Medical Journal of The Islamic Republic of Iran (MJIRI)

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Background: Chondromalacia patella is the most common cause of mechanical knee pain in young women. Q angle and knee alignment are important clinical parameters for biomechanics of the patellofemoral joint. Objective: To identify the prevalence of knee malalignment and to find out if there is a correlation between knee mal alignment and Q angle with age at onset of disease. Methods: All patients under 40 years old complaining of mechanical knee pain with positive shrug sign and normal knee radiography who were referred to Amir A'lam Rheumatology Clinic during the period of September 2000 to September 2002 were included in this study. The patients were examined by a rheumatologist for measuring Q angle and detection of knee malalignment. Age at onset of disease was defined as initiation of knee pain according to the patient's history. Results: The cases were 260 with 189 females. Prevalence of knee mal alignment was 32.4%. The mean age at onset of disease was 22.8 ± 7.08 years. The mean age at onset in patients with knee mal alignment (21.41 ± 5.66 years) was significantly lower than the mean age at onset in those without knee malalignment (23.6 ± 7.43 years) (p= 0.002). There was a positive correlation between Q angle and age at onset of disease (r=0.17,p= 0.006). Conclusion: It seems reasonable to identify knee malalignment in chondromalacia patella patients and perform proper management to postpone progression of disease. There are many other factors that influence age at onset of disease, so further investigation is recommended.

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  Abstract

  Objective: The aim of this study was to evaluate the efficacy of antibiotic-loaded bone

  cement in controlling local infection and in regard to its physical characteristics, elastic

  modulus, and tensile strength in-vitro.

  Methods: Acrylic bone cement, based on polymethylmethacrylate (PMMA) was

  mixed with the powder form of three antibiotics, i.e., gentamicin, tobramycin, and cefuroxime

  with different doses below 2gr per 40gr of cement powder thereafter, liquid

  monomer was added to process the cement. Sensitivity to common clinical isolates was assessed

  by counting the inhibition zone of each ALBC disc in cultured strains. Elution with

  normal saline was performed to evaluate the effects on ALBC disks and their antimicrobial

  efficiency. Cement structure, tensile strength, and elastic modulus were assessed by biomechanical

  tests to understand the characteristics of ALBCs after loading antibiotics with

  different doses and two methods of vacuum and manual mixing.

  Results: Gentamicin, tobramycin, and cefuroxime reduced bacterial growth significantly

  with doses more than 1gr of antibiotics in 40gr of the cement. Cefuroxime was less

  efficient than the other two antibiotics in controlling pseudomonas. Elution with normal

  saline has not affected antibacterial results, significantly. All the 3 antibiotics had the same

  pattern of physical characteristics while loaded in bone cement. Gross structure of ALBCs

  with different doses of the three antibiotics was the same as non-ALBC and the elasticity or

  strength did not decline after loading antibiotics. The elastic modulus of ALBC was increased

  by boosting the doses of antibiotics however, doses of 1gr to 1.5gr were the optimal

  doses in this regard. The tensile strength of ALBC was increased by doses of 1gr to

  1.5gr of antibiotics however, below and above these doses, the strength was decreased, but

  it did not exceed the basic strength of non-ALBC. Vacuum mixing method increased

  strength and elasticity more than manual one, remarkably.

  Conclusion: Optimal protective effects of ALBCs against infection could be seen with

  mixing doses of about 1gr to 1.5gr of antibiotics in 40gr of acrylic bone cements by vacuum

  method, while optimal elastic modulus and tensile strength could be achieved at the same

  doses.

 

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 Abstract 

 Background: Reamed interlocking intramedullary nailing of the tibia is a procedure

 for the treatment of a non-infected tibial non:::union:::. The purpose of this clinical

 study was to evaluate the outcome of this method as a treatment of tibial non:::union:::.

 Methods: Twenty-nine patients with non:::union::: after initial therapy for tibial fracture

 were retrospectively assessed after a reamed interlocking intramedullary nailing.

 The main measurements were derived from radiographic and clinical :::union::: as

 well as time from reamed nailing to :::union:::.

 Results: Twenty-eight patients achieved :::union::: of their fracture (97%). The average

 time from reamed nailing to :::union::: was 7.6 months. Serious complications included

 one severe infection in the site of surgery (3%) and one tibial fracture distal to

 the nail (3%).

 Conclusion: Reamed interlocking intramedullary nailing for non:::union:::s of the

 tibia resulted in a high :::union::: rate and was associated with a low complication rate.

 This technique is recommended as a standard procedure for non-infected tibial

 non:::union:::s.

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 Abstract

 Background: In the recent decade, many primary total knee arthroplasties have

 been carried out in Iran and the number of revision cases is expected to rise with the

 aging population. The aim of this study was to report the outcome of revision surgery

 in the country and make a comparison between the outcome of revision and that of

 the primary arthroplasty.

 Methods: Retrospectively, each case of 19 consecutive revision total knee arthroplasties was matched individually with two cases of primary total knee arthroplasty

 based on gender and age (within 5 years) in order to compare the outcome in the two

 groups of revision and primary arthroplasties. Detailed demographic data, underlying

 diagnosis, patient-reported pain severity, and Knee Society score were recorded

 pre-operatively and in the third month after the surgery for each patient in the two

 groups. Using chi-square, fisher's exact, one-way ANOVA, independent, and paired

 t-tests, we compared the outcomes in two groups as well as in each group before and

 after the arthroplasty.

 Results: Knee pain was significantly decreased after the surgery in the two groups

 of revision (p = 0.031) and the primary (p < 0.001) arthroplasty. There was no statistically notable difference of post-operative pain between the two groups of revision

 and primary TKA. The Knee Society score remarkably increased in both groups after

 the surgery (both ps < 0.001). The differences of Knee Society scores before and after

 the surgery were calculated separately in each group and compared to show that the

 primary group had a better outcome (p < 0.001) rather than the revision arthroplasty

 group.

 Conclusion: Conclusion: Satisfactory outcomes were obtained in our revision total

 knee arthroplasties however, the primary arthroplasties had better results. The results

 of surgery appear to be closely related to the technical demands placed on surgeon.

 Because we have to deal with more cases of revision total knee arthroplasty in

 near future, more comprehensive risk factor assessment studies with large sample

 size are required for gaining better results.

 

 

 

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  Abstract

  Introduction: Inflammation and wear debris may be responsible for bone lysis

  and subsequent lost in aseptic arthroplasty. Prostaglandin E2, platelet activating factor,

  and histamine are important mediators of inflammatory cells. We studied

  histopathological changes of cement-bone interface after using specific antagonists

  of these mediators.

  Methods: Left and right tibiae of 120 rats in ten groups were drilled. The left side

  was filled with polymethylmethacrylate and the right side was used as control. The

  first three groups respectively received 1mg/kg, 10mg/kg, and 25mg/kg of terfenadine,

  the second three groups respectively received 0.08mg/kg, 0.32mg/kg, and

  0.64mg/kg of alprazolam, and the third three groups respectively received 1mg/kg,

  5mg/kg, and 25mg/kg of naproxen. The tenth group received no drug and served as

  the control group. The animals were killed after 16 weeks and studied by one pathologist.

  Results: Cellular reaction in the left side was significantly more than the right side

  in all cases. Medium and high doses of terfenadine and naproxen and high doses of

  alprazolam could also significantly decrease giant cells and histiocytes.

  Conclusion: Increased cellular reaction in the cement-bone interface was suppressed

  by administration of PGE2, PAF, and histamine specific inhibitors. The use

  of these agents may induce retardation of the bone loss associated with early prosthetic

  loosening.

 

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  Background :This study was performed to evaluate the effect of Stoppa hernia repair on sexual function of the patients with bilateral inguinal hernia.

  Methods: In a prospective follow-up study, 50 patients with bilateral inguinal hernia were investigated to assess sexual function before and 1 and 6 months after standardized Stoppahernioplasty using the International Index of Erectile Function (IIEF) questionnaire. The mean scores obtained on pre- and postoperative visits for all domains of sexual function were analyzed and compared with the Friedman and paired Wilcoxon tests.

  Results: The mean score of IIEF at the first month after surgery was significantly declined compared to that before surgery and 6 months after surgery (P< 0.001), while the difference between preoperative score and the score at 6 months after surgery was not significant.

  Conclusion: Bilateral inguinal mesh repair with Stoppa technique can decreased sexual activity of the patients at one month after surgery, nevertheless it returns to its initial condition at 6 months after surgery. This suggests that the Stoppa technique does not affect the sexual function of patients with bilateral inguinal hernia.