Deniz Cankaya

Blood Loss and Transfusion Rates in the Revision of Unicompartmental Knee Arthroplasty to Total Knee Arthroplasty Are Similar to Those of Primary Total Knee Arthroplasty But Are Lower Compared With the Revision Total Knee Arthroplasty

A total of 42 patients revised from unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) were matched with 40 aseptic patients, including both component revision TKA and 88 primary TKA patients. The hemoglobin and hematocrit levels of each patient were screened preoperatively and postoperatively. There were no statistically significant differences in the postoperative hemoglobin or hematocrit levels, calculated blood loss, or blood transfusion rates between the revision UKA and primary TKA groups, whereas the hemoglobin (P = .010) and hematocrit (P = .015) levels were lower and the calculated blood loss (P = .034) and blood transfusion rates (P = .031) were higher in the revision TKA group. Revision of a failed UKA is more similar to primary TKA with respect to blood loss and transfusion rate.

The combined use of oral and topical tranexamic acid is a safe, efficient and low-cost method in reducing blood loss and transfusion rates in total knee arthroplasty

Aims: The combined (IV (intravenous) + topical) use of tranexamic acid (TXA) has been shown to be a safe method and more effective than single (IV or topical) application. The optimal administration method of TXA is still being investigated and safety, efficiency and cost are the three main crucial parameters in achieving the best administration method. We aimed to determine whether combined (oral + topical) use of TXA reduced blood loss and transfusion rates more than single (topical) administration in TKA and whether oral + topical use is as safe and efficient as the IV + topical use, in addition to the main advantage of relatively low cost. Methods: In this prospective, randomized study, 100 patients were randomly assigned to either the topical TXA group or the combined (oral + topical) TXA group. There were no significant differences between the groups in age, body mass index or gender. The haemoglobin and haematocrit levels of each patient were recorded preoperatively and on post-operative days 0, 1, 2 and 3. The post-operative suction drainage and blood transfusion volumes were also recorded. Results: There were statistically significant differences between the groups in haemoglobin and haematocrit levels on post-operative days 0, 1, 2 and 3 (p < 0.05) in favour of the combined group. The post-operative drainage amounts (p = 0.0001), measured blood loss volume (p = 0.003) and transfusion rates (p = 0.03) were lower in the combined (oral + topical) group compared to the topical group. Conclusions: Of the different methods of TXA administration, the combined use of oral and topical TXA is a safe, efficient and low-cost method in reducing blood loss and transfusion rates after TKA.

The impact of joint line restoration on functional results after hinged knee prosthesis.

Background: Hinged knee prosthesis is an effective treatment method as a salvage procedure in marked ligamentous insufficiency and severe bone defects. Joint line determination and restoration are difficult due to large bone defects and distorted anatomy. We evaluated the impact of joint line alteration on the outcome in rotating hinge knee arthroplasty (RHKA). Materials and Methods: 35 patients who had rotating hinged knee prosthesis applied between 2008 and 2013 were evaluated in this retrospective study. The patients were studied radiologically and clinically. Five patients were lost to followup and two patients died, leaving a total of 28 (7 male, 21 female) patients for final evaluation. The average age of the patients was 66.19 ± 8.35 years (range 52–83 years). The patients were evaluated clinically with Knee Society knee and functional score and patellar score. The joint line positions were evaluated radiographically with femoral epicondylar ratio method. The outcomes were also evaluated according to age, body weight and gender. Students t-test, independent t-test, and the Wilcoxon signed rank test were used in the statistical analysis. Results: The mean Knee Society knee and functional score significantly improved from preoperative 19.52 ± 11.77 and 12.5 ± 15.66 respectively to 72.46 ± 14.01 and 70.36 ± 9.22 respectively postoperatively (P < 0.001). The mean range of motion of the knee improved from 55.95° ± 25.08° preoperatively to 92.14° ± 13.47° postoperatively (P < 0.001). Joint line position was restored in 20 patients (71.4%). Joint line alteration did not affect Knee Society Scores (KSSs) in contrast to patellar scores. Additionally, KSS was better in the patients with body mass index ≤30 at followup (P = 0.022 and P = 0.045). Conclusion: RHKA is an effective salvage procedure for serious instability and large bone defects. Restoration of the joint line improves the patellar score although it had no effect on the clinical outcome.

COMBINED INSIDE-OUT AND ALL-INSIDE TECHNIQUE IN BUCKET-HANDLE MENISCUS TEARS

ABSTRACT Objective: To determine the outcomes after combined inside-out and all-inside repair technique of bucket-handle meniscus tears. Methods: A retrospective review was made of patients with bucket-handle meniscus tears repaired with combined techniques, using the all-inside technique in posterior meniscal tears and the inside-out technique in the middle part of the meniscal tears. Meniscal healing was assessed clinically using Barretts criteria and MRI. Results: The study comprised 52 patients with a mean age of 28.4 years old (range, 19-52 years old). The mean follow-up period was 31.3 months (range, 24-59 months). Two patients had ACL re-rupture, and complete meniscal healing was achieved in all but one patient. Although improved from preoperative status, Tegner and Lysholm scores were lower in the ACL reconstructed patients than in the intact ACL patients. Conclusion: Combined inside-out and all-inside meniscal repair technique is a successful and cost-effective treatment method in bucket-handle meniscus tears. Level of Evidence IV, Therapeutic Study.

Are metric parameters sufficient alone in evaluation of the patellar instability? New angular measuring parameters: The trochlear groove–patellar tendon angle and the trochlear groove–dome angle

Purposes: When the evaluation of patellar instability is examined from the aspect of the conical-cylindrical anatomy of the tibia, metric measurement parameters such as the tuberositas tibia (TT)–trochlear groove (TG) and patellar tendon (PT) insertion–trochlear groove (TG) distances are not sufficient. We asked whether defined angular parameters reveal the rotational movement of the tuberositas tibia on the tibia shaft, additional to the metric parameters and there is a correlation between the metric and angular parameters. Methods: 19 patients with patellar instability and 22 patients without patellar instability were evaluated. For all patients, two angle and three length parameters were evaluated on the slices taken. Evaluations were made of the TT-TG, the midpoint of the PT insertion-TG distances, the anatomic midpoint of the dome of the TT-TG, the TG-PT angle, and the TG-dome angle (DA). The Pearson correlation test was used for the statistical analysis of correlations between groups. Results: A statistically significant increase was determined in the patellar instability group in the TG-DA and TG-PT angle values compared to the group without patellar instability (p < 0.05). In both groups, a positive and strong correlation was determined between the TT-TG and the TG-PT and dome of the TT-TG distances, but no statistically significant correlation was determined between the tuberositas TT-TG and TG-PT angle and TG-DA. Conclusion: Metric parameters may not be sufficient alone in the evaluation of patellar instability. Metric parameters should be supported by additional angular parameters which reveal the rotational movement of the TT on the tibia shaft.

The impact of surgery for trochanteric femur fracture on sexuality in men and their female partners

Purpose: This study was aimed to investigate the effects of trochanteric femur fracture treatment methods on erectile functions of the patients and on sexual functions with their female partners. Materials and Methods: A total of 43 patients with trochanteric femur fracture who underwent proximal femoral nail (PFN) or proximal femur locking compression plate (PF-LCP) surgery were included in the study. The PFN implant was applied to group 1 (n = 23) and the PF-LCP implant to group 2 (n = 20). All the patients and their female partners completed the 5-item version of the International Index of Erectile Function (IIEF-5) and the Female Sexual Function Index (FSFI) preoperatively and at 1 year postoperatively after the rehabilitation period. Results: The mean preoperative IIEF-5 and FSFI score was 21.910.9 and 21.911.1, 72.319.7 and 70.516.2 for the PFN and PF-LCP treatment groups, respectively, and at postoperative 1 year after rehabilitation, change in IIEF-5 score and FSFI score of each group was −6.512.1 versus −3.811.6, (p < 0.001) and −16110.7 versus −6.314, (p = 0.001), respectively. Conclusion: These data show that trochanteric femur fractures treated with PFN or PF-LCP had a negative impact on sexual function. PF-LCP had a greater negative effect than PFN on sexual function.

Comparison of continuous interscalene block and subacromial infusion of local anesthetic for postoperative analgesia after open shoulder surgery

Purpose: This study compared the efficacy of continuous interscalene block (CISB) and subacromial infusion of local anesthetic (CSIA) for postoperative analgesia after open shoulder surgery. Methods: This randomized, prospective, double-blinded, single-center study included 40 adult patients undergoing open shoulder surgery. All patients received a standardized general anesthetic. The patients were separated into group CISB and group CSIA. A loading dose of 40 mL 0.25% bupivacaine was administered and patient-controlled analgesia was applied by catheter with 0.1% bupivacaine 5 mL/h throughout 24 h basal infusion, 2 mL bolus dose, and 20 min knocked time in both groups postoperatively. Visual analog scale (VAS) scores, additional analgesia need, local anesthetic consumption, complications, and side effects were recorded during the first 24 h postoperatively. The range of motion (ROM) score was recorded preoperatively and in the first and third weeks postoperatively. Results: A statistically significant difference was determined between the groups in respect of consumption of local anesthetic, VAS scores, additional analgesia consumption, complications, and side effects, with lower values recorded in the CISB group. There were no significant differences in ROM scoring in the preoperative and postoperative third week between the two groups but there were significant differences in ROM scoring in the postoperative first week, with higher ROM scoring values in the group CISB patients. Conclusion: The results of this study have shown that continuous interscalene infusion of bupivacaine is an effective and safe method of postoperative analgesia after open shoulder surgery.

Periprosthetic Femur Fracture Occuring after Contralateral Neglected Femoral Neck Fracture.

Introduction: Periprosthetic fractures of the femur are uncommon, but at times may lead to complications especially in elderly patients. As treatment of these fractures is difficult, prevention by identifying the risk factors is the best way to overcome these complex problems. Case Report: A periprosthetic right femur fracture associated with a neglected left femoral neck fracture in the contralateral femur in a 78-year-old elder woman patient is reported in the present article. We discuss the prevention of periprosthetic fractures after hip arthroplasty and address the risk factors associated with this complication. Conclusion: The present case emphasizes the importance of investigating and treating the cause of sudden onset of restriction on full weight-bearing in the contralateral limb, to prevent periprosthetic femoral fracture after hip arthroplasty in elderly patients.

Higher reliability of triple-phase bone scintigraphy in cementless total hip arthroplasty compared to cementless bipolar hemiarthroplasty.

Purpose Periprosthetic infection is one of the main reasons for revision surgery after hip arthroplasty. The purpose of the present study is to compare the reliability of triple-phase bone scintigraphy (TPBS) in the diagnosis of periprosthetic infection between cementless total hip arthroplasty (THA) and bipolar hemiarthroplasty (BHA). Methods In this retrospective study, 52 patients were analyzed; 33 of them were performed with THA and 19 of them were performed with BHA. The exclusion criteria were cementation in previous surgery, romatological joint disorders, periprosthetic fracture and malignancy history. C reactive protein (CRP) and erythrocyte sedimentation (ESR) rate results were recorded preoperatively. Tissue samples from the different areas periprosthetic tissue were obtained for histopathological examination and sample tissue culture. Results In the present study, the sensitivity, specificity and accuracy were 90.9%, 77.3% and 81.8%, respectively, for THA and 77.8%, 60.0% and 68.4%, respectively, for BHA. Positive predictive values for THA and BHA were 66.7% and 63.6%, and negative predictive values were 94.4% and 75.0%, respectively. Conclusions Due to the higher sensitivity, specificity and accuracy, TPBS has a more reliable diagnostic value for cementless THA in the diagnosis of periprosthetic infection compared to cementless BHA.

Fracture of the cemented femoral component following hemiarthroplasty in physically active patient: A case report

Introduction: Fracture of the femoral stem following hip arthroplasty has become very rare since the developments in modern prosthetic designs. Prevention by identifying the risk factors is the best way to overcome these complex problems, as treatment is difficult. Case Report: Femoral component fracture after cemented hemiarthroplasty in a physically active 64-year-old, male patient is reported in this present article. Conclusion: The present case emphasizes the importance of preserving the joint after hip fracture and avoidance of using mono block prosthesis in younger patients. If the patient is physically active, he/she should be advised to limit her/his daily activities to moderate intensity after hemiarthroplasty surgery.