Long-term outcomes of first metatarsophalangeal hemiarthroplasty for hallux rigidus.

Hallux rigidus (HR) is arthritis of the first metatarsophalangeal joint.First metatarsophalangeal joint hemiarthroplasty surgery is one of the treatment options for end stage hallux rigidus.The aim of this study is to evaluate the long-term outcomes of hemiarthroplasty of the first MTPJ with a metallic implant in patients with end-stage HR. Patients who underwent hemiarthroplasty surgery with the diagnosis of HR were included in the study. Self-Administered Foot Evaluation Questionnaire (SAFE-Q) and Foot and Ankle Disability Index (FADI) scores were used in pre-operative and post-operative final follow-ups to evaluate the clinical status of the patients. Post-operative 1st metatarsophalangeal joint range of motion was measured and recorded separately for each patient. The intra-hospital and follow-up complications and revision surgeries of the patients were recorded. Thirty-five patients with a mean follow-up of 8.1 years were included in the study. There was a statistically significant positive change in both FADI and SAFE-Q scores compared to the pre-operative process(p = 0.0001). The average dorsiflexion angle at the final follow-up was 22.0 ± 8.2. Thus, it was determined that the 5-year and 8-year survival rates of patients in this study were 97.1% and 87.8%, respectively. In conclusion, the long-term results show that the use of hemiarthroplasty in the treatment of end-stage HR leads to high patient satisfaction, increased range of motion and a high survival rate.

Validity of the Novel Radiological Classification System of the Distal Femur.

OBJECTIVE: Aseptic loosening (AL) is among the most important causes of failure after total knee arthroplasty (TKA). However, while there are numerous underlying causes of AL, the morphometry of the distal femur and intramedullary canal has not been sufficiently demonstrated. This study aimed to show the interobserver and intraobserver reliability and validity of the Citak classification, which has been recently defined according to the morphometry of the distal femur and provides a risk factor definition for AL. MATERIALS AND METHODS: A total of 200 patients whose standardized anteroposterior (AP) and lateral images of the knee joint were obtained between October 2019 and April 2020 were retrospectively evaluated in this study. Patients with a history of extra-articular deformity and knee surgery were excluded from the study. For AL, morphologies of the distal femur were identified by two observers using the new radiological classification system of the distal femur. Mean pairwise Cronbach's alpha coefficient was used to assess the intra- and interobserver agreement of the classification. RESULTS: There was excellent interobserver agreement for the 20 cm proximal and 2 cm proximal to the lateral joint line (PLJL) and adductor tubercle (PAD), respectively. The mean Cronbach's alpha coefficient was 0.96 (range 0.764-0.944) for the PAD and 0.98 (range 0.734-0.929) for the PLJL. There was also an excellent intraobserver agreement, with 93% average pairwise percent agreement for the index group and 95.5% average pairwise percent agreement for the anatomical classification group. CONCLUSIONS: The level of inter- and intraobserver agreement for the morphology of the distal femur was excellent in the new radiological classification system, which was shown to be beneficial in the planning of revision knee arthroplasty for AL. However, there is a need for further studies in order to make a correlation of the classification with specific intraoperative findings.

Role of Biomarkers in Periprosthetic Joint Infections.

Periprosthetic joint infection (PJI) is one of the most serious complications after joint arthroplasty. The incidence rate of PJI after total joint replacement is 1-3%. Although there are different guidelines and diagnostic criteria used to diagnose PJI, diagnosing PJI is a highly difficult process for orthopedists. The current Musculoskeletal Infection Society (MSIS) criteria are widely used for the diagnosis of PJI. These criteria include results from blood/synovial fluid tests, physical examination, and histological and microbiological analyses of intra-operative samples. However, there is currently no blood or synovial test that can definitively diagnose PJI. To make a more effective diagnosis of PJI, a large number of studies have explored and continue to investigate biomarkers. This review aims to provide general information about serum and synovial markers used for the diagnosis of PJI that may be used to create a database to guide researchers in new studies.

Fixation of the neglected subcutaneous osteochondral fragment of large medial femoral condyle defect in adult male: A case report.

Knee osteochondral fractures are among the most common orthopaedic injuries, and their diagnosis and treatment is always open to debate among orthopaedic surgeons. In this case report, we described the surgical treatment and 2 years of follow-up of an adult male patient who underwent delayed osteochondral fixation with an iliac graft. A medial parapatellar incision was made to perform open reduction and internal fixation. The fracture surface at the medial condyle of the femur was debrided with a curette, followed by placement of the tricortical graft harvested from the iliac crest into the defect at the medial femoral condyle. The osteochondral fragment was then placed on top and was fixed with three headless compression screws together with the iliac crest graft for joint surface restoration. While the patient's preoperative knee injury and osteoarthritis outcome score (KOOS) was 38 and it increased to 74 during two years follow-up. Despite the scarcity of information on delayed fixation of osteochondral fractures, osteochondral fragments with preserved viability should be fixed, regardless of the timing, as suggested by the successful outcomes obtained in this study.

Low-Degree Tibial Slope Angle Prevents Component Overhang by Enlarging the Lateral Plateau Surface Area in Total Knee Arthroplasty.

This study aimed to investigate whether overhang or underhang around the tibial component that occurs during the placement of tibial baseplates was affected by different slope angles of the tibial plateau and determine the changes in the lateral and medial plateau diameters while changing the slope angle in total knee arthroplasty. Three-dimensional tibia models were reconstructed using the computed tomography scans of 120 tibial dry bones. Tibial plateau slope cuts were performed with 9, 7, 5, 3, and 0 degrees of slope angles 2-mm below the subchondral bone in the deepest point of the medial plateau. Total, lateral, and medial tibial plateau areas and overhang/underhang rates were measured at each cut level. Digital implantations of the asymmetric and symmetric tibial baseplates were made on the tibial plateau with each slope angles. Following the implantations, the slope angle that prevents overhang or underhang at the bone border and the slope angle that has more surface area was identified. A significant increase was noted in the total tibial surface area, lateral plateau surface area, and lateral anteroposterior distance, whereas the slope cut angles were changed from 9 to 0 degrees in both gender groups. It was found that the amount of posteromedial underhang and posterolateral overhang increased in both the asymmetric and symmetric tibial baseplates when the slope angle was changed from 0 to 9 degrees. Although the mediolateral diameter did not change after the proximal tibia cuts at different slope angles, the surface area and anteroposterior diameter of the lateral plateau could change, leading to increased lateral plateau area. Although prosthesis designs are highly compatible with the tibial surface area, it should be noted that the component overhangs, especially beyond the posterolateral edge, it can be prevented by changing the slope cut angle in males and females.

Local curvature mismatch may worsen the midterm functional outcomes of osteochondral allograft transplantation.

PURPOSE: This study aimed to determine the magnitude of local curvature matching in the sagittal plane between an implanted graft and the condylar region receiving the graft and to analyze its effect on clinical outcomes in patients undergoing osteochondral allograft transplantation (OCA). METHODS: Patients who underwent knee OCA between 2016 and 2019 without circumferential step-off and were matched with a donor in accordance with the conventional matching process were included. The magnitude of donor-host local curvature matching was measured using postoperative sagittal magnetic resonance imaging data with Syngo (Siemens Medical Solutions, Forchheim, Germany) and GeoGebra (GeoGebra GmbH, Linz, AU) software. In addition to radiological evaluation, ROC analysis was performed to compare the patient-reported outcome measures (PROMs) obtained during the 2-year follow-up period among the patients in the SagA group, who had a graft match in the sagittal plane; SagB group, who had low convexity of the graft in the sagittal plane; and SagC group, who had high convexity of the graft in the sagittal plane in accordance with the determined indices. RESULTS: The study included 27 patients who fulfilled the inclusion criteria, and the mean clinical scores of the SagC group were not statistically significantly higher than those of the other groups at any timepoint during the follow-up. The mean Tegner, IKDC, total KOOS and SF-12 physical and mental health scores of the SagC group were lower than those of the other two groups at various follow-up time points, particularly at month 24 (p < 0.05). There were no significant differences between the SagA and SagB groups in the PROMs at any of the follow-up time points (n.s.). The significant differences observed between the SagC group and the other groups in the mean KOOS scores for function in daily living and function in sport and recreation were also observed between the SagA and SagB groups at the follow-ups (p < 0.05). CONCLUSION: During OCA, a local curvature mismatch between the donor and the host involving large graft convexity may have a negative impact on midterm clinical outcomes. A preoperative analysis of the convexity relationship between the defect site and the graft region in the hemicondylar allograft to be used may enhance donor-host matching. The local analysis method described in the current study may also facilitate graft supply by ensuring donor-host matching without condyle-side and size matching. LEVEL OF EVIDENCE: III.

Radiographs are not sufficient for evaluation of component fit in subtle knee pain after total knee arthroplasty.

PURPOSE: To determine the component fit by radiography or computed tomography after total knee arthroplasty and the relation of imaging with clinical examination of residual knee pain. METHODS: The study was conducted in 172 patients with residual knee pain after total knee arthroplasty. The patients were examined to determine whether they experienced pain upon palpation at nine regions surrounding the tibial and femoral components, and the results were noted. The Knee Society Clinical Rating System and The Western Ontario and McMaster Universities Arthritis Index pain scale score forms were completed for all patients. Radiologic evaluation was performed using computed tomography and anteroposterior, lateral, and oblique radiographs to determine component overhang/underhang status at these nine regions. Overhang, underhang, and cortical fit groups were created based on the position of the component at the bone margin. A statistical relationship was sought between the clinical scores and the values measured to determine which imaging method showed the best correlation with clinical scores. Consistency of CT and Rx measurements was compared using the McNemar-Bowker test. Comparisons between groups were made using Student's t test for normally distributed data, and the Mann-Whitney U test. RESULTS: Computed tomography and radiographic measurements were similar in the medial, anterior, and lateral tibial regions. However, no similarities were observed in the anteromedial, anterolateral, posteromedial, and posterolateral tibial regions, and in the distal-medial and distal-lateral aspects of the femur. Statistical relationships among decreased clinical scores, pain with palpation, and the presence of overhang/underhang were only observed in the medial tibial region for imaging using radiography. A statistically significant relationship was observed in the medial, posteromedial, and posterolateral tibial regions, and in the distal-medial region of the femur for imaging based on computed tomography. CONCLUSIONS: Radiography could only aid in assessing the component fit in the anteromedial, medial, and lateral regions of the tibia in patients with residual knee pain following knee arthroplasty, but it was not sufficient in comparison with computed tomography in six other regions. LEVEL OF EVIDENCE: Prospective study, level of evidence II.

Medial Meniscus Scaffold Implantation in Combination with Concentrated Bone Marrow Aspirate Injection: Minimum 3-Year Follow-up.

The objective of this study is to show the short-term clinical and radiological outcomes of concentrated bone marrow aspirate (CBMA) injection administered in combination with medial meniscus scaffold implantation. Twenty-three patients who received intra-articular CBMA injection in combination with polyurethane-based medial meniscus scaffold implantation were evaluated within the scope of this study. The International Knee Documentation Committee (IKDC) questionnaire and the Knee injury and Osteoarthritis Outcome Score (KOOS) were used to evaluate the results, and the visual analog scale was used to assess the pain scores. Magnetic resonance imaging (MRI) scans were obtained in the preoperative period and at postoperative months 1, 12, 24, and 36 to assess the scaffold position as well as chondral degeneration/damage in a comparative manner. MRI assessment was performed by using the modified Outerbridge scale for cartilage and the Genovese scoring system for the meniscal implant. Twenty-three patients who were included in the study were evaluated for a mean follow-up period of 38.3 months. Patients exhibited statistically significant improvement according to all scoring data from the preoperative period until the follow-up period. The mean postoperative extrusion at year 3 was 2.39 mm (distribution 2.30-2.56 mm). There was no significant difference in the distribution of the degree of chondral damage between the preoperative and 3-year follow-up periods. Four patients did not show any improvement nor had lower scores according to the assessment. Medial meniscus scaffold implantation combined with intra-articular CBMA injection resulted in a significant improvement in all functions and pain scores as well as a statistically significant clinical improvement in IKDC and KOOS values in the short-term follow-up. The Level of evidence for this study is IV.

Autologous stem cell-derived chondrocyte implantation with bio-targeted microspheres for the treatment of osteochondral defects.

BACKGROUND: Chondral injury is a common problem around the world. Currently, there are several treatment strategies for these types of injuries. The possible complications and problems associated with conventional techniques lead us to investigate a minimally invasive and biotechnological alternative treatment. Combining tissue-engineering and microencapsulation technologies provide new direction for the development of biotechnological solutions. The aim of this study is to develop a minimal invasive tissue-engineering approach, using bio-targeted microspheres including autologous cells, for the treatment of the cartilage lesions. METHOD: In this study, a total of 28 sheeps of Akkaraman breed were randomly assigned to one of the following groups: control (group 1), microfracture (group 2), scaffold (group 3), and microsphere (group 4). Microspheres and scaffold group animals underwent adipose tissue collection prior to the treatment surgery. Mesenchymal cells collected from adipose tissue were differentiated into chondrocytes and encapsulated with scaffolds and microspheres. Osteochondral damage was conducted in the right knee joint of the sheep to create an animal model and all animals treated according to study groups. RESULTS: Both macroscopic and radiologic examination showed that groups 3 and 4 have resulted better compared to the control and microfracture groups. Moreover, histologic assessments indicate hyaline-like cartilage formations in groups 3 and 4. CONCLUSION: In conclusion, we believe that the bio-targeted microspheres can be a more effective, easier, and safer approach for cartilage tissue engineering compared to previous alternatives.

Three-dimensional analysis of acetabular cup orientation and an evaluation of the relationship with pelvic sagittal parameters.

BACKGROUND: This study aimed to evaluate the effect of total hip arthroplasty (THA) on sagittal pelvic parameters and to evaluate the effect of sagittal pelvic parameters on acetabular cup orientation. METHODS: The study included 86 patients who underwent THA for a diagnosis of unilateral coxarthrosis between 2011 and 2015. Measurements were taken of the preoperative and postoperative acetabular cup inclination (ACI), anteversion, and sagittal pelvic parameters. The effect of THA on sagittal pelvic parameters and the effects of the sagittal pelvic parameters on acetabular cup orientation were investigated. RESULTS: The sagittal pelvic tilt values calculated were mean 9.7° ± 6.3° (2°; 23°) preoperatively and 11.0° ± 6.1° (2°; 25°) postoperatively. The increase in postoperative pelvic incidence (PI) values was determined to be statistically significant (p < 0.05). The preoperative PI values had no significant effect on ACI, but in cases with high preoperative PI values, a tendency to high anteversion values was determined. The mean inclination values were found to be 40.2° ± 11.0° in the low PI group, 41.7° ± 7.4° in the normal PI group, and 44.1° ± 8.3° in the high PI group. As no increase in inclination values was observed with an increase in PI values, no statistical correlation was determined (p = 0.343). Average of anteversion values in the low PI group was 9.2° ± 13.7°, in the normal PI group 19.3° ± 10.5°, and in the high PI group 21.1° ± 12.5°. The difference between the groups was statistically significant (p = 0.001). CONCLUSION: Evaluating the results of this study, it can be concluded that varying PI values do affect the acetabular cup anterversion in THA. So, preoperative assessment of PI values is important in preventing postoperative acetabular cup malposition.

Definition of a Novel Proximal Femur Classification in the Sagittal Plane According to the Femur Morphometric Analysis.

BACKGROUND: Studies on prosthesis positioning and implant design in total hip arthroplasty (THA) have generally focused on the anatomy of the proximal femur in the coronal plane. The aim of this study was to investigate the proximal femur morphology in the sagittal plane to provide better positioning of the femoral component in THA and contribute to the determination of proximal femur morphology through possible outcomes that can be shown also by considering the sagittal plane in the selection and design of the femoral component. METHODS: Computerized tomography scans were obtained from 270 femoral bones belonging to adult skeletons, followed by 3D reconstruction using Leonardo Dr/Dsa Va30a software (Siemens, Erlangen, Germany) and measurements. Canal widths were measured in the coronal and sagittal planes at the lesser trochanter (LT) level, at 20 millimeters proximal to the LT(LT+20) and at various levels distal to the lesser trochanter in 25 mm jumps up to 200 mm from the lesser trochanter. RESULTS: The average width was wider at the level of the lesser trochanter and all points distal to it in the sagittal plane compared to the coronal plane except LT-200 mm. At each levels from LT-25 to LT-175, the differences were statistically significant (P < .05). The ratio of the femoral width at the lesser trochanter level to the width 50 mm distal to the LT was stated as the most prevalent one, and a novel classification in the sagittal plane was developed in accordance with these findings. CONCLUSION: A novel and simple classification in the sagittal plane was developed based on the findings of this study, and this classification may improve the accuracy, validity, and reliability of femoral stem fixation in total hip arthroplasty.

Factors Influencing the Results in Matrix-Associated Autologous Chondrocyte Implantation: A 2 - 5 Year Follow-Up Study.

BACKGROUND: This study aimed to investigate the outcomes of matrix-associated autologous chondrocyte implantation (MACI) on the treatment of osteochondral lesions in the knee joint and to determine the factors affecting the functional results. METHODS: The study included 34 patients with a cartilage defect in the knee joint who were applied MACI® (GenzymeBiosurgery, Cambridge, Massachusetts, USA) technique between the years 2010 - 2015. The defect localizations and sizes, past surgeries were recorded. The clinical results were measured with Cincinnati and Lysholm scores. RESULTS: As a result of the repeated measures at postoperatively, it was found that the patients had increased Lysholm and Cincinnati functional scores in all follow-up periods (P = 0.0001). When the mean value of Lysholm and Cincinnati functional scores were assessed according to BMI group, no statistically significant difference was determined (P = 0.941 and P = 0.779). The measurements at 6 and 12 months of the follow-up indicated that the mean scores of the group with no concomitant pathologies were significantly higher than those of the group with concomitant pathologies. CONCLUSIONS: The MACI application provides good and stable outcomes for focal cartilage damage in young patients. In order to obtain significant results after autologous chondrocyte implantation, the selection of appropriate patients without concomitant pathologies is required.

Transtrochanteric approach can provide better postoperative care and lower complication rate in the treatment of hip fractures.

PURPOSE: Dislocation is an important complication that increases the mortality, morbidity, and postoperative care following bipolar hemiarthroplasty. It is thought that the transtrochanteric approach that enables access to the femoral neck directly from the fracture line at the coronal plane of the greater trochanter without opening the posterior and anterior capsules could reduce the risk of dislocation. Additionally, it is argued that preservation of the external rotators could also be advantageous for patient rehabilitation and muscle strength. The aim of this study is to compare the effectiveness of the standard posterolateral approach and transtrochanteric approach performed from the fracture line, primarily the rate of dislocation, in osteoporotic Evans Type IV-V unstable intertrochanteric fractures on which bipolar hemiarthroplasty was performed. PATIENTS AND METHOD: One hundred and twelve patients had Type IV-V fracture according to Evans classification and underwent hemiarthroplasty were enrolled in the study. Patients operated using the posterolateral approach, that is, Group 1 (n=48), and patients operated using the transtrochanteric (transfracture) approach, that is, Group 2 (n=64), were compared in terms of dislocation, surgical duration, amount of blood transfusion, infection, mortality, and trochanteric nonunion. Factors that could affect the development of dislocation from the patient, surgery, and implant were also analyzed. RESULTS: It was found that the rate of dislocation was statistically significantly higher in Group 1 in comparison to Group 2 (P<0.05). It was also observed that the surgical duration was statistically significantly shorter in Group 2 (P<0.05). It was found that the presence of a cognitive disorder, trochanteric nonunion, and use of posterolateral surgical approach resulted in a statistically significant increase in the rate of dislocation (P<0.05). CONCLUSION: Transtrochanteric (transfracture) approach is an effective method for minimizing possible complications following hemiarthroplasty, especially dislocation.

Does inflammatory joint diseases affect the accuracy of infection biomarkers in patients with periprosthetic joint infections? A prospective comparative reliability study.

BACKGROUND: The diagnosis of periprosthetic joint infections (PJI) in patients with inflammatory joint diseases (IJD) could be challenging. Several tests used for diagnosing PJI may be inaccurate due to baseline inflammatory characteristics of such diseases. We aimed to evaluate the accuracy of several infection biomarkers, in a specific subgroup of patients with PJI and IJD. METHODS: From January 2014 to August 2017, patients with resisting pain at the relevant site, following total knee arthroplasty were evaluated prospectively. A total of 38 patients were undergone revision arthroplasty. Patients were categorized in terms of MSIS criteria: Patients with PJI (Group 1, n = 17) and patients without PJI (Group 2, n = 21). Serum ESR, CRP, Procalcitonin, synovial cell count, percentage of neutrophils in synovial fluid, synovial CRP, Lactoferrin, ELA-2, Thiol - Disulphide levels, BPI and the Alpha defensin test results were obtained. The results of two groups were compared and the diagnostic accuracy of each variable was evaluated. RESULTS: There were 22 women, 16 men with a mean age of 67.8 ± 6.9 years. The differences were significant in all evaluated biomarkers in terms of PJI (p values of all biomarker were <0.001). Alpha defensin, Lactoferrin, ELA-2, BPI, Procalcitonin and synovial CRP were the most accurate tests with area under curve >0.90. CONCLUSIONS: Our results demonstrated that IJD may not affect the accuracy of infection biomarkers in patients with PJI. Alpha defensin test, Lactoferrin, ELA-2, BPI, Procalcitonin and synovial CRP can be used in the diagnosis of PJI in patients with IJD.

Sonoelastography of the knee joint.

Magnetic resonance imaging (MRI) is generally the preferred method for assessing lesions of the knee cartilage and subchondral bone. There have been a few cartilage imaging studies using real-time elastosonography (RTE), which has increased in importance and range of use in recent years. The aim of this cadaveric study was to assess the efficacy of a new diagnostic method combining USG and RTE and also to perform intra-articular examinations together with arthroscopy. A total of 12 fresh unpaired human knees were examined. The laparoscopic ultrasound transducer was deployed using standard anteromedial and anterolateral arthroscopic portals. Iatrogenic defects were examined using mosaicplasty tools in healthy-looking areas of cartilage, and strain in those areas was measured using RTE. The median strain value of the pathological femoral cartilage region was significantly higher than that of the normal cartilage region (1.23 [0.71-2.24] vs. 0.01 [0.01-0.01], P = 0.002, respectively). Arthroscopic study of cartilage using RTE can be a guide for orthopedic surgeons and use of intra-articular probes could be universalized. Clin. Anat. 32:99-104, 2019. © 2018 Wiley Periodicals, Inc.

Fixed-bearing unicompartmental knee arthroplasty tolerates higher variance in tibial implant rotation than mobile-bearing designs.

BACKGROUND: UKA necessitates a learning period. From this point of view, it would be logical to prefer the design that tolerates suboptimal tibial rotations better, especially for inexperienced surgeons. The aim of this study was to evaluate and compare the clinical and radiological results of mobile-bearing and fix-bearing UKA designs in case of suboptimal tibial rotations. METHODS: A retrospective case-control evaluation was made of all the patients with medial compartment osteoarthritis, treated between January 2011 and January 2015. 324 patients ideal femoral rotation were enrolled in the study. 153 patients (Group 1) were treated with fix-bearing design with a mean 28.8 ± 11.3 month follow-up and 171 patients (Group 2) were treated with mobile-bearing design with a 31 ± 14.3 month follow-up. Each patient in groups was subdivided into (A): optimal tibial rotation, (B): external rotation of tibial component > 5°, (C): internal rotation of tibial component > 5° subgroups. WOMAC and KSS scores of each patient at preoperative and postoperative final control were compared between groups and subgroups. RESULTS: No significant differences were determined between the groups in terms of mean follow-up time (p = 0.0612), preoperative WOMAC, and KSS scores (p = 0.754 and p = 0.832, respectively). No significant differences were determined between subgroups 1A and 2A in terms of WOMAC and KSS scores at the final evaluation (p = 0.314 and p = 0.546, respectively). A significant difference was determined between subgroups 1B and 2B in terms of WOMAC and KSS scores (p = 0.021 and p = 0.012, respectively). In addition, the difference between subgroups 1C and 2C was significant (p = 0.047 and p = 0.034, respectively) at the final evaluation. CONCLUSION: Both mobile- and fix-bearing designs are beneficial in the treatment of medial compartment osteoarthritis of the knee. However, in case of both tibial internal or external suboptimal tibial rotations, fix-bearing design have better results compared to mobile-bearing design. STUDY DESIGN: Level III retrospective comparative clinical study.

Posterolateral overhang affects patient quality of life after total knee arthroplasty.

PURPOSE: To investigate the appropriate mediolateral placement of symmetrical tibial components and the amount of overhang expected from the posterolateral of tibial components implanted to give ideal coverage and the subsequent incidence of residual knee pain and reduction in functional capacity. METHOD: A retrospective evaluation was made of 146 consecutive total knee arthroplasties. The posterolateral overhang, rotational alignment and coverage of the tibial component were measured on a post-operative CT scan and the effect of posterolateral overhang on clinical outcomes was analysed 3 years after surgery. RESULTS: Complaints of local pain in the posterolateral corner were determined in 76 (52.1%) patients. At the Posterolateral corner, overhang was determined in 111 (76%) patients, in the cortical border in 11 (7.6%) patients and underhang in 24 (16.4%) patients. In 71 (48.6%) patients, pain was determined together with oversize and in the evaluation of the overhang of the tibial component in the posterolateral region and the rotation status, there was determined to be overhang in 75 (96.2%) patients where the tibial component was placed in ideal rotation, in 25 (100%) where placement was in external rotation and in 11 (25.6%) where placement was in internal rotation. The mean KSS, KSS-F and WOMAC-P scores were 83.9 ± 6.3, 83.3 ± 7.8 and 4.6 ± 2.9, respectively, in those with posterolateral overhang of the tibial component .The mean KSS, KSS-F and WOMAC-P scores were 86.6 ± 8.4, 89.5 ± 7.8 and 2.8 ± 2.1, respectively, in those with no overhang and the difference was determined to be statistically significant. The amount of overhang was determined as mean 3.6 ± 2.0 mm in those with posterolateral pain and 0.02 ± 3.4 mm in those without pain and the difference was statistically significant. CONCLUSIONS: This study demonstrated that overhang in the posterolateral region is surprisingly high and negatively affects the clinical results following TKA, thereby presenting a danger to the success of TKA. The risk of posterolateral oversizing can increase with placement of the tibial component in external rotation.

Efficacy of rapid recovery protocol for total knee arthroplasty: a retrospective study.

OBJECTIVE: Our aim was to compare the clinical results and cost-effectiveness of a rapid recovery protocol for total knee arthroplasty (TKA) with a current standard protocol. METHODS: The study included patients undergoing primary elective TKA with at least 6 months of follow-up. The rapid recovery protocol was applied to 96 patients (Group 1) and the standard protocol to 108 (Group 2). All patients underwent standard TKA. All pre-, peri-, and postoperative procedures in the treatment and follow-up of patients were appropriately standardized to the philosophies of the different treatment plans. The postoperative length of hospital stay, total financial cost, postoperative surgical infection, 6-month American Knee Society scores, and knee range of motion (ROM) were compared between the groups. RESULTS: A total of 169 patients were included. Group 1 patients had significantly shorter postoperative length of hospital stay (p=0.021), significantly lower mean total financial cost (p=0.041), significantly lower infection rates (p=0.034), and significantly higher 6-month knee function scores (p=0.032). In comparison with Group 2, Group 1 knee flexion (p=0.04) and extension (p=0.48) ROM at 6 months postoperatively were both significantly improved. CONCLUSION: Application of the rapid recovery protocol to patients who underwent TKA reduced costs and infection rates and improved functional results.

Chronic Expanding Hematoma in the Popliteal Fossa after Pseudoaneurysm Surgery because of Nail Puncture.

Hematomas caused by surgery or trauma that persist and expand slowly for more than a month are defined as chronic expanding hematomas (CEH). Magnetic resonance imaging (MRI) is useful for the diagnosis. Total excision with the pseudocapsule is the treatment method. Pseudoaneurysms result from arterial wall disruptions and can be mistaken for CEH. We present a rare case report of a 45-year-old man with a large, painful swelling in his left popliteal fossa. He had a puncture wound by a nail 11 years ago and a gradually expanding mass occurred in his popliteal fossa. A pseudoaneurysm was detected and operated a year later. After surgery, a gradually expanding mass recurred in his popliteal fossa. On the arteriography, the popliteal artery was occluded and the blood flow was maintained with collateral vessels. On MRI, an enormous swelling of 115 × 107 × 196 cm in diameter was seen. It was diagnosed as CEH and was excised completely protecting the collateral vessels and there was no recurrence after a year from the surgery.