Evaluation of the Early-Mid-Term Results of Isolated Tibial Insert Exchange After Total Knee Arthroplasty.

OBJECTIVE: This study aimed to assess the early and mid-term results of patients who had undergone total knee arthroplasty (TKA) and then underwent an isolated tibial insert exchange due to tibial insert fracture and/or melting. METHODS: A retrospective study was conducted at the Orthopedics and Traumatology Clinic in a secondary-care public hospital in Türkiye on seven knees of six patients aged 65 years and above who underwent an isolated tibial insert exchange and were followed up for at least six months. Pain and functional assessments of the patients were made with the visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) performed at the last control before the treatment and at the final follow-up visit after the treatment. RESULTS: The median age of the patients was 70.5 years. The median length of time between the primary TKA and the isolated tibial insert exchange was 5.96 years. After isolated tibial insert exchange, the patients were followed for a median of 268 days and a mean of 414 days. The WOMAC pain, stiffness, function, and total indexes were median 15, 2, 52, and 68, respectively, before the treatment. In contrast, the final follow-up WOMAC pain, stiffness, function, and total indexes were median 3 (p = 0.01), 1 (p = 0.023), 12 (p = 0.018), and 15 (p = 0.018), respectively. It was observed that the median VAS, which was "9" preoperatively, showed a statistically significant improvement to become "2" in the postoperative period. A strong negative correlation was found between age and the amount of decline in the total score of the WOMAC pain scale (r = -0.780; p = 0.039). There was a powerful negative correlation between the body mass index (BMI) and the amount of decline in WOMAC pain scores (r = -0.889; p = 0.007). A strong negative correlation was found between the length of time passing between two surgical procedures and the amount of decline in the WOMAC pain score (r = -0.796; p = 0.032). CONCLUSION:  Individual patient factors and prosthetic conditions should be considered undoubtedly when determining the best revision strategy in TKA patients. In cases where the components are well-aligned and well-fixed, isolated tibial insert exchange is an alternative to revision TKA since it is less invasive and more cost-effective.

Femoral Neck Fractures in Elderly Patients With Coxarthrosis and High Dislocation: The Application of Conservative Treatment.

OBJECTIVE: In this study, our aim was to evaluate the results obtained by conservative treatment of femoral neck fracture in patients with untreated Crowe type 4 coxarthrosis with high dislocation. METHODS: This was was a retrospective study done at the Orthopaedics and Traumatology Clinic in a secondary care public hospital between 2002 and 2022, in Türkiye. Femur neck fractures were evaluated in six patients who had untreated Crowe type 4 coxarthrosis with high dislocation. RESULTS:  In the study, we had six patients with undiagnosed developmental dysplasia of the hip (DDH) who suffered femoral neck fractures. The youngest among these patients was 76 years old. Conservative treatment (bed rest, analgesics, non-steroidal anti-inflammatory drugs, and, if needed, opiates and low molecular weight heparin for antiembolic treatment) was found to reduce Harris Hip Score (HHS) and Visual Analogue Scale (VAS) scores significantly (p<0,05). Stage 1 sacral decubitus ulcer occurred in two (33.3%) patients. Patients acquired daily activity capacity similar to their situations before fracture within five to six months. None of the patients suffered embolisms and there was no union in the fracture line of the patients.  Conclusion: Based on our data, we think that conservative treatment is a remarkable option for these patients, as the complication risks are low and positive results can be obtained. Thus, we may conclude that conservative treatment can be considered in femoral neck fractures of elderly patients with DDH.

The Impact of Vitamin D deficiency on Depression in Obese Adults.

BACKGROUND: There are studies showing associations between hypovitaminosis D and obesity, obesity and depression, and hypovitaminosis D and depression. This study aims to investigate the relationship between vitamin D levels and depression status of patients followed in an obesity center. METHODS: This retrospective study included 107 obesity patients followed up and treated at an obesity center. Patients were divided into two groups as serum 25(OH)D level < 20 ng/mL (deficient) and ≥ 20 ng/mL (not deficient) and compared in terms of Beck Depression Inventory scores. Patients were also divided into two groups according to BDI scores < 17 and ≥ 17, and serum 25(OH)D levels were evaluated. RESULTS: Patients at higher risk for depression (BDI score ≥ 17) had statistically significantly higher weight (p = 0.003) and BMI (p < 0.001), but had significantly lower serum 25(OH)D levels (p < 0.001). The BDI scores were found to be moderately positively related with the BMI (r = 0.404, p < 0.001), weakly negatively related with vitamin D levels (r = -0.383, p < 0.001), weakly positively related with weight (r = 0.293, p = 0.002). The BDI score me-dians (12 and 8, respectively) were found to be statistically significantly higher in patients with serum 25(OH)D levels of < 20 ng/mL compared to those with ≥ 20 ng/mL (p < 0.001). The increased BMI and decreased serum 25(OH)D levels have been found to independently increase the risk of depression in multivariate logistic regression analysis. The ROC analysis performed to evaluate the discriminative performance of serum 25(OH)D levels in predicting the risk of depression. The analysis showed that the serum 25(OH)D parameter was likely to reveal patients who were at higher risk for depression. For the cutoff point of 25(OH)D ≤ 19.21 level determined by Youden index, the sensitivity was found as 92.86% and the selectivity as 68.82%. CONCLUSIONS: In our study, the BMIs were higher and serum 25(OH)D levels were lower in obese individuals at risk for depression. Understanding or explaining the relationship between vitamin D deficiency and depression will contribute to revealing the preventive or therapeutic role of vitamin D supplementation for depression.

The Effect of the COVID-19 Pandemic on the Characteristics of Inpatients at the Orthopaedics and Traumatology Clinic in a Secondary Care Public Hospital in Turkey.

Objective The aim of this study was to evaluate patients who were hospitalized at an orthopaedics and traumatology clinic in a secondary care public hospital in Turkey during the first two years of the COVID-19 pandemic. Methods This was a cross-sectional and retrospective study that included a total of 7439 patients - those who had been hospitalized between 11 March 2020, the date of the first confirmed case of COVID-19 in Turkey, and 10 March 2022 (2949 patients), and those hospitalized in the same clinic between 11 March 2018 and 10 March 2020, designated as the pre-pandemic group (control group; 4490 patients). Patients were divided into three groups: <18 years old, 18-65 years old and >65 years old and compared separately in terms of clinical, diagnostic and therapeutic characteristics as pandemic patients and control group. Results Despite the decline in both the number of admissions to the emergency service and visits to the outpatient clinic among inpatients during the pandemic period, the rate of admissions to the emergency department remained higher than that of the control group throughout the pandemic period (p<0.001). Surgical procedures were lower both numerically and proportionally in the patients who presented during the pandemic than in the pre-pandemic period (p<0.001). While the rate of traumatic surgery was higher in the pandemic group (29%) than in the pre-pandemic group (26.7%), the rate of elective surgery was higher in the pre-pandemic group (71.3%) than in the pandemic one (67.5%) (p=0.037 and p=0.001).The number of patients with fractures in all age groups decreased numerically in the pandemic cohort. While no significant difference was observed between pandemic and pre-pandemic cohorts in terms of the length of hospitalization in all age groups, Intensive Care Unit (ICU) hospitalization rate was found to have increased significantly in adult and elderly patient groups during the pandemic (p<0.001). Conclusion In our study, when the number of patients who underwent orthopaedic surgical treatment, in general, was examined, it appeared that the number of both traumatic and elective surgeries decreased during the pandemic significantly. It was found that the ICU stay rate increased significantly in adult and elderly patient groups during the pandemic. Although there were no confirmed cases of COVID-19 among the patients included in the study, it is known that the pandemic and especially the lockdown periods adversely affected the mental, physical and biological health of individuals. In this context our study will be able to serve as a guide for taking measures like: 1. increasing the ICU capacity of hospitals, 2. providing in-service training to improve the experience of nurses, doctors or other healthcare workers, especially in specialized units such as ICUs, operating rooms and emergency services, considering the number of personnel who may be affected by the pandemic, and 3. ensuring a balanced distribution of orthopaedic operations in private and public hospitals, to reduce the negative effects on orthopaedic health services of other pandemics that may arise in the future.

Metatarsal head restoration versus dorsal closing-wedge osteotomy in the treatment of advanced-stage Freiberg's disease.

PURPOSE: Freiberg's disease is mostly characterized by osteonecrosis of second metatarsal head and is widely seen in adolescent women. Metatarsal head restoration technique is a novel surgical procedure intended to protect intact articular surface and regenerate avascular bone under cartilage. This study aimed to evaluate and compare the results and clinical outcomes of metatarsal head restoration technique with those of dorsal closing-wedge osteotomy technique in patients with advanced-stage Freiberg's disease. METHODS: In this retrospective study, 60 patients who were operated for Freiberg's disease were evaluated. Patients were divided into two groups as who underwent metatarsal head restoration and dorsal closing-wedge osteotomy. Groups were compared according to "American Orthopaedic Foot & Ankle Society score" (AOFAS), "visual analog score" (VAS) and passive "range of motion" (ROM) score. RESULTS: Thirty-two feet of 29 patients underwent metatarsal head restoration, while 33 feet of 31 patients were subject to dorsal closing-wedge osteotomy. Mean AOFAS score increased from 58.72 ± 6.89 to 89.35 ± 7.43 following metatarsal head restoration, while it increased from 54.13 ± 6.12 to 78.24 ± 6.54 after dorsal closing-wedge osteotomy. Mean VAS score decreased from 6.89 ± 1.18 to 1.33 ± 0.64 after metatarsal head restoration, while it decreased from 6.64 ± 0.92 to 2.71 ± 1.91 following dorsal closing-wedge osteotomy. Mean ROM increased from 12.25° ± 1.65 to 56.28° ± 2.77 after metatarsal head restoration, and it increased from 11.18° ± 0.66 to 47.65° ± 2.05 after dorsal closing-wedge osteotomy (all p < 0.05). In addition, postoperative mean AOFAS (p = 0.044), VAS (p = 0.041) and passive ROM (p = 0.034) scores improvement were found to be statistically significantly better in the metatarsal head restoration group. CONCLUSION: This study revealed that metatarsal head restoration is a safe and successful surgical technique. It leads to better results than dorsal closing-wedge osteotomy in patients with stages 3-4 Freiberg's disease. LEVEL OF EVIDENCE: III.

Effects of intralesional pulsed radiofrequency treatment on pain in patients with calcaneal spur: results of 460 patients.

BACKGROUND: This study aimed to investigate the efficacy of intralesional pulsed radiofrequency (RF) in the treatment of calcaneal spur and the results of patients who underwent single and double sessions of RF treatment. METHODS: The population of this retrospective study consisted of 460 patients who were diagnosed with calcaneal spur with clinical examination and direct radiography. The Wong-Baker Faces Pain Rating Scale and The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score were used to determine the pain status and functional capacities of the patients. Posttreatment evaluation was carried out on average in the 6th week. RESULTS: The study involved 460 patients, 76.9% of whom were female, with the average age of 50.8 ± 10.9 years in total. Of the patients 43% was given RF therapy in a single session, and 57% of them in double sessions. After the RF procedure, the number of patients whose pain decreased according to both AOFAS and Wong-Baker pain scoring systems increased statistically significantly (p < 0.001). There was a statistically significant increase in the AOFAS-pain scores and the total AOFAS scores and a significant decrease in the Wong Baker-pain scale after treatment. However, there was no significant change in treatment success with respect to the number of RF sessions. Although not statistically significant, the differences in the AOFAS-pain scores and in the total AOFAS scores were found to be higher in patients who underwent single session RF, while the difference in the Wong Baker-pain ranking was higher in patients who received double sessions RF. CONCLUSION: Intralesional pulsed RF procedure can be preferred as a relatively less invasive method that does not have any serious complications in patients with persistent calcaneal spurs who do not respond to the use of oral anti-inflammatory drugs and shoe insoles, nor corticosteroid injection to the lesion area.

Post-Operative Red Cell Distribution Width Increase May Predict Mortality in Patients Operated for Hip Fracture.

BACKGROUND: Hip fractures, with significant morbidity and mortality, increase day by day with the aging population. Inflammation may play a critical role in addition to deep vein thrombosis due to pulmonary embolism in morbidity and mortality after hip fractures and hip arthroplasty surgeries. The aim of the study is to investigate the impacts of post-operative changes in inflammatory markers such as red blood cell distribution width (RDW), mean platelet volume (MPV), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR) on 30-day mortality rates in patients operated for hip fracture. METHODS: The data of 231 patients operated for hip fracture at a state hospital, between 2017 and 2020, were evaluated retrospectively. Survivor and non-survivor patients were compared in terms of whether or not they needed intensive unit care, length of hospital stay, intensive care unit (ICU) length of stay, and test parameters (RDW, MPV, PLR, and NLR). RESULTS: Of the patients, 61% were women and the mean age was 77.2 ± 10.7 years. The 30-day mortality (6 patients in-hospital, 10 patients after discharge) developed in 16 patients (6.9%). The mean age, the incidence of preoperative anemia, ICU hospitalization rate and ICU length of stay increased significantly in non-survivor patients. A statistically significant increase was observed in RDW (p = 0.009), MPV (p < 0.001), NLR (p < 0.001), and PLR (p < 0.001) values in postoperative complete blood count testing in both survivor and non-survivor patients. Among the CBC parameters, only the increase in RDW levels was found to be statistically significant in non-survivor patients compared to survivors postoperatively (p < 0.001). The optimal cut-off value for the RDW difference in predicting 30-day mortality was calculated as > 0.8. The increase in preoperative and postoperative RDW differences in multivariate logistic regression was found to be positively associated with 30-day mortality. CONCLUSIONS: Detecting the change in RDW levels can be useful and practical for the clinician not only in revealing the patients under risk, but also in the management of such patients. Further prospective and multi-center clinical studies that will support our results and aim to reveal the reason for this change will contribute to the reduction of mortality in such patients.