The Results of Core Decompression Treatment in Avascular Necrosis of the Femoral Head.

OBJECTIVE: Avascular necrosis of the femoral head (AVNFH) is a progressive disease seen in young, active patients, leaving significant disability in the joint when untreated. We retrospectively examined the results of patients with early stage AVNFH who had been operated in our clinic. METHODS: In our study, 65 hips of 46 patients were evaluated retrospectively. These patients were evaluated clinically by the Merle d'Aubigné-Postel Score and Harris Hip Score. The patients were radiologically staged according to the criteria by Ficat and Arlet with hip anterior-posterior and lateral graphs and magnetic resonance imaging. RESULTS: The mean follow-up period of the patient group was 73 months, and the mean age of the patients was 35 years. Of these patients, 59% were female and 41% were male; 41% had bilateral and 40% had right hip involvement. One of the patients developed AVNFH while she was pregnant, 7 were idiopathic, and 38 (81%) developed AVNFH due to steroid use. According to the Ficat and Arlet classification, 18 hips were found to be stage 1, 37 hips stage 2, and 9 hips stage 3 during admission. From the etiological point of view, 81% of the patients developed AVNFH while using steroid and 19% had idiopathic AVNFH. As for clinical improvement of the patients, the Harris Hip Score increased from 58 to 90 in idiopathic patients and 55 to 83 among steroid users. The Merle d'Aubigné-Postel classification scores increased from 6 to 15 in the idiopathic group and from 6 to 13 among steroid users. Radiologically, according to the Ficat and Arlet stage, progression was seen in all stages. Of the patients, 38.8% in stage 1, 70.2% in stage 2, and 88.8% in stage 3 showed progression, whereas 20% demonstrated rapid progression and needed total hip prosthesis. All patients who demonstrated progression were on chronic steroid therapy. The mean time to conversion to total hip replacement was 27 months. CONCLUSION: Osteonecrosis is a disease associated with high morbidity. Early diagnosis can reduce morbidity and improve a patient's quality of life. Core decompression has the effect of stopping the progression of AVNFH in the early (stage 1) stages, although it has a significant and long-term palliative effect in all stages. Most of the young and active patients with AVNFH still do not have any ideal method for treatment today, but core decompression in the early stages has been seen to reduce morbidity. It is a time-saving attempt before the final treatment, which is hip arthroplasty, is performed.

Aspergillus fumigatus infection as a delayed manifestation of prosthetic knee arthroplasty and a review of the literature.

Fungal infection after total joint arthroplasty is a very rare but serious complication and a challenge to the treating and consulting physicians. The literature includes little information about the treatment protocol for Aspergillus infection after total knee arthroplasty, since only 3 cases have been reported. We describe the case of a non-immunocompromised patient who lacked predisposing risk factors and presented with pain and swelling. An aspiration under sterile conditions revealed Aspergillus fumigatus. The patient was treated successfully with a 2-stage exchange reimplantation and 6-week course of liposomal amphotericin B. At 4 y after reimplantation, the patient had no evidence of infection or pain.

Treatment of hallux valgus by modified McBride procedure: a 6-year follow-up.

BACKGROUND: Surgical decision-making was reevaluated by comparison with an algorithm designed to analyze treatment of hallux valgus deformities. MATERIALS AND METHODS: A modified McBride procedure was performed on 52 feet of 35 patients with hallux valgus deformity. From this series, 36 feet of 21 patients were evaluated preoperatively, early postoperatively, and late postoperatively by means of subjective evaluation and clinical and radiological findings. RESULTS: The hallux valgus angle preoperatively, early postoperatively, and late postoperatively was 32.7 +/- 8.5 degrees, 10.1 +/- 6.9 degrees, and 20.6 +/- 9.5 degrees, respectively. Hallux valgus recurrence of 72.2% was observed. Subjective results were better and the patients rated their satisfaction with the procedure as excellent or high in 23 cases (63.9%) and moderate, low, or unsatisfactory in 13 cases (36.1%). CONCLUSIONS: This level of patient satisfaction demonstrates that the McBride procedure is an efficient approach for eliminating pain due to hallux valgus deformity.

[Treatment of intertrochanteric femur fractures in elderly patients: internal fixation or hemiarthroplasty]. / Yaslilarda intertrokanterik femur kiriklarinin tedavisi: Internal tespit mi, hemiartroplasti mi?

OBJECTIVES: There is no consensus as to whether internal fixation or hemiarthroplasty is more appropriate for the treatment of intertrochanteric femur fractures in elderly patients. While the latter offers early mobilization, internal fixation preserves the hip joint and avoids long-term complications associated with the prosthesis. This retrospective study aimed to compare the early results of these treatment modalities. METHODS: The study included 81 patients who were available for follow-up after surgery for intertrochanteric femur fractures. Of 38 patients (mean age 77.7 years; range 65 to 99 years) treated with internal fixation, 25 were alive; of 43 patients (mean age 80 years; range 67 to 97 years) treated with hemiarthroplasty, 22 were alive at the last follow-ups. The two groups were compared with regard to perioperative characteristics, mobilization time, complications, mortality, and daily activities according to the Barthel Activities of Daily Living Index. The mean follow-up was 22.7 months (range 6 to 39 months) in internal fixation, and 22.3 months (range 7 to 39 months) in hemiarthroplasty groups. RESULTS: Subsequent to the operation, mortality occurred in 34.2% after a mean of 13 months (range 1 to 36 months) and in 48.8% after a mean of six months (range 1 to 24 months) in patients treated with internal fixation and endoprosthesis, respectively. There were no significant differences with respect to mobilization in bed, standing, weight bearing without support, complications, and daily activity scores. The only significant difference in favor of hemiarthroplasty was that full weight bearing with two crutches took a shorter time (p<0.05). CONCLUSION: Short-term results suggest that hemiarthroplasty is not an advantageous alternative to internal fixation; moreover, its postoperative survival is shorter and mortality rate is higher. Osteosynthesis seems to be the first choice in the treatment of elderly patients with intertrochanteric femur fractures.

Evaluation of patellar height and measurement methods after valgus high tibial osteotomy.

Several controversies exist regarding the surgical difficulties and the results of total knee arthroplasty performed after failed valgus high tibial osteotomy (HTO), and the main subject is the change in patellar height that results as patella baja or infera. The purpose of this retrospective study was to evaluate patellar height after valgus HTO and the measurement methods that were actually used. Eighty-five knees that were subjected to valgus HTO were evaluated both preoperatively and postoperatively according to the Insall-Salvati Index (ISI), Blackburne-Peel Index (BPI), and Caton Index (CI) to assess any alteration of patellar tendon height that was present. All cases underwent closing wedge osteotomy with three staples or plate internal fixation and were allowed early range of motion. Significant decrease in mean patellar height ratios was detected according to all three indexes at 85 months of mean follow-up. The percentages of the decrease were 8.26% in ISI, 9.08% in BPI, and 6.34% in CI. Two knees showed patella infera according to ISI, one according to BPI and three according to CI. There were no significant correlations between the indexes and clinical status of the patients. Elevation of patella relative to the femur in closing wedge valgus HTO procedure due to the shortening of the segment between tibial tuberosity and joint line is normally expected. A significant decrease in patellar height according to ISI suggests that there should be patellar tendon shortening as patellar height cannot be changed. BPI and CI for determining patellar height in valgus HTO do not accurately measure the alteration of patella because they may affect the tibial inclination and antero-posterior translation of the proximal fragment. Another measuring system based on femoral reference points should be proposed to determine the exact change of patellar height in the valgus HTO procedure.

[The use of a modified Weber technique for high tibial osteotomy]. / Yüksek tibial osteotomi için modifiye Weber teknigi.

OBJECTIVES: We evaluated fixation in high tibial osteotomy with the use of a modified Weber technique (MWT), together with its advantages. METHODS: Thirty-nine patients (40 knees) underwent high tibial osteotomy for varus deformities of the knee joint and medial compartment degeneration. Fixation was performed by a modified Weber technique in which a semi-tubular plate and a long leg screw were used in place of the original Weber instrumentation. Thirty-five patients were women and four were men, with a mean age of 52.5 years (range 25 to 67 years). The patients were evaluated before surgery both clinically and by HSS scores and the advantages and disadvantages of the technique were assessed. The mean follow-up was 22 months (range 8 to 45 months). RESULTS: All patients were allowed to give weight on the affected leg to the extent of utmost tolerability on the forth postoperative day. At the end of two weeks, 60% of the patients could bear half of the body weight. Screw breakage occurred in one patient due to faulty application of the technique. Pseudoarthrosis was seen in none of the patients, nor were there any early or late complications. Radiologic evidence of union was observed in all osteotomy sites. All patients achieved full extension except two who had a flexion deformity of 5 degrees. The mean knee flexion was 130.2 degrees. CONCLUSION: High tibial osteotomy may provide a rigid fixation, postoperative early motion and low complication rates in varus deformities and medial gonarthrosis of the knee. Our data suggest that MWT results in good stability both statically and dynamically in the fixation of high tibial osteotomy.