Patellar resurfacing in total knee arthroplasty leads to better isokinetic performance.

BACKGROUND: For decades there have been concerns about patellar resurfacing (PR) in total knee arthroplasty (TKA) and the individual preference of the surgeon is still the main determinant of whether or not resurfacing is applied. According to preference, surgeons can be categorized in 3 main groups of those who usually, selectively, or rarely resurface. The aim of this prospective, randomized, controlled study was to compare the isokinetic performance and clinical outcome of TKAs with PR and without PR. METHODS: A total of 50 patients scheduled to undergo TKA for primary osteoarthritis of the knee were randomly assigned to either the PR or non-PR groups. There were no significant differences between the groups in respect of age, BMI, gender and preoperative Knee Society Score (KSS) and isokinetic performance. Patients were evaluated at postoperative 3, 6, and 12 months with KSS and at 6 months and 1 year with isokinetic measurements. RESULTS: The PR group had a higher mean score, especially in the functional component of KSS, but the difference was not statistically significant. Knee extension peak torque was significantly higher in the PR group at 6 months (p = 0.029) and 1 year (p = 0.004) postoperatively. There were no significant differences between the groups in respect of knee flexion peak torque values following TKA. CONCLUSIONS: The results of this study demonstrated that PR during TKA is associated with better isokinetic performance and higher knee scores. These results support routine/usually resurfacing of the patella. For surgeons who selectively resurface the patella, the advantage of better isokinetic performance may be taking into consideration in favor of resurfacing the patella where they are undecided. LEVEL OF EVIDENCE: Level I, therapeutic study.

Does Electrocauterization of the Matrix After the Wedge Resection of the Toe-Nail Affect Recurrence in Discrete Age Groups Differently? A Retrospective Analysis.

The onychocryptosis, also known as ingrown toe-nails, is a painful, common disorder which is less common in children than in adults. The purpose of the present study was to focus on the effect of electrocautery matricectomy on recurrence rate and clinical outcomes in different age groups. We performed a retrospective assessment of 189 consecutive ingrown toe-nails surgeries. Electrocautery matricectomy was performed in 68 (49.2%) of 138 (73%) adults, 25 (49%) of 51 (27%) adolescents. Recurrence was observed in 11 (21.5%) adolescent patients, while recurrence was observed in 12 (8.6%) adult patients. Recurrence was observed in 9 (9.6%) of 93 patients in whom cautery was used, while 14 (14.5%) recurrences were observed in 96 patients who did not use cautery. When the adolescent patient group was evaluated separately, recurrence was observed in 2 (8%) of 25 patients in the cautery group, while recurrence was observed in 9 (34.6%) of 26 patients in the other group. EM addition to the wedge excision does not affect the results in adult patients, but it significantly reduces recurrence in adolescent patients. Especially in younger patients, it is recommended to complete the matricectomy with electrocoagulation.

Isokinetic performance and function are similar after total hip arthroplasty applied with a posterior or anterolateral approach: a randomised controlled trial.

BACKGROUND: There are ongoing debates on the effects of surgical approach on outcome after total hip arthroplasty (THA). It was hypothesised that with the anterolateral approach, trauma to the abductor arm can occur and related detrimental effects can diminish the postoperative outcomes. In this first randomised controlled trial in the literature on this subject, isokinetic performance and patient-reported functional outcomes were evaluated in patients undergoing THA with a posterior approach (PA) and an anterolateral approach (ALA). METHODS: A total of 48 patients scheduled to undergo THA were randomised to ALA or PA groups. The patients were evaluated preoperatively and at 6 and 12 months postoperatively, with flexion, extension and abduction strength measurements and the Harris Hip Score (HHS). The physiatrist performing isokinetic tests and the patients were blinded to the study groups. RESULTS: Both groups were similar in respect of age, body mass index (BMI), gender and preoperative isokinetic performance and HHS. Both groups demonstrated similar isokinetic performance (p < 0.05) and there was no difference in HHS (p < 0.05) at the 6- and 12-months follow-up evaluations. CONCLUSION: Although there is concern about potential abductor muscle damaging during ALA, the results of this randomised controlled study demonstrated that ALA can produce similar isokinetic performance and functional outcome to PA at 6 and 12 months, despite the close proximity to the abductor arm. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT04640740 (retrospectively registered).

The self-assessment of newly graduated orthopedic surgeons on essential surgical procedures.

OBJECTIVE: The aim of this study was to assess the self-confidence of newly graduated orthopedic surgeons on performing essential surgi- cal procedures. METHODS: The study included 151 orthopedics and traumatology surgeons who had completed their (orthopedics and traumatology) training within the last year. They were asked to complete an online questionnaire which was available from February 2020 to May 2021. In the questionnaire, newly graduated orthopedic surgeons were asked whether they could do the 18 listed essential adult and 8 listed essential pediatric cases independently. They were asked about patient follow-up systems and who these were supervised by, the demo- graphic data of the city and about the institution they were trained in, and how many times they performed the listed surgeries during their training. RESULTS: 74 (49%) of the participants received their training in training and research hospitals, 69 (45.7%) in state university hospitals, and 8 (5.3%) in foundation university hospitals. More than 80% of the participants answered, "I can do it independently" for 13 (81.6%) out of 16 adult cases and 7 (87.5%) out of 8 paediatric cases. The average self-efficacy score of the participants was 32.22 out of 36 for adult cases and 15.3 out of 16 for paediatric cases. The total average self-efficacy score was 47.52 out of 52. CONCLUSION: This study has shown us that newly graduated orthopedic surgeons have the self-confidence to handle many of the essential types of cases independently.

Comparison of the first and second waves of the COVID-19 pandemic with a normal period in terms of orthopaedic trauma: Data from a level 1 trauma centre.

OBJECTIVE: The aim of this study was to compare the characteristics and distribution of trauma surgeries performed in the first phase of the COVID-19 pandemic, the second phase of the pandemic, and the normal period before the pandemic. METHODS: Three different time periods were determined.Group 1 represented the first wave of the pandemic, in which lockdowns andrestrictions were strictly applied and only emergency and trauma surgeries wereperformed, between 1 April and 31 May 2020. Group 2 represented the second waveof the pandemic, during which restrictions were not applied and only emergencyand trauma surgeries were performed, from 1 September to 31 October 2020. Group3 represented the normal period before the pandemic, including surgeriesperformed between 1 September and 31 October 2019. In addition, patients ineach group were divided into two groups as younger than 16 or older than 16 inorder to understand the difference between paediatric and adult orthopaedictraumas. The distribution of patients and their fractures were evaluated. RESULTS: In Group 1, the rates of intra-articular fractures, distal extremity fractures, and proximal humerus fractures decreased, while the rate of proximal femur fractures increased (P < 0.05 for all). The frequency of hand fractures treated in Groups 1 and 2 compared to Group 3 was reduced (P < 0.05 for both). There was no statistically significant difference between Groups 2 and 3 for fractures in different parts of the body except for hand fractures (P = 0.001 for hand fractures, P > 0.05 for the other fractures). CONCLUSION: We observed that the frequency of fractures decreased, and the distribution changed due to severe restrictions and lockdowns in the first wave of the pandemic. When the restrictions and lockdowns were removed in the second wave, the frequency of fractures decreased, but the distribution of fractures was similar to the normal period in 2019. LEVEL OF EVIDENCE: Level III, Diagnostic Study.

Rate of conversion of reports presented at the Turkish Society of Sports Traumatology, Arthroscopy and Knee Surgery Congress into publication.

OBJECTIVE: The aim of this study was to evaluate the conversion rate of oral and poster presentations into publications presented at four consecutive congresses held by the Turkish Society of Sports Injuries and Arthroscopy between 2008 and 2014 and to determine the publication pattern. METHODS: The manuscripts published in peer-reviewed journals were identified using the Web of Knowledge, PubMed, Google Scholar databases, ULAKBIM, and Endnote citation management software (X7.7.1). The identified manuscripts were classified according to the level of evidence, number of citations, subject, publication journals, time period until publication, and citation index of the journal. RESULTS: Between 2008 and 2014, a total of 561 presentations were made, comprising 278 posters and 283 oral presentations. Of these presentations, 164 (29.2%) were published as a manuscript. Of the published articles, 114 were originated from oral presentations (40.2% of total) and 50 from poster presentations (18% of total). A significantly higher number of oral presentations compared to poster presentations were converted into publications (p < 0.05). However, no significant difference was determined between the conversion rates of oral and poster presentations in 2014. The mean time from presentation at the congress to publication was 15.4 months (range: -144 months to +62 months). The mean impact factor of the journals at the time of publication increased for each congress. Evidence level of presented articles was significantly higher in the 2014 congress when compared to previous congresses. CONCLUSION: The rate of conversion into publication was higher for oral presentations, which can be attributed to the fact that studies with a higher level of evidence are more likely to have been presented as oral presentations. Based on these study results, authors of oral presentations at congresses should be encouraged to increase the rate of conversion into publication.