Predictors of Persistent Pain after Total Knee Arthroplasty.

BACKGROUND: Total knee arthroplasty (TKA) is an orthopedic procedure performed on patients with severe knee pain and advanced knee conditions, such as osteoarthritis and rheumatoid arthritis, in order to restore joint function. Despite the procedure's high success rates, persistent postoperative pain (PPP) remains a significant complication, affecting a substantial proportion of patients. Identifying predictors of PPP is crucial for improving patient outcomes and satisfaction. METHODS: A retrospective analytic study was conducted, reviewing the medical records of patients who underwent unilateral or bilateral TKA at King Abdulaziz Medical City. The data collection focused on demographics, comorbidities, clinical presentations, surgical details, and postoperative outcomes. Data were analyzed using JMP software. A p-value of less than 0.05 was considered statistically significant. RESULTS: This study included 838 patients, predominantly female (71.5%), with an average age of 65.4 years. Osteoarthritis was the primary reason for surgery (98.3%). The mean preoperative pain score was 3.4, and the average pain duration prior to surgery was 6.2 years. We identified dyslipidemia as a significant predictor of PPP (OR 1.40, p = 0.042), while we found younger age to be a significant predictor (OR 0.979, 95% CI 0.967-0.991, p = 0.001). Other factors such as gender, diabetes, hypertension, cardiovascular disease, anxiety disorder, mood disorder, tobacco use, chronic kidney disease, chronic lung disease, and BMI were not significant predictors of PPP. CONCLUSION: This study identifies younger age and dyslipidemia as significant predictors of persistent postoperative pain and improved outcomes following total knee arthroplasty Further research is needed to validate these results in diverse populations and settings, with the objective should be to refine preoperative counseling and postoperative pain management protocols.

Awareness of Anterior Cruciate Ligament Injury-Preventive Training Programs among Saudi Athletes.

BACKGROUND: Anterior cruciate ligament (ACL) tear is a common medical condition that entails a stretch or sprain of the ACL, which is present in the knee joint. The incidence of ACL injury in the Kingdom of Saudi Arabia is estimated to be 31.4%. Prevention training programs (PTPs) can be used to reduce ACL injuries sustained during physical activity, as they primarily focus on improving strength, balance, and lower limb biomechanics and reducing landing impact. This study aimed to assess Saudi athletes' awareness of ACL injury PTPs. METHODS: A cross-sectional survey in the form of a self-administered questionnaire in the Arabic language was carried out from 22 December 2022 to 7 March 2023 and included 1169 Saudi athletes. Statistical analyses were performed on the collected data using frequency and percentages. Binary logistic regression was used for the adjusted analysis and determining associations between athletes playing high- and low-risk sports. RESULTS: Overall, 52% of participants were female athletes, and 48% were male athletes. The western region of the country had the highest response rate (28.9%). The most common sport played was football at 36.6%. Most participants (70.97%) reported that their information on ACL injury was taken by their coaches. When assessing whether participants were familiar with the concept of an ACL injury PTP, the majority of the participants answered no, representing 971 (662 high-risk, 309 low-risk), compared to those who answered yes, representing only 198 (167 high-risk, 31 low-risk), with a statistically significant difference (adjusted OR: 2.106; 95% confidence interval: 1.544-2.873; p-value < 0.001). CONCLUSION: In general, the level of awareness of ACL injury PTPs among Saudi athletes was poor.

Frequency of Knee Pain and Risk Factors and Its Impact on Functional Impairment: A Cross-Sectional Study from Saudi Arabia.

BACKGROUND: Adolescents frequently self-report pain, according to epidemiological research. The knee is one of the sites wherein pain is most commonly reported. Musculoskeletal disorders play a significant role in the prolonged disability experienced by individuals, leading to substantial global personal, societal, and economic burdens. Patellofemoral pain (PFP) is a clinical knee pain commonly affecting adolescents. This study aimed to estimate the frequency of knee pain in Saudi adolescents. METHODS: This cross-sectional survey was conducted from June to November 2022 and included 676 adolescents aged 10 to 18 years. The participants were questioned regarding their demographics, school habits, and the impact of these factors on back pain, musculoskeletal pain in the past 12 months, as well as quality-of-life scale and knee pain symptoms. The data were analyzed using descriptive statistics, with frequencies and percentages presented for categorical variables. Analysis of variance (ANOVA) was performed to compare means between groups, while the chi-squared test was used to compare categorical variables. Statistical significance was set at p < 0.05. RESULTS: A total of 676 adolescents participated in the study, with 57.5% females and 42.5% males. Among the participants, 68.8% were aged between 15 and 18 years. The prevalence of knee pain was notably higher among females (26%) compared to males (19.2%). Age and BMI were identified as significant predictors of knee pain. A significant association was also found between BMI classification and knee stiffness (p-value = 0.008). Furthermore, a significant difference was observed between adolescents who engaged in physical activities during leisure time and those who experienced difficulty bending (p-value = 0.03). CONCLUSIONS: Our study highlights a high prevalence of knee pain among Saudi adolescents, emphasizing the need for increased awareness about its risk factors. Preventive measures, including conservative approaches and lifestyle/activity modifications, can effectively mitigate adolescent knee pain.

Cytokines' Role in the Pathogenesis and Their Targeting for the Prevention of Frozen Shoulder: A Narrative Review.

Frozen shoulder (FS) is a common name for shoulder movement limitation with different degrees of shoulder rigidity and pain. It is characterized by varying developmental courses, different levels of shoulder movement limitation, and background ambiguity due to the multiplicity of its causative factors. Systemic inflammatory cytokines monitoring and restraining is easy to apply, fast to conduct, and needs lower costs compared to invasive methods for frozen shoulder stage evaluation and early controlling of its progress to the stage that necessitates surgical intervention. The aim of this review was to assess the recent findings concerning the role of cytokines in FS pathogenesis and the possibility of preventing or controlling their progress through targeting these cytokines by the new drugs candidates, such as hyaluronan (HA), botulinum toxin type A (BoNT A), Tetrandrine, tumor necrosis factor-stimulated gene-6 (TSG-6), and cannabidiol. Searching the PubMed site, we encountered out of 1608 records, from which 16 original studies were included for the quantitative construction of this systematic review screening of the recent studies to investigate the different FS pathogenic pathways. Most of the scenarios are centered around the inflammatory and fibrotic process triggered by synovial and capsular fibroblast stimulation. This mechanism depends mainly on alarmins cytokines, including thymic stromal lymphopoietin (TSLP), interleukin-33 (IL-33), and interleukin-25 (IL-25), with the stimulation of interleukin-1 α (IL-1α), interleukin-1 ß (IL-1ß), tumor necrosis alpha (TNF-α), cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) in a joint capsule. Different pathways of transforming growth factor- ß (TGF-ß) stimulation, resulting in overexpression of the fibrotic factors as tenascin C (TNC), fibronectin 1, collagen I (COL 1) and collagen III (COL III), and matrix metalloproteinases (MMPs) in the capsular or synovial/capsular fibroblasts. The overall investigation of these studies led us to conclude that the new drug candidates proved their efficiency in controlling the common pathogenesis of the inflammatory and fibrotic pathways of frozen shoulder and therefore represent a prospect for easy and early controlling and efficiently treating this serious disease.

Prevalence and Associated Factors of Vitamin D Deficiency in High Altitude Region in Saudi Arabia: Three-Year Retrospective Study.

Background: Vitamin D has many functions in the human body, and its deficiency is associated with skeletal and non-skeletal diseases. Vitamin D deficiency (blood level of 25 (OH) vitamin D < 20 ng/mL) has been reported worldwide, including Kingdom of Saudi Arabia (KSA). Its prevalence and associated factors vary according to KSA region. Therefore, this study aimed to explore the prevalence and risk factors of vitamin D deficiency in the Taif region of KSA. Methods: This retrospective study included patients who attended outpatient clinics at the Alameen General Hospital from 2019 to 2021. Demographic, clinical, and laboratory data were collected using a hospital software system. Results: The study included 2153 patients and vitamin D deficiency was diagnosed in 900 (41.8%) of whom were diagnosed with vitamin D deficiency. It was more common in males (P=0.021), younger age (<0.001), and in patients without comorbidities. There was a positive correlation between 25 (OH) vitamin D levels and blood cholesterol, high-density lipoprotein, calcium, and vitamin B12 levels. In the binary logistic regression analysis, age was the most significant predictor (P<0.001), followed by the absence of thyroid disease (P=0.012) and asthma (P=0.030). Conclusion: Vitamin D deficiency is common in the Saudi population despite sunny weather in KSA. It is more prevalent among males, younger individuals, and those without comorbidities such as thyroid diseases and asthma.

Multiple Primary Aneurysmal Bone Cysts: A Case Report and Literature Review.

Herein, we report the case of a 12-year-old boy diagnosed with multiple aneurysmal bone cysts (ABCs) who had previously undergone surgery on the proximal left tibia, proximal left femur, and distal tibia. During follow-up after the surgery, he developed another lesion on the proximal left humerus. Although rare, the pathological diagnosis was multiple ABCs.

Short leg cast versus orthotic removable support for the management of pseudo-Jones avulsion fracture: A systematic review and meta-analysis.

BACKGROUND: The fifth metatarsal base avulsion fracture (i.e., Pseudo-Jones fracture) is one of the most common foot fractures. The management of pseudo-Jones fractures could be carried out surgically or conservatively. This systematic review and meta-analysis aimed to provide an update about the efficacy of orthotic removable support compared to short-leg casting for individuals with pseudo-Jones fracture. METHODS: We searched Embase, Medline, and Cochrane Central register of Controlled Trials (CENTRAL) for randomized controlled trials (RCTs) that compared the clinical outcomes of orthotic removable support and short-leg cast for adult individuals with a fifth metatarsal base avulsion fracture. We used 95% as a confidence level and P <0.05 as a threshold. The standardized mean difference (SMD) was used for the continuous outcomes, and the risk ratio (RR) was used for the dichotomous outcomes. RESULTS: A total of 6 RCTs incorporating 403 individuals out were deemed eligible. There was no significant difference between orthotic removable support and short-leg casting regarding AOFAS score (standardized mean difference (SMD)= 0.31, 95% CI -0.17 to 0.8), pain on VAS score (SMD= -0.08, 95% CI -0.39 to 0.22), VAS-FA score (SMD= 0.22, 95% CI -0.19 to 0.62) EQ-5D VAS score, and non-union rate (RR=0.37, 95% CI 0.05 to 2.74). CONCLUSION: The current meta-analysis reveals that there is no difference between orthotic removable support and short-leg casting for the conservative management of individuals sustaining pseudo-Jones fracture.

Outcomes in Bone Giant Cell Tumors Treated With Surgical Resection With and Without Denosumab Injection: A Single-Institution Retrospective Study.

BACKGROUND: Giant cell tumors of the bone (GCTB) are rare, benign, aggressive, recurrent tumors that are most often found at the ends of long bones. They account for 5% of all primary bone tumors and 20% of all benign bone tumors. The clinical features of GCTB include local swelling, pain, and limitations in joint movement. Approximately half of GCTB arise around the knee joint, affecting either the distal femur or proximal tibia. Tissue biopsy reveals an excess of multinucleated giant cells on a stromal cell background, indicating a diagnosis. Intralesional curettage is used to treat GCTB and is associated with minimal disability; however, local recurrence may occur in many patients. Resection and endoprosthetic repair or bone graft reconstruction are often used to treat GCTB near the joint. To our knowledge, there are currently no studies on this topic in the city of Jeddah, where we conducted our study. Our aim was to evaluate the outcome of surgical resection accompanied by denosumab injection compared to that of surgery alone in treating GCTB. METHODS: All cases of GCTB at King Abdulaziz Medical City, Jeddah, between January 2008 and December 2018, that fulfilled the inclusion and exclusion criteria were included. All cases of GCTB in the pre-specified period were classified as surgical resection with denosumab injection or surgical resection alone. The outcomes of the two modalities were compared. Recurrence was investigated in patients belonging to both the groups. RESULTS: Twenty-six cases that met the inclusion criteria were included in the study and the data were analyzed. The subjects were divided into two groups: denosumab and surgery (n = 7) and surgery alone (n = 19). Patients treated with denosumab and surgery had a higher recurrence rate (57%); however, the difference was not significant (p = 0.407). CONCLUSION: Our study showed that when comparing local recurrence after curettage in patients treated with denosumab and patients who did not receive it, preoperative denosumab therapy was associated with an increased incidence of local recurrence. We recommend a systematic review that can include more studies in this field to acquire more definitive results regarding this topic.

Association Between Osteoporosis and Refracture Rate Among Patients With Hip Fractures at King Abdulaziz Medical City, Saudi Arabia.

Background Hip fracture is a major medical and surgical topic and is a significant cause of morbidity and mortality. Older women, especially those with osteoporosis, are at an increased risk for hip fractures. Multiple studies have shown the effect of osteoporosis on the refracture rate among the elderly population. Therefore, selecting a targeted population for screening and treating osteoporosis has an essential role in decreasing the hip fracture rate. This study aimed to determine the association between osteoporosis treatment and refracture rate among patients with hip fractures at King Abdulaziz Medical City, Jeddah, Saudi Arabia. Methods Collected data included patient demographics (men: ≥55 years old; women: ≥50 years old), the used osteoporosis investigation method, osteoporosis treatment history, presence of comorbidities, and refracture as a primary outcome. The refracture rate among patients with hip fracture was calculated and used to determine the association between hip refracture and osteoporosis. Results Our study included a total of 292 patients who presented to our hospital due to hip fractures. The patients were divided into two groups, the osteoporotic and non-osteoporotic groups. These groups were then compared. There was no statistical significance between osteoporosis and hip refracture (p = 0.721), and there was no association between the treatment of osteoporosis and hip refracture (p = 0.493). Statistical difference was found between patients who had undergone dual-energy X-ray absorptiometry scan and were not treated for osteoporosis (p = 0.00). Lastly, the mortality of the refracture group was 10%, while it was 11% in the no-refracture group (p = 1.00). Conclusion Morbidity and mortality rates are higher among patients with hip fractures. Our study showed that there was no association between hip refracture rate and osteoporosis whether the patient is treated for osteoporosis or not. We recommend a systematic review that can include more studies in this field to acquire more definitive results regarding this topic.

Chondroblastoma-Like Soft-Tissue Chondroma of the Hand: A Case Report.

We present a case of chondroblastoma-like chondroma (CLC) of soft tissue that manifested as a palmar mass on the left hand of an 84-year-old man. Physical examination, imaging investigation, and needle biopsy initially suggested a giant cell tumor of the tendon sheath, until a correct diagnosis was made based on excised specimen histology. The patient underwent a marginal excision for soft-tissue mass removal. Follow-up examination showed excellent relief of symptoms, and full hand mobility was regained. The diagnosis of CLC is challenging because the radiographic and pathological features vary. Therefore, we highly emphasize the importance of utilizing excisional tissue for histopathological assessment in atypical chondroma presentations.

Electronic early notification of sepsis in hospitalized ward patients: a study protocol for a stepped-wedge cluster randomized controlled trial.

BACKGROUND: To evaluate the effect of screening for sepsis using an electronic sepsis alert vs. no alert in hospitalized ward patients on 90-day in-hospital mortality. METHODS: The SCREEN trial is designed as a stepped-wedge cluster randomized controlled trial. Hospital wards (total of 45 wards, constituting clusters in this design) are randomized to have active alert vs. masked alert, 5 wards at a time, with each 5 wards constituting a sequence. The study consists of ten 2-month periods with a phased introduction of the intervention. In the first period, all wards have a masked alert for 2 months. Afterwards the intervention (alert system) is implemented in a new sequence every 2-month period until the intervention is implemented in all sequences. The intervention includes the implementation of an electronic alert system developed in the hospital electronic medical records based on the quick sequential organ failure assessment (qSOFA). The alert system sends notifications of "possible sepsis alert" to the bedside nurse, charge nurse, and primary medical team and requires an acknowledgment in the health information system from the bedside nurse and physician. The calculated sample size is 65,250. The primary endpoint is in-hospital mortality by 90 days. DISCUSSION: The trial started on October 1, 2019, and is expected to complete patient follow-up by the end of October 2021. TRIAL REGISTRATION: ClinicalTrials.gov NCT04078594 . Registered on September 6, 2019.

General population knowledge about osteoarthritis and its related risk factors in Jeddah Saudi Arabia.

OBJECTIVES: To identify the knowledge gap and misconceptions about osteoarthritis (OA) and its risk factors among the general population of Jeddah, Saudi Arabia. METHODS: This is a cross-sectional study conducted Jeddah, Saudi Arabia, between 11-13 April, 2019. The study was approved by King Abdullah International Medical Research Center. A representative sample of the public in well-known mall was asked to complete the questionnaire to assess their knowledge regarding OA. The questionnaire consisted of 3 parts: 1) demographic data, 2) general knowledge regarding OA, and 3) a quiz of 20 questions. A descriptive analysis was carried out with t-test and F-test-based method. RESULTS: The study had 1238 respondents. Approximately 55% of them were females, with 51.8% between the ages of 18 to 29. Approximately 62% held a bachelor's degree and 63% had a family member or a friend afflicted with OA. Relatives and friends were the main source of information regarding OA. Only 37% correctly identified the mechanism behind OA. The mean score for the 20-item quiz was 9.84. No significant differences were found when comparing scores of males and females or those of age groups. However, significant differences in scores were identified between respondents of varying educational levels (p less than 0.001), participants' knowledge of the mechanism leading to OA (p less than 0.001), information sources (p less than 0.001), and knowing someone with it (p less than 0.001). CONCLUSION: The results of our study suggest a low level of knowledge regarding OA among Jeddah population. Many misconceptions regarding OA were identified, so more information be brought to the public.

The surgical and functional outcome of limb-salvage surgery with vascular reconstruction for soft tissue sarcoma of the extremity.

BACKGROUND: This study compared the surgical, oncological, and functional outcomes of patients undergoing limb-salvage surgery for extremity soft tissue sarcoma with vascular resection and reconstruction with the outcomes of those undergoing limb-salvage without vascular reconstruction. METHODS: Nineteen patients were identified from a prospective soft-tissue sarcoma database who underwent vascular resection and reconstruction as part of their limb-salvage surgery and who were followed up for at least 1 year or until death. Each of these 19 patients was case-matched to 2 additional patients on the basis of tumor location, size, and depth; patient age; and timing of radiation. To compare functional outcome, a subset of patients was case-matched with additional criteria including wound-complication status, motor nerve sacrifice, similar preoperative function as determined by the Toronto Extremity Salvage Score, and no metastases at diagnosis or the 1-year follow-up. RESULTS: Patients in the vascular reconstruction group were more likely to require a muscle transfer (53% vs. 18%; P = .008), experience a wound complication (68% vs. 32%; P = .03), experience deep venous thrombosis (26% vs. 0; P = .003), experience significant limb edema (87% vs. 20%; P = .001), and ultimately require an amputation (16% vs. 3%; P = .07). Patients who underwent vascular reconstruction had only slightly lower Toronto Extremity Salvage Score scores 1 year after surgery (78.5 vs. 84.2; P = .35). There were no significant differences in local or systemic tumor relapse between the two groups. CONCLUSIONS: Vascular reconstruction is a feasible option in limb-salvage surgery for soft tissue sarcoma but is associated with an increased risk for postoperative complications, including amputation. Although function is not significantly worse after vascular reconstruction, the results are less predictable.