Which knee replacement do the patients forget? Unicondylar or total knee arthroplasty.

OBJECTIVE: The aim of this study was to determine which type of knee arthroplasty is easier to forget by comparing levels of joint awareness evaluated with the Forgotten Joint Score (FJS-12) after unicondylar versus total knee arthroplasty. METHODS: Patients who underwent either unicondylar or total knee arthroplasty due to primary gonarthrosis were retrospectively identified and then divided into 2 groups: the TKA group (218 patients; mean age = 68.93 ± 7.14 years) and the UKA group (131 patients; mean age = 60.39 ± 7.03 years). The status of joint awareness after knee replacement surgery was assessed using the Turkish version of the FJS-12 at the final follow-up by telephone interview. Also, The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and The EuroQol five-dimensional (EQ-5D) scores were obtained to assess the clinical status of the patients. RESULTS: The mean follow-up was 2.8 years (range = 24-49 months) in the TKA group and 3.2 years (range = 24-50 months) in the UKA group. The FJS-12 was significantly higher in the UKA group (73.60 ± 9.95) than in the TKA group (64.88 ± 9.47) (P = .001). The WOMAC score was significantly better in the UKA group (81.39 ± 9.84) than in the TKA group (74.92 ± 9.99) (P = .001). No significant difference in EQ-5D existed between the groups (0.76 ± 0.14 for the TKA group, 0.79 ± 0.17 for the UKA group; P = .441). In terms of gender, the FJS-12 showed no differences between the groups; however, more favorable scores were recorded in younger patients with UKA. CONCLUSION: The results of this study have demonstrated that UKA may be better than TKA in terms of the patient perception of pain, stiffness, and physical functioning. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Total knee replacement-cementless tibial fixation with screws: 10-year results.

BACKGROUND: The aim of this study was to evaluate the long term clinical and radiological results of cementless total knee replacement. METHODS: A total of 51 knees of 49 patients (33 female and 16 male; mean age: 61.6 years (range, 29-66 years)) who underwent TKR surgery with a posterior stabilized hydroxyapatite coated knee implant were included in this study. All of the tibial components were fixed with screws. The HSS scores were examined preoperatively and at the final follow-up. Radiological assessment was performed with Knee Society evaluating and scoring system. Kaplan-Meier survival analysis was performed to rule out the survival of the tibial component. RESULTS: The mean HSS scores were 45.8 (range 38-60) and 88.1 (range 61-93), preoperatively and at the final follow-up respectively. Complete radiological assessment was performed for 48 knees. Lucent lines at the tibial component were observed in 4 patients; one of these patients underwent a revision surgery due to the loosening of the tibial component. The 10-year survival rate of a tibial component was 98%. CONCLUSION: Cementless total knee replacement has satisfactory long term clinical results. Primary fixation of the tibial component with screws provides adequate stability even in elderly patients with good bone quality. LEVEL OF EVIDENCE: Level IV, Therapeutic study.

Femoral shortening osteotomy in total hip arthroplasty for severe dysplasia: a comparison of two fixation techniques.

PURPOSE: The purpose of this study was to compare two distinct fixation methods for a total hip replacement performed via transverse femoral shortening osteotomy for patients with severe hip dysplasia. METHODS: In this retrospective study we compared two fixation methods for total hip replacement of 78 hips in 76 patients exhibiting Crowe type IV developmental hip dysplasia (DDH). The hip replacements were performed via a transverse femoral shortening osteotomy and carried out between September 2009 and December 2013. Group I patients underwent fixation of the shortened femoral segment via a cable attached to the osteotomied segment, and group II patients underwent fixation with a plate and screw. We compared the two techniques based on operating time, osteotomy site union time, Harris hip score, hip loosening signs, and overall clinical outcomes. RESULTS: The mean operating time for groups I and II was determined to be 116.5 ± 12.8 min and 137.7 ± 14 min, respectively (p < 0.05), while the average union time was 113 ± 51 days for group I and 152 ± 37 days for group II (p < 0.05). Fixation of the femur with a cable (group I) is therefore faster and results in more rapid union time when compared to plate osteosynthesis at the osteotomy site (group II). We observed only one non-union in group I compared with three in group II (p = 0.49). Harris hip scores at the final patient follow-up were 82.8 ± 7.8 and 80.8 ± 6.7 for groups I and II, respectively (p = 0.23). Thus, notably no significant differences were observed between the groups with regard to clinical outcomes such as the Harris hip score or loosening of the replacement components. CONCLUSION: Fixation of the removed femoral segment with a cable provided adequate rotational stability and decreased the operating time, leading to early union at the osteotomy site.

Minimally Invasive Plate Osteosynthesis of Distal Tibia and Fibular Fractures Through a Single Distal Anterolateral Incision.

Treating distal tibia fractures is often challenging given the extent of soft tissue damage around the fracture and the risk of infection and other complications with internal fixation and the accompanying incisions. Minimally invasive plate osteosynthesis minimizes these complications and can be performed through a single incision. From April 2009 to January 2011, we treated 20 patients who had both tibial and fibular distal fractures through a distal anterolateral approach with this technique. The mean follow-up period was 15.5 (range 12 to 26) months. The mean interval to bony union was 21 (range 18 to 25) weeks. A 5° varus deformity was found in 1 patient. Another patient, who had a history of alcohol consumption and smoking, developed wound necrosis that was treated successfully with debridement and without skin grafting. The mean American Orthopaedic Foot and Ankle Society score for all patients was 91.8 (range 84 to 97). The anterolateral, minimally invasive plate osteosynthesis technique is a useful method for treating distal tibial and fibular fractures at the same level, with a low complication rate.

Early results of HemiCAP(®) resurfacing implant.

OBJECTIVE: Metallic implants in the first metatarsophalangeal (MTP) joint have been used for many years in the treatment of hallux rigidus (HR). The HemiCAP(®) prosthesis is the first implant used for resurfacing the metatarsal head in HR treatment. The aim of our study was to evaluate the early results of the HemiCAP(®) prosthesis for the treatment of HR. METHODS: A total of 27 toes of 25 patients with MTP arthritis of the great toe were treated with an Arthrosurface(®)HemiCAP(®) resurfacing implant. The average follow-up time was 37.6 (range: 30 to 43) months. All patients were evaluated clinically and radiographically. Postoperative satisfaction and function were scored according to the American Orthopaedic Foot and Ankle Society (AOFAS) score. Pain was assessed with the use of a visual analogue scale (VAS) ranging from 0 to 10, with 0 indicating the absence of pain and 10 describing the worst pain imaginable. RESULTS: Mean preoperative AOFAS score improved from 40.94 (range: 25 to 63) to 85.1 (range: 54 to 98) at the final follow-up (p<0.0001). Preoperative average VAS pain scores improved from 8.30 preoperatively to 2.05 at the final follow-up (p<0.0001). The average MTP joint range of motion (ROM) the improved from 14.36 degrees preoperatively to 54.38 degrees at the final follow-up. No radiologic loosening or osteolysis was observed in patients with HemiCAP(®) implant. CONCLUSION: The early results of the HemiCAP(®) implant on the metatarsal head are promising. However, studies over a longer period involving more patients would be beneficial in terms of defining and reviewing the stability of the implant and any innovations in the treatment strategy for HR.

Intra-articular levobupivacaine, lornoxicam and morphine analgesia after knee arthroscopy: a randomized, controlled trial.

OBJECTIVE: The aim of this study was to compare the analgesic effects of intra-articular levobupivacaine alone, intra-articular levobupivacaine in combination with lornoxicam, and intra-articular levobupivacaine in combination with lornoxicam and morphine on patients following arthroscopic surgery. METHODS: The study included 60 ASA 1 and 2 patients between the ages of 20 and 70 years, scheduled for elective arthroscopy. Patients were divided into three groups of 20 through a randomized, double-blind method. Group 1 received 50 mg of levobupivacaine intra-articularly, Group 2 received 50 mg of levobupivacaine plus 8 mg of lornoxicam, and Group 3 received 50 mg of levobupivacaine plus 8 mg of lornoxicam and 8 mg of morphine. Visual analog scale (VAS) data was collected prospectively for the first 24 postoperative hours. RESULTS: Group 2 showed statistically significant differences, especially in VAS values with movement at 0, 4, and 6 hours (p<0.001). CONCLUSION: The combination of levobupivacaine and lornoxicam is superior to levobupivacaine alone and the addition of morphine does not improve VAS scores. It appears that the addition of additional drugs for more effective analgesia has its limits.

Comparison of anterior and lateral approaches in the treatment of extension-type supracondylar humerus fractures in children.

Eighty-four patients who underwent open reduction and Kirschner wire (K-wire) fixation for supracondylar humerus fractures through anterior or lateral approach with or without additional medial incisions were compared with regard to complications and end results. A total of 46 patients were operated through the anterior and 38 through the lateral approach. In lateral approach cases, medial incision was added only in those patients in whom the medial condyle and therefore the ulnar nerve were not easily distinguished due to excessive oedema. All the fractures were Gartland type III extension fractures. The patient series was consecutive, and lateral approach had a longer follow-up of 89 months (70-134 months); the incision protocol was changed approximately mid-series to the anterior approach, and therefore a shorter follow-up time of only 50 months (24-84 months) was possible. All patients were treated according to the same postoperative protocol. A follow-up examination was performed and all the patients were evaluated according to Flynn's criteria; loss of flexion or extension clinically, any deviation of the carrying angle radiologically, and the appearance of the incision scar were evaluated. According to the above parameters, results were excellent in 19, good in 18, and fair in one in the lateral incision group, whereas in the anterior incision group, excellent results were obtained in 31 patients and good results in 15 of them. Cosmetically, two patients in the lateral incision group had hypertrophic scar tissue, whereas the anterior incisions were barely noticeable as they were included into the flexion crease. In conclusion, we can say that anterior incision when open reduction is needed in pediatric supracondylar fractures offer the advantage of a smaller scar and easy access to structures that might be injured between the fractured fragments.

Fixation of femoral neck fractures with three screws: results and complications.

OBJECTIVES: To evaluate the results and complications of femoral neck fractures treated with internal fixation with three screws with an average follow-up of three years. METHODS: Thirty seven patients operated upon between June 2000 and May 2005 for fractures of the femoral neck with three screws were identified as the study population. The final results of 26 patients (11 male, 15 female, with an average age of 39.8, range 16-69) that had a minimum of two year follow-up (average 37 months, range 24-64 months) were evaluated. Those patients that had additional fractures were not included in the evaluation. Preoperatively based on Garden classification four patients (15%) were Type I, eight patients (31%) were type 2, six patients (23%) were type three and eight patients (31%) were type 4. Functional results were evaluated according to the UCLA hip score. RESULTS: The average time to union was 5.5 months (range 3-12 months). One patient did not achieve union and a total hip replacement was done in the 15th postoperative month. Four patients had avascular necrosis (AVN) of the femoral head. The incidence of AVN in patients who had an operation within 24 hours of fracture was 9.5% while 40% in patients operated later than that. In patients with AVN one required a total hip replacement, another required treatment with bipolar hemiarthroplasty, the other two patients did not require further operations. One patient underwent bipolar hemiarthroplasty after screw pullout occurred on the 35th postoperative day. Fifteen patients (58%) had excellent results, five (19%) had good, 5 (19%) had moderate results and one (4%) had a poor result. CONCLUSION: Operative treatment with internal fixation using three screws in femoral neck fractures in the first 24 hours after a fracture gives favourable results in young patients that are too young to be considered for arthroplasty.

Long-Term Results of Modified Green Method in Sprengel's Deformity.

AIM: Congenital undescended scapula (Sprengel deformity) is a rare deformity that is reported in the literature mostly as small case series with short- or medium-term follow-up periods. Here, we aimed to present the long-term results of this deformity treated with modified Green procedure. METHOD: The modified Green procedure was performed in 24 patients (28 shoulders) with Sprengel deformity. Clavicular osteotomy accompanied in all, and omovertebral bone excision in 13 shoulders. The mean age of the patients at the time of surgery was 4.5 years (range 1.5-17 years). Mean follow-up period was 11 years 4 months (4.3-17 years). Preoperative cosmetic appearance was noted as Cavendish III in 17 shoulders and as IV in 11 shoulders. In addition to the Cavendish scale, shoulder abduction, shoulder asymmetry, and scapular elevation and medialization were evaluated. RESULTS: The decrease in scapular elevation and Cavendish scale, and the improvement in shoulder abduction and scapular medialization postoperatively were statistically significant (P < 0.001). Cosmetic improvement of at least one Cavendish grade were attained in 88.9% of shoulders. One patient (unilateral) who was Cavendish grade IV preoperatively died in the early postoperative period from unrelated causes. Of the remaining 10 preoperatively grade IV shoulders, 2 remained at the same grade, 1 improved to grade III, and 7 shoulders to grade I. Of the 17 preoperatively grade III shoulders, 1 shoulder stayed the at same grade, 7 shoulders improved to II, and 9 shoulders to grade I. Postoperative winging in 2 shoulders and hypertrophic scarring in 6 shoulders were noted. CONCLUSION: The modified Green procedure is a relatively safe and reliable method in the treatment of severe Sprengel deformity cases and provides highly constructive and aesthetic results in the long term.

[Assessment of surgical and conservative treatment of forearm fractures: results in juveniles]. / Büyük çocuklarda önkol çift kiriklarinin konservatif ve cerrahi tedavi sonuçlarinin degerlendirilmesi.

BACKGROUND: We aimed to assess treatment outcomes of forearm fractures in patients aged between 10-18 years, for whom strict guidelines for surgical and conservative treatment are not yet clear. METHODS: From a total of 41 patients between the ages of 10-18 years, 34 patients with a minimum of one-year follow-up in our clinic with the diagnosis of forearm fracture were evaluated retrospectively. All the patients had open epiphyses. Twenty-three of these patients were treated conservatively and 11 surgically. Patients were evaluated according to time of union, function and cosmesis. Average follow-up was two years (12-36 months). RESULTS: Conservative treatment gave excellent and good results in 21 (91%), while surgical treatment gave excellent and good results in 9 (82%) of the patients when evaluated according to Anderson's criteria. A bad result was seen in one patient who did not accept an operation, and had an angulation of over 15 degrees. We also had one bad result in the operatively treated group because of implant failure and a need for a second operation. CONCLUSION: According to our results, conservative treatment should be the mainstay in the treatment of childhood fractures of the forearm. However, we should not hesitate in considering surgical treatment when the patients have a malalignment of more than 15 degrees.

[The effects of lumbar plexus block and epidural block on total blood loss and postoperative analgesia in total hip arthroplasty]. / Total kalça protez operasyonlarinda lomber pleksus blogu ve epidural blogun total kan kaybi ile postoperatif analjeziye etkileri.

OBJECTIVES: In this study, the effects of lumbar plexus block and epidural block on total blood loss and postoperative analgesia in patients undergoing total hip arthroplasty (THA) under general anesthesia was documented. METHODS: The study included 45 patients undergoing THA under general anesthesia. Group GA (n=15) received general anesthesia, Group GA+E (n=15) received general anesthesia + epidural catheter and Group GA+LPB (n=15) received general anesthesia + lumbar plexus catheterization. Intraoperative blood transfusion (IOBT) requirements and intraoperative bleeding (IOB) were documented. Postoperative hemoglobin, hematocrit and total blood loss through the drains were also documented. All patients received patient-controlled analgesia through the IV route. Time to first analgesic requirement (TFAR), total IV morphine consumption (MORPH 24) and 24-hour visual analogue scale (VAS) values were evaluated. RESULTS: TFAR was the lowest (8.7+/-4.0 min.) in the GA group and highest (42.7+/-14.4 min) in the GA+LPB group, and the GA+E group had lower values than the GA+LPB (32.3+/-16.0 min) group (p<0.05). IOBT, IOB, and MORPH 24 average values were the lowest in the GA+LPB group and highest in the GA group, with GA+E in between (p<0.05). Postoperative first VAS values were significantly different between the GA group and the others (p<0.001). There was also a significant difference between the GA group and the others regarding postoperative average Hb values (p<0.02). CONCLUSION: THA using either regional technique provides less blood loss and better analgesia. We will consider LPB in our future cases in view of the lower intraoperative blood loss and better analgesia.

Treatment of supracondylar fractures of the humerus in children through an anterior approach is a safe and effective method.

In this prospective case series we evaluated the effectiveness and safety of using an anterior approach to paediatric supracondylar humerus fractures. We gathered data on 46 children that had a displaced supracondylar fracture of the humerus. All the patients had sustained a Gartland type III extension fracture that could not be reduced by closed means. Open reduction through an anterior approach was performed and two Kirschner wires were used to fix the fracture to the medial and lateral sides. Patients were recalled for follow-up and were evaluated using Flynn's radiological and clinical criteria. Loss of extension and flexion was noted by clinical assessment and carrying angle measured on radiograms. A follow-up examination performed in the 24th postoperative week showed that all fractures had healed; the patients' outcomes were rated as excellent or good according to Flynn's criteria. As a result the anterior approach for open reduction of paediatric supracondylar humeral fractures is a safe and reliable method with very good results.

Saphenous nerve block is an effective regional technique for post-menisectomy pain.

In this study we have evaluated the post menisectomy pain relief offered by Saphenous nerve block. This study was planned on 40 patients with a pre-operative and post operative diagnosis of medial meniscus lesion undergoing partial menisectomy arthroscopically. Patients were randomized into 2 groups where Group I received a preoperative Saphenous block while group 2 did not receive a peripheral block, but received 1 ml of saline as placebo injection. After blocks both groups received general anesthesia and IV patient controlled analgesia (PCA) with tramadol for post operative pain relief. Patients rest and activity pain scores were evaluated on post operative 0, 2, 4, 6, 12 and 24 h using visual analog scale (VAS). Total tramadol consumption as well as pain at rest, when weight bearing and the need for external support while walking were recorded. Group I VAS scores were statistically lower then group II during the time of observation periods at rest as well as active movement periods. Tramadol consumption through IV PCA was statistically significantly lower in group I than in group II (P < 0.05). Pain during walking measured at 24 h was significantly different with better results in group I (P < 0.001). Saphenous nerve block is used for different indications; it can also be a good analgesic method for arthroscopic interventions. We have shown it to be effective after medial partial menisectomies. According to our knowledge this report is the first one utilizing saphenous nerve block for pain after arthroscopic medial menisectomy.

[Early results of balloon kyphoplasty for osteoporotic spinal fractures]. / Osteoporotik vertebra kiriklarinda balon kifoplasti uygulamasinin erken dönem sonuçlari.

OBJECTIVES: We evaluated early results of osteoporotic spinal fractures treated with balloon kyphoplasty. METHODS: The study included 16 patients (11 females, 5 males; mean age 66 years, range 55 to 75 years) who were treated with balloon kyphoplasty for osteoporotic spinal fractures. One patient had vertebral fractures at two levels. The mean duration from trauma to kyphoplasty was two months (range 0 to 4 months). The mean amount of cement used during the procedures was 4 ml (range 3 to 6 ml). Kyphoplasty was performed with a bipedicular approach in all the patients. Functional results were assessed with the Oswestry Disability Scale (ODS) and a visual analog scale (VAS). The mean follow-up period was 18 months (range 13 to 27 months). RESULTS: Compared to the preprocedure measurements, the mean local kyphosis angle decreased from 16 degrees to 11.8 degrees , and anterior compression angle decreased from 16.7 degrees to 9.6 degrees , the improvements being 26.3% and 42.5%, respectively. The mean vertebral body and anterior wall heights increased by 44.4% and 37.9%, respectively. At final evaluations, the ODS score decreased by 52.2% (from 13.8 to 6.6) and the VAS score decreased by 59.5% (from 4.2 to 1.7). No complications were encountered other than cement extrusion at two aspects of the vertebral body (2 anterior, 2 posterior leaks). CONCLUSION: Being a minor surgical procedure, balloon kyphoplasty is an appropriate treatment in osteoporotic vertebral fractures with high patient satisfaction and low complication rate.

[Midterm results of Oxford phase 3 unicondylar knee arthroplasty for medial osteoarthritis]. / Medial gonartrozda Oxford faz 3 unikondiler diz artroplastisinin orta dönem sonuçlari.

OBJECTIVES: We evaluated midterm results of Oxford phase 3 unicondylar knee arthroplasty (UKA) in patients with medial osteoarthritis. METHODS: Twenty-seven patients (24 females, 3 males; mean age 57 years; range 47 to 73 years) underwent Oxford phase 3 UKA with the diagnosis of medial knee osteoarthritis. All patients had primary osteoarthritis but one with spontaneous osteonecrosis. Nine knees were Ahlback grade 2, and 18 knees were grade 3. All femoral and tibial components were cemented and mobile tibial polyethylene inserts were used in all the patients. Pre- and postoperative evaluations were made using the Knee Society clinical rating system. The mean follow-up was 28 months (range 24 to 36 months). RESULTS: Compared to the preoperative values, significant improvements were obtained in the following at final follow-up (p<0.05): knee flexion (106.4 degrees and 117.4 degrees , respectively), tibiofemoral angle (7 degrees varus and 1 degrees valgus), knee score (47.5 and 78.9), and functional knee score (48.7 and 83.6). Only two patients needed blood transfusion. No major complications occurred including infection, deep vein thrombosis, pulmonary emboli, and neurovascular injury. Two patients underwent revision surgery at postoperative 8 and 10 months, respectively, because of progressive collapse of the tibial plateau. Knee Society clinical scores were excellent or good in 21 (77.8%), moderate in four (14.8%), and poor in two (7.4%) patients. The corresponding figures for functional results were 23 (85.2%), 2 (7.4%), and 2 (7.4%). CONCLUSION: Our results demonstrate that Oxford phase 3 UKA is effective with considerable success in the treatment of medial osteoarthritis.

Does bilateral total knee arthroplasty affect gait in women?: comparison of gait analyses before and after total knee arthroplasty compared with normal knees.

We performed gait analysis of 24 patients with bilateral knee osteoarthritis (OA) before, 1 year, and 2 years after bilateral total knee arthroplasty and compared these results to 12 normal controls. Cadence was significantly decreased in OA patients when compared with controls. Step and stride lengths were significantly different preoperatively (shorter) and postoperatively (P < .05), but postoperative results showed no significant difference when compared with normal controls (P < .05). Step and stride times were significantly different (P < .05) between the preoperative OA group and controls, but no difference was seen with the postoperative measurements when compared with controls. In the OA group, the mean vertical component of the ground reaction forces expressed as percent body weight was significantly lower when compared with controls and postoperative results. No correlation was found between the preoperative and postoperative clinical scores and objective data obtained from gait analysis. Our results demonstrate that gait analysis is not a useful tool in evaluating the success of total knee arthroplasty patient.