Neutral Mechanical Alignment and Prevalence of Constitutional Varus Knees Among the Saudi Population at King Saud University Medical City.

Background Various studies have described the restoration of the neutral mechanical alignment of the lower limb in total knee replacement (TKR) as a key factor of knee implant durability. Mechanical alignment of the knee requires that the tibial and femoral cuts are perpendicular to the mechanical axis of each bone in the coronal plane. Objectives The aim of this study is to investigate mechanical knee alignment and the prevalence of constitutional varus knee among the Saudi population at a single tertiary center with no history of musculoskeletal abnormalities. Methodology This is a retrospective cross-sectional study involving patients with no musculoskeletal abnormality who had their lower limb X-ray Centigram using the universal viewer zero footprint system made between 2015 and 2021. The study took place at King Saud University Medical City. The X-rays were obtained from patients' electronic medical records retrospectively. A total of 728 knees of 370 males and 358 females were included in this study. Results The results showed that 165 male knees (44.4%) and 218 female knees (60%) had constitutional varus alignment with the hip-knee-ankle (HKA) angle of ≤3° or less. The average HKA angle was smaller in males than in females: -3.69° versus -1.98°, respectively. Conclusion We have identified variables and factors that can help surgeons detect the constitutional varus on a full leg radiograph preoperatively at the time of TKA, regardless of the osteoarthritic changes of the knee. We encourage the scientific community to look for causes and risk factors for developing constitutional varus.

Foot health and quality of life among adults in Riyadh, Saudi Arabia: a cross-sectional study.

BACKGROUND: Foot conditions are frequent among the Saudi population. However, little is known regarding the effects of foot health on quality of life among the general Saudi population. This study aimed to assess foot health status, general health, and quality of life among the population of Riyadh using the Foot Health Status Questionnaire (FHSQ). METHODS: In this cross-sectional study, out of the total number of participants approached, using a preset questionnaire, by trained medical students to participate in this study, 398 met the inclusion criteria. The questionnaire started with an informed consent followed by a set of questions regarding the sociodemographic and past medical characteristics of the participants. Foot health and overall health were assessed using a FHSQ. RESULTS: A statistically significant positive correlation was observed between all the FHSQ domains, except for footwear. The strongest correlation was observed between foot pain and foot function, foot pain and general foot health, and foot function and general foot health. A statistically significant positive correlation was observed between general foot health and general health, vitality, social function. Our results also showed that foot pain, general foot health, vitality, and social function scores were significantly lower in women as compared to men. CONCLUSION: Significant positive correlation was observed between poor foot health and declining quality of life; thus, it is crucial to increase society's awareness of the importance of medical foot care and continuous follow-up and consequences if left unrecognized and untreated. This is a major domain that can improve the well-being and quality of life of a population.

Total synovectomy and total knee arthroplasty in old patient with pigmented villonodular synovitis - A case report.

Pigmented villonodular synovitis (PVNS) is a rare and benign lesion of unknown cause. Most cases reported in adult age patients. The diagnosing of PVNS is more difficult in old age patients and might be confused with osteoarthritis. This article reviews detailed history, examination, and investigations of 79 years-old male patient with 5 years history of right knee pain and deformity. The patient was diagnosed with PVNS, and total synovectomy was performed, followed by constrained total knee arthroplasty. The present report aimed to highlight that the total synovectomy with total knee arthroplasty is a viable option with the advantage of favorable outcome in treating patients with PVNS associated with advanced osteoarthritis.

Awareness about total knee replacement among Saudi population.

Introduction: The purpose of this study is to identify the knowledge of the general population about knee osteoarthritis and its surgical interventions in the management of knee osteoarthritis. Knee osteoarthritis is a prevalent disease. A lack of knowledge about the nature of the disease may delay seeking medical advice until the advanced stage of the disease. Methods: This cross-sectional study was conducted among 486 participants (≥18 years) who were sampled randomly from an osteoarthritis awareness campaign located within a shopping facility located in Riyadh in 2020. Data were collected via a structured questionnaire, which included six domains; demographic information, causes, symptoms, treatment, complications, and general questions. Data for this study were analyzed by using the Statistical Package for Social Studies (SPSS 22; IBM Corp., New York, NY, USA). Continuous variables were expressed as mean ± standard deviation and categorical variables were expressed as percentages. The t-test and one-way Analysis of Variance (ANOVA) were used for continuous variables. Univariate and multivariate logistic regression were used to assess the associated factors with a low level of knowledge. A P value of <0.05 was considered statistically significant. Results: Most of the participants in our study were males (56.8%) and Saudi nationals (89.7%). (83.74%). Consider that surgical intervention is the best treatment when non-surgical options do not work. The mean questionnaire score for the 486 participants was found to be 20.85 ± 5.29 out of 35 points. In comparing the male to female total scores, we found the mean female total score to be statistically significant and higher than that of the males with a P value of 0.036. Furthermore, we found that the non-Saudis had a total score higher than the Saudis with a P value of 0.016. On the other hand, the difference in the total scores between the city and rural area residents and different educational levels were statistically insignificant. Conclusions: Our results demonstrate that the majority of the community has satisfactory awareness about the treatment options of knee osteoarthritis. It also demonstrates the domains that require more effort for increased public awareness of knee osteoarthritis.

Concurrent Research Around Meniscus: A Bibliometric Analysis and Review of the Top Fifty Cited Papers.

Purpose: The knowledge regarding meniscus has vastly evolved over the past few decades. The meniscus's intact, injured, and repaired status can affect other joint structures, i.e., ligaments, articular surfaces, and overall biomechanics of the knee joint. Due to available evidence's extensiveness, it is challenging to determine the most influential topics and the emerging trends in concurrent meniscus research. This study aims to identify the top fifty cited papers in meniscus research and concurrent knee issues and analyse their characteristics. Methods: A comprehensive search was conducted on the Thompson Reuters Web of Science database to prepare a list of top fifty cited articles that included original articles and review articles concerning meniscus. The included articles were analysed for the source journal, investigating institution, country of the corresponding author, year of publication, total citations, annual citation rate, and a qualitative review. Results: The search strategy resulted in 6768 original articles and 453 review articles. The top fifty cited articles were published from 1969 to 2014 and belonged to 14 journal sources. There were 43 original articles and seven review articles. The average citations per article were 417.4 and the average citations per paper per year were 22.6. Besides the meniscus, a general interest in the clinical assessment scores, anterior cruciate ligament, long-term osteoarthritis, and cartilage was observed. Conclusion: Most of the research concerning meniscus relates to the importance of meniscus preservation, the link between meniscus injuries and concomitant anterior cruciate ligament and chondral injuries, and its role in long-term gonarthrosis. The western countries have contributed the maximum to the top-cited evidence concerning meniscus. The meniscus repair and transplantation techniques have recently gained importance and need further research to qualify for the top-cited evidence.

Use of Antibiotic Lavage in Total Knee Replacement to Prevent Postoperative Infection.

Purpose To determine the effectiveness of using antibiotic lavage in preventing postoperative infections in total knee replacement (TKR) patients. Methods Data on all patients who underwent TKR, either primary or secondary, during the period from May 2015 to April 2019 were collected. Many factors (both patient-related and surgery-related) that can increase the risk of surgical site infection (SSI) were taken into consideration to eliminate confounding factors. Results A total of 685 patients were identified; out of those, 232 patients received intraoperative antibiotic lavage and 453 did not. We noted that out of all 13 patients who developed SSI, only one patient (7.7%) had received antibiotic lavage, while the other 12 (92.3%) patients did not receive antibiotic lavage. However, the difference was not statistically significant (p=0.078). Conclusion Using intraoperative vancomycin lavage was associated with a decrease in the incidence of SSI post-TKR, but the difference was not statistically significant. However, more studies are needed in this area.

Comparison of Ceramic-on-Ceramic and Ceramic-on-Highly-Crosslinked-Polyethylene in Primary Total Hip Arthroplasty: Findings of a Meta-Analysis.

Introduction An optimal hip implant is biocompatible, durable, and resistant to chemical and mechanical wear. This analysis aimed to compare failure (revision) and complication rates between ceramic-on-ceramic (CoC) and ceramic-on-highly-crosslinked-polyethylene (CoHXLPE) implants. Methods This review comprised of scientific literature published between 1995 and 2019. We included randomized controlled trials in adults (>18 years) that presented results of CoC and CoHXLPE total hip arthroplasty (THA) with more than two years of mean follow-up and drafted in English. The primary outcomes for this analysis were complications, revision rates, and loosening rates. Results Eight studies (1,689 hips) were included in this systematic review. There was no significant differences between COC and CoHXLPE for the risk of post-surgical complications (relative risk [RR]: 1.98, 95% confidence interval [CI]: 0.83-4.69, P = 0.12). Revision rates (RR: 1.25, 95% CI: 0.71-2.20, P = 0.43] and loosening rates between the two implants were not significantly different (RR: 1.17, 95% CI: 0.30-4.52, P = 0.82). Conclusion We report no significant differences between CoHXLPE and CoC in adults undergoing primary THA. Although introduced relatively recently, CoHXLPE is a cost-effective bearing that can be used for younger patients with no risk of increased complications in comparison to CoC. Further studies with longer follow-up periods are recommended to confirm the findings of this meta-analysis.

Prevalence of knee injuries among male college students in Riyadh, Kingdom of Saudi Arabia.

BACKGROUND: The knee is considered the most common injured joint between young sport participants. However, there is lack of proper prevalence estimation in our population. The purpose of this study was to identify the prevalence of knee injuries among male college students and to observe the demographic data associated with it. Our secondary objective was to evaluate the awareness and knowledge about these injuries. METHODS: This is a cross-sectional study. A survey was distributed to collect the data among male college students, King Saud University, Riyadh, Saudi Arabia. Out of 688 students who participated and completed the questionnaire, a total of 482 were considered valid and met the inclusion criteria. Data were analyzed using Statistical Package for Social Sciences (SPSS). RESULTS: The overall prevalence of knee injury was 23.2% (n = 112). Most of them injured during sport activities especially soccer and 68.7% involved in a non-contact mechanism of injury. Among those who went to a hospital mostly were diagnosed as contusion (31.4%) then as meniscus tear, ACL, and collateral ligament injury, respectively. Majority was treated conservatively and only 10.7% needed surgery surprisingly. There was no statistically significant difference between those who are injured and whether they were warmed up and stretched or not (P = 0.619). Low level of knowledge about knee injuries was noticed among the participants 57.7%. CONCLUSION: Our study has highlighted the high prevalence of knee injuries and the need to raise the level of awareness and knowledge about these injuries in our population. Soccer was the most common sport associated with knee injuries; most of these injuries were treated conservatively.

Knowledge and awareness of plantar fasciitis in the Saudi population.

OBJECTIVE: To evaluate and assess the knowledge and awareness level of lay people about plantar fasciitis (PF). METHODS: The cross-sectional study was conducted at a shopping mall in Riyadh, Saudi Arabia, from May to July 2017, and comprised random individuals busy shopping in the area. Data was collected through a self-administered questionnaire. , and was analysed using SPSS 22. . RESULTS: Of the 176 subjects, 101(57.4%) were females and 75(42.6%) were males. The age range was 18-55 years, and 153(87%) belonged to urban population. Overall, 60(34%) subjects had never heard of plantar fasciitis. Also, 148(84%) subjects thought that specialised medical shoes can be used as possible treatment for plantar fasciitis (p<0.001).Females had significantly higher knowledge regarding plantar fasciitis than males (p=0.009). CONCLUSIONS: Over 30% subjects did not have any knowledge about plantar fasciitis.

The Impact of Mechanical and Restricted Kinematic Alignment on Knee Anatomy in Total Knee Arthroplasty.

BACKGROUND: Total knee arthroplasty (TKA), aiming at neutral mechanical alignment (MA), inevitably modifies the patient's native knee anatomy. Another option is kinematic alignment (KA), which aims to restore the original anatomy of the knee. The aim of this study was to evaluate the variations in lower limb anatomy of a patient population scheduled for TKA, and to assess the use of a restricted KA TKA protocol and compare the resulting anatomic modifications with the standard MA technique. METHODS: A total of 4884 knee computed tomography scans were analyzed from a database of patients undergoing TKA with patient-specific instrumentation. The lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), and hip-knee-ankle angle (HKA) were measured. Bone resections were compared using a standard MA and a restricted KA aiming for independent tibial and femoral cuts of maximum ±5° deviation from the coronal mechanical axis and a resulting overall coronal HKA within ±3° of neutral. RESULTS: The mean preoperative MPTA was 2.9° varus, LDFA was 2.7° valgus, and overall HKA was 0.1° varus. Using our protocol, 2475 knees (51%) could have undergone KA without adjustment. To include 4062 cases (83%), mean corrections of 0.5° for MPTA and 0.3° for LDFA were needed, significantly less than with MA (3.3° for MPTA and 3.2° for LDFA; P < .001). CONCLUSION: The range of knee anatomy in patients scheduled for TKA is wide. MA leads to greater modifications of knee joint anatomy. To avoid reproducing extreme anatomy, the proposed restricted KA protocol provides an interesting hybrid option between MA and true KA.

Does warming up improve surgical outcome in total hip arthroplasty?

PURPOSE: Warming up prior to surgery has been shown to enhance surgeons' performance during laparoscopic procedures. It is unknown whether or not warming up prior to total hip arthroplasty (THA) will have a similar effect on surgical outcome. METHODS: We retrospectively evaluated the effect of warming up on the intraoperative outcome of 82 patients who underwent a primary THA with identical implants. The patients were divided equally into two groups. Group 1 (first case of the day) served as "warm-up procedure," while Group 2 (second case of the day) was the "post-warm-up procedure." RESULTS: We found no statistically significant difference when we compared cup abduction and anteversion angles, femoral offset, postoperative LLD, stem alignment, hip center of rotation and femoral stem canal fill between the two groups (p > 0.05). CONCLUSION: Warming up prior to performing surgery does not make a difference for primary THA when performed by an experienced surgeon. However, these results may not reflect its effect on procedures that require fine motor skills or done by an orthopedic trainee or less experienced surgeons.

Effect of acetaminophen and nonsteroidal anti-inflammatory drugs on gene expression of mesenchymal stem cells.

We have previously shown that mesenchymal stem cells (MSCs) from patients with osteoarthritis (OA) constitutively express type X collagen, a marker of late-stage chondrocyte hypertrophy, osteogenic marker genes, including alkaline phosphatase (ALP), bone sialoprotein (BSP), and osteocalcin (OC), and chondrogenesis marker gene aggrecan (ACAN). As patients with arthritis often take nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (Acet), the purpose of the study was to assess whether these drugs can affect the gene expression of human MSCs. MSCs isolated from the bone marrow of patients with OA or normal donors were cultured without (control) or with Acet or NSAIDs, which include ibuprofen, diclofenac (Dic), naproxen, and celebrex. After 3 days of culture, the expression of type X collagen alpha 1 (COL10A1), ACAN, COL1A1, as well as ALP, BSP, OC, and Runt-related transcription factor 2 was analyzed by real-time reverse transcription (RT)-polymerase chain reaction. The results showed that COL10A1 and the osteogenic and chondrogenic marker genes can be regulated by NSAIDs and Acet in normal MSCs. In contrast, Acet did not significantly affect COL10A1 expression in OA MSCs, while Dic is the only drug that had no significant effect on all markers in normal MSCs. The upregulation of COL10A1 in normal MCSs by Acet and Npx may explain why stem cells from patients with OA express COL10A1 constitutively. This knowledge may help in designing better strategies for stem cell differentiation into chondrocyte-like cells, from this source, with Dic being a viable option for treating OA pain, with an eye toward preventing the potential to enhance calcification in the repair of cartilage and degenerated intervertebral discs.