Comparison of bilateral cementless total knee arthroplasty results between patients in different BMI groups.

INTRODUCTION: The aim of this study was to compare the results of cementless bilateral total knee arthroplasty (TKA) between individuals in different obesity groups. MATERIALS AND METHODS: This was a retrospective cohort study. Patients with a body mass index (BMI) greater than 25 who underwent bilateral TKA for gonarthrosis between 2014 and 2020 and completed a minimum follow-up of 24 months were included. Age, sex, height, weight, BMI, operation time, length of stay, patient satisfaction, knee scores and complications were compared. Patients with missing data, who were followed for less than 24 months or had postoperative fractures around the knee were excluded. RESULTS: There was a significant difference between the groups in terms of operation time (Class III > overweight > Class II > Class I p < 0.001). There was a significant difference in complications between the groups (Class III > Class I > Class II > overweight p = 0.010). According to our pairwise comparison, complications were more common in the class III group than in the overweight group. Knee score (KS) and function score (FS) increased significantly after surgery in all groups (p < 0.001), with no difference in FS (p = 0.448). Knee score changes were greater in the overweight and class I groups (p < 0.001). There was a significant interaction between both KS and FS and person satisfaction (p < 0.001). CONCLUSION: Cementless TKA improved KS and FS in all obesity groups, yielded high patient satisfaction. Although the incidence of complications was higher in the morbidly obese patients than in the overweight patients, the difference was not significant. Patients with morbid obesity should be informed about related risks before planning cementless TKA.

Effects of preoperative anxiety level on pain level and joint functions after total knee arthroplasty.

This study examined the effect of preoperative anxiety level on postoperative pain, opioid and nonopioid analgesic use requirements and joint function in patients undergoing primary knee arthroplasty for knee osteoarthritis. 106 patients were included in the study. Situational anxiety score (STAI-S) and trait anxiety score (STAI-T) were divided into two groups as below and above 40. Visual analog scale (VAS), Lysholm scores, and anxiety levels were assessed preoperatively, at the third and sixth month postoperatively to investigate their effects on the use of opioid and non-opioid drugs during the postoperative period. For those with low situational and trait anxiety scores, the median duration of hospital stays was significantly shorter compared to those with high anxiety scores. In groups where anxiety levels were initially low, the median anxiety levels at the postoperative 3rd month were also observed to be lower compared to the other group. In the same groups, the median VAS values and the median Lysholm knee scores were significantly better both preoperatively and at the postoperative 3rd month compared to the other group. There was no significant difference in Lysholm score between the two groups at the 6th postoperative month. Similarly, in the preoperative period, groups with low anxiety levels had a significantly lower median usage of both opioids and non-opioids compared to the other group. These findings suggest that high preoperative anxiety may have a negative effect on functional outcomes in the early postoperative period, but this effect disappeared at 6 months. It can be concluded that reducing preoperative anxiety may have a positive effect on early outcomes. We believe that preoperative psychological evaluation and treatment can increase the satisfaction level in patients undergoing total knee arthroplasty (TKA).

A Comparison of Clinical Outcomes Between the Winograd and Modified Winograd Methods for Ingrown Toenails: A Retrospective Study of the Importance of Suturing Techniques.

AIM: This study aimed to compare the effects of the Winograd and modified Winograd methods for nail bed suturing on clinical outcomes in patients with nail ingrown. METHODS: In total, 45 patients who underwent surgery for ingrown toenails between December 2019 and December 2020 were randomised retrospectively. In this study, different methods applied by the authors were studied, and the methods applied by each author were divided into two separate groups. All patients had partial germinal matrix and nail bed excisions. Thirty (53.6%) of the nails were dressed in gauze, leaving the excised area of ​​the nail unsutured (group 1). Then, the remaining 26 nails (group 2) were sutured with the mattress suturing technique to ensure that the skin was under the nail. Clinical outcomes, visual analogue scale (VAS) scores, and verbal satisfaction status were statistically evaluated. RESULTS: In our study, 56 nails of 45 patients were evaluated retrospectively. The patients were followed up for an average of 13 (10-19) months. The mean age was 27.13 (15--48) years. In total, 31 (68.9%) of the patients were men, and 14 (31.1%) were women. The incidence of postoperative bleeding and granulation tissue development decreased in the sutured group. In group 1, the development of hypertrophic granulation tissue after surgery had a significantly negative impact on VAS score and recovery time. In the sutured group, patients returned to work or performed activities of daily living for a shorter period. Approximately 95% of patients were satisfied or extremely satisfied. CONCLUSION: Partial matrix excision using the appropriate suturing technique is associated with a fast recovery, low recurrence rate, high patient satisfaction, and earlier return to work activities of daily life among patients treated for ingrown toenails.

Does plate-screw density affect the functional outcomes in the treatment of proximal humerus fractures?

BACKGROUND: The aim of the study is to evaluate the relationship between plate-screw density (PSD), functional results, and complication rates in the treatment of proximal humerus fractures (PHFs) with proximal humerus locking anatomical plate (PHLAP). METHODS: Consecutive 43 patients (22 females and 21 males) who underwent PHLAP for the treatment of PHF between 2010 and 2016 were evaluated. AO classifications were used for the classification of fractures. Based on the biomechanical stability the-ory of Erhardt et al., the patients were divided into two groups as <60% and >60% according to the number of screws fixed to the humeral head for the determination of PSD. The patients were divided into two groups as PSD <60% (n=21) and PSD>60% (n=22) according to the number of screws fixed to the humeral head for the determination of PSD. Functional results were evaluated using the Constant-Murley shoulder score (CMS). Radiological evaluation was performed with collodiaphyseal angle (CDA), varus-valgus angulation, avascular necrosis (AVN), and arthrosis. The groups were compared in terms of demographic characteristics, functional results, radiological scores, and complications. RESULTS: The mean age was 54.47±17.43 years and the mean follow-up time was 19.51±5.27 months. Although the CMS scores of patients with a PSD of over 60% were higher than those below 60%, the CMS score did not differ statistically. In groups, the mean CDA of the operated shoulder was significantly lower than that of the non-injured side (p=0.002). Eight patients had varus angulation, whereas two patients had humerus head AVN. No significant relationship was observed between PDS and functional scores, radiolog-ical results, and complications. CONCLUSION: Functional results of PSD >60% are higher than PSD <60% group but there is no statistical difference between groups according to functional, radiological results, and complications.

Ceramic femoral head in highly cross-linked polyethylene cup. 5 year results of a randomized trial.

BACKGROUND: Although few methods are used to estimate polyethylene liner wear from radiographs of total hip replacements, there is no consensus with regard to the accuracy of these methods. Highly cross-linked polyethylene (XLPE) is reported to have low rates of linear wear in the literature. However, there are not reports about wear rate of ceramic head in hxple cup at 5 years postoperatively, evaluated by Dorr method. We evaluated the wear rate of HXPLE, within the first five years after implantation using manual techniques of Dorr. MATERIAL AND METHODS: We evaluated 143 patients (93 males and 50 females) with one design of uncemented acetabular component, a 40-mm (77 hips) or 44-mm (66 hips) ceramic femoral head and the annealed highly cross-linked crossfire polyethylene (X3) insert used in combination with Secur-Fit Advanced stems at a mean follow-up of 5 years. Selection of these femoral heads was based on several factors, including the perceived risk of dislocation, the outer diameter size of the acetabular component, and liner availability. Measurements of linear wear were performed by experienced surgeons with Dorr method and analyzed using the first-to-last method. Standard radiographs were used to detect periprosthetic osteolysis. Clinical records were used to determine all demographic data (age, height, weight, gender, months of follow-up, etc.). RESULTS: For the entire cohort, the median linear wear rate was 0.0438 mm per year at 5 years and there was no any revision due to loosening, no liner fracture, and no patient with symptomatic corrosion. The head size was selected intraoperatively based on the size of the acetabular component and presumed risk of dislocation. There was no hip with pelvic or femoral osteolysis. The median linear wear rate was 0.0461 mm (±0.0183) and 0.0409mm (±0.0118), respectively, at head diameters of 40 and 44 mm. We found no association between femoral head size and the linear wear rate. This sentence can be excluded from here CONCLUSIONS: This acetabular component and HXLPEs with large ceramic heads had low rates of linear wear. Large ceramic femoral heads did not lead to liner fracture, loosening, or symptomatic trunnion corrosion in this patient population. However, we recommend longer clinical follow-up studies and caution in the routine use of larger ceramic femoral heads in other, younger patient populations. KEY WORDS: Ceramic femoral heads, Highly cross-linked polyethylene, Large heads, Total hip arthroplasty.

Treatment of Psoas abscess related coxarthrosis due to salmonella infection in a patient with chronic renal failure. A case report.

INTRODUCTION: The most common microorganisms isolated from septic arthritis are staphylococcus aureus and streptoccocci. Septic arthritis due to Salmonella spp. is extremely rare. PRESENTATION OF CASE: A 55-year-old man, chronic renal failure, is admitted hip arthtritis with newly arised symptoms. The findings were not compatible with primary arthritis. The laboratory findings which include white blood cell count, erythrocyte sedimentation rate (esr) and c-reactive protein (crp) were elevated. In magnetic resonance (mr) imaging there were psoas abscess and septic arthritis of the hip. They were treated by drainage. The culture was confirmed as Salmonella spp. Antibiotic treatment were done. DISCUSSION: Uremia in patients with chronic renal failure is associated with a state of immune dysfunction. In our case, uremia may cause immunosuppressive conditions and hematogenous dissemination of salmonella. CONCLUSION: Salmonella infection in a patient with chronic renal failure may be occured. It must be kept in mind that early diagnosis, administration of appropriate systemic antibiotics and surgical intervention play a pivotal role in successful management. KEY WORDS: Arthritis, Failure, Psoas, Salmonella Renal Abscess.

Can water lacerate a tendon? A car-wash accident: A lacerated extensor hallucis longus tendon.

Our purpose in this report, involving an unusual mechanism described for the first time in the literature, is to show that high-pressure water sprays used for washing cars can cause injury to the extensor hallucis longus (EHL). A 21-year-old man presented to our emergency department (ED) due to looseness in the hallux. His history revealed that while operating a pressurized water spray machine for car-washing one week before, he had inadvertently sprayed his foot, and despite wearing protective plastic boots this had resulted in a laceration at the level of the hallux, which had been sutured in a state hospital. Cleaning equipment using pressurized water can be dangerous if sufficient safety measures are not taken. We think that such occupational accidents with serious outcomes can be prevented through simple protective measures.

Comparison of Four Different Supraglottic Airway Devices in Terms of Efficacy, Intra-ocular Pressure and Haemodynamic Parameters in Children Undergoing Ophthalmic Surgery.

OBJECTIVE: The aim of this study was to compare insertion parameters of four different types of supraglottic airway devices (SGAD) (Classic LMA, I-gel LMA, Proseal LMA, Cobra PLA) in children undergoing ophthalmic surgery and to determine the effect on intra-ocular pressure (IOP) and haemodynamic responses during insertion. METHODS: Sixty American society of Anesthesiologists (ASA) I-II children aged 1-10 years undergoing extra-ocular ophthalmic surgery were randomly divided into four groups (Group LMA, Group I-gel LMA, Group PLMA and Group CPLA) in this prospective, randomised study. Anaesthesia was induced with decreasing sevoflurane concentrations (8%-2%) in a mixture of 50% N2O-O2. All SGADs were inserted under deep anaesthesia. The characteristics of insertion (number of attempts, ease and time), oropharyngeal leak pressure (OLP) and complications were recorded. IOP in both eyes, heart rate (HR), mean arterial pressure (MAP) and EtCO2 were measured before and 2 and 5 min after insertion of the SGADs. RESULTS: There was no difference between the groups in terms of the characteristics of insertion. The mean IOP did not increase significantly in all groups. MAP and HR changes were similar among the groups during follow-up. In all groups, HR increased 2 min after insertion (statistically insignificant) and returned to the baseline value 5 min after insertion. A statistically significant correlation was seen between HR increase and IOP values before and after insertion of the SGADs (p=0.006, correlation coefficient=0.352). Desaturation was seen in one patient in Groups LMA, PLMA and CPLA, and laryngospasm was seen in two patients in Group CPLA and in one patient in Group LMA. CONCLUSION: It was seen that during insertion of Classic LMA, I-gel LMA, Proseal LMA and Cobra PLA, IOP did not increase and haemodynamic stability was maintained in children undergoing extra-ocular ophthalmic surgery.

Efficiency and cost analysis of cell saver auto transfusion system in total knee arthroplasty.

BACKGROUND: Blood loss and replacement is still a controversial issue in major orthopaedic surgery. Allogenic blood transfusion may cause legal problems and concerns regarding the transmission of transfusion-related diseases. Cellsaver Systems (CSS) were developed as an alternative to allogenic transfusion but CSS transfusion may cause coagulation, infection and haemodynamic instability. AIMS: Our aim was to analyse the efficiency and cost analysis of a cell saver auto-transfusion system in the total knee arthroplasty procedure. STUDY DESIGN: Retrospective comparative study. METHODS: Those patients who were operated on by unilateral, cemented total knee arthroplasty (TKA) were retrospectively evaluated. Group 1 included 37 patients who were treated using the cell saver system, and Group 2 involved 39 patients who were treated by allogenic blood transfusion. The groups were compared in terms of preoperative haemoglobin and haematocrit levels, blood loss and transfusion amount, whether allogenic transfusion was made, degree of deformity, body mass index and cost. RESULTS: No significant results could be obtained in the statistical comparisons made in terms of the demographic properties, deformity properties, preoperative laboratory values, transfusion amount and length of hospital stay of the groups. Average blood loss was calculated to be less in Group 1 (p<0.05) and cost was higher in Group 1 (p<0.05). CONCLUSION: Cell saver systems do not decrease the amount of allogenic blood transfusion and costs more. Therefore, the routine usage of the auto-transfusion systems is a controversial issue. Cell saver system usage does not affect allogenic blood transfusion incidence or allogenic blood transfusion volume. It was found that preoperative haemoglobin and body mass index rates may affect allogenic blood transfusion. Therefore, it is foreseen that auto-transfusion systems could be useful in patients with low haemoglobin level and body mass index.