Staged hip replacement for neglected bilateral Crowe's Grade 4 dysplasia.

Factors such as consanguinity, breech presentation, and family history have been attributed to the diagnosis of developmental dysplastic hip (DDH) in Saudi Arabia. The prevalence of DDH in Saudi Arabia is higher in females than in males, with 10.46 cases per 1000 live births. Cases with bilateral high hip dislocation rarely cause early symptoms and can easily be neglected; therefore, these cases present later in life with degenerative osteoarthritis requiring a challenging hip replacement. This report presents the case of a 54-year-old female with bilateral high dislocated dysplastic hip joints. A successful staged bilateral total hip replacement resulted in painless and stable hip joints. The surgery was conducted successfully by ensuring the availability of personnel with the necessary skills, equipment, and an experienced treatment team. Therefore, the results stress the need to utilize screening tests for the early diagnosis and treatment of developmental dysplastic hip.

Cervical Joint Position Sense and Its Correlations with Postural Stability in Subjects with Fibromyalgia Syndrome.

Cervical joint position sense (JPS) and postural stability are vital to maintaining balance and preventing falls in fibromyalgia syndrome (FMS). Impaired cervical JPS may influence postural stability, and understanding the relationship between them can aid in formulating treatment strategies in individuals with FMS. This study aims to (1) assess cervical JPS and postural stability between FMS and control group and (2) determine the correlation between cervical JPS and postural stability in the FMS group. This cross-sectional study recruited 92 FMS patients (mean age: 51.52 ± 7.7 yrs.) and 92 healthy controls (mean age: 49.36 ± 6.9 yrs.). A cervical range of motion (CROM) unit was utilized to assess cervical JPS. The postural stability was assessed using an IsoFree force platform, and anterior-posterior (A/P) and medial-lateral (M/L) directions of sway and ellipse area were measured. Cervical JPS and postural stability tests were assessed and compared between FMS and control groups. Cervical JPS was significantly impaired in FMS compared to the control group (p < 0.001). The JPS errors in FMS group were larger in flexion (FMS = 5.5°, control = 2.4°), extension (FMS = 6.4°, control = 3.0°), and rotation in left (FMS = 5.4°, control = 2.2°) and right directions (FMS = 5.1°, control = 2.8°). FMS individuals demonstrated statistically significant impaired postural stability compared to control in both the dominant and non-dominant legs tested (p < 0.001). The cervical JPS test showed moderate to strong positive correlations with postural stability variables. Statistically significant correlations were observed in all the JPS directions tested with all the postural stability variables (A/P and M/L sway and ellipse area). The correlation coefficients ranged between r = 0.37 (moderate) to 0.75 (strong). Cervical JPS and postural stability are impaired in FMS individuals. A moderate to strong relationship existed between JPS and postural stability. Individuals with FMS who had a greater magnitude of cervical JPS errors exhibited more severe postural control deficits. Therefore, cervical JPS and postural stability tests should be incorporated into routine clinical practice when assessing or formulating treatment strategies for patients with FMS.

Targeting Hydrogen Sulfide Modulates Dexamethasone-Induced Muscle Atrophy and Microvascular Rarefaction, through Inhibition of NOX4 and Induction of MGF, M2 Macrophages and Endothelial Progenitors.

Long-term use of Glucocorticoids produces skeletal muscle atrophy and microvascular rarefaction. Hydrogen sulfide (H2S) has a potential role in skeletal muscle regeneration. However, the mechanisms still need to be elucidated. This is the first study to explore the effect of Sodium hydrosulfide (NaHS) H2S donor, against Dexamethasone (Dex)-induced soleus muscle atrophy and microvascular rarefaction and on muscle endothelial progenitors and M2 macrophages. Rats received either; saline, Dex (0.6 mg/Kg/day), Dex + NaHS (5 mg/Kg/day), or Dex + Aminooxyacetic acid (AOAA), a blocker of H2S (10 mg/Kg/day) for two weeks. The soleus muscle was examined for contractile properties. mRNA expression for Myostatin, Mechano-growth factor (MGF) and NADPH oxidase (NOX4), HE staining, and immunohistochemical staining for caspase-3, CD34 (Endothelial progenitor marker), vascular endothelial growth factor (VEGF), CD31 (endothelial marker), and CD163 (M2 macrophage marker) was performed. NaHS could improve the contractile properties and decrease oxidative stress, muscle atrophy, and the expression of NOX4, caspase-3, Myostatin, VEGF, and CD31 and could increase the capillary density and expression of MGF with a significant increase in expression of CD34 and CD163 as compared to Dex group. However, AOAA worsened the studied parameters. Therefore, H2S can be a promising target to attenuate muscle atrophy and microvascular rarefaction.

Total Hip Replacement in Sickle Cell Disease Patients with Avascular Necrosis of Head of Femur: A Retrospective Observational Study.

BACKGROUND: Femoral head avascular necrosis leads to osteoarthritis of the hip joint and affects its functional capacity in sickle cell disease patients. The functional outcomes of total hip replacement (THR) on patients with congruous joints who underwent hip replacement after having a failed joint preservation surgery are unknown. This study aimed to compare the functional outcomes of THR in patients with sickle cell disease having avascular necrosis with and without loss of hip joint congruency. METHODS: This retrospective study included 35 patients (age, 20-52 years; 18 males and 17 females) who underwent uncemented THR. Patients were divided into Group-A (n = 18, good hip joint congruency) and Group-B (n = 17, obliterated hip joint congruency). The Harris Hip Score (HHS) was used to assess functional outcomes. All patients were followed up at 6-weekly intervals then 6-monthly intervals. RESULTS: The mean follow-up period was 8.26 ± 3.01 years. The mean preoperative HHSs of Group-A and Group-B were 45.22 ± 3.021 and 25.94 ± 4.437, respectively. Postoperatively, a subsequent increase in HHS was found in both groups, and a significant difference between the groups was observed at 6 weeks (p < 0.0001*) and 1 year (p < 0.0006*). Interestingly, HHS was not significantly different (p = 0.0688) at 5-year follow-up between the groups. The differences in HHS within the group at each subsequent follow-up were also statistically significant (ANOVA, p < 0.0001*). CONCLUSION: A significant improvement was observed with THR in both groups. Nevertheless, the flattened hip joint congruency group showed significantly better HHS improvements than the normal congruency groups. These findings may aid in the decision-making capabilities of the surgeons.

Total knee replacement at Southwestern Saudi Arabia: A single-center experience.

BACKGROUND: Knee replacement enables the surgical management of end-stage knee joint osteoarthritis. In Saudi Arabia, there has been a recent increase in total joint replacement surgery. However, there is insufficient literature regarding patient outcomes in this region. Here, we assessed characteristics of patients who underwent total knee arthroplasty and their improvements on knee society score, timed up and go test, and 2-min. walk test. METHODS: Patients who underwent primary total knee replacement at our tertiary care private hospital in Abha from January 2013 to January 2020 were included. The same orthopedic surgery performed primary cemented cruciate-substituting knee replacement. Knee function was evaluated using the knee society scoring system, timed up and go test, and 2-min. walk test. RESULTS: Out of 420 patients, 350 were females (83.33%) and 70 males (16.67%). The mean age was 69.50 ± 7.48 years (range, 48-90). Most patients had osteoarthritis (84.5%), either degenerative or secondary because of trauma. Knee society functional and knee scores were poor preoperatively (mean, 38.21 ± 9.65; SD, 36.89 ± 8.23) but improved postoperatively (mean, 81.42 ± 12.74; SD, 85.49 ± 11.69; P < 0.001). The timed up and go test significantly changed from 28.51 ± 3.29 s to 18.18 ± 3.17 s (P < 0.001) and 2-min. walk test from 51.83 ± 6.48 m to 85.72 ± 8.92 m (P < 0.001). CONCLUSION: Despite knee replacement's late acceptance in Saudi Arabia, there have been increased cases in recent years and excellent improvements in knee function. The resulting knee society functional and knee scores, timed up and go tests, and 2-min. walk tests were better or similar to results seen by other researchers worldwide.

Burnout syndrome among southern region orthopedic surgeons, Saudi Arabia.

BACKGROUND: Burnout is known as result of long term exposing to stress. There are some factors that may cause stress in physicians: nature of work, their training, their public image, their families and themselves. The person who has burnout syndrome (BOS) seems like to have tiredness, low energy, nervousness, and mentally unstable. The aim of the study is to assess the pattern and magnitude of burnout among orthopedic surgeons in southern region, Saudi Arabia. METHODOLOGY: A descriptive cross-sectional survey was applied targeting all orthopedic surgeons in 12 hospitals all southern region, Saudi Arabia during the period from December 2018 to April 2019. Data were collected using self-administered questionnaire that was developed by the researchers. The questionnaire included personal data. Burnout was assessed using Maslach Burnout Inventory Scale. RESULTS: A total sample of 107 orthopedic surgeons were included with their ages ranged from 25 to 65 years old with mean age of 38.1 ± 8.9 years. About 94% of the surgeons were males and 43.9% were Saudi. Generally, the surgeons recorded mean score for emotional exhaustion of 18.9 points out of 54 with mean score% of 35.1%. Regarding depersonalization, the surgeons had mean score % of 30.7% and had a score of 39.6% for personal accomplishment. CONCLUSIONS: The study revealed that all included physicians had moderate levels of burnout. Personal accomplishment was the highest level of burnout recorded. Health education sessions and periodic training is required to improve surgeons coping strategies to overcome burnout.