Burak Akan

Cemented versus Uncemented Oxford Unicompartmental Knee Arthroplasty: Is There a Difference?

Purpose. The use of uncemented unicompartmental knee prostheses has recently increased. However, few studies on the outcomes of uncemented unicompartmental knee prostheses have been performed. The purpose of this study was to compare the outcomes of cemented and uncemented Oxford unicompartmental knee arthroplasty. Materials and Methods. This retrospective observational study evaluated the clinical and radiological outcomes of 263 medial Oxford unicompartmental prostheses (141 cemented, 122 uncemented) implanted in 235 patients. The mean follow-up was 42 months in the cemented group and 30 months in the uncemented group. Results. At the last follow-up, there were no significant differences in the clinical results or survival rates between the two groups. However, the operation time in the uncemented unicompartmental knee arthroplasty group was shorter than that in the cemented unicompartmental knee arthroplasty group. In addition, the cost of uncemented arthroplasty was greater. Conclusion. Despite the successful midterm results in the uncemented unicompartmental knee arthroplasty group, a longer follow-up period is required to determine the best fixation mode.

Does thromboprophylaxis prevent venous thromboembolism after major orthopedic surgery

OBJECTIVE: Pulmonary embolism (PE) is an important complication of major orthopedic surgery. The aim of this study was to evaluate the incidence of venous thromboembolism (VTE) and factors influencing the development of VTE in patients undergoing major orthopedic surgery in a university hospital. METHODS: Patients who underwent major orthopedic surgery (hip arthroplasty, knee arthroplasty, or femur fracture repair) between February of 2006 and June of 2012 were retrospectively included in the study. The incidences of PE and deep vein thrombosis (DVT) were evaluated, as were the factors influencing their development, such as type of operation, age, and comorbidities. RESULTS: We reviewed the medical records of 1,306 patients. The proportions of knee arthroplasty, hip arthroplasty, and femur fracture repair were 63.4%, 29.9%, and 6.7%, respectively. The cumulative incidence of PE and DVT in patients undergoing major orthopedic surgery was 1.99% and 2.22%, respectively. Most of the patients presented with PE and DVT (61.5% and 72.4%, respectively) within the first 72 h after surgery. Patients undergoing femur fracture repair, those aged ≥ 65 years, and bedridden patients were at a higher risk for developing VTE. CONCLUSIONS: Our results show that VTE was a significant complication of major orthopedic surgery, despite the use of thromboprophylaxis. Clinicians should be aware of VTE, especially during the perioperative period and in bedridden, elderly patients (≥ 65 years of age).

Two cases with HSS/DRESS syndrome developing after prosthetic joint surgery: does vancomycin-laden bone cement play a role in this syndrome?

We report two cases of hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (HSS/DRESS) syndrome following systemic and local (via antibiotic laden bone cement (ALBC)) exposures to vancomycin. Both cases developed symptoms 2–4 weeks after the initiation of treatment. They responded to systemic corticosteroid treatment and were cured completely. Various drug groups may cause HSS/DRESS syndrome, and vancomycin-related cases do not exceed 2–5% of the reported cases. Almost all of these cases developed the syndrome following systemic exposure to vancomycin. ALBC seems to be the safer antibiotic administration method, as systemic antibiotic levels did not reach a toxic threshold level. However, local administration may not always be sufficient for bone–related/joint–related infections; these infections may require systemic antibiotics as well. As HSS/DRESS syndrome can mimic infectious diseases, it must be considered during differential diagnosis before suspecting failure of treatment and initiation of a different antibiotic course.

The effect of adding dexmedetomidine to levobupivacaine for interscalene block for postoperative pain management after arthroscopic shoulder surgery.

Objective:Arthroscopic subacromial decompression may cause substantial postoperative pain. We undertook a randomized controlled trial to examine whether adding dexmedetomidine to the local anesthetic in an interscalene brachial plexus block and subsequent patient-controlled interscalene analgesia (PCIA) regime improved postoperative pain scores, patient satisfaction, rescue analgesic requirement, and local anesthetic consumption. Methods:A total of 48 patients aged between 18 and 65 years undergoing arthroscopic subacromial decompression were enrolled and randomized into 1 of the 2 groups. Group L (n=25) received levobupivacaine and epinephrine, whereas Group LD (n=23) received levobupivacaine, epinephrine, and dexmedetomidine through an interscalene catheter. Four hours after surgery, a PCIA regime was commenced. In Group L patients were administered levobupivacaine and in Group LD levobupivacaine and dexmedetomidine. Demographic and hemodynamic data, duration of motor and sensory blocks, pain VAS, side effects, PCIA demand and delivery values, consumption of lornoxicam as a rescue analgesic, and patient satisfaction were recorded for 24 hours after surgery. Results:PCIA demand and delivery, and pain VAS values were significantly lower, and patient satisfaction was significantly higher in the dexmedetomidine group (P=0.004, 0.001, 0.004, and 0.002, respectively). The side effect profile was similar between the groups. Levobupivacaine consumption was significantly lower in Group LD (P=0.009). In the first 24 postoperative hours, Group LD consumed significantly less lornoxicam (P=0.01). Discussion:Addition of dexmedetomidine to levobupivacaine for interscalene brachial plexus block decreases pain scores and increases patient satisfaction after arthroscopic subacromial decompression.

Outcomes for revision total knee replacement after unicompartmental knee replacement

OBJECTIVE The aim of this retrospective, observational study was to describe the outcomes of total knee replacement (TKR) after failed Oxford phase 3 medial unicompartmental knee replacement (UKR). METHODS The study included 24 revision TKRs (20 females, 4 males; mean age: 61 years) performed following failed aseptic UKR. Outcomes were assessed using the Knee Society Score (KSS). RESULTS The most common causes for revision were mobile bearing dislocation and unexplained pain. Mean preoperative KSS was 50.3 (range: 37 to 66) and 82.2 (range: 58 to 97) after TKR. There were 17 excellent, 4 good, 2 fair and 1 poor results. CONCLUSION The type of UKR performed (cemented versus uncemented) had no effect on TKR success. Revision for failed UKR with TKR appears to be a technically straightforward procedure with satisfactory early clinical results.

Medial femoral condyle fracture after cementless unicompartmental knee replacement: A rare complication

This case report describes a rare complication of unicompartmental knee arthroplasty. Femoral fracture after TKR is a serious and relatively common problem, but to the best of our knowledge, only one case of femoral condylar fracture after UKA has been reported thus far.

Dorsal Dislocation of the Intermediate Cuneiform with a Medial Cuneiform Fracture: A Case Report and Review of the Literature

Dorsal dislocation of the intermediate cuneiform and isolated medial cuneiform fractures are rare injuries. In this report, we present a patient who sustained a dislocation of the intermediate cuneiform and describe predisposing factors and the treatment procedure.

Cementless total hip arthroplasty in developmental dysplasia of the hip with end stage osteoarthritis: 2-7 years' clinical results.

Between 2006 and 2011, 102 hips of 78 patients with end-stage osteoarthritis secondary to developmental dysplasia of the hip (DDH) underwent cementless total hip arthroplasty (THA). According to the Crowes classification, 22 hips (21%) were type 1, 19 hips (18%) were type 2, 22 hips (21%) were type 3 and 39 hips (38%) were type 4 respectively. Functional and clinical analyses were performed by Harris Hip Scores (HHS). There were 73 (71%) excellent or good results according to HHS. The postoperative HHS was significantly lower in patients who underwent femoral shortening (p<0.01). We observed 25 (24.5%) complications in total, 15 (14.7%) of which required revision surgery. The authors concluded that THA for DDH is a safe and a reliable procedure with good clinical outcomes.

Arthroscopic Repair of Horizontal Meniscus Tears by Vertical Sutures With Packing Technique

Objectives: The aim of this study is to report short term results of arthroscopic repair of horizontal meniscus tears by vertical sutures with packing technique Methods: Seventeen patients with an average age of 33 years were treated. Repair was performed to the patients that horizontal component of the tear extends into the capsular zone of the meniscus after excision of the unstable, central or flap components of the tears. The repair was performed after rasping and trephination, with vertical sutures that one leg of the suture is on the superior surface of the menisci and the other leg of the suture is under the inferior surface of the menisci by inside-out technique using the zone-specific curved canulas and all-inside technique using all inside meniscal devices. 9 medial and 8 lateral meniscus tears were treated. Results: Evaluation was performed by Lysholm functional knee scores. All patients were followed clinically and radiological by means of MRI to assess meniscus integrity at the repair site with an average follow-up of 12 months. MRI showed a healed meniscus at the repair sites in only five cases (29%) but with no further disruption of the tear components and osteoarthritic changes in all cases. Mean of Lysholm scores improved from 58 preoperatively to 92 postoperatively that was found statistically significant. Conclusion: Repairing of horizontal meniscus tears that extend into capsular zone instead of resection improves activity level and prevents meniscal loss.

Is balloon osteoplasty attractive or questionable treatment for Hill-Sachs lesion?

Dear Editor, We have read the article “Balloon osteoplasty—a new technique for minimally invasive reduction and stabilisation of Hill-Sachs lesions of the humeral head: a cadaver study” by Sandmann et al. [1] with great interest. Hill-Sachs lesion treatment is very difficult regarding its widespread approaches. Too many treatment protocols can be found in current literature with different success rates. The balloon-osteoplasty technique may be seen as attractive, but we have many questions to the authors about this technique. We use balloon osteoplasty for fresh spinal compression fracture. If compression healed with fibrosis, balloon strength is not sufficient for restoration. Short tau inversion recovery (STIR) sequence is very sensitive for detecting vertebral oedema following fresh fractures or micro-fractures [2]. This study was performed on cadaveric bone and all fractures created manually and were therefore fresh. This is not the case with old Hill-Sachs fractures, which is why it is not so easy to restore height in Hill-Sachs lesions. Violatin might cause joint fracture and leakage to occur into the joint space. Is this technique effective for all kinds of Hill-Sachs lesions? Other technical complications from the inappropriate placement of instruments during balloon osteoplasty have resulted in a breach of the joint and inadvertent leakage of cement into the spinal canal. Your instruments were modified; thus, is the entrance point the same for all patients? And is one modified instrument sufficient for all kinds of Hill-Sachs lesions? What is the time of exposure to radiation? Is the modified instrument cost high? What is the ideal amount of augmentation necessary to restore a desirable degree of local strength and stiffness?