Patellar height: an important parameter in knee MRI associated with tendinopathy, quadriceps fat pad edema (QFPE), anterior cruciate ligament mucoid degeneration (ACL-MD), and lateral cartilage damage.

BACKGROUND: Some pathologies associated with abnormal patellar height have been reported in the literature. However, its relationship with some pathologies, such as anterior cruciate ligament mucoid degeneration (ACL-MD) and focal cartilage defect, has not been investigated. PURPOSE: To investigate the relationship between patellar height with patellar-quadriceps tendinopathy, quadriceps fat pad edema, ACL-MD, and focal cartilage defect. MATERIAL AND METHODS: Magnetic resonance imaging of the knees of 261 patients were classified into three groups as normal, patella alta, and patella baja, and evaluated in terms of patellar-quadriceps tendinopathy, quadriceps fat pad edema, ACL-MD, and focal cartilage defect. RESULTS: There were 261 patients (140 men, 121 women; age range = 18-60 years; mean age = 30 ± 4.7 years). Of the 261 patients, 181 (69.3%) were normal, 56 (21.4%) were patella alta, and 24 were patella baja (9.1%). Patellar-quadriceps tendinopathy, quadriceps fat pad edema, and ACL-MD rates were significantly higher compared to the normal group (P <0.05). While a moderate positive correlation was found between patellar height shift and patellar-quadriceps tendinopathy and ACL-MD, there was a small correlation between patellar height shift and quadriceps fat pad edema. The rate of focal cartilage defect was significantly higher in the middle part of the lateral femoral condyle and lateral knee joint only in patella alta. CONCLUSION: The risk of patellar-quadriceps tendinopathy, quadriceps fat pad edema, ACL-MD, and lateral focal cartilage defect is higher in patients with alta-baja. The radiologist should evaluate these pathologies more carefully, especially subtle ones, in patients with abnormal patellar height.

The effect of eccentric glenoid reaming in reverse shoulder artrhoplasty for glenohumeral osteoarthritis.

Background: The objective of this study was to evaluate the abilitiy of eccentric reaming in reverse total shoulder arthroplasty (RSA), in patients with glenohumeral osteoarthritis (GHOA), to correct preoperative glenoid retroversion and to compare with cuff tear arthopaty (CTA) cases. Methods: Fifty-nine patients who underwent RSA with GHOA or CTA diagnosis between 2013 and 2022 and who had pre- and postoperative computed tomography scans were included in the study. Preoperative glenoid version and postoperative glenoid component versions of 17 patients with GHOA and 40 patients with CTA were measured by Friedman method. Results: The median preoperative glenoid versions in GHOA and CTA groups were measured as 16° and 4° retroverted respectively (p < 0.01). The median postoperative glenoid component versions in GHOA and CTA groups were 5° and 3° retroverted respectively (p = 0.09). The version change differences between the two groups varied significantly (p < 0.01). Conclusions: GHOA is related with higher preoperative glenoid retroversion compared to CTA. However; with eccentric glenoid reaming, adequate version correction and similar postoperative glenoid version can be achieved in GHOA compared to CTA when performing a RSA. Level of evidence: Level III. Retrospective study. Treatment study.

Fibroblast Growth Factor Soaked Collagen Membrane Shows No Biomechanical or Histological Advantages in the Treatment of Chronic Rotator Cuff Tears in a Rabbit Model.

PURPOSE: To investigate the histological and biomechanical effects of a fibroblast growth factor (FGF-2)-soaked collagen membrane used to treat a full-thickness chronic rotator cuff (RC) rupture in a rabbit model. METHODS: Forty-eight shoulders from 24 rabbits were used. At the beginning of the procedure, 8 rabbits were killed to assess the control group (Group IT) with intact tendons. To establish a chronic RC tear model, a full-thickness subscapularis tear was created on both shoulders of the remaining 16 rabbits and left for 3 months. The transosseous mattress suture technique was used to repair tears in the left shoulder (Group R). The tears in the right shoulder (Group CM) were treated using the same approach, with an FGF-soaked collagen membrane inserted and sutured over the repair site. Three months after the procedure, all rabbits were killed. Biomechanical testing was performed on the tendons to determine failure load, linear stiffness, elongation intervals, and displacement. Histologically, the modified Watkins score was used to evaluate tendon-bone healing. RESULTS: There was no significant difference among the three groups in terms of failure load, displacement, linear stiffness, and elongation (P > .05). The total modified Watkins score was not affected by applying the FGF-soaked collagen membrane to the repair site (P > .05). Fibrocytes, parallel cells, large-diameter fibers, and the total modified Watkins score were significantly lower in both repair groups when compared to the intact tendon group (P < .05). CONCLUSIONS: In addition to tendon repair, FGF-2 soaked collagen membrane -application at the repair site provides neither biomechanical nor histological advantages in the treatment of chronic RC tears. CLINICAL RELEVANCE: FGF-soaked collagen membrane augmentation provides no impact on the chronic RC tear healing tissue. The need to investigate alternative methods that may have a positive effect on healing in chronic RC repairs continues.

Three-Dimensional Finite Element Analysis of a Notched Insert Design for Reverse Total Shoulder Arthroplasty to Prevent Scapular Notching.

Purpose: Reverse total shoulder arthroplasty (RSA) is an effective treatment option for rotator cuff arthropathy. Scapular notching following RSA remains a major complication and has a high incidence. This finite element analysis (FEA) study provides a future reference for the optimal design of the insert component of RSA. This study aims to clarify the effect of a new design RSA with a notched insert on the range of adduction, scapular notching, and stress variation of its insert component using three-dimensional (3D) FEA. Methods: 3D nominal Grammont-type monobloc RSA implant components are modeled on the sawbones glenohumeral joint. The polyethylene insert is redesigned with notching of the inferior part. The comparison of standard and notched designs was performed by FEA for stress pressure of scapular notching and the degree of adduction. 3D mesh models are created for stress analysis to compare the results between standard and notched inserts for the adduction. Results: The redesigned notched inserts had an additional ~ 11.2° on adduction and prevented scapular notching. The stress analysis results for the notched insert design were lower than the standard ones (4.7 vs 22.4 Kpa). Conclusions: Notched insert design of Grammont-type RSA could provide additional adduction with lower stress on the glenoid, leading to less scapular notching. Further experimental and clinical studies on different RSA types are needed to verify this effect. Study Design: Basic Science Study; Biomechanics and Computer Modeling.

Traumatic coccydynia patients benefit from coccygectomy more than patients undergoing coccygectomy for non-traumatic causes.

PURPOSE: Conservative treatment is the first step in the management of coccydynia. However, surgical treatment is required in cases where conservative treatment fails. The aim of this study was to compare the effect of traumatic and atraumatic etiologies on functional outcomes in patients who underwent coccygectomy for chronic coccydynia. METHODS: Ninety-seven patients who underwent partial coccygectomy between October 2010 and December 2018 for the diagnosis of chronic coccygodynia were evaluated retrospectively. The patients were divided into two groups according to etiologies as atraumatic (group AT) and traumatic (group T). Concomitant disorders of the patients were recorded as psychiatric and musculoskeletal diseases. Visual Analog Scale (VAS) for low back pain, the Oswestry Disability Index (ODI) scale, Short Form-36 Physical Component Summary and Short Form-36 Mental Component Summary were used to evaluate the clinical outcomes pre- and postoperative at the last follow-up. RESULTS: The mean follow-up time was 67.3 ± 13.9 (range; 44-115) months. Group AT and group T included 48 (mean age 37.1 ± 11.3 and 36 (75%) female) and 49 patients (mean age 36 ± 11 and 35 (71.4%) female), respectively. The groups were statistically similar in terms of age (p = 0.614), gender (p = 0.691), body mass index (p = 0.885), tobacco usage (p = 0.603) and duration of pain (p = 0.073). However, the rate of musculoskeletal and total concomitant disorders was higher in the Group AT than in Group T (p < 0.05). The average preoperative SF-36 MCS and SF-36 PCS scores improved at the last follow-up from 43.3 ± 6.2 and 35.6 ± 4.9 to 72 ± 14.1 and 58.3 ± 10.9, respectively. The preoperative VAS and ODI decreased from 8 ± 1.4 and 39.8 ± 8.5 to 2.6 ± 1.8 and 13.4 ± 8.9 at the last follow-up, respectively. CONCLUSION: Successful results were obtained with surgical treatment in chronic coccygodynia. In addition, functional outcomes in patients with traumatic etiology are better than in atraumatic ones. Levels of evidence Level III; Retrospective Comparative Study.

Local Prophylactic Teicoplanin Effect on Spinal Fusion Surgery: A Comparative Retrospective Study.

BACKGROUND: Surgical site infection (SSI) is one of the severe complications of spinal fusion surgery that leads to increased morbidity and mortality rates. Prophylactic antibiotic usage is one of the methods that reduce the SSI possibility in this procedure. To determine the effect of local subfascial teicoplanin and compare it to vancomycin on surgical outcomes in patients who underwent decompression with posterior instrumentation (DPI) for lumbar spinal stenosis (LSS). PATIENTS AND METHODS: Medical charts of patients with LSS who received DPI and met the study criteria were divided into three groups: the teicoplanin group included patients who underwent DPI with local teicoplanin before closure, the vancomycin group, included patients who underwent DPI with local vancomycin, and the control group included patients who underwent DPI without any local prophylactic antibiotics. RESULTS: A total of 101 patients were included in the study. No significant differences were found among groups regarding demographics, follow-up, and clinical and functional outcomes. No significant differences were observed among groups regarding postoperative improvements in SF-36-MCS, SF-36-PCS, Oswestry disability index, and VAS (p>0.05). In the teicoplanin and vancomycin groups, the SSI rate was lower without statistical significance (2/35, 1/34, and 5/32, respectively, p=0.136); however, the postoperative fusion volume was significantly higher in the teicoplanin group when compared to other groups (3.35±1.08 cm3, 2.68±1.17 cm3, and 2.65±1.28 cm3, respectively, p=0.007). CONCLUSIONS: Although its cost is relatively higher, teicoplanin was a good alternative for vancomycin in preventing SSIs with a higher fusion rate, but no superiority was observed regarding other outcomes.

Clinical Outcomes of Two-Stage Implantation in Reverse Shoulder Arthroplasty for Postinfectious End-Stage Glenohumeral Arthritis in Native Shoulders: A Single-Center Cohort Study with a Minimum 2-Year Follow-up.

Background: Septic arthritis of the shoulder is a rare but devastating condition that may lead to joint destruction. There are few studies and limited outcome data on shoulder arthroplasty for infected native shoulders with end-stage glenohumeral arthritis (GHA). Hence, this study aimed to demonstrate the clinical outcomes of two-stage implantation in reverse shoulder arthroplasty (RSA) using an antibiotic spacer in the first stage for this challenging condition. Methods: We conducted a retrospective study on two-stage implantation in RSA in infected shoulders. Patients were diagnosed with end-stage GHA due to primary shoulder sepsis or infection following non-arthroplasty shoulder surgery. Laboratory data, range of motion (ROM), and functional scores including American Shoulder and Elbow Surgeons score, Constant score, and Disabilities of the Arm, Shoulder and Hand score were assessed prior to spacer placement and at the latest follow-up. Furthermore, intraoperative and postoperative complications were recorded. Results: In this study, 10 patients with a mean age of 54.8 ± 15.8 years (range, 30-77 years) were included. The mean follow-up period was 37.3 ± 9.1 months (range, 25-56 months). All postoperative ROM measurements and functional scores were improved significantly. Although no reinfection was observed, a total of 5 complications including 2 hematomas, 1 intraoperative humeral fracture, 1 humeral stem loosening, and 1 anterior deltoid dysfunction were observed in 4 patients after a follow-up period of at least 2 years after RSA. Conclusions: Two-stage implantation in RSA is an effective method for improving the function and controlling the infection in postinfectious end-stage GHA in native shoulders.

Surgical Management and Outcomes of Patients with Idiopathic Peroneal Spastic Flatfoot: A Retrospective Case Series.

BACKGROUND: Although tarsal coalition represents the most common cause of peroneal spastic flatfoot, its existence cannot be verified in several cases. In some patients with rigid flatfoot, no cause can be detected after clinical, laboratory, and radiologic examination, and the condition is called idiopathic peroneal spastic flatfoot (IPSF). This study aimed to present our experience with surgical management and outcomes in patients with IPSF. METHODS: Seven patients with IPSF, who were operated on between 2016 and 2019, and followed for at least 12 months were included, whereas those with known causes, such as tarsal coalition or other causes (eg, traumatic) were excluded. All patients were followed up for 3 months with botulinum toxin injection and cast immobilization as a routine protocol, and clinical improvement was not achieved. The Evans procedure and grafting with tricortical iliac crest bone graft in five patients and subtalar arthrodesis in two patients were performed. The American Orthopaedic Foot and Ankle Society ankle-hindfoot scale scores and Foot and Ankle Disability Index scores were obtained preoperatively and postoperatively from all patients. RESULTS: On physical examination, all feet manifested rigid pes planus with varying degrees of hindfoot valgus and limited subtalar motion. Overall, the mean American Orthopaedic Foot and Ankle Society and Foot and Ankle Disability Index scores significantly increased from 42 (range, 20-76) and 45 (range, 19-68) preoperatively (P = .018) to 85 (range, 67-97) and 84 (range, 67-99) (P = .043) at the final follow-up, respectively. No major intraoperative or postoperative complications were observed in any of the patients. All computed tomographic and magnetic resonance imaging scans revealed no evidence of tarsal coalitions in any of the feet. All radiologic workups failed to demonstrate secondary signs of fibrous or cartilaginous coalitions. CONCLUSIONS: Operative treatment seems to be a good option in the treatment of patients with IPSF who do not benefit from conservative treatment. In the future, it is recommended to investigate the ideal treatment options for this group of patients.

Comparison of the Functional and Radiological Outcomes of Single- and Two-Stage Bilateral Open Wedge High Tibial Osteotomy.

PURPOSE: This study compared the functional and radiological outcomes and complications of single- (SS) and two-stage (TS) bilateral high tibial osteotomy (HTO). METHODS: From 2014 to 2018, 48 patients underwent bilateral HTO surgery for osteoarthritis. The outcomes of SS in 28 knees and TS in 32 knees were compared using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Oxford Knee Score (OKS) as functional outcomes, and the medial proximal tibial (MPTA), hip-knee-ankle (HKA), tibial slope (TSA) angles, and mechanical axis deviation (MAD) as radiological outcomes. We also evaluated the estimated blood loss (EBL). RESULTS: No significant differences in the pre- and postoperative mean OKS and KOOS were found between the groups. There was a significant difference between the groups in the last postoperative HKA angle (- 0.9 ± 3.9 and 1.8 ± 4.3°, respectively). In SS and TS, the respective total mean surgical time was 108 ± 28 and 143 ± 36 min (p < 0.001). The mean calculated EBL was 612 ± 267 and 544 ± 357 mL, respectively, (p = 0.5), and the mean length of stay (LOS) was 2.2 ± 0.83 and 3.5 ± 1.0 days, respectively, (p = 0.01). CONCLUSION: SS bilateral HTO is a safe reasonable option for certain patients with bilateral knee osteoarthritis because it involves a single hospitalization, one-time exposure to anesthesia risks, accelerated rehabilitation, earlier return to expected life status, reduced total hospital stay, and a likely decrease in total cost.

Sagittal Patellar Offset Ratio Can Be a Predictor of Anterior Knee Pain after Primary Total Knee Arthroplasty without Patella Resurfacing.

BACKGROUND: Anterior knee pain (AKP) is an issue that persists even after successful total knee arthroplasty (TKA). In some patients, reasons for AKP occurrence are known, but it is unexplained in some others despite the patellofemoral joint being thought to be the main focus of pain. We investigated the relationship between unexplained AKP and the patellofemoral joint in the sagittal plane after primary TKA. METHODS: We evaluated 372 knees of 317 patients retrospectively, who had completed a minimum 24-month follow-up. We divided them into two groups according to the presence of AKP. Sagittal patellar offset ratio (SPOR), anterior femoral offset ratio (AFOR), and Insall-Salvati ratio (ISR) were measured on lateral X-rays. Clinical outcomes were evaluated using the Oxford knee score (OKS) and WOMAC pre-and postoperatively, and AKP was evaluated using a visual analog scale (VAS) postoperatively. RESULTS: Between non-AKP and AKP groups, SPOR (p < 0.001) and AFOR (p = 0.03) were significantly different but not ISR (p = 0.89). SPOR and AFOR were found to be two independent risk factors that may predict the likelihood of AKP. Receiver operating characteristic (ROC) analysis revealed that AFOR is a poor value, whereas SPOR is a reasonable predictive value. No correlation between SPOR and postoperative OKS (p = 0.92) and WOMAC (p = 0.25) and no correlation between AFOR and postoperative OKS (p = 0.44) and WOMAC (p = 0.58) were found. CONCLUSION: We found that SPOR is a good predictive tool with a cutoff value of 46.4% and 91.5% sensitivity for AKP and its increased ratio increases the probability of AKP following TKA. Considering that the patellar offset will not change, especially in patients without patella resurfacing, care should be taken not to increase the anterior femoral offset.

Comparison of 3 Cell-Free Matrix Scaffolds Used to Treat Osteochondral Lesions in a Rabbit Model.

BACKGROUND: Various cell-free scaffolds are already in use for the treatment of osteochondral defects (OCDs); however, a gold standard material has not yet been defined. PURPOSE: This study compared the macroscopic, histological, and scanning electron microscopy (SEM) characteristics of Chondro-Gide (CG), MaioRegen (MA), and poly-d,l-lactide-co-caprolactone (PLCL) cell-free scaffolds enhanced with small-diameter microfractures (SDMs) for OCDs in a rabbit model. STUDY DESIGN: Controlled laboratory study. METHODS: In total, 54 knees from 27 rabbits were used in this study. Three rabbits were sacrificed at the beginning of the study to form an intact cartilage control group (group IC). An OCD model was created at the center of the trochlea, and SDMs were generated in 24 rabbits. Rabbits with OCDs were divided into 4 groups (n = 12 knees per group) according to the cell-free scaffold applied: CG (group CG), MA (group MA), PLCL (group PLCL), and a control group (group SDM). Half of the rabbits were sacrificed at 1 month after treatment, while the other half were sacrificed at 3 months after treatment. Healed cartilage was evaluated macroscopically (using International Cartilage Regeneration & Joint Preservation Society [ICRS] classification criteria) and histopathologically (using modified O'Driscoll scores and collagen staining). Additionally, cell-free scaffold morphologies were compared using SEM analysis. RESULTS: ICRS and modified O'Driscoll classification and staining with collagen type 1 and type 2 demonstrated significant differences among groups at both 1 and 3 months after treatment (P < .05). The histological characteristics of the group IC samples were superior to those of all other groups, except group PLCL, at 3 months after treatment (P < .05). In addition, the histological properties of group PLCL samples were superior to those of group SDM samples at both 1 and 3 months after treatment in terms of the modified O'Driscoll scores and type 1 collagen staining (P < .05). Concerning type 2 collagen staining intensity, the groups were ranked from highest to lowest at 3 months after treatment as follows: group PLCL (30.3 ± 2.6) > group MA (26.6 ± 1.2) > group CG (23.3 ± 2.3) > group SDM (18.9 ± 0.9). CONCLUSION: OCDs treated with enhanced SDM using cell-free PLCL scaffolds had superior histopathological and microenvironmental properties, more hyaline cartilage, and more type 2 collagen compared with those treated using CG or MA scaffolds. CLINICAL RELEVANCE: OCDs treated with PLCL cell-free scaffolds may have superior histopathological properties and contain more type 2 collagen than do OCDs treated with CG or MA cell-free scaffolds.

Is Only Peripheral Hip Arthroscopy Enough for Selected Patients with Femoroacetabular Impingement Syndrome?

Background: Peripheral compartment hip arthroscopy has gained popularity over central compartment hip arthroscopy as peripheral compartment arthroscopy does not cause perineal post compression, prolonged lower extremity traction and thus complications such as acetabular labrum and articular cartilage injuries. The study, in essence, aims to emphasize that peripheral hip arthroscopy (OPHA) alone is sufficient without an additional surgical method in the treatment of femoroacetabular impingement syndrome (FAI). Methods: A total of 35 patients, being 21 female and 14 male, among a group of patients who were suffering from FAI syndrome and applied to private hip conservatory centers and has undergone hip arthroscopy at a later stage by a senior surgeon (I.T.) were selected from the medical-based software of the hospital. Patients with intra-articular pathology as a result of magnetic resonance imaging (MRI) were excluded from the study. The group had a mean age of 40.6, youngest being 17 and oldest 69, while the mean observation period was 26.6 months, varying between shortest 6 months and longest 63. In order to assess the patient satisfaction as well as clinical outcomes, Postel Merle d'Aubigné (PMA) score was used. Results: When patient satisfaction was evaluated, overall decrease in pain was found and when gait characteristics were evaluated together with movement, an increase in overall satisfaction was found (P<0.05). Secondary arthroscopic procedures was not required in any of the patients included in this study. A group of three patients only needed some additional surgical interventions like stem cell therapy, hip arthroplasty and pelvic osteotomy. Conclusion: OPHA can provide adequate treatment in selected FAI patients as it allows us to avoid critical complications such as damage to the cartilage, avascular necrosis, complications caused by traction and prolonged operation times seen in central compartment arthroscopy.

Does correction of reverse shoulder arthroplasty angle improve clinical outcomes in cuff tear arthropathy?

OBJECTIVE: The aim of this study was to investigate the impact of correction of the reverse shoulder arthroplasty (RSA) angle on clinical outcomes in patients with cuff tear arthropathy (CTA). METHODS: This single-center retrospective study was conducted in patients with CTA treated with RSA between 2013 and 2018. A structured questionnaire collecting demographic data, postoperative follow-up time, pre- and postoperative range of motion (ROM), American Shoulder and Elbow Surgeons (ASES) and Constant functional scores as well as scapular notching according to the Sirveaux Classification and RSA angle were evaluated by independent observers. The association between functional outcomes and RSA angle was analyzed using a curve estimation approach. RESULTS: Seventy-four patients with a mean age of 69.4 ± 8 years and mean follow-up period of 38.2 ± 10.8 months were included the study. The medialized inlay component was implanted in 35 patients, and the lateralized onlay component was used in 39 patients. The mean preoperative ASES and Constant scores improved from 28.4 ± 5.1 and 31.1 ± 5.9 to 73.4 ± 23.3 and 70.5 ± 16, respectively, at the last follow-up (both P < 0.001). The mean pre- and postoperative RSA angles were measured to be 21.3 ± 9.3° and 5.5 ± 10.1°, respectively, on X-ray. The postoperative RSA angle was 10.4 ± 10.3° in computerized tomography (CT) scans. There was an excellent correlation between X-ray and CT measurements (rs: 0.971, P < 0.001). It was found that patients with good postoperative functional scores tended to have an RSA angle of 0-10° postoperatively. The delta internal rotation of the medialized design group was greater than that of the lateralized design group (P = 0.029). CONCLUSION: In patients undergoing RSA for CTA, satisfactory clinical outcomes can be obtained by achieving a postoperative RSA angle of 0-10° with an asymmetrical inferior reaming technique. LEVEL OF EVIDENCE: Level III, Therapeutic Study.

Are the functional outcomes really inferior following unicondylar knee arthroplasty in patients with partial-thickness cartilage loss?

OBJECTIVE: The main indication for medial Unicondylar Knee Arthroplasty (UKA) is Full-Thickness Cartilage Loss (FTCL) in the isolated medial compartment of the knee. However, controversial outcomes were reported in patients with Partial-Thickness Cartilage Loss (PTCL). The aim of this study is to compare PTCL and FTCL based on intraoperative findings in medial UKA in terms of functional outcomes and complication rates requiring reoperation and revision. METHODS: Two hundred and fifteen knees of 174 patients who underwent mobile-bearing UKA between October 2014 and February 2018 for the diagnosis of symptomatic anteromedial osteoarthritis were evaluated retrospectively. A single senior surgeon evaluated the type of cartilage loss in the medial compartment intraoperatively according to the International Cartilage Repair Society classification system. Clinical outcomes were evaluated using Oxford Knee Score (OKS) and International Knee Documentation Committee (IKDC) score pre- and post-operatively at the last follow-up. Patients with PTCL and FTCL were compared in terms of their pre- and post-operative OKS and IKDC scores, and their improvements, as well as complication rates requiring reoperation and revision. RESULTS: The mean follow-up time was 33.1 ± 5.3 months. The PTCL (n = 80) and FTCL (n = 135) groups were statistically similar in terms of age (P = 0.41), gender (P = 0.921), body mass index (P = 0.165), bilaterality (P = 0.111), American Society of Anesthesiologists physical status (P = 0.218), Charlson Comorbidity Index (P = 0.74), and post-operative follow-up (P = 0.167). The mean pre-operative OKS and IKDC scores were improved from 24.5 ± 4.1 and 39.9 ± 5 to 40.3 ± 3.6 and 73.9 ± 7.7 at the last follow-up, respectively (P < 0.001). Pre-operative OKS and IKDC scores were superior in favor of the PTCL group. However, no significant difference was found between the groups in terms of post-operative OKS (P = 0.53) and IKDC (P = 0.975) scores, and their improvements (OKS, P = 0.953; IKDC, P = 0.536). The complication rates requiring reoperation was 5% (n = 11) in all patients. Of these, 9% (n = 7) from the PTCL group and 3% (n = 4) from the FTCL group were reoperated. Nevertheless, no significant difference was found between the groups (P = 0.105). CONCLUSION: In PTCL, medial UKA is a reliable surgery in terms of functional outcomes, the same as in FTCL; however, its complication rates requiring reoperation is higher without statistical significance. LEVEL OF EVIDENCE: Level III, Therapeutic Study.

Comparison of tapered-wedge short and standard-length femoral stems in single-stage bilateral direct anterior total hip arthroplasty.

PURPOSE: This study was performed to compare short and standard-length tapered-wedge-type femoral stems in single-stage bilateral total hip arthroplasty (THA) through a direct anterior approach (DAA). MATERIALS AND METHODS: The patients were divided into two groups according to their femoral stem types as short tapered-wedge stem and standard-length tapered-wedge stem groups. Outcome parameters were the surgical time, estimated blood loss (EBL), length of stay (LOS), thigh pain, Harris Hip Score (HHS), and visual analog scale (VAS) score clinically, and canal fill ratio (CFR), coronal plan alignment of the stems, subsidence, and postoperative leg length difference (LLD), radiologically. RESULTS: The short-stem group and standard-length-stem group consisted of 20 patients (40 hips, mean age 52.0 ± 14.1) and 22 patients (44 hips, mean age 49.4 ± 11.9), respectively. There were no significant differences between the groups in terms of mean surgical times (p = 0.6), EBL (p = 0.2), LOS (p = 0.2), the rate of thigh pain (p = 0.4), improvements in HHS (p = 0.4) and VAS scores (p = 0.6), LLD (p = 0.3), amount of subsidence (p = 0.9), and varus or valgus misalignment (p = 0.7). The CFR at the level of the lesser trochanter was significantly higher in the short-stem group (0.79 ± 0.1) than the standard-length-stem group (0.73 ± 0.1) (p < 0.01). CONCLUSION: In single-stage bilateral THA through DAA, short, tapered-wedge femoral stems provide similar radiographic and functional results to standard stems at short-term follow-up.

Do Techniques for Hill-Sachs Remplissage Matter in Terms of Functional and Radiological Outcomes?

BACKGROUND: Different techniques are used for the remplissage procedure, including the double-pulley and mattress suture techniques. Both techniques have shown good results; however, it is unclear if one technique is superior. HYPOTHESIS: The remplissage procedure using the double-pulley technique with 2 anchors would have superior functional and radiological outcomes compared with the mattress suture technique with a single anchor. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: This study included patients with anterior shoulder instability who were treated using arthroscopic Bankart repair combined with remplissage between 2012 and 2017. A structured questionnaire was used to gather information on the following metrics: Instability Severity Index Score, hyperlaxity, Sugaya index, presence of a Hill-Sachs defect, number of dislocations before surgery, sports participation, radiological measurement of the Hill-Sachs lesion, postoperative range of motion in both shoulders, Rowe score, Walch-Duplay score, American Shoulder and Elbow Surgeons score, and Filling Index Score of Remplissage grade according to magnetic resonance imaging scans at the last follow-up. RESULTS: There were 41 patients included with a mean age of 30 ± 7 years who underwent the Hill-Sachs remplissage procedure using the double-pulley technique with 2 anchors (n = 21; group DA) or the mattress suture technique with a single anchor (n = 20; group SA). At the final follow-up, there were no significant differences between the groups regarding the Instability Severity Index Score (P = .134), the Sugaya index (P = .538), sports participation (P = .41), the radiological measurement of the Hill-Sachs lesion (P = .803), or the Rowe score (P = .182). However, there were significant differences between the groups in the Walch-Duplay score (P = .012), American Shoulder and Elbow Surgeons score (P = .005), and Filling Index Score of Remplissage grade (P = .015), favoring group DA, as well as differences in external rotation in a neutral position (external rotation loss: 9° ± 3° [group SA] vs 12° ± 3° [group DA]; P = .003) and at 90° of abduction (external rotation loss: 8° ± 3° [group SA] vs 11° ± 3° [group DA]; P = .006), favoring group SA. CONCLUSION: In the remplissage procedure, the double-pulley technique provided better filling of the lesion and improvement in functional scores, but external rotation was limited compared with the mattress suture technique.

Unicompartmental knee arthroplasty combined with high tibial osteotomy in anteromedial osteoarthritis: A case report.

INTRODUCTION AND IMPORTANCE: Anteromedial osteoarthritis (AMOA) is a common knee pathology. However, the best treatment of AMOA remains unclear. Unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) are surgical options for AMOA patients who do not benefit from conservative treatment. We aimed to show an unusual treatment option where UKA and HTO are performed simultaneously. CASE PRESENTATION: We present a 52-year-old man with AMOA secondary to spontaneous osteonecrosis of the knee (SONK) and metaphyseal tibial varus malalignment, who was successfully treated with a combined UKA and HTO. His functional scores were excellent at the 5-year follow-up. CLINICAL DISCUSSION: Advanced SONK that causes AMOA can be treated with osteochondral autograft transplantation (OAT), HTO, UKA, or total knee arthroplasty (TKA). Although good results have been reported selecting appropriate patients for all of these methods, the best treatment method remains unclear. CONCLUSION: Although HTO and UKA are alternative treatments for AMOA, successful results can be obtained using both in individual cases.

Does performing total joint arthroplasty in the afternoon or evening increase the risk of prosthetic joint infection?

PURPOSE: Does performing total joint arthroplasty in the afternoon or evening increase the rate of early prosthetic joint infection and the likelihood of early prosthetic joint infection? METHODS: We evaluated patients retrospectively, who underwent primary total hip (THA) or knee arthroplasty (TKA) between January 2016 and December 2019, met the inclusion criteria and had at least 90 days of follow-up. Patients were divided into two groups. Group I consisted of patients whose surgeries had been started and finished before 14:00, and group II included patients whose surgeries started after 14:01. All patients were operated after non-septic cases in specific orthopedic operating rooms. Their demographic data and comorbidities were noted. Primary outcome was to compare the risk of PJI between the groups. RESULTS: Group I and group II included 2309 and 1881 patients. Total number of patients with the diagnosis of PJI was 58 (1.4%). It was 31 (1.3%) and 27 (1.4%), respectively (p = 0.79). Performing total joint arthroplasty after 14:01 did not increase likelihood of infection (p = 0.83, OR 1.03). Among the parameters, PJI was significantly associated with age (p < 0.01, OR 0.99), smoking status (p < 0.01, OR 0.15) and operating time (p = 0.04, OR 0.99) in TKA and with direct anterior approach (p = 0.02, OR 4.72) in THA. Age (p = 0.06, OR 1.03) was the factor affecting the risk of subsequent PJI after total joint arthroplasty. CONCLUSION: Performing total joint arthroplasty in the afternoon or in the evening, after aseptic cases does not increase the risk of subsequent of PJI.

Use of cement combined grafting in upper and lower extremity benign bone tumors.

OBJECTIVES: This study aims to investigate the effectivity of cement combined demineralized bone matrix (DBM) treatment on new bone formation in the cortical window as well as to evaluate the effect of new bone formation on functional outcomes. PATIENTS AND METHODS: Thirty-two benign bone tumor patients (15 males, 17 females; median age 38 years; range, 12 to 68 years), who were treated with cement combined DBM between February 2010 and December 2014, were evaluated retrospectively. Patient characteristics were recorded as age, gender, tumor localization, histological diagnosis, Enneking stage, tumor size, size of the cortical window, usage of prophylactic fixation, time to return to work, Musculoskeletal Tumor Society (MSTS) functional score, tumor relapse, and new bone formation on the cortical window in the computed tomography scans after one year of surgery. RESULTS: Median tumor volume was 17.2 cm3 (range, 2.8 to 139.6 cm3), median area of the cortical window was 8.3 cm2 (range, 1.6 to 28.4 cm2), and median postoperative one-year MSTS score was 84.5 (range, 66 to 97). MSTS scores were significantly worse with the usage of prophylactic fixation (p<0.001). There was a statistically significant difference between the usage of prophylactic fixation and cortical window size (p=0.013). There was a low-level negative correlation in terms of age and bone formation on the cortical window (p=0.046, r= -0.356) and mid-level negative correlation between cortical window size and functional scores (p=0.001, r= -0.577). CONCLUSION: Application of cement combined with DBM procedure is an effective, alternative, and biological treatment in bone tumors that provides immediate stability and stimulates new bone formation on the cortical window.

Effect of nonoperative concomitant intraarticular pathologies on the outcome of arthroscopic capsular release for adhesive capsulitis of the shoulder.

OBJECTIVE: The aim of this study was to investigate whether coexistent intraarticular lesions are negative prognostic factors for the results of arthroscopic capsular release in frozen shoulder patients. METHODS: Seventy-two patients who met inclusion criteria and underwent arthroscopic capsular release between March 2011 and August 2015 for the frozen shoulder were retrospectively evaluated. The patients were divided into two groups according to existence of concomitant intraarticular pathologies detected during arthroscopy. Preoperative and postoperative functional results were assessed with Constant score and shoulder ranges of motion; and the amount of pain was evaluated using visual analog scale (VAS). RESULTS: Group I consisted of 46 patients (mean age 47.2 years and mean follow-up 26 months) without concomitant shoulder pathologies and group II consisted of 26 patients (mean age 48.6 years and mean follow-up 15 months) with coexistent lesions (SLAP lesions, n = 8; SLAP and partial rupture of the RC, n = 4; SLAP, partial rupture of RC and impingement, n = 10; SLAP and impingement, n = 2; and AC arthritis and impingement, n = 2). Preoperatively, the mean ranges of forward flexion (p = 0.221), abduction (p = 0.065), internal rotation (p = 0.564), Constant (p = 0.148) and VAS (p = 0.365) scores were similar between the groups. After a minimum 12 months of follow-up, all patients significantly improved but no statistically significant difference was detected in the mean ranges of forward flexion (152 vs 150; p = 0.902), abduction (137 vs 129; p = 0.095), external rotation (45 vs 40; p = 0.866), internal rotation (5 vs 5 point; p = 0.474), Constant (82 vs 82.3; p = 0.685) and VAS (1.2 vs 1.2; p = 0.634) scores between the groups. CONCLUSION: The presence of concomitant shoulder pathologies does not appear to affect the clinical outcomes in patients undergoing arthroscopic capsular release for frozen shoulder. LEVEL OF EVIDENCE: Level III, Therapeutic study.