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Sarzaeem MM, Movahedinia M, Mirahmadi A, Abolghasemian M, Tavakoli M, Amouzadeh Omrani F. Kinematic Alignment Technique Outperforms Mechanical Alignment in Simultaneous Bilateral Total Knee Arthroplasty: A Randomized Controlled Trial. J Arthroplasty 2024:S0883-5403(24)00261-4. [PMID: 38537837 DOI: 10.1016/j.arth.2024.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 04/24/2024] Open
Abstract
BACKGROUND The aim of this study was to compare the clinical results of kinematic alignment (KA) with those of mechanical alignment (MA) in single-stage bilateral total knee arthroplasty. METHODS In this double-blinded randomized controlled trial, 65 patients who had bilateral knee osteoarthritis underwent simultaneous bilateral total knee arthroplasty. One knee was randomly selected to be operated on with the calipered-KA technique and the other with MA. The participants were assessed via the Oxford Knee Score, Western Ontario and McMaster Universities Osteoarthritis Index questionnaire, and visual analog scale before the surgery and the same plus the Forgotten Joint Score at their last follow-up visit, 2 years postoperatively. Maximum knee flexion and the time reaching maximum knee flexion, named the recovery time, were also recorded. Hip-knee-ankle angle, medial proximal tibial angle, and lateral distal femoral angle were measured before and after the surgery using 3-joint-view radiographs. RESULTS At 2 years, there were significant differences between the KA and MA techniques in terms of duration of surgery, recovery time, and final Western Ontario and McMaster Universities Osteoarthritis Index, Forgotten Joint Score, and maximum flexion range in favor of KA (P < .05), but no significant difference in visual analog scale score or Oxford Knee Score. In patients who have a preferred knee, the KA knee was preferred over the MA knee by most patients. No prosthetic failure or revision was reported in either group. CONCLUSIONS The KA technique yields acceptable functional outcomes compared to the MA technique. The KA technique was associated with a shorter surgery time, a faster recovery time, and higher patient satisfaction in 2-year follow-ups. Larger multicenter studies with longer follow-ups are warranted to confirm these findings. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Mohammad Mahdi Sarzaeem
- Department of Orthopedic Surgery and Traumatology, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Movahedinia
- Bone, Joint and Related Tissue Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Mirahmadi
- Bone, Joint and Related Tissue Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mahdi Tavakoli
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada
| | - Farzad Amouzadeh Omrani
- Department of Orthopedic Surgery and Traumatology, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Amouzadeh Omrani F, Sarzaeem MM, Noorbakhsh M, Baroutkoub M, Afzal S, Barati H, Panjeshahi A. The Outcomes of Distraction Osteogenesis over an Intramedullary Nail for the Treatment of Bone Defects in Infectious Nonunions. Arch Bone Jt Surg 2024; 12:204-210. [PMID: 38577507 PMCID: PMC10989721 DOI: 10.22038/abjs.2023.73572.3407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 12/18/2023] [Indexed: 04/06/2024]
Abstract
Objectives The concurrent utilization of an external fixator and intramedullary nail (IMN) for segment transportation may potentially decrease the duration of external fixator implementation and reduce associated complications. This study aimed to report the outcomes of bone transport utilizing a combination of IMN and Ilizarov frame in a cohort of individuals who had tibia or femur critical-sized bone deficiency resulting from nonunion. Methods The present research used a single-arm clinical trial design to enroll a series of patients presenting with critical-sized bone defects resulting from infectious nonunion of the tibia or femur. The study was conducted during the period of 2017-2020 in a referral Orthopedic Surgery Center located in Tehran, Iran. The management of patients with infectious nonunion was carried out through two main stages, including infection eradication and bone transportation. The process of bone healing and segment transportation was evaluated by radiographic assessment throughout the follow-up period. Results A total of 39 patients with bone defects in the tibia (19 cases) or femur (20 cases) with a mean age of 31.44 (±11.95, range=18-60) were included in this study. Twenty-nine (74.3%) patients had open fractures. The bone defect exhibited an average size of 6.31 ± 1.95 cm. The mean of the consolidation index (CI) was 0.97 (range=0.51-1.32) mo/cm, and the mean of the external fixator index was 0.67 (range=0.41-1.10). Although the CI was longer in patients with open fracture compared to those with closed fracture, the difference was not statistically significant (P=0.353). After the end of the two-year follow-up, complete union was observed in 35 patients (89.7%). Conclusion Intercalary segmental bone transportation using the Ilizarov technique over an IMN, as well as preserving the advantages of the conventional callotasis method, reduces the complications of long-term use of the Ilizarov frame and increases patient adherence to treatment.
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Affiliation(s)
- Farzad Amouzadeh Omrani
- Department of Orthopedic Surgery, School of medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdi Sarzaeem
- Department of Orthopedic Surgery, School of medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Noorbakhsh
- Cellular and Molecular Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mojtaba Baroutkoub
- Department of Orthopedic Surgery, School of medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sina Afzal
- Department of Orthopedic Surgery, School of medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hasan Barati
- Department of Orthopedic Surgery, School of medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Panjeshahi
- Department of Orthopedic Surgery, School of medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Sarzaeem MM, Amouzadeh F, Salehi B, Movahedinia M, Soleimani M. A New Concept of Using Femoral Condyles Surface for Femoral Component Alignment During Total Knee Arthroplasty: A Technical Note. Indian J Orthop 2023; 57:2088-2094. [PMID: 38009183 PMCID: PMC10673776 DOI: 10.1007/s43465-023-01023-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 10/09/2023] [Indexed: 11/28/2023]
Abstract
Background Orthopedic surgeons favor an intramedullary guiding system on the femoral component during total knee arthroplasty (TKA); nevertheless, improper positioning of the entry point affects the final alignment. We have designed a new femoral cutting system for TKA that uses the distal and posterior femoral condyles as reference points for the setting of the cutting system regardless of the femoral canal. This study aims to evaluate the outcomes of this new guiding system. Methods We enrolled a series of 75 consecutive knees undergoing TKA. The alpha, gamma, and hip-knee-ankle (HKA) angles were assessed three months postoperatively. Also, surgical time and intraoperative blood loss were recorded for all patients. Results Fifteen patients underwent TKA using the mechanical alignment (MA) strategy, and 60 underwent kinematically aligned (KA) TKA. Both groups showed normal coronal and sagittal alignment 3 months postoperatively. The mean intraoperative blood loss was 213.11 ± 52.73 ml, which was not different between the two groups (n.s.). The mean surgical time was 43.12 ± 11.62 min, which was significantly shorter in the KA-TKA (41.11 ± 3.77 min) than in the MA-TKA (49.34 ± 4.56 min) (P < 0.001). Conclusion Using the new guiding system with good femoral alignment, we introduced the easily palpable and available condylar surface as a new landmark for cutting the distal femur in TKA. Level of Evidence IV.
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Affiliation(s)
| | - Farzad Amouzadeh
- Imam Hossien Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bentolhoda Salehi
- Medicine Faculty, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Movahedinia
- Department of Orthopedics and Traumatology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Sharifi Manesh Street, Shariati Street, Tehran, Iran
| | - Mohammad Soleimani
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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Ramezani K, Sarzaeem MM, Feizi D, Bonakdar M, Ramezani M, Sarzaeem M, Movahedinia M. Evaluation of the Validity and Reliability of a Persian Version of the Forgotten Joint Score in Patients Undergoing Total Hip Arthroplasty. Arch Bone Jt Surg 2023; 11:752-756. [PMID: 38146521 PMCID: PMC10748817 DOI: 10.22038/abjs.2023.65360.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/26/2023] [Indexed: 12/27/2023]
Abstract
Objectives The increasing number of total hip arthroplasties (THA) has led to increased patient demands and expectations, making it crucial to assess patients' ability to "forget" their implants in daily life. This study aimed to determine the reliability and validity of a Persian version of the Forgotten Joint Score (P-FJS) in THA patients. Methods The questionnaire was translated bidirectionally with the permission of the questionnaire designer. Data were collected from 2018 to 2020 and included 142 patients who had undergone THA by the same surgeon at least one year ago. Participants completed the FJS questionnaire twice within a one-week interval, and the validity, reliability, and feasibility of the questionnaires were assessed using statistical tests on the HHS and OHS forms completed by all participants. Results In 142 patients (52.1% male) with a mean age of 65 ± 0.5 years who answered the questionnaires, P-FJS correlated strongly with OHS and HHS. The internal consistency (α = 0.91) and reproducibility of the questionnaire were excellent. None of the floor and ceiling effects were detected. Conclusion The P-FJS questionnaire in the THA is considered a legitimate, repeatable, and self-administered survey that can be compared to its English-language counterpart. In addition, it is noteworthy that this version does not show any floor or ceiling effects.
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Affiliation(s)
- Keyvan Ramezani
- Department of Orthopedics, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdi Sarzaeem
- Department of Orthopedics, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davud Feizi
- Department of Orthopedic, School of Medicine, Beasat hospital, AJA University of Medical Sciences, Tehran, Iran
| | - Moein Bonakdar
- Department of Orthopedics, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mitra Ramezani
- Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahdi Sarzaeem
- Medical student, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Sarzaeem MM, Beigi AN, Darestani RT, Omrani FA, Baroutkoub M, Rasi AM. Candida albicans Prosthetic Joint Infection After Total Knee Arthroplasty: A Rare Case Report. Adv Biomed Res 2022; 11:111. [PMID: 36798917 PMCID: PMC9926025 DOI: 10.4103/abr.abr_302_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 12/28/2022] Open
Abstract
In this article, a 75-year-old patient with pain in left knee and restricted range of motion following total knee arthroplasty (TKA) is presented. Serological evaluation and aspiration of knee joint suggested a fungal prosthetic joint infection. After the diagnosis was confirmed, treatment started with antifungal drugs, removing prosthesis, exhaustive debridement, and revision of TKA after efficient antifungal treatment. At one-year follow-up, she has a painless motion range of 10 to 90 degrees, and there was no recurrence of infection observed.
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Affiliation(s)
- Mohammad Mahdi Sarzaeem
- Department of Orthopedic, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amin Norouz Beigi
- Department of Orthopedic, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Tavakoli Darestani
- Department of Orthopedic, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Amuzadeh Omrani
- Department of Orthopedic, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojtaba Baroutkoub
- Department of Orthopedic, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Manafi Rasi
- Department of Orthopedic, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Address for correspondence: Dr. Alireza Manafi Rasi, 7th Floor, Bldg No. 2 SBUMS, Arabi Ave, Daneshjoo Blvd, Velenjak -19839-63113, Tehran, Iran. E-mail:
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Ahmadi A, Mazloomnejad R, Kasravi M, Gholamine B, Bahrami S, Sarzaeem MM, Niknejad H. Recent advances on small molecules in osteogenic differentiation of stem cells and the underlying signaling pathways. Stem Cell Res Ther 2022; 13:518. [PMID: 36371202 PMCID: PMC9652959 DOI: 10.1186/s13287-022-03204-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/09/2022] [Indexed: 11/15/2022] Open
Abstract
Bone-related diseases are major contributors to morbidity and mortality in elderly people and the current treatments result in insufficient healing and several complications. One of the promising areas of research for healing bone fractures and skeletal defects is regenerative medicine using stem cells. Differentiating stem cells using agents that shift cell development towards the preferred lineage requires activation of certain intracellular signaling pathways, many of which are known to induce osteogenesis during embryological stages. Imitating embryological bone formation through activation of these signaling pathways has been the focus of many osteogenic studies. Activation of osteogenic signaling can be done by using small molecules. Several of these agents, e.g., statins, metformin, adenosine, and dexamethasone have other clinical uses but have also shown osteogenic capacities. On the other hand, some other molecules such as T63 and tetrahydroquinolines are not as well recognized in the clinic. Osteogenic small molecules exert their effects through the activation of signaling pathways known to be related to osteogenesis. These pathways include more well-known pathways including BMP/Smad, Wnt, and Hedgehog as well as ancillary pathways including estrogen signaling and neuropeptide signaling. In this paper, we review the recent data on small molecule-mediated osteogenic differentiation, possible adjunctive agents with these molecules, and the signaling pathways through which each small molecule exerts its effects.
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Affiliation(s)
- Armin Ahmadi
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, P.O. Box: 1985711151, Tehran, Iran
| | - Radman Mazloomnejad
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, P.O. Box: 1985711151, Tehran, Iran
| | - Mohammadreza Kasravi
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, P.O. Box: 1985711151, Tehran, Iran
| | - Babak Gholamine
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, P.O. Box: 1985711151, Tehran, Iran
| | - Soheyl Bahrami
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in AUVA Research Center, Vienna, Austria
| | - Mohammad Mahdi Sarzaeem
- Department of Orthopedic Surgery, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hassan Niknejad
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, P.O. Box: 1985711151, Tehran, Iran.
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Sarzaeem MM, Amoozadeh Omrani F, Omidian MM, Sahebalzamani MA, Maniei E. Clinical Outcome Comparison between Staged -Bilateral Versus Simultaneous Bilateral Total Knee Replacements. Arch Bone Jt Surg 2021; 9:641-646. [PMID: 35106328 PMCID: PMC8765198 DOI: 10.22038/abjs.2021.48053.2379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/08/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND This retrospective study aimed to compare the clinical outcomes of patients with staged and simultaneous bilateral total knee arthroplasty (TKA). METHODS The present study included 100 patients with a mean age of 62±3.72 years from 2014 to 2017. Among them, 51 and 49 patients underwent simultaneous and staged bilateral TKA, respectively. The two groups were compared regarding the range of motion (ROM), Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) improvement, and Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) scores. The mean follow-up duration was 24 months (range: 12-36 months). RESULTS According to the results obtained from the SF-36 questionnaire (possessing eight different factors of quality of life), there was no significant difference between the two groups. Furthermore, the OKSs were 39.98±1.52 and 38.68±2.55 in the simultaneous and staged groups, respectively. Moreover, the WOMAC improvement scores were obtained at 84.15±2.2 and 83.26±2.6 in the simultaneous and staged groups, respectively. The final knee ROM was acceptable without a significant difference between the two groups. CONCLUSION Substantial controversy about the complications, functional, and clinical outcomes has negatively affected the decision of the surgeons on conducting bilateral sequential TKA. This clinical assessment revealed that all determinants, including OKS, WOMAC, SF-36, ROM, postoperative bleeding, and hospitalization duration exhibited almost the same improvement in both groups. According to this study, no statistically significant difference exists in both procedures.
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Affiliation(s)
- Mohammad Mahdi Sarzaeem
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences (SBUMS), Tehran, Iran
| | - Farzad Amoozadeh Omrani
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences (SBUMS), Tehran, Iran
| | - Mohammad Mahdi Omidian
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences (SBUMS), Tehran, Iran
| | - Mohammad Ali Sahebalzamani
- Department of Biomaterials, Faculty of Biomedical Engineering, Science and Research, Branch, Islamic Azad University, Tehran, Iran
| | - Ehsan Maniei
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
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Aghamiri SM, Sarzaeem MM, Shahrezaee M, Omidian M, Amouzadeh Omrani F. Outcomes of Tibial Plateau Fracture Surgical Fixation: a Comparative Study between Younger and Older Age Groups. Arch Bone Jt Surg 2021; 9:647-652. [PMID: 35106329 PMCID: PMC8765196 DOI: 10.22038/abjs.2021.52884.2629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 07/07/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Tibial plateau fractures account for approximately 8% of the fractures of the elderly. Low bone quality that is more common in the elderly is one of the major challenges in fixing fractures and may be a barrier to achieving satisfactory outcomes after a surgical fracture treatment. Accordingly, surgical fixation of tibial plateau fractures was controversial in the elderly. This study aimed to investigate and compare the clinical outcomes of surgical fixation in patients over and under 60 years of age. METHODS This study was conducted as a retrospective cohort study of data that were prospectively collected. In total, 48 patients who underwent surgery with open reduction and internal fixation before August 2019 were recruited and followed up at least one year after surgery. Demographic characteristics, the range of motion of the knees, visual analog scale (VAS) score of pain intensity, and the Oxford Knee Score (OKS) were obtained in this study. Furthermore, Short Form-36 (SF-36) questionnaire was used to evaluate patient satisfaction. RESULTS In total, 19 and 29 patients were over and under 60 years of age, respectively. According to Schatzker's classification, the most common type of fracture was type VI. The range of motion in the knees did not differ significantly between the two groups (P>0.05). Moreover, OKS and the VAS of pain intensity were not significantly different in both groups (P>0.05). In addition, SF-36 scores were not significantly different between elderly patients and the age-matched general population. However, younger patients had lower scores in the physical function and vitality scales of SF-36, compared to the age-matched general population. CONCLUSION Based on the results of the present study, it can be stated that increasing age did not affect the surgical outcomes of patients with tibial plateau fractures.
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Affiliation(s)
- Seyed Majid Aghamiri
- Department of Orthopedic Surgery, AJA University of Medical Sciences, Tehran, Iran
| | | | - Mostafa Shahrezaee
- Department of Orthopedic Surgery, AJA University of Medical Sciences, Tehran, Iran
| | - Mohammadmahdi Omidian
- Department of Orthopedic, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Kazemian GH, Khak M, Ravarian B, Sarzaeem MM, Okhovatpour MA, Amouzadeh Omrani F. Closed K-wire Fixation for the Treatment of Perilunate Dislocation and Trans-Scaphoid Perilunate Fracture Dislocations without Ligamentous Repair: Short Term Follow-Up. Arch Bone Jt Surg 2020; 8:633-640. [PMID: 33088866 DOI: 10.22038/abjs.2020.42341.2152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The purpose of this study was to evaluate the treatment outcomes of perilunate dislocations (PLDs) and transscaphoid perilunate fracture dislocations (TSPLDs) treated with operative volar approach without ligament repair or reconstruction. Methods A total of seven patients (10 hands) were studied during 2017-2018. We fixed scaphoid fractures thorough a volar approach and 3 k-wires were inserted to stabilize the scaphoid to the adjacent bones. We evaluated patients' range of motion by VAS and grip strength, sensitivity assessment, and radiographs. Mayo and DASH scores were also recorded for wrist evaluation. Results All fractures united well. The mean Mayo wrist score was 81.5. Five patients scored good and excellent results (90-100). Excellent DASH scores (˂20) were observed in 4 patients and there was no poor DASH score (˃50). Conclusion Treatment of PLDs and TSPLDs with k-wire and screw fixation using a volar approach and without any ligament repair or reconstruction results in minimal manipulation and has favorable short-term outcomes.
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Affiliation(s)
- Gholam Hossein Kazemian
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Khak
- Department of Orthopedic Surgery, Guilan University of Medical Sciences, Rasht, Iran
| | - Behdad Ravarian
- Department of Orthopedic Surgery, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Mahdi Sarzaeem
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Okhovatpour
- Department of Orthopedic Surgery, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Amouzadeh Omrani F, Elahi M, Sarzaeem MM, Sayadi S, Farzaneh H. Infection Rate of Reamed versus Unreamed Intramedullary Nailing in Open Tibia Fractures. jost 2020. [DOI: 10.18502/jost.v5i2.3749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Intramedullary nailing (IM nailing) is the standard of care for the treatment of most diaphyseal lower extremity fractures. A few studies have assessed and compared the infection rate following reamed and unreamed IM nailing in open long bone fractures. In the present study, we attempted to compare the infection rate between two procedures in open fractures of tibia.
Methods: In this prospective study, we included consecutive patients suffering from open fractures of tibia (Gustilo subtypes II or IIIA) who required IM nailing. Patients younger than 16 years old, other Gustilo types (I, IIIB, and IIIC), fractures reaching to the tibial plateau articular surface, and simultaneous fractures of other bones in the extremity were excluded. All patients were followed up for one year to assess the postoperative infection rate.
Results: Of 59 patients, 37 underwent reamed IM nailing and 22 underwent unreamed IM nailing. In reamed group, 4 cases (10.8%) experienced an infection requiring reoperation and antibiotic therapy, while in the unreamed group, it was 5 cases (22.7%). The difference between the groups was not statistically significant.
Conclusion: Reamed and unreamed IM nailing procedures for fractures of tibia have similar outcome regarding long-term postoperative infections that require reoperation and antibiotic therapy.
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Sarzaeem MM, Razi M, Omrani FA, Azimi F, Aghaalikhani M. Modified patellar side harvest technique for bone-patella, tendon-bone autograft anterior cruciate ligament reconstruction; a three-year prospective cohort. J Orthop 2020; 18:95-98. [PMID: 32189892 DOI: 10.1016/j.jor.2019.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 10/23/2019] [Indexed: 01/10/2023] Open
Abstract
Purpose To introduce and discuss the outcome of a modified patellar side harvest technique. Methods This prospective cohort was conducted on patients with torn ACL who were eligible candidates for surgical intervention. Demographics and baseline characteristics were gathered for each patient. Results In total, 1024 patients with a mean age of 30.6 ± 3.6 were enrolled in this cohort. Results of modified IKDC scores reported with good and excellent outcome in 75% of patients. Conclusion Most of the patients who underwent BPTB-ACL reconstruction surgery with modified patellar side harvest technique, experienced acceptable clinical outcome.
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Affiliation(s)
- Mohammad Mahdi Sarzaeem
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid BeheshtiUniversity of Medical Sciences, Tehran, Iran
| | - Mohammad Razi
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid BeheshtiUniversity of Medical Sciences, Tehran, Iran
| | - Farzad Amuzade Omrani
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid BeheshtiUniversity of Medical Sciences, Tehran, Iran
| | - Farya Azimi
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Aghaalikhani
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid BeheshtiUniversity of Medical Sciences, Tehran, Iran
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Kazemian G, Manafi Rasi A, Baroutkoub M, Mahdi Sarzaeem M. Does Aspirin Like Enoxaparin Effective to Reduce Thromboembolic Disease in Patients with Total Knee Arthroplasty Surgery? JPRI 2020. [DOI: 10.9734/jpri/2019/v31i630370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background: Thromboembolic disease is a common complication among patients undergoing total hip and knee arthroplasty. There are a large number of clinical trials demonstrating the efficacy of aspirin and enoxaparin in preventing pulmonary emboli and deep venous thrombosis. This study aimed to investigate the preventive role of aspirin and enoxaparin after knee arthroplasty (TKA).
Methods: In this retrospective study, 160 patients undergoing knee arthroplasty at Imam Hossein Hospital, Tehran, Iran between January 2010 and February 2012 were studied. Patients were divided into treatment groups receiving enoxaparin and aspirin and were evaluated within 28 days after surgery. After examining demographic factors including age and sex, variables such as DVT, pulmonary embolus, infection, transfusion RBCs and mortality were evaluated.
Results: A total thrombosis rate of 0.0125% (one deep venous thrombosis) was observed. The two groups were not significantly different in the number of patients with complications such as DVT, pulmonary embolism, infection, average number of packed RBCs, and mortality.
Conclusion: We believe that course aspirin is as effective and safe as enoxaparin for thromboprophylaxis.
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Moshirabadi A, Razi M, Arasteh P, Sarzaeem MM, Ghaffari S, Aminiafshar S, Hosseinian Khosroshahy K, Sheikholeslami FM. Polymerase Chain Reaction Assay Using the Restriction Fragment Length Polymorphism Technique in the Detection of Prosthetic Joint Infections: A Multi-Centered Study. J Arthroplasty 2019; 34:359-364. [PMID: 30471785 DOI: 10.1016/j.arth.2018.10.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/05/2018] [Accepted: 10/14/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism) techniques have been used for the diagnosis of bacteria in some infections. In this study, we aimed to evaluate the diagnostic accuracy of PCR for the diagnosis of prosthetic joint infections (PJI) and to identify isolated microorganisms, using the RFLP method. METHODS During January 2015 to January 2018, patients who were suspected of having PJI after arthroplasty surgery or were candidates for revision surgery due to loosening of implant entered the study. Patients who had 1 major criterion or 3 minor criteria for PJI based on the Philadelphia Consensus Criteria (PCC) on Periprosthetic Joint Infection were considered as cases of PJI. Both culture results and PCR findings, were cross compared with results of the PCC (as the gold standard criteria). RESULTS Overall, 76 samples were included in the study. Mean (standard deviation) age of patients was 66.72 ± 11.82 years. Overall, 57.9% of patients were females. Prevalence of PJI was 50% based on the PCC. Sensitivity, specificity, positive predictive value, negative predictive value, and general efficacy of PCR for detection of PJI was 97.4%, 100%, 100%, 97.4%, and 98.7%, respectively. Sensitivity, specificity, positive predictive value, negative predictive value, and general efficacy of culture was 31.6%, 100%, 65.7%, 100%, and 59.4%, respectively. We isolated a broad range of bacteria using PCR-RFLP including Gram-positive cocci such as Staphylococcus sp., Streptococcus sp., and Enterococcus sp., and Gram-negative bacilli such as Enterobacteriaceae sp., Pseudomonas sp. Citrobacter sp., as well as Chlamydophila pneumonia, Stenotrophomonas maltophilia, Brucella melitensis, non-gonococcal Neisseria, Kingella kingae, Bacteroides ovatus, and Proteus mirabilis from PJI patients. CONCLUSION Inhere, for the first time, we showed that PCR-RFLP is a powerful tool for identifying the type of bacteria involved in PJI, and can be used for follow-up of patients suspected of PJI and those with a history of antibiotic use. PCR-RFLP may be able to substantially decrease detection time of PJI among PCR-based methods, while allowing more accurate identification of the bacteria involved.
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Affiliation(s)
| | - Mohammad Razi
- Department of Orthopedic Surgery, Hazrat-e-Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Peyman Arasteh
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran; Department of MPH, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Mahdi Sarzaeem
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saman Ghaffari
- Department of Orthopedic Surgery, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Saied Aminiafshar
- Department of Infectious Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Fellow of Royal Society of Tropical Medicine and Hygien, London, United Kingdom
| | | | - Fatemeh Maryam Sheikholeslami
- Department of Molecular Pathology, National Research Institute of Tuberculosis and Lung Diseases, Shahid Behshti University of Medical Sciences, Tehran, Iran; Department of Molecular Biology, Dr. Khosroshahi's Pathobiology Laboratory, Tehran, Iran
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Razi M, Sarzaeem MM, Kazemian GH, Najafi F, Najafi MA. Reconstruction of the anterior cruciate ligament: a comparison between bone-patellar tendon-bone grafts and fourstrand hamstring grafts. Med J Islam Repub Iran 2014; 28:134. [PMID: 25694992 PMCID: PMC4322334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 03/12/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Disruption of anterior cruciate ligament (ACL) is a common ligamentous injury of the knee. The choice of graft for (ACL) reconstruction remains controversial. This prospective, randomized clinical trial aimed to compare clinical results of bone-patellar tendon-bone (BPTB) grafts and four-strand semitendinosus-gracilis (ST) grafts for ACL reconstruction over a 3-year follow-up interval. METHODS Seventy-one patients with an average age of 29± 4.5yearswere treated for torn ACL between 2008 and 2009. Forty-sixpatients underwent reconstruction with BPTB autograft, and 41 were treated with ST autograft. At the time of final follow-up, 37 patients in patella group and 34 patients in hamstring group were evaluated in terms of return to pre-injury activity level, pain, knee stability, range of motion, IKDC (International Knee Documentation Committee) score and complications. RESULTS At 36thmonth of follow-up, 34 (92%) and 28 (82%) patients in BPTB and ST group, respectively had good-to-excellent IKDC score (p > 0.05). The activity levels were higher in BPTB group (p> 0.05). At 3rd yearof follow up, the Lachman test was graded normal, for 23 (62%) and 11 (32%) patients in BPTB and ST group, respectively (p=0.019). Regarding the pivot-shift test, 29 (79%) and 15 (44%) patients in patella and hamstring group, respectively had normal test at the latest follow-up (p=0.021).There were no significant differences in terms of thigh circumference difference, effusion, knee range of motion, pain and complications. CONCLUSION The results indicate a trend toward increased graft laxity and pivot-shift grades in patients undergoing reconstruction with hamstring autograft compared with patella tendon. However, the two groups had comparable results in terms of activity level and knee function.
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Affiliation(s)
- Mohammad Razi
- 1. Assistant Professor of Orthopedics, Department of Orthopedics and Sport Medicine, Rassole Akram Hospital, Iran University of Medical Sciences,Tehran, Iran.
| | - Mohammad Mahdi Sarzaeem
- 2. Assistant Professor of Orthopedics, Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Gholam Hossein Kazemian
- 3. Associate Professor of Orthopedics, Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Farideh Najafi
- 4. Resident of Orthopedics, Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mohammad Amin Najafi
- 5. Medical Student, Faculty of Medicine, Isfahan University of Medical Sciences, Esfahan, Iran.
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Sarzaeem MM, Razi M, Kazemian G, Moghaddam ME, Rasi AM, Karimi M. Comparing efficacy of three methods of tranexamic acid administration in reducing hemoglobin drop following total knee arthroplasty. J Arthroplasty 2014; 29:1521-4. [PMID: 24726174 DOI: 10.1016/j.arth.2014.02.031] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 02/25/2014] [Accepted: 02/25/2014] [Indexed: 02/01/2023] Open
Abstract
The ideal method of providing tranexamic acid (TXA) for decreasing hemoglobin drop after TKA is still controversial. In this clinical trial, 200 patients were randomly allocated to four groups. In group 1,500 mg TXA was administered intravenously. In group 2, the joint irrigated with 3 g of TXA in 100 cc of saline. In group 3, 1.5 g of TXA was injected through the drain. Group 4 did not take TXA. Albeit all methods had a statistical effect on hemoglobin drop, drainage and number of transfused units when compared to controls, but intravenous injection of TXA seems to be much more effective in terms of reducing hemoglobin drop and transfused units; and what's more TXA injection by drain is more effective regarding to reducing postoperative drainage.
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Affiliation(s)
- Mohammad Mahdi Sarzaeem
- Department of Orthopedics, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Razi
- Department of Orthopedics, Hazrat-e-Roasul Akram Medical Center, Iran University of Medical Science, Tehran, Iran
| | - Gholamhosein Kazemian
- Department of Orthopedics, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Emami Moghaddam
- Department of Orthopedics, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Manafi Rasi
- Department of Orthopedics, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Meysam Karimi
- Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
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Sarzaeem MM, Najafi F, Razi M, Najafi MA. ACL reconstruction using bone-patella tendon-bone autograft: press-fit technique vs. interference screw fixation. Arch Orthop Trauma Surg 2014; 134:955-62. [PMID: 24756534 DOI: 10.1007/s00402-014-1999-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE The gold standard in ACL reconstructions has been the bone-patellar tendon-bone autograft fixed with interference screws. This prospective, randomized clinical trial aimed to compare two methods of fixation for BPTB grafts: press-fit fixation vs. interference screw, over a 12-month follow-up interval. METHODS 158 patients with an average age of 29.8 years, between 2011 and 2012, were treated for torn ACL. 82 patients underwent reconstruction with BPTB autograft with a press fit fixation technique, and in 76 cases an interference screw was used. At the time of final follow-up, 71 patients in press-fit group and 65 patients in interference screw group were evaluated in terms of return to pre-injury activity level, pain, knee stability, range of motion, IKDC score and complications. RESULTS At 12-month follow-up, 59 (83 %) and 55 (85 %) in press-fit and screw group, respectively had good-to-excellent IKDC score (p > 0.05). The mean laxity assessed using a KT-1000 arthrometer improved to 2.7 and 2.5 mm in press-fit and screw group, respectively. Regarding Lachman and pivot shift test, there was a statistically significant improvement in the integrity of the ACL in both the groups, but no significant differences was noted between groups. There were no significant differences in terms of femur circumference difference, effusion, knee range of motion, pain and complications. CONCLUSIONS The press-fit technique is an efficient procedure. Its outcome was comparable with the interference screw group. Furthermore it has unlimited bone-to-bone healing, no need for removal of hardware, ease for revision and cost effectiveness.
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Affiliation(s)
- M M Sarzaeem
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
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