Does Early-Period Patient Dissatisfaction Turn Into Satisfaction Over Time After Total Knee Replacement?

BACKGROUND Total knee arthroplasty (TKA) is frequently used in the treatment of end-stage gonarthrosis, and the patient satisfaction rate varies. This study aimed to reveal the change in mid-term patient satisfaction results and functional scores of patients with low early postoperative satisfaction scores. MATERIAL AND METHODS We included 163 patients who underwent total knee prosthesis between September 2017 and February 2018. Among these patients, early (6 months) and mid-term (24 months) satisfaction and functional results of 34 patients with low satisfaction scores (Likert evaluations 1, 2, and 3) were evaluated. We assessed early-term functional results and satisfaction rates, mid-term analysis of patients who were not satisfied in the early period, and the relationship between functional scores and satisfaction. RESULTS The Likert score was 4 or 5 in 124 (80%) of 158 patients, and early dissatisfaction was detected in 34 patients (20%). In the early-period dissatisfied group, satisfaction scores 6 months after surgery were 1.9±1.1 (1-3) and 4.2±1 (3-5) 24 months after surgery. A statistically significant difference was observed between the dissatisfied group's early and mid-term KSS and KS values. A correlation was observed between satisfaction scores and KS and KSS scores (P<0.05). CONCLUSIONS Patients who do not have mechanical problems with total knee arthroplasty but are not satisfied with the surgery in the early period can be satisfied over time after regular follow-up, appropriate communication and information, and effective rehabilitation.

Periacetabular vascular anatomy in high-riding dysplastic hips: a CT angiographic study.

BACKGROUND: Developmental hip dysplasia (DDH) is shown to have osseous and neural abnormalities but literature is sparse with investigation of vascular structures. Therefore, we aimed to evaluate periacetabular vascular structures. METHODS: By computerised tomography angiography (CTA), 13 highly dislocated hips of 11 patients' iliac bone to external iliac and obturatory artery and vein proximities were measured and compared with the same measurements of 20 healthy hips of 12 patients. Numbering from superior to inferior, a total of 7 axial images were created on the 2D CTA coronal images with 1 cm apart, the 4th being at the level of acetabular dome. RESULTS: The mean age of the patients was 53 (18-72) years. Dysplastic hips tended to have curved (53%) and healthy hips tended to have straight iliac arteries (p = 0.037). As compared to healthy hips, external iliac veins were significantly closer to the bone at all levels, but the external iliac arteries were closest at 1st to 4th levels (p < 0.001) in dysplastic hips. The course of the obturatory arteries was similar in both groups (p = 0.147). CONCLUSIONS: The external iliac artery and vein is in close proximity to the iliac bone which dangers acetabular screw, acetabular reaming or retractor placement in highly dislocated hips. The surgeon should be aware of this proximity in operations of these hips to avoid vascular complications.

Is Radiographic Osteoporotic Hip Morphology A Predictor For High Mortality Following Intertrochanteric Femur Fractures?: Osteoporotic Hip Morphology & Mortality.

INTRODUCTION: Factors related to mortality after intertrochanteric femur fractures (ITFF) have been investigated intensively in the literature except for radiographic osteoporotic hip morphology. The aim of this study is to investigate the relationship between mortality and radiographic osteoporotic hip morphology of patients with ITFF. PATIENTS AND METHODS: Patients who underwent surgery between the dates of January 2012 and June 2018 due to ITFF were retrospectively reviewed. Osteoporotic status of the proximal femur was determined based on Singh Index grading and Dorr classification systems on preoperative anteroposterior pelvis radiographs of contralateral hips. The mortality rates of the patients were measured at 1st, 3rd, 6th, and 12th months. For controlling the confounders, multiple regression analysis was performed. RESULTS: A total of 321 consecutive ITFFs were included in the study. The mean age of the patients was 81.5 ± 6.6 years. All patients were treated with osteosynthesis utilizing a cephalomedullary nail. The overall mortality rates at 1st, 3rd, 6th, and 12th months were 7.2%, 13.4%, 16.2%, 22.7%, respectively. There was 2.196 (1.140 - 4.229) folds increase in the mortality rate of patients with the Dorr type C femurs at 6th month (p=0.019). However, Singh index grade was not significantly associated with mortality. CONCLUSION: Patients with Dorr type C femur seem to have 2.1 times increased mortality at 6th months following ITFFs. A simple anteroposterior pelvis radiograph obtained during the initial evaluation of the patients may be used to estimate the mortality rate after ITFF.

The Fate of Failed Debridement, Antibiotics, and Implant Retention in Infected Knee Arthroplasties: Nothing to Lose.

Purpose The frequency of periprosthetic knee infections increases yearly because of the popularity of the total knee prostheses. Revision knee arthroplasty is an annoying problem for both the surgeons and the patients. Debridément, antibiotics, and implant retention (DAIR) is a popular alternative for the treatment of periprosthetic knee infections. Little is known about the fate of the failed DAIR patients. This study aims to investigate the effect of the failed DAIR on the clinical result after two-staged revision arthroplasty. Method Ninety-nine two-staged revision arthroplasties and 85 DAIR patients from two reference clinics were retrospectively analyzed. The minimum follow-up was 36 months. Patients were grouped according to the treatment as, two-staged revision without DAIR, two-staged revision after failed DAIR, and successful DAIR. Their Knee Society Scores (KSS), functional KSS (KSS-f) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were analyzed and compared. Results DAIR has a 52.9% success rate for the treatment of infection. Elevated erythrocyte sedimentation rates and C-reactive peptide levels are not risk factors for failure, but the time passed since the index surgery is a risk factor for worse outcome scores. Failed DAIR is not a risk factor for reinfection after two-staged revision. Last KSS after failed DAIR, successful DAIR, and two-staged revision were 83.98±7.033, 91.89±4.386, and 91.38±4.735, respectively. Last KSS-f after failed DAIR, successful DAIR, and two-staged revision were 86.25±9.524, 94.56±8.106, and 94.85±5.996, respectively. Last WOMAC after failed DAIR, successful DAIR, and two-staged revision were 86.16±7.745, 94.750±4.964, and 93.319±5.961, respectively.  Conclusion Failed DAIR is associated with lesser, but still good, or excellent clinical scores. DAIR is suggested as a promising treatment option for periprosthetic knee infections in well-selected patients.

Is there an optimal timing for surgical treatment of pediatric supracondylar humerus fractures in the first 24 hours?

BACKGROUND: We aimed to determine the ideal surgical timing in the first 24 hours after admission to the hospital of pediatric supracondylar humerus fractures (SHF) that do not require emergent intervention. MATERIALS AND METHODS: Patients who underwent surgery in our institution between January 2011 and January 2019 due to pediatric Gartland type 3 SHFs were evaluated retrospectively. Open fractures, fractures associated with vascular injury and compartment syndrome, flexion type fractures were excluded. A total of 150 Gartland type 3 were included. The effect of early (<12 hours) or late (>12 hours) surgical interventions, daytime or night-time surgeries, working or non-working hour surgeries on operative parameters (operative duration and open reduction rate, reduction quality on postoperative early radiographs) were evaluated in pediatric SHFs. RESULTS: Early (<12 hours) or late (>12 hours), daytime or nighttime, working or non-working hour surgeries were found to be similar in Gartland type 3 patients regarding early postoperative reduction quality, duration of surgery, open reduction rate (p>0.05). Mean times passed from first admission to hospital until surgery were longer in working hour, late (>12 hours) and daytime surgery groups than non-working hour, early (<12 hours) and night-time surgery groups (p<0.001). CONCLUSION: Although delaying the operation to the working hours seems to prolong the time until surgery in pediatric Gartland type 3 SHF patients who do not require emergent intervention such as open fractures, neurovascular impairment and compartment syndrome, there may not be a time interval that makes a difference for the patients if surgery is performed within the first 24 hours, thus the surgery could be scheduled according to the surgeons' preference. LEVEL OF EVIDENCE: Level 3, Retrospective cohort study.

The Cost and Consequences of Failed Osteosynthesis of Intertrochanteric Femur Fractures: A Matched Cohort Study.

BACKGROUND: We aimed to evaluate the cost and consequences of failed osteosynthesis of intertrochanteric femur fracture (ITFF) patients and compare with primary ITFF patients. METHODS: We retrospectively evaluated 689 patients who underwent surgery due to ITFF via cephalomedullary nail. 31 patients (5.8%) had revision surgery because of osteosynthesis failure of ITFF. Each revision case included in the study was matched with four primary ITFF cases as control group based on age, gender, year of operation, type of fracture and American Society of Anesthesiologists (ASA) grade. Total cost for the admission that patients underwent surgery, mortality rate at first year, infection rate, length of stay at hospital, length of stay at intensive care unit, and erythrocyte transfusion amounts were recorded from hospital registry records. Tip apex distances (TAD) were noted. RESULTS: The mean total cost of the revision cases and primary cases was 10,027 ± 6387 and 5261 ± 1773 Turkish Liras, respectively (p < 0.001). TAD was ≥ 20 mm in 32.3% (10/31) of patients in revision group while 2.4% (3/124) of the patients in control group (p < 0.001). The mean length of stay at hospital, length of stay at intensive care unit, erythrocyte transfusion amounts, infection rate and mortality rate at first year were significantly higher in revision cases compared to matched primary control cases (p < 0.05). CONCLUSION: Revision surgeries due to failed osteosynthesis of ITFFs with cephalomedullary nail have at least two times higher mean total cost than primary cases. The awareness of the cost, morbidity and mortality of the revision surgeries may reduce the modifiable risk factors of osteosynthesis failure including maintenance of TAD below 20 mm, obtaining optimal lag screw position and reduction quality. LEVEL OF EVIDENCE: Level 3, retrospective cohort study.

Do Low Hemoglobin Levels Affect the Healing Process of Periprosthetic Joint Infection?

Background Revision knee arthroplasty (RKA) is associated with low hemoglobin (Hb) levels after surgery, which results mostly from perioperative blood loss. Periprosthetic joint infection (PJI) is one of the common reasons for RKA. This study aimed to determine whether low Hb levels affect the healing process of PJI. Methodology This retrospective study included 69 patients who underwent two-stage revision for PJI between 2013 and 2016. Patients were divided into two groups according to the latest Hb levels (Hb < 10 and Hb > 10 g/dL) during hospitalization for the first-stage revision surgery. Laboratory parameters of infection were measured during the cement spacer retention period: C-reactive protein (CRP), sedimentation rate (SEDIM), and white blood cell (WBC) count. Treatment was evaluated in two periods: cement spacer retention period (between the first surgery and second surgery) and the first normal CRP period (between the first surgery with the first normal CRP level during the cement spacer retention period). Infection parameters in the two time periods and reoperation with cement spacer were compared between the groups. Results The mean patient age was 67.3 ± 7.94 (50-87) years, and the female-to-male ratio was 4:1. No difference was found in the postoperative first control CRP, SEDIM, and WBC between the groups (p = 0.953, p = 0.3341, and p = 0.444, respectively). CRP-SEDIM control curves were observed in parallel, and no significant difference was found. The cement spacer retention period was 60.3 ± 24.8 (17-123) days, and the first normal CRP period was 87.3 ± 28.4 (14-161) days; no statistical difference was found between the groups (p = 0.727, p = 0.754). Conclusions In RKA, as low Hb level was not a negative factor of infection, blood transfusion should be avoided as it has many complications.

Dynamic and Stabilometric Analysis After Syndesmosis Injuries.

BACKGROUND: Distal tibiofibular syndesmosis contributes to dynamic stability of the ankle joint and thereby affects gait cycle. The purpose of this study was to evaluate the grade of syndesmosis injury on plantar pressure distribution and dynamic parameters of the foot. METHODS: Grade of syndesmosis injury was determined by preoperative plain radiographic evaluation, intraoperative hook test, or external rotation stress test under fluoroscopic examination, and two groups were created: group 1, patients with grade III syndesmosis injury (n = 17); and group 2, patients with grade II syndesmosis injury (n = 10). At the last visit, radiologic and clinical assessment using the Foot and Ankle Outcome Score was performed. Dynamic and stabilometric analysis was carried out at least 1 year after surgery. RESULTS: The mean age of the patients was 48.9 years (range, 17-80 years), and the mean follow-up was 16 months (range, 12-24 months). No statistically significant difference was noted between two groups regarding Foot and Ankle Outcome Score. The comparison of stabilometric and dynamic analysis revealed no significant difference between grade II and grade III injuries (P > .05). However, comparison of the data of patients with grade III syndesmosis injury between injured and healthy feet showed a significant difference for dynamic maximum and mean pressures (P = .035 and P = .49, respectively). CONCLUSIONS: Syndesmosis injury does not affect stance phase but affects the gait cycle by generating increased pressures on the uninjured foot and decreased pressures on the injured foot. With the help of pedobarography, processing suitable orthopedic insoles for the injured foot and interceptive measures for overloading of the normal foot may prevent later consequences of ankle trauma.

Percutaneous reduction of irreducible dislocation of the interphalangeal joint of the hallux: A simple technique for a rare injury.

Irreducible dislocation of the interphalangeal joint (IPJ) of hallux is a rare injury due to its intrinsic stabile anatomy. Open reduction is the commonly preferred treatment option once closed reduction attempts fail. In this article, we present a 37-year-old male patient with an irreducible dislocation of the IPJ of the hallux treated with Kirschner (K)-wire assisted percutaneous reduction. The patient was symptom free at the sixth month of follow-up. In conclusion, K-wire assisted percutaneous reduction might be an option in the treatment of irreducible dislocation of IPJ of the hallux.

Injury mechanisms of ankle fractures with dislocation and analysis of differences on functional outcome.

BACKGROUND: In the existing classifications, no importance is given to dislocations accompanying ankle fractures. The present study aims to investigate differences in injury mechanisms of ankle fractures with concomitant dislocation injury in respect of functional outcomes and complications. METHODS: A retrospective evaluation was carried out of 285 patients who underwent surgery in our clinic for an ankle fracture between January 2012 and December 2018. A comparison was made of functional scores and complications between the patients with ankle fracture with dislocation (AF-D group) and patients with ankle fracture without dislocation (AF-WD). The correlation of dislocation with current classifications (Lauge-Hansen and Danis-Weber) and the effects on functional outcomes were also evaluated. In addition to functional scores, a record was also made for each patient of infection during follow-up, soft-tissue defect, malalignment, non-union, arthrosis and Reflex Sympathetic Dystrophy Syndrome (RSD). RESULTS: The mean age of the patients was 44.7±12.04 years (range, 18-72 years) and the mean follow-up period was 3.2 years. Ankle fracture with dislocation was observed in 88 (30.8%). Similar functional results were determined in the AF-WD and AF-D groups with mean AOFAS 84.05±10.5, and 80.33±9.47, respectively (p=0.379), and mean VAS scores of 1±0.5 and 1.23±0.48, respectively (p=0.117). When the AOFAS values of the dislocation function results were evaluated according to the Lauge-Hansen and Danis-Weber subgroups, no significant difference was observed (p=0.562, 0.723). Arthrosis was seen in two of the AF-WD group and seven of the AF-D group (p=0.004). RSD was determined in two of the AF-WD group and in 10 of the AF-D group (p=0.000). From a medico-legal perspective, patients should be informed about arthrosis, and RSD is another significant problem encountered in this patient group. CONCLUSION: Although dislocation accompanying ankle fracture was not seen to worsen functional results, arthrosis and RSD were determined more often in these patients.

The mid-term effects on quality of life and foot functions following pilon fracture.

BACKGROUND: Although pilon fractures are uncommon, they are of importance to orthopaedic surgeons because of the difficulty of treatment. Poor outcomes and high complication rates are seen despite various surgical methods. This study aims to examine the changes affecting the quality of life and foot functions in patients applied with open reduction and internal fixation (ORIF) for a pilon fracture. METHODS: In this study, a total of 45 patients treated with ORIF for a pilon fracture in our clinic between January 2010 and December 2016 were evaluated with AOFAS and SF-12 in a total of 10 categories according to demographic data, fracture classification and surgical technique. In addition to functional values, patient records were examined regarding complications, including infection, soft-tissue defect, malalignment, non-union, arthrosis and Sudeck atrophy. In patients with AOFAS <85 and low SF-12 scores, variables were examined and the relationship with complications was evaluated. RESULTS: The mean follow-up period was 3.7 years (range 2 to 7). The AOFAS value was determined to fall to <85 when the Ruedi Allgower classification increased (p=0.010), when AO classification increased (p=0.020), when there was a concomitant lateral malleolar fracture (p=0.028), and when the status was non-anatomic according to the Ovadia Bell criteria (p=0.031). The SF-12 PCS value was observed to decrease when the Ruedi Allgower classification increased (p=0.018) and when the status was non-anatomic according to the Ovadia Bell criteria (p=0.012). A correlation was determined between the SF-12 PCS and the AOFAS values (p=0.000). CONCLUSION: The reasons for the failure of ORIF in tibia pilon fractures were found to be Ruedi 3 classification, concomitant lateral malleolar fracture, and non-anatomic surgical reduction. Failure in foot functions has a direct effect on quality of life in both the short and mid term.

Total hip arthroplasty for high-riding hips: A retrospective analysis of 79 cases and proposal of a new classification.

PURPOSE: Total hip arthroplasty (THA) for high-riding hips is a complex procedure and the requirement for subtrochanteric osteotomy (STO) is an important decision that needs to be taken preoperatively. STO renders this complex surgery even more complicated and there are no guidelines to determine the STO requirement. In this study, the outcomes of THA for patients with high-riding hips were evaluated and a practical classification system is proposed to predict any osteotomy requirement. METHODS: A retrospective evaluation was made of 79 hips of 76 patients who underwent THA for high-riding hip dysplasia. The amount of shortening in patients with STO and in patients without STO was compared. All patients were evaluated in respect of Harris hip score, operating time, erythrocyte suspension need, and actual limb length discrepancy. Preoperative radiographs were classified into four types according to the ratio of the distance between the lesser trochanter and the ischial tuberosity with pelvic height (LT-IT/P) to grade the degree of dislocation. RESULTS: The mean follow-up was 30 ± 6.54 months. STO was applied to 47 (60%) hips and not to 32 (40%). There was no statistically significant difference between the groups in respect of the functional scores. STO prolonged the operating time and increased the need for blood transfusion (p = 0.026, p < 0.001, respectively). When the LT-IT/P index was <0.19 (type 1), no additional surgical approach was required for reduction, at 0.19-0.29 (type 2), the head can be safely reduced with additional reduction methods, and when >0.3 (type 3), a shortening osteotomy will most likely be required. The rate of complications is increased if LT-IT/P is >0.4 (type 4). CONCLUSION: STO adjunct to THA increases the rate of complications. This practical classification system may guide the surgeon in the decision of whether an STO should be added to the procedure or not. LEVEL OF EVIDENCE: Level III, clinical trial.

The evaluation of radiological measurements used in diagnosis and treatment of syndesmosis injury: A regional study in Turkey.

OBJECTIVES: This study aims to improve the diagnostic reliability of syndesmosis injuries through evaluation of radiological measurements in the Turkish population and to provide mean reference values to prevent malreduction and overcompression during the treatment. PATIENTS AND METHODS: This retrospective study was performed between January 2018 and May 2018. The bilateral anteroposterior (AP) and lateral radiographs of 100 patients (60 males, 40 females; mean age 42.9 years; range, 23 to 72 years) who presented at our polyclinic were analyzed. Tibiofibular overlap (TFO), tibiofibular clear space (TFCS) and medial clear space (MCS) measurements were performed on the AP radiographs. The lateral radiographs were evaluated in respect of the anterior tibiofibular interval (ATFI), posterior tibiofibular interval (PTFI), and anterior tibiofibular ratio (ATFR) for syndesmosis reduction assessment. The lower and upper limits, mean and median values of the measurements were recorded. RESULTS: The measurements on the AP radiographs were determined to be as TFO: 7.9±2.4 mm (4-13), TFCS: 3.8±0.9 mm (2.2-6), MCS: 3.3±0.4 mm (2.7-4.5), and superior clear space: 3.3±0.3 mm (2.7-3.8). According to the measurements on the AP radiographs, the TFCS did not show any difference in terms of the variables of age, gender and side (p=0.070, p=0.219 and p=1.0, respectively). These measurements on the AP radiographs showed a high statistical consistency in terms of side (p=0.72, p=1.0, p=0.900 and p=0.920, respectively). The measurements on the lateral radiographs were as ATFI: 12.8±2.4 mm (8-18), PTFI: 6.1±2.9 mm (3-15) and ATFR: 0.4±0.1 (0.28-0.5). According to the measurements on the lateral radiographs, the ATFR did not show any difference in terms of the variables of age, gender and side (p=0.750, p=0.570 and p=0.848, respectively). The lateral measurements indicated statistical consistency in terms of side (p=0.400, p=0.260 and p=0.848, respectively). CONCLUSION: On the AP radiographs, TFCS was found to be reliable and the intraoperative evaluation of its high consistency with the opposite extremity is appropriate to avoid overcompression. The evaluation of ATFR on lateral radiographs was found to be reliable and evaluation is recommended to avoid intraoperative malreduction.

Comparison of two platelet rich plasma formulations with viscosupplementation in treatment of moderate grade gonarthrosis: A prospective randomized controlled study.

BACKGROUND: The success of platelet rich plasma (PRP) applications in conservative treatment of moderate gonarthrosis has increased over time. Two different PRP formulations that buffy coat (Leukocyte rich PRP: LR-PRP) and plasma-based (Leukocyte poor PRP: LP-PRP) are obtained by different centrifugation methods. This prospective randomized trial was whether LP-PRP will be more effective combination for moderate gonarthrosis when compared to LR-PRP or HA. METHODS: A total 90 patients suffering from moderate knee osteoarthritis were enrolled. Patients were divided equally into three groups and treated with 3 times LR-PRP, LP-PRP and HA injections. A prospective evaluation was done at baseline, and then at 2, 6 and 12 months of follow-up using VAS, WOMAC and Likert scoring systems. RESULTS: The 2nd, 6th and 12th month VAS and WOMAC scores of LR-PRP demonstrated the most obvious improvement. Recurrence of symptoms was statistically lower (3; 10%) in LR-PRP group (p < 0.001). Male gender had lower recurrence rate than females (1 vs. 18; p = 0.043). Only high BMI had statistically negative effect on recovery and recurrence rates (p = 0.004). Local adverse effects were more common in LR-PRP group (p < 0.05). CONCLUSIONS: PRP injections produced superior results than HA. LR-PRP seems to be the most effective treatment modality for moderate gonarthrosis especially in normal weighted men at the 6th decade of age.

Results of Crowe Type IV Developmental Dysplasia of Hip Treated by Subtrochantric Osteotomy and Total Hip Arthroplasty.

Background: Crowe type IV developmental dysplasia of hip (DDH), subtrochanteric shortening osteotomy is required to restore the hip joint. Several approaches have been described for subtrochanteric shortening osteotomy. Several osteotomy fixation techniques have been defined for Crowe type IV DDH. This study evaluates the outcomes of subtrochanteric shortening osteotomy fixed with a combination of split onlay autograft and distal fluted femoral stem. Materials and Methods: A retrospective study was carried out on 41 hips of 37 patients treated with total hip replacement for Crowe type IV developmental dysplasia of the hip by subtrochanteric transverse osteotomy and fixed with split intercalary autograft by two cables. A femoral stem with proximal coated and distally fluted was used. The patients were evaluated at a mean of 34 months (range 12-68 months) for union time, leg equalization, and clinical outcomes. Results: Mean time of union was 13.5 ± 4.6 weeks (range 6-24 weeks). Intraoperative instability of the osteotomy site (n = 16) that was encountered at the trial stage was restored properly by this surgical protocol. Leg length discrepancies were improved to 1.4 ± 0.8 cm (range 0-3 cm). Harris scores were improved from 47.7 ± 10.8 (range 30-68) to 88 ± 5.6 (range 72-98) (P < 0.05) points. There was no nonunion. Conclusions: Distally well-fitted stem and strengthening of fixation with split intercalary autograft promote additional rotational stability and improve bone union.

Intraobserver and interobserver reliability assessment of tibial plateau fracture classification systems.

OBJECTIVES: This study aims to assess the intra- and interobserver reliability of commonly used tibial plateau fracture classification systems. PATIENTS AND METHODS: This retrospective cohort study included computed tomography (CT) and plain radiographic images (lateral and anteroposterior X-rays) of 60 patients (40 males, 20 females; mean age 45.9 years; range 18 to 80 years) who presented to two orthopaedic clinics between January 2011 and January 2015 with unilateral tibial plateau fractures. All plain X-rays (XR) and CT images were evaluated by four observers on two separate occasions, 1.5 months apart. All fractures were classified according to the Arbeitsgemeinschaft für Osteosynthesefragen-Orthopaedic Trauma Association (AO-OTA), Schatzker, Hohl and Moore, Luo and revised Duparc systems. Intraobserver reliability was measured with Cohen's kappa (κ) coefficient and interobserver reliability with Fleiss' kappa coefficient. RESULTS: When Schatzker classification was performed, interobserver reliability was in moderate level for (κ=0.51) for XR and in substantial level for CT (κ=0.61). When AO/OTA classification was used, interobserver reliability was in moderate level for both methods of diagnosis (κXR=0.43 and κCT=0.54, respectively). In the Hohl and Moore classification, the interobserver reliability was also moderate for both methods of diagnosis (κXR=0.45 and κCT=0.51, respectively). Revised Duparc classification showed the lowest interobserver reliability ranging from fair to moderate level (κXR=0.27-0.55 and κCT=0.44-0.61). Interobserver reliability for Luo classification was κCT=0.47. Intraobserver reliability for CT in Luo classification was in substantial level for observers 1, 2 and 3 (κCT=0.67-0.71) and in perfect level for observer 4 (κCT=0.84). Intraobserver reliability was in substantial level in Schatzker classification and in moderate level at the other classifications. CONCLUSION: Among the classification systems compared in this study, Schatzker was the most reliable particularly when CT was used. On the other hand, revised Duparc classification presented the worse reliability results due to its complexity and different morphological subtypes.

Posterior hip approach yields better functional results vis-à-vis anterolateral approach in total hip arthroplasty for patients with severe hip dysplasia: A prospective randomized controlled clinical study.

OBJECTIVES: We aimed to compare functional outcomes of two common hip approaches for patients with severe hip dysplasia in total hip replacement (THR) surgery. MATERIALS AND METHODS: Seventy hips of 68 patients randomized into two groups with regard to hip approach as posterior (group I) and anterolateral (group II). All patients underwent THR surgery with femoral shortening osteotomy. The groups were compared for operation time, preoperative and 6 months after abductor muscle strengths (AMSs), gait disorders, union time of the osteotomied site and dislocation rates. RESULTS: There were two early dislocations in group I, and two early and one late dislocations in group II. No significant difference was observed regarding hip dislocations. Mean union time of the osteotomied site was 113.9 ± 51 days in group I while 111.1 ± 29.3 days in group II ( p = 0.774). Six months after surgery, group I had higher AMS than group II ( p < 0.0001). More patients in group II had Trendelenburg gait pattern ( p = 0.043), while no difference was observed regarding antalgic and deviated gait patterns between groups. CONCLUSION: THR surgery for patients with severe developmental dysplasia of hip is a challenging procedure, and posterior approach provides better functional outcomes regarding gait and AMSs.

Affective temperament does not influence satisfaction after total knee arthroplasty.

BACKGROUND: Inherent temperament of the patient may predict the outcome of the surgical procedure. The purpose of this study was to ascertain whether negative affective temperament affects patient satisfaction and outcome measures. METHODS: This prospective study included 143 patients who underwent total knee arthroplasty for primary arthrosis. Preoperatively, the Memphis, Pisa, Paris and San Diego-Auto questionnaire was used to define the temperament of the patient. Knee Society Score (KSS) and short form-36 (SF-36) outcome measures were used to evaluate the functional outcome. RESULTS: No relationship was determined between temperament and satisfaction (P = .734). Overall, the satisfaction rate of the procedure in our patients was 93%. The KSS improved from a mean of 47.9 to 70.1 (F = 124.275; P < .05) and the SF-36 physical component summary, and SF-36 mental component summary scores improved to a mean of 39.5 and 43.04 points, respectively. CONCLUSION: Temperament was not found to have any effect on patient satisfaction. However, patient satisfaction was directly related to better functional outcomes.

Platelet-rich plasma versus open surgical release in chronic tennis elbow: A retrospective comparative study.

PURPOSE: To compare short and mid-term results in the treatment of chronic elbow tendinosis with platelet-rich plasma (PRP) or Nirschl surgical technique. METHOD: A retrospective study was conducted on patients with chronic lateral epicondylitis, treated by Nirschl surgical technique (50 elbows) or PRP (60 elbows). Outcome was evaluated with Visual Analog Score (VAS), Mayo Elbow Scores and grip strength measurements. RESULTS: VAS and Mayo Elbow Scores of the PRP group had improved as a mean of 83% (p = 0.0001), 74% (p = 0.0001) over baseline and 34.2 pounds gain of grip strength. CONCLUSION: The PRP seems to be better for pain relief and functionality in the short and mid-term periods.