Does Inferior Oblique Muscle Overaction Affect Ocular Vestibular Evoked Myogenic Potentials?

Objectives: Inferior oblique muscle overaction (IOOA) is a common ocular motility disorder. Ocular Vestibular Evoked Myogenic Potentials (oVEMP) are tests that evaluate the reflex pathway between the utricular macula and the inferior oblique muscle to detect vestibular diseases. Our study is of great importance as it is the first study in the literature to evaluate the effect of inferior oblique muscle overaction on oVEMP parameters. Methods: Thirty-five patients with unilateral inferior oblique muscle overaction (IOOA group) and 18 healthy volunteers without any neurological or vestibulocochlear disease were included in this study. All patients and healthy volunteers were evaluated with oVEMP. Results: No statistically significant difference was found between the n1 latency, p1 latency, n1-p1 latency measurement values of the participants included in the study (p\u3e0,05). A statistically significant difference was found between the n1-p1 amplitude measurement values of the participants in patient groups (non-squint eyes, squint eyes) and control groups (p-value was 0.038). Conclusion: In IOOA patients, vestibulo-ocular reflex pathway may be affected, vestibular symptoms may develop thus o-VEMP responses may be affected. A careful anamnesis should be taken in IOOA patients, and it should be kept in mind that n1-p1 amplitudes and asymmetries may be significantly higher when o-VEMP is performe

No differences in clinical outcomes or isokinetic performance between cruciate-substituting ultra-congruent and posterior stabilized total knee arthroplasties: a randomized controlled trial

Purpose: Whether ultra-congruent (UC) or posterior cruciate ligament-stabilized (PS) inserts should be used in posterior cruciate ligament (PCL)-sacrificing total knee arthroplasty (TKA) remains debatable. Therefore, the aim of this prospective randomized controlled study was to compare the isokinetic performance and clinical outcomes of these inserts in PCL-sacrificing TKA. Methods: Sixty-six patients diagnosed with primary knee osteoarthritis were randomly assigned to either the UC or the PS group. There were no significant differences between the groups in terms of age, body mass index or sex. The Knee Society score (KSS) and isokinetic performance results for each patient were recorded preoperatively and at 3, 6 and 12 months postoperatively. The physiatrist that performed the isokinetic tests and the patients were blinded to the study groups. Results: There were no significant differences between the groups in terms of the preoperative KSS or isokinetic performance. Gradual improvement in the KSS was observed in both groups, but no significant differences were detected between the groups during the whole follow-up period. The UC and PS groups exhibited similar peak extension and flexion torque values normalized to body weight at 3, 6 and 12 months postoperatively (p > 0.05). Conclusion: The use of UC or PS inserts in TKA did not affect the clinical outcomes or isokinetic performance.The clinical relevance of this study is that the potential differences in clinical outcomes and isokinetic performance between UC and PS inserts do not need to be considered when sacrificing the PCL in TKA. Level of evidence: I

Unicompartmental knee arthroplasty results in a better gait pattern than total knee arthroplasty: Gait analysis with a smartphone application

Objectives: The aim of this study was to compare the smartphone-based gait analysis data of patients who underwent total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA). Patients and methods: Between January 2016 and April 2019, a total of 51 patients (3 males, 48 females; mean age: 60.92 years; range, 51 to 70 years) who were operated with UKA or TKA in our clinic were retrospectively analyzed. The patients were divided into two groups according to the type of procedure as the UKA group (n=17) and unilateral TKA group (n=34). Gait analysis was made via a smartphone application (Gait Analyzer software version 0.9.95.0) with data acquired from the accelerometer of the smartphone. This analysis was performed using data collected from the Acceleration Sensor LSM6DSO into the Samsung Galaxy Note 10 Plus phone. Gait velocity, step time, step length, cadence, step time symmetry, step length symmetry, and vertical COM (vert-COM) parameters were measured. Results: There were no statistically significant differences between the groups in respect of age, sex, body mass index, operated side, and follow-up duration. Compared to the TKA group, the UKA patients showed a better gait pattern in gait velocity (p=0.03), step time symmetry (p=0.005), and step length symmetry (p=0.024). No significant difference was detected in step time (p=0.807), step length (p=0.302), cadence (p=0.727) and vert-COM parameters (p=0.608). Conclusion: The gait of UKA patients is closer to the physiological pattern with a better gait velocity, step time symmetry, and step length symmetry than TKA patients. The surgical treatment option of UKA for knee medial compartment osteoarthritis leads to a better gait pattern than TKA

Efficiency of platelet-rich plasma on acellular dermal matrix application with coronally advanced flap in the treatment of multiple adjacent gingival recessions: A randomized controlled clinical trial

Background/Purpose: The aim of this study was to evaluate the effectiveness of platelet rich plasma (PRP) combined with coronally advanced flap plus acellular dermal matrix application (CAF + ADM) in the treatment of multiple adjacent gingival recessions (MAGRs). Materials and methods: 12 patients with 84 Miller Class I or II recession defects were participated. Sites were randomly assigned into CAF + ADM + PRP or CAF + ADM groups. Gingival recession depth (GRD), recession width (GRW), width of keratinized tissue (WKT), creeping attachment (CRA), root coverage (RC) as well as plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment level (CAL) were recorded at baseline and 3rd,6th and 12th months postoperatively. The data were analyzed statistically. Results: GRD and GRW values were statistically higher in group CAF + ADM compared to the CAF + ADM + PRP group at 6th and 12th month (P < 0.05). CRA showed statistically significant increases in 3rd, 6th and 12th months with regard to the baseline in CAF + ADM + PRP group (P < 0.05), however CRA remained stable in CAF + ADM group at 6th and 12th month. The mean RC% was 77.9% and 69.4% for the CAF + ADM + PRP and CAF + ADM groups, respectively, at 12th month (P < 0.05). GRD reduction was statistically greater in the maxillary teeth treated with CAF + ADM + PRP compared to mandibular teeth treated with CAF + ADM at 12 months. Conclusion: Our data suggested that addition of PRP to CAF + ADM in the treatment of MAGRs significantly improved the clinical outcomes, according to 1-year follow-up results.(Clinicaltrials.gov identification NCT03043638). Keywords: Multiple, Adjacent gingival recessions, PR

Effect of platelet-rich plasma, fat pad and dural matrix in preventing epidural fibrosis

Güler, Serkan ( Aksaray, Yazar )Objective: Epidural fibrosis is one of the main reasons for requiring repeated surgical intervention. Our objective was to compare the effect of Platelet Rich Plasma (PRP) on the development of epidural fibrosis with collagen dural matrix and free autogenous fat graft. Methods: Male rats were separated into 3 groups. Laminectomy was implemented on the rats and epidural fat pad was placed in the first group (n = 7); equal size of collagen dural matrix was applied in the second group (n = 7); a single dose of PRP was applied in the third group (n = 7). Results: Epidural fibrosis was more common in the group that collagen dural matrix was applied when compared the ones that PRP was applied. PRP group presented better values in preventing epidural fibrosis when compared to the fat pad group, however this difference was not statistically significant. Conclusion: PRP is a material that can be easily obtained from the very blood of patients and at an extremely low cost; the main clinical relevance of our study is that the PRP might be an efficient material for better clinical results after laminectomy surgery due to its tissue healing and epidural fibroris preventing potentials.Objetivo: A fibrose epidural é uma das principais razões que motiva intervenções cirúrgicas repetidas. O objetivo deste estudo foi comparar o efeito do plasma rico em plaquetas (PRP) no desenvolvimento de fibrose epidural com matriz de colágeno e enxerto de gordura autógena. Métodos: Ratos machos foram separados em 3 grupos. A laminectomia foi aplicada nos ratos e gordura epidural foi colocada no primeiro grupo (n = 7); matriz de colágeno de tamanho igual foi aplicada no segundo grupo (n = 7); uma dose única de PRP foi aplicada no terceiro grupo (n = 7). Resultados: A fibrose epidural foi mais comum no grupo em que a matriz de colágeno foi aplicada, quando comparada aos animais do grupo PRP. O grupo PRP apresentou os melhores valores na prevenção da fibrose epidural quando comparado ao grupo enxerto de gordura, porém a diferença não foi estatisticamente significante. Conclusão: PRP é um material de fácil obtenção do sangue dos pacientes e a baixo custo; a principal relevância clínica de nosso estudo é que o PRP pode ser um material eficiente para obter melhores resultados clínicos após a laminectomia devido à sua cicatrização tecidual e potencial de prevenção de fibrose epidural

The effect of tranexamic acid on hidden blood loss in total hip arthroplasty

Objectives: In this study, we aimed to examine the effect of tranexamic acid (TXA) on hidden blood loss in total hip arthroplasty (THA) patients. Patients and methods: Between June 2015 and June 2021, a total of 120 patients (45 males, 75 females; mean age 57.2±4.9 years; range, 45 to 67 years) with primary osteoarthritis who underwent THA without the use of TXA and 53 patients who received TXA were retrospectively analyzed. Demographic data, amount of transfusion, early complications, preoperative and postoperative hemoglobin and hematocrit values, total blood loss, visible blood loss, and hidden blood loss values were compared. Results: There was a significant difference between the groups with and without the use of TXA in terms of intraoperative bleeding, amount of blood in the drain, total blood loss, hidden blood loss, and blood transfusion (p<0.05). A significant positive correlation was found between intraoperative blood loss and hidden blood loss (r=0.325 p<0.01), while no significant correlation was found between postoperative drainage volume and hidden blood loss (r=-0.006 p=0.946). Conclusion: The use of TXA in patients undergoing THA reduces blood loss, including hidden blood loss, thereby reducing the need for blood transfusion after hip arthroplasty. However, there seems to be no linear relationship between postoperative blood loss and hidden blood loss. Considering these results, the routine use of TXA can be recommended in THA, unless there is a contraindication

Primer Kalça Osteoartritli Hastaların Demografik Özellikleri: Total Kalça Replasmanı Sonrasında Fonksiyonel İyileşme Üzerinde Etkili midir?

Objective: The aim of this study was to investigate the influence of demographic features such as age, gender, body mass index (BMI), educational and employment status, place of residence and comorbidities of patients with primary hip osteoarthritis and radiographic severity on the functional improvements of the patients after total hip arthroplasty. Material and Methods: Fifty patients (41 females/9 males) with primary hip osteoarthritis were included. The radiographs were graded according to Kellgren-Lawrence system (KL). The operations were performed by the same orthopedist with the same surgical technique. Functional level was determined with hip disability and Osteoarthritis Outcome Score-Physical function Short-form (HOOS-PS) before and six months after the operation. Results: The functional levels of all the patients improved at the sixth month. Age, BMI, presence of a comorbidity, working in a job or not, place of residence (rural or city) and obesity did not influence the functional improvement rates. The males, the patients with KL grade 4 osteoarthritis and the primary school graduates showed significantly much more improvements. Conclusion: The clinical relevance of this study is that age, gender, BMI, co-morbidities, education degree, place of residence and being an employee or not does not need to be considered by physicians when recommending total hip replacement surgery after failure of conservative treatment in patients with primary hip osteoarthritis. Male patients, patients with radiographically end stage osteoarthritis and educated patients may improve much more in comparison with their counterparts.Amaç: Primer koksartroz tanısı ile total kalça artroplastisi geçiren hastalarda; yaş, cinsiyet, beden kitle indeksi (BKİ), eğitim ve çalışma durumu, yerleşim alanı, komorbid hastalıklar ve osteoartritin radyografik düzeyinin fonksiyonel düzelme üzerindeki etkisini araştırmaktır. Gereç ve Yöntemler: Primer kalça osteoartriti tanısı olan 50 hasta (41 kadın/9 erkek) dahil edildi. Radyografiler Kellgren-Lawrence (KL) sınıflaması ile değerlendirildi. Operasyonlar aynı ortopedist tarafından aynı cerrahi teknik ile gerçekleştirildi. Fonksiyonel seviye Kalça Dizabilite ve Osteoartrit Sonuç Skoru-Fiziksel Fonksiyon Kısa formu (HOOS-PS) ile operasyon öncesi ve 6 ay sonrasında değerlendirilmiştir. Bulgular: Operasyon sonrası 6. ayda tüm hastalarda fonksiyonel olarak iyileşme kaydedilmiştir. İncelenen faktörlerden yaş, BKİ, çalışma durumu ve yerleşim bölgesinin (kırsal-kentsel) fonksiyonel iyileşme ile ilşkisi olmadığı görülmüştür. Bunu yanında erkek hastalarda, KL’ye göre Evre 4 osteoartriti olanlarda ve ilkokul mezunlarında fonksiyonel iyileşme oranının daha yüksek olduğu saptandı. Sonuç: Bu çalışmanın klinik önemi, konservatif tedavilerden fayda görmeyen kalça osteoartriti olan hastalara total kalça replasmanı önerilir iken; yaş, BKİ, çalışma durumu ve yerleşim bölgesinin cerrahi sonrasında fonksiyonel iyileşmeyi etkilemeceği; ancak erkek hastaların, radyolojik olarak son evre osteoartrit olan hastaların ve ilkokul mezunlarının daha fazla fonksiyonel düzelme göstereceğinin farkında olmaktır

Total infrapatellar fat pad excision leads to worse isokinetic performance in total knee arthroplasty: a randomized controlled trial

*Çankaya, Deniz( Aksaray, Yazar ) *Aktı, Sefa ( Aksaray, Yazar )There are concerns that total infrapatellar fat pad (IPFP) excision in total knee arthroplasty (TKA) results in patellar tendon shortening due to ischemic contracture, but individual preference of the surgeon is still the main determinant between total or partial excision. The aim of this randomized controlled study was to compare isokinetic performance and clinical outcome of TKAs with total and partial excision of the IPFP. Seventy-two patients scheduled to undergo TKA for primary knee osteoarthritis by a single surgeon were randomly assigned to either total or partial excision group. Patients were evaluated preoperatively and at postoperative 1 year, with Knee Society Score (KSS) and isokinetic measurements. The physiatrist performing isokinetic tests and patients were blinded to the study. There were no significant differences between the groups in respect of age, body mass index, gender, and preoperative KSS and isokinetic performance. Postoperatively, both groups had improved KSS knee and KSS function scores, with no difference determined. Knee extension peak torque was significantly higher postoperatively in the partial excision group at postoperative 1 year (p = 0.036). However, there were no significant differences in knee flexion peak torque following TKA (p = 0.649). The results of this study demonstrated that total excision of the IPFP during TKA is associated with worse isokinetic performance, which is most likely due to changes in the knee biomechanics with the development of patella baja. Partial excision of the IPFP appears to be a valid alternative to overcome this potential detrimental effect without impeding exposure to the lateral compartment. This is a Level I, therapeutic study