Effects of total knee arthroplasty on ankle alignment in patients with varus gonarthrosis : do we sacrifice ankle to the knee?

Total knee arthroplasty is one of the most commonly preferred surgical methods in the treatment of patients with varus gonarthrosis. In this study, we aimed to evaluate the radiological changes observed in the ankles after total knee arthroplasty. Between May 2012 and June 2013, 80 knees of 78 patients with varus deformity over 10A degrees underwent total knee arthroplasty. For each patient, full-leg standing radiographs were obtained pre- and post-operatively. Mechanical and anatomical axes (HKA and AA), lateral distal femoral angle, medial proximal tibial angle, lateral distal tibial angle (LDTA), ankle joint line orientation angle (AJOA), tibial plafond talus angle (PTA) and talar shift were measured for each patient both pre- and post-operatively. Pre-operatively, the mean HKA was 16.6A degrees and the mean AA was 10.41A degrees, both in favour of varus alignment. Post-operatively, the mean HKA decreased to 3.6A degrees and the mean AA to -2.1. The mean LDTA was 87.3A degrees. Before the operation, the mean AJOA was -7.6A degrees, opening to the medial aspect of the ankle, and it was 0.04A degrees after the operation and opening to the lateral aspect (p < 0.05). Our study reveals the changes occurring in the ankle after acute correction of long-standing varus deformity of the knee using total knee arthroplasty. In cases undergoing knee arthroplasty, effect of the acute change in the alignment of the knee on the ankle should be taken into consideration and the amount of correction should be calculated carefully in order not to damage the alignment of the ankle

The relationship between indication and complication of implant removal

AMAÇ: Bu çalışmanın amacı, implant çıkarımı cerrahisinin endikasyonları ve komplikasyonları arasındaki ilişkiyi değerlendirmektir. GEREÇ VE YÖNTEM: 2011-2014 yılları arasında implant çıkarımı ameliyatı yapılan hastaların verileri tıbbi kayıtlarımızdan incelendi. Hastaların yaşı, cinsiyeti, implantın anatomik bölgesi ve implantın türü değerlendirildi. Tüm hastalar için kırık tedavisi ve implant çıkarımı ameliyatı arasındaki süre kaydedildi. İmplant çıkarımı ameliyatı endikasyonları analiz edildi ve komplikasyonlar ile olan ilişkisi Pearson Ki-Kare testi ile değerlendirildi. BULGULAR: Yaş ortalaması 36.2 ± 18.4 olan (dağılım, 5-79 yıl) 276 hastadan (116 kadın, 160 erkek) 279 implant çıkarıldı. İlk operasyondan implant çıkarımı ameliyatına kadar geçen ortalama süre 27.9 ± 33 aydı (aralık 0.25 ila 240 ay). İmplantların en yaygın anatomik yerleşimlerinin 93 hastada (% 33.6) tibia, 63 hastada femur (% 22.8) ve 39 hastada (% 14.1) fibula olduğu görüldü. İmplant çıkarımı endikasyonları; 54 hastada (% 20) implant yetmezliği, 21 hastada (% 8) derin enfeksiyon, 167 hastada (% 60) implant iritasyonu, 9 hastada (%3) psödoartroz, 44 hastada (% 16) hastanın talebi ve 40 hastada (% 14) cerrahın talebi olarak tespit edildi. Genel olarak komplikasyon oranı %17 (48 hasta) olarak bulundu. İmplantın enfeksiyon nedeni ile alınması ile postoperatif enfeksiyon ve refraktür arasında anlamlı korelasyon mevcuttu. Psödoartroz nedeniyle implantın çıkarılması ile beklendiği gibi yeni implant ihtiyacı arasında anlamlı korelasyon elde edildi. SONUÇ: İmplant çıkarma ameliyatı sırasındaki veya sonrasındaki komplikasyonların, daha önce enfeksiyon, psödoartroz ve implant yetmezliği gibi sorunlu klinik durumlarla ilişkili olduğu tespit edildi.OBJECTIVE: The main purpose of this study was to evaluate the relationship between indications and complications of implant removal surgery. MATERIAL AND METHODS: The data of patients who underwent implant removal surgery between 2011 and 2014 were evaluated from our medical records. Patients’ age, gender, anatomical site of implant and the type of the implant were evaluated. The interval between the fracture treatment and implant removal were recorded for all patients. The indications for implant removal surgery were analyzed and their relationships with complications were evaluated by Pearson Chi-Square test. RESULTS: 276 patients (116 female, 160 male) with the mean age of 36.2 ± 18.4 (range, 5 to 79 years) years underwent removal of 279 implants. The mean interval from initial operation to implant removal operation 27.9 ± 33 months (range, 0.25 to 240 months). The most common anatomical sites of implants were tibia in 93 patients (33.6 %), femur in 63 patients (22.8 %) and fibula in 39 patients (14.1 %). Implant removal was indicated for implant failure in 54 patients (20%), for deep infection in 21 patients (8%), for implant irritation in 167 patients (60%), for pseudoarthrosis in 9 patients (3%), for only patient’s demand in 44 patients (16%) and for only surgeon’s demand in 40 patients (14%). Overall complication rate was 17%. There was a significant correlation between the implant removal due to infection and postoperative refracture and infection (r=0.101 p<0.001 and r=0.273 p<0.001, respectively). Significant correlation was obtained between implant removal due to implant failure and pseudoarthrosis and the need of new implant as expected (r=0.375 p<0.001 and r=0.639 p<0.001, respectively). CONCLUSIONS: Complications related to implant removal surgery has a relationship with implant removal indications such as infection, pseudoarthrosis, and implant failure

Posterior-Only Approach with Pedicle Screws for the Correction of Scheuermann's Kyphosis

Study DesignRetrospective study (level of evidence: level 3).PurposeThe purpose of this study was to evaluate the clinical and radiological results of the posterior-only approach with pedicle screws for the treatment of Scheuermann's kyphosis (SK).Overview of LiteratureThe correction of SK with instrumentation can be performed using posterior-only or combined anterior-posterior procedures. With the use of all-pedicle screw constructs in spine surgery, the posterior-only approach has become a popular option for the definitive treatment of SK. In a nationwide study involving 2,796 patients, a trend toward posterior-only fusion with lower complication rates was reported.MethodsWe retrospectively reviewed the data of patients who underwent posterior-only correction for SK between January 2005 and May 2013. Patients with a definite diagnosis of SK who fulfilled the minimum follow-up criterion of 24 months were included. The thoracic kyphosis (T5–T12), lumbar lordosis (L1–S1), and thoracolumbar junction (T10–L2) angles were measured from preoperative, postoperative, and last control radiographs. Sagittal balance, thoracic length, thoracic diameter, Voutsinas index and the sacral slope, pelvic tilt, proximal junction kyphosis, and distal junction kyphosis angles were also measured.ResultsForty-five patients underwent surgery for the treatment of SK between 2005 and 2013. After applying the exclusion criteria, 20 patients (18 males and 2 females) with a mean age of 19 years were included. The mean thoracic kyphosis angle was 79.8 degrees preoperatively, 44.6 degrees postoperatively, and 44.9 degrees at the last control. There were statistically significant differences between preoperative and postoperative values in the thoracic kyphosis and lumbar lordosis angles, thoracic length, thoracic diameter, and Voutsinas index (p<0.05).ConclusionsThe clinical and radiological results of the current study suggest that posterior-only fusion is an efficient technique for the treatment of SK

Konjenital İdyopatik Talipes Ekinovarus Artmış Gelişimsel Kalça Displazisi Sıklığı İçin Risk Faktörü müdür?

Amaç: Gelişimsel kalça displazisi GKD ve idyopatik talipes ekinovarus PEV en sık görülen çocukluk çağı ortopedik deformitelerindendir. Bu çalışmanın temel amacı ülkemizde PEV deformitesi nedeniyle tedavi edilen pediatrik hasta grubunda GKD sıklığını ve PEV deformitesinin GKD sıklığı açısından bir risk faktörü olup olmadığını araştırmaktır.Gereç ve Yöntem: Konjenital idiopatik pes ekinovarus tanısı ile Ponseti metodu uygulanarak tedavi edilmiş 113 çocuk Grup 1 ve ulusal rutin GKD tarama programı kapsamında kalça ultrasonografisi uygulanmış fakat PEV deformitesi olmayan 129 sağlıklı çocuk Grup 2 çalışmaya dahil edildi. Çocukların ultrasonografi esnasında ortalama yaşı Grup 1’de 3.8 hafta ve Grup 2’de 4.6 hafta olarak saptandı. Grup 1’de 65 kız ve 48 erkek, Grup 2’de 69 kız ve 60 erkek vardı. Her iki grupta Graf sınıflamasına göre GKD sıklığı mukayeseli olarak değerlendirildi.Bulgular: Ultrasonografi uygulanan toplam 484 kalçanın 20 tanesinde %4.1 GKD görüldü. Grup 1’de 10 çocuk %8.8 ve Grup 2’de 6 çocuğa %4.6 GKD tanısı kondu. Grup 1’deki 13 kalçanın 4 tanesi Tip 2A, 1 tanesi Tip 2B, 4 tanesi Tip 3 ve 4 tanesi Tip 4 olarak sınıflandırıldı. Grup 2’de ise 6 kalçada Tip 2A ve 1 kalçada Tip 3 displazi saptandı. Graf sınıflamasına göre GKD teşhisi konmuş kalçalar içinde Tip 3 veya Tip 4 displazi oranı ve aynı zamanda bilateral GKD oranı PEV grubunda anlamlı olarak daha yüksekti.Sonuç: Gruplar arasında displazik kalça sıklığı bakımından anlamlı farklılık gözlemlenmemiş olmasına rağmen, GKD teşhisi konmuş kalçalar içinde Tip 3 veya Tip 4 displazi oranı ve aynı zamanda bilateral GKD oranı PEV grubunda anlamlı olarak daha yüksekt

Periprostetik Eklem Enfeksiyonu Tanısında Serolojik Belirteçlerin Değeri

Amaç: Bu çalışmanın amacı enfekte total kalça ve diz artroplastisi hastalarında pozitif ve negatif mikrobiyolojik kültür sonuçları ile mukayeseli olarak ESH ve CRP değerlerinin tanı koymadaki duyarlılık ve özgüllüğünü değerlendirmektir.Gereç ve Yöntem: Bu çalışmada enfekte total kalça veya total diz artroplastisi tanısı ile tedavi edilmiş toplam 80 hastanın klinik verileri retrospektif olarak değerlendirildi.Serum ESH ve CRP değerleri ile birlikte cerrahi olarak elde edilmiş mikrobiyolojik kültür sonuçları kaydedildi. 30 mm/saat üzerindeki ESH ve 10 mg/L üzerindeki CRP değerleri pozitif test olarak tanımlandı. Kültür sonuçları da pozitif ve negatif steril olarak sınıflandı.Bulgular: Çalışmada elde edilen verilere göre periprostetik enfeksiyon tanısında CRP’nin duyarlılığı %98 %88 - %99 aralığında ve özgüllüğü %0 %0 - %15 aralığında ; ESH’nin ise duyarlılığı %98 %88 - %99 aralığında ve özgüllüğü %7 %1 - %15 aralığında tespit edilmiştir.Sonuç: ESH ve CRPperiprostetik enfeksiyon tanısında yüksek duyarlılığa sahip değerli serolojik belirteçlerdir. Ortopedik cerrahlar yalancı pozitif sonuçlar olabileceğini göz önünde bulundurmalı ve gerekli görüldüğünde kesin tanı için ek yöntemler kullanılmalıdı

Does fondaparinux have really positive effect on fracture healing? An experimental study in rats

OBJECTIVE: Antiembolic agents are routinely used in orthopaedics and traumatology clinics especially in arthroplasty, tumor and trauma surgery to decrease the embolism prob-lems. The effect of fondaparinux on fracture healing is unclear. The aim of this study is to find out the effect of fondaparinux on frac-ture healing and to compare with the effect of enoxaparin using a rat model. MATERIALS AND METHODS: 64 Wistar-Albino rats were randomi-zed into eight groups. Standard closed left femur fractures crea-ted under general anaesthesia. The control groups (A, B), heparin groups (C, D), enoxaparin groups (E, F), and fondaparinux groups (G, H), which administered isotonic NaCl solution (1cc/day), hepa-rin (1000 anti Xa IU/kg/day), enoxaparin (100 anti Xa IU/kg/day) and fondaparinux (0.2mg/ kg/day) respectively for 14 days. The rats in groups A, C, E, G were sacrificed at the end of day14 and the rats in groups B, D, F, H were scarified at the end of day 28 postopera-tively. All the femurs were radiologically evaluated with standard AP and lateral X-rays of the sacrificed femurs were rated according to the Goldberg classification system. Histological classification of healing was done according to Huo’s histological healing sca-le. Statistical analysis in this study was performed with GraphPad Prisma V.3 package software. Significance in the results were eva-luated at the level of p<0.05. RESULTS: Radiological evaluation did not reveal any significant difference between the groups in the second and the fourth weeks. Histological callus formation was found to be significantly poorer in the heparine group compared to other groups at the end of the fourth week. No significant differences were found between the groups histologically except the heparin group. Besides that, there was no significant difference on fracture healing radiologically and histologically between the enoxaparine and fondaparinux groups. CONCLUSION: We did not detect any extra positive effect of fondaparinux on fracture healing compared to enoxaparin. But fondaparinux can be used to prevent embolism problems in traumatic cases as the application of fondaparinux has no negative effect bone healing.AMAÇ: Antiembolik ajanlar ortopedi ve travmatoloji kliniklerinde özellikle artroplasti, tümör ve travma cerrahilerinde embolizm problemlerini azaltmak için rutin olarak kullanılmaktadır. Fondaparinuks’un kırık iyileşmesi üzerine etkisi belirsizdir. Bu çalışmanın amacı sıçan modeli kullanarak fondaparinuksun kırık iyileşmesi üzerine etkisinin incelenmesi ve enoksaparinin etkisi ile karşılaştırılmasıdır. GEREÇ VE YÖNTEM: 64 adet Wistar-Albino sekiz gruba randomize olarak ayrıldı. Genel anestezi altında sol femur kapalı standart kırıkları oluşturuldu. Kontrol grupları (A, B), heparin grupları (C, D), enoksaparin grupları (E, F), ve fondaparinuks grupları (G, H), sırasıyla izotonik NaCl (1cc/gün), heparin (1000 anti Xa IU/kg/gün), enoksaparin (100 anti Xa IU/kg/gün) ve fondaparinuks (0.2mg/kg/ gün) olacak şekilde 14 gün süre ile uygulandı. A, C, E, G gruplarındaki sıçanlar postoperatif 14. günün, B, D, F, H gruplarındakiler ise 28. günün sonunda sakrifiye edildiler. Tüm femurların radyolojik incelemesi standart ön-arka ve yan grafiler kullanılarak Goldberg sınıflamasına göre yapıldı. Histolojik inceleme ise Huo histolojik iyileşme sınıflamasına göre yapıldı. Bu çalışmanın istatiksel analizleri GraphPad Prisma V.3 paket programı kullanılarak yapıldı. Sonuçlarda anlamlılık p<0.05 düzeyi olarak belirlendi. BULGULAR: Radyolojik incelemede, ikinci ve dördüncü hafta sonundaki sonuçlar incelendiğinde, gruplar arasında istatiksel olarak anlamlı fark saptanmadı. Histolojik incelemede ise heparin almış olan H grubundaki iyileşme sonuçları diğer gruplarla karşılaştırıldığında istatiksel olarak anlamlı şekilde kötü olarak saptandı. Diğer gruplar arasında histolojik açıdan, heparin grubu hariç, istatiksel olarak anlamlı bir fark saptanmadı. Ayrıca histolojik ve radyolojik olarak fondaparinuks ve enoksaparin grupları arasında kırık iyileşmesi üzerine etkileri arasında istatiksel olarak anlamlı fark saptanmadı (p>0.05). SONUÇ: Çalışmamızda fondaparinuksun enoksaparin ile karşılaştırıldığında kırık iyileşmesi üzerine herhangi ekstra olumlu etkisini saptamadık. Fondaparinuks uygulamasının kırık iyileşmesi üzerine negatif bir etkisi saptanmamış olması nedeniyle travma vakalarında embolizm problemlerini önlemede kullanılabileceği kanaatindeyiz

Clinical and Radiological Outcomes of Total Knee Arthroplasty Performed with Midvastus and Medial Parapatellar Approaches in Obese Patients

Background. The use of total knee arthroplasty (TKA) for primary osteoarthritis of the knee has remarkably increased recently. We aimed to compare the clinical and radiological outcomes of TKA in obese patients (>30 kg/m2) operated with midvastus (MV) or medial parapatellar (MPP) approaches. Methods. This retrospective study was performed using data derived from 80 patients (70 women; 10 men) with an average age of 66.17 ± 5.42 (range: 54 to 77). Patients were allocated into 2 groups as for the type of approach conducted during TKA: group I (n = 41) underwent TKA by MV approach, while the MMP technique was used in group II (n = 39). Results. Demographic, clinical, and radiological parameters included age, side of involvement, sex, BMI, diameters of thigh and calf, length of incision, duration of operation, amount of bleeding and transfusion, duration of hospitalization and follow-up, complications, and range of motion, as well as Knee Society Score (KSS) and Knee Society Function Score (KSFS). Patients with a higher BMI (≥35 kg/m2) experienced more profound bleeding and needed more transfusion of erythrocyte suspension. The range of motion was more favorable in groups with BMI <35 kg/m2. The functional outcomes as reflected in KSS and KSFS were much better in patients with BMI <35 kg/m2. Conclusions. Our data indicated that obesity can adversely influence the clinical and radiological outcomes after TKA performed by both MV and MPP approaches. A careful analysis of patient characteristics and selection of appropriate operative procedures is critical. Further randomized, controlled trials on larger series must be designed to elucidate the relationship between obesity and therapeutic outcomes after TKA with different approaches

Giant cell tumor of the capitate: an unusual case with 10 years follow-up

Giant cell tumor of the small bones, particularly the carpal bones of the hand, is exceedingly rare. We present a case report of giant cell tumor of the capitate in a 24 year-old female with 10 years postoperative follow-up. Although carpal bones are extremely unusual location, orthopedic surgeons should always keep in mind that differential diagnosis must include giant cell tumor of bone whenever an expansile osteolytic lesion with well-defined but nonsclerotic margins is identified in a young adult with closed physes

Pure elbow dislocation in the paediatric age group

WOS: 000371084600017PubMed: 26686496Purpose The main purpose of the present study was to evaluate the clinical results and prognosis of pure elbow dislocations in the paediatric age group following non-surgical treatment. Methods Acute traumatic pure elbow dislocations treated between January 2008 and January 2013 were evaluated. The median age was eight years. The mean follow-up time was 46 months. Active and passive range of motion (ROM), elbow stability, neurovascular status, functional status and any early or late complications were evaluated and recorded at the latest follow-up. Results The mean flexion-extension ROM was measured as 119.5 degrees. The mean pronation and supination were 67 and 79 degrees. Moderate instability was diagnosed in four cases. The mean Mayo Elbow Performance Score (MEPS) score was 91.6 points; the clinical outcome was excellent in nine patients, good in two and fair in one. Conclusions Acute traumatic pure elbow dislocation in childhood is a very rarely seen emergency that can be treated safely with closed reduction combined long-arm plaster splinting and physical rehabilitation

Eklem Hastalıkları ve Cerrahisi Use of quadriceps tendon versus hamstring tendon autograft for arthroscopic anterior cruciate ligament reconstruction: a comparative analysis of clinical results Artroskopik ön çapraz bağ onarımı için hamstring tendon otogr

Knee ligament injuries are among the most frequently encountered injuries. Anahtar sözcükler: Ön çapraz bağ onarımı; ön çapraz bağ; artroskopi; kuadriseps kası; tendon. Objectives: This study aims to evaluate midterm clinical results of the use of two autogenous graft types. Patients and methods: Between June 2005 and November 2010, clinical data of 44 patients who were operated were retrospectively analyzed. Quadriceps tendon-patellar bone autograft was used for reconstruction surgery in 23 patients (QT-PB group), while quadrupled hamstring tendon autograft was used in 21 patients (HT group). The Tegner&apos;s activity scale, Lysholm scoring system, single-leg-hop test and KT-2000 arthrometric measurements were used for data collection. Results: The mean length of follow-up was 37.6 months. Although the mean Lysholm score increased in both groups, excellent results in HT group were two-fold higher compared to QT-PB group. The mean laxity for the operated knee joint was 5.65 mm (3.5 to 8.0 mm) in QT-PB group and 3.67 mm (3.0 to 5.5 mm) in HT group. Head-to-head analysis using KT-2000 arthrometer demonstrated that 12 patients (52.1%) in QT-PB group and two patients (9.6%) in HT group had more than 3 mm of anterior laxity difference. Conclusion: Quadrupled hamstring tendon autograft is superior to central quadriceps tendon-patellar bone in arthroscopic anterior cruciate ligament reconstruction surgery