Clinical and radiological results of oxford phase-3 medial unicompartmental knee arthroplasty

PubMed ID: 31832288Purpose The aim of this retrospective study was to investigate the effectiveness of medial unicompartmental knee arthroplasty (UKA) by showing the results of the radiological and clinical outcomes of the patients. Materials and methods Seventy-two knees of 54 patients who underwent UKA between September 2005 and March 2011 for medial knee arthritis with a minimum follow-up of six months were evaluated. Range of motion (ROM), Hospital for Special Surgery (HSS) knee score, Knee Society Score (KSS), and Oxford Knee Score (OKS) were investigated both preoperatively and postoperatively. On the other hand, Oxford radiographic evaluation criteria were used to evaluate prostheses radiologically at the final follow-up. Results The average age was 53.4 years (47 to 79 years). The average follow-up time was 39.8 months (8 to 72 months). There was a significant difference between preoperative and postoperative ROM, HSS, and OKS (p<0.05). Radiologically, there was no sign of arthritis on the unoperated side of the knee or failure of prosthesis detected. Before the operation, the average clinical KSS was 63.2 and improved to 91.4 after the operation. In addition, the average functional KSS was 54.9 before the operation and improved to 86.5 after the operation. The average knee flexion degree was 109.1 before the operation and there was an improvement to 123.6 degrees after the operation. Before the operation, the average HSS score was 67.5 (range, 52 to 75) and improved to 89.9 (range, 85 to 100) at the final control examination. Conclusion This study supports the use of Oxford Phase 3 UKA, which has excellent clinical and radiological results in patients with medial knee arthritis

Osteochondritis dissecans of the glenoid cavity: a case report

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Osteochondrosis dissecans (OCD) is a form of osteochondrosis limited to the articular epiphysis. The most commonly affected areas include, in decreasing order of frequency, the femoral condyles, talar dome and capitellum of the humerus. OCD rarely occurs in the shoulder joint, where it involves either the humeral head or the glenoid. The purpose of this report is to present a case with glenoid cavity osteochondritis dissecans and clinical and radiological outcome after arthroscopic debridement. The patient underwent arthroscopy to remove the loose body and to microfracture the cavity. The patient was followed-up for 4 years and she is pain-free with full range of motion and a stable shoulder joint

Kilitli plak ile tedavi edilen proksimal humerus kırıklarında görülen komplikasyonlar

İstanbul Bilim Üniversitesi, Tıp Fakültesi.OBJECTIVES: We evaluated the complications encountered following locking plate fixation of proximal humerus fractures. METHODS: The study included 103 patients (70 females, 33 males; mean age 62 years; range 21 to 90 years) who were treated with open reduction and locking plate fixation for proximal humerus fractures between September 2005 and April 2009. Fixation was performed using the PHILOS locking plate in 93 patients, and S3 humerus plate in 10 patients. Postoperatively, a shoulder-arm sling was applied for six weeks and a standard rehabilitation program was used in all the patients. Intraoperative, acute postoperative, and late postoperative complications were assessed on radiographs. Varus inclination was defined as less than 120 degrees of the inclination angle on immediate postoperative radiographs, and varus displacement as postoperative increases in the varus angle. The mean follow-up period was 19 months (range 2 weeks to 43 months)

Complications encountered in proximal humerus fractures treated with locking plate fixation

Amaç: Proksimal humerus kırıklarının kilitli plak ile cerrahi tedavisinde görülen komplikasyonlar değerlendirildi. Çalışma planı: Eylül 2005 ve Nisan 2009 tarihleri arasında kliniğimizde proksimal humerus kırığı nedeniyle açık redüksiyon ve kilitli plakla tedavi edilen 103 hasta (70 kadın, 33 erkek; ort. yaş 62; dağılım 21-90) değerlendirmeye alındı. Tespit için 93 hastada PHILOS plağı, 10 hastada S3 humerus plağı kullanıldı. Ameliyat sonrasında hastalara altı hafta omuz kol askısı ve standart rehabilitasyon programı uygulandı. Hastaların radyografik takiplerinde ameliyat sırasındaki, akut ameliyat sonrası ve geç ameliyat sonrası dönemdeki komplikasyonlar araştırıldı. Ameliyattan hemen sonra çekilen radyografilerde inklinasyon açısının 120 derecenin altında olması varus açılanması olarak, varus açısının ameliyat sonrasında artması varus yer değiştirmesi olarak kabul edildi. Ortalama takip süresi 19 ay (dağılım 2 hafta-43 ay) idi. Sonuçlar: On hastada (%9.7; ort. yaş 67) komplikasyon görüldü. Bu olguların dokuzunda PHILOS, birinde S3 plağı kullanılmıştı. Beş hastada (%4.9) varus açılanması (inklinasyon açısı ort. 112.6°; dağılım 105°-118°), dört hastada (%3.9) varus yer değiştirmesi (inklinasyon açısı ort. 102.5°; dağılım 95°-110°), beş hastada (%4.9) eklem içine vida girişi görüldü. Diğer komplikasyonlar birer hastada (%1) tespit başarısızlığı, implant kırılması ve enfeksiyon idi. Vidanın eklem içine 3 mm’den fazla girdiği üç hastada revizyon cerrahisi uygulandı. Varus açılanması, varus yer değiştirmesi ve eklem içine vida girişi olan hastaların yaş ortalaması sırasıyla 76.6, 74.4 ve 71 idi. Varus açılanması olan hastaların üçünde (%60) varus yer değiştirmesi görüldü. Eklem içine vida girişi varus açılanması olan beş hastanın üçünde (%60), varus yer değiştirmesi olan tüm hastalarda görüldü. Komplikasyon gelişen hastaların Constant-Murley omuz skoru ortalaması 67.8 (dağılım 50-90) bulundu. Çıkarımlar: Bulgularımız, parçalı yer değiştirmiş proksimal humerus kırıklarının cerrahi tedavisinde kilitli plak vida sistemlerinin, kabul edilebilir komplikasyon oranı ile önemli bir yere sahip olduğunu göstermektedir. Doğru endikasyon, uygun cerrahi girişim ve teknik ile başın inklinasyon açısının korunması ve vida boylarının uygun seçilmesi başarılı fonksiyonel sonuç için gereklidir.Objectives: We evaluated the complications encountered following locking plate fixation of proximal humerus fractures. Methods: The study included 103 patients (70 females, 33 males; mean age 62 years; range 21 to 90 years) who were treated with open reduction and locking plate fixation for proximal humerus fractures between September 2005 and April 2009. Fixation was performed using the PHILOS locking plate in 93 patients, and S3 humerus plate in 10 patients. Postoperatively, a shoulder-arm sling was applied for six weeks and a standard rehabilitation program was used in all the patients. Intraoperative, acute postoperative, and late postoperative complications were assessed on radiographs. Varus inclination was defined as less than 120 degrees of the inclination angle on immediate postoperative radiographs, and varus displacement as postoperative increases in the varus angle. The mean follow-up period was 19 months (range 2 weeks to 43 months). Results: Complications were seen in 10 patients (9.7%; mean age 67 years). The PHILOS plate was used in nine patients and S3 plate was used in one patient. Five patients (4.9%) had varus inclination with a mean inclination angle of 112.6&deg; (range 105&deg; to 118&deg;), four patients (3.9%) developed varus displacement with a mean inclination angle of 102.5&deg; (range 95&deg; to 110&deg;), and intra-articular screw penetration was seen in five patients (4.9%). The remaining complications were fixation failure (n=1, 1%), implant fracture (n=1), and deep infection (n=1). Screw penetration exceeded 3 mm in three patients, requiring revision surgery. The mean ages of patients with varus inclination, varus displacement, and screw penetration were 76.6, 74.4, and 71 years, respectively. Three patients with varus inclination (60%) developed varus displacement. Screw penetration was observed in three patients (60%) with varus inclination, and in all patients with varus displacement. The mean Constant-Murley shoulder score was 67.8 (range 50 to 90) in patients who developed a complication. Conclusion: Our findings show that locking plate and screw systems represent a significant treatment option in the treatment of comminuted and displaced humerus fractures, with low complication rates. Accurate indication, protection of the head&amp;#8217;s inclination angle through appropriate surgical approach and proper technique, and fine calculation of screw length are essential for successful functional results

Surgical treatment of elbow dislocations accompanied by coronoid fractures

Amaç: Regan-Morrey tip 2-3 koronoid kırıklarının eşlik ettiği dirsek çıkıklarının cerrahi tedavi sonuçları değerlendirildi. Çalışma planı: Çalışmaya, koronoid kırığının eşlik ettiği dirsek çıkığı nedeniyle cerrahi tedavi uygulanan sekiz hasta (6 erkek, 2 kadın; ort. yaş 44; dağılım 23-76) alındı. Koronoid kırıkları, Regan-Morrey sınıflamasına göre, üç hastada tip 2, beş hastada tip 3 idi. Eşlik eden diğer yaralanmalar, Mason-Johnston tip 4 radius başı kırığı (n=6), olekranon kırığı (n=4), humerus lateral kondil kırığı (n=1), lateral (n=5) ve medial (n=2) kollateral bağ yırtığı idi. Koronoid kırıklarından birine eksizyon uygulanırken, diğerlerine serklaj, vida veya koronoid plağı ile tespit uygulandı. Radius başı kırıklarının ikisi plak veya vida ve K-teli ile tespit edilirken, dördüne radius başı protezi ile rekonstrüksiyon uygulandı. Olekranon kırıkları ise plak veya AO tension band yöntemiyle tedavi edildi. Fonksiyonel sonuçlar Mayo dirsek performans skoru ile değerlendirildi. Ortalama takip süresi 22.6 ay (dağılım 1-65.5 ay) idi. Sonuçlar: Tüm olgularda kaynama sağlandı. Son kontrollerde Mayo dirsek performans skoru ortalama 84.3 (dağılım 50-100) bulundu. Koronoid kırığı için eksizyon uygulanan hasta hariç, tüm hastalar sonuçtan memnundu. Olekranon kırıklı hastalarda, kaynama sonrasında implanta bağlı ağrı nedeniyle olekranondaki tespit materyalleri çıkarıldı. Koronoid anteromedial faset kırıklı iki hastada ulnar sinir transpozisyonu yapıldı. İki hastada dirsek hareket açıklığını etkilemeyen heterotopik ossifikasyon saptandı. Çıkarımlar: Regan-Morrey tip 2-3 koronoid kırıklarının eşlik ettiği dirsek çıkıklarında cerrahi tedavi dirseğin konsantrik redüksiyonu ve stabilitesini sağlamakta, erken hareketi mümkün kılmaktadır.Objectives: We evaluated the results of surgical treatment for elbow dislocations accompanied by Regan-Morrey type 2-3 coronoid fractures. Methods: Eight patients (6 males, 2 females; mean age 44 years; range 23 to 76 years) underwent surgical treatment for elbow dislocations accompanied by a coronoid fracture. Three patients had Regan-Morrey type 2, five patients had type 3 coronoid fractures. Accompanying injuries were Mason- Johnston type 4 radial head fractures (n=6), olecranon fractures (n=4), lateral humeral condyle fracture (n=1), and lateral (n=5) or medial (n=2) collateral ligament ruptures. Coronoid fractures were fixed with a plate, screw, or a cerclage wire in all the patients except for one patient who underwent coronoid excision. For radial head fractures, plate or screw and Kwire fixation was performed in two patients and radial head prosthesis was used in four patients. Olecranon fractures were fixed with a plate or AO tension band. Functional results were assessed using the Mayo elbow performance score. The mean follow-up period was 22.6 months (range 1 to 65.5 months). Results: Union was achieved in all the patients. At the latest assessments, the mean Mayo elbow performance score was 84.3 (range 50 to 100). All the patients expressed satisfaction with surgical treatment except for one patient who underwent coronoid excision. All the fixation materials used for olecranon fractures were removed after union due to implant-associated pain. Ulnar nerve transposition was required in two patients with fractures involving the anteromedial facet of the coronoid process. Two patients developed heterotopic ossification that did not affect the range of motion of the elbow. Conclusion: Surgical treatment of elbow dislocations associated with Regan-Morrey type 2-3 coronoid fractures enables a concentric reduction of the elbow, stability, and early motion

Early results of autologous mononuclear bone marrow cell transplantation in nontraumatic avascular necrosis of the femoral head

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Amaç: Erken dönem femur başı osteonekrozunda kor dekompresyon ve otolog konsantre mononükleer kemik iliği hücre naklinin erken dönem klinik ve radyolojik sonuçları değerlendirildi. Çalışma planı: Çalışmaya, Steinberg sınıflamasına göre evre I- II travmaya bağlı olmayan femur başı osteonekrozu olan dokuz hasta (1 kadın, 8 erkek; ort. yaş 46.5; dağılım 33-59) alındı. Kemik iliğinden elde edilen CD34 hücre konsantresi, kor dekompresyon tüneli içerisinden femur başına enjekte edildi. Tüm olgular klinik olarak görsel ağrı skalası (GAS), Harris kalça skoru ve WOMAC osteoartrit indeksine göre değerlendirildi. Radyolojik kontrollerde, femur başında çökme, koksofemoral eklem mesafesinde daralma, osteonekrotik bölgede artış olup olmadığı araştırıldı. Ortalama izlem süresi 27.2 ay (dağılım 24-38 ay) idi.Objectives: We evaluated early clinical and radiologic results of core decompression combined with autologous mononuclear bone marrow cell implantation for early stage nontraumatic avascular necrosis of the femoral head. Methods: The study included nine patients (1 female, 8 males, mean age 46.5 years; range 33 to 59 years) with stage I-II nontraumatic avascular necrosis of the femoral head, according to the Steinberg classification. Bone marrow-derived CD34 cells were injected through a core decompression channel into the femoral head. Clinical assessment included a visual analog scale (VAS), Harris hip score, and the WOMAC Osteoarthritis Index. Radiologically, femoral head collapse, narrowing of the coxofemoral joint space, and the size of the osteonecrotic area were assessed. The mean follow-up was 27.2 months (range 24 to 38 months)

Koronoid kırıklarının eşlik ettiği dirsek çıkıklarında cerrahi yaklaşım

İstanbul Bilim Üniversitesi, Tıp Fakültesi.OBJECTIVES: We evaluated the results of surgical treatment for elbow dislocations accompanied by Regan-Morrey type 2-3 coronoid fractures. METHODS: Eight patients (6 males, 2 females; mean age 44 years; range 23 to 76 years) underwent surgical treatment for elbow dislocationsaccompanied by a coronoid fracture. Three patients had Regan-Morrey type 2, five patients had type 3 coronoid fractures. Accompanying injuries were Mason-Johnston type 4 radial head fractures (n=6), olecranon fractures (n=4), lateral humeral condyle fracture (n=1), and lateral (n=5) or medial (n=2) collateral ligament ruptures. Coronoid fractures were fixed with a plate, screw, or a cerclage wire in all the patients except for one patient who underwent coronoid excision. For radial head fractures, plate or screw and K-wire fixation was performed in two patients and radial head prosthesis was used in four patients. Olecranon fractures were fixed with a plate or AO tension band. Functional results were assessed using the Mayo elbowperformance score. The mean follow-up period was 22.6 months (range 1 to 65.5 months). RESULTS: Union was achieved in all the patients. At the latest assessments, the mean Mayo elbow performance score was 84.3 (range 50 to 100). All the patients expressed satisfaction with surgical treatment except for one patient who underwent coronoid excision. All the fixation materials used for olecranon fractures were removed after union due to implant-associated pain. Ulnar nerve transposition was required in two patients with fracturesinvolving the anteromedial facet of the coronoid process. Two patients developed heterotopic ossification that did not affect the range of motion of the elbow. CONCLUSION: Surgical treatment of elbow dislocations associated with Regan-Morrey type 2-3 coronoid fractures enables a concentric reduction of the elbow, stability, and early motion