48 knees that underwent of TKA with OA diagnosis as an RCT with prospective plan divided double blind in two groups of patelloplasty & boney medialization And sham group with regular patelloplasty. We followed them for a year and 3 times clinical and x-Ray checking, immediately after surgery and in 3 months and 12 months post surgery. In term of clinical finding they looked the same but in radiography, patellar medialization had superior manifestations. Although is seems that is too soon to talk about mid or long term results of this procedure, but to be sure about positioning of patella in x-Ray looks better.

There are several case reports or small series of stress tibial fracture around the OA knees in literature.

Our study goes on 10 tibial stress fracture in 9 patients.

All of the fractures have been distal to proximal tibial methaphysis.

8 of them have been in mid shaft or proximal of mid tibia, only 2 had fractures in distal half of tibia 8 were manage by braces for at least 8 months post TKA.

Left side of the Bilateral one was fixed by simple IM nail and in 10 months was changed by TKA.

Another very interesting case after failure of plate fixation without revision of knee was fixed by custom – made extended nail that attached to tibial tray.

Conclusion: for all patients who are candidate to underwent T K A procedure, an update 3 – joints view is mandatory.

Beside of patho anatomy and preoperative planning 3-joints view helps us to assure about peri arthicular stress (pathologic) fractures.

We all aware about overuse syndrome, as compensation of other parts of body. Our famous poet Sa'adi: when part of our body sustains become painful, the other parts can't tolerate and reciprocate.

Among our patients who underwent total Knee arthroplasty few of them have pain especially in 1st 3 months (Anterior Knee pain, effusion, ….) but almost 15 – 20 percents are not satisfied enough by this Procedure.

In a Cohort historic study on 301 TKA with at least 2 years follow up 47 patients had not enough satisfaction in our clinic we tried to visit them to find out why?

Criteria's we chose, were:

Age

We exclude those who had problem by their new knees.

11 patients, all have been over age 68 years, and duration of start of symptoms in knee (s) to the surgery were more than 12 years, clearly showed painful arch of shoulder motion or frozen shoulder or established gleno humeral alone or G.H. and A.C. joints OA.

A group of Athletes with torn ACL (insufficient knees) suffer from bowleg or valgus knees.

AT this points we don't have a general consensus in literature.

This study is based on a randomized clinical trial with double blind randomization of young athletes not more than 36 years and not over than 82 kg weight.

Each groups contained by 30 patient with ACL deficient knees and bowlegs with Mikolicz line on the most medical 1/3rd of medial condyle of femur on worse. with follow up of 2 to 6 years and in all three groups we tried to control the knee by KT 2000, Tegner's score and IKDC and lysholm's scores in all patient.

At final exam we had chance to meet 29 patients with simultaneous HTO (open wedge + plate) and ACL – R and 26 patients with HTO 1st, and 6 months later for ACL – R and only 24 patients with ACL – R 1st, 6 patients of this group and a patient of HTO 1st didn't show for rest of their procedures.

Conclusion: by P value (o.o1) Simultaneous ACL – R and HTO had higher rate of success and between two other groups except osteoarthritis out come in short period of time (2 – 6 years) HTO had better results than ACL –R 1st with P value of (0.05).

High tibial osteotomy generally helps patients to postpone the TKA or even stay in peace for rest of their life, but sometimes these procedures enhance the process of osteoarthritis (1) several reasons like unhealthy lateral compartment of the knee or age or weight or concomitant debilitating diseases could be included in account.

In this study we focused on those patients that were selected properly with correct procedure but still shows the knee OA enhancement.

Hypothesis: probably bone bruise around the site of osteotomy as trauma of surgery can make a bad condition.

As a RCT study between 2 groups with different technique of osteotomy especially the distance of osteotomy site from the joint line of proximal tibia was our main reason to choose the different procedures.

We did a randomized clinical trial with not more than a year follow up and mostly emphasis in geometry of bone bruise around osteotomy site.

Group A: 50 knees, open wedge and plate technique.

Group B: reversed-v MIS the same 50 other knees (FM)

Method: All patient asked for MRI before and in 1st 10 days post surgery from their target knees.

Those with positive bone bruise sign before surgery were excluded. In post op MRIs we measured the geometry of bone bruise.

1- Our finding shows upward-downward length of bone bruise in MIS (F.M) reversed-v = 14–40 mm and in open wedge = 14–37 mm

Depth (Medial-lateral) and AP diameter almost the same.

2- To omit the bias of bone bruise around the open wedge technique we ignored this part.

Result and conclusion:

Group A: had 14 – 40 mm bone bruise that in 61% reached to sub chondral bone (distance of osteotomy's site from sub chondral bone).

Area was (17−4mm).

Group B: because of the distance of osteotomy site from joint line were 60–70 mm. in no one bone bruise was closer than 26mm to sub chondral bone.

So, our Iatrogenic bone bruise from joint line in reversed - v is in safer zone than open wedge and plating with p. value of 0.0001.

In future we need to follow our patients to be sure if bone bruise makes any hazard for the knees.

Background

The role of different surgical approaches and types of implant (1-17), surgical technique (9, 10, 21-24), patient's age (6, 8, 31), activity level (5), weight (17) and other demographic factors have been investigated in a lot of studies. The aim of this study is to assess the effect of demographic factors as well as the effect of traditional life-style in patients who had total hip arthroplasty (THA) in our centre within the past 20 years.

Suction drains provide an easy and feasible method for controlling hemorrhage after total knee arthroplasty. However, there has been no compromise regarding the optimal clamping time for these drains. We conducted a randomized clinical trial to compare 12-hour drain clamping and continuous drainage after total knee arthroplasty in terms of wound complications, blood loss and articular range of motion. In order to eliminate any other factor except duration of clamping, we chose to compare knees belonging to one single person, as well as restricting the study to those knees undergoing surgery due to osteoarthritis. From a total of 100 knees (50 patients) studied, the 12-hour clamping method resulted in a significantly smaller amount of post-operative blood loss (p<0.001). The passive ranges of motion and wound complications were not significantly different between the two groups.