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PURPOSE: This study aimed to analyze and compare gait patterns and deviations at long-term follow-up in children who received medial open reduction (MOR) before 18 months for unilateral or bilateral hip developmental dysplasia (DDH). METHODS: A retrospective chart review was conducted on children who underwent MOR. The study population was divided into two groups: the unilateral group, including unilateral (five children with unilateral) and bilateral (five children with bilateral DDH). Ten healthy children were recruited for the control group. Spatiotemporal, kinematic, stiff-knee gait (SKG), and kinetic gait characteristics were analyzed. RESULTS: Stance time was significantly shorter in both the unilateral (median [IQR]; 590 ms, [560.0-612.5] and bilateral (575 ms, [550-637.5]) groups than in the control group (650, [602.5-677.5]) (p < 0.001), whereas swing time did not differ substantially (p = 0.065) There was no considerable difference in the mean knee flexion at swing between the unilateral (31.6°, [30-36]) and control (30.11°, [27.8-33.6] groups (p > 0.05), but the bilateral group (28.5°, [24.9-32.1]) showed the lower values than the other groups (p < 0.001 for bilateral vs unilateral group; p = 0.008 bilateral vs unilateral group). All the SKG parameters significantly differed among the groups in multi-group comparisons (p < 0.001 for each parameter). Three children had borderline SKG, and two had not-stiff limbs in the unilateral group. In the bilateral group, four children had stiff limbs, and one had borderline SKG. Most kinetic gait parameters were not statistically different between groups (p > 0.05). CONCLUSION: This study has revealed notable deviations in gait patterns of children with DDH treated by MOR at long-term follow-up compared to healthy children's gait. MOR could negatively affect pelvic motion during gait due to impaired functions of the iliopsoas and adductor muscles, and SKG can be encountered secondary to iliopsoas weakness.
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INTRODUCTION: Malign peritoneal mesothelioma (MPM) is an uncommon disease that is difficult to treat. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) are the gold standards for treating MPM. Sometimes extreme cytoreductive surgery (eCRS) is required to achieve complete cytoreduction, which is one of the most important prognostic factors. There is limited information in the literature about the contribution of eCRS in patients with MPM. In this study, we aimed to investigate the impact of eCRS on survival and perioperative outcomes. METHODS: The Department of Surgical Oncology at Cumhuriyet University database was retrospectively reviewed for MPM patients who underwent CRS-HIPEC between January 2004 and December 2018. Patients who underwent CRS-HIPEC were divided into eCRS and less extensive CRS (leCRS) groups. A resection of ≥5 organs or ≥3 small bowel anastomoses were defined as eCRS. Both groups were compared regarding survival, demographic information, and perioperative outcomes. RESULTS: A total of 31 patients were included. eCRS-HIPEC was used in 15 patients. Complete cytoreduction (CC score 0/1) was achieved in all 31 patients. Compared to leCRS, the eCRS group had a longer median length of stay, longer intensive care unit stay, a higher median peritoneal cancer index (PCI), higher intraoperative blood loss, more frequent occurrence of any complication, and a longer operative time (all p values < 0.001). Clavien Dindo 3-4 complications, ASA, and gender were similar in both groups of patients (p > 0.05). It was found that there was no significant difference between the OS of the eCRS and leCRS groups (37.5 vs. 42.8 months, p = 0.895). CONCLUSIONS: Rates of serious complications and morbidity are similar in patients undergoing eCRS compared to leCRS. In patients with high PCI and multiorgan involvement, complete cytoreduction can be achieved by performing eCRS, and survival results equivalent to those with low PCI can be achieved.