Eklem Hastaliklari Ve Cerrahisi-Joint Diseases and Related Surgery最新文献

Objectives: This study aims to evaluate the clinical outcomes of children with spastic type cerebral palsy (CP) treated with botulinum toxin type A (BoNT-A) injection for lower limb contracture and the influence of age, gender, functional level and degree of initial contracture on treatment outcomes.

Patients and methods: Clinical records at pre-BoNT-A injection and post-BoNT-A injections of 153 sessions of a total of 118 consecutive children (67 boys, 51 girls; mean age 5.9±2.6 years; range, 2.5-16 years) were retrospectively evaluated. Degrees of pre- and post-injection contracture were evaluated. Post-injection supplemental casting for 10 days was recorded in all cases. Less than 20° of hip flexion contracture, more than 30° of hip abduction, a negative prone Ely test, less than 50° of popliteal angle and at least 5° of ankle dorsiflexion values at post-injection were accepted as sufficient clinical improvement.

Results: Sufficient post-injection range of motion (ROM) was observed in 80% of cases with hip flexion contracture, in 45% of cases with hip adduction contracture, in 84% of cases with knee flexion contracture and in 77% of cases with ankle equinus contracture. Prone Ely test that was positive in 60% of cases with knee extension contracture was negative at post-injection. Improvement in contractures were prominent in children with lesser degree initial contractures.

Conclusion: Botulinum toxin type A injection increases ROM in hip, knee and ankle joint contractures in CP. Although age, gender and functional level may influence the clinical outcomes, pre-treatment level of contracture is the main determinant in improvement in ROM at post-injection.

Objectives: This study aims to determine whether there is a difference in the rate of survival and risk of revision for mobile-bearing (MB) compared with fixed-bearing (FB) total knee replacements (TKRs).

Patients and methods: This prospective observational study included 1,571 cemented non-posterior-stabilized TKRs without patellar resurfacing with the subsequent revision surgery in 63 patients (23 males, 40 females; mean age 69.7 years; range, 46.5 to 85.5 years). The group of FB TKRs consisted of 756 non-revised and 31 revised implants. The group of MB TKRs included 752 non-revised and 32 revised knees. We determined the survival rate of TKR with Kaplan-Meier method and the relative risk (RR) of the revision in relation to the type of the insert. The analysis of the RR was divided into subgroups based on the time to revision and the reason for revision.

Results: No significant difference was found between FB and MB TKRs regarding the cumulative survival rate and the RR of total revision for any reasons. In the subgroup of early revisions for any reason, 2.22-fold increased risk of revision was found in the MB (p=0.02). The risk of late revisions for any reason in MB was lower than the risk in FB (RR 0.27; p=0.009). Higher risk of revision for instability was found in the subgroup of early revisions in MB (RR 23.8; p=0.03). MB was associated with significantly lower risk of total (RR 0.46; p=0.049) and late revisions for aseptic loosening (RR 0.14; p=0.008).

Conclusion: No differences were found in the cumulative survival rates between MB and FB TKRs. MB TKRs were associated with a lower risk of revision due to aseptic loosening in comparison with FB TKRs. MB inserts represented a significant risk factor only for early revisions due to instability.

Objectives: This study aims to compare the results of total knee arthroplasties (TKAs) performed after previous combined high tibial osteotomy (CO) to those of a matched control group of primary TKA.

Patients and methods: Between 01 August 2006 and 31 December 2011, we performed 24 consecutive cemented TKAs in 24 patients (10 males, 14 females; mean age 69.5 years; range, 60 to 79 years) who had undergone previous CO (study group). The study group was compared to a control group of 24 patients (10 males, 14 females; mean age 69.9 years; range, 63 to 79 years) who were performed primary TKA during the same period. Pre- and postoperative The Knee Society knee and function score and range of movement were determined. The femorotibial angle, the distance between the tangent to the lateral subchondral plate and the top of the fibular head, the transposition of the tibial condyle, the length of the patellar tendon and the tibial slope angle were measured preoperatively. At final follow-up, the same parameters were calculated and the amount of lateral tibial bone resection was determined.

Results: The mean follow-up duration was 97 months (range, 61 to 124 months) in the study group and 97 months (range, 61 to 123 months) in the control group. TKA survivorship rate was 100% in both groups. At final follow-up, there were no significant differences regarding the clinical and radiographic data. However, only the amount of the resected lateral bone was significantly lower in the study group than in the control group.

Conclusion: In young and active people with medial knee arthrosis, in whom the planned correction is 10° or higher, we continue to suggest CO since it does not seem to influence the results of TKA negatively.

Objectives: This study aims to compare mechanical stability of osteosynthesis (plate and screw fixation) alone versus the same method supplemented with hip arthroplasty (hybrid solution) for double column fractures in elderly.

Patients and methods: Mechanical investigations were performed on an advanced finite element pelvis model developed for double column fractures. The following simulated implant combinations were analyzed: modular acetabular basket with a ring with polyaxial screws and U-plate; plates with polyaxial screws placed on the medial-horizontal (linea terminalis) and quadrilateral bone surfaces; modular acetabular cup with U-plates; and polyaxial screws in sizes optimized based on a finite element model (FEM). Using the models, the possible shifts in peak load positions arising in different movement patterns caused by load and tension and implant deformation were measured.

Results: Hybrid systems resulted in minimal deformation of the implants already available on the market. We observed less possible shifts and greater stability in the acetabular fracture zones, compared to conventional osteosynthesis alone. Optimization with available and compatible implant sizes led to a further significant increase in stability.

Conclusion: Hybrid method combining osteosynthesis and prosthesis implantation provide more stability in biomechanical models in the treatment of double column fractures in elderly.

Objectives: This study aims to clinically evaluate the efficacy of pedicle bone flap treatment in stage II Kienböck's disease.

Patients and methods: This retrospective study included 10 patients (8 males, 2 females; mean age 33.3 years; range, 23 to 46 years) treated with pedicle bone flap between January 2012 and June 2016. In all patients, a fourth extensor compartment artery (ECA) pedicle bone flap from the dorsal surface of the radius was prepared and placed through a window opened on the lunate bone. Clinical results of the patients were evaluated according to the Mayo wrist score.

Results: All patients could return to their daily activities after surgery. No superficial or deep infection developed requiring debridement or antibiotic use other than prophylaxis. None of the patients required reoperation due to complications or the progression of the disease. The mean Mayo wrist score was measured as 81 (good).

Conclusion: In this study, results of the fourth ECA pedicle bone flap application were found to be effective in the treatment of avascular necrosis of the lunate bone. Further comparative and long-term follow-up studies are required including large and homogeneous patient groups.

Objectives: This study aims to investigate the role of physical examination and magnetic resonance imaging (MRI) findings in predicting meniscal tear surgery.

Patients and methods: Medical records of a total of 997 patients (563 females, 434 males; mean age 40.53 years; range 18 to 66 years) who were recommended surgery for meniscal tear in an external center, but continued follow-up in our hospital between January 2012 and March 2018 were retrospectively analyzed. Data of the patients including demographic and clinical characteristics, physical examination findings, and MRI results were recorded. The visual analog scales (VAS) scores and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were evaluated.

Results: Of all the patients evaluated by MRI, 62.4% were recommended surgical treatment in private hospitals and 37.6% were recommended surgical intervention in state hospitals. Only 282 of them (28.3%) were treated surgically for meniscal tear after MRI evaluation and physical examination in our clinic. The median pre-treatment VAS score was 7.0 (range, 4 to 10) and 6.0 (range, 3 to 8) in the patients undergoing surgery and undergoing conservative treatment, respectively. The VAS and KOOS scores were similar between the groups at the postoperative sixth month and first year (p=0.940, p=0.203; p=116, p=0.057, respectively). Pain scores significantly decreased, while the KOOS scores significantly increased after the treatment in both groups (for all p=0.001).

Conclusion: Decision for surgery should be solely based on physical examination and radiological findings in meniscal tears.

Objectives: This study aims to investigate the effect of simultaneous coracoplasty on postoperative clinical outcomes of patients undergoing shoulder arthroscopy due to the tear of the isolated subscapularis.

Patients and methods: The study included 53 patients (16 males, 37 females; mean age 55.8 years; range, 44 to 70 years) who underwent arthroscopic repair for isolated subscapularis tear (type 2 and type 3) with anterior shoulder pain and tenderness. All patients had a coracohumeral distance of less than 7 mm on the preoperative magnetic resonance images and a minimum follow-up period of two years. Patients were divided into two groups as group 1 including patients who underwent coracoplasty and group 2 including those who did not undergo coracoplasty. Patients were evaluated pre- and postoperatively by the University of California Los Angeles (UCLA) shoulder score and the simple shoulder test (SST) score.

Results: There were no significant differences between the groups in terms of age, gender and follow-up time (p>0.05). The preoperative mean UCLA score was 19.65 for group 1 and 20.45 for group 2. The postoperative mean UCLA scores were 27.92 and 29.00, respectively. The preoperative mean SST score was 4.9 for group 1 and 5.1 for group 2. The postoperative mean SST scores were 10.0 and 9.5, respectively. Functional scores increased significantly in both groups postoperatively when compared to the preoperative values (p<0.01). However, there was no statistically significant difference in terms of the increase in UCLA and SST scores between the two groups (p>0.05).

Conclusion: We believe that concomitant coracoplasty during arthroscopic repair may not be a necessary routine in the treatment of isolated subscapularis tears.

Pigmented villonodular synovitis (PVNS) is a benign tumorous condition commonly found in tendon sheathes, bursa, or joint synovium. Unlike the diffuse type which invades the entire synovium of the affected joint, synovium of localized PVNS shows relatively normal appearance. It presents nonspecific symptoms and typically progresses for a long time but acute locking phenomenon or internal derangement of knee symptoms suddenly commence in early stage. In this article, we present a 48-year-old female patient with well-capsulated localized PVNS with intra-capsular hemorrhage occurring from the junction of the mid-body of lateral meniscus and the lateral joint capsule in the knee. It expanded and then moved to the lateral joint space, which caused pain, limitation of knee flexion and locking spontaneously. Arthroscopic complete excision, biopsy, and focal synovectomy were performed with punch and motorized shaver. Full weight-bearing with full knee range of motion was allowed at one day post-surgery. The mechanical symptom of locking and severe pain disappeared. At the clinical follow-up one month post-surgery, the symptoms were no longer present.

Objectives: This study aims to evaluate the clinical and radiological results of patients with multiple dorsal carpometacarpal (CMC) joint fracture dislocations treated with open reduction and internal fixation (ORIF).

Patients and methods: We evaluated 14 patients (12 males, 2 females; mean age 35.1 years; range, 22 to 64 years) between January 2013 and December 2017. Our main outcome measurements were the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, loss of grip strength, limitation of range of motion (ROM), and Kellgren-Lawrence osteoarthritis classification identified with radiographs and computed tomography images.

Results: The mean QuickDASH scores at seventh week and third month were 73.57 (range, 65-90) and 29.11 (range, 25-42.5), respectively. The mean QuickDASH score at seventh, ninth, and 12th month, and final follow-up was 4.64 (range, 0-30) and the QuickDASH score at these follow-up points was not 0 for only three patients. The mean loss of grip strength was 32.14% and two patients (14.29%) had limitation of ROM in third proximal interphalangeal joint at final follow-up. Four patients had grade I, nine patients had grade II, and one patient had grade III osteoarthritis according to Kellgren-Lawrence classification at final follow-up.

Conclusion: Although functional results demonstrated that multiple CMC joint fracture dislocations can be treated with ORIF, the high rate of osteoarthritis is a disadvantage.