A novel robot-assisted knee arthroplasty system (ROSA) and 1-year outcome: A single center experience.

BACKGROUND: Total knee arthroplasty is a successful procedure in the treatment of knee osteoarthritis. Searches in surgical technique have focused surgeons in particular on implant alignment. For this purpose, the use of robot-assisted total knee arthroplasty has become increasingly common in the last 10 years. METHODS: A total of 46 patients (66 knees) who were operated for knee osteoarthritis with Robotic Surgical Assistant (ROSA, Zimmer-Biomet, Warshaw, Indiana, USA) between 2021 and 2023 were included in the study. Preoperative planning and intraoperative incision time, total surgical time, range of motion and follow-up time recorded. Oxford knee scores and knee society scores (KSS) of the patients were compared before and after surgery. At the last follow-up Forgotten Joint Score and the sagittal and coronal plane alignments were evaluated. RESULTS: Preoperative mean Oxford score of the right knee of the patients was 18.5 ±â€…3.2, post-surgery mean Oxford score progressed to 43.5 ±â€…2.2. While the preoperative left knee Oxford score of the patients was 16.9 ±â€…2.3, the mean left knee Oxford score improved to 43.4 ±â€…2.2 postoperatively. The mean KSS score of the patients' right knee preoperatively was 49.7 ±â€…3.5, and progressed to 89.2 ±â€…4.7 postoperatively. While the preoperative mean left knee KSS score of the patients was 46.5 ±â€…4.3, the mean KSS score improved to 89.8 ±â€…3.2 postoperatively. The mean Forgotten Joint Score of the left knee at the last follow-up of the patients was 77.4 ±â€…3.8, while the mean Forgotten Joint Score of the right knee was 75.4 ±â€…5.9. CONCLUSION: The results of ROSA-supported knee arthroplasty found to be functionally successful.

Effects of Routine Antithrombotic-Adjusted Dose of Rivaroxaban and Nadroparin Calcium on Tendon Healing of Rats: An Experimental Study.

Introduction Achilles tendon injury necessitates thromboembolism prophylaxis after repair. This study aimed to investigate the effects of antithrombotic-adjusted prophylactic doses of nadroparin calcium and rivaroxaban on Achilles tendon healing. Materials and Methods Twenty-four young adult male Wistar Albino type rats were randomly divided into three groups. All rats underwent a full-thickness surgical incision of the Achilles tendon, followed by primary repair. After the procedure, group 1 was determined as the control group and received no medication. Group 2 received 2.03 mg/kg rivaroxaban daily via gastric lavage once daily, and group 3 was given subcutaneous 114 IU AXa nadroparin calcium once daily for 28 days. After euthanization, the degrees of inflammation, neovascularization, fibroblastic activity, and collagen fiber sequencing were examined and scored for histopathological evaluation. The Statistical Package for Social Science (SPSS) version 21.0 for Windows software (SPSS, Inc., Chicago, Illinois, United States) was used for all statistical analyses. The number of inflammatory cells, capillary vessels, and fibroblasts, which met the parametric tests' assumptions, were compared between three independent groups by one-way analysis of variance. The significance level was set at p- value < 0.05. Results Histological examination of the group 1 sample showed the presence of inflammatory cells, an increase in the number of fibroblasts, and sequencing of collagen fibers scattered. The presence of inflammatory cells, remarkable increases in the number of fibroblasts, the presence of mature collagen fibers, and regular sequencing of collagen fibers regular were shown in groups 2 and 3. There were statistically significant differences between the groups regarding the number of inflammatory cells and fibroblasts. In group 2, the number of inflammatory cells was lower than in groups 1 and 3. Elsewhere, the number of fibroblasts was higher in group 1 compared than in groups 2 and 3. Conclusion Both rivaroxaban and nadroparin calcium in their daily dosage have a beneficial effect on Achilles tendon healing.

Histological and Biomechanical Effects of Local Anesthetics and Steroids on Achilles Tendon: A Study in Rats.

BACKGROUND: Peritendinous injection of local anesthetics, alone or in combination with corticosteroids, is widely used in the treatment of tendinopathies. Toxicity of local anesthetics has been demonstrated in many cells, including myocytes, chondrocytes, and neurons. Bupivacaine and lidocaine are known to have time- and dose-dependent cytotoxicity in these cells. The effects of these agents on the tendon remain unknown. PURPOSE: To show histological and biomechanical effects after the injection of different local anesthetics and steroids, both single and combined, at different concentrations into the peritendinous sheath of rat Achilles tendon. STUDY DESIGN: Controlled laboratory study. METHODS: In the study, 100 rats were divided into 10 groups with equal body weights. Inflammation was induced in both Achilles tendons of each rat by means of the ball drop technique; 7 hours later, injections were made into the peritendinous sheaths of both Achilles tendons using lidocaine, bupivacaine, and dexamethasone as appropriate for the rat's group. At the end of the first week, the right Achilles tendons of the rats were removed for histological study. Left Achilles tendons were evaluated in terms of biomechanics. RESULTS: Histological findings demonstrated that the group with the most toxicity to the tendon was the group that received injection of dexamethasone alone. The groups with the least toxicity were those receiving dexamethasone combined with low- or high-dose bupivacaine. Biomechanical findings showed that the experimental groups had similar results to each other with the exception of the groups receiving 0.25% bupivacaine alone and dexamethasone alone, in which tendons revealed higher tensile strength. CONCLUSION: Local anesthetic and steroid applications have different histological and biomechanical effects on the tendon. Although the dexamethasone-injected group was the most affected in terms of histology, these changes could not be demonstrated biomechanically. CLINICAL RELEVANCE: In future clinical studies, the effect of steroids on the tendon should be investigated more comprehensively. Whether biomechanical results overlap with histological results should be investigated further.

Comparison of Single-Dose Infraclavicular Brachial Plexus Block and Continuous Infraclavicular Brachial Plexus Block Applications in the Treatment of Finger Amputations.

Introduction The aim of this study is to evaluate the replantation success of single-dose infraclavicular brachial plexus block and continuous infraclavicular brachial plexus block (CIBPB) applied with bupivacaine and prilocaine in patients with finger amputation. Materials and Methods This prospective randomized nonblinded study was conducted between January 2012 and September 2017, and 47 patients, all male, were included. Patients were randomly separated into two groups as 23 patients CIBPB applied group (group A) and 24 patients single-dose infraclavicular block applied group (group B). In group B, after the effect of block is ceased, intravenous patient-controlled (PC) opioid analgesia and, where necessary, 1 mg/kg meperidine and 75 mg diclofenac sodium intramuscularly were alternately administered at 4 to 6 hours intervals. The average ages were 30.7 ± 10.06 and 29 ± 9.08, respectively. Replantations were applied as being two venous anastomoses to one artery, where possible. Hourly skin temperatures of fingers of the hands in which both surgeries applied and no surgery applied in both the groups were measured for 3 days with an infrared thermometer. Also, Numerical Rating Scale (NRS) evaluations in both the groups were performed in 3-hour intervals for 3 days. Results Replantations were successful in 22 patients in whom CIBPB was applied (95.6%) and in 19 patients in whom single block was applied (79.16%). Regarding the finger temperatures, no significant difference was detected between both the groups for 3 days following the operation. No significant difference was found between the length of hospital stays (4.73 ± 2.21-4.71 ± 1.53) and duration of operations (2.90 ± 0.73-2.83 ± 0.58). There was no significant difference between the temperature values of both the groups. NRS scores of group A were statistically significantly lower than those of group B. Conclusion In this prospective randomized study performed by using bupivacaine and prilocaine on 24 patients, the success rate of finger replantations with CIBPB was found to be higher. CIBPB is a very beneficial method that should be taken in consideration in hand injuries with anastomosis and high risk of vasospasm. Further studies with more number of cases would help reduce the question marks related with the success of this method.

Effect of pentoxifylline on healing of segmental bone defects and angiogenesis.

OBJECTIVE: The aim of this study was to determine the effect of pentoxifylline (PTX) on angiogenesis and the healing of a critical-sized segmental defect of the radius diaphysis in a rat model, using radiological and histological grading systems. METHODS: The study included 24 female Sprague-Dawley rats (weight: 300±20 g) divided into 4 groups. A critical-sized segmental defect was created in the radius diaphysis in all rats. In Group 1, morcellized iliac crest autografts were used to fill the segmental bone defect. In Group 2, segmental bone defects were filled using morcellized iliac crest autografts, and 25 mg/kg/day PTX was applied intraperitoneally. In Group 3, the segmental bone defects were not filled, and in Group 4 the segmental bone defects were left unfilled, and an intraperitoneal (IP) dose of 25 mg/kg/day PTX was applied. Rats were sacrificed at postoperative Week 8, and defects were evaluated using radiographic, histological and immunohistochemical methods. RESULTS: There were significant differences between Group 1 and 2 according to radiological evaluation (p=0.003) and quality of union at the defect site (p=0.01). Union quality was higher in Group 4 than Group 3 (p=0.01). Cluster of differentiation 31 (CD31) and vascular endothelial growth factor (VEGF) levels were higher in Group 2 than in Groups 3 and 4. CONCLUSION: According to radiological and histological parameters, PTX appears to improve angiogenesis and healing of segmental cortical bone defects of the radius in a rat model.

Hypothenar hammer syndrome: a case series and literature review.

OBJECTIVES: This study aims to report our experience regarding patients who were surgically treated due to hypothenar hammer syndrome and review the related literature. PATIENTS AND METHODS: The study included 11 hands of eight patients (5 males, 3 females; mean age 48 years; range 29 to 60 years) who underwent surgery due to hypothenar hammer syndrome between September 2004 and March 2013. Mean follow-up period was 50 months (range 3-103 months). The time of symptom onset, occupational history, and detailed physical examination findings were recorded. Surgery was performed under sedation and axillary anesthesia. Distal segment of the forearm, all thrombosed segments of the Guyon and superficial arch were removed. Reconstruction of the ulnar artery and the superficial arch was performed using vein grafts obtained from the forearm. RESULTS: While all patients' dominant hand was affected, both hands were affected in three patients. All patients complained of pain and color change in one finger or multiple fingers. While minimal amputation and debridement of fingertip pulp was performed in two patients, all other patients recovered uneventfully. Patency of the ulnar artery was uneventful at follow-up in five of the eight patients, whereas three patients were performed revision surgery for a new vein graft. Most patient complaints resolved during the follow-up period. CONCLUSION: Hypothenar hammer syndrome is a disease of the upper extremities that should be considered in patients with digital ischemia, and a history of manual labor and smoking. Although this disease can be treated with conservative therapy, advance-stage patients who fail to respond to conservative treatment can be treated surgically with vein grafts.

Plantar fascia coronal length: a new parameter for plantar fascia assessment.

The effects of gender and various anthropometric variables were previously reported as significant predictors of plantar fascia thickness. Although a strong correlation between either the body weight or body mass index (BMI) and plantar fascia thickness were not demonstrated, a moderate relation was stated. We retrospectively investigated the role of gender, height, weight, and body mass index on plantar fascia thickness at the calcaneal origin (PFCO) and 1 cm distal from the calcaneal origin (PF1cm) and the coronal length of the plantar fascia at the calcaneal origin (CLPF) in healthy subjects. The PFCO, PF1cm, and CLPF were retrospectively measured from magnetic resonance images of 100 healthy subjects. The gender, height, weight, and body mass index of the participants were also noted. Gender was a predictive factor for the length of the CLPF. The subjects with a BMI >25 kg/m(2) had a significantly greater PFCO, PF1cm, and CLPF. Height was mildly and BMI and weight were moderately related to the PFCO. However the CLPF showed a better correlation with height, BMI, and weight than that of plantar fascia thickness. CLPF better reflected the role of weight, BMI, and height than its thickness. It is a new parameter that could be valuable in the evaluation of plantar fascia disorders.

[Arthroscopic excision of elastofibroma dorsi at scapulothoracic joint: a surgical technique]. / Skapulotorasik eklemde elastofibroma dorsinin artroskopik eksizyonu: cerrahi teknik.

Elastofibroma dorsi is a rare soft tissue pseudotumor which is located at the anteroinferior aspect of the scapula. In this article, we report a 19-year-old female case who had arthroscopic marginal excision of elastofibroma dorsi at the scapulothoracic joint without recurrences during follow-up. The arthroscopic marginal excision of the elastofibroma dorsi may have good clinical results in selected cases.

Peri- and postanalgesic properties of lidokain, lornoxicam, and nitroglycerine combination at intravenous regional anesthesia.

BACKGROUND: This study was conducted to compare and evaluate the effect of adding lornoxicam or nitroglycerine as adjuncts to lidocaine in intravenous regional anesthesia (IVRA). METHODS: 60 patients were randomly separated into three groups, lidocaine group (group L), lidocaine+lornoxicam group (group LL), and lidocaine+lornoxicam+transdermal nitroglycerine group (group LL-N). Hemodynamic parameters, sensory and motor blocks onset, and recovery times were recorded. Analgesic consumption for tourniquet pain and postoperative period were recorded. RESULTS: Sensory block onset times and motor block onset times were shorter in the LL-N and LL groups compared with L group. Sensory block recovery time and motor block recovery time were prolonged in the LL and LL-N groups compared with group L. The amount of fentanyl required for tourniquet pain was less in group LL and group LL-N when compared with group L. VAS scores of tourniquet pain were higher in group L compared with the other study groups. Postoperative VAS scores were higher for the first 4 hours in group L compared with the other study groups. CONCLUSION: The adjuvant drugs (lornoxicam or TNG) when added to lidocaine in IVRA were effective in improving the overall quality of anesthesia, reducing tourniquet pain, increasing tourniquet tolerance, and improving the postoperative analgesia.

The effect of pronation and inclination on the measurement of the hallucal distal metatarsal articular set angle.

OBJECTIVE: In this study, we tried to evaluate the effect of pronation and the inclination of the first metatarsal on the measurement of distal metatarsal articular angle (DMAA) in 10 cadaver first metatarsals. METHODS: Ten cadaver first metatarsals were fixed to a device. This device can change the inclination and pronation angles of the metatarsal. 15-30-45 degrees of inclination and 0-10-20 degrees of pronation were applied to the metatarsals. After applying radio-opaque putty to the medial and lateral articular edges and metatarsal dorsal diaphyseal ridge, the X-ray and digital images were taken at different degrees of inclination and pronation. A graphics software did the measurement of DMAA. The statistical analysis was done by paired sample t-test. RESULTS: The inclination had no effect on DMAA (p>0.1). The pronation of the first metatarsal was found to have a positive effect on DMAA (p<0.005). As the degree of pronation increased, the degree of DMAA was found to also increase. We found no difference between the measurements of the X-ray and the digital images. CONCLUSION: According to the current data, the measurement of DMAA is not suitable for making clinical and surgical decisions. The inclination of the first metatarsal can change, depending on the height of the medial longitudinal arch. By doing this study, we are trying to simulate the pes cavus and pes planus deformity on the radiologic measurement of pronation of the hallux. According to our results, inclination has no effect on the measurement of DMAA. However, the measurement of DMAA is expected to be dependent on the rotational deformity of the hallux.

Negative pressure wound therapy in patients with diabetic foot.

OBJECTIVE: In this study our aim was to compare the results of standard dressing treatment to negative pressure wound therapy (NPWT) performed with a vacuum-assisted closure (VAC) device in patients with diabetic foot ulcers. METHODS: We assessed the results of 35 patients treated for diabetic foot ulcer between 2006 and 2008. Of these cases, 20 (4 women and 16 men; mean age: 66 years; range: 52-90 years) were treated with standard wet dressings and 16 feet in 15 patients (10 men, 5 women; mean age: 58.9 years; range: 42-83 years) with VAC therapy. The success of treatment was evaluated in terms of hospitalization length and rate of limb salvation. RESULTS: The average hospitalization period with VAC treatment was 32 days compared to 59 days with standard dressing treatment. All patients treated with standard dressings eventually had to undergo amputation. However, the amputation rate was 37% in the VAC treated group and 88% of patients had a functional extremity at the end of treatment. CONCLUSION: VAC therapy, together with debridement and appropriate antibiotic therapy, enables a higher rate of limb salvage, especially in Wagner Grade 3 and Grade 4 ulcers.

Evaluation and comparison of the effects of hyperbaric oxygen and ozonized oxygen as adjuvant treatments in an experimental osteomyelitis model.

BACKGROUND: We evaluated and compared the efficacy of ozone (O(3)) and hyperbaric oxygen (HBO) therapies in an experimental rat model of osteomyelitis. MATERIALS AND METHODS: Forty-eight male Sprague-Dawley rats were divided into sham, osteomyelitis (control), vancomycin (V), vancomycin + HBO (VHB), vancomycin + O(3) (VO), and vancomycin + HBO + O(3) (VOHB) groups. Osteomyelitis was induced by a bone injection of 10(8) CFU/mL methicillin-resistant Staphylococcus aureus. HBO was administered daily at 2.8-atm pressure for 90 min; O(3) therapy was provided as intraperitoneal injections of 0.7 mg/kg O(3)/O(2) gas mixture once daily. Treatments were continued from d 7 to 21 after induction of osteomyelitis. Bone tissues and blood samples were harvested for biochemical, histopathologic, and microbiologic analyses. RESULTS: Rats in the sham, VO, and VOHB groups gained weight but those in the control, V, and VHB groups did not. Levels of malondialdehyde, superoxide dismutase, and glutathione peroxidase were lower in the VHB, VO, and VOHB groups than in V and control groups. Levels of interleukin-10 and -1ß and tumor necrosis factor-α were decreased in the VHB, VO, and VOHB groups; transforming growth factor-ß was increased in these groups compared with V and control groups (P ≤ 0.001). Bacteria counts in VOHB were significantly lower than those in group of V (P = 0.012). Histopathologic scores in group VO were significantly lower than those in group V (P = 0.046). CONCLUSIONS: O(3) was as effective as HBO in decreasing oxidative parameters and inflammatory cytokines. Rats in the VO and VOHB groups gained more weight than did the other groups. Bacteria counts were significantly decreased in group VOHB compared with the other groups. Histopathologic scores in group VO were significantly decreased compared with the other groups.

Brucella melitensis infection in total knee arthroplasty: a case report.

We report a case of a 63-year-old female patient who underwent a total knee arthroplasty in which the knee later became infected with Brucella melitensis. Diagnosis was made by positive culture of a sinus tract discharge. Radiological views of the knee did not show signs of implant loosening. The patient was successfully treated with rifampicin and doxycycline without surgery.

Effect of synthetic cell-binding peptide on the healing of cortical segmental bone defects.

OBJECTIVE: To determine the effect of inorganic bone matric/Pepgen P-15 (ABM/P-15) on the healing of a critical sized segmental defect in a rat radius using a radiological and histological grading system. METHODS: We carried out this study at the Research Laboratories, Gazi University School of Medicine in 2004. Critical sized segmental defects were created in the radius of 36 Wistar rats. Thirteen defects were filled with ABM/P-15 Flow (gel form), 12 defects were filled with ABM/P-15, and 11 defects were used as a control group. The rats were sacrificed at the tenth week, and healing of the defects was evaluated radiographically and histologically. RESULTS: The usage of ABM/P-15 and ABM/P-15 Flow were demonstrated to improve healing of segmental bone defects compared with the control group. Statistical evaluation showed that there were significant differences between control sites, and the sites treated with P-15 and P-15 Flow (p=0.011). The highest radiological and histological grades were achieved by P-15. CONCLUSION: Segmental cortical bone defects may be treated with ABM/P-15 instead of bone allografts, and autografts. According to the radiological and histological parameters measured in this study, the implantation of ABM/P-15 resulted in optimum healing of the segmental cortical bone defects. Pepgen P-15 has a positive effect on bone healing, without any immunogenic features and disease transmission risk. Therefore, ABM/P-15 can also be used for orthopedic surgery.

[Evaluation of the surgical results of Achilles tendon ruptures by gait analysis and isokinetic muscle strength measurements]. / Asil tendon yirtiklarinda cerrahi tedavi sonuçlarinin yürüme analizi ve kas gücü ölçümüyle degerlendirilmesi.

OBJECTIVES: We evaluated the long-term results of surgical treatment of Achilles tendon ruptures. METHODS: Fifteen male patients (mean age 39.5 years; range 28 to 58 years) underwent surgery for Achilles tendon ruptures. All the ruptures but one occurred during sport recreation. Eleven patients were treated within the first week of trauma. After surgery, a cast was applied for four weeks, after which it was switched to a polyethylene splint that did not allow dorsiflexion. Partial weight bearing was allowed in the fourth postoperative week. Subjective and objective evaluations were made according to the system by Thermann et al. Muscle strength was measured by an isokinetic dynamometer and gait analysis was performed. Data from the healthy sides were used for comparisons. The mean follow-up was 16.8 months (range 8 to 48 months). RESULTS: Seven patients (46.7%) had no pain, while six patients (40%), one patient (6.7%), and one patient complained of pain during heavy, medium, and light sports activities, respectively. Muscle strength did not decrease in nine patients (60%). Seven patients (46.7%) returned to preinjury activity levels. Twelve patients (80%) evaluated the outcome as very good or good. The mean muscle atrophy on the affected side was 0.43 cm. The overall results were very good or good in nine patients (60%), moderate in four patients (26.7%), and poor in two patients (13.3%). One patient had superficial infection and delayed healing. Isokinetic measurements showed decreased peak torque, and increased total work. By gait analysis, no significant relationship was found between the dorsiflexion and plantar flexion difference and forefoot ground reaction forces. CONCLUSION: Early surgical treatment of Achilles tendon ruptures followed by a shorter immobilization period is associated with satisfactory results, and in the long-term, with a higher rate of patient satisfaction.