Outcomes after bilateral implantation of AcrySof IQ PanOptix trifocal intraocular lens: a prospective interventional study.

Background: Implantation of multifocal intraocular lenses (IOLs) is becoming increasingly popular for the treatment of visual demands at various distances in patients undergoing phacoemulsification cataract surgery. We aimed to assess the visual performance and rates of photic phenomena, posterior capsule opacification (PCO), and spectacle independence in patients with bilateral implantation of the AcrySof® IQ PanOptix® multifocal IOL model TFNT00 at one and six months postoperatively. Methods: This prospective interventional cohort study included adult patients who underwent uneventful phacoemulsification cataract surgery with bilateral implantation of AcrySof® IQ PanOptix® IOL. Uncorrected and corrected visual acuities at far, intermediate, and near distances were measured preoperatively and at the one- and six-month postoperative follow-up examinations. The rates of photic phenomena, postoperative need for near and distance spectacles, and PCO were also recorded. Results: We included 164 eyes of 82 patients with a male-to-female ratio of 38 (46.3%) to 44 (53.7%) and a mean (standard deviation [SD]) age of 52.37 (7.62) years. There were statistically significant improvements in the visual acuities of both eyes across all distances at the one- and six-month follow-up examinations compared to the preoperative values (all P < 0.001), except for corrected near visual acuity in the right eye (P > 0.05) at six-month. We also detected significant postoperative improvements in visual acuities of both eyes across all distances at the six-month follow-up compared to values at the one-month follow-up (all P < 0.05), except for corrected near visual acuity in the right eye (P > 0.05). The photic phenomenon was reported by 12 (14.6%) of the 82 patients at the six-month postoperative follow-up. Five (6.1%) and eight (9.8%) of the 82 patients reported using spectacles for distance and near, respectively. Additionally, PCO developed in 19 (11.6%) of the 164 included eyes, although it was not clinically significant at six months. Conclusions: The AcrySof® IQ PanOptix® IOL model TFNT00 is recommended for use, given its excellent performance in all ranges of vision, a high rate of spectacle independence, and a good safety profile. Future comparative studies with longer follow-up periods are warranted to verify superiority of its performance over that of other available multifocal IOLs.

Comparison of Contemporary Surgical Indications for Revision Total Knee Arthroplasty between 2005-2011 and 2012-2017 in a Referral Center.

Background: Different causative factors for revision total knee arthroplasty (TKA) surgeries are elucidated in the arthroplasty registry data of different countries and the patient records at tertiary care centers. We aimed to determine the changes in the causes for revision TKAs before and after 2011 (The year that the Musculoskeletal Infection Society proposed a new definition for periprosthetic joint infection) and the changes in the demographics of patients who underwent revision TKAs during the same time intervals. Methods: Patients who underwent revision TKAs between 2004 and 2017 were evaluated. A total of 291 patients operated before (period 1, n = 139) and after (period 2, n = 152) 2011 were included, while 53 patients with inconclusive diagnoses were excluded. The demographic data of patients and the causes for revision TKAs were collected and compared between the two periods. Results: Infection was the most common cause of revision TKAs during periods 1 (58%) and 2 (48%). Aseptic loosening (46%) and infection (37%) were the 2 most common causes for late revisions during period 2. Aseptic loosening almost doubled during period 2 compared with that in period 1. Age, sex, and body mass index distribution in patients were similar across both the periods. Conclusion: Although the incidence of aseptic loosening has significantly increased since 2011, infection is still the most common cause for revision knee arthroplasty surgery.

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.

Foot orthoses use for pediatric flexible flatfoot: comparative evaluation of quality of life for children and parents.

This study aimed to comparatively evaluate the quality of life scores of patients with pediatric flexible flatfoot (PFF) according to the use of foot orthoses. We also aimed to compare quality of life scores of children and their parents. Nonobese children aged between 5 and 10 years old who were diagnosed as PFF according to physical and radiological examinations were included in this cross-sectional comparative study. All children and their parents completed the Turkish translation of Oxford ankle foot questionnaire (OxAFQ) which contains four domains (physical, school and play, emotional, and footwear). Patients were grouped according to the use of foot orthoses (group I: no foot orthoses group and group II: foot orthoses group). Comparison of OxAFQ scores demonstrated no significant differences between the two groups. However, the mean emotional scores of parents were significantly lower in group II (P = 0.007). In group I, the mean emotional score of children was significantly lower compared to their parents' scores (P = 0.001). In group II, the mean physical score of children was significantly lower compared to their parents' scores (P = 0.003). According to our results, we observed no significant difference in terms of quality of life scores between children using foot orthoses and not using foot orthoses. However, we observed significantly lower emotional scores in parents whose children were using foot orthoses. We recommend that physicians should be aware of low physical scores in children with PFF and should inform parents about this situation rather than considering foot orthoses to relieve parents' concern about foot deformity.

Clinical and radiographic outcomes of chitosan-glycerol phosphate/blood implant are similar with hyaluronic acid-based cell-free scaffold in the treatment of focal osteochondral lesions of the knee joint.

PURPOSE: To determine the clinical and radiographic efficacy of chitosan-glycerol phosphate/blood implant versus hyaluronic acid-based cell-free scaffold in patients with focal osteochondral lesion of the knee joint. METHODS: Clinical data of 46 patients surgically treated using either chitosan-glycerol phosphate/blood implant (25 patients, Group 1) or hyaluronic acid-based cell-free scaffold (21 patients, Group 2) in combination with microfracture were retrospectively evaluated. All lesions were Outerbridge grade III or IV with a mean lesion size of 3.3 ± 0.7 cm2. The mean follow-up time was 24.4 months. Visual analogue scale (VAS), Lysholm knee score, and Tegner activity scale were the instruments to evaluate the clinical status. Magnetic resonance observation of cartilage repair tissue (MOCART) system was used to analyze the characteristics of repair tissue. RESULTS: No significant differences were detected between the groups regarding VAS, Lysholm, and Tegner scores at any time interval during the whole follow-up. The mean post-operative VAS and Lysholm scores at the latest follow-up was significantly better in cases with the lesion size ≤ 3 cm2 in Group 1 (p = 0.001, p < 0.001, respectively). However, no significant differences according to the lesion size were detected in Group 2 (n.s.). Complete repair with the filling of the defect was achieved in 7 (28%) of the knees in Group 1 and it was 7 (33.3%) of the knees in Group 2 according to MOCART system at the latest follow-up. CONCLUSION: Single-stage regenerative cartilage surgery using chitosan-glycerol phosphate/blood implant combined to microfracture for focal osteochondral lesions of the knee revealed similar clinical and radiographic outcomes with hyaluronic acid-based cell-free scaffold at short-term follow-up. However, clinical outcomes of hyaluronan scaffold were less sensitive to defect size than chitosan. With the advantages of no hypertrophic repair tissue formation as well as no need to arthrotomy during surgery, chitosan is an effective choice especially in patients with the lesion size ≤ 3 cm2. LEVEL OF EVIDENCE: III.

The incidence and distribution of primary fibula tumors and tumor-like lesions: A 35-year experience.

PURPOSE: Primary bone tumors of the fibula are rare. There are only a few studies reporting the incidence, histologic, and anatomic distribution of primary fibula tumors. This study aimed to comprehensively report the incidence, presenting symptoms, and histologic tumor types with the anatomic and histologic distribution of primary bone tumors of the fibula. METHODS: Between January 1983 and December 2017, 6457 primary bone tumors and tumor-like lesions were diagnosed and treated in our musculoskeletal oncology surgery clinic. Of these, 264 (4.08%) were primary bone tumors and tumor-like lesions of the fibula. We retrospectively reviewed patients' records, histopathology records, and radiologic images regarding age, gender, anatomic localization, histopathologic diagnosis, and treatment methods. RESULTS: There were 209 (79.2%) benign and 55 (20.8%) malignant lesions. The most common benign and malignant tumors were osteochondroma (51 of 209; 24.4%) and chondrosarcoma (16 of 55; 29.1%). The proximal fibula was the most common location for both benign and malignant tumors (141 of 209; 67.5% and 45 of 55; 81.8%, respectively), followed by the distal fibula (52 of 209; 24.9% and 8 of 55; 14.5%, respectively) and the diaphysis (17 of 209; 8.14% and 2 of 55; 3.64%, respectively). CONCLUSION: The incidence of primary bone tumors is higher than that reported in previous studies. Benign lesions constitute the majority of cases. One-fifth of all cases are malignant. The most common anatomic site involving the primary fibula tumors is the proximal fibula. LEVEL OF EVIDENCE: III.

Predictive factors for early hospital readmission and 1-year mortality in elder patients following surgical treatment of a hip fracture.

BACKGROUND: Early hospital readmission after surgically treated hip fracture is a common entity, often involving an adverse event and causing strains on an already overburdened healthcare system. The main purposes of the present study were to determine the 30-day readmission rate, analyze the predictive factors for early hospital readmissions, and assess 1-year mortality following surgical treatment of hip fracture in elderly patients. Retrospective case-control study. METHODS: In total, 517 patients with a mean age of 74 years were evaluated. The rate of early readmission, age, gender, body mass index, fracture type, pre-fracture mobility status, preoperative time to surgery, American Society of Anesthesiologists score, implant type, postoperative intensive care unit stay, total length of postoperative hospital stay, comorbidities, and the main reasons for readmission were the criteria for data collection. Multivariate analysis was performed to determine the main predictors of early hospital readmission. Mortality within the first year after surgery was also assessed. RESULTS: A higher prevalence of chronic obstructive pulmonary disease, cardiac arrhythmia or ischemic heart disease, diabetes, and dementia or Parkinson's disease was detected in readmitted patients. Advanced age, American Society of Anesthesiologists (ASA) grade ≥3, postoperative intensive care unit (ICU) stay, and pre-existing cardiac arrhythmia or ischemic heart disease were identified as the main predictors. The 1-year mortality rate for the readmitted group was 53.9%, whereas it was 24% for those patients who were not readmitted. CONCLUSION: The readmission rate following surgical treatment of hip fracture in elder patients was 12%, and its main predictive factors were advanced age, ASA grade ≥3, postoperative ICU stay, and pre-existing cardiac arrhythmia or ischemic heart disease. Hospital readmission within the first 30-day period following initial discharge was significantly correlated with an increased 1-year mortality rate.

Can flexor tenosynovectomy and microsurgical epineurectomy improve clinical outcomes following open carpal tunnel release?

INTRODUCTION: The purpose of this study was to comparatively evaluate the clinical outcomes of open carpal tunnel release with or without flexor tenosynovectomy and epineurectomy for the treatment of idiopathic carpal tunnel syndrome. METHODS: In this prospective single-blinded study, 61 wrists of 47 patients randomized to open carpal tunnel release without (Group-1) or with (Group-2) flexor tenosynovectomy and microsurgical epineurectomy. Physical examination including Phalen and Tinel's signs, visible thenar atrophy, two-point discrimination, and grip strength measurement was performed. Visual Analogue Scale (VAS), Quick Disability of Arm Shoulder Hand (DASH) Questionnaire, Symptoms Severity Scale, Functional Status Scale, and electrophysiological study were assessed. RESULTS: The increase in the grip strength and Quick Disability of Arm Shoulder Hand Questionnaire score were significantly better in flexor tenosynovectomy and microsurgical epineurectomy group. The average pre-operative two-point discrimination was 6.3 ± 2 mm in Group-1 and 5.8 ± 1.7 mm in Group-2. Post-operatively at the end of 12 months, the mean two-point discrimination was measured as 5.9 ± 1.6 mm in Group-1 and 5.6 ± 1.3 mm in Group-2. When we compare the two groups according to the changes in VAS, Quick-DASH, symptoms severity scale, and functional status scale, only Quick-DASH score improvement was significantly better in Group-2 (p < 0.05). Improvements in VAS, symptoms severity scale, and functional status scale did not differ significantly. CONCLUSION: We do not recommend routine flexor tenosynovectomy and microsurgical epineurectomy during open carpal tunnel release in patients with idiopathic carpal tunnel syndrome.

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.

Results of Hyaluronic Acid-Based Cell-Free Scaffold Application in Combination With Microfracture for the Treatment of Osteochondral Lesions of the Knee: 2-Year Comparative Study.

PURPOSE: To determine the clinical and radiographic efficacy of hyaluronic acid-based cell-free scaffold applied in combination with microfracture versus microfracture alone in patients with focal osteochondral lesion of the knee joint. METHODS: Clinical data of 43 patients between 24 and 55 years of age were evaluated. Hyaluronic acid-based cell-free scaffold was applied in combination with microfracture for 19 knees (group 1), whereas microfracture alone was the surgical intervention for 24 knees (group 2). All lesions were Outerbridge grade III or IV with a mean size of 3.6 ± 1.3 cm2. The mean follow-up time was 25.7 months. Visual analog scale (VAS), Lysholm knee score, and Tegner activity scale were the instruments used to evaluate the clinical status. Magnetic resonance observation of cartilage repair tissue (MOCART) system was used to analyze the characteristics of repair tissue. RESULTS: Better VAS and Lysholm scores were detected in group 1 at 12 and 24 months (P = .019 and P = .025). According to the Tegner activity scale, group 1 had also better activity level at the end of 24 months after surgery (P = .020). The mean time from surgery to return to nonimpact sports activities was 7.8 months in group 1, whereas it was 9.2 months in group 2 (P = .013). Complete repair with the filling of the defect was achieved in 7 (36.8%) of the knees in group 1, whereas it was 4 (16.6%) of the knees in group 2 according to the MOCART system at 24 months. CONCLUSIONS: Single-stage regenerative cartilage surgery using hyaluronic acid-based cell-free scaffold in combination with microfracture for focal osteochondral lesions of the knee revealed promising clinical outcomes at 24 months of follow-up, but the clinical significance of the differences seen is simply not known. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Predictors of the Clinical Outcome After Arthroscopic Partial Meniscectomy for Acute Trauma-Related Symptomatic Medial Meniscal Tear in Patients More Than 60 Years of Age.

PURPOSE: To determine predictors of the clinical outcome after arthroscopic partial meniscectomy performed for acute trauma-related medial meniscal tear leading to mechanical symptoms in patients more than 60 years of age. METHODS: In this retrospective study with 4.1 years' follow-up, the clinical data of 154 arthroscopic partial medial meniscectomies were evaluated. The body mass index (BMI), duration of symptoms, the hip-knee-ankle angle, type of the meniscal tear, presence of any chondral lesions, degenerative changes in the patellofemoral joint, the status of the cruciate ligaments and lateral meniscus, and the presence of any plica or synovitis were the independent variables. Visual Analog Scale (VAS) and Lysholm Knee Scoring Scale were the instruments used as outcome measures. Multivariate analysis was performed to determine the major predictors. RESULTS: The mean VAS score for 154 knees evaluated in this study improved from 5.6 points preoperatively to 2.3 points at the latest follow-up. The mean Lysholm score improved from 43 points to 72.7 points. VAS and Lysholm scores at the latest follow-up were significantly worse in patients with a preoperative BMI ≥ 26 kg/m(2), hip-knee-ankle angle > 5°, grade III or IV chondral lesion of the medial compartment according to Outerbridge classification, degenerative changes in patellofemoral joint surfaces, and an anterior cruciate ligament that was either partially ruptured or degenerative with increased laxity. CONCLUSIONS: A preoperative BMI ≥ 26 kg/m(2), Outerbridge grade III or IV chondral lesion of the medial compartment of the operated knee joint diagnosed during arthroscopic intervention, degenerative changes in patellofemoral joint surfaces, and the presence of an anterior cruciate ligament either partially ruptured or degenerative with increased laxity should be considered as the major predictors of the clinical outcome after arthroscopic partial meniscectomy performed for acute trauma-related symptomatic medial meniscal tear in patients more than 60 years of age. LEVEL OF EVIDENCE: Level IV, prognostic case series.

Clinical and radiographic outcomes after femoral varus derotation osteotomy for Legg-Calvé-Perthes disease at 25 years follow-up: what are the determinants of outcome in the long term?

OBJECTIVE: The main purposes of the present study were to analyse the long-term clinical and radiographic results of femoral varus derotation osteotomy performed in a group of patients with the diagnosis of Legg-Calvé-Perthes (LCP) disease and to compare the effects of age, lateral pillar classification, radiographic stage according to Waldenström's classification, and the amount of varisation obtained on long-term results. DESIGN: The study group consisted of 21 hips. The mean postoperative follow-up time was 25.1 years. The effect of age at the time of surgery, preoperative lateral pillar classification, Waldenström's classification, and the amount of varisation on Merle d'Aubigne score, Stulberg class, and presence of degenerative arthritis of the hip joint were assessed at the final follow-up. RESULTS: Better clinical and radiographic outcomes were detected in patients operated younger than 10 years. The hips with lateral pillar group C involvement preoperatively were found to be significantly associated with worse clinical scores, worse radiographic outcome, and higher rate of degenerative arthritis. The overall rate of the hips with good radiologic outcome was 52.4%. 7 hips had degenerative arthritis at the final follow-up. CONCLUSIONS: Femoral varus derotation osteotomy revealed a congruent joint in half of the operated hips and arthritis-free hip joint in 2/3 at 25 years follow-up. Age at the time of surgery and preoperative lateral pillar classification were the main determinants of the radiographic outcome whereas the factors significantly correlated with progression to degenerative arthritis were determined preoperative lateral pillar classification and Stulberg group at maturity.

Pure elbow dislocation in the paediatric age group.

PURPOSE: The main purpose of the present study was to evaluate the clinical results and prognosis of pure elbow dislocations in the paediatric age group following non-surgical treatment. METHODS: Acute traumatic pure elbow dislocations treated between January 2008 and January 2013 were evaluated. The median age was eight years. The mean follow-up time was 46 months. Active and passive range of motion (ROM), elbow stability, neurovascular status, functional status and any early or late complications were evaluated and recorded at the latest follow-up. RESULTS: The mean flexion-extension ROM was measured as 119.5 degrees. The mean pronation and supination were 67 and 79 degrees. Moderate instability was diagnosed in four cases. The mean Mayo Elbow Performance Score (MEPS) score was 91.6 points; the clinical outcome was excellent in nine patients, good in two and fair in one. CONCLUSIONS: Acute traumatic pure elbow dislocation in childhood is a very rarely seen emergency that can be treated safely with closed reduction combined long-arm plaster splinting and physical rehabilitation.

Effects of total knee arthroplasty on ankle alignment in patients with varus gonarthrosis: Do we sacrifice ankle to the knee?

PURPOSE: Total knee arthroplasty is one of the most commonly preferred surgical methods in the treatment of patients with varus gonarthrosis. In this study, we aimed to evaluate the radiological changes observed in the ankles after total knee arthroplasty. METHODS: Between May 2012 and June 2013, 80 knees of 78 patients with varus deformity over 10° underwent total knee arthroplasty. For each patient, full-leg standing radiographs were obtained pre- and post-operatively. Mechanical and anatomical axes (HKA and AA), lateral distal femoral angle, medial proximal tibial angle, lateral distal tibial angle (LDTA), ankle joint line orientation angle (AJOA), tibial plafond talus angle (PTA) and talar shift were measured for each patient both pre- and post-operatively. RESULTS: Pre-operatively, the mean HKA was 16.6° and the mean AA was 10.41°, both in favour of varus alignment. Post-operatively, the mean HKA decreased to 3.6° and the mean AA to -2.1. The mean LDTA was 87.3°. Before the operation, the mean AJOA was -7.6°, opening to the medial aspect of the ankle, and it was 0.04° after the operation and opening to the lateral aspect (p < 0.05). CONCLUSION: Our study reveals the changes occurring in the ankle after acute correction of long-standing varus deformity of the knee using total knee arthroplasty. In cases undergoing knee arthroplasty, effect of the acute change in the alignment of the knee on the ankle should be taken into consideration and the amount of correction should be calculated carefully in order not to damage the alignment of the ankle. LEVEL OF EVIDENCE: IV.

Epidemiologic Properties of Pediatric Fractures in a Metropolitan Area of Turkey.

Occurrence of fractures is highly dependent on lifestyle. Domestic data should be used when needed. In this cross-sectional study, the authors aim to find the most recent distribution of pediatric fracture types and the attributes of fracture occurrence within a large sample size in a metropolitan area of Turkey.This study consists of 4879 pediatric age patients with a fracture who took advantage of the emergency service of a trauma center in a metropolitan area between March 2010 and December 2013 (1397 days). Date, hour, age, sex, fracture type, and social security status of the patients were studied.A total of 65% of the patients were men and 35% were women. A total of 81% of the fractures were in the upper extremities, whereas 19% of them were in the lower extremities. In 22 patients (0.5%), there were open fractures. Fractures showed some seasonal, daily, and circadian variations. Different types of fractures showed some specific patterns in different age groups. Ankle, elbow, and shoulder fractures were more common in girls, whereas wrist and forearm fractures were more in boys and the difference was statistically significant (P < 0.05).Fractures in pediatric ages vary depending on the age, sex, season, and the hour of the day. Types of fractures show some obvious patterns especially depending on the age. This data can be useful in making optimizations in fracture care units. Considering these specific patterns would enable more effective planning of providing preventive measures for pediatric injuries.

Isolated subtalar arthrodesis.

The aim of this study is to review the results of isolated subtalar arthrodesis in adults and to make a comparative analysis of the clinical outcomes between the patients with posttraumatic subtalar arthritis and the ones with other etiologic factors, and to evaluate the effects of grafting. This study included 19 men and 12 women. The mean postoperative follow-up was 36.8 months. The mean AOFAS hindfoot score improved from a mean of 46 preoperatively to a mean of 77.3 postoperatively. Thirty-one of 33 arthrodeses achieved bony union at a mean time of 15.7 weeks. The mean increase in the talocalcaneal height was 3.8 mm in the feet operated without grafting, whereas it was 8.1 mm in the feet for which grafting was performed. Improvement in talocalcaneal angle was significantly better in the feet operated with bone grafting. The feet with posttraumatic subtalar arthritis were more prone to Reflex Sympathetic Dystrophy.

Two-Stage Cementless Revision Total Hip Arthroplasty for Infected Primary Hip Arthroplasties.

The main purpose of the present study was to analyze the clinical features, the most common infective agents, and the results of two-stage total hip revision using a teicoplanin-impregnated spacer. Between January 2005 and July 2011, 41 patients were included. At the clinical status analysis, physical examination was performed, Harris hip score was noted, isolated microorganisms were recorded, and the radiographic evaluation was performed. The mean Harris hip score was improved from 38.9 ± 9.6 points to 81.8 ± 5.8 points (P<0.05). Infection was eradicated in 39 hips. Radiographic evidence of stability was noted in 37 acetabular revision components, and all femoral stems. Two-stage revision of the infected primary hip arthroplasty is a time-consuming but a reliable procedure with high rates of success.

Transverse Subtrochanteric Shortening Osteotomy During Cementless Total Hip Arthroplasty in Crowe Type-III or IV Developmental Dysplasia.

The purpose of this study was to review the outcomes of transverse subtrochanteric shortening osteotomy during cementless total hip arthroplasty in Crowe Type-III or IV developmental dysplasia. Seventy-three osteotomies were included in our study. Mean follow-up was 61 months. Harris hip score, leg length discrepancy, neurological status, union status of the osteotomy, and femoral component stability were the criteria for evaluation. All complications were noted. The mean Harris hip score improved from 38.6 points to 83.7 points. The mean leg length discrepancy decreased from 56.5 mm to 10.7 at the latest follow-up. The mean union time was 5.2 months. We observed 4 non-unions. Transverse subtrochanteric shortening osteotomy is an effective and reliable method in restoration of a more normal limb.

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.

Talectomy and tibiocalcaneal arthrodesis with intramedullary nail fixation for treatment of equinus deformity in adults.

BACKGROUND: Severe equinovarus foot deformity in adults is a challenging problem. Conservative treatment rarely is effective, and operative options are limited. The aim of this study was to evaluate the results of talectomy and tibiocalcaneal arthrodesis with intramedullary nail fixation for the treatment of severe equinovarus deformity in adults. METHODS: Twelve patients (average age 39 years, range 15-70 years) with severe equinovarus deformities of the foot were treated with talectomy and tibiocalcaneal arthrodesis with intramedullary nail fixation between March 2010 and February 2013. Average follow-up was 20 months (range 10-37 months). RESULTS: Tibiocalcaneal fusion was achieved in all patients at an average of 12 weeks (range 8-17 weeks). Preoperatively, all patients had severe, irreducible equinovarus deformities; at last follow-up, almost all feet had mild residual deformity, but were plantigrade and did not require a brace or orthosis. The average AOFAS ankle score improved from 41.1 (range 8-66) preoperatively to 78.4 (range 67-86) postoperatively (P = .02). There was a similar improvement in the average VAS score from 6.3 (range 2-10) preoperatively to 0.8 (range 0-4) postoperatively (P = .02). CONCLUSION: The combination of talectomy and tibiocalcaneal arthrodesis was effective in correcting severe rigid equinovarus deformity in adults. Removal of the talus resulted in laxity of the soft tissues, making correction of the deformity easier. Tibiocalcaneal arthrodesis achieved a stable foot without the problems associated with talectomy alone. LEVEL OF EVIDENCE: Level IV, case series.