Midterm results of intra-articular stromal vascular fraction injection for the treatment of knee osteoarthritis.

PURPOSE: This study aimed to evaluate the safety and efficacy of intra-knee stromal vascular fraction (SVF) injection in patients with symptomatic knee osteoarthritis at the midterm (3-year) follow-up. METHODS: SVF injection was applied to 25 knees of 20 patients. Eighteen patients (90%) were female, and the means ± standard deviations of age was 61.9 ± 7.8 (range, 50-76) years. Patients who received conservative treatment for at least 6 months and had radiographic Kellgren-Lawrence (K-L) grades 2 and 3 varus gonarthrosis were included in the study. SVF was obtained from the umbilical region by liposuction using local anaesthesia. Patients were followed-up for 36 months. Their visual analogue scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Lysholm scores were evaluated before and at 6, 12, 24 and 36 months post-SVF injection. RESULTS: A statistically significant improvement (p < 0.05) was observed in VAS, WOMAC and Lysholm scores at the first 2-year follow-up compared to baseline. However, no statistically significant difference (n.s.) was observed in VAS, WOMAC and Lysholm scores at the 3-year follow-up compared with baseline. CONCLUSION: Intra-articular SVF injection decreased pain and significantly improved the functional outcomes in the first 2 years in knees with grade 2-3 osteoarthritis; however, these positive effects of the injection disappeared in the 3rd year. Although short-term successful results of SVF have been reported in the literature, prospective studies are needed for medium- and long-term results.

Does Surgical Experience Affect the Outcomes During Percutaneous Release of the Trigger Finger?

Background Trigger finger is a condition characterized by clicking or locking during finger movement, sometimes resulting in the freezing of a finger in flexion or extension. The aim of our retrospective study was to determine the effect of the surgeon's learning curve on clinical outcomes in percutaneous release of the trigger finger. In addition, we evaluated the effects of diabetes and local steroid injections on clinical outcomes. Methodology A total of 954 trigger fingers in 678 patients were reviewed from 2012 to 2022. All percutaneous release procedures were performed by a single surgeon in our institute under local anesthesia. The main outcome measures were recurrence and patient satisfaction. In addition, all patients were evaluated in terms of re-operation and complications. The mean follow-up period was 54.87 months. Results There was complete relief of symptoms in 636 (93.81%) patients, and 22 (3.24%) patients had mild pain but were satisfied. We found that the success rate increased over time. The success rate was 91.4% in the first three years and increased to 98.25% in the next seven years (p = 0.001). There was no statistically significant difference between the diabetic and non-diabetic groups in terms of recurrence, satisfaction rate, and complications (p > 0.05). There was no statistically significant difference in terms of recurrence, satisfaction rate, and complications between the groups that received and did not receive steroid injections (p > 0.05). Conclusions Percutaneous release is a safe and reliable procedure in the treatment of trigger fingers, and the success rate increases as the experience increases. Moreover, diabetes mellitus and steroid injections did not affect the clinical results.

Is Intraoperative Bleeding Control Useful After Tourniquet Release in Arthroscopic Anterior Cruciate Ligament Reconstruction?

Background Arthroscopic anterior cruciate ligament (ACL) reconstruction is a common orthopedic surgery, and rehabilitation is very important to achieve successful postoperative results. Postoperative hemarthrosis causes pain and limitation of movement, which prolongs the rehabilitation period. For these reasons, various strategies are used to reduce hemarthrosis in patients undergoing ACL reconstruction. This study aimed to evaluate the effect of bleeding control after releasing the tourniquet in ACL reconstruction surgery on the amount of hemarthrosis and pain in the postoperative period. Methodology A total of 60 patients who underwent arthroscopic single-bundle ACL reconstruction were enrolled in this prospective randomized control study. Bleeding control with the radiofrequency (RF) probe after releasing the tourniquet was done at the end of the arthroscopic ACL reconstruction in 30 patients (coagulation group) while bleeding control was not done for the other 30 patients (control group). Both groups were compared in terms of the degree of hemarthrosis using the Coupens and Yates classification in the early postoperative period and the degree of pain using the Visual Analog Scale (VAS) score and postoperative complications. Results In both groups, isolated ACL reconstruction was performed in 10 patients, additional partial meniscectomy in three patients, and additional arthroscopic meniscus repair in 17 patients. There was no statistically significant difference between the coagulation and control groups in terms of VAS (p > 0.05) and the degree of hemarthrosis (p > 0.05). Although the duration of tourniquet application was similar in both groups (p = 0.78), the duration of anesthesia was significantly longer in the coagulation group (p = 0.001). There was no significant difference between the groups in terms of postoperative complications. Conclusions Bleeding control with the RF probe after tourniquet release does not yield superior outcomes. More research with larger populations is needed to confirm these findings.

Percutaneous release for trigger thumb in children under local anesthesia.

Trigger thumb surgery can be performed through open surgery or percutaneous release. Open surgery often requires hospitalization, an operating room, a surgical incision, and postoperative wound care; however, percutaneous release does not require hospitalization or surgery, and is relatively easier and faster. We aimed to assess the results of percutaneous A-1 pulley release using local anesthesia without hospitalization for the treatment of pediatric trigger thumb. In this retrospective study, we included patients operated on between March 2013 and August 2020 with the diagnosis of trigger thumb. The percutaneous release under local anesthesia was applied to all the children by one orthopedic surgeon. All percutaneous release procedures were performed in outpatient clinic conditions. There were 183 children (218 thumbs) who were enrolled in the clinic. Eighty-seven patients were male (47.5%) and 96 were female (52.5%). The average follow-up duration was 5 years (1-8.5 years). Among the 218 trigger thumb cases, 211 were satisfactory (successful result rate 96.8%). Relapse was seen in only 3 thumbs in the early postoperative period. No patient experienced neurovascular deficit or infection. The percutaneous surgical release in pediatric trigger thumb treatment is a simple, minimally invasive procedure that can be done in an outpatient setting under local anesthesia. In addition, the procedure duration is short and has minimal complication rates and maximum patient satisfaction. Level of Evidence III.

Online resources for platelet-rich plasma injections for orthopedic therapy: What are patients reading? A survey of Turkish websites.

OBJECTIVES: This study aims to evaluate the quality, accuracy, and readability of Turkish online resources for platelet-rich plasma (PRP) injections for orthopedic therapy. PATIENTS AND METHODS: In this retrospective study, online searches using Google, Yandex, and Yahoo search engines were performed on 21-22-23 May 2019, respectively. "Platelet-rich plasma", "platelet-rich plasma treatment", "PRP", and "PRP treatment" were entered in Turkish into these three search engines. The first 50 websites from each search were collected. The quality and accuracy of online information related to PRP injections for orthopedic therapy were evaluated by three reviewers with the use of scoring criteria specific to PRP. The Flesch-Kincaid (FK) score was used to determine readability. RESULTS: Eighty-six unique websites were evaluated. The average quality and accuracy scores of all websites were 7.1±4.3 out of a maximum of 25 points and 7.3±2 out of a maximum of 12 points, respectively. The average FK score of all websites was 10.8±2.2. Only 27 websites (31.4%) had a FK score that was at or below the eighth-grade level. There were no significant differences among the mean scores of websites categorized by search terms, search results ranking, owners or reading level for both quality and accuracy scores. CONCLUSION: The information regarding PRP usage in orthopedic conditions provided by Turkish online resources has low quality and low accuracy ratings and is also difficult to read.

Assessment of periprosthetic joint infection prevention methods amongst Turkish orthopedic surgeons in total joint replacement: A survey.

OBJECTIVES: This study aims to assess the methods employed by Turkish orthopedic surgeons to prevent periprosthetic joint infection (PJI) in total joint arthroplasty (TJA). PATIENTS AND METHODS: The data obtained for this study, conducted between January 2019 and February 2019, were gathered by sending out an online survey to Turkish Society of Orthopedics and Traumatology members (n=2,267). A total of 354 orthopedic surgeons responded and completed survey. The survey had 23 questions which include the experience, academic position, hospital where the physician works, monthly arthroplasty numbers, and infection prevention methods employed before, during, and after surgery. RESULTS: The period for antibiotics prophylaxis showed variability, with about 63% of surgeons using prophylaxis longer than 24 hours. In terms of academic position, 52.4% of professors and 52.8% of associate professors used prophylaxis for the first 24 hours whereas this rate was 31.3% in operators (p=0.01). Of surgeons, 50.7% who perform more than 10 arthroplasties per month and 33.6% of surgeons who perform less than 11 arthroplasties per month used 24-hour antibiotic prophylaxis (p=0.006). Blood glucose level assessment prior to surgery was performed by the majority of surgeons (94%). A total of 118 orthopedic surgeons (33.3%) performed methicillin- resistant Staphylococcus aureus (MRSA) decolonization with 54.7% of associate professors, 59.5% of professors, and 24.7% of operators (p=0.001). Only 60 surgeons (16.9%) checked vitamin D levels. CONCLUSION: Our study results demonstrated that the majority of orthopedic surgeons in Turkey do not follow the antibiotic prophylaxis recommendations and they use antibiotic prophylaxis for longer periods. Professors and associate professors, and surgeons with higher monthly arthroplasty numbers than surgeons with lower monthly arthroplasty numbers follow the recommended periods more than their counterparts. Most surgeons assess blood glucose levels whereas a small number of surgeons perform MRSA decolonization and check vitamin D levels.

The changes in preferences for venous thromboembolism prophylaxis after total joint arthroplasty in Turkey: A survey.

OBJECTIVES: This study aims to investigate the changes in preferences of orthopedic surgeons for venous thromboembolism (VTE) prophylaxis after total knee arthroplasty (TKA) and total hip arthroplasty (THA) and the factors that affect such changes in Turkey. MATERIALS AND METHODS: Turkish Orthopedics and Traumatology Association members (n=2,180) were invited to fill in the questionnaire. A total of 366 orthopedic surgeons responded and completed questionnaire. The questionnaire was comprised of 12 questions investigating the demographics of surgeons, their preferences for VTE prophylaxis, the changes in their preferences over the course of the past three years, and the causes of such changes. RESULTS: In the past three years, 31.1% of surgeons changed their VTE prophylaxis method and 32.7% used risk classifications. The use of low molecular weight heparin (LMWH) decreased from 89.4% to 42.5% and from 85.8% to 44.2% after TKA and THA, respectively. The use of aspirin increased from 10.6% to 43.4% and from 9.7% to 37.2% after TKA and THA, respectively. The use of oral anticoagulants increased from 11.5% to 41.6% and from 10.6% to 39.8% after TKA and THA, respectively. Still, orthopedic surgeons in Turkey preferred LMWH at rates of 75.7% and 74% after TKA and THA, respectively. Congressional presentations were the first (47.7%) among the causes of the changes in preferences for VTE prophylaxis. Preferences of up to 60% of surgeons working at universities were influenced by the American Academy of Orthopedic Surgeons guidelines. CONCLUSION: In the past three years, approximately one third of orthopedic surgeons changed their preferences for VTE prophylaxis after total joint arthroplasty in Turkey. Changes in preferences were largely in favor of aspirin and oral anticoagulants in parallel to changes in guidelines for VTE prevention.

Synthesis, characterization and optoelectronic properties of a new perylene diimide-benzimidazole type solar light harvesting dye.

A perylene diimide type small molecule (BI-PDI) has been synthesized through Suzuki coupling reaction between N,N'-bis(2,6-diisopropylphenyl)-1,7-dibromoperylene-3,4,9,10-tetracarboxylic diimide and 2-(2-hydroxyphenyl)-7-phenyl-1H-benzimidazole-4-boronic acid. BI-PDI small molecule has showed an absorption band between 350 and 750 nm on thin films. HOMO and LUMO energy levels of BI-PDI dye have been calculated to be about -5.92 eV and -3.82 eV, respectively. Solution-processed bulk heterojunction (BHJ) solar cells have been constructed using BI-PDI as donor and [6,6]-phenyl-C61-butyric acid methyl ester (PC61BM) as acceptor or poly(3-hexylthiophene) (P3HT) as donor and BI-PDI as acceptor. The external quantum efficiencies (EQE) of the devices cover the most of the visible region between 400 and 700 nm for both configurations. Photovoltaic performances of BI-PDI-based organic solar cells are limited by the aggregation tendency of PDI structure and poor hole/electron mobilities of the active layer.

Early results of arthroscopic lateral retinacular release in patellofemoral osteoarthritis.

The aim of this study was to define the postoperative course of middle-aged and elderly patients with patellar chondral lesions after lateral retinacular release and joint debridement. Thirty-five patients in their fifth to seventh decades with Grades 2-4 chondral lesions of the patellofemoral joint, with no patellar instability or severe malalignment, underwent lateral retinacular release and patellofemoral joint debridement by bipolar radiofrequency. Both VAS and WOMAC scores in all three lesion grades were significantly reduced postoperatively. The greatest decrease was observed in the first visit at 3 months, and the pain level continued at about the same level over the next 24 months without significant changes. There were no significant differences between the three lesion grades with respect to changes in VAS scores at each visit. Thermal lateral retinacular release improves the subjective condition of the patient by reducing pain, especially in the postoperative first 3 months.

Risk factors in redisplacement of distal radial fractures in children.

BACKGROUND: The causes of redisplacement following closed treatment of distal metaphyseal radial fractures in children are still controversial. Various risk factors and radiographic indices have been suggested to predict redisplacement. The aims of this study were to prospectively identify the causes of redisplacement and to test the accuracy of previously described radiographic indices and our new method, the "three-point index." METHODS: This prospective study included seventy-five displaced or severely angulated distal radial fractures in seventy-four children under the age of fifteen years. Age, gender, initial complete displacement of the radius, an associated ulnar fracture, the accuracy of the reduction, the maximum degree of obliquity of the fracture line in the sagittal or coronal plane, and the distance to the physis were examined as possible risk factors. Logistic regression analysis was utilized to search for risk factors. We also calculated the cast index, padding index, Canterbury index, gap index, and three-point index on the radiographs of each reduction. The sensitivity, specificity, negative predictive value, and positive predictive value were calculated for each test. RESULTS: Initial complete displacement and the degree of obliquity of the fracture were the most important risk factors for redisplacement. Fractures that were completely displaced initially were 11.7 times more likely to redisplace than were angulated but incompletely displaced fractures. A 20 degree oblique fracture was 4.9 times more likely to redisplace and a 30 degree oblique fracture was 10.9 times more likely to redisplace than was a 0 degree true transverse fracture. The three-point index was superior to the other radiographic indices for predicting redisplacement, with a sensitivity of 94.7%, a specificity of 95.2%, a negative predictive value of 98.4%, and a positive predictive value of 85.7%. The gap index was the next-best measure, but it had a sensitivity of 63.2%, a specificity of 76.2%, a negative predictive value of 87.3%, and a positive predictive value of 44.4%. CONCLUSIONS: Initial complete displacement and the degree of obliquity of the fracture line are the dominant factors affecting redisplacement. Our new radiographic index, the three-point index, should be used to predict redisplacement and assess the quality of the cast treatment of these fractures.

Morphometric effects of acute shortening of the spine: the kinking and the sliding of the cord, response of the spinal nerves.

Spinal shortening is performed for a wide spectrum of diseases. This study was designed to investigate the morphologic effects of shortening on the spinal cord, to enlighten the amount and direction of the sliding of the cord, the alteration of the angles of the roots, and to identify the appropriate laminectomy length. Total vertebrectomy of T12 was applied to ten sheep models after spinal instrumentation. Gradual shortening was applied to five sheep; then, the degree and direction of the sliding of the spinal cord and the angles of the adjacent roots were measured. On five other sheep, additional sagittal sectioning was performed via excision of the pedicles. Measurements were taken at different laminectomy lengths to record kinking of the spinal cord with gradual shortening. The mean sliding of the spinal cord was 9 mm cranially and 7.8 mm caudally. T11 spinal nerves became more vertical caudally, and T12 spinal nerves achieved an ascending position with gradual shortening. Both T11 and T12 spinal nerves were sharply bent in the foramen and on the pedicle of T13, respectively. In full-length shortening, the mean kink of the spine in the sagittal plane was 92.4 degrees for two levels of hemi-laminectomies, 24.6 degrees for complete laminectomy of T11 with hemilaminectomy of T13, and 20.2 degrees for two levels of complete laminectomies. The slippage of the cord is dominant in the earlier stages and kinking is dominant in later stages of shortening. Increasing the laminectomy length by only a half or one level prevents excessive kinking and compressions at the upper and lower margins of the laminectomy. In the later stages of shortening, the spinal nerves near the vertebrectomy site are at risk because of the sharp bending of the nerves. This study describes the mechanism of the sliding and kinking of the cord due to gradual shortening of the spine, which might be useful in spinal surgery procedures. It also states that it is possible to avoid excessive kinking by planning the appropriate technique of laminectomy style in full-length shortening.

Results of intravenous regional anaesthesia with distal forearm application.

The aim of this study was to evaluate the clinical effectiveness of distal forearm intravenous regional anaesthesia (IVRA) with the tourniquet applied 3 cm above the wrist. One hundred and twenty patients undergoing out-patient hand surgery were operated for 13 different hand problems under distal forearm IVRA, using 10 ml of a solution containing 1.5 mg/kg prilocaine. Sensory block onset time was 4.5 minutes (3.5-6.5 min.). Mean tourniquet time was 17.6 minutes (range, 7-27.5 min). Mean tourniquet pressure was 240 mmHg (range, 220-270 mm Hg). The mean VAS score for tourniquet pain was 3.8 (range, 2-10). No local or systemic side effects related to the IVRA were observed. The study showed that distal forearm IVRA using 10 ml of a solution containing 1.5 mg/kg prilocaine provides safe, rapid and effective anaesthesia for patients undergoing outpatient hand surgery.