Mehmet Akif Altay

Patellar denervation in total knee arthroplasty without patellar resurfacing: A prospective, randomized controlled study

BACKGROUND Anterior knee pain is still a major problem in total knee arthroplasty (TKA). Although the most widely accepted opinion is that anterior knee pain is often associated with a patellofemoral etiology, there is no clear consensus as to etiology or treatment. Disabling pain receptors by electrocautery could theoretically achieve denervation of the anterior knee region. The present prospective randomized controlled study aimed to evaluate results after patellar denervation with electrocautery in TKA at a minimum follow-up of 2 years. HYPOTHESIS Patellar denervation provides some benefit in terms of pain and clinical outcomes after TKA without patellar resurfacing. PATIENTS AND METHODS Clinical and radiological results for 35 patients with single-stage bilateral TKA (70 knees; 26 women, nine men; mean age, 68 years [range, 58 to 77 years]) were reviewed. In addition to removal of all osteophytes, patellar denervation by electrocautery was performed on one patella; and debridement alone, removing all osteophytes, was performed on the contralateral patella, as a control. KSS score and a visual analog scale (VAS) were used to assess pre- and postoperative anterior knee pain. RESULTS Mean follow-up was 36 months (24 to 60 months). No revisions or re-operations were performed. There were no patellar fractures. On all parameters (KSS score, range of motion and VAS), there was a statistically significant pre- to postoperative difference in favor of the denervation group. DISCUSSION Patellar denervation with electrocautery can reduce anterior knee pain, with satisfactory clinical and radiological outcome, in TKA without patellar resurfacing. LEVEL OF EVIDENCE Level II: low-powered prospective randomized trial.

Paraoxonase-1 activity and oxidative status in patients with knee osteoarthritis and their relationship with radiological and clinical parameters

Abstract Background. The aim of this study was to investigate serum paraoxonase-1 (PON1) activity and oxidative/anti-oxidative status in knee osteoarthritis (OA), and evaluate their relationship using radiological and clinical parameters. Materials and methods. The study population comprised 127 patients with knee OA and 107 healthy volunteers. Patients with knee OA were divided into four subgroups according to the Kellgren–Lawrence (K&L) grading scale. In addition, each patient was clinically evaluated by the Western Ontario and McMaster University Osteoarthritis Index (WOMAC). Serum PON1 activity was measured spectrophotometrically. Oxidative status was assessed by measuring serum lipid hydroperoxide (LOOH) and total oxidant status (TOS). Anti-oxidative status was assessed by measuring serum free sulfydryl groups (–SH = total thiol) and total antioxidant capacity (TAC). Oxidative stress index (OSI) was calculated. Lipid parameters were determined by routine laboratory methods. Results. Serum PON1 activity was significantly lower in the knee OA group compared to the control group (p < 0.001), whereas serum LOOH, TOS, and OSI levels of the knee OA group were significantly higher than those of the controls (p < 0.001 for all). However, TAC and –SH levels did not differ between the two groups (p > 0.05). The lowest and highest mean serum PON1 activities were detected in patients with grades 4 and 1, respectively (ANOVA p < 0.001). In multiple regression analysis, WOMAC score was independently associated with serum PON1 activity (β = –0.248, p = 0.027). Conclusions. Decreased serum PON1 activity and elevated LOOH, TOS, and OSI levels may be associated with knee OA, and serum PON1 activity may be a useful adjunctive indicator of the severity of knee OA for follow-up.

A radiological comparison of Salter and Pemberton osteotomies to improve acetabular deformations in developmental dysplasia of the hip.

We investigated whether the following acetabular scores influence operative outcomes in patients with developmental dysplasia of the hip who underwent Salter innominate osteotomy (SIO) or Pemberton osteotomy (PO): the acetabular depth ratio (ADR), the acetabular index, the center-edge (CE) angle of Wiberg, and the femoral head migration rate (Reimer’s index). A total of 47 hips were treated with SIO and 50 hips were treated with PO. Changes in ADR were greater in children who underwent PO compared with those who underwent SIO. However, the acetabular index, the center-edge angle, and Reimer’s index did not differ between the groups at final follow-up. Children who underwent PO achieved an improved radiological ADR compared with those who underwent SIO on an average follow-up of 5 years after innominate osteotomy.

De Quervain's disease treatment using partial resection of the extensor retinaculum: A short-term results survey

BACKGROUND Several operative methods have been described for de Quervains disease, but no definite consensus has emerged in the literature. Sometimes simple release of the extensor retinaculum can cause incomplete relief, whereas re-adhesion and excessive excision of the extensor retinaculum can cause volar subluxation of the abductor pollicis longus and extensor pollicis brevis tendons. In this prospective study, we evaluated the early results of operative treatment with one-quarter partial resection of the extensor retinaculum when conservative methods have failed. HYPOTHESIS We hypothesized that partial removal of the extensor retinaculum may be used as an alternative to solve problems such as incomplete release or re-adhesion and volar subluxation of the tendons. PATIENTS AND METHODS Thirty-four patients (36 hands; 30 females and four males; mean age: 48.2 years; range: 20 to 75 years) with de Quervains disease were surgically treated. The surgical procedure was performed under local infiltration anesthesia. One-quarter partial resection of the extensor retinaculum on the dorsal side of the wrist was performed. During the clinical follow-up period, treatment results, a patient-based scoring system and visual analogue scale were used. The mean follow-up duration was 23.7 months (range: 12 to 71 months). RESULTS Two patients with wound infections were treated with adapted antibiotics. All patients were relieved of their symptoms; no triggering, recurrence or volar subluxation of the tendons of abductor pollicis longus or extensor pollicis brevis occurred. With this partial resection technique and according to a treatment scoring system described by Sawaizumi et al., 23 hands had excellent results, 11 hands had good results, and two hands had fair results; no hand exhibited a poor result. The mean visual analogue scale score was 1.8 (range: 0-6). DISCUSSION Our results showed that one-quarter partial resection of the extensor retinaculum on the dorsal side of the wrist can be safely used for the operative treatment of de Quervains disease with satisfactory short-term clinical results and no serious complications. LEVEL OF EVIDENCE Level IV: low-power prospective study.

Serum prolidase activity and oxidative-antioxidative status in Legg-Calve-Perthes disease.

We aimed to find out that whether collagen turnover is altered in the context of Legg–Calve–Perthes disease (LCPD) by evaluating serum prolidase activity. We also investigated the correlation between collagen turnover and oxidative–antioxidative status in LCPD. Plasma prolidase activity, total oxidant status (TOS), total antioxidant capacity, and oxidative stress index (OSI) were determined for 39 patients with LCPD and 40 healthy controls. Serum prolidase activity, TOS, and OSI were higher, but TAC was lower in patients with LCPD compared with controls. Prolidase activity was positively correlated with TOS and OSI levels. Serum prolidase activity is significantly associated with LCPD.

A preliminary study pointing out the role of serum prolidase activity and oxidative-antioxidative status parameters during the treatment process of patients with idiopathic clubfoot

Abstract Background. We aimed to investigate serum prolidase activity and to find out its association with oxidative-antioxidative status in patients with idiopathic clubfoot and during the course of the disease. Material and methods. Oxidative status parameters, including total free sulfhydryl groups (−SH), total antioxidant capacity (TAC), total oxidant status (TOS), and oxidative stress index (OSI), as well as serum prolidase activity were assessed at the beginning of the treatment in patients with idiopathic clubfoot (n = 38), at the end of 3 months during the treatment of the disease and in healthy controls (n = 40). All patients were managed with the Ponseti method and severity of the foot deformity was evaluated according to the Pirani Severity Score. Results. Serum prolidase activity, TOS and OSI values of the patients at the beginning of the treatment were found to be significantly higher but –SH and TAC values were found to be significantly lower as compared to controls. In the treatment process, a significant decrease in serum prolidase activity, TOS and OSI values and Pirani Severity Score of the patients was observed, however a significant increase in –SH and TAC values of the patients was observed at the end of 3 months during the treatment of the disease as compared to the beginning of the treatment. Conclusion. Elevated levels of serum prolidase activity, TOS and OSI, and decreased levels of –SH and TAC may be associated with idiopathic clubfoot, and that these parameters may be useful adjunctive tools for follow-up in patients with idiopathic clubfoot.

Do additional intramedullary elastic nails improve the results of definitive treatment with external fixation of open tibia fractures? A prospective comparative study

PURPOSE External fixation has been associated with a high incidence of complications and poor outcomes due to the instability and difficulty in treating open tibia fractures. We use intramedullary (IM) elastic nails to supplement the external fixator. We compared the results of fractures treated by external fixation with and without IM-elastic nail. HYPOTHESIS The combination of external fixation with IM-elastic nails may be used as an alternative to solve problems due to the external fixators alone in open tibia fractures. METHODS Group 1 included prospectively 26 cases (15 males and 11 females, mean age 37.5 ± 12.4 years) treated with external fixation and IM-elastic nails, whereas group 2 consisted of 28 cases (23 males and five females, mean age 30.7 ± 14.0 years) treated with standard external fixation. Functional and bone results were made using the criteria proposed by ASAMI. RESULTS The mean follow-up period was 3.96 ± 2.0 years in group 1 and 3.32 ± 2.1 years in group 2. The mean duration to external fixation and mean time to union were significantly lower in group 1 (P<0.001). In addition, bone and functional results were significantly higher in group 1 (P<0.01), however, pin track infections were lower in group 1 (P<0.01). CONCLUSION Our results showed the improvement in outcomes with IM-elastic nails: decreased duration of external fixation need and decreased bone healing delay. Therefore, this method may be a superior alternative for preventing complications related to external fixation in open tibia fractures. LEVEL OF EVIDENCE Level III: prospective comparative study.

Mitchell’s Osteotomy With Mini-Plate and Screw Fixation for Hallux Valgus

Background: The aim of this study was to evaluate the use of mini-plate and screw fixation to stabilize the first metatarsal osteotomy in patients undergoing Mitchell bunionectomy, with the outcomes of interest being radiological alignment and the time to bony union. Methods: We used mini-plates and screws in 43 feet of 25 patients to avoid cast immobilization and prevent osteotomy displacement. The mean age at operation was 45.4 ± 13.4 years (range, 17.0-65.0 years). The mean follow-up was 16.9 ± 3.6 months (range, 12.0-30.0 months). The hallux valgus angles, intermetatarsal angles, and American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scores were evaluated preoperatively and at postoperative month 12. Results: The mean preoperative value for the hallux valgus angle was 35.9 ± 4.4 degrees (range, 26.0-45.0 degrees) and for the intermetatarsal angle was 12.1 ± 1.4 degrees (range, 10.0-15.0 degrees). The mean postoperative value for the hallux valgus angle was 16.0 ± 2.12 degrees (range, 12.0-20.0 degrees) and for the intermetatarsal angle was 7.7 ± 1.2 degrees (range, 5.0-10.0 degrees). The mean AOFAS score was 50.5 ± 12.8 points (range, 30.1-76.0 points) preoperatively and 75.9 ± 11.3 points (range, 43.3-92.3 points) at postoperative month 12. Improvement of range of motion of the metatarsophalangeal joint, pain relief, and satisfactory alignment of the first ray were achieved in 41 feet (95.3%). Conclusions: We recommend this fixation for Mitchell’s bunionectomy because it provided stable fixation without the need for casting. Level of Evidence: Level IV, retrospective case series.

Ultrasonographic examination of the radial and ulnar nerves after percutaneous cross-wiring of supracondylar humerus fractures in children: a prospective, randomized controlled study.

In this prospective study, we aimed to find out whether there is a change in the ultrasonographic features of the radial and ulnar nerves as well as clinical outcomes after traditional and lateral percutaneous cross-wiring of the supracondylar humerus fractures in children. Twenty-nine consecutive children with completely displaced Gartland type III supracondylar humerus fractures were treated with the traditional (group T) or lateral (group L) cross-wiring technique. Our findings showed that ultrasonographic features of the radial nerve were not changed in both groups but the ulnar nerve movement was reduced, and the diameter of major axis of the ulnar nerve during elbow flexion was larger (P=0.040) than in elbow extension in the traditional cross-wiring technique but not in the lateral cross-wiring technique. Lateral cross-wiring technique does not change the ultrasonographic features of the radial and ulnar nerves, and provides satisfactory results.

A giant congenital fibrosarcoma of the leg.

Congenital fibrosarcoma is a rare, malignant, soft-tissue tumor in infants and the pediatric age group. The clinical behavior of congenital fibrosarcoma is more favorable, and metastatic spread is rare, but local recurrence is a common problem. The patient was a 1-year-old girl at the time of operation, and there was a giant mass in the posterior region of the right leg. A wide surgical excision was performed and histological findings showed the diagnosis of congenital fibrosarcoma. After one and a half years, femoral supracondylar amputation was performed because of the recurrence of the local tumor.