Abdul Fettah Buyuk

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.

Detection of Normal Plantar Fascia Thickness in Adults via the Ultrasonographic Method

BACKGROUND Heel pain is a prevalent concern in orthopedic clinics, and there are numerous pathologic abnormalities that can cause heel pain. Plantar fasciitis is the most common cause of heel pain, and the plantar fascia thickens in this process. It has been found that thickening to greater than 4 mm in ultrasonographic measurements can be accepted as meaningful in diagnoses. Herein, we aimed to measure normal plantar fascia thickness in adults using ultrasonography. METHODS We used ultrasonography to measure the plantar fascia thickness of 156 healthy adults in both feet between April 1, 2011, and June 30, 2011. These adults had no previous heel pain. The 156 participants comprised 88 women (56.4%) and 68 men (43.6%) (mean age, 37.9 years; range, 18-65 years). The weight, height, and body mass index of the participants were recorded, and statistical analyses were conducted. RESULTS The mean ± SD (range) plantar fascia thickness measurements for subgroups of the sample were as follows: 3.284 ± 0.56 mm (2.4-5.1 mm) for male right feet, 3.3 ± 0.55 mm (2.5-5.0 mm) for male left feet, 2.842 ± 0.42 mm (1.8-4.1 mm) for female right feet, and 2.8 ± 0.44 mm (1.8-4.3 mm) for female left feet. The overall mean ± SD (range) thickness for the right foot was 3.035 ± 0.53 mm (1.8-5.1 mm) and for the left foot was 3.053 ± 0.54 mm (1.8-5.0 mm). There was a statistically significant and positive correlation between plantar fascia thickness and participant age, weight, height, and body mass index. CONCLUSIONS The plantar fascia thickness of adults without heel pain was measured to be less than 4 mm in most participants (~92%). There was no statistically significant difference between the thickness of the right and left foot plantar fascia.

Sacral agenesis: evaluation of accompanying pathologies in 38 cases, with analysis of long-term outcomes.

PurposeSacral agenesis (SA), or caudal regression syndrome, is a congenital malformation of the spine of varying degree of severity. The aim of our study was to identify associated impairments in structure and function of the orthopedic, neurological, cardiopulmonary, genitourinary, and gastrointestinal systems, and to evaluate their impact on function.MethodsThis was a retrospective case series analysis of 38 patients with SA. Patients were divided into two groups: SA with myelomeningocele (group 1) and without myelomeningocele (group 2). Between-group comparisons in terms of the features of the SA, impairments in associated systems, impact on gross motor function, need for surgery, and association with prenatal screening and maternal gestational diabetes were evaluated.ResultsThe majority of comorbidities were orthopedic and neurological in nature. Impairments in sphincter control and independent transferring were more prevalent in group 1, resulting in lower function. Scoliosis, kyphosis, and hip dislocation/subluxation were the most common orthopedic problems, with a higher prevalence of kyphosis in group 1. The requirement for neurosurgery was significantly higher in group 1.ConclusionsOrthopedic and neurological comorbidities are commonly associated with SA and are more prevalent in the presence of a myelomeningocele. As the impairments impact a child’s ability for maximum function, early identification and intervention is required to correct or ameliorate the impairment.Level of Evidence: Level IV.

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.

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

Abstract 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.

Art in Science: Jusepe de Riberaʼs Puzzle in The Clubfoot

T hrough a careful inventory of the objective anatomical features portrayed by Jusepe de Ribera in his 1642 painting entitled The Clubfoot, Abdulhamit Misir MD and his team propose this young beggar may have had poliomyelitis. Whether this new interpretation of the image is correct remains lost to the centuries, but the process of reexamining the many potential clues to diagnosis embedded in this painting is commendable. Kudos also to the artist, who presumably recorded the findings depicted herein with accuracy, even in the absence of fully understanding the significance of these observations. Honesty, objectivity, and rigor are at the heart of exceptional physical diagnosis. If the authors have arrived at the correct diagnosis, based upon their contemporary interpretation of a nearly 400year-old painting, then we have an exciting addition to the history of a disease (poliomyelitis in this instance) that can now be traced well before it was described in the medical literature. —Gary E. Friedlaender MD, Linda K. Friedlaender BA, MS