Effects of obesity on elective spinal surgery

Background: Obesity (Body Mass Index > 30 kg/m2) is currently a public health problem with increasing incidence. Obesity increases the challenges and complications of surgery in all surgical branches. In this study, we aimed to evaluate the intraoperative and perioperative complications of obesity encountered in spinal surgery.Materials and Methods: All patients undergoing elective spinal surgery in one orthopedic surgery practice between 2017 and 2018 were included in this study. Patient demographics, body mass index (BMI), preoperative hemoglobin and hematocrit values, volume of blood transfused, incision lengths, number of surgical levels, operational time, and amount of bleeding were retrospectively identified. Patients were divided into two groups according to BMI levels (Group A, 30 kg/m2), and statistical analyses were performed using the Student’s t and Mann-Whitney U tests.Results: Seventy-seven patients with a mean age of 57.8 years (range, 19–72) were included in this study. Their mean BMI was 29.3 kg/m2 (19.9–39 kg/m2). The mean BMI of Group A was 25.7 kg/m2 and that of Group B was 34.6 kg/m2. The amount of bleeding, number of surgical levels, and skin-incision length were statistically significantly different between the two groups. The mean values of all of these parameters were higher in Group B.Conclusion: Although numerous factors play roles in operational success, we believe that identifying obesity in a patient is important for pre- and postoperative surgical preparation by the operation team

Posterior cruciate-retaining versus posterior-stabilized total knee arthroplasty for osteoarthritis with severe varus deformity

Objective: The aim of this study was to compare the radiological and functional results of posterior cruciate ligament (PCL) - retaining and posterior-stabilized total knee arthroplasties in patients with severe varus gonarthrosis. Methods: Medical records of 112 knees of 96 patients who underwent total knee arthroplasty for severe varus (?15°) were reviewed. PCL-retaining and PCL-stabilizing groups consisted of 58 and 54 knees, respectively. Mean follow-up time was 56.6 months (range: 24-112 months). Knee Society (KS) clinical rating system was used in clinical evaluation. Range of motion, degree of flexion contracture, postoperative alignment, and complication rates were compared between the groups. Results: Mean preoperative mechanical tibiofemoral angle was 20.1° in varus alignment, and was restored to 4.6° in valgus postoperatively. No statistically significant differences were found between PCL-stabilizing and PCL-retaining groups when KS knee scores, function scores, and flexion arc were evaluated. Two patients in PCL-retaining group underwent revision surgery due to aseptic loosening of tibial component. One patient in PCL-stabilizing group needed arthrotomy due to patellar clunk syndrome. Conclusion: There were no notable differences between the 2 groups and PCL-retaining design had outcomes as good as PCL-stabilizing total knee implant in osteoarthritic knees with severe varus deformity. Level of evidence: Level III, Therapeutic study

The surgical overcorrection of lenke type 1 deformities with selective fusion segments: What happens to the coronal balance?

Purpose: The aim of our study is to determine the alterations on coronal balance after overcorrection of Lenke type 1 curve, retrospectively. Methods: Datas of 34 patients (29 female, 5 male patients; mean age, 16.3±3.3 years; range, 13-24 years) surgically treated for scoliosis between 2004 and 2010 were reviewed, retrospectively. The adolescent idiopathic scoliosis patients with Lenke type 1 curve treated with only posterior pedicle screw and postoperative thoracic curves less than 10° by Cobb method on frontal plane were enrolled in this study. Mean follow-up period was 52.5±29.7 months. Results: The mean amount of the preoperative thoracic curves was measured as 41.2°±6.1° (range, 30°-56°). The mean amount of the early postoperative thoracic curves was measured as 6.5°±1.8° (range, 3°-9°). The mean amount of the thoracic curves was measured as 8.5°±4.6° (range, 3°-22°) during the last follow-up (p=0.01). The mean preoperative coronal balance was measured as 8.5 mm (range, 1-30 mm). The mean early postoperative coronal balance was measured as 3.5 mm (range, 0-36 mm). The mean coronal balance was measured as 5.5 mm (range, 0-38 mm) during the last follow-up (p>0.05). Conclusion: We suggest that Lenke type 1B and 1C should be carefully evaluated and the fusion levels should be accurately selected in order to maintain the correction of coronal balance. We suggest that selective fusion with overcorrection in Lenke type 1A are applied to curves that can be corrected lumbar curve at the preoperative bending radiograph and curves that not have coronal decompensation and >10° distal junctional kyphosis, preoperatively

A new and simple suturing technique applied after surgery to correct ingrown toenails may improve clinical outcomes: A randomized controlled trial

turhan, yalcin/0000-0002-1440-9566; Uygur, Esat/0000-0002-6900-1226WOS: 000386894600001PubMed: 27514456Introduction: In the present study, we investigated the efficacy of a new suturing technique applied after the Winograd procedure has been completed. Methods: This study was prospective, randomized, and controlled. In total, 128 patients were recruited and divided into two groups. The outcomes of those treated with the new suturing technique (group I) were compared with those of patients treated with the traditional suturing technique (group II), both of which were applied after the Winograd procedure had been completed. The clinical outcomes and recurrence rates of the two groups were compared. Results: Patients in group I required significantly more time to return to work or school than did those in group II (p = 0.015). We found no significant difference between youths (age < 18 years, n = 55) and adults (age = 19 years, n = 69) in this context (p = 0.161). The recurrence rate was significantly higher in group II than in group I (p = 0.011). The extent of satisfaction was significantly higher in group I (p = 0.042). Conclusions: Our new suturing technique is associated with lower recurrence and higher satisfaction rates. However, the times elapsing before shoes could be worn were similar in the two groups. (C) 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved

Comparison of Weight-Based Versus Standard Dosing of Tranexamic Acid for Blood Loss and Transfusion Amount in Knee Arthroplasty Without Tourniquet

The aim of the study is to compare weight-based versus standard dosing of intravenous (IV) tranexamic acid (TXA) for blood loss and transfusion amount in total knee arthroplasty (TKA) without a tourniquet. A total of 99 patients were divided into two groups: Group 1 (standard): 1 g of IV TXA 30 min before skin incision, and 1 g at postoperative 30 min and 3 h. Group 2 (weight-based): 10 mg/kg IV TXA 30 min before the skin incision, and 10 mg/kg at postoperative 30 min, and 3 h. Hemoglobin levels, before, and 1, and 2 days after the operation, postoperative amount of decrease in hemoglobin levels, and amount of erythrocyte transfusion were recorded. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Society Score (KSS) were applied in the evaluation of TKA results preoperatively, and at 1., 3., 6., and 12. months, postoperatively. In both study groups, hemoglobin levels in male patients dropped significantly more deeply than female patients. Also, in both study groups, hemoglobin levels were significantly lower in patients with comorbid illnesses. A statistically significant difference was not detected between both groups in terms of pre-and postoperative WOMAC scores, KSS knee scores, and KSS function scores. Our study showed that standard and weight-based dosing of IV TXA treatments were similar in efficacy and safety. Both treatments reduce blood loss and the need for transfusion. Also, there was no significant difference in terms of reliability between two groups

Posterior cruciate-retaining versus posterior-stabilized total knee arthroplasty for osteoarthritis with severe varus deformity

Objective: The aim of this study was to compare the radiological and functional results of posterior cruciate ligament (PCL) – retaining and posterior-stabilized total knee arthroplasties in patients with severe varus gonarthrosis. Methods: Medical records of 112 knees of 96 patients who underwent total knee arthroplasty for severe varus (≥15°) were reviewed. PCL-retaining and PCL-stabilizing groups consisted of 58 and 54 knees, respectively. Mean follow-up time was 56.6 months (range: 24–112 months). Knee Society (KS) clinical rating system was used in clinical evaluation. Range of motion, degree of flexion contracture, postoperative alignment, and complication rates were compared between the groups. Results: Mean preoperative mechanical tibiofemoral angle was 20.1° in varus alignment, and was restored to 4.6° in valgus postoperatively. No statistically significant differences were found between PCL-stabilizing and PCL-retaining groups when KS knee scores, function scores, and flexion arc were evaluated. Two patients in PCL-retaining group underwent revision surgery due to aseptic loosening of tibial component. One patient in PCL-stabilizing group needed arthrotomy due to patellar clunk syndrome. Conclusion: There were no notable differences between the 2 groups and PCL-retaining design had outcomes as good as PCL-stabilizing total knee implant in osteoarthritic knees with severe varus deformity. Level of evidence: Level III, Therapeutic study. Keywords: Posterior cruciate ligament-retaining, Posterior cruciate ligament-stabilization, Total knee arthroplasty, Varus deformit