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Introduction Total hip arthroplasty (THA) is a commonly performed and successful orthopedic practice procedure. However, failure of arthroplasty may require revision THA and pose substantial clinical challenges for orthopedic surgeons. Therefore, this retrospective study aimed to estimate the revision rate of THA and its risk factors at a tertiary care hospital. Methods A retrospective cohort study was conducted in 2021 of patients who had undergone THA during 2016-2020 in a tertiary care hospital. All patients above 18 years old who had a THA were included in the study. The data was collected from patients' medical charts/electronic databases. Results A total of 148 THAs were included in this study. In total, 77 (52%) were females, and 71 (48%) were males. The average age of our patients was 49±17 years old, and the mean recorded BMI was 29.6. A total of 62% (n=92/148) of our participants were shown to have at least one comorbid disease, with hypertension being the most common comorbidity. Our findings show that half of the patients, 74 (50%), had a THA due to both primary and secondary osteoarthritis, 37 (25%) patients had avascular necrosis of the hip, and 25 (17%) were due to trauma. The most performed surgical approach was Kocher-Langenbeck (posterior) approach on 128 (86%), followed by the Hardinge (lateral) approach on 20 (13.51%). The most observed complication in the patients was postoperative pain in 35 (23.65%), followed by UTIs in 5 (3.38%). Of the 148 patients, nine (6.08%) had revision surgery. Regarding the revision rate, male patients were associated with a significantly higher rate of revision (P=<0.001), and older patients had a significantly increased risk of revision (P=0.026). Patients who developed complications, such as UTI, were associated with a higher revision rate (P=0.035). Also, a posterior approach (Kocher-Langenbeck) of the procedure was significantly linked to an increased risk of revision (P=0.014). Conclusion All in all, there are multiple associated factors with an increased incidence of revision THA. For example, male patients, older patients, complication development during the hospital stay, and posterior surgical approach were all associated with a significantly higher rate of revision., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Alsheikh et al.)

Purpose Owing to the difficulty of establishing a screening program for scoliosis and back pain, along with their disabling consequences and the lack of local prevalence rates, we sought to study the prevalence of scoliosis and back pain in adolescents in Saudi Arabia and the burden reported by the affected age group on the health system. Materials and methods A school-based, cross-sectional pilot study covering all school districts in Riyadh, Saudi Arabia, was conducted. Students between 12 and 18 years of age were included. Students with any spinal or neurological disorders were excluded. Physical examinations to screen for scoliosis and student-filled questionnaires to assess back pain and health-related quality of life were performed. Results Of the 700 students, 591 met the inclusion criteria. High suspicion of adolescent idiopathic scoliosis (AIS) was considered in 174 students (29.44%). In addition, 45.42% of the students had a history of back pain. The Oswestry Disability Index showed that 87 students had disabilities. The average Scoliosis Research Society-22 score was 3 out of 5. A significant difference was found in the self-image and mental health domains for AIS ( p = 0.04, p = 0.02, respectively). Age showed a significant increase in the odds ratio of a positive physical exam for every increase of one year in age ( p < 0.01). Conclusion Identifying the prevalence rates and early associated factors during adolescence would help lower the burden on the health system and benefit public health in general. A nationwide study is required to identify the relationship between scoliosis and back pain., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, AlAssiri et al.)

Purpose: Total knee arthroplasty (TKA) is one of the most performed procedures. Postoperative pain control is an important factor for the improvement of patient's quality of life. The aim of this study is to report pain control results and functional outcome scores associated with adductor canal blockade (ACB) usage post-TKA., Methods: A prospective case series study of patients who underwent TKA for degenerative osteoarthritis with ACB postoperatively from 2018 to 2019 in a single center in Saudi Arabia, Riyadh. Assessment of functional outcome scores and pain level were measured preoperatively and postoperatively respectively using Knee injury and Osteoarthritis Outcome Score (KOOS) and the Visual Analog Scale (VAS)., Results: Average KOOS score preoperatively for all 5 domains showed a marked improvement at 3 months compared to preoperative values. Pain score postoperatively was measured at 12, 24, and 48 h with an average of 0.7, 1.2, and 0.6 out of 10 on the VAS scale, respectively. The incidence of associated common side effects with the use of analgesic use was included as an add-on in the postoperative questionnaire., Conclusion: In conclusion, by comparing preoperative and postoperative pain levels and functional outcome scores, our study showed a significant pain control and improved functional outcome scores following TKA using ACB., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Saudi Journal of Anesthesia.)

Objectives: To assess the efficacy of vancomycin powder (VP) in total knee arthroplasty (TKA)., Methods: The study design was retrospective cohort. All patients who underwent primary TKA for osteoarthritis between January 1, 2018, and March 1, 2020, in King Abdulaziz Medical City, Riyadh, Saudi Arabia were included (n=98). Of the total participants, 48 participants in the experimental group matched with 48 participants in the control group were included in the final study sample. Numerical variables are reported as means, standard deviations, and standard errors. The hypothesis was tested using the Chi-square test and independent t-test., Results: In comparison to the control group, intraoperative vancomycin powder (VP) did not decrease surgical site infection risk in the experimental group ( p =0.31)., Conclusion: We found no significant differences in the infection rates following primary TKA when using VP., (Copyright: © Saudi Medical Journal.)

Background: Scoliosis is a spinal deformity consisting of lateral curvature and rotation of the vertebrae. The goal of corrective scoliosis surgery is to restore alignment of the spine and maintain motion. However, there is no global agreement among spine surgeons on the best method of surgical intervention, and little is known about the variations in practice among spine surgeons in Saudi Arabia., Objectives: The aim of this study is to examine the current surgical practices relating to adolescent idiopathic scoliosis and to establish the degree of variation and consensus among spine surgeons in Saudi Arabia., Methods: This was a cross-sectional study conducted among spine surgeons in Saudi Arabia, using a self-administered questionnaire. The questionnaire addressed four areas: surgeons' demographics, pre-operative assessment, operative assessment, and infection control practices. There were a total of 27 questions. Data was analyzed using statistical package for social sciences (SPSS) software (SPSS Inc., Chicago, IL, USA)., Results: A total of 150 surgeons were included in this study. Of these, 73 responded to the questionnaire (response rate: 48.6%), 46 (63.01%) of whom were fellows. All respondents were males, and 37 (51.39%) were aged between 30 and 40 years. Fifty five (75.34%) were orthopedic surgeons. The most commonly used pre-operative health assessment test was an echocardiogram. Sixty six (90%) surgeons requested scoliosis anteroposterior (AP) view and lateral radiograph for curvature between 40 degrees and 90 degrees, and 65 (89%) requested it for curvature greater than 90 degrees. For the posterior construct, 29 (45.31%) did not use cross-links for fewer than 10 levels, and 23 (35.94%) did not use cross-links for more than 10 levels. In addition to a local bone graft, the most commonly used transplant method was allograft 37 (50.68%). Fifty five (85.94%) respondents favored an all-screw pedicle construct over a hybrid construct., Conclusion: A large variation in surgical practices was observed. This was especially apparent in practices including the use of cross-links, intra-operative cell salvage, and the intra-operative use of traction. Some degree of variation was observed in pre-operative imaging assessment practices. Surgical guidelines should be developed to build a consensus among surgeons. A unified surgical training curriculum may help in achieving this goal., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Al-qahtani et al.)

Background: Hip fractures are one of the leading causes of disability and dependency among the elderly. The rate of hip fractures has been progressively increasing due to the continuing increase in average life expectancy. Surgical intervention is the mainstay of treatment, but with an increasing prevalence of comorbid conditions and decreased functional capacity in elderly patients, more patients are prone to postoperative complications., Objectives: Assess the value of surgical intervention for hip fractures among the elderly by quantifying the 1-year mortality rate and assessing factors associated with mortality., Design: Medical record review., Setting: Tertiary care center., Patients and Methods: All patients 60 years o age or older who sustained a hip fracture between the period of 2008 to 2018 in a single tertiary healthcare center. Data was obtained from case files, using both electronic and paper files., Main Outcome Measures: The 1-year mortality rate for hip fracture, postoperative complications and factors associated with mortality., Sample Size: 802 patients., Results: The majority of patients underwent surgical intervention (93%). Intra- and postoperative complications were 3% and 16%, respectively. Four percent of the sample died within 30 days, and 11% died within one year. In a multivariate analysis, an increased risk of 1-year mortality was associated with neck of femur fractures and postoperative complications ( P =.034, <.001, respectively) CONCLUSION: The 1-year mortality risk in our study reinforces the importance of aggressive surgical intervention for hip fractures., Limitation: Single-centered study., Conflict of Interest: None.

Background Anterior cervical discectomy and fusion (ACDF) is a commonly used procedure. However, few studies reported post-operative complications. This study looks into the prevalence of possible complications and the mortality rate in the first 30 days postoperatively.  Methods A retrospective review of patients who underwent ACDF for degenerative disc disease from 2008-2017, in a single center in Riyadh, Saudi Arabia was performed. Patient demographic data, comorbidities, operative notes, immediate and delayed complications were all collected, with a minimum of 30 days follow-up.  Results Out of 434 medical charts reviewed, 163 met the inclusion criteria. Mean population age was 52 ± 11 years. Elective cases comprised 90% of sample and most patients had one or two levels operated on, 95% had ACDF and only 5% had corpectomy. The drain was left in 69% of patients and planned intensive care admission was done for 3%. Instrumentation and graft was used, with 92% needing a cage plus plate. Intraoperative complications were minimal. Mean hospital stay was 12.5 ±18 days. Majority of population had no complications in a 30 days period (98.2%). Only one case underwent revision surgery.  Conclusions While ACDF is considered a safe procedure, postoperative complications may have long-term implications. This study showed minimal complications in the immediate postoperative period, but due to the limited sample size, a study with larger population is needed to further confirm the results., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Al Eissa et al.)

Background: Cervical spine injury is the most common vertebral injury after major trauma, 20% of all cervical fractures happen to be odontoid fractures. In young adults, odontoid fracture usually happens as a result of high-energy trauma after a motor vehicle accident (MVA). MVA in Riyadh represents 38.4% of all trauma cases, in which the head-and-neck are the most injured body parts. This research aims to provide information about the incidence of odontoid process fracture post-MVA in Riyadh, Saudi Arabia., Methods: The design of this study was retrospective. A single level one trauma center database (trauma registry) was used to identify odontoid fractures post-MVA. All trauma cases from 2008 to the most recent were included, a total of 17,047 patients, to identify cervical spine fractures and further identify odontoid fracture incidence. The patients' radiographs were reviewed retrospectively, and odontoid fractures were classified by a board-certified spine surgeon. A descriptive analysis was carried out to report basic data distribution. Pearson's correlation was carried out to assess associations., Results: A total number of cervical spine fracture was 1195 patients (6.6% of the total sample). The incidence of odontoid fractures during the entire study period from 2008 to 2018 was 42 of 480 patients with C2 cervical trauma, constituting 8.75% C2 fractures, and 3.5% of cervical spine fractures. The mean age was 41.75 ± 18 years. There were three patients (onemale, two females) with type I odontoid fracture, 26 (all males) with type II, and 13 (11 males, 2 females) with type III. Most patients were managed conservatively (83.33%), whereas 16.67% underwent surgical management., Conclusion: The incidence of posttraumatic odontoid fractures is low, given the younger population of this study. This does not predict future incidence rates with the continued improvement of road traffic laws and awareness in the population., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Craniovertebral Junction and Spine.)

Background: Total knee arthroplasty is associated with intense pain postoperatively. Thus, adequate pain relief is essential in the immediate postoperative period to enable ambulation, initiation of physiotherapy, and prevention of postoperative complications. The objective of this study was to compare the effectiveness and early outcomes of adductor canal blockade (ACB) and continuous epidural analgesia (CEA) in patients who underwent a unilateral total knee replacement (TKR)., Materials and Methods: This is a retrospective cohort study that was conducted in Riyadh with 80 patients receiving a unilateral total knee arthroplasty from August 2017 to July 2018. Forty patients received ACB, and 40 received CEA exclusively. The primary outcomes measured were the degree of knee flexion and extension in physiotherapy sessions on postoperative day 1 and discharge, how soon patients walked after surgery, length of hospital stay (LOS), local anesthetic and total opioid consumption, postoperative blood drainage output, incidence of nausea and vomiting, and pain scores., Results: Significantly more patients receiving ACB could flex their knee in the first 24 h postoperatively ( P < 0.05), and the total drain output was also significantly less ( P < 0.05). Pain in the first 8, 24, and 48 h was less in the ACB group using a Visual Analog Scale ( P < 0.05). In addition, LOS, total opioid consumption, postoperative blood drain output, incidence of nausea and vomiting, and pain scores were significantly decreased after using ACB compared with epidural analgesia., Conclusion: This study provided evidence that ACB as postoperative analgesia after TKR is associated with better outcomes in terms of facilitating early functional recovery and mobility, and consequently prevents major postoperative complications., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Saudi Journal of Anesthesia.)

Objectives: To assess the primary healthcare physicians' adherence to referral guidelines for acute low back pain and if there is any association with experience level.  Methods: A cross-sectional study held in Tertiary care hospital, Riyadh, Kingdom of Saudi Arabia.Questionnaires were distributed in-person between October 2017 and January 2018 among 100 primary healthcare physicians, with a 79% response rate. Results: The distribution between male to female was 43%-57%. Twenty-five percent of physicians encounter 1-5 patients weekly, while 28% encounter more than 15 patients. The physicians included had a higher than expected adherence to referral guidelines with percentages ranging between 63-94% referral rates for back pain related red flags. A trend was noted where there was an increase in referral decisions with increased experience when encountering red flags. More experienced physicians were more likely to refer when encountering; pain worse after prolonged sitting, limited mobility, and pain worse while coughing or sneezing (p less than 0.05). Conclusion: Primary healthcare physicians working in one health system in Riyadh had a higher than expected adherence to referral guidelines for back pain related red flags.

Purpose: To assess ulnocarpal joint stability after treatment of a peripheral triangular fibrocartilage complex (TFCC) injury with all-inside arthroscopic suture repair (SR), extensor retinaculum capsulorrhaphy with the Herbert sling (HS), and a combination of both (SR+HS)., Methods: Twelve fresh-frozen, age-matched, upper-extremity specimens intact from the distal humerus were prepared. Nondestructive mechanical testing was performed to assess native ulnocarpal joint stability and load-displacement curves were recorded. A peripheral, ulnar-sided TFCC injury was created with arthroscopic assistance, and mechanical testing was performed. Each specimen was treated with SR or HS and testing was repeated. The 6 specimens treated with SR were then treated with HS (SR+HS), and testing was repeated. We used paired Student t tests for statistical analysis within cohorts., Results: For all cohorts, there was an average increase in ulnar translation after the creation of a peripheral TFCC injury and an average decrease after repair. Herbert sling decreased translation by 21%, SR decreased translation by 12%, and SR+HS decreased translation by 26%., Conclusions: Suture repair plus HS and HS reduce ulnar translation the most after a peripheral TFCC injury, followed by SR alone., Clinical Relevance: Ulnocarpal joint stability should be assessed clinically in patients with peripheral TFCC injury, and consideration should be made for using extensor capsulorrhaphy in isolation or as an adjunct to SR as a treatment option., (Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)