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Total knee arthroplasty (TKA) is a commonly performed surgery for individuals experiencing advanced knee osteoarthritis. Patients undergoing TKA can present with a variety of comorbidities, ranging from the absence of chronic illnesses to the presence of multiple health conditions. The complexity of these comorbidities can pose challenges in carrying out the desired procedure due to the elevated risk profile; this limits the anesthesia modalities that the physician can utilize. Careful consideration of patients' overall health status and personalized anesthesia approaches are crucial to ensure optimal outcomes in this diverse patient population. This case involves an eighty-year-old male with a history of multiple comorbidities who underwent a left TKA. The patient presented a high-risk profile during evaluation, classified as American Society of Anesthesiology (ASA) class IV, which made general and neuraxial anesthesia unfavorable due to high risks. Regional anesthesia was utilized as the sole modality of anesthesia and was successful. This demonstrates that regional anesthesia is a viable option when attending to patients with high risks associated with other anesthesia modalities.
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Femoral shaft fracture is one of the most common injuries encountered. However, improper management can lead to significant long-term complications, of which is malunion. Patients with femoral malunion are at increased risk of developing knee osteoarthritis, and if arthroplasty is indicated, these extra-articular deformities pose a challenge as corrective osteotomy and soft tissue release are also required. In such circumstances, robotic arm-assisted total knee arthroplasty (RATKA) might be an appropriate option. In this case, we present a 66-year-old woman who had previously suffered a femur shaft fracture, which was treated conservatively, and developed a varus malunion and severe knee osteoarthritis, and who was treated with RATKA.
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Context Although the Modified Harris Hip Score (MHHS) is used worldwide, it has not been translated into Arabic or validated for use among Arabic populations. Aim This study aimed to translate the MHHS into Arabic and to culturally adapt and validate the Arabic version. Design A cross-sectional study of the MHHS was performed. Methods The MHHS was translated into Arabic using forward-backward translation. A total of 183 adults who could speak and read Arabic completed the questionnaire. Cronbach's alpha was used to assess internal consistency with respect to the total and subscale scores. Pearson's correlation coefficient was used to evaluate associations between the total scores, and the subscales and intersubscales. Test-retest reliability was assessed using the intraclass correlation coefficient (ICC). The Kaiser-Meyer-Olkin value was determined before principal component analysis to evaluate the validity of the construct and the reliability of the data, and correlations among the score items were estimated. Results All the participants understood the questions. The ICCs for the total score, function subscale, and pain subscale were 0.936, 0.936 and 0.893, respectively. Cronbach's alpha was acceptable for the total score (0.792) and good for the function subscale (0.895). The total score and the function (r = 0.976; p < 0.001) and pain (r = 0.971; p < 0.001) subscales correlated significantly. Regarding score validity, all the MHHS items correlated with the total score (p < 0.001). Conclusions The reliability and validity of the Arabic version of the MHHS was demonstrated. The MHHS can be used to assess hip pathology among adults in Saudi Arabia.
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Stiffness following total knee arthroplasty (TKA) can be a devastating complication to the patient by limiting his function. Various causes have been reported in the literature, including heterotopic ossification (HO). HO is one of the rarely reported complication of TKA characterized by deposition of bone cells in non-skeletal tissue. This is a case of 32-year-old female known to have rheumatoid arthritis with history of TKA 4-years-ago complaining of right knee pain and restricted range of motion. She was later found to have HO and was treated with a revision TKA. In conclusion, the incidence and outcome of HO following total knee replacement in patients with RA remains underexplored topic in the literature.
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Myelofibrosis is a myeloproliferative disease that falls under a group of bone marrow malignancies known as myeloproliferative neoplasms. It manifests with splenomegaly, anemia, leukocytosis and, less commonly, bone pain. Ruxolitinib, Janus kinase inhibitor, has been shown to increase survival, to improve symptoms and has the potential to decrease osteosclerotic changes. Herein, we present a case of primary myelofibrosis (PMF) in a 60-year-old female who presented with 8-month history of progressive left hip pain and later was diagnosed with pathological neck of femur fracture that was treated with cementless hemiarthroplasty. In conclusion, the use of cementless implants in hip arthroplasty in the presence of PMF has shown to be an effective and safe choice.
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OBJECTIVES: To identify the prevalence of different types of femoral fractures post-motor vehicle accident (MVA) based on fracture location: proximal, middle and distal. METHODS: A cross-sectional study of all femoral fracture post-MVA x-ray charts carried out at the National Guard Hospital, Riyadh, Kingdom of Saudi Arabia between November 2007 to December 2013. RESULTS: Among the 471 patients reviewed, most fractures were in male (87%) compared with female (13%) victims, with breaks more in the right femur (56%) than the left femur (44%). As for location of the femur fracture, middle fractures (64%) exceeded proximal (26%) and distal fractures (10%). The most common age group was between 16-30 years, representing 56% of these fractures. CONCLUSION: Prevalence of the femur fracture location varies depending on gender, age, and other factors.
