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Elifranji ZO, Al-Ajlouni JM, Al-Saber MG, Hammad YS, Baniatta BA, Alshoubaki SN, Jabaiti MS, Alkhatib AM, Abu awad AM, Altarazi AE, Abdin AN, Al-Ani A, Alshrouf MA. Effect of Preoperative Antianxiety Medications on Blood Pressure and Blood Loss in Total Knee Arthroplasty: A Case-Control Study. Adv Orthop 2023; 2023:6355849. [PMID: 37456533 PMCID: PMC10349676 DOI: 10.1155/2023/6355849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/14/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023] Open
Abstract
Background The increasing number of canceled operations in patients undergoing total knee arthroplasty (TKA) due to high blood pressure readings has put a considerable burden on surgeons. In this study, we aim to assess the effect of giving antianxiety drugs preoperatively on maintaining blood pressure (BP) and blood loss for patients undergoing TKA surgery. Methods This retrospective case-control study included patients who underwent total knee arthroplasty and divided them into two main groups: those who had taken a 3 mg bromazepam oral tablet at the night preoperatively and the control group. The blood pressure of patients was then measured preoperatively (baseline), in the morning of surgery, in the operating room before anesthesia, and during the surgery. The percentage of measured BP was calculated by dividing the measured BP by the baseline, then multiplying by 100. Results 301 patients were included in our study: 137 received bromazepam and 164 as a control group. The ratio of systolic BP (SBP) in the morning of surgery to the baseline (percentage of morning SBP) decreased significantly in the bromazepam group compared with the controls. The ratio of SBP, in the operating room before anesthesia (percentage of preanesthesia SBP) also decreased significantly in the bromazepam group. However, the percentage of SBP in the middle of surgery did not change significantly. In addition, there was a significant difference change from the baseline in diastolic BP and mean arterial BP between the two groups in the morning of surgery, inside the theatre, and in the middle of the operation. The bromazepam group also showed a significant decrease in blood loss. Conclusion Preoperative oral antianxiety drugs (bromazepam) helps in controlling hemodynamic changes associated with anxiety, including maintaining BP in well-controlled hypertensive and healthy patients undergoing TKA, and it plays a role in decreasing the total blood loss.
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Affiliation(s)
- Zuhdi O. Elifranji
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Jihad M. Al-Ajlouni
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Munther G. Al-Saber
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Yazan S. Hammad
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Basel A. Baniatta
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Sara N. Alshoubaki
- Medical Internship, Jordan University Hospital, The University of Jordan, Amman 11942, Jordan
| | - Mohammad S. Jabaiti
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Ahmad M. Alkhatib
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Abdelrahman M. Abu awad
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Abdelrahman E. Altarazi
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Aseel N. Abdin
- Medical Internship, Jordan University Hospital, The University of Jordan, Amman 11942, Jordan
| | - Abdallah Al-Ani
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman 11942, Jordan
| | - Mohammad Ali Alshrouf
- Medical Internship, Jordan University Hospital, The University of Jordan, Amman 11942, Jordan
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Al-Ajlouni JM, Alisi MS, Hammad YS, Alsousi AA, Karameh HO, Kawasmi SH, Aladwan RH, Awawdeh RA, Almazaraa YA, Hassan FOA. Staples versus sutures wound closure in hip and knee arthroplasty: a prospective cohort study. J Wound Care 2023; 32:98-103. [PMID: 36735525 DOI: 10.12968/jowc.2023.32.2.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study aimed to compare two methods of wound skin closure-staples versus vertical mattress nylon sutures-in patients undergoing primary total hip (THR) and total knee replacements (TKR). The comparison was for wound complications as a primary outcome, and satisfaction of patient and nurse as secondary outcomes. METHOD A prospective cohort study was conducted at an academic teaching hospital. All the patients who were admitted for either primary THR or TKR from September 2018 to September 2019 were included. Revision surgeries, patients >85 years of age, and those who were on steroid therapy were excluded. Patients were divided into two groups (staples and sutures) to compare the two methods of wound closure. Patients in each group were assessed for characteristics such as age, sex, weight, height, comorbidities, smoking status, postoperative wound complications, reoperation and patient/nurse satisfaction. RESULTS A total of 100 patients met the inclusion criteria. In the staples group (n=50), 26 patients underwent THR while 24 patients underwent TKR. In the sutures group (n=50), 23 patients underwent THR and 27 patients underwent TKR. Overall, there was no significant difference between the two groups (staples versus sutures) in terms of wound complications (p=0.401), patient satisfaction (p=0.357) and nurse satisfaction (p=0.513). Further analysis compared THR and TKR subgroups (THR staples versus THR sutures and TKR staples versus TKR sutures). The results showed no significant difference between the staples and sutures subgroups of THR and TKR in terms of wound complications, patient satisfaction and nurse satisfaction. CONCLUSION In THR and TKR, there was no significant difference between either vertical mattress nylon sutures or staples primary skin closure in terms of wound complications and patient satisfaction in this study. The decision on wound closure method should be based on the availability of resources in the institution/country.
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Affiliation(s)
- Jihad M Al-Ajlouni
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Mohammed S Alisi
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan.,Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Yazan S Hammad
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Ahmed A Alsousi
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Haya O Karameh
- School of Medicine, The University of Jordan, Amman, Jordan
| | | | | | - Reem A Awawdeh
- School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Freih O Abu Hassan
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
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Abstract
Introduction: Prosthetic joint infection (PJI) is a rare complication of total knee replacement (TKR), yet it is a serious and debilitating condition. Bacterial infection accounts for the majority of cases and fungal infection is estimated to cause 1% of all prosthesis infection. Case Report: This case presents a 60years female, who presented to our outpatient orthopedic clinic complaining of right knee pain, swelling, and hotness. The physical examination revealed redness, hotness, restricted range of movement, and tibial loosening, 9 months following TKR revision. Culture of the joint aspirate showed growth of “Candida parapsilosis” and second aspirate confirmed the diagnosis. The patient then underwent two stages revision surgery with placement of amphotericin B loaded cement, to maintain high local antifungal concentration in addition to decrease the side effects of amphotericinB infusion such as thrombophlebitis and the more serious systemic effect as nephrotoxicity. The post-operative course was uneventful, with gradual improvement and restoration of normal movement range. Conclusion: Fungal PJI is a rare complication of TKR, yet it results in severe debilitating symptoms and impairment of the patient functional capacity. Careful evaluation of the patient followed by a detailed workup is necessary for the identification of the underlying causative micro-organism. Two-stage revision surgery with antifungal loaded cement spacer and antifungal therapy currently is the standard of management. To the best of our knowledge, this is the first fungal PJI following total knee arthroplasty reported in Jordan.
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Affiliation(s)
| | | | | | - Jihad M Al-Ajlouni
- Department of Orthopaedic Surgery, University of Jordan and Jordan University Hospital, Aljubeiha, Amman, Jordan
| | - Yazan S Hammad
- Department of Orthopaedic Surgery, University of Jordan and Jordan University Hospital, Aljubeiha, Amman, Jordan
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Al-Ajlouni JM, Alisi MS, Yasin MS, Khanfar A, Hamdan M, Halaweh AA, Al Hawamdeh H, Elessi K, Alsbou MS. Long-Term Outcomes of the Knee and Hip Arthroplasties in Patients with Alkaptonuria. Arthroplast Today 2020; 6:689-693. [PMID: 32875021 PMCID: PMC7451899 DOI: 10.1016/j.artd.2020.07.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 07/06/2020] [Accepted: 07/23/2020] [Indexed: 11/24/2022] Open
Abstract
Alkaptonuria is a rare autosomal recessive metabolic disorder. It is characterized by the accumulation of homogentisic acid in the body due to a lack of enzymes that degrade it. Over time, it results in joint degeneration and eventually leads to ochronosis. Ochronosis refers to bluish-black discoloration of connective and other tissues within the body. In this study, we present 5 distinct cases diagnosed with alkaptonuria. They have undergone 8 total joint replacement surgeries (4 hips and 4 knees) within 8 years (2010-2018). All patients had an excellent outcome over several years. The follow-up period ranged from 2 to 10 years. Although none of the presented cases had intraoperative or postoperative adverse sequelae, we must take care when dealing with patients with ochronotic arthropathy. They carry a higher risk of complications than other patients with osteoarthritis disease. These complications include fractures due to fragile bone quality, muscle or tendon rupture, joint instability, and anesthesia-related complications. Total joint arthroplasty is a valid and safe option in the management of hip and knee ochronotic arthropathy.
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Affiliation(s)
- Jihad M Al-Ajlouni
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Mohammed S Alisi
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Mohamad S Yasin
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Aws Khanfar
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Mohammad Hamdan
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Ahmad Abu Halaweh
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Hashem Al Hawamdeh
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Khamis Elessi
- Faculty of Medicine, The Islamic University of Gaza, Gaza, Palestine
| | - Mohammad S Alsbou
- Department of Pharmacology, Faculty of Medicine, Mu'tah University, Karak, Jordan
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Al-Khlaifat L, Okasheh R, Muhaidat J, Hawamdeh ZM, Qutishat D, Al-Yahya E, Al-Ajlouni JM, Mohammad MT. Perceptions and performance of exercise in people with knee osteoarthritis in the Middle East: are they different to countries in the developed world? A qualitative study in Jordan. Physiother Theory Pract 2020; 38:55-66. [PMID: 32077786 DOI: 10.1080/09593985.2020.1728793] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background: Culture and lifestyle could justify the variability in clinical patterns of knee osteoarthritis (OA) and was reported to affect exercise adherence.Objective: To explore perceptions and aspects influencing exercise adherence in people with knee OA in Jordan (a developing country) as they might be different from those reported in the developed world.Methods: Fourteen participants were included in the study (13 females, one male). One focus group and seven in depth semi-structured interviews were conducted. The discussions were audio-taped and transcribed. Framework analysis was used and data were interpreted using the socio-ecological model.Results: At the individual level, knowledge of the role of exercise in knee OA and personal factors influenced exercise performance and adherence. At the sociocultural level, cultural attitudes and beliefs and social interaction affected exercises adherence. At the organizational/political level, suboptimal service delivery process, inappropriate delivery of home exercises, accessibility of services affected exercise adherence. Opportunities for improving service delivery were also reported. At the environmental level, geography and weather affected adherence.Conclusions: Understanding the interaction of health-related behavior with individual, social/cultural, organizational, and environmental aspects would improve exercise adherence and equip physiotherapists with knowledge and resources to facilitate the implementation of patient-centered services.
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Affiliation(s)
- Lara Al-Khlaifat
- Physiotherapy Department, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Rasha Okasheh
- Physiotherapy Department, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Jennifer Muhaidat
- Physiotherapy Department, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | | | - Dania Qutishat
- Physiotherapy Department, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Emad Al-Yahya
- Physiotherapy Department, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | | | - Maha T Mohammad
- Physiotherapy Department, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
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Hadidi FA, Bakri FG, Abu Mughli RA, Saleh SS, Al-Ajlouni JM, Samara OA, Samarah OQ, Al-Najar MS, Hadidy AM. Postpartum Enterobacter Pyogenic Sacroiliitis: A Case Report and Literature Review. JBJS Case Connect 2013; 3:e16. [PMID: 29252321 DOI: 10.2106/jbjs.cc.l.00129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Fadi A Hadidi
- Special Surgery Department, Orthopedic Division, University of Jordan Hospital, Queen Rania Street, P.O. 13046, Amman 11942, Jordan.
| | - Faris G Bakri
- Internal Medicine Department, Infectious Diseases Division, University of Jordan Hospital, Queen Rania Street, P.O. 13046, Amman 11942, Jordan
| | - Rawan A Abu Mughli
- Radiology and Nuclear Medicine Department, University of Jordan Hospital, Queen Rania Street, P.O. 13046, Amman 11942, Jordan
| | - Shawqi S Saleh
- Obstetric and Gynecology Department, University of Jordan Hospital, Queen Rania Street, P.O. 13046, Amman 11942, Jordan
| | - Jihad M Al-Ajlouni
- Special Surgery Department, Orthopedic Division, University of Jordan Hospital, Queen Rania Street, P.O. 13046, Amman 11942, Jordan.
| | - Osama A Samara
- Radiology and Nuclear Medicine Department, University of Jordan Hospital, Queen Rania Street, P.O. 13046, Amman 11942, Jordan
| | - Omar Q Samarah
- Special Surgery Department, Orthopedic Division, University of Jordan Hospital, Queen Rania Street, P.O. 13046, Amman 11942, Jordan.
| | - Mahasen S Al-Najar
- Radiology and Nuclear Medicine Department, University of Jordan Hospital, Queen Rania Street, P.O. 13046, Amman 11942, Jordan
| | - Azmy M Hadidy
- Radiology and Nuclear Medicine Department, University of Jordan Hospital, Queen Rania Street, P.O. 13046, Amman 11942, Jordan
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Abstract
BACKGROUND Different clinical profiles of knee osteoarthritis (KOA) have been reported in the literature. The aim of this investigation was to describe the clinical patterns of KOA in an ethnically distinct and homogenous population that has not been widely reported. Patients with KOA were seen in outpatient rehabilitation and orthopedic clinic of Jordan University Hospital (JUH), to determine any possible association between age, BMI, radiographic severity, and pain severity. METHODS Patients diagnosed with KOA attending an outpatient rehabilitation clinic at JUH were studied to describe their clinical characteristics. They were included based on criteria developed by the American College of Rheumatology. Detailed histories, clinical examinations and X-rays, and anthropometric data were obtained. Data analysis focused on descriptive statistics and correlations among demographic and clinical characteristics. RESULTS The study included 214 patients with a mean age of 55.3 years (range = 30-84 years). The mean BMI was 29.5± 5.6. We found a significant moderate positive correlation between age and radiographic severity of KOA (0.435; p <. 001) and pain severity (0.383; p. <. 001). There was also a significant weak positive correlation between BMI, radiographic severity of KOA (0.242, p <. 05), and pain severity (0.266, p. <. 01). CONCLUSIONS We concluded that in this hospital-based cohort study in Jordan, the clinical pattern of KOA is comparable to Western cultures. However, the combination of BMI and mechanical loading during everyday activities that include different religious and cultural habits and may help explain the high level of radiographic severity in our sample.
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Affiliation(s)
- Ziad M Hawamdeh
- Faculty of Rehabilitation Sciences, The University of Jordan, Amman, Jordan.
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