Mehmet Akif Kaygusuz

Two-Stage Cementless Revision Total Hip Arthroplasty for Infected Primary Hip Arthroplasties

The main purpose of the present study was to analyze the clinical features, the most common infective agents, and the results of two-stage total hip revision using a teicoplanin-impregnated spacer. Between January 2005 and July 2011, 41 patients were included. At the clinical status analysis, physical examination was performed, Harris hip score was noted, isolated microorganisms were recorded, and the radiographic evaluation was performed. The mean Harris hip score was improved from 38.9 ± 9.6 points to 81.8 ± 5.8 points (P<0.05). Infection was eradicated in 39 hips. Radiographic evidence of stability was noted in 37 acetabular revision components, and all femoral stems. Two-stage revision of the infected primary hip arthroplasty is a time-consuming but a reliable procedure with high rates of success.

Vitamin-d measurement in patients with adolescent idiopathic scoliosis

Our retrospective study compared vitamin-D levels in 229 patients with adolescent idiopathic scoliosis (AIS) and 389 age-matched controls, and evaluated the correlation between vitamin-D levels and sex, Cobb’s angle, and serum levels of calcium (Ca), phosphorus, and alkaline phosphatase in the AIS group. Vitamin-D levels were lower in the AIS group, with no sex-specific effects, indicative of a possible vitamin-D resistance in AIS. Vitamin-D levels correlated positively with Ca levels and negatively with Cobb’s angle, indicative of a possible role of vitamin D in the etiopathogenesis of AIS. Patients with AIS should be monitored for vitamin-D deficiency/insufficiency.

The prevalence of femoroacetabular impingement as an aetiologic factor for end-stage degenerative osteoarthritis of the hip joint: analysis of 1,000 cases

Objective The main purpose of the present study was to determine the prevalence of FAI among patients who underwent total hip arthroplasty (THA) with the diagnosis of end-stage osteoarthritis (OA) of the hip joint in a tertiary referral centre. Design A retrospective search of the institutional archive database for patients who had undergone THA between the years 2005 and 2010 was conducted with the analysis of the recorded radiographic images. A total of 1,004 patients including 690 (68.7%) females and 314 (31.3%) males were identified. All radiographs were reviewed by 3 of the authors. Intra- and interobserver consistencies were calculated. The prevalence of femeroacetabular impingement (FAI) as a predisposing diagnosis resulting in end-stage degenerative joint disease treated with THA was determined. Results The most common diagnosis was developmental dysplasia of the hip (DDH). The predisposing aetiologic factor leading to end-stage degenerative hip disease treated with THA was undetermined for 26 patients (2.6%). The number of patients who were diagnosed as cam-type FAI by all of the observers was 83, whereas it was 16 for pincer-type FAI. Interobserver agreement was very high in the evaluation of the stated ethiologies of hip osteoarthritis. The contingency coefficient for the diagnosis of FAI was 0.71 between observers. Conclusions Our study may be a reference for further investigations to develop a better understanding of the underlying pathological factors in patients undergoing THA due to end-stage OA of the hip joint.

Detection of Normal Plantar Fascia Thickness in Adults via the Ultrasonographic Method

BACKGROUND Heel pain is a prevalent concern in orthopedic clinics, and there are numerous pathologic abnormalities that can cause heel pain. Plantar fasciitis is the most common cause of heel pain, and the plantar fascia thickens in this process. It has been found that thickening to greater than 4 mm in ultrasonographic measurements can be accepted as meaningful in diagnoses. Herein, we aimed to measure normal plantar fascia thickness in adults using ultrasonography. METHODS We used ultrasonography to measure the plantar fascia thickness of 156 healthy adults in both feet between April 1, 2011, and June 30, 2011. These adults had no previous heel pain. The 156 participants comprised 88 women (56.4%) and 68 men (43.6%) (mean age, 37.9 years; range, 18-65 years). The weight, height, and body mass index of the participants were recorded, and statistical analyses were conducted. RESULTS The mean ± SD (range) plantar fascia thickness measurements for subgroups of the sample were as follows: 3.284 ± 0.56 mm (2.4-5.1 mm) for male right feet, 3.3 ± 0.55 mm (2.5-5.0 mm) for male left feet, 2.842 ± 0.42 mm (1.8-4.1 mm) for female right feet, and 2.8 ± 0.44 mm (1.8-4.3 mm) for female left feet. The overall mean ± SD (range) thickness for the right foot was 3.035 ± 0.53 mm (1.8-5.1 mm) and for the left foot was 3.053 ± 0.54 mm (1.8-5.0 mm). There was a statistically significant and positive correlation between plantar fascia thickness and participant age, weight, height, and body mass index. CONCLUSIONS The plantar fascia thickness of adults without heel pain was measured to be less than 4 mm in most participants (~92%). There was no statistically significant difference between the thickness of the right and left foot plantar fascia.

The effect of component position on clinical outcomes in resurfacing hip arthroplasty

OBJECTIVE The aim of this study was to evaluate the relationship between component position and clinical results in resurfacing hip arthroplasty. METHODS Resurfacing hip arthroplasty was performed on 41 hips of 38 patients (22 male, 16 female; mean age: 53.7 years; mean follow-up time: 20.1 ± 5.8 months). The femoral and acetabular component orientation angles in the coronal plane were evaluated on anteroposterior radiographs. Harris and Oxford hip scores were used in the clinical evaluation. RESULTS The mean angle between the collum and diaphysis was 139.5 ± 8.8 degrees. In 22 hips, the femoral component angle between collum and diaphysis was less than 5 degrees valgus position when compared with the same anatomical femur angle. In the other 19 hips, the femoral component angle was greater than 5 degrees valgus position. The mean inclination angle of the acetabular component was 46.1 ± 7 degrees. In 22 hips, the mean inclination angle of the acetabular components was 45 degrees or less. There was no significant difference in the clinical outcomes between patients with femoral component angles of greater than 5 degrees valgus position and those with angles of less than 5 degrees valgus position (p>0.05). There was also no significant difference between the clinical results of patients with an acetabular inclination of 45 degrees or less and those with an acetabular inclination exceeding 45 degrees (p>0.05). CONCLUSION The orientation of femoral and acetabular components in the coronal plane does not appear to have an effect on clinical outcomes in resurfacing hip arthroplasty.

Preoperative and Postoperative Photographs and Surgical Outcomes of Patients With Kyphosis.

Study Design. A retrospective clinical study was performed. Objective. The aim of the study was to show patients their pre- and postoperative body photographs, and determine the effect on postoperative patient satisfaction for thoracic and thoracolumbar sharp and round angular kyphosis. Summary of Background Data. Previous studies have reported the normative values of pelvic sagittal parameters and the classification of normal patterns of sagittal curvature, but no study has investigated and compared the clinical photographs of sharp and round kyphosis. Methods. In patients who underwent surgery for thoracic and thoracolumbar sharp and round angular kyphosis, whole spine anteroposterior and lateral radiographs, and clinical photographs were obtained preoperatively and at the final follow-up. Pelvic and spinal parameters were measured, and the pre- and postoperative photographs were shown to patients. The Scoliosis Research Society 22r (SRS22r) and Short Form 36 surveys were administered to all patients, and the scores were analyzed. Results. Thirty-eight patients diagnosed with kyphosis (mean age 19.6 yr, mean follow-up duration 26.4 mo) were divided into two groups: sharp (18 patients, mean age 20.1 yr) and round (20 patients, mean age 19.6 yr) kyphosis. There was no difference between values in the sharp and round groups in terms of age, follow-up duration, and Risser score (P > 0.05). In both groups, the subscores for pain, self-image, mental health, and satisfaction, except for the function/activity score, and the total score of the SRS22r survey were, however, significantly different between pre- and postoperative photographs. In addition, there was no significant difference between the two groups in any SRS22r domain and Short Form 36 scores. Conclusion. The surgical treatment of kyphosis was uniformly associated with improved quality of life, regardless of the kyphosis type. Thus, showing patients their pre- and postoperative photographs may enhance patient satisfaction, as measured by SRS22r scores. Level of Evidence: 4

Tibiotalocalcaneal arthrodesis by using proximal humeral locking plate

Objectives The aim of this study was to evaluate the short-term clinical and radiological results of tibiotalocalcaneal arthrodesis (TTCA) with proximal humeral locking plate. Material and methods Eight patients (7 female, 1 male; average age 53 years (range: 24–67)) who underwent TTCA with proximal humeral locking plate between 2009 and 2011, were retrospectively evaluated with AOFAS hindfoot scale and Maryland foot score system. The mean follow up was 32.6 months (range: 23–54). Results Complete fusion was achieved in 7 patients. Soft tissue infection was observed in 2 patients and reflex sympathetic dystrophy in 3 patients. All patients recovered with medical treatment. At the final follow-up, mean AOFAS Hindfoot score was 60 (range: 41–81) and Maryland Foot Score was 67.8 (range: 41–85). The satisfactory rates of AOFAS and MFS were found as 12.5% (1/8) and 50% (4/8), respectively. One patient had an incomplete union with 5 degrees of heel varus deformity and 5 degrees of equinus deformity was observed in another. There were no implant failure or deformation of the plate during the follow-up period. Conclusion Our study suggests that proximal humeral plate may be an alternative for fixation in tibiotalocalcaneal fusion surgery.

Analysis of complications following posterior vertebral column resection for the treatment of severe angular kyphosis greater than 100

Objective The aim of this study was to evaluate the complications, efficacy and safety of posterior vertebral column resection (PVCR) in severe angular kyphosis (SAK) greater than 100°. Methods The medical records of 17 patients (mean age 17.9 (range, 9–27) years) with SAK who underwent PVCR, were reviewed. Mean follow-up period was 32.2 (range, 24–64) months. Diagnosis of the patients included congenital kyphosis in 11 patients, post-tuberculosis kyphosis in 3 patients and neurofibromatosis in 3 patients. The sagittal plane parameters (local kyphosis angle, lumbar lordosis, sagittal vertical axis, pelvic tilt, sacral slope and pelvic incidence) were measured in the preoperative and the early postoperative periods and during the last follow-up on the lateral radiographs. Results The mean preoperative localized kyphosis angle was 121.8° (range, 101°–149°). The mean local kyphosis angle (LKA) was 71.5° at postoperatively evaluation (p < 0.05). Complications were detected in 12 patients (70.6%) with spinal shock in 4 patients, hemothorax in 3 patients, postoperative infection in 2 patients, dural laceration in 2 patients, neurological deficit in 2 patients (1 paraplegia and 1 root injury), the shifted cage in 2 patients and rod fracture in 2 patients. Neurological events occurred in six patients (35%) with temporary neurological deficit in 5 patients and permanent neurological deficit in 1 patient. Conclusion PVCR is an efficient and a successful technique for the correction of SAK. However, it can lead to a large number of major complications in SAK greater than 100°. Level of evidence Level IV, therapeutic study.

Can Teicoplanin Be an Effective Choice for Antibiotic-Impregnated Cement Spacer in Two-Stage Revision Total Knee Arthroplasty?

Abstract The main purpose of this study was to evaluate the clinical results of two‐stage revision total knee arthroplasty using a teicoplanin‐impregnated cement spacer for infected primary total knee replacements. Twenty‐five patients operated between 2005 and 2012 were included in this study. At the clinical status analysis, rate of infection eradication was assessed, physical examination was performed, Knee Society Score (KSS) was noted, isolated microorganisms were recorded, and the radiographic evaluation was performed. The mean KSS improved from 40 (range, 25‐69) preoperatively to 77 (range, 32‐96) at the latest follow‐up (p < 0.05). Methicillin‐resistant Staphylococcus epidermidis was isolated in 9 of 25 patients as the most frequently isolated pathogen, and the other isolated pathogens were methicillin‐susceptible S. epidermidis, methicillin‐resistant Staphylococcus aureus, and methicillin‐susceptible S. aureus. Infection was successfully eradicated in 24 of 25 patients. Two‐stage revision of the infected primary knee replacement is a time‐consuming but a reliable procedure with high rates of success. Teicoplanin was found to be an effective choice for antibiotic‐impregnated cement spacer applied for the eradication of the infection.

A comparison of two techniques: Open and percutaneous biopsies of thoracolumbar vertebral body lesions.

Aim: The purpose of this article is to compare the similarity of initial radiological diagnosis and pathological diagnosis between thoracal and lumbar vertebral bodies and the adequacy and the reliability of open and percutaneous biopsies performed via transpedicular approach in the lesions located in vertebral bodies. Materials and Methods: Thirty-three patients who had undergone transpedicular biopsy for vertebral body lesions were retrospectively evaluated. Seventeen patients were diagnosed by percutaneous transpedicular biopsy (11 in the lumbar vertebrae, 6 in the thoracal vertebrae). Sixteen patients were diagnosed by open transpedicular biopsy (9 in the lumbar vertebrae, 7 in the thoracal vertebrae). Results: The similarity ratio between the initial radiological diagnosis and the final pathological diagnosis was 71.4% in the open biopsy and was 69.2% in the percutaneous biopsy (P > 0.05). The similarity ratio between the initial radiological diagnosis and the final pathological diagnosis was 66.7% in the lumbar region and was 77.8% in the thoracal region (P > 0.05). For percutaneous biopsy group, the similarity ratio was 72.7% in the lumbar region and was 66.7% in the thoracal region (P > 0.05). For open biopsy group, the similarity ratio was 62.5% in the lumbar region and 83.3% in the thoracal region (P > 0.05). No complication was observed. Conclusion: Specimen adequacy of open biopsy was higher than percutaneous biopsy. Particularly, the open thoracal biopsy has provided the highest similarity ratio between the initial radiological diagnosis and the final pathological diagnosis.