Association Between Knee Flexor Strength and Preservation of the Tibial Attachment of the Sartorial Fascia During Hamstring Tendon Harvest.

Background: During anterior cruciate ligament (ACL) reconstruction, there are various autograft options. Donor-site morbidity is an important consideration while deciding the type of the autograft. Gracilis and semitendinosus autografts are commonly used in ACL reconstruction, resulting in weakness of the hamstring muscle. Hypothesis: We hypothesized that if we preserved the tibial insertion site of the sartorial fascia (SF) during hamstring tendon harvest, there would be better recovery of knee flexor strength. Study Design: Case-control study; Level of evidence, 3. Methods: In this retrospective study, 34 patients (aged 20-59 years) underwent ACL reconstruction using hamstring tendon autograft with 2 different incision techniques on the SF. The tibial attachment site of the SF was preserved in 17 patients. The insertion site of the muscle was incised transversely in 17 patients. The follow-up duration was ≥2 years. Patients were recalled to the institute for examination and muscle strength assessment. The results were compared between the groups in terms of flexor and extensor knee isokinetic muscle strength at 60 and 180 deg/s. Results: There was no statistical difference between the groups in terms of age, sex, or body mass index. When compared with patients whose SF attachment site was incised, patients with a preserved SF tibial insertion were found to have a higher flexion peak torque at the angular speed of 180 deg/s (P < 002). No statistically significant difference was noted at 60 deg/s. Conclusion: During collection of gracilis and semitendinosus autografts, preserving the SF tibial attachment site was associated with better knee flexion peak torque.

Use of tranexamic acid may reduce the need for routine tourniquet use in total knee arthroplasty.

OBJECTIVES: The aim of this study was to evaluate the effects of tranexamic acid (TXA) administration on bleeding control and to compare its utilization with and without simultaneous use of conventional pneumatic tourniquets during total knee arthroplasty (TKA). PATIENTS AND METHODS: Between January 2017 and December 2017, a total of 204 patients (23 males, 181 females; mean age: 66±6.9 years; range, 45 to 86 years) who underwent TKA for Stage 4 gonarthrosis were retrospectively analyzed. The patients were divided into two groups as those with (n=110) and without (n=94) pneumatic tourniquet use. Tranexamic acid (1 g) was administered intravenously to all patients in both study groups. Intra- and postoperative blood loss were calculated, and postoperative pain was evaluated by a Visual Analog Scale. Demographic and clinical data were compared between the study groups. RESULTS: The amount of total blood loss and postoperative blood loss were significantly higher in the tourniquet group than that in the no-tourniquet group (589.4±69.5 mL vs. 490.8±55.2 mL and 326±56 mL vs. 164±35.5 mL, respectively; p<0.001 for both). Intraoperative blood loss was significantly higher in the no-tourniquet group (326.9±42.9 mL vs. 263.5±53.8 mL, respectively; p<0.001). The pain score at 24 h was significantly higher in the tourniquet group (p<0.001). CONCLUSION: Total blood loss and postoperative pain were significantly higher among patients in whom a tourniquet was used during TKA. Therefore, the routine use of tourniquets with TXA should be reconsidered.

Effects of Preoperative Pregabalin On Postoperative Pain Control in Total Knee Arthroplasty Surgery.

OBJECTIVE: Pain management is a major component of postoperative patient care. Pain management following total knee arthroplasty (TKA) provides patient comfort and early mobilization and prevents serious complications. The present study aimed to evaluate the effects of preoperative administration of oral pregabalin on postoperative pain control in patients undergoing TKA. METHODS: One hundred and twenty-six patients undergoing TKA were retrospectively included, of whom 65 (51.6%) received 150 mg pregabalin 2 hours before the operation and 61 (48.4%) did not. All patients received the same postoperative pain management protocol. Resting pain was recorded using a visual analog scale (VAS) at the postoperative 4th, 12th, and 48th hours. Findings including headache, dizziness, nausea-vomiting, constipation, dry mouth, pruritus, urinary retention, and sleepiness were recorded. RESULTS: The mean age of 126 patients (84.1% female) was 65.5 ± 4.5 years (range, 55-72 years). No significant differences were found in age, sex, ASA score, and operation duration between the groups. VAS scores at the postoperative 4th, 12th, and 48th hours, frequency of pushing the button of PCA system, and the total tramadol dose were significantly lower in the pregabalin group. The percent decrease in the postoperative VAS scores from the 4th hour to the 48th hour was significant in the pregabalin group. Nausea was the most frequent side effect followed by urinary retention, constipation, and pruritus. CONCLUSION: Preoperative pregabalin administration provided a favorable contribution to the postoperative pain management in the patients undergoing TKA. Preoperative pregabalin administration could reduce opioid drug usage and opioid related side effects.

In vitro and in vivo evaluation of linezolid loaded electrospun PLGA and PLGA/PCL fiber mats for prophylaxis and treatment of MRSA induced prosthetic infections.

In this study, it was aimed to formulate linezolid loaded electrospun PLGA and PCL fiber mats doing controlled drug release, to be used in the treatment and prophylaxis of the prosthesis related infections. The effect of PLGA concentration, PLGA to PCL ratio and the amount of linezolid on the fiber and mat properties were examined. Fiber diameter has been shown to increase with increasing amount of PLGA and linezolid. Increase in PLGA amount resulted in reduced linezolid release, whereas increase in linezolid amount resulted in increased drug release. All PLGA fiber mats have shown to have favorable encapsulation efficiency (≥73%) and mechanical properties. Encapsulation efficiency and the mechanical properties deteriorated with the addition of PCL to the formulations. PLGA fiber mats have shown a biphasic controlled release and in vitro antibacterial activity against methicillin-resistant Staphylococcus aureus (MRSA), pattern up to one month. The formulation selected as the optimum has been evaluated in vivo on the infected rats, which had prosthetic implantation after bone fracture. Consequently, it has been demonstrated microbiologically and histopathologically that a more efficient therapy and prophylaxis have been achieved with a 37-fold lower dose of linezolid.

Comparison of different locking plate fixation methods in lateral malleolus fractures.

BACKGROUND: Several fixation methods may be used for displaced lateral malleolar fractures. We aimed to compare clinical and radiologic outcomes associated with use of locking one third tubular plate vs. anatomical distal fibula locking plate in lateral malleolar fractures. METHODS: A total of 62 orthopedic patients operated for lateral malleolus fracture were included in this retrospective study. Patients were divided into two groups regarding the plate used for fixation as locking one third tubular plate (group I; n=37) and locking anatomical distal fibula plate (group II; n=25). Data on Danis-Weber ankle fracture classification (Type A, Type B), duration of follow up, clinical outcome [ankle range of motion (ROM), American Orthopaedic Foot & Ankle Society (AOFAS) score], radiological outcomes (adequacy of reduction, loss of alignment), time to fracture healing and complications were recorded in study groups. RESULTS: No significant difference was noted between groups in terms of AOFAS score [87.0 (73-100) vs. 85.0 (71-100), respectively (p=0.339)] and no patients had severe restriction in sagittal and hindfoot motion in both groups. The two groups showed similar healing time [9.0 (7-13) weeks vs. 10.0 (8-13) weeks, respectively (p=0.355)] and complication rate [0.0% vs. 4.0%, respectively (p=0.403)]. CONCLUSIONS: This study revealed no significant difference between use of locking one third tubular plate and locking anatomical distal fibula plate in lateral malleolar fixation, in terms of clinical and radiological outcomes, complication rates and fracture healing time.

The effect of tourniquet type and thigh conicity on the length of hamstring autograft.

PURPOSE: We studied the effect of using wide contoured pneumatic tourniquet (PT) versus ultra-narrow sterile exsanguination tourniquet (SET) on the length of hamstring autograft for anterior cruciate ligament (ACL) reconstruction in patients with tubular and conical thighs. METHODS: Fifty-eight patients undergoing ACL reconstruction between 2012 and 2013 were assigned to either SET or PT groups. We measured the tendon graft length and width as well as the patients' height, weight, and thigh circumference of 10 cm proximal to the patella and the distance from the anterior-superior iliac spine to the medial malleolus (ASIS-MM). We defined the ratio between the ASIS-MM and the thigh circumference as the conicity index (CI). All grafts were measured after folding into half, and the found value was recorded as functional graft length (FGL). Tendon graft dimensions were correlated with the individual anthropometric data and with CI in each of the groups. RESULTS: PT was used in 34 patients and SET on 24 patients. FGL was 12.7 ± 0.84 mean + standard deviation for the SET group versus 11.5 ± 1.61 for the PT group ( p = 0.0011) with a strong positive correlation between FGL and CI for the PT group ( R2 = 0.625; p = 2.6 × 10-8) but nonsignificant correlation for the SET ( R2 = 0.222). Graft thickness was correlated with the patient age ( R2 = 0.450) but not with CI or type of tourniquet used. We found the CI to be a better measure of thigh conicity than thigh circumference, length, height, weight, or body mass index individually. CONCLUSION: We conclude that using the SET which occupies less space on the thigh yielded significantly longer hamstring autologous ACL graft compared to the PT and the FGL became essentially independent from the CI when the SET was used.

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.

Total knee replacement-cementless tibial fixation with screws: 10-year results.

BACKGROUND: The aim of this study was to evaluate the long term clinical and radiological results of cementless total knee replacement. METHODS: A total of 51 knees of 49 patients (33 female and 16 male; mean age: 61.6 years (range, 29-66 years)) who underwent TKR surgery with a posterior stabilized hydroxyapatite coated knee implant were included in this study. All of the tibial components were fixed with screws. The HSS scores were examined preoperatively and at the final follow-up. Radiological assessment was performed with Knee Society evaluating and scoring system. Kaplan-Meier survival analysis was performed to rule out the survival of the tibial component. RESULTS: The mean HSS scores were 45.8 (range 38-60) and 88.1 (range 61-93), preoperatively and at the final follow-up respectively. Complete radiological assessment was performed for 48 knees. Lucent lines at the tibial component were observed in 4 patients; one of these patients underwent a revision surgery due to the loosening of the tibial component. The 10-year survival rate of a tibial component was 98%. CONCLUSION: Cementless total knee replacement has satisfactory long term clinical results. Primary fixation of the tibial component with screws provides adequate stability even in elderly patients with good bone quality. LEVEL OF EVIDENCE: Level IV, Therapeutic study.

Femoral shortening osteotomy in total hip arthroplasty for severe dysplasia: a comparison of two fixation techniques.

PURPOSE: The purpose of this study was to compare two distinct fixation methods for a total hip replacement performed via transverse femoral shortening osteotomy for patients with severe hip dysplasia. METHODS: In this retrospective study we compared two fixation methods for total hip replacement of 78 hips in 76 patients exhibiting Crowe type IV developmental hip dysplasia (DDH). The hip replacements were performed via a transverse femoral shortening osteotomy and carried out between September 2009 and December 2013. Group I patients underwent fixation of the shortened femoral segment via a cable attached to the osteotomied segment, and group II patients underwent fixation with a plate and screw. We compared the two techniques based on operating time, osteotomy site union time, Harris hip score, hip loosening signs, and overall clinical outcomes. RESULTS: The mean operating time for groups I and II was determined to be 116.5 ± 12.8 min and 137.7 ± 14 min, respectively (p < 0.05), while the average union time was 113 ± 51 days for group I and 152 ± 37 days for group II (p < 0.05). Fixation of the femur with a cable (group I) is therefore faster and results in more rapid union time when compared to plate osteosynthesis at the osteotomy site (group II). We observed only one non-union in group I compared with three in group II (p = 0.49). Harris hip scores at the final patient follow-up were 82.8 ± 7.8 and 80.8 ± 6.7 for groups I and II, respectively (p = 0.23). Thus, notably no significant differences were observed between the groups with regard to clinical outcomes such as the Harris hip score or loosening of the replacement components. CONCLUSION: Fixation of the removed femoral segment with a cable provided adequate rotational stability and decreased the operating time, leading to early union at the osteotomy site.

Reduced Postoperative Functional Length Ratio Influences Patient Satisfaction in First Metatarsophalangeal Joint Replacement.

Complications of first metatarsophalangeal joint metallic arthroplasty are well known. However, the resulting shortening of the metatarsals can lead to transverse metatarsalgia or medial column pain at the metatarsophalangeal joints by creating Morton's toe/foot, which increases pressure on the second metatarsal head. The effect of the functional length ratio of the first and second metatarsals on pain and patient satisfaction has not been rigorously evaluated. We evaluated the effect of the first/second metatarsal ratio on patient satisfaction with first metatarsophalangeal joint metallic arthroplasty. From October 2008 to February 2010, 34 patients (median age 66.2, range 55 to 70 years) with hallux rigidus were treated surgically using the Toefit-Plus(™) prosthesis. At a mean follow-up period of 27.5 (range 17 to 35) months, 30 patients (88.24%) underwent re-evaluation. The functional length of the first and second metatarsals and the lucency around the prosthesis were evaluated. Statistically significant (p ≤ .05) improvements were found for the mean modified American Orthopaedic Foot and Ankle Society score (from 44 to 80), pain (from 7 to 3 on a 10-cm visual analog scale), and mean total range of motion (from 42.2° to 59.4°). Also, 20 patients (58.82%) were fully satisfied with the procedure (scores of 8 to 10 on a 3-point Likert scale). Shortening the first metatarsal reduced the functional length ratio (r = 0.95; p < .001) and was associated with lower patient satisfaction (r = 0.66, p = .007). Preoperative consideration of the first/second metatarsal functional length ratio could be useful in preventing medial column pain due to a relatively short first metatarsal to a long second metatarsal axis in the transverse plane.

Treatment of the Bullet, Traversing Femoral Neck, Lodged in Hip Joint: Initial Arthroscopic Removal and Subsequent Cartilage Repair.

INTRODUCTION: There have been several reports on arthroscopically assisted removal of the bullet imbedded in hip joint in the literature. Similarly, in this case, a bullet lodged in acetabulum was extracted with arthroscopic technique. What makes this case unique in the literature is that the bullet removed from the acetabulum traversed the femoral neck. CASE REPORT: Male patient aged 32 years with a low-velocity gunshot wound was referred to the emergency room on August 28, 2012. The projectile was lodged in acetabular side of the hip joint transversing through the femoral neck. A hip arthroscopy was performed for bullet removal. Two years after surgery, the patient had groin pain and underwent a safe dislocation for femoral chondral injury. In the last follow-up in the second post-operative year, the patient had no clinical complaint. CONCLUSION: Hip arthroscopy is a minimally invasive and proper procedure for removal of foreign materials such as a bullet in the hip joint. Arthrotomy can be reserved for further complications such as chondral injury as in this case.

Remote ischemic preconditioning enhances fracture healing.

PURPOSE: We hypothesized that RIP accelerates fracture healing. METHODS: Rats (n = 48) were used for the technique of ischemic preconditioning involved applying 35 min of intermittent pneumatic tourniquet for 7 cycles of 5 min each to the fractured hind limb. RESULTS: We observed greater callus maturity in RIP group at first week after fracture when compared to controls (p < 0,0001). The serum MDA levels demonstrated statistically lower values at the RIP group at the first week after fracture; however, there were not significant differences at 3rd and 5th weeks (p = 0.0001, p = 0.725, p = 0.271, respectively). CONCLUSIONS: Greater callus maturity was obtained in RIP group.