Are unilateral or staged bilateral total knee arthroplasty really safer than simultaneously bilateral TKA, or is it a myth?

Purpose: To evaluate feasibility of simultaneous TKA in comparison with staged and unilateral procedures.                                                                              Patients and methods: 72 simultaneous bilateral, 61 staged bilateral and 222 unilateral TKAs were included.                                                                                                                                           Results: Mean age in the simultaneous group was lower than the other groups. Heart failure as comorbidity was observed less in the simultaneous TKA group than the other two groups. There was no significant difference between simultaneous and staged groups with respect to postoperative WOMAC and SF36 scores. Rates of thrombotic complications and mortality were not different. There was no significant difference in terms of wound healing, periprosthetic infection and TKA revision rates.                                                               Conclusions: Younger age and heart failure as a comorbidity were found to be decisive in the selection of simultaneous procedure. Thus, in the case of advanced bilateral knee osteoarthritis, simultaneous bilateral TKA should be performed after a proper preoperative risk assessment when there is a medical rationale, or the patient’s personal preference. In the light of aforementioned conditions, hesitancy about simultaneous TKA seems unnecessary

Chemotherapy in primary osteogenic sarcoma in patients over the age of forty

Objective: In this study, we sought to review the clinical and histopathological features and the chemotherapy regimens in osteogenic sarcoma in patients over 40 years of age, and we aimed at identifying the possible prognostic factors in this particular group of patients. Methods: We reviewed 287 patients with osteosarcoma treated between the year 1986 and 2010. Patients from this group who met the following criteria were considered eligible for our study; presence of primary OS, had typical histological and radiographic features of OS, no prior history of cancer or any treatment elsewhere and no prior history of preexisting bone abnormalities. Results: The Kaplan–Meier survival curve for the entire group, with a 95% confidence interval, at two and five years showed the survival rates as 76.2% and 72.8% respectively. The surgical margin was a significant factor affecting the survival. Presence of a pathological fracture also had a significant effect on the survival rate. Conclusion: Osteogenic sarcoma remains a challenging disease to treat. Despite the expectation that elderly patients may not tolerate aggressive modern chemotherapy as the younger patients, we believe that patients with primary OS over the age of 40 should be treated aggressively with effective chemotherapy and complete surgical excision whenever possible. Level of evidence: Level IV, therapeutic study Keywords: Chemotherapy, Elderly, Osteogenic sarcoma, Survival rat

The relationship between serum adiponectin level and anthropometry, bone mass, osteoporotic fracture risk in postmenopausal women

WOS: 000269083500004PubMed: 19619110Objectives: The aim of the present study was to evaluate the possible correlation between bone mass and serum adiponectin levels, and the correlation between adiponectin levels and osteoporotic fracture risk in a prospective clinical trial. Patients and methods: Postmenopausal non-diabetic 105 women (mean age 63.4 +/- 8.1; range 52 to 64 years) with hip fracture were evaluated. Of these 105 patients, 46 had trochanteric fractures, 24 had subtrochanteric fractures and 35 had femoral neck fractures. Anthropometric measurements were performed. Serum adiponectin level was measured by means of ELISA. Total bone mineral density and bone mineral content of lumbar spine and proximal femur were measured by dual-energy X-ray absorptiometry (DEXA). Results: Lumbar bone mineral density and proximal femoral bone mineral density were not correlated with serum adiponectin levels. Serum adiponectin level was not found to have any significant effect on bone mass. Serum adiponectin levels were not significantly different between the patients with osteoporotic fractures and those with non-osteoporotic fractures. Conclusion: Our study showed that serum adiponectin level is not associated with bone mass and osteoporotic fracture risk. Investigation of local adiponectin levels in bony tissue is needed to clarify the possible relation between adiponectin and bone mass, and risk of fractures associated with osteoporosis

No difference in blood loss between posterior-cruciate-ligament-retaining and posterior-cruciate-ligament-stabilized total knee arthroplasties

PURPOSE: Posterior-cruciate-ligament-retaining (PCR) and posterior-cruciate-ligament-stabilized (PS) arthroplasties are two major common practices in total knee arthroplasty (TKA). The hypothesis of the present study was that compared with the PCR technique, the PS technique is associated with a higher amount of postoperative blood loss and greater need for blood transfusion in cemented TKA. METHODS: In this prospective, randomized study, 100 patients diagnosed with primary knee osteoarthritis were randomly assigned to either the PCR group (Group I) or the PS group (Group II). The exclusion criteria were rheumatological joint disease, previous knee surgery, anticoagulant therapy and hypertension. There were no significant differences in age, body mass index and gender, between the groups. The haemoglobin and haematocrit levels of each patient were recorded preoperatively and on postoperative days 1, 3 and 5. The postoperative suction drainage and blood transfusion volumes were also recorded. RESULTS: There were no statistically significant differences in haemoglobin or haematocrit levels between the groups on postoperative days 1, 3 and 5. There were also no statistically significant differences in the total measured blood loss volume, postoperative drainage amounts or transfusion rates between the groups. CONCLUSION: Use of the PS technique during cemented TKA does not appear to influence the amount of perioperative blood loss or the need for postoperative blood transfusion in general. The clinical relevance of this study is that the difference in blood loss between the PCR and PS techniques does not need to be considered by surgeons when performing TKA. LEVEL OF EVIDENCE: I

Factors affecting the results of tibial pilon fractures treated with open reduction internal fixation

The purpose of this study is to evaluate the short and medium term functional results of tibial pilon fractures treated in our clinic with the open reduction and internal fixation method and to investigate the factors affecting such results. 41 patients who were treated in our clinic between 1995 and 2009 with open reduction and internal fixation were included in this study. Looking at the postoperative radiographs, quality of reduction was evaluated as per the criteria of Ovadia and Beals. Functional results of the patients were assessed in line with the criteria of Teeny and Wiss. With the evaluation of postoperative radiographs, 17 (41.5%) excellent and good, 21 (51.2%) fair and 3 (7.3%) poor results were obtained. Functionally speaking, 26 patients (63.5%) displayed excellent and good, 8 displayed (19.5%) fair and 7 displayed (17%) poor results. It was found out that age, sex, the time spent before the operation, the period of immobilization following the operation and the presence of an accompanying fracture did not have a significant impact on the functional results. It was revealed that the type of fracture affects functional results. A positive correlation was found between the quality of reduction and the functional results. In the light of the findings of this study, it was concluded that in tibial pilon fractures treated with the internal fixation method, the type of fracture and the quality of reduction are important in identifying the short and medium term prognosis. [Med-Science 2018; 7(1.000): 58-61

Total hip arthroplasty performed in secondary hip osteoarthritis caused by hartofilakidis type 2 and type 3 developmental dysplasia of the hip; evaluation of outcomes and comparison of clinical scores of these two types

The aim of this study was to evaluate the outcomes of Total hip arthroplasty (THA) performed for hip osteoarthritis caused by Hartofilakidis type 2 and 3 developmental dysplasia of the hip (DDH) and to compare these two types in terms of clinical scores. Thirty-six hips of thirty patients who suffered from hip osteoarthritis caused by DDH and who underwent THA operations from January 2005 to May 2010 were included in the study. In the case of insufficient coverage of the acetabular cup, roof reconstruction was performed using femoral head autografts. Subtrochanteric transverse femoral osteotomy was performed when required. Clinical evaluations were performed using Harris Hip Score (HHS). 3 male and 27 female patients were included in this study. Mean age was 57.2 (25-76) years. Mean follow up time was 34.3 (1265) months. 24 hips were classified as Hartofiladikis type 2, and 12 as type 3. HHS was 43.2 (38-54) points and 90.1 (76-96) points at the preoperative and postoperative last control visits, respectively (p [Med-Science 2018; 7(2.000): 378-82

Isokinetic performance of hip muscles after revision total hip arthroplasty via previous anterolateral approach.

We investigated the isokinetic performance of hip muscles and clinical outcomes after revision total hip arthroplasty (THA) via same anterolateral approach used in primary surgery. Thirty patients who had undergone previous THA via an anterolateral approach underwent both acetabular and femoral component revision after aseptic loosening. The Harris Hip Score (HHS) was evaluated during a minimum 2-year follow-up. The isokinetic muscle strength of the operated and nonoperated hips was assessed 1 year after surgery. The HHS improved from 49.0 to 77.4. Operated and nonoperated hips exhibited similar isokinetic performance during all measurements (flexion, extension, and abduction) (p > 0.05). This prospective study showed that the anterolateral approach preserves abductor strength after revision THA in aseptic cases with acceptable functional and clinical results. The main clinical relevance of this study is that the same anterolateral approach used in previous primary THA is also safe and viable for revision THA