Joint diseases and related surgery最新文献

Objectives: This study aimed to evaluate the results of the Cakırgil method in patients with advanced developmental dysplasia of the hip (DDH).

Patients and methods: Patients who underwent surgical treatment with the Cakırgil method between January 2011 and December 2022 with a diagnosis of DDH were retrospectively scanned. Thirteen patients (7 females, 6 males; 8.0±2.7 years; range, 5 to 12 years) with severe DDH were included in the study. The results of the Cakirgil method, including adductor tenotomy, open reduction, femoral shortening, varus and derotation osteotomy, and Dega acetabuloplasty, were retrospectively evaluated in 17 hips of these 13 patients. Clinical and radiological evaluation was performed according to the acetabular index, center edge angle, Severin score, and McKay criteria.

Results: Five patients had comorbidities. The mean follow-up period was 78.3±28.9 (range, 12 to 135) months. The acetabular index decreased from 35.24° to 22.06° and center edge angle improved from -34.71° to 26.59°. The Severin score decreased from 4.82 to 2.29 and the McKay criteria from 3.47 to 1.88. All changes were statistically significant (p<0.001). Redislocation was observed in only one hip.

Conclusion: Surgical treatment of the older patients with neglected DDH is technically difficult, and the results are prone to complications. The technique outlined by Prof. Dr. Güngör Sami Cakırgil, a renowned specialist in DDH surgeries in Türkiye who has made notable contributions to the relevant research, yields satisfactory outcomes when employed under suitable circumstances.

Objectives: In this study, we aimed to determine the bioefficacy of epidermal growth factor (EGF), boric acid (BA), and their combination on cartilage injury in rats.

Materials and methods: In in vitro setting, the cytotoxic effects of BA, EGF, and their combinations using mouse fibroblast cell (L929), human bone osteosarcoma cell (Saos-2), and human adipose derived mesenchymal stem cells (hAD-MSCs) were determined by applying MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide] test. In in vivo setting, 72 rats were randomly divided into four groups. A standard chondral defect was created and microfracture was performed in all groups. Group A was determined as the control group. In addition to the standard procedure, Group B received 100 ng/mL of EGF, Group C received a combination of 100 ng/mL of EGF and 10 µg/mL of BA combination, and Group D 20 µg/mL of BA.

Results: The cytotoxic effect of the combinations of EGF dilutions (1, 5, 10, 25, 50, 100, 200 ng/mL) with BA (100, 300, 500 µg/mL) was observed only in the 72-h application period and in Saos-2. The cytotoxic effect of BA was reduced when combined with EGF. There was no significant difference in the histopathological scores among the groups (p=0.13).

Conclusion: Our study showed that EGF and low-dose BA application had a positive effect on cartilage healing in rats. Significant decreases in recovery scores were observed in the other groups. The combination of EGF and BA promoted osteoblast growth. Detection of lytic lesions in the group treated with 20 µg/mL of BA indicates that BA may have a cytotoxic effect.

Objectives: The purpose of this study was to investigate whether hydroxychloroquine (HCQ) sulfate causes oxidative stress (OS) and its effect on fracture healing in an experimental rat model.

Materials and methods: In this experimental study, open diaphyseal femur fractures were induced in 24 eight-week-old male rats (mean weight: 225±25 g; range, 200 to 250 g) and then fixed with K-wire. The rats were divided into four groups: HCQ-2, control-2 (C-2), HCQ-4, and control-4 (C-4). During the study period, rats in the HCQ groups received an HCQ solution (160 mg/kg/day), whereas rats in the control groups received saline. The HCQ-2 and C-2 groups were sacrificed on the 14^th day, and the HCQ-4 and C-4 groups were sacrificed on the 28^th day. After sacrifice, malondialdehyde levels induced by OS were calculated for each rat, and fracture healing was evaluated radiographically, histomorphometrically, histopathologically, and immunohistochemically.

Results: Malondialdehyde levels were higher in the HCQ groups than in the control groups (p<0.05). Hydroxychloroquine caused OS in rats. The ratio of total callus diameter to femur bone diameter was lower in HCQ groups compared to control groups (p<0.05). No differences were observed when comparing radiological and histological healing results between the control and HCQ groups. Alkaline phosphatase levels were lower in the HCQ-4 group than the C-4 group at week four (p<0.05), although osteocalcin and osteopontin levels did not differ between groups (p>0.05). Oxidative stress had no adverse effects on histologic healing outcomes and osteoblast functions. Cathepsin K and tartrate-resistant acid phosphatase-5b levels were higher in the HCQ-4 group than in the C-4 group (p<0.05). While the number and function of osteoclasts increased due to OS in callus tissue, a decrease in the number of chondrocytes was observed.

Conclusion: Hydroxychloroquine-induced OS increases the number and function of osteoclasts and decreases the number of hypertrophic chondrocytes and endochondral ossification but has no significant effect on mid-late osteoblast products and histological fracture healing scores.

Objectives: The study aimed to analyze the efficacy of the blood management protocol developed by our team for patients who are Jehovah's Witnesses (JW) presenting for primary total hip replacement (THR).

Patients and methods: Thirty JW patients (6 males, 24 females; mean age: 70.1±9.8 years; range, 65 to 81 years) and 30 age- and sex-matched controls (6 males, 24 females; mean age: 68.7±9.1 years; range, 62 to 79 years) who underwent primary THR at our institution between January 2018 and June 2020 were retrospectively evaluated. While the surgical technique of THR was not different among the groups, blood loss management differed between the groups. Patients in the control group were given 1 g of intravenous tranexamic acid (TXA) 15 min before the surgical incision. In addition to the same TXA protocol, intraoperative cell salvage with a continuous autologous transfusion system was used for JW patients. The estimated blood loss (EBL) was determined using Meunier's formula. Hemoglobin (Hgb) decline, EBL on the first and third postoperative days, allogenic blood transfusion (ABT) requirement, and complications were analyzed between groups.

Results: There were no significant differences between groups regarding demographic and clinical characteristics (p>0.05), ABT requirement (p>0.999), and Hgb decline in the first and third postoperative days (p=0.540 and p=0.836, respectively). Furthermore, both groups did not significantly differ between EBL in the first and third postoperative days (p=0.396 and p=0.616, respectively) and the length of hospital stay (p=0.547). Similar complication rates were noted for both groups. Hemoglobin level assessments revealed that values on the first and third postoperative days were significantly lower than the baseline Hgb value in both cohorts (p<0.001).

Conclusion: A combination of intravenous administration of 1 g of TXA, meticulous hemostasis, and intraoperative use of cell saver constitutes a reasonable strategy for achieving the goal of transfusion-free primary THR with predictable levels of blood loss that are similar to non-JW patients.

Trigger finger is usually caused by stenosing tenosynovitis and hypertrophy of the retinacular sheath, and the most common site of tendon triggering is the A1 pulley. Although the A3 pulley trigger finger has been described in a few cases caused by hypertrophy of the retinacular sheath and ganglion, associated skin findings have not been reported to date. Herein, we report a rare case of the A3 pulley trigger finger due to osteochondroma with unique skin findings in a 50-year-old woman. In this case, we observed a V-shaped skin depression on the palmar side of the proximal interphalangeal joint of the right middle finger during finger locking. Additionally, we observed bilateral linear skin depressions on the sides of the proximal phalange. These findings might be caused by the traction force on the A3 pulley, connected to the skin via the Grayson and Cleland ligaments, which are fibrous tissues that connect the skin and tendon sheath.

Objectives: This study aimed to investigate the relationship between the ratio of stem size to intramedullary canal diameter, stem length, and functional outcome in revision total knee arthroplasty (RTKA) procedures, which remains largely unexplored in the current literature.

Patients and methods: A single surgeon series of RTKA procedures performed between October 2014 and November 2022 were included in this case series, and data were analyzed retrospectively. A total of 32 patients (27 females, 5 males; mean age: 73.2±8.1 years; range, 52 to 88 years) were identified, with a minimum follow-up period of five months and a maximum of eight years. Filtering the patients based on >24 month follow-up, we were left with 13 patients aged between 65 and 88 (mean 74.9±6.9) years. The latest X-rays of patients were analyzed, and the ratio of intramedullary canal diameter to stem width was calculated for both femur and tibia in both anteroposterior and lateral planes. Household income, preoperative C-reactive protein, erythrocyte sedimentation rate, comorbidities, body mass index, and implant dimensions were also recorded. Postoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form-12 (SF-12) scores, and range of motion (ROM) measurements were used to evaluate functional outcome.

Results: A moderate negative relationship between the tibial canal fill ratio (CFR) in anteroposterior views and ROM of the patients was noted. Additionally, a significant positive correlation was found between SF-12 physical score and CFR in lateral view. A moderate level of correlation between femoral CFR in anteroposterior views was also established. Due to insufficient data, joint ROM data did not show normal distribution. Therefore, a cutoff value indicating the relationship between the stem size and knee ROM could not be calculated using receiver operating characteristic analysis. Multiple regression analysis did not yield significant results, suggesting that hypothesized predictor variables were not sufficient to predict the variation in functional scores. Otherwise, no clear statistical importance or correlation between functional scores, such as WOMAC or SF-12, and CFR was found.

Conclusion: In conclusion, the findings suggest that other factors, such as other patient characteristics, surgical techniques, or implant designs, may have a more substantial impact on the functional outcomes in RTKA patients.

Objectives: This study aims to investigate the reliability of acromiohumeral distance (AHD) measurements using conventional radiographs and to compare non-standardized and standardized radiographs with intra-/interobserver reliability measurements.

Patients and methods: Between February 2021 and January 2022, a total of 110 shoulders of 55 patients (25 males, 30 females; mean age: 49.7±12.6 years; range, 25 to 77 years) were included. Radiographs were taken in four different positions: primarily shoulder anteroposterior (AP), true AP, standardized true AP, and standardized outlet views. The AHD was measured by three orthopedists. A prospective ultrasonography (US) evaluation was performed by an experienced physiatrist, and the relationship between US and radiographic measurements was evaluated. The intra- and interobserver reliability of radiographic measurements was assessed.

Results: On the standardized true AP view measurements, all observers showed a moderate to good agreement with US measurements (intraclass correlation coefficients [ICC]: 0.68-0.75). There was no significant difference between the AHD measurements of the senior orthopedist on standardized true AP and outlet views, and the US measurements. The intraobserver agreement of US measurements was excellent (ICC: 0.98, 95% confidence interval [CI]: 0.98-0.99), and the intraobserver agreement level of measurements on radiographs were good to excellent with a wide range of ICC values (ICC: 0.79-0.97). Interobserver reliability was the highest on the standardized outlet view, with an ICC of 0.91 and 0.88 in two measurement times. Interobserver reliability of other measurements were good with ICC values ranging from 0.82 to 0.88.

Conclusion: The AHD measurements on radiographs are compatible with US measurements within up to 2 mm difference if standardization is ensured. Also, measurements on standardized views have a superior consistency with lower standard error of measurement and minimal detectable change values. Therefore, we recommend using standardized true shoulder AP and standardized outlet radiographs in clinical practice and studies, as these are the most accurate in demonstrating true AHD.

Objectives: This study aimed to analyze the biomechanics of cannulated screws (CS) with or without a lateral locking plate (LLP) in talar neck fractures through a finite element analysis.

Patients and methods: The computed tomography image of the talus from a healthy volunteer (adult male) was used to reconstruct a three-dimensional talar model. The method for fixing talar neck fractures with CS and an LLP was planned using computer-aided design software. Afterward, the three-dimensional models of comminuted talar neck fractures were used to simulate fixation with anteroposterior parallel dual CS, single CS+LLP, and dual CS+LLP. Finally, finite element analysis was carried out to compare the outcomes of dual CS+LLP to those of single CS+LLP and to those of using dual CS alone. The displacement and von Mises stress values of the three groups with different internal fixation were analyzed.

Results: For a simple talar neck fracture, the lowest amount of displacement was obtained with CS+LLP (0.407 mm), while dual CS (0.459 mm) showed the highest amount of total displacement; the lowest amount of peak stresses was obtained with CS+LLP (5.38 MPa), while dual CS (8.749 MPa) showed the highest amount of total peak stresses. For a comminuted talar neck fracture, the lowest amount of displacement was obtained with CS+LLP (0.398 mm), while dual CS (0.408 mm) showed the highest amount of total displacement; the lowest amount of peak stresses was obtained with CS+LLP (129.9 MPa), while dual CS (205.9 MPa) showed the highest amount of peak stresses.

Conclusion: Compared to the other two groups, the dual CS+LLP group had better biomechanics properties in the displacement and stress peak of the talus and implant. Thus, the use of dual CS+LLP fixation is recommended for the surgical treatment of comminuted talar neck fractures.

Objectives: This study aimed to demonstrate the volar plate fixation technique for fixing Bennett's fractures due to its buttress effect.

Patients and methods: The retrospective study included 10 patients (8 males, 2 females; mean age: 35.9±11.56 years; range, 17 to 51 years) who were treated using the volar plate fixation technique between January 2018 and August 2022. The postoperative functional scores of the patients were evaluated using the Q-DASH (Quick Disabilities of the Arm, Shoulder, and Hand) score, and their pain status was evaluated with the Visual Analog Scale (VAS). We also assessed fracture union and development of complications. We assessed opposition according to Kapandji grade and abduction of the thumb.

Results: The mean follow-up time was 16.6±2.91 (range, 12 to 21) months. The technique was performed on the right extremity in eight patients and on the left extremity in two patients. All patients were right-hand dominant. The VAS score was 1 in two cases and 0 in the other cases. The mean Q-DASH score was 1.36±2.44. The mean pinch strength was 6.4±0.89 kg, and the mean grasp strength was 18.8±3.52 kg on the injured side. The mean Kapandji grade of opposition was 9.3±0.82, while the mean abduction degree was 37.4±2.01.

Conclusion: Based on the early results of this technique, we conclude that volar plate fixation for Bennett's fractures is reliable and allows for early motion, providing anatomical and stable joint reduction, and it does not have implant complications such as hardware irritation. However, fixation of small fragments may be particularly challenging.

Objectives: The study aimed to compare the efficacy and safety of percutaneous kyphoplasty (PKP) and vertebral body stenting (VBS) in the treatment of osteoporotic vertebral compression fractures (OVCFs) and evaluate the clinical efficacy, Cobb angle correction, and cement leakage associated with both methods for OVCFs.

Patients and methods: A systematic search was conducted in PubMed, EMBASE, Cochrane Library, Medline, China National Knowledge, and Wanfang Data for clinical studies comparing VBS with PKP for OVCF up to May 2023. The meta-analysis was performed using Review Manager 5.3, with a focus on evaluating clinical and radiologic outcomes.

Results: A total of eight eligible clinical studies were included in this meta-analysis. In terms of clinical outcomes, VBS was found to have a longer surgical time compared to PKP (standard mean difference [SMD]=1.06 min; 95% confidence interval [CI]: 0.20, 1.92; p=0.02). However, VBS demonstrated comparable blood loss to PKP (SMD =0.00 mL; 95% CI: -0.45, 0.45; p=0.99). Additionally, VBS showed slight superiority in alleviating back pain as measured by the Visual Analog Scale (VAS) (SMD=-0.38; 95% CI: -0.63, -0.12; p=0.004), as well as in improving functional disability based on the Oswestry Disability Index (ODI) (SMD= -0.28; 95% CI: -0.54, -0.03; p=0.03). Radiographically, VBS achieved better Cobb angle correction compared to PKP (SMD= -1.00; 95% CI: -1.48, -0.51; p<0.0001), while there was no significant difference in cement leakage between VBS and PKP (odds ratio=0.81; 95% CI: 0.21, 3.14; p=0.76).

Conclusion: The findings suggest that VBS has a comparable clinical outcome to PKP based on operation time, intraoperative blood loss, VAS, and ODI. Furthermore, VBS showed slightly better maintenance of Cobb angle correction, whereas VBS did not demonstrate a significant advantage over PKP in terms of cement leakage.