Clinical and Radiological Results of Oxford Phase-3 Medial Unicompartmental Knee Arthroplasty.

Purpose The aim of this retrospective study was to investigate the effectiveness of medial unicompartmental knee arthroplasty (UKA) by showing the results of the radiological and clinical outcomes of the patients. Materials and methods Seventy-two knees of 54 patients who underwent UKA between September 2005 and March 2011 for medial knee arthritis with a minimum follow-up of six months were evaluated. Range of motion (ROM), Hospital for Special Surgery (HSS) knee score, Knee Society Score (KSS), and Oxford Knee Score (OKS) were investigated both preoperatively and postoperatively. On the other hand, Oxford radiographic evaluation criteria were used to evaluate prostheses radiologically at the final follow-up. Results The average age was 53.4 years (47 to 79 years). The average follow-up time was 39.8 months (8 to 72 months). There was a significant difference between preoperative and postoperative ROM, HSS, and OKS (p<0.05). Radiologically, there was no sign of arthritis on the unoperated side of the knee or failure of prosthesis detected. Before the operation, the average clinical KSS was 63.2 and improved to 91.4 after the operation. In addition, the average functional KSS was 54.9 before the operation and improved to 86.5 after the operation. The average knee flexion degree was 109.1 before the operation and there was an improvement to 123.6 degrees after the operation. Before the operation, the average HSS score was 67.5 (range, 52 to 75) and improved to 89.9 (range, 85 to 100) at the final control examination. Conclusion This study supports the use of Oxford Phase 3 UKA, which has excellent clinical and radiological results in patients with medial knee arthritis.

Criteria for Ending the Distal Fusion at the L3 Vertebra vs. L4 in Surgical Treatment of Adolescent Idiopathic Scoliosis Patients with Lenke Type 3C, 5C, and 6C Curves: Results After Ten Years of Follow-up.

Introduction The selection of the most distal caudal vertebra in spinal fusion surgeries in adolescent idiopathic scoliosis patients with structural lumbar curvatures is still a matter of debate. The aim of this study was to determine the preoperative radiological criteria on the traction X-rays under general anesthesia (TrUGA) for selection between the L3 and L4 vertebrae and to assess the efficacy of these criteria via the long-term results of patients with Lenke Type 3C, 5C, and 6C curves. Methods Radiological data of 93 patients (84 females, 9 males) who met the inclusion criteria were retrospectively evaluated. The relationship between the L3 vertebra and the central sacral vertebral line, the portion of the L3 vertebra in the stable zone of Harrington, the parallelism of the L3 with the sacrum, and the tilt and rotation of the L3 on TrUGA radiographs were evaluated for the selection of the lowest instrumented vertebrae (LIV). Clinical results were analyzed using the Scoliosis Research Society-22 (SRS-22) questionnaire. Results The mean follow-up period of the study group was 149.3 months. According to the Lenke classification, 29 patients had Type 3C, 33 had Type 5C, and 31 had Type 6C curves. The preoperative analysis was based on standing anteroposterior (AP), supine traction, and bending X-rays, and the L3 vertebra was selected as the LIV in 37 patients (40%). These X-rays suggested L4 as the LIV in 56 patients (60%); however, based on our study criteria, the L3 vertebra was selected. No significant loss of correction was observed nor additional surgery due to decompensation was required in the follow-up period. Conclusion  The use of TrUGA radiographs with the identified criteria is an efficient alternative method in the selection of the LIV in patients with Lenke Type 3C, 5C, and 6C curves.

Determining the Optimal Length and Safety of Pedicle Screws in the T12 Vertebra: A Morphometric Study.

INTRODUCTION: Despite the developments in implant technology and imaging methods and the advances in surgical techniques, there are still potential problems and complications of transpedicular screw application. This is a morphometric study to examine the proximity of the T12 vertebra to the thoracic aorta. Our aim was to define the appropriate length of the pedicle screw to be used in the 12th thoracic vertebra, using computed tomography (CT) data. METHODS: Randomly selected cases from the same ethnic group in a specific age group were examined in terms of the length from the anterior vertebral body and the screw entry point of the T12 vertebra to the thoracic aorta. In light of these data, a statistical analysis was made for the selection of the most appropriate screw length. RESULTS: A statistically significant difference was detected in the distance from the T12 left screw entry point to the aorta between males and females (p=0.001). No statistically significant correlation was found between age and the distance between the left screw entry point and the aorta (p=0.105). Also, no statistically significant difference was detected between the T12 vertebral body-aorta distance in males and in females (p=0.212). The relationship between the shortest aorta-vertebral body distance and age was not statistically significant (p=0.7). Similarly, there was no statistically significant difference between the left screw entry point-aorta distance and the aorta-vertebral body shortest distance (p=0.731). CONCLUSIONS: Significant differences were observed between males and females in terms of the distance between the T12 vertebra left screw entry point and the thoracic aorta (p=0.001). Thus, we can assert the need for the preoperative evaluation of patients with computed tomography in selecting the appropriate screw length and avoiding complications.