Comparison of clinical characteristics and 10-year survival rates of revision hip arthroplasties among revision time groups.

INTRODUCTION: No significant regression has been reported in revision total hip arthroplasty (THA) rates despite substantial progress in implant technologies and surgical techniques. It is critical to investigate how patient demographics, THA indications, surgical techniques, types of implants, and other factors influence the frequency of early and late revision surgery. The main purpose of the present study was to evaluate the clinical characteristics and 10-year survival rates of revision hip arthroplasties among revision time groups. MATERIAL AND METHODS: The clinical data of 396 patients who underwent revision hip arthroplasty between 2005 and 2011 were evaluated in this multi-centre study. Patients were assigned to one of four revision time groups based on the interval between the index hip arthroplasty and the revision surgery (< 2, 2-5, 5-10, and > 10 years). RESULTS: There were significant differences among revision time groups in terms of aetiology for primary hip arthroplasty, indications for revision hip arthroplasty, and types of revision procedures. Patients with hip dysplasia more frequently received revision hip arthroplasty within 2 years in contrast to those with osteoarthritis. Revision hip arthroplasties due to periprosthetic infection and instability were conducted earlier compared to aseptic loosening. The overall 10-year survival rate of revision hip arthroplasty was 83.2%, and it was highest for the very early revisions (< 2 years). CONCLUSIONS: According to our results, early revision hip arthroplasty was found to be mostly dependent on surgery-related factors rather than demographic factors. On the other hand, we observed that survival rates of very early revision hip arthroplasties are higher than late revision hip arthroplasties.

Tibiofemoral subluxation in the coronal plane does not affect WOMAC and KOOS after total knee arthroplasty.

PURPOSE: To investigate the effect of preoperative coronal tibiofemoral subluxation (CTFS) on functional outcome, prosthesis type, insert thickness and revision rates in patients who underwent total knee arthroplasty (TKA). METHODS: A total of 224 knees of 186 patients were included. Patients were divided into two groups as either with (Group 1, 114 knees of 86 patients) or without (Group 2, 124 knees of 100 patients) coronal lateral tibiofemoral subluxation. The mean follow-up period was 71.3 ± 7.3 (range 60-84) months in group 1 and 69.4 ± 6.6 (range 61-79) months in group 2 (n.s.). Coronal tibiofemoral subluxation degree was measured in degrees on standing anteroposterior knee radiographs. Group 1 was divided into three subgroups according to amount of subluxation (< 5 mm, 6-10 mm and > 10 mm). Functional outcome was evaluated using the Western Ontario and McMaster Osteoarthritis Index (WOMAC) score and Knee Injury and Osteoarthritis Outcome Score (KOOS) preoperatively and at the last follow-up visit. Prosthesis type, insert thickness and revision rates were compared between the two groups. RESULTS: There were no significant differences between the two groups regarding patient demographics, prosthesis type, and revision rates (n.s.). The insert thickness was found significantly higher in group 1 (p < 0.001). The preoperative and postoperative WOMAC and KOOS scores were found no significantly different between the two groups (n.s.). Among subluxation (+) subgroups, there was no significant difference in functional outcome scores and revision rates (n.s.). However, prosthesis type and insert thickness were significantly associated with the amount of subluxation (p = 0.009 and p = 0.001, respectively). There was no significant correlation between the degree of lower extremity deformity and coronal tibiofemoral amount of subluxation (n.s.). CONCLUSION: Preoperative CTFS does not adversely affect the WOMAC score, KOOS and revision rates after TKA. In the clinical practice, surgeons should be aware of the need for a posterior cruciate stabilizing prosthesis and a thicker insert in the presence of CTFS, especially with subluxation greater than 10 mm and to consider a spared bony resection on the tibia in patients suffering from CTFS. LEVEL OF EVIDENCE: IV.

Effect of surgical approaches on deltoid innervation and clinical outcomes in the treatment of proximal humeral fractures.

OBJECTIVES: This study aims to investigate the effects of deltopectoral and anterolateral acromial approaches commonly used in open reduction-internal fixation of proximal humeral fractures on the clinical outcomes, and axillary nerve damage through electrophysiological assessment. PATIENTS AND METHODS: Forty-eight patients (22 males, 26 females; mean age 47.9±13.2 years; range, 22 to 73 years) diagnosed with Arbeitsgemeinschaft für Osteosynthesefragen (AO)/Orthopaedic Trauma Association (OTA) type 11 proximal humeral fractures who underwent osteosynthesis with anatomical locking plates in our hospital between January 2015 and June 2016 were prospectively examined. The patients were divided into two groups according to either the deltopectoral or anterolateral deltoid-split surgical approach used. Clinical outcomes were evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH) scores and Constant-Murley scores (CMS) obtained at three- and 12-month follow-up visits. Needle electromyography (EMG) was performed for the electrophysiological assessment of the deltoid muscle. RESULTS: There were no significant differences between the groups in terms of demographic data, follow-up times, and complications. DASH scores and CMS obtained postoperatively at three months (p=0.327 and p=0.531, respectively) and 12 months (p=0.324 and p=0.648, respectively) revealed no significant differences. In addition, the two groups did not significantly differ with respect to the presence of EMG abnormalities (p=0.792). Avascular necrosis of the humeral head was detected in only two patients from the deltopectoral group. CONCLUSION: Deltopectoral and anterolateral approaches do not differ regarding the presence of postoperative EMG abnormalities and functional outcomes. Surgeons can thus adopt either approach. However, dissection without damaging the soft tissue should be performed in both approaches.

Does mammalian target of rapamycin or sestrin 1 protein signaling have a role in bone fracture healing?

Background/aim: Fracture healing is a complex physiological process that involves a well-orchestrated series of biological events. The mammalian target of rapamycin (mTOR) and sestrin 1 (SESN 1) play a central role in cell metabolism, proliferation, and survival. The aim of our study is to present serum mTOR and SESN 1 levels by comparing patients with or without bone fractures. It is also a guide for further research on the roles of these proteins in fracture healing. Materials and methods: A total of 34 patients (10 females, 24 males) with bone fractures and 32 controls (10 females, 22 males) participated in this study. After collecting serum venous blood samples, the quantitative sandwich ELISA technique was used for the determination of serum mTOR and SESN 1 levels. Results: The mean serum mTOR level was significantly higher in the fracture group compared to the control group (P = 0.001). However, SESN 1 levels did not significantly differ between groups (P = 0.913). Conclusion: We found that serum mTOR levels increased on the first day after fracture compared to the control group. However, we obtained no significant difference between groups in terms of SESN 1 levels. This study may guide further clinical studies investigating the potential role of mTOR signaling in the bone healing process.

Obesity-related metabolic and endocrine disorders diagnosed during postoperative follow-up of slipped capital femoral epiphysis.

Background and purpose - Patients with slipped capital femoral epiphysis (SCFE) are phenotypically overweight or obese and may therefore require clinical follow-up of obesity-related disorders. We evaluated obesity-related disorders such as dyslipidemia, type 2 diabetes mellitus (DM), and vitamin-D deficiency during the postoperative period in patients with SCFE. Patients and methods - 51 patients who were operated and followed-up for SCFE and 62 healthy adolescents without SCFE (control group) were included in this retrospective study. Patients' BMI, serum lipid profile (total cholesterol, LDL-C, HDL-C, triglyceride), fasting blood glucose, HbA1c, and serum vitamin D levels were evaluated. Results - At the time of surgery, 45 patients in the SCFE group were overweight or obese (BMI >25). At the latest follow-up, 42 patients in the SCFE group and 53 patients in the control group were overweight/obese. Abnormal serum lipid profile and ratio of total dyslipidemia were similar between the groups. 8 patients had abnormal HbA1c levels in the SCFE group and mean HbA1c levels were significantly higher in the SCFE group (p = 0.03). All patients and controls had low levels of vitamin D. Interpretation - Although serum lipid profile and vitamin D levels were detected as similar in SCFE and control groups, the potential risk of type 2 DM identified via abnormal HbA1c levels was significantly higher in patients with SCFE. We recommend that patients diagnosed with SCFE should be considered as potential candidates for type 2 DM; thus follow-up after surgical treatment should include not only orthopedic outcomes but also evaluation of future risk for DM.

COMPARED EFFICACY OF INTRA-ARTICULAR INJECTION OF METHYLPREDNISOLONE AND TRIAMCINOLONE.

OBJECTIVE: To compare the effect of two different corticosteroid types in bilateral and symmetrical knee osteoarthritis (OA). METHODS: One hundred and twenty-six patients received injections of methylprednisolone acetate (MP) in one knee and triamcinolone hexacetonide (TH) in the contralateral knee. Patients were evaluated before injection and 2, 4, 8, 12, and 24 weeks after. RESULTS: Mean patient age was 68.5±9 years. Mean BMI was 26.3±2.6 kg/m2. At first admission, mean VAS score was 7.7±1.3 for the right side and 7.5±1.5 for the left side, and mean WOMAC score was 67.6±14.4. After bilateral intra-articular injection, VAS scores for both knees and WOMAC scores decreased significantly when initial scores were compared with 2, 4, 8, 12, and 24 weeks after injection (p<0.05). A statistically significant change was seen over time when VAS and WOMAC scores for 2, 4, 8, 12, and 24 weeks post-injection were compared to each other (p<0.05). No significant difference was seen between knee sides (p>0.05). CONCLUSION: MP and TH have similar efficacy in relieving pain and improving function. The efficacy of intra-articular corticosteroid injection peaks 2 weeks after injection and the effect continues until the 24th week. Level of Evidence II, Comparative Prospective Study.

OBJETIVO: Comparar o efeito de dois tipos de corticosteroides em osteoartrite (OA) de joelho bilateral e simétrica. MÉTODOS: Cento e vinte e seis pacientes receberam injeções de acetato de metilprednisolona (MP) em um joelho e de triancinolona hexacetonida (TH) no joelho contralateral. Os pacientes foram avaliados antes da injeção e 2, 4, 8, 12 e 24 semanas depois. RESULTADOS: A média de idade dos pacientes foi 68,5 ± 9 anos. O IMC médio foi 26,3 ± 2,6 kg/m2. Na primeira internação, o escore médio da EVA foi 7,7 ± 1,3 para o lado direito e 7,5 ± 1,5 para o esquerdo e a média do escore WOMAC foi 67,6 ± 14,4. Depois da aplicação bilateral das injeções intra-articular, os escores da EVA e do WOMAC para ambos os joelhos diminuíram significantemente ao comparar os escores iniciais com os de 2, 4, 8, 12 e 24 semanas depois da injeção (p < 0,05). Constatou-se diferença estatisticamente significante no decorrer do tempo, quando os escores EVA e WOMAC às 2, 4, 8, 12 e 24 semanas depois da injeção foram comparados entre si (p < 0,05). Não houve diferença significante entre os lados direito e esquerdo (p > 0,05). CONCLUSÃO: MP e TH têm eficácia similar quanto ao alívio da dor e à melhora da função. A eficácia da injeção intra-articular de corticosteroides atinge o máximo duas semanas depois da aplicação e o efeito continua até a 24a semana. Nível de Evidência II, Estudo Prospectivo Comparativo.

Compared efficacy of intra-articular injection of methylprednisolone and triamcinolone / Comparação de eficácia de injeção intra-articular de metilprednisolona e triancinolona

ABSTRACT Objective: To compare the effect of two different corticosteroid types in bilateral and symmetrical knee osteoarthritis (OA). Methods: One hundred and twenty-six patients received injections of methylprednisolone acetate (MP) in one knee and triamcinolone hexacetonide (TH) in the contralateral knee. Patients were evaluated before injection and 2, 4, 8, 12, and 24 weeks after. Results: Mean patient age was 68.5±9 years. Mean BMI was 26.3±2.6 kg/m2. At first admission, mean VAS score was 7.7±1.3 for the right side and 7.5±1.5 for the left side, and mean WOMAC score was 67.6±14.4. After bilateral intra-articular injection, VAS scores for both knees and WOMAC scores decreased significantly when initial scores were compared with 2, 4, 8, 12, and 24 weeks after injection (p<0.05). A statistically significant change was seen over time when VAS and WOMAC scores for 2, 4, 8, 12, and 24 weeks post-injection were compared to each other (p<0.05). No significant difference was seen between knee sides (p>0.05). Conclusion: MP and TH have similar efficacy in relieving pain and improving function. The efficacy of intra-articular corticosteroid injection peaks 2 weeks after injection and the effect continues until the 24th week. Level of Evidence II, Comparative Prospective Study.

RESUMO Objetivo: Comparar o efeito de dois tipos de corticosteroides em osteoartrite (OA) de joelho bilateral e simétrica. Métodos: Cento e vinte e seis pacientes receberam injeções de acetato de metilprednisolona (MP) em um joelho e de triancinolona hexacetonida (TH) no joelho contralateral. Os pacientes foram avaliados antes da injeção e 2, 4, 8, 12 e 24 semanas depois. Resultados: A média de idade dos pacientes foi 68,5 ± 9 anos. O IMC médio foi 26,3 ± 2,6 kg/m2. Na primeira internação, o escore médio da EVA foi 7,7 ± 1,3 para o lado direito e 7,5 ± 1,5 para o esquerdo e a média do escore WOMAC foi 67,6 ± 14,4. Depois da aplicação bilateral das injeções intra-articular, os escores da EVA e do WOMAC para ambos os joelhos diminuíram significantemente ao comparar os escores iniciais com os de 2, 4, 8, 12 e 24 semanas depois da injeção (p < 0,05). Constatou-se diferença estatisticamente significante no decorrer do tempo, quando os escores EVA e WOMAC às 2, 4, 8, 12 e 24 semanas depois da injeção foram comparados entre si (p < 0,05). Não houve diferença significante entre os lados direito e esquerdo (p > 0,05). Conclusão: MP e TH têm eficácia similar quanto ao alívio da dor e à melhora da função. A eficácia da injeção intra-articular de corticosteroides atinge o máximo duas semanas depois da aplicação e o efeito continua até a 24a semana. Nível de Evidência II, Estudo Prospectivo Comparativo.

Can Teicoplanin Be an Effective Choice for Antibiotic-Impregnated Cement Spacer in Two-Stage Revision Total Knee Arthroplasty?

The main purpose of this study was to evaluate the clinical results of two-stage revision total knee arthroplasty using a teicoplanin-impregnated cement spacer for infected primary total knee replacements. Twenty-five patients operated between 2005 and 2012 were included in this study. At the clinical status analysis, rate of infection eradication was assessed, physical examination was performed, Knee Society Score (KSS) was noted, isolated microorganisms were recorded, and the radiographic evaluation was performed. The mean KSS improved from 40 (range, 25-69) preoperatively to 77 (range, 32-96) at the latest follow-up (p < 0.05). Methicillin-resistant Staphylococcus epidermidis was isolated in 9 of 25 patients as the most frequently isolated pathogen, and the other isolated pathogens were methicillin-susceptible S. epidermidis, methicillin-resistant Staphylococcus aureus, and methicillin-susceptible S. aureus. Infection was successfully eradicated in 24 of 25 patients. Two-stage revision of the infected primary knee replacement is a time-consuming but a reliable procedure with high rates of success. Teicoplanin was found to be an effective choice for antibiotic-impregnated cement spacer applied for the eradication of the infection.

Unusual localizations of unicameral bone cysts and aneurysmal bone cysts: A retrospective review of 451 cases.

Unicameral bone cysts (UBC) and aneurysmal bone cysts (ABC) are benign cystic lesions of bone which are easily diagnosed. However, unusual locations may lead to a false diagnosis. Therefore the aim of this retrospective study was to determine the frequency of unusual localizations. The authors studied 451 cases with histopathologically confirmed diagnosis of UBC or ABC, seen between 1981 and 2012. In the UBC group (352 cases) humerus, femur and calcaneus were found to be the most common sites, while acetabulum, scapula, scaphoid, lunatum, metacarpals, metatarsals, toe phalanges and ulna each accounted for less than 1%. In the ABC group (99 cases) the most common sites of involvement were femur, humerus and tibia, while finger phalanges, ilium, acetabulum, pubis, calcaneus, cuboid, and toe phalanges each accounted for only 1%. The differential diagnosis of cystic bone lesions should include both UBC and ABC. Pain complaints plead for the latter, except in case of fracture.

Tönnis triple pelvic osteotomy for Legg-Calve-Perthes disease.

PURPOSE: The aim of this study is to evaluate the efficacy of Tönnis triple pelvic osteotomy in patients with LCP disease. METHODS: Between 2007 and 2011, Tönnis triple pelvic osteotomy was performed for 43 patients with LCP, in our institute. During the follow-ups of patients with LCP the indications for the surgery were lateralization of the femoral head, insufficient femoral head coverage and subluxation of the femoral head. The mean age of patients at the time of surgery was 9.4 years. RESULTS: Before surgical intervention, according to Waldenstrom classification, three patients were in the necrosis stage (7 %), six patients in the fragmentation stage (13.9 %), 16 patients in the re-ossification stage (37.2 %) and 18 patients in the remodeling stage (41.9 %). According to Herring classification, four patients were in group B (9.3 %), one patient in group B/C (2.3 %) and 38 patients in group C (88.4 %). After the operation, patients were evaluated with Stulberg classification, and good outcome (Stulberg I/II) was achieved in 23 patients (53, 5 %), fair outcome (Stulberg III) in 16 patients (37, 2 %) and poor outcome (Stulberg IV/V) was seen in only four patients (9.3 %). The mean value of CEA was 0.37° pre-operatively and in the last follow-ups the mean value of CEA was 23.7°. CONCLUSIONS: We recommend triple pelvic osteotomy for patients with LCP when conservative methods are not successful. According to our results we believe that Waldenstrom classification is a better option than Herring classification to determine the prognosis of disease after containment surgery.