High tibial valgus osteotomy and functional outcome

This is a case series of 76 knees of 62 patients who underwent upper tibial valgus osteotomy for treatment of medial compartment osteoarthritis during a 20-year period and who were followed for a mean of 7.6 years. The patients were evaluated by validated outcome assessment systems of general health status short form [SF-36], the Western Ontario McMaster osteoarthritis index [WOMAC], McMaster Toronto arthritis patient preference questionnaire [MACTAR] and also knee society clinical rating system [KSS]. Two control groups one consisting of 60 patients with similar age with osteoarthritis who had not received any surgical treatment and another 60 patients who had received knee replacement for osteoarthritis were also studied. The results were compared among these three groups. Tibial osteotomy caused improvement in SF-36 and WOMAC scores compared to the non-operated control group, but it did not do so when it was compared with knee arthroplasty. The mean +/- SD KSS was 103.37 +/- 12.19 with a failure rate [defined as candidacy for knee arthroplasty] of 28.94%. Improvement in patients pain level, social activity, housework activities and self-esteem was observed. Stair navigation, surface walking, getting on and off a car were not significantly better than the non-operated group

Functional outcome study in total knee arthroplasty

The aim of this study was to validate the well-recognized outcome measure instruments [Medical Outcome Study Short Form-SF-36, Western Ontario and McMaster University Osteoarthritis Index-WOMAC, McMaster Toronto Arthritis Patient Preference Disability Questionnaire-MACTAR] for patients who had undergone total knee arthroplasty in Iran, with its cultural and ethnic differences and compare them with the reports from other parts of the world. Sixty patients, 56 women and 4 men, who had undergone total knee arthroplasty by a single surgeon, were recruited for clinical evaluation and for filling out the questionnaires on 3 outcome instrument systems, namely SF-36, WOMAC and MACTAR. Two control groups consisting of 44 cases of similar age from general population with knee discomfort and susceptible to osteoarthritis as well as 26 patients scheduled for knee arthroplasty filled out the same questionnaires. The health status measurement [SF-36], disease-specific outcome measure and patient preference arthritis scores all showed significant improvement in operated cases, in both short and long term follow-up groups. Certain aspects of function like socialization with others, attending religious ceremonies and similar activities, often requiring full knee bending and /or sitting on the carpeted floor, were the main reasons for dissatisfaction with the procedure. The knee arthroplasty increased quality of life, improved function and produced great satisfaction in the majority of cases in our society. This is, however, a viable option for people who could change their lifestyle and household and are able to make the adjustments mentally and financially

Osteoarthritis: Possible role of ethnic and cultural factors

This is a study on one-hundred consecutive patients, over 45 years of age, with symptomatic primary osteoarthritis, referred to the teaching clinics of Shiraz University of Medical Sciences. Eighty-six females and 14 males were clinically examined and radiographic evaluation of the hips, knees, and hands was done. Predominant female [male/female ratio 1:6.1] and 94% knee involvement were the major findings of this study. Hip osteoarthritis was infrequent and observed in only 2% of cases. Fifty-nine per cent of the cases were housewives. Obesity was observed in 60 patients. Sitting in cross-legged or in kneeling positions was practiced in 93 patients, and seemed to contribute to high prevalence of knee osteoarthritis. Heberden's nodes were seen in 72 cases, with more in the older age group. Nodosity correlated with severity of knee osteoarthritis

High-velocity missile injury of the peripheral nerves experience from the Iran-Iraq war

Forty-five cases of nerve injuries in 44 patients from the Iran-Iraq war were retrospectively evaluated over a period of 14-64 months, following surgical treatment. Thirteen radial, 12 ulnar 5 median, and 15 sciatic nerves were studied. Epineural neurorrhaphy was performed in 25, internal neurolysis in 15 and nerve grafting in 3 cases. Two nerve injuries were found irreparable at surgery. The operations were performed without magnification and within 2-5 months delay. The results were satisfactory in 83% of radial nerves, 75% of ulnar, 75% of median and 46% of sciatic lesions

Experience with sixty cases of spinal cord injury from Iran-Iraq war

Sixty cases of spinal cord injury from the Iran-Iraq war, with an average follow-up of 33 months, were studied. Thirty cases had undergone surgery. Spinal deformity was recognized in 93.3%, with higher frequency and severity in those who had laminectomy. Ninety percent of these cases remained wheelchair-bound, 5% had only bed independence and 5% were community ambulators. Forty-eight cases [80%] developed bed sore and 31.6% ectopic ossification, mainly in the spastic group. It is concluded that spinal deformity is a common sequel to cord injury, which does not usually cause major functional impairment and often self-stabilizes within one year in adults. Laminectomy was found to be useless for neurological recovery and harmful for spinal stability. Functional ambulation seemed to be a far-reaching goal in most cases. Spasticity was at least subjectively a very troublesome situation for the sufferer and also contributed to a higher rate of ectopic ossification