A retrospective comparison of costs for the primary and revision total knee arthroplasty in Turkey.

OBJECTIVE: This study aimed to compare the cost profiles of patients who underwent a primary or revision total knee arthroplasty (TKA) and to determine the effects of the length of hospital stay, comorbidities, and septic and aseptic revision rates on the treatment costs. METHODS: A total of 1,487 patients who underwent primary (n=1,328; 1,131 females, 197 males) or revision TKA (n=159; 137 females, 22 males) between 2010 and 2017 at our institution were retrospectively included in the current study. The patients' demographics (age and gender), the length of hospital stay, comorbidities, and septic and aseptic revision rates were collected from our hospital database. The total costs of revision and primary TKAs were calculated based on the prostheses and surgical equipment used, hospital stay, and other administrative costs in both the Turkish lira (TRY) and US dollar (USD) based on the parity of the 2 currencies from 2010 to 2017. RESULTS: The average cost per patient for primary TKAs was 7,985±2,927 TRY (5,265 USD) in 2010 and 7,070±1,775 TRY (1,852 USD) in 2017. The average cost for revision TKAs was 13,647±4,095 TRY (8,999 USD) in 2010 and 22,806±6,155 TRY (5,973 USD) in 2017. In terms of the total costs, significant differences existed over the years, with a significantly higher difference in 2015 compared with that from 2010 to 2013 (p<0.001); however, no difference was determined among the age groups (p=0.675). The difference between the total costs of the septic (n=34; 17,964±13,028 TRY) and aseptic revisions (n=125; 23,377±12,815 TRY) was significant (p=0.001), with a higher cost for patients with septic TKAs but with no significant difference between the total costs for the patients with and without comorbidities (p=0.254). Additionally, the length of hospital stay was 2 times higher in patients with revision TKAs than in those with primary TKAs (12.3 vs 6.2 days). CONCLUSION: Revision TKAs cause higher costs than primary TKAs, with a prolonged hospital stay. The septic background seems to be an independent predictive factor for increased costs in revision TKAs.

Matrix induced autologous chondrocyte implantation in the knee: Comparison between osteochondritis dissecans and osteonecrosis and effect of chondrocyte thickness on prognosis.

OBJECTIVE: The aim of this study was compare the clinical success of treatments for avascular necrosis and osteochondritis dissecans in cases who underwent matrix autologous chondrocyte implantations, and evaluate cartilage thickness on the clinical outcomes after implantation. METHODS: A total of 37 patients (29 men, and 8 women; mean age: 23.8 years (16-38)) were treated prospectively with a two-stage matrix autologous chondrocyte implantation (avascular necrosis, n=21; osteochondritis dissecans, n=18). Clinical improvements and follows-up were assessed based on the patients' International Cartilage Repair Society (ICRS) scores with simultaneous cartilage thickness measurement using short-TI inversion recovery magnetic resonance imaging. The patients were divided into four subgroups based on their clinical scores, as group D <65 points, Group C 65-83 points, Group B 84-90 and Group A ≥90. RESULTS: The mean ICRS score was 28.33±7.14 in the preoperative period in the avascular necrosis group, which increased to 70.88±12.61 at 60 months; while the mean ICRS score increased from 29.75±7.15 preoperatively to 87.58±12.83 at 60 months in the osteochondritis dissecans group. A statistically significant difference in the ICRS scores was noted between the two groups, and also between the ICRS scores and cartilage thicknesses of the subgroups (p<0.05). CONCLUSION: Our study results revealed that greater clinical improvement was achieved in patients with osteochondritis dissecans undergoing matrix autologous chondrocyte implantation than in those with avascular necrosis. In addition, cartilage thickness greater than 3.7 mm following an autologous chondrocyte transplantation showed excellent clinical improvement. LEVEL OF EVIDENCE: Level III, Therapeutic Study.

One-stage anatomic double bundle anterior and posterior cruciate ligament reconstruction.

INTRODUCTION: Main evidence of the heavy knee dislocations is the rupture of both Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL). There are limited sources for the treatment of both ligaments at a single stage. Materials-method: One-staged anatomic double-bundle ACL and PCL reconstruction technique has been applied to 2 cases aged 20 and 36 with traumatic knee dislocation. Lateral collateral ligament and posteriolateral corner reconstruction added to one case, and medial collateral ligament and posteriomedial corner reconstruction for the other case. Because of additional femur fractures of the both cases, ligament reconstructions have been applied after the main treatment. Anterior tibialis tendon (ATT) allograft has been used for graft for both cases because of other stabilization deficiencies of knees. It has been confirmed that femoral and tibial tunnels constructed with anatomic double-bundle technique are fitting to anatomic locations by the post-operation CT results. Post fixation screw has been used for tibia, and endobutton at femur. RESULTS: Tracking records of patients at 8th month shows that; Lysholm score of the case aged 20 was 89, and 85 for the case aged 36. While KT-1000 values was 3.7 mm, and 4.1 mm for 15 N power; and 9.1 mm-9.6 mm with the maximum power. CONCLUSION: Surgical technical details of one-staged double-bundle reconstruction for ACL and PCL injuries which is gaining popularity recently has been stated.

Lyophilised medial meniscus transplantations in ACL-deficient knees: a 19-year follow-up.

PURPOSE: The treatment of meniscal tears has changed since the early 1980s. Meniscus transplantation emerged as a treatment option during that period. This study aims to present the long-term results of the first lyophilised meniscus allograft transplants in Turkey. METHODS: Between 1990 and 1992, four transplants of the medial meniscus combined with anterior cruciate ligament (ACL) reconstruction were performed on patients with a history of medial meniscectomy and anterior knee instability at our institution. For all patients who underwent meniscus lyophilised allograft transplantation and revision ACL reconstruction, clinical outcomes were evaluated over a mean period of 19 years of postoperative follow-up by clinical assessment, Tegner score, Lysholm score, Knee Society Score, radiography and magnetic resonance imaging (MRI). RESULTS: The median value of Tegner score was 3 before index surgery and 2.5 at year 19 postoperatively. The median value of Lysholm score was 60.5 before index surgery and 62.5 at year 19. All of the patients had Outerbridge grade IV osteoarthritis by X-ray examination at year 19. CONCLUSION: Successful meniscus transplantation depends on many factors. This study examines the effect of allografts on these factors and describes experiences with lyophilised allografts in four male patients. LEVEL OF EVIDENCE: IV.