Hakan Boya

A novel hybrid type (custom-made plus off-the-shelf) total femoral PROSTALAC

Introduction Treatment of periprosthetic joint infection following revision-Total Hip Arthroplasty is more problematic when there is poor bone quality and severe bone loss. Migration of revision prosthesis with a long stem to the knee joint in infected cases makes treatment more complex. In these cases, total femoral replacement is the only treatment option and eradication of infection is mandatory before the replacement. In 2-staged reconstruction treatment, there is a need for a PROSTALAC to replace the whole femur. Methods We describe here a novel hybrid type (custom-made plus off-the-shelf) total femoral PROSTALAC for cases in need of whole femoral bone and femoral component removal for the treatment of periprosthetic joint infection in total hip arthroplasty. Result Both sides of the PROSTALAC have anatomical joint surfaces, so the articulation with the acetabulum proximally is expected to be more stable. The off-the-shelf anatomic joint surface of the PROSTALAC distally allows articulation compatible with a proximal tibial off-the-shelf spacer. Conclusions This simple hybrid-type total femoral PROSTALAC can be adjusted to femoral length, has anatomical joint surfaces that produce a more stable articulation, and can articulate with an off-the-shelf proximal tibial spacer.

A rare complication of total knee arthroplasty: Type l complex regional pain syndrome of the foot and ankle

Complex regional pain syndrome (CRPS) is a painful and disabling disorder that usually affects the extremities. This complication may affect the knee joint after total knee arthroplasty (TKA). We report a unique case of CRPS of the foot and ankle, which was an unusual involvement site for CRPS after TKA.

Tourniquet pressure settings based on limb occlusion pressure determination or arterial occlusion pressure estimation in total knee arthroplasty? A prospective, randomized, double blind trial

Objective The aim of this study was to compare the limb occlusion pressure (LOP) determination and arterial occlusion pressure (AOP) estimation methods for tourniquet pressure setting in adult patients undergoing knee arthroplasty under combined spinal-epidural anesthesia. Methods Ninety-three patients were randomized into two groups. Pneumatic tourniquet inflation pressures were adjusted based either on LOP determination or AOP estimation in Group 1 (46 patients, 38 female and 8 male; mean age: 67.71 ± 9.17) and Group 2 (47 patients, 40 female and 7 male; mean age: 70.31 ± 8.27), respectively. Initial and maximal systolic blood pressures, LOP/AOP levels, required time to estimate AOP/determinate LOP and set the cuff pressure, initial and maximal tourniquet pressures and tourniquet time were recorded. The effectiveness of the tourniquet was assessed by the orthopedic surgeons using a Likert scale. Results Initial and maximal systolic blood pressures, determined LOP, estimated AOP, duration of tourniquet and the performance of the tourniquet were not different between groups. However, the initial (182.44 ± 14.59 mm Hg vs. 200.69 ± 15.55 mm Hg) and maximal tourniquet pressures (186.91 ± 12.91 mm Hg vs. 200.69 ± 15.55 mm Hg) were significantly lower, the time required to estimate AOP and set the tourniquet cuff pressure was significantly less (23.91 ± 4.77 s vs. 178.81 ± 25.46 s) in Group II (p = 0.000). No complications that could be related to the tourniquet were observed during or after surgery. Conclusion Tourniquet inflation pressure setting based on AOP estimation method provides a bloodless surgical field that is comparable to that of LOP determination method with lower pneumatic inflation pressure and less required time for cuff pressure adjustment in adult patients undergoing total knee arthroplasty under combined spinal epidural anesthesia.

Treatment of Meniscus Degeneration and Meniscus Cysts

The menisci have indispensable functions for the knee joint. Loss of the meniscus leads to irreversible degeneration via abnormal loading of articular cartilage. Meniscal degeneration is responsible for loss of critical functions of the menisci and can create a situation similar to meniscus loss. Degenerative meniscal lesions are seen as primary degenerative meniscal lesions and meniscal lesions in osteoarthritic knees. Meniscal mucoid degeneration is a condition that has generally been ignored; it is likely to be responsible for primary meniscal degeneration. Meniscal cysts are associated with meniscal mucoid degeneration. Treatment of meniscal mucoid degeneration and meniscal cysts was evaluated in the light of the pertinent literature and clinical experiences of the authors. Other objective of this chapter is to draw attention to mucoid degeneration of the meniscus due to its serious implications in younger patients.

Does severe osteoarthritis in knees with varus deformity alter the adductor ratio

Objective In our retrospective study, we aimed to investigate the differences between the adductor ratio (AR) in knees with and without osteoarthritis, and its validity in determining the articular level. Methods Data from 80 knees of 80 patients were retrospectively evaluated. Anteroposterior weight-bearing knee radiographs of the patients with and without osteoarthritis (40 knees in each group) were obtained. The adductor ratio was determined using the following formula: ATJL/FW (adductor tubercle-joint line distance/femoral width). All radiographs were evaluated at the baseline and at one-month intervals afterwards. Intraobserver reliability of the two measurements was assessed using interclass correlations (ICC). Pearsons correlation test was used to evaluate the correlation between the ATJL and the FW. The differences between the adductor ratios of the two groups were evaluated by the independent samples two-tailed t-test. Results Most of the ICC values were well above 0.95, indicating a very high intraobserver reliability. The adductor ratio was significantly greater in Group 2 in comparison to Group 1 (Mean AR in Group 2: 0.522 ± 0.031 and Mean AR in Group 1: 0.502 ± 0.032; p = 0.005). There was a significant correlation between the ATJL and FW in the groups when assessed both separately and combined. Conclusion In conclusion, we can assert that if the AR is used to determine the articular level in revision arthroplasty cases, it may be sensible to measure the FW intraoperatively rather than measuring it on primary or contralateral radiographs of arthritic patients. Level of evidence Level III, Diagnostic study.

Anterior capsular repair in total hip arthroplasty performed for late-presenting displaced femoral neck fractures

Dislocation after total hip arthroplasty performed for femoral neck fractures occurs frequently due to the significantly higher range of movement of the postoperative hip joint. Proper wound closure can prevent the loss of structural support provided by the capsule and myofascial structures, and is essential for postoperative hip stability. On 32 consecutive patients (four men, 28 women; mean age 64 years, range 48-83 years) with unilateral late-presenting displaced femoral neck fractures, a careful anterior capsule repair technique during total hip arthroplasty was performed by a single surgeon between 1997 and 2000. At one-year follow-up, no dislocation had occurred in any patient. Intraoperative protection and careful anatomic reattachment of the hip joint capsule may increase the stability of the hip joint after total hip arthroplasty and lead to a lower incidence of dislocation.