user-friendly features, and low-cost maintenance, leading to level-up patient care and THA efficacy. Further studies are necessary for clarifying the role of the assessor's experience and expertise in THA preoperative templating. LEVEL OF EVIDENCE: Level III (retrospective observational study).

Content Validity and Reliability of the Persian Version of the Forgotten Joint Score Questionnaire in Patients Undergoing Total Hip Arthroplasty.

Background: Forgotten Joint Score (FJS) is a patient-reported outcome measurement that evaluates patients' ability to forget the replaced joint (knee or hip) in everyday activity. This study aimed to evaluate the validity and reliability of the Persian version of this questionnaire in Iranian patients who underwent total hip arthroplasty. Methods: A team of specialists reviewed this questionnaire and voted for its clarity and content validity. Then, the FJS was filled out by 100 randomly selected total hip arthroplasty patients between 2019 and 2021 with at least 6 months of follow-up. The reliability coefficient (Cronbach's alpha) was calculated. Results: A total of 95 patients who met the inclusion criteria, with the mean age 59.9 ± 11.6 years and 26.6% being female, participated in the study. Patients had no difficulty with the content and linguistic format of the Persian FJS-12. The mean FJS for these patients was 50.8 ± 4.6. The Cronbach's alpha was measured at 0.87. The mean content validity index was 0.93. Conclusion: FJS-12 can discriminate even patients with eximious pain and functional outcomes after joint reconstruction surgery. The Persian format of FJS-12 showed acceptable internal consistency using Cronbach's alpha and acceptable content validity. Therefore, it can be utilized in the Iranian population for future research studies.

Total Hip Arthroplasty via direct anterior approach for osteonecrosis; comparison with primary hip osteoarthritis in a mid term follow up.

Background: To determine the mid-term outcomes of conventional cementless Total Hip Arthroplasty (THA) in patients with avascular necrosis (AVN) of the femoral head and compare to patients with primary hip osteoarthritis (OA). Method: A total of 330 consecutive primary THA procedures (AVN and OA) performed between 2010 and 2013 by a single surgeon and in a single center using the direct anterior approach (DAA) were included. Assessments including SF-36, WOMAC, and Harris Hip Scores (HHS) were retrieved from patients before the surgery and at the latest follow-up. Clinical and functional outcomes were compared between the AVN and OA groups. Results: A total of 294 consecutive THA (AVN = 107, OA = 187) with 104.4 ± 6.2 months follow-up were analyzed, which AVN patients were significantly younger (32.0 vs. 59.6 y/o). Corticosteroid 34 (31.8%), idiopathic AVN 31 (29.0%) and use of unapproved weight gain supplements (UWGS) 23 (21.5%) were the main reasons for AVN. Despite that preoperative scores were comparable (P > 0.05), the HHS, SF-36, and WOMAC scores are significantly higher in the AVN group after THA surgery (P < 0.05). Moreover, flexion and abduction ROM were significantly higher in the AVN group (P < 0.05). Regarding each complication, no significant difference was observed between groups. In the whole sample, there were 5 (1.7%) revisions due to loosening of acetabular components, all the OA group (P > 0.05). Conclusion: Conventional cementless THA with highly cross-linked polyethylene provides satisfactory mid-term results in patients with AVN with a low rate of postoperative complications. Compared to primary OA patients, this group reaches superior postoperative scores.

COVID-19 infection rate after urgent versus elective total hip replacement among unvaccinated individuals: A multicenter prospective cohort amid the COVID-19 pandemic.

Background: Due to the COVID-19 pandemic, hospitals have become unsafe for patients as potential sources of virus transmission. This study aims to determine the COVID-19 infection rate after primary total hip arthroplasty (THA) among unvaccinated patients. THA patients undergoing elective or traumatic (urgent) THA were compared regarding COVID-19 contraction. Methods: Primary THA patients were prospectively followed from three hospitals in *two great cities* of the country between April 2020 to August 2021. If the patient had suspected COVID-19 symptoms, had a SARS-CoV-2 PCR test from nasopharyngeal and oropharyngeal swabs and/or chest CT scan. Results: Finally, information was received from 436 patients, including 345 (79.1%) elective and 91 (20.9%) traumatic THAs. Eight patients (1.8%) contracted COVID-19 within a month after THA discharge, and two died due to COVID-19. There was no statistical difference between COVID-19 disease and type of surgery (elective 1.4% versus traumatic 3.3%, P = 0.24). Women (Odds ratio (95% CI) = 8.5 (2.1-35.2), P = 0.01) and those who have heart disease (Odds ratio with Haldane-Anscombe correction ≈ 14.0, P = 0.01) were more likely to contract COVID-19 postoperatively. Conclusion: In both elective and urgent cases of THA, researchers found that there is not a high risk of contracting the virus during the peri-surgery period. Urgent THA surgeries are comparable to elective THA-with those strict pre-elective surgery protocols-in terms of COVID-19 risk of infection from the hospital stay if appropriate health protocols are followed.