14 research outputs found
Postoperative mechanical alignment analysis of total knee replacement patients operated with 3d printed patient specific instruments: A prospective cohort study
Objective: Total knee replacement (TKR) is a surgical treatment for final stage gonarthrosis. The lifespan of the prosthetic implants used in TKR surgery is a major interest for the orthopaedic research community.Previously, proper implant alignment of the implants has been advocated for longevity of the TKR surgery. Recently, patient-specific (PSI) instruments have been proposed to improve the mechanical alignment of the TKR by permitting better implant positioning over conventional TKR surgery. The aim of this study is to compare the mechanical alignment results of patients operated with PSIs and conventional instruments. Methods: Two groups of 20 patients chosen in a quasi-random manner have been compared in this study. In the first group femoral distal and tibial osteotomies were made by a PSI which was produced by the patients’ computed tomography scans. All osteotomies in the control group were made with the TKR set's routine instruments by conventional means. Patients’ preoperative and postoperative mechanical femorotibal angles (mFTA), femoral coronal angles (FCA), tibial coronal angles (TCA) were measured and the number of outliers which showed more than 3° of malalignment were counted in both groups for comparison. Results: The average postoperative mFTA was found to be 2.09° for the PSI group and in was found to be 284° for the control which was not statistically significant. The comparison of postoperative FCA and TCA also did not show significant difference between the groups. The number of outliers showing more than 3° of malalignment per group were found to be 1 out of 20 (5%) for the PSI group and 7 out of 20 (35%) for the control which was statistically significant. Conclusion: In this study patient-specific instrumentation provided significantly better mechanical alignment compared to conventional TKR for the frequency of outlier cases with malalignment beyond 3°. PSI proved no significant difference when the groups were compared for mFTA, FCA and TCA. Our findings support that PSI may improve TKR alignment by improving the ratio of the outlier patients with marked malalignment. Level of Evidence: Level III, Therapeutic Study
The effect of low-molecular-weight heparin on rat tendon healing
Objectives: We investigated the effect of low-molecular-weight heparin (LMWH) on the healing of tendons. Methods: Forty-five adult Wistar rats weighing 300 g were randomized into three groups equal in number. All the rats underwent full-thickness surgical incision of the Achilles tendon followed by primary repair. After the operation, two groups received daily subcutaneous LMWH injections (nadroparin calcium) for four weeks at high or low doses (group 1, 6 mg/kg, 170 IU AXa; group II, 3 mg/kg, 85 IU AXa). Group III remained untreated as the control group. Histologically, the specimens were examined under light and electron microscopy with regard to the amount of fibrillar collagen synthesis, mitochondrial degeneration, and the composition of the extracellular matrix collagen. Biomechanically, maximum load to failure and correspondent elongation of the tendons were measured. Results: Compared to the control group, histologically, both LMWH-treated Groups exhibited increased number of fibroblasts, increased fibrillar collagen formation in the extracellular matrix, and higher counts of granular endoplasmic reticula in cytoplasmic contents of fibroblasts as well as decreased mitochondrial vacuolization and degeneration. Biomechanical assessments showed that tendons in group I had significantly higher maximum load to failure and elongation values than group II and III (31 N vs. 24.6 N and 23.1 N; 25 mm vs. 19.6 mm and 17.3 mm, respectively; p0.05). Conclusion: Daily administration of single dose LMWH improves tendon healing through increasing the number of fibroblasts and fibrillar collagen synthesis and decreasing mitochondrial degeneration.Publisher's Versio
KAVİTER KEMİK DEFEKTLERİNİN İYİLEŞMESİNDE OTOJEN PERİOST VE SERAMİK KOMPOZİT GREFTİNİN ETKİSİ
Amaç: Bu çalışmada, otojen periost parçalarının osteokondüktif sentetik kemik greft
alternatifleriyle birlikte kullanımının, kaviter kemik defektlerinin iyileşmesindeki
histolojik davranışının incelenmesi amaçlanmıştır.
Gereç ve Yöntem: Çalışmada, ortalama ağırlıkları 1000-1500 gr ağırlığında, 8-12 aylık
12 Yeni Zelanda tavşanı kullanıldı. 12 tavşana ait 24 femur eşit sayıda üç gruba ayrıldı.
Tüm tavşanlarda, bilateral lateral girişimle, femur suprakondiler bölgede, 5 mm.’lik
oyucuyla kaviter defekt oluşturuldu. Grup I’de dört tavşana ait sekiz femur boş
bırakılarak kontrol grubu olarak atandı. Grup II’de kalan sekiz tavşanın sağ femurları
(sekiz femur) sadece seramik greft granülleriyle dolduruldu. Grup III’de ise ikinci
gruptaki tavşanların sol femurları (sekiz femur) seramik greft granülleri ve tibia kaynaklı
periost parçaları karışımıyla greftlendi. Seramik olarak Cem-Ostetic™ 5 cc granules
(Berkeley Advanced Biomaterials, Inc. CA, U.S.A.) kullanıldı. Grup III’de defektlere
konulan otojen periost şeridi deneğin ipsilateral tibia proksimalinin medial yüzünden
alındı ve keskin bisturi yardımıyla minimal manuplasyon ile 1-2 mm2’lik parçalara
ayrıldı. Denekler postoperatif 6. Haftada feda edildi ve defekteler kemik iyileşmesini
değerlendirmek üzrere histolojik incelemeye tabi tutuldu
Bulgular: Grup I’de (kontrol grubu) kemik oluşumunun oldukça az gözlendiği, defekt
alanın fibröz doku yapısıyla kemiği taklit edercesine kapatıldığı dikkati çekti. Yeni
kemiğin varlığı bölgede çok dar alanlarda gözlendi. Grup II’de (seramik grubu) fibröz
dokunun aralarında yeni kemik oluşumunun kontrol grubuna göre daha fazla olduğu
gözlendi. Kemiğin biçimlendiği bölgelerde damarlar ve osteositler yoğun çekirdekleriyle
dikkati çekti. Grup III’de (periost-seramik kompozit) defekt bölgesinde proliferatif
kıkırdak oluşumu gözlendi. Bölgede kemik oluşumu diğer gruplara göre daha yoğundu.
Fibröz doku bölmeleri son derece azalmıştı.
Histomorfometrik yöntemlerle elde edilen ölçümlerin istatistiksel analizi
sonucunda, Grup III’de (periost-seramik kompozit) diğer iki gruba göre artmış örgü
kemik oluşumu ve daha az fibröz doku oluşumu istatistiksel olarak kanıtlandı.
Sonuç: Serbest periost parçalarının seramiklerle harmanlanması ile elde edilen kompozit
greftin, hem kontrol grubundan, hem de tek başına seramik uygulanan gruptan çok daha
üstün iyileşme performansı sağladığını söyleyebiliriz. Bunun seramiğin kabul görmüş
osteokondüktif özelliklerinin, periostun osteojenik özellikleriyle birleştirilmesinin sonucu
olduğunu düşünüyoruz. Ek olarak serbest periost parçacıklarının defektin her bölgesinde
homojen şekilde bulunmalarını sağlayan uygulama şeklinin de iyileşme performansını
olumlu etkilediğini düşünüyoruz.Objective: The aim of this study is to investigate the role of composite graft constituting
of free autologue periosteal particles along with osteoconductive ceramic bone graft
extenders for the healing of cavitary bone defects.
Materials and Method: 12 New Zealand type rabbits aged 8-12 months and weighing
approximately 1000-1500 gr were used in this study. 24 femurs of the rabbits were
separated to three groups of eight femurs. Bilateral lateral exposure of the femoral
condyle was followed by the creation of cavitary defects with the use of an 5mm drill bit.
In group I (eight limbs of four animals) the defect was left empty and so was attended as
a control. In group II the right lower limbs of the remaining eight animals were only
filled with ceramic graft particles. In group III the defects in the left lower limbs of the
same animals for group II were filled with both ceramic graft particles and autogenous
periosteal particles. The ceramic particles used was Cem-Ostetic™ 5 cc granules
(Berkeley Advanced Biomaterials, Inc. CA, U.S.A.). The periosteal particles
administered in group III were harvested from the ipsilateral medial tibial metaphysis and
were cut in to 1-2 mm2 particles with minimal manipulation. All animals were sacrificed
at the end of sixth week and were evaluated histologycally for bone healing.
Results: In group I (control) new bone formation was clearly inferior and defect was
mostly obliterated with fibrous tissue. In group II (ceramic only) islets of new bone were
scattered more frequent in the fibrous tissue background when compared to group I. New
vasculature and osteocytes with dense nuclei were present within the newly formed bone
tissue. In group III (ceramic and periosteum composite) the defects were obliterated with
new bone tissue which was superior to the other groups, along with cartilage proliferation
which was not notable in group I and II. The amount of fibrous tissue covered area was
clearly less when compared to the control group and ceramic only group.
The statistical evaluation of the histomorphometrically gathered quantitative results
revealed meaningful increase in woven bone and decrease in fibrous tissue in group III,
confirming the histological analysis. Furthermore, cartilage tissue seen only in group III
is expected to transform into bone tissue by means of enchondral ossification process.
Conclusion: The composite graft constituting of free autologue periosteal particles along
with osteoconductive ceramic bone graft extenders appears to be facilitating the bone
healing process far bypassing the ceramic bone graft extenders alone. We think that
these findings can be owed to the osteoconductive properties of the ceramic graft and
osteogenetic properties of periosteum acting in a synergistic behavior. We also think that
the application method of the periosteum, which clearly helps to distribute osteogenic
potential evenly throughout the defect is yet as important in achieving the results
Analysing the change of sagittal balance in patients with Lenke 5 idiopathic scoliosis
Objective: The aim of this study was to evaluate preoperative and postoperative spinopelvic parameters and the influence of lowest instrumented vertebrae on sagittal parameters in Lenke 5 Adolescent Idiopathic Scoliosis (AIS) patients. Methods: A total of 42 patients (37 females, 5 males; mean age: 16.71 ± 3.46 years) were included in the study. Preoperative and postoperative last follow up lumbar lordosis (LL), thoracic kyphosis (TK), pelvic tilt (PT), pelvic incidence (PI) and sacral slope (SS) angles measured. By stopped fusion in L3, L4 or L5 we divided the group into three parts. Results: Mean follow-up was 43 months. Preoperatively, the mean TK and LL were 36.8° and 55.3°. At the last follow up, the mean TK and LL were 27.1° and 49.0° degrees, respectively. Preoperatively, the mean PI, PT and SS were 53.3°, 16.1° and 37.4° degrees. At the last follow up, the mean PI, PT and SS were 52.7°, 19.9° and 33.0° respectively. Significant differences were observed for SS (p = 0.003), TK (p = 0.004), LL (p = 0.012) and PT (p = 0.013) postoperatively for all patients. According the L3 and L4 groups there is significant difference in SS, LL (p = 0.013) and PT (p = 0.018) which means a significant decrease occurs in SS and LL when the distal fusion level changes from L3 to L4 but significant increase in PT in L3 group to compensate spinopelvic change after surgery. Conclusion: The selection of more distal level for fusion adversely affects the compensation mechanisms of sagittal balance in Lenke 5 AIS patients. Level of Evidence: Level IV, Therapeutic study. Keywords: Lenke 5, Scoliosis, Sagittal, Spinopelvic, Compensat
Lenke 5 curves. Is thoracic fusion really necessary?
Objective: The recommended surgery for Lenke type 5 curve is only the fusion of structural curve (SF: Selective fusion). However, some surgeons
prefer to fuse both the thoracolumbar and lumbar (TL/L) curve and the non-structural thoracic (T) curve (NSF: Non-selective fusion). There is a
lack of data with regard to the mid-to-long-term outcomes of the SF and NSF. In this study, it was aimed to compare SF and NSF in terms of TL/L
and T curve correction rates and the prognosis of the corrected curves.
Materials and Methods: A retrospective study of AIS patients treated at a single institution was conducted. A total of 59 patients (55F/M4) were
included in the study. Preoperative, early postoperative, and last follow-up TL/L Cobb and T Cobb angles were measured with software. SF and
NSF correction rate comparison was done using the Mann-Whitney U test.
Results: Overall, 35 patients underwent NSF while 24 patients underwent SF. The mean follow-up duration was 43±18.05 months (54-98). Early
T Cobb correction rate was 69% in group 1 (SF) and 79% group 2 (NSF); however, this difference was not statistically significant when the groups
were compared (p=0.71138). The last follow-up T Cobb correction rates for group 1 and group 2 were 66% and 79%, respectively (p=0.5485). Early TL/
L Cobb correction rate was 78% in group 1 and it was 79% in group 2 (p=0.8493). Last follow-up TL/L Cobb follow-up correction rates for groups
were 79% and 76%, respectively (p=0.9203).Conclusion: This study concluded that SF had favorable outcomes without loss of correction for the patients with Lenke type 5C AIS in the
mid-to-long-term.Keywords: Lenke type 5C AIS, selective fusion, non-selective fusion, loss of correction, prognosi
Quantitative comparison of a laterally misplaced pedicle screw with a re-directed screw. How much pull-out strength is lost?
Objective: Redirecting of a laterally misplaced pedicle screw into the accurate position decreases the pull-out strength due to the reinsertion, lateral wall cortical perforation and widening of the pedicle hole. Thus, this biomechanical study was performed to quantitatively analyze the pullout strength of a redirected laterally misplaced pedicle screw into the accurate position
Comparison of effectiveness of kyphoplasty and vertebroplasty in patients with osteoporotic vertebra fractures
Objective: The aim of this study was to compare the functional and
radiological outcomes of vertebroplasty and kyphoplasty in patients with
osteoporotic vertebra fractures.
Methods: The files of the patients who underwent vertebroplasty or
kyphoplasty for osteoporotic vertebrae fractures were retrieved from the
archives. Forty-three patients with complete follow-up data were
included in the study group. The patients were evaluated for
radiological outcomes in terms of local kyphosis angle, wedging index,
compression ratio, visual analog pain scale (VAS) and Oswestry
Disability Index (ODI).
Results: In the study group, kyphoplasty was performed on 24 vertebrae
of 22 patients (17 females, 5 males; mean age: 73 years) whereas
vertebroplasty was applied on 24 vertebrae of 21 (16 females, 5 males;
mean age: 74.7 years) patients. The mean follow-up time was 26 months.
When the VAS and ODI values of the groups were analyzed, both groups
showed statistically significant progress after the operation.
Radiological data showed that the kyphoplasty group showed statistically
significant improvement in the sagittal index values whereas the
vertebroplasty group did not. The overall complication ratio was 4\%.
Conclusion: Both vertebroplasty and kyphoplasty are effective treatment
methods for functional recovery and pain relief in osteoporotic
fractures of the vertebra. Although radiological outcomes of the
kyphoplasty seem to be better, this does not have any clinical
relevance. We suggest vertebroplasty over kyphoplasty since it is an
easier method to manage. (C) 2016 Turkish Association of Orthopaedics
and Traumatology. Publishing services by Elsevier B. V. This is an open
access article under the CC BY-NC-ND license