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Clinical Improvement of osteoarthritic knee pain by adding intra-articular steroid Injection to viscosupplementation

Author: Ahmed Latteef Al-Shamari
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2015 Volume: 14 Issue: 1 Pages: 51-57
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Intra-articular injections have been used for many years to treat painful joint disorders, especially by means of injecting crystalline suspensions of long-duration corticosteroids. Viscosupplementation, which is a relatively new intervention, consists of injection of exogenous hyaluronic acid into joints in order to treat osteoarthritis of knee joint. Patients and Methods: A prospective cohort study was conducted in a private orthopedic clinic in Baghdad from March 2013 to the end of September 2014, where it enrolled a total of fifty six (56) patients of middle ages, ranging from 39 to 64 years, classified as either grade II or III according to Kellgren and Lawrence radiographic criteria. Intra-articular injection of two drugs (a long acting steroid drug, then hyaluronic acid) were given locally in one or both knee joints with one week apart. To evaluate the effect of therapy, current study group patients were assessed by Visual Analogue Scale (VAS) after 1 week, and after 4-8 weeks from the beginning of the therapeutic trial. Results: more than two-third of cases were women (a ratio of 2.1:1), with age group of 50- 59 years old. No statistical correlation was found between Visual analogue scale (VAS) and radiographic grading (i.e. Kellgren and Lawrence radiographic criteria). Significant statistical difference (P<0.05) was shown in patients receiving intra-articular corticosteroids after week "1" of therapy, and a slightly better effect after adding hyaluronic acid on week "4" regarding the VAS scale of pain for radiographic grade II patients. Radiographic grade III patients showed a significant statistical correlation in VAS after week (4) of therapy for both moderate and severe classes. Conclusion: Intra-articular injections of both corticosteroids and hyaluronic acid with one week apart appear to give clinical improvement better than using Intra-articular injection of hyaluronic acid alone.


Article
Comparative study of anterior knee pain after patelloplasty with and without circumferential denervation in a total knee arthroplasty

Author: Ahmed Latteef Al-Shamari, M.B.Ch.B, F.I.B.M.S.
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2017 Volume: 13 Issue: 2 Pages: 114-119
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: The anterior knee pain is an important chief complaint of the patients with knee osteoarthritis due to patellofemoral pathology. The pain receptors denervation can be achieved by circumferential denervation of the patellar area by a process of electrocautery. Objectives: The aim of current study is to assess the pain after total knee arthroplasty (TKA) by patelloplastywith and without circumferential denervation via electrocautery at a minimum follow up with 1 year separately for each patient.Type of the study:Cross- sectional study.Methods: Thirty five patients,with mean age of about (62.8) years, were enrolled in this prospective, hospital based study that was held at Al-Yarmouk Teaching Hospital in Baghdad from October 2012 to November 2016. These patients were divided into 2 groups, first group was composed of 19 patients who have TKA with patellar circumferential denervation by electrocautery with patelloplasty by removing peripheral osteophytes of patella , the second group of 16 patients were undergone TKA without denervation, but only patelloplasty. The second group was considered as the control group. Visual analogue scale (VAS) was used to evaluate pain pre and post operatively. The patient’s functional ability was assessed by knee society score (KSS) also before and after TKA for both groups and pain killer was given according to patients need.Results: All of the patients were followed for 12 months period. No drugs were used other than occasional use of pain killers in first month after operation for all patients in group one of study. On VAS scale, significant statistical difference in pre and post-operative scales were noticed between both groups of study. The Knee Society Scale (KSS) was showing a non- significant statistical significance between both study groups before and after TKA. ConclusionA: nterior knee pain can be reduced through the use of patelloplasty with circumferential denervation of patella byelectrocautery, compared with non- denervated procedure. Good clinical outcome was also present.


Article
Comparison between dome and wedge osteotomy in management of hallux valgus deformity
مقارنة بين بضع العظم والقبة إسفين في إدارة تشوه أروح الإبهام

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Abstract

Background: the condition of hallux valgus is considered as the most common deformities affecting females more than males, characteristically manifested as lateral deviation of the big toe and widening of first and second inter -metatarsal angle with a deformity of second toe in some severe cases.Objective: to make a radiological and clinical assessment of two surgical methods of osteotomy used in treatment of hallux valgu and to compare between them: first one is the distal dome osteotomy, and second one is a distal wedge metatarsal osteotomy.Patients and methods: a total of 36 feet of 28 patients suffer from hallux valgus, with mean age of 50.3 years were included in this study, followed for 6- 30 months ( mean follow-up of 8.8 months). Nineteen feet treated by dome osteotomy and seventeen feet treated by wedge osteotomy. All the cases were evaluated by the american orthopedics foot and ankle society (aofas) score, also, through the hallux valgus angle and intermetatarsal angle, both before and after surgery. Results: by dome osteotomy, the preoperative mean result of aofas score was about 45.7, with hallux valgus angle (hva) of 33.2o and intermetatarsal angle (IMA) of 11.7º. Postoperatively, the mean result of AOFAS score was 82.8, with HVA of 14.3º and IMA of 7º, with about 94.7% satisfactory results. In the other hand, the method of wedge osteotomy showed a preoperative mean result for AOFAS score of 45.2, with HVA of 34º and IMA of 12.8º , compared with postoperative mean result of AOFAS score of about 80.7, with HVA of 15.8º and IMA of 7.7º, with about 82.8 % satisfactory results.Conclusions: the two methods of osteotomy were used with very good outcome in radiological and clinical treatment of hallux valgus.

المقارنه بين طريقه القبه والإيقاع في علاج ابهام القدم الاروحالطريقةتم دراسه 36 قدم ل 28 مريض معدل اعمارهم 50.3سنه مصابون بإبهام القدم الاروح.معدل وقت المتابعه 8 اشهر 19 قدم تم معالجتها بواسطة القبه و 17 بواسطة الايقاع.ثم تم دراسة النتائج حسب مقياس AOFAS الامريكي.الذي يعتمد على ثماني عوامل منها حساب الزوايا حسب الرقائق الشعاعيه.الاستنتاجكلا الطريقتين متساوية الفعالية سريريا وشعاعيا في النتائج

Keywords

Hallux valgus --- osteotomy --- dome --- wedge.

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