Osseoscopy-assisted core decompression and debridement in the treatment of avascular necrosis of the femoral head.

Core decompression of the femoral head is a standard surgical procedure used in the early stages of the femoral head avascular necrosis (AVN) (Steinberg I to III). This study aimed to determine whether the advantages of osseoscopy-assisted core decompression using a standard arthroscopic set up in the early stages of AVN of the femoral head. Twelve hips of 12 patients who underwent osseoscopy-assisted core decompression and debridement with the diagnosis of AVN of the femoral head were reviewed between 2019 and 2021. The etiology was idiopathic in 2 patients; ten had a history of steroid use. The preoperative and postoperative first month Harris Hip Score (HHS) and visual analogue scale (VAS) were recorded. Standard X-rays, computerized tomography, and magnetic resonance imaging (MRI) were noted at preoperatively and sixth month follow-ups. In a 1-year follow-up, X-rays and MRIs were reviewed. All patients significantly improved in the VAS and HHS after the osseoscopy-assisted core decompression (P = .002). Two of the 12 patients with an initial stage of Steinberg IIC and IIB and one with Steinberg IA had a progressive femoral collapse and, therefore, had a total hip replacement at the end of the follow-up. Nine patients (75%) had satisfactory functional and radiological results in 1-year of follow-up. However, 3 patients (25%) culminated in total hip arthroplasty in a 1-year follow-up. Using an arthroscopic set up during osseoscopy-assisted core decompression surgery of the femoral head AVN has the benefits of direct visualization and accurate debridement of the involved area. The osseoscopy-assisted core decompression technique avoids excessive debridement of the healthy bone tissue adjacent to the necrotic area.

Comparison of the effectiveness of late-phase clinic-based and home-based progressive resistance training in female patients with total knee arthroplasty.

BACKGROUND: Early rehabilitation after total knee arthroplasty (TKA) is crucial in functional outcomes. However, considering improvements in the first six months, there may be benefits to continuing rehabilitation beyond three months postoperatively to achieve maximum functionality and strength. OBJECTIVE: The aim was to compare: (a) effectiveness of late-phase clinic-based and home-based progressive resistance training (PRT) in female patients with TKA; and (b) crude cost of both interventions and explore feasibility. METHODS: Thirty-two patients were assigned to clinic-based PRT (n = 16) and home-based PRT (n = 16) groups. A training program was performed at the clinic or at home for eight weeks. Pain, quadriceps and hip abductor strength, patient-reported and performance-based outcomes, knee range of motion (ROM), joint awareness, quality of life (QoL) were assessed at baseline (three months postoperatively) and after 8-week intervention (five months postoperatively). Feasibility and crude cost were examined. RESULTS: Exercise adherence was 100% in clinic-based PRT and 90.6% in the home-based PRT group. Both interventions improved quadriceps and hip abductor muscle strength, performance-based and patient-reported outcomes, knee ROM, and joint awareness without side effects (p < .05). Clinic-based PRT showed better results in: activity pain (p = .004, ES = -0.888); knee flexion (p = .002, ES = 0.875) and extension ROM (p = .004, ES = -1.081); chair sit-to-stand test (p = .013, ES = 0.935); joint awareness (p = .008, ES = 0.927); and QoL than home-based PRT (p < .05). CONCLUSION: Late-phase clinical-based and home-based PRT interventions may be beneficial in improving muscle strength and functionality in patients with TKA. Late-phase PRT is feasible, cost-effective, and recommended for rehabilitation after TKA.

A comparison of balance and fall risk in patients with unilateral and bilateral total knee arthroplasty.

BACKGROUND: Static or dynamic postural control cannot be fully restored in patients with knee osteoarthritis, even after total knee arthroplasty (TKA), which may contribute to an increased risk of falls in the elderly. OBJECTIVE: To evaluate balance and the fall risk before and after TKA in patients with bilateral knee osteoarthritis. Secondary outcomes were patient-reported and performance-based activity limitations. METHODS: A total of 45 patients were separated into two groups as unilateral TKA (UTKA, n= 24) and bilateral TKA (BTKA, n= 21) groups. All the patients received standard postoperative physical therapy for 3 months. Balance and fall risk (Biodex Balance System SD), patient-reported and performance-based functionality (WOMAC, 30-second chair-stand test, 9-step stair climbing test and 40-meter fast-paced walk test) and Short Form-12 (SF-12) were evaluated at preoperatively, and at 3 months postoperatively. RESULTS: There was no difference between the groups in postoperative fall risk and balance (p> 0.05). The BTKA group obtained better results in the sit-to-stand test and SF-12 physical dimension (p< 0.05). CONCLUSIONS: UTKA and BTKA interventions and the standard postoperative rehabilitation were seen to improve balance and quality of life, and reduce the fall risk, patient-reported and performance-based activity limitations. However, despite improvements in balance, the risk of falling persists.

Distance learning in the COVID-19 pandemic: acceptance and attitudes of physical therapy and rehabilitation students in Turkey.

INTRODUCTION: To reduce the rate of spread of the COVID-19 pandemic in Turkey, distance education was initiated in all universities on 23 March 2020. Distance learning had not been experienced in physical therapy and rehabilitation education before the COVID-19 outbreak. This study aimed to (a) determine the acceptance and attitudes of Pamukkale University Physical Therapy and Rehabilitation undergraduate students towards distance learning during the COVID-19 outbreak and (b) compare the results among years. METHODS: This study was conducted from May 2020 to June 2020 at the Pamukkale University School of Physical Therapy and Rehabilitation in Turkey. A total of 381 students (271 female, 110 male) participated. The Distance Learning Systems Acceptance Scale (ease of use, benefit), the Community Feeling Scale (affective and actional dimension), and the Distance Learning Attitude Scale (general acceptance, individual awareness, perceived usefulness, effective participation) were used to measure students' acceptance and attitudes towards distance education. RESULTS: Students had partly positive attitudes towards distance learning but were undecided about individual awareness, usefulness, and effective participation. The sense of community among students was moderate in the distance learning environment. Distance learning acceptance and attitude, and the sense of community levels, were highest in fourth-year students (last year of the school), followed by first-, third-, and then second-year students. The distance learning and sense of community scores of first- and fourth-year students were significantly higher than those of second- and third-year students (p≤0.01). CONCLUSION: Physical therapy and rehabilitation undergraduate students' attitudes towards distance learning during the COVID-19 outbreak were positive. However, when comparing between years, students in the second and third academic years had less positive attitudes. This may be because most of their curricula consisted of practical courses and summer field internships, and there were no opportunities to practise on mannequins, peers, and patients in distance education. In this study, the sense of community among students in the distance learning environment was also moderate. This may be because students were not enthusiastic about attending course lectures online, and because they did not have to view the lectures at a set time.

Does mini-midvastus approach have an advantageous effect on rapid recovery protocols over medial parapatellar approach in total knee arthroplasty?

OBJECTIVES: This study aims to compare the effects of mini-midvastus (MMV) versus medial parapatellar (MPP) approach on rapid recovery protocols during total knee arthroplasty (TKA). PATIENTS AND METHODS: This prospective, randomized, single-blinded study was performed in 54 patients (4 males, 50 females; mean age 64.1±6.4 years) diagnosed as primary knee osteoarthritis and planned for unilateral TKA between May 2018 and March 2019. Patients were randomly assigned as MMV (1 male, 26 females; mean age 65±6.4 years) and MPP (3 males, 24 females; mean age 63.2±6.3 years) groups. Rapid recovery TKA protocol and discharge criteria were assembled and all patients were evaluated preoperatively, and at postoperative first and third months. Length of hospital stay (LOS) was recorded for all patients. Hemoglobin and hematocrit values, radiologic assessment of alignment, knee range of motion (ROM), quadriceps muscle strength, visual analog scale (VAS), 30-sec chair-stand test, stair-climb test, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Short Form-36 (SF-36) were used for evaluations by blinded observers. RESULTS: There was no significant difference in demographic variables between two groups. Operative time in MMV Group (78.1±2.7 min) was significantly longer than the MPP Group (65.9±2.6 min) (p<0.0005). LOSs in the MMV and MPP Groups were 27.6±3.1 hours and 29.1±6.7 hours with no significant difference. There was no statistically significant difference in postoperative measurements between groups in hemoglobin and hematocrit values, radiologic alignment of components, knee ROM, VAS, 30-sec chair-stand test, stair-climb test, WOMAC, KOOS, and SF-36 evaluations (p>0.05). In terms of quadriceps muscle strength gain, we could not find any difference between groups in pre- and postoperative difference of changes (p>0.05). CONCLUSION: With the use of contemporary rapid recovery protocols during TKA, MMV approach had no superiority over MPP approach when quadriceps muscle strength, LOS, pain, function, and quality of life were assessed. Longer operative time in the MMV approach compared to MPP approach may be considered as a disadvantage.