Ahmed Adel Khalifa

Ankle sprains are a common musculoskeletal injury, accounting for up to 20%. Although most of these injuries are initially treated nonoperatively, a subset of patients develops chronic lateral ankle instability (CLAI) over time, which, if symptomatic, will require operative intervention. To report our early results from a specialized North African sports medicine surgery unit after performing a modified Broström–Gould procedure using a suture anchor and augmenting the repair using a distally based fibular periosteal flap. Twenty-two patients, with a mean age of 33.48 ± 8.23 years, including 10 (45.45%) males and 12 (54.55%) females, presented with CLAI and were treated with the modified Broström–Gould procedure. The mean follow up was 29.3 ± 7.18 months, and the clinical assessment included the American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot score and visual analog scale (VAS) for pain. Any complications were reported. The mean operative time was 61.3 ± 11.15 min. Two (9.1%) patients had complications: one with a superficial surgical site infection and the other with superficial peroneal nerve neuropraxia; both were treated conservatively. The AOFAS improved significantly at the last follow up compared to the preoperative scores, 83.9 ± 10.73 vs. 57.1 ± 14.78, respectively (p < 0.01). The VAS score improved significantly from a preoperative median of 7 to a last follow up median of 2 (p < 0.01). The patients returned to their activities of daily living after a mean of 13.30 ± 2.38 weeks. The majority of patients (95.5%) were either very satisfied or satisfied with the outcomes. None of the patients had instability recurrence or required secondary surgical intervention. Using suture anchors for ligament reattachment and augmenting the repair with a distally based fibular periosteal flap as a modification to the Broström–Gould procedure for managing CLAI demonstrated efficacy and acceptable clinical and patient satisfaction outcomes. Furthermore, despite a relatively high complication rate, it was consistent with the literature. However, future comparative studies are warranted to validate the obtained results.

Background: Periprosthetic joint infection is a severe complication after hip and knee arthroplasty, and using perioperative antibiotic prophylaxis (PABP) per guidelines and recommendations is one step in its prevention. The current study aimed to evaluate the attitude of Egyptian joint replacement surgeons toward PABP, their adherence to guidelines, and their insight into developing national guidelines. Methods: We conducted an online cross-sectional questionnaire study comprising three sections to collect information on various aspects of PABP and to gather insights into the development of national guidelines among members of the Egyptian Pelvis, Hip, and Knee Society (EPHAKS). The questionnaire targeted active practicing hip or knee replacement surgeons and was first sent by email to all members two weeks before the eighth EPHAKS annual conference. A reminder was announced during the conference, and subsequent email reminders were sent one week apart after the conference. The study was registered in clinicaltrials.gov (NCT06451224). Results: Out of 469 EPHAKS members, and among the 434 successfully delivered email invitations, 105 responded, giving a response rate of 24.2%. All were males, with a mean age of 42.98 ± 10.12 years; a total of 70.5% were consultants, and 13.3% performed more than 100 procedures annually. Most participants reported not following national or international guidelines, with response percentages of 80.9% and 62.9%, respectively. Consultants and surgeons performing more than 50 procedures annually showed significantly higher adherence to guidelines than others, with p-values of 0.046 and 0.004, respectively. Adherence to national or international guidelines for prescribing first- or second-generation cephalosporins was reported by 65.7% (preoperatively) and 59% (postoperatively). Only 9.5% reported prescribing antibiotics for the first 24 h postoperatively. Overall, 80% agreed that Egyptian patients are different and that PABP international guidelines do not suit them, and 98.1% agreed that developing national Egyptian PJI prevention guidelines is necessary owing to deficiencies and the broad applicability of the current national guidelines. Conclusions: Egyptian joint replacement surgeons rarely adhere to national or international guidelines for PABP, with higher adherence noticed among more experienced surgeons. The majority agreed that our patients are different and that international guidelines might not suit them, and nearly all participants expressed a strong desire to develop national guidelines.

Background The peroneus longus tendon (PLT) has emerged as a promising graft option for anterior cruciate ligament reconstruction (ACLR), with acceptable outcomes; however, concerns have been raised about potential donor-site morbidity, particularly affecting ankle and foot function. Aim To evaluate ankle dynamic stability, eversion, and first-ray plantarflexion strength after harvesting PLT for ACLR, besides reporting the effect on foot and ankle functional outcomes and radiological foot parameters. Methods Forty-two patients having a mean age of 31.7 ± 9.95 years who underwent ACLR using a full-thickness PLT autograft with peroneus brevis tenodesis were evaluated preoperatively and at three and six months of follow up. Functional and clinical outcomes were assessed using the AOFAS score, ankle range of motion (ROM), and muscle strength; ankle dynamic stability was evaluated using the Eccentric-Concentric Bodyweight Power Test (ECBPT). In contrast, radiological outcomes included evaluating the Talonavicular Coverage Angle (TNCA), the Calcaneal Pitch angle (CPA), the lateral Talo-first metatarsal angle (lateral Meary's angle), and the Hindfoot Alignment Angle (HFAA). Results The Ankle plantarflexion increased significantly over time (p = 0.014). Eversion ROM demonstrated a small but statistically significant decline over time (p < 0.001). Ankle dorsiflexion and inversion remained stable throughout follow-up (p = 0.55 and 0.65, respectively). Strength of the first ray plantarflexion improved significantly over time (p < 0.001). Eversion power improved but did not reach statistical significance (p = 0.125). ECBPT decreased significantly over time (p < 0.001). Median values decreased from median 9.5 (IQR 6.0–12.0) preoperatively to 7.0 (IQR 4.2–9.8) at three months and 6.5 (IQR 4.2–9.0) at six months (p < 0.001). AOFAS scores were at the ceiling at all time points (median 100 [IQR 100–100] preoperatively, at 3 months, and at 6 months) with a statistically significant, yet clinically meaningless decline over time p < 0.001), which was noticed comparing preoperative to three and six months of follow up, p = 0.005 and 0.008, respectively, and no difference between three and six months, p = 0.157. The CPA showed a slight but statistically significant decline over time (p < 0.001). No changes were noted in TNCA (p = 0.297), lateral Meary's angle (p = 0.913), and HFAA (p = 0.629). Conclusion Overall foot and ankle function, strength, and range of motion did not show clinically relevant deterioration after PLT harvesting; however, we observed potential alteration in dynamic ankle stability and possible decline in the foot longitudinal arch. Further investigation focused mainly on evaluating the PL muscle's primary functions, and longer follow up studies are warranted to reach conclusive evidence regarding the safety and efficacy of PLT for ACLR.

Background. To address instability after total hip arthroplasty (THA), a Reverse Hip Replacement System (RHRS) has been proposed, inspired by the concept of reverse total shoulder arthroplasty. The aim of the review — to gather reported results, explore early outcomes, and identify potential challenges of the reverse hip replacement system. Methods. A systematic search in PubMed and Scopus databases was performed in March 2025 using predetermined search terms, which revealed an initial 656 results. Only four studies were eligible for inclusion: one biomechanical study and three clinical studies (one case series and two case reports). Results. The three clinical studies included 24 patients aged 60 to 79 years; 13 (54.2%) were male, and all were diagnosed with advanced hip osteoarthritis. After follow-up ranging from 3 weeks to 24 months, all patients were satisfied with the results, except for 2 (8.3%). Detailed function and PROMs outcomes for 22 patients at 24 months of follow-up showed significant improvement in WOMAC, HHS, OHS, HOOS, SF-36 physical component summary (PCS), and ED-5D (p 0.05). However, there was a nonsignificant change in the SF-36 mental component summary (MCS) (p = 0.272). Radiological outcomes, as determined by RSA analysis, at 24 months for 18 acetabular cups showed a mean migration of 0.087±0.152 mm. The overall complication rate was 29.2% 7 (cases): one intraoperative calcar crack, one deep periprosthetic joint infection, one postoperative traumatic dislocation, one femoral neuropraxia, one occasional pain, and two recalcitrant iliotibial band syndrome. The biomechanical study results showed lower polyethylene wear debris equivalent to other systems, no wear debris due to metal-on-metal contact, and no signs of polyethylene edge or backside wear. Conclusion. Besides the promising biomechanical results, early functional and radiological outcomes of the reverse hip replacement system are encouraging; however, the incidence of complications is considerably high. Moreover, the results should be interpreted cautiously owing to the small number of included patients and the short follow-up period.

“Outcomes of total hip arthroplasty in lions with hip osteoarthritis operated upon by monkey surgeons:” An allegory on how artificial intelligence-generated text and peer review reports might distort scientific research

BACKGROUND Various factors affecting the outcomes after primary total knee arthroplasty (TKA) have been investigated in the literature; however, the effect of surgeon handedness on outcomes has rarely been addressed. AIM To assess whether the radiological and functional outcomes differ between right and left primary TKA when operated by right-handed surgeons. METHODS A retrospective evaluation of 370 TKAs performed by right-handed surgeons [47.8% right TKAs, dominant side (Group D), and 52.2% left TKAs, non-dominant side (Group N)]. The radiological outcomes were the overall alignment measured as the hip-knee-ankle (HKA) angle, and the tibial and femoral component alignment in the coronal plane measured as the medial tibial proximal angle (MPTA) and mechanical lateral distal femoral angle (mLDFA). The percentage of each alignment outside the accepted safe zone values (outliers) were calculated. The functional outcome at the last follow up was evaluated per the Knee Society Score (KSS) System for 206 knees only. RESULTS There were no difference in patients' basic characteristics or in postoperative radiological or functional outcomes between Group D and Group N as follows: HKA, 177.96° ± 3.13° vs 178.55° ± 3.38° (P = 0.082), MPTA, 88.90° ± 2.61° vs 89.43° ± 2.71° (P = 0.056), mLDFA, 90.16° ± 2.54° vs 89.76° ± 2.53° (P = 0.140), and KSS, 80.59 ± 14.73 vs 79.56 ± 15.64 (P = 0.628). There was no significant difference in the percentage of outliers in the HKA and mLDFA between groups. For the MPTA, Group D had significantly more implants within the safe zone than Group N, 53.7% vs 41.4% (P = 0.022). There was no difference regarding using intramedullary (IM) vs extramedullary (EM) alignment for the tibial cut between both groups (P = 0.687). In Group D, there was no significant difference in mean MPTA between IM (88.86° ± 3.26°) and EM (88.93° ± 1.76°) methods (P = 0.862); however, EM resulted in significantly fewer outliers compared to IM (29.2% vs 63.6% respectively; P < 0.001). In Group N, the EM method produced a significantly more valgus alignment than IM (90.38° ± 1.99° vs 88.56° ± 3.00°, P < 0.001), but this did not translate into a significant reduction in outliers (P = 0.650). CONCLUSION The overall radiological and functional outcomes after primary TKA were unaffected by the surgeon's handedness; however, the placement of the tibial component was significantly more precise on the dominant side with fewer outliers.