Bora Bostan

Antioxidant Effects of Propofol on Tourniquet-Induced Ischemia-Reperfusion Injury: An Experimental Study

PURPOSE This experimental study aimed to investigate the antioxidant effects of propofol anesthesia at induction doses in a rat skeletal muscle ischemia/reperfusion injury model. METHODS Twenty-six rats were randomly divided into three groups to receive one of the following interventions: sham operation (n = 6), ischemia/reperfusion (I/R) injury (n = 10), or propofol administration in addition to I/R injury (n = 10). I/R injury was attained by 2-h clamping of femoral artery followed by 3-h perfusion. Then blood and tissue samples were collected for biochemical analysis and histopathologic examination. Glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) enzyme activities and nitric oxide (NO) and malondialdehyde (MDA) levels were measured in both plasma and muscle tissue. In addition, catalase (CAT) activity and protein carbonyl (PC) content were measured in muscle tissue. RESULTS I/R group had significantly higher SOD activity (9.05 versus 5.63 and 6.18 U/mL, P < 0.05) and NO level (46.77 versus 30.62 and 33.90 μmol/L, P < 0.05) compared with sham-operated group and I/R plus propofol group. In addition, GSH-Px activity of the I/R group was significantly higher than sham-operated group (1.26 versus 1.05 U/mL, P < 0.05). I/R group had significantly higher tissue activities of CAT (0.11 versus 0.06 and 0.04 k/g protein, P < 0.05) and SOD (0.12 versus 0.08 and 0.07 U/mg protein, P < 0.05) compared with the sham and I/R plus propofol group. Histopathologic examination showed that I/R plus propofol group had significantly lower degeneration (P = 0.021) and inflammation (P = 0.028) scores compared with I/R group. CONCLUSION Propofol anesthesia seems to enhance the antioxidant capacity against tourniquet induced ischemia-reperfusion injury.

Comparison of intra-articular hyaluronic acid injections and mud-pack therapy in the treatment of knee osteoarthritis

OBJECTIVES Conservative treatment should be tried prior to surgical treatment in knee osteoarthritis. This study was designed to evaluate the short-term effects of mud-pack therapy on pain relief and functional improvement in knee osteoarthritis in comparison with intra-articular hyaluronic acid injections. METHODS The study included 23 patients who were diagnosed as having knee osteoarthritis according to the ACR (American College of Rheumatology) criteria, and had complaints lasting for more than three months. All the patients had stage 2 or 3 osteoarthritis radiographically according to the Kellgren-Lawrence criteria. Twelve patients (3 males, 9 females; mean age 54+/-6 years; range 46 to 67 years) received mud therapy bilaterally. Mud packs were heated to 45 degrees C and applied on both knees for 30 minutes daily for a total of 12 weekdays. Eleven patients (2 males, 9 females; mean age 53+/-9 years; range 40 to 66 years) received a total of three bilateral intra-articular hyaluronic acid injections, each interspersed by weekly intervals. The patients were evaluated before and after treatment in terms of pain and functionality using the pain subscale of the WOMAC (Western Ontario and McMaster Universities) osteoarthritis index, Hospital for Special Surgery (HSS) score, and Knee Society clinical rating system (knee and function scores). The patients were followed-up for a mean of 5.9+/-6.3 months (range 4 to 8 months) after mud-pack therapy, and 5.8+/-0.8 months (range 5 to 7 months) after intra-articular hyaluronic acid injections. RESULTS No significant differences were found between the two groups with respect to pre-and posttreatment WOMAC, HSS, and knee and function scores (p>0.05). The scores of all instruments showed significant improvements following treatment in both groups (p<0.001). Posttreatment changes in relation to baseline scores did not differ significantly between the two groups (p>0.05). CONCLUSION Treatment of knee osteoarthritis with intra-articular hyaluronic acid injections or mud-pack therapy yielded similar results in the short-term in terms of functional improvement and pain relief. Mud-pack therapy is a noninvasive, complication-free, and cost-effective alternative modality for the conservative treatment of knee osteoarthritis.

A biomechanical comparison of polymethylmethacrylate-reinforced and expansive pedicle screws in pedicle-screw revisions

OBJECTIVES Different techniques and choices exist for revision of pedicle screws, two of which are pedicle screw combined with cement augmentation and expansive pedicle screw fixation. This biomechanical study was designed to compare the pullout strengths of two different revision techniques. METHODS Fourteen lumbar vertebrae obtained from four calves (mean age 15 months) were divided into two groups equal in number. Monoaxial 6.0-mm pedicle screws were inserted into the right pedicles, and axial pullout testing was performed at a rate of 10 mm/min and failure strengths were recorded. Revision was performed with the same-sized pedicle screws reinforced with polymethylmethacrylate in group 1, and with 7.0-mm expansive pedicle screws in group 2, and pullout testing was repeated to record maximum revision pullout strengths. RESULTS The mean pullout strengths recorded before and after revision were significantly different in both groups, being 2,162.9+/-718.5 N and 2,794.3+/-979.2 N in group 1 (p=0.041) and 2,605.0+/-487.6 N and 3,327.1+/-640.8 N in group 2 (p=0.012), respectively. However, the mean pullout strengths recorded before and after revision did not differ significantly between the two groups (p>0.05). CONCLUSION Our results showed that expansive pedicle screws 1 mm larger in diameter provide similar pullout strengths to those of same-sized, polymethylmethacrylate-reinforced screws in revision of pedicle screw fixation, suggesting that they can be preferred with the additional advantages of ease of application and avoiding risks for pedicle fracture and cement leakage.

Arthroscopic excision of the osteoid osteoma at the distal femur

Osteoid osteoma is a benign, osteoblastic and painful tumoral lesion. Apart from en-bloc resection, intralesional resection and percutaneous excision or destruction of the nidus, arthroscopic removal of the lesion in intraarticular locations have been reported. We present a patient with osteoid osteoma at distal femur which is accessible through knee joint, treated by arthroscopic complete excision.

Simvastatin improves spinal fusion in rats

OBJECTIVE Statins stimulate bone formation by inducing the expression of bone morphogenetic proteins (BMP-2). The aim of our study was to investigate the effects of orally administered simvastatin on spinal fusion in rats. METHODS Twenty rats were randomized into a spinal fusion group (SF) (n=10) or a spinal fusion and oral simvastatin administered group (SFS) (n=10). A spinal fusion was performed between L4-L6 representing two levels. Simvastatin (120 mg/kg/day) was administered orally in the SFS group. The rats were killed at the end of the 12 week study period. RESULTS Manual palpation revealed two moderate fusions in the SF group. The SFS group did not reveal any signs of pseudoarthrosis. An average three-point bending force causing failure of fusion revealed results of 148.80±39.403 Newtons and 123.80±28.479 Newtons in SFS and SF groups, respectively (p>0.05). Histological examination revealed better fusion grades in the SFS group (mean: 9.30±0.949) than in the SF group (mean: 6.80±2.044) (p=0.003). Radiographic examination revealed Grade C fusion in two levels and Grade A fusion in 18 levels in the SF group. In the SFS group, Grade C fusion was detected in one level and Grade A fusions in 19. CONCLUSION Our results suggest that simvastatin can promote spinal fusion and can be used as an adjunct to spinal fusion procedures in an elderly population with high cholesterol levels.

Minimal invasive midvastus versus standard parapatellar approach in total knee arthroplasty

OBJECTIVE The aim of this study was to compare the short-term results of total knee arthroplasty (TKA) surgeries performed with minimally invasive mini-midvastus (MMV) incision and the standard medial parapatellar technique (ST). METHODS Twenty patients (18 males, 2 females; mean age: 67.25±6.70) operated with the ST and 19 patients (4 males, 15 females; mean age: 64.53±7.53) operated with the MMV approach were retrospectively evaluated. The surgery time, blood loss, time to straight leg raise (SLR) postoperatively, range of motion (ROM) and Knee Society (KSS) score and Hospital for Special Surgery (HSS) score were compared between the groups. Radiological evaluation was made with standing orthoroentgenographs both pre- and postoperatively. Mean follow-up time was 29.4±8.2 months in the ST and 17.7±11.1 months in the MMV group. RESULTS In the early postoperative period (10th day), the MMV group was significantly better than the ST group in terms of ROM. Time to SLR and blood loss values were also significantly better in the MMV group. However, there was no significant difference between the groups after the sixth month, for ROM, KSS and HSS values (p>0.05). Surgery time was significantly longer (with a mean difference of 22 minutes) in the MMV group. Radiological examination revealed ideal alignment in both groups. No deep or superficial infection was detected. Two patients in the MMV group had skin problems which healed after clinical follow-up. CONCLUSION Our results suggested that functional results of TKAs performed via the MMV approach are better in the first six months when compared to those of the ST.

Osteoid Osteoma of the Trapezium: Case Report

Osteoid osteoma is a benign bone tumor representing approximately 10% of all benign bone tumors. Although osteoid osteoma of the long bones and carpus is frequent, the location in the trapezium is extremely rare. We found only one other report in the literature regarding osteoid osteoma of the trapezium.

Total hip arthroplasty using the anterolateral minimally invasive approach

OBJECTIVES We evaluated the clinical and radiographic results of total hip arthroplasties (THA) performed with the minimally invasive anterolateral (MIA) and standard anterolateral (SA) approaches. METHODS We retrospectively reviewed 25 patients (17 women, 8 men; mean age 57.7+/-12.5 years) and 15 patients (11 women, 4 men; mean age 68.9+/-5.5 years) who underwent THA with the SA and MIA approaches, respectively. The mean body mass index was 32.5+/-5.8 kg/m2 in the SA group and 28.7+/-2.7 kg/m2 in the MIA group. The two groups were compared with respect to blood loss, operation time, blood transfusions, and length of hospital stay. Pain was assessed with a visual analog scale (VAS), and functional results were assessed with the Harris hip score (HHS). The SF-36 questionnaire was administered pre- and postoperatively. Radiographic evaluations included femoral and acetabular components and signs of loosening. The mean follow-up was 25.2+/-8.7 months in the SA group and 26.1+/-7.2 months in the MIA group. RESULTS The amount of blood loss and blood transfusions were significantly reduced and length of hospital stay was significantly shorter in the MIA group (p<0.001). The mean operation time did not differ between the two groups (p>0.05). Improvements in the VAS and HHS scores were significantly better in the MIA group (p<0.001). Similarly, improvements in all the SF-36 subscales other than general health, mental health, and role-physical subscales were significantly greater in the MIA group. Radiographically, no signs of loosening and osteolysis were seen. Superficial or deep wound infections did not occur. CONCLUSION Compared to the SA approach, the MIA approach in THA operations is associated with shorter hospital stay, reduced blood loss and blood transfusions, better postoperative pain control, and higher levels of improvements in HHS and SF-36 scores.

Intraarticular Hyaluronic Acid Injection after Microfracture Technique for the Management of Full-Thickness Cartilage Defects Does Not Improve the Quality of Repair Tissue

Objective: Tissue repair that occurs after microfracture does not include hyaline-like cartilage. Therefore, other treatment modalities must be combined with microfracture to improve repair tissue quality. In this study, we combined exogenous hyaluronic acid with microfracture. Design: Thirty mature New Zealand rabbits were randomly divided into 3 groups as control, microfracture (MF), and microfracture and hyaluronic acid (MFHA). Four-millimetre full-thickness cartilage defects were created in the medial femoral condyle of each rabbit. Microfracture was performed on defects in the MF and MFHA groups. At 1 week following surgery, 1 mL of saline was injected into the knees of the control and MF groups, whereas 1 mL (15 mg/mL) hyaluronic acid was injected into the knees of the MFHA group 3 times weekly. At 6 months postsurgery, defects were evaluated according to the ICRS (International Cartilage Repair Society) and Wakitani scales. Results: According to the ICRS and Wakitani scales, the quality of repair tissue was improved in MF and MFHA groups as compared the control group (P = 0.001 and 0.001, respectively). No significant difference was observed between the MF and MFHA groups (P = 0.342). Conclusions: According to the model in this study, no beneficial effect was obtained when HA injection was combined with microfracture in the treatment of full-thickness cartilage defects.

[Joint immobilization increases reactive oxygen species: an experimental study].

OBJECTIVES It has been shown that reactive oxygen species (ROS) contribute to the onset and progression of osteoarthritis. We investigated cartilage destruction and oxidative stress parameters in the blood and synovial fluid of knee joints of rabbits exposed to varying periods of immobilization. METHODS Twenty-eight mature New Zealand albino male rabbits were divided into four groups equal in number. In three groups, the knees were immobilized with a rigid cast for 3, 6 and 9 weeks, respectively. The cartilaginous tissue of the femoral condyles and tibial plateau were analyzed with respect to total count, total volume, and numerical density of chondrocytes using stereohistological methods. Antioxidant activities of superoxide dismutase (SOD), catalase (CAT), and glutathion peroxidase (GSH-Px), and oxidative stress parameters including nitric oxide (NO) and malondialdehyde (MDA) levels were measured in the plasma and synovial fluid. RESULTS Compared to the control group, total count and total volume of chondrocytes in the femoral condyle and tibial plateau showed significant decreases, while numerical density showed a significant increase at 3 weeks of immobilization. Subsequent immobilization periods resulted in significant decreases in all these parameters, being most remarkable compared to the control group at the end of nine weeks (p<0.001). In plasma and knee joint synovial fluid, all antioxidant enzyme activities (SOD, CAT, and GSH-Px) and oxidative stress parameters (NO and MDA) showed consistent increases compared to the control group throughout the immobilization period (p<0.001). CONCLUSION Increased levels of ROS in the blood and synovial fluid might result in cartilage destruction and ROS may be one of the potential factors involved in the etiopathogenesis of osteoarthritis. Prolonged joint immobilization should be avoided in the treatment of orthopedic diseases.