Malpractice litigation after total hip arthroplasty: A legal 10-year database.

OBJECTIVES: In this study, we aimed to identify the most frequently reported claims after total hip arthroplasty (THA) and the reasons put forward by the plaintiffs. PATIENTS AND METHODS: Between January 2011 and December 2020, data of a total of 74 cases (21 males, 53 females; mean age: 53.7±12.8 years; range, 29 to 83 years) obtained from the Turkish Forensic Medicine Institute were retrospectively analyzed. Claims for litigation, demographic data, data regarding the identity of the accused and the hospital setting were recorded. RESULTS: The most common reason for lawsuits was death (n=15; 20.3%), followed by nerve injury (n=13; 17.6%), and eight patients had more than one complaint. According to the forensic medicine reports, malpractice was detected in 10 (12.5%) of the cases. Among the hospital types, only nerve injury made a significant difference among all complaint sources in different hospital settings (p=0.003). CONCLUSION: In our study, death was the most common reason for lawsuits regarding malpractice accusations after THA, which is different from medical malpractice allegations throughout the world.

Comparison of radiographic vs. computed tomography canal filling ratio measurement of stems in revision knee prostheses.

Background: Lack of consensus on which measurement method gives the most accurate results for medullary canal filling ratio (CFR) of stems used in revision knee prostheses causes confusion when interpreting scientific studies. Therefore, the present study aims to find the most accurate measurement method of CFR on direct radiographs. Methods: Twenty-eight femoral and 27 tibial components of 29 patients with a mean age of 72.86 ± 6.32 years were included in the study. Two different methods were used for computerized tomography CFR measurement. These methods and five different radiographic measurement methods used for CFR were compared statistically. Results: There was no statistically significant difference between the real tomographic CFR of the femoral stem and the CFR calculation made by using ellipse area (p > 0.05). There was also no statistically significant difference between the tomographic CFR measurement calculated according to the largest stem size that can be implanted, and the method that accepted the smallest value as CFR after the measurement made according to Parsley's method on AP and lateral radiographs (p > 0.05). The results obtained by using all other tests were statistically different from each other. Conclusion: CFR calculation made by using ellipse area, is the most accurate method for femoral stem CFR. The method that accepted the smallest value as CFR after the measurement made according to Parsley's method on AP and lateral radiographs is the most accurate method for tibial stem CFR.

Correlations of proximal junctional kyphosis with radiographic measurements, spinopelvic parameters, and health-related quality of life in Lenke type V adolescent idiopathic scoliosis.

OBJECTIVES: This study aims to investigate the effects of radiographic measurements, spinopelvic parameters, and Scoliosis Research Society-22r (SRS-22r) subscales on proximal junctional kyphosis (PJK) in patients with Lenke type V adolescent idiopathic scoliosis operated with only a posterior all-pedicle-screw instrumentation technique. PATIENTS AND METHODS: Between January 2011 and March 2019, data of 115 patients (17 males, 98 females; mean age: 14.6±2.9 years; range, 10 to 18 years) with Lenke type V AIS who were operated with posterior fusion were retrospectively analyzed. Proximal junctional angle (PJA) was measured as a Cobb angle (CA) between the inferior endplate of the upper instrumented vertebra and the superior endplate of the second suprajacent vertebra. A ≥10° PJA and being ≥10° greater than its preoperative value was defined as PJK. Radiographic measurements, SRS-22r scores, and correlations with the PJA were evaluated for PJK and non-PJK groups. RESULTS: The prevalence of PJK was 35.6%. There were statistically significant differences between the groups in terms of preoperative CA (p=0.002), preoperative thoracic kyphosis angle (TKA) (p<0.001), postoperative TKA (p=0.001), PJA (p<0.001), postoperative pelvic tilt (p=0.038), preoperative pain (p=0.005), preoperative self-image (SI) (p=0.045), preoperative subtotal score (p=0.006), preoperative total score (p=0.007), and sex distribution (p=0.002). No statistically significant differences were detected for other parameters (p>0.050). Positive correlations were found between PJA and preoperative TKA (p=0.042), postoperative TKA (p=0.002), preoperative sagittal balance (SB) (p=0.015), preoperative SI (p=0.012), postoperative SI (p=0.032), postoperative mental health (p=0.011), postoperative subtotal score (p=0.018), postoperative total score (p=0.014), and postoperative sacral slope (SS) (p=0.015). A negative correlation was found between PJA and preoperative satisfaction (p=0.044). CONCLUSION: The occurrence of PJK is multifactorial, including clinical, surgical, and radiographic factors. Male patients with higher pre and postoperative TKA, preoperative SB, and postoperative SS and patients with lower satisfaction have a higher risk of PJK development.

Quality of Life Among Patients with Early-Onset Scoliosis Treated with Magnetically Controlled Growing Rods-Early-Term Results.

BACKGROUND: The term "early-onset scoliosis" (EOS) refers to spinal deformities that develop before the age of 10 years. The aim of surgical treatment for EOS is stopping the progression of the curvature, maintaining the correction, ensuring the maximum growth of the vertebrae, and ensuring that the vertebrae remain mobile. Using magnetically controlled growing rods (MCGRs) in the treatment of EOS is intended to protect the patient from the negative effects of repetitive surgeries, increase patient compliance and satisfaction, and increase the speed of return to normal social life. Our aim was to report the early radiological evaluation findings and detect the changes in the quality of life of patients and their parents after the diagnosis of EOS and treatment with MCGRs. METHODS: We performed a retrospective clinical study (level 4 case series) of 20 patients with a surgical indication for the treatment of EOS. The 20 patients had undergone treatment with MCGRs and lengthening procedures at 3-month intervals from August 2014 to August 2016. The mean patient age at surgery was 7.9 years (range, 4-10 years), and the mean length of follow-up was 14.9 months (range, 6-30 months). The preoperative, early postoperative, and final follow-up radiographs of all patients were obtained. The Cobb angle, thoracic kyphosis, spinal height, thoracic height, sagittal balance, coronal balance, shoulder balance, and pelvic balance were measured from the radiographs. All the patients had undergone preoperative and final follow-up respiratory function tests, and all the patients completed the Early Onset Scoliosis 24-item questionnaire (EOSQ-24). The outcome measures were the Cobb angle, thoracic kyphosis, spinal height, thoracic height, sagittal balance, coronal balance, shoulder balance, and pelvic balance. All the patients had undergone preoperative and final follow-up respiratory function tests, and the parents of every patient completed the Turkish version of the EOSQ-24. RESULTS: The preoperative, early postoperative and final follow-up mean Cobb angles were 56.6° (range, 38°-93°), 30.5° (range, 13°-80°), and 33.5° (range, 14°-86°), respectively. These findings showed statistically significant improvement in the Cobb angle (P < 0.05). The thoracic height was also significantly increased. The preoperative, early postoperative, and final follow-up mean height was 181 mm (range, 123-224 mm), 200 mm (range, 164-245 mm), and 212 mm (range, 167-248 mm), respectively (P < 0.05). The measurements for spinal height had also increased significantly, with preoperative, early postoperative, and final follow-up values of 219 mm (range, 213-366 mm), 315 mm (range, 260-402 mm), and 338 mm (range, 261-406 mm), respectively (P < 0.05). The thoracic kyphosis measurement was 41° (range, 5°-65°) preoperatively, which had decreased significantly to 32.5° (range, 0°-53°) at the final follow-up (P < 0.05). Our measurements showed no statistically significant differences in the coronal and sagittal balance, pelvic balance, or shoulder balance. No significant differences were found between the preoperative and postoperative respiratory function test results. The assessment of the EOSQ-24 scores had demonstrated significant improvements in the mean scores at the final follow-up (P < 0.05). When different categories in the EOSQ-24 were evaluated separately, no statistically significant differences were found between the preoperative and final follow-up scores for general health, pain and discomfort, respiratory function, movement capability, physical function, or effects on daily life (P > 0.05). However, the exhaustion and energy levels, emotional state, effect of the disease on the parents and patient, and parent satisfaction scores had increased significantly from the preoperative assessment to the final follow-up (P < 0.05). The financial effect had decreased significantly at the final follow-up compared with the preoperative values (P < 0.05). Four patients had developed complications requiring further treatment, and none of the patients had developed infection that required surgical intervention. CONCLUSIONS: Our study showed that insertion of a MCGR is a safe procedure for treatment of EOS to correct the deformity and improve function in daily life. This method reduces the need for repetitive surgery and the likelihood of complications associated with other treatments. Thus, treatment with MCGRs increases patient satisfaction and facilitates patient compliance.

Formulae derived from Anthropometric Measurements to Estimate Ideal Tibial Nail Length.

INTRODUCTION: Ideal Nail Length (INL) provides better outcomes after Intramedullary Nailing (IMN) of Tibia Shaft Fractures (TSF). Intraoperative methods do not allow for preoperative planning. Changing the nail may cause complications. X-rays are commonly used, but displacement or magnification errors may occur. Forearm measurements may be benefical in bilateral TSF. We aim to examine correlations of anthropometric measurements (AMs) and INL and use them to obtain formulae. MATERIALS AND METHODS: Tuberositas Tibia-Medial Malleolus (TM), Tuberositas Tibia-Ankle joint (TA), knee-ankle joint (JJ), and olecranon tip-5th Metacarpal head (OM) distances were evaluated in 76 IMN patients. Correlation analyses were performed and the results used to create formulae. RESULTS: The correlations between INL and TM-left, TM-right, TA-left, TA-right, OM-left, OM-right, JJ-left, JJ-right were 0.81, 0.83, 0.77, 0.77, 0.82, 0.80, 0.90, 0.91 respectively for males; and 0.93, 0.89, 0.88, 0.86, 0.80, 0.82, 0.90, 0.89 respectively for females. AMs show excellent correlation in both sexes (p<0.0001). Regression analysis was statistically significant in all formulae. The most compatible correlations in males were JJ-right and JJ-left; and in females, TM-left, TM-right, and JJ-right. CONCLUSION: The most compatible correlations wth INL were JJ in males, and TM and JJ in females. OM can be used in the presence of bilateral TSF, edema, wounds and obesity. AMs are useful preoperatively. The formulae can be used to ensure INL and reduce errors, time and radiation. Level of Evidence: Level I, Testing of previously developed diagnostic criteria on consecutive patients (with the universally applied reference gold standard).

INTRODUÇÃO: O comprimento ideal da haste (CIH) proporciona desfechos melhores depois da colocação de haste intramedular (HIM) em fraturas da diáfise da tíbia (FDT). Os métodos dessa cirurgia não permitem o planejamento pré-operatório. A troca da haste pode causar complicações. Em geral, são usadas radiografias, mas podem ocorrer erros de deslocamento ou de tamanho. As medições do antebraço podem ser benéficas nas FDTs bilaterais. Nosso objetivo é examinar as correlações das medidas antropométricas (MAs) e CIH e usá-las para obter fórmulas. MATERIAIS E MÉTODOS: As distâncias entre Tuberosidade da tíbia-Maléolo medial (TM), Tuberosidade da tíbia-Articulação do tornozelo (TT), Articulações do joelho e do tornozelo (JT) e extremidade do olécrano-cabeça do 5o metacarpal (OM) foram avaliadas em 76 pacientes com HIM. Foram realizadas análises de correlação e os resultados foram usados para criar fórmulas. RESULTADOS: As correlações entre CIH e TM-esquerda, TM-direita, TT-esquerda, TT-direita, OM-esquerda, OM-direita, JT-esquerda, JT-direito foram 0,81, 0,83, 0,77, 0,77, 0,82, 0,80, 0,90, 0,91 para homens e 0,93, 0,89, 0,88, 0,86, 0,80, 0,82, 0,90, 0,89 para mulheres. As MAs tiveram excelente correlação em ambos os sexos (p < 0,0001). A análise de regressão foi estatisticamente significativa em todas as fórmulas. As correlações mais compatíveis em homens foram JT-direita e JT-esquerda; nas mulheres, foram TM-esquerda, TM-direita, e JT-direita. CONCLUSÃO: As correlações mais compatíveis com CIH foram JT em homens e TM e JT em mulheres. A OM pode ser usada em FDT bilateral, edema, feridas e obesidade. As MAs são úteis no pré-operatório. As fórmulas podem ser usadas para garantir o CIH e reduzir erros, tempo e radiação. Nível de evidência: Nível I, Desenvolvimento de critérios diagnósticos em pacientes consecutivos (com padrão de referência "ouro" aplicado).

Effect of Instrumentation Level on Mental Health Subscale of Scoliosis Research Society Outcomes Questionnaire in Adolescent Idiopathic Scoliosis.

Introduction Adolescent idiopathic scoliosis (AIS) surgery aims to obtain a flexible and stable spine, correct axial rotation and halt curve progression by fusing the least number of motion segments. Longer fusions can improve deformity correction, but late decompensation and lumbar degeneration may occur. Even some daily issues can be problematic in some scoliosis patients. Reduction in mobility, segmental mobility adjacent to fusion, degeneration of junctional unfused levels and low-back pain (LBP) results in poor outcomes. It is reported that AIS patients have more mental and psychological problems including depression. Preoperative concerns due to deformity may continue postoperatively as instrumentation fuses motion segments. We wanted to present the relationship between the remaining mobile segments and Scoliosis Research Society-22r (SRS-22r) mental health (MH) scores of AIS patients. Methods It is a retrospective study of 110 posterior fusion AIS patients, age between 10 and 18 years, and followed-up for at least two years who filled SRS-22r forms both preoperatively and in postoperative second year (POY2). Patients are grouped according to the lowest instrumented vertebra (LIV) as LIV L5: group 1, LIV L4: group 2, LIV L3 and above: group 3. Results A statistically significant difference (SSD) was not found in preoperative and POY2 comparison of truncal shift (TTS), thoracic kyphosis (TK), lumbar lordosis (LL), sagittal balance (SB) in group 1; SB in group 2, and LL in group 3 (p>0.05). SSD was found in all other radiologic measurements of groups and in all patients. No SSD was found in function and MH in group 1, in function and pain in group 2 and in pain in group 3 and all patients (p>0.05). SSD was found in the remaining SRS-22r subscales. There was an SSD between groups 1 and 2 in terms of instrumentation level (p=0.013). SSD was found between groups 1 and 2 in preoperative Cobb angle (p=0.016). SSD was found between groups 2 and 3 in POY2 Cobb angle (p=0.025). SSD was found between groups 2 and 3 in POY2 apical vertebral translation (p=0.01). There was no SSD in other radiological parameters (p>0.05). SSD was found between groups 1 and 2 (p=0.02) and between groups 1 and 3 (p=0.037) in terms of POY2 MH, but no SSD was found between groups 2 and 3 (p>0,05). There was no SSD in other preoperative or POY2 SRS-22r subscales (p>0.05). Conclusion More distal LIV is associated with a reduction of mobility and SRS scores. The self-image scores of groups were not statistically different. However, in group 1, MH was significantly lower. With the improvement of body images, patients start to worry about mobility instead of cosmesis. Higher depression has been reported in AIS patients. In POY2, there was no SSD between groups in terms of pain, function and satisfaction in addition to the self-image score as indicated in the literature. We especially recommend that L5 LIV patients should receive psychiatric support in order to prevent anxiety, and inform and support them that they are not different in terms of pain, self-image and function scores compared to more proximal LIV patients, and also we recommend encouraging L5 LIV patients that POY2 SRS22-r pain, self-image, satisfaction, subtotal and total scores are improved. As reported in the literature which shows increased suicidal thoughts and depression in scoliosis patients; our findings regarding MH are important and considerable.

Effect of malpractice claims on orthopedic and traumatology physicians in Turkey: A survey study.

OBJECTIVE: This study aimed to investigate the malpractice claims experienced by orthopedic and traumatology physicians and to determine their effects on burnout, job satisfaction, and clinical practice. METHODS: A questionnaire survey was conducted on orthopedic and traumatology specialists between May 2019 and February 2020. Data collection was carried out via e-survey at "turk-ortopedi" mail group, which is an electronic communication network of orthopedic and traumatology physicians. For data collection, sociodemographic data forms were used including the general characteristics, working conditions, and the malpractice claim events along with the Maslach Burnout Inventory scale to evaluate burnout and the Minnesota Satisfaction Questionnaire to investigate job satisfaction. RESULTS: In total, 353 orthopedic and traumatology physicians (348 men, 5 women), including 37 professors, 41 associate professors, and 275 surgeons, completed the questionnaire. In total, 65.4% of the participants (231 physicians and 471 relevant dossiers) stated that they were currently facing a malpractice claim. Emotional burnout and hesitant behavior in medical practices were significantly higher among the physicians who had undergone an investigation/trial with the claim of malpractice (p<0.05), whereas intrinsic job satisfaction was significantly lower (p<0.05). It was determined that orthopedic and traumatology physicians dealing with arthroplasty, vertebral surgery, hand surgery, and foot/ankle surgeries had undergone significantly more trials (p<0.05). In the evaluation of the burnout levels and job satisfaction scores of the physicians according to the age, academic title, seniority, and institution, it was determined that burnout level decreased with age, those between the ages of 25 and 34 years were exhausted the most, and job satisfaction increased with age. It was also found that burnout level decreased and job satisfaction increased as the academic title became higher, and attending physicians were the most exhausted. Moreover, burnout level decreased as seniority increased, the most senior ones were the ones most exhausted, and job satisfaction increased with seniority. CONCLUSION: Evidence from this study has revealed that malpractice claims cause emotional burnout, low intrinsic job satisfaction, and a hesitant behavior in medical practice for the orthopedic and traumatology physicians. The concept of malpractice alone may result in unnecessary analyses/examinations for patients. LEVEL OF EVIDENCE: Level IV, Diagnostic Study.

Formulae derived from Anthropometric Measurements to Estimate Ideal Tibial Nail Length / Fórmulas derivadas de medidas antropométricas para estimativa do comprimento ideal da haste tibial

ABSTRACT Introduction: Ideal Nail Length (INL) provides better outcomes after Intramedullary Nailing (IMN) of Tibia Shaft Fractures (TSF). Intraoperative methods do not allow for preoperative planning. Changing the nail may cause complications. X-rays are commonly used, but displacement or magnification errors may occur. Forearm measurements may be benefical in bilateral TSF. We aim to examine correlations of anthropometric measurements (AMs) and INL and use them to obtain formulae. Materials and methods: Tuberositas Tibia-Medial Malleolus (TM), Tuberositas Tibia-Ankle joint (TA), knee-ankle joint (JJ), and olecranon tip-5th Metacarpal head (OM) distances were evaluated in 76 IMN patients. Correlation analyses were performed and the results used to create formulae. Results: The correlations between INL and TM-left, TM-right, TA-left, TA-right, OM-left, OM-right, JJ-left, JJ-right were 0.81, 0.83, 0.77, 0.77, 0.82, 0.80, 0.90, 0.91 respectively for males; and 0.93, 0.89, 0.88, 0.86, 0.80, 0.82, 0.90, 0.89 respectively for females. AMs show excellent correlation in both sexes (p<0.0001). Regression analysis was statistically significant in all formulae. The most compatible correlations in males were JJ-right and JJ-left; and in females, TM-left, TM-right, and JJ-right. Conclusion: The most compatible correlations wth INL were JJ in males, and TM and JJ in females. OM can be used in the presence of bilateral TSF, edema, wounds and obesity. AMs are useful preoperatively. The formulae can be used to ensure INL and reduce errors, time and radiation. Level of Evidence: Level I, Testing of previously developed diagnostic criteria on consecutive patients (with the universally applied reference gold standard).

RESUMO Introdução: O comprimento ideal da haste (CIH) proporciona desfechos melhores depois da colocação de haste intramedular (HIM) em fraturas da diáfise da tíbia (FDT). Os métodos dessa cirurgia não permitem o planejamento pré-operatório. A troca da haste pode causar complicações. Em geral, são usadas radiografias, mas podem ocorrer erros de deslocamento ou de tamanho. As medições do antebraço podem ser benéficas nas FDTs bilaterais. Nosso objetivo é examinar as correlações das medidas antropométricas (MAs) e CIH e usá-las para obter fórmulas. Materiais e métodos: As distâncias entre Tuberosidade da tíbia-Maléolo medial (TM), Tuberosidade da tíbia-Articulação do tornozelo (TT), Articulações do joelho e do tornozelo (JT) e extremidade do olécrano-cabeça do 5o metacarpal (OM) foram avaliadas em 76 pacientes com HIM. Foram realizadas análises de correlação e os resultados foram usados para criar fórmulas. Resultados: As correlações entre CIH e TM-esquerda, TM-direita, TT-esquerda, TT-direita, OM-esquerda, OM-direita, JT-esquerda, JT-direito foram 0,81, 0,83, 0,77, 0,77, 0,82, 0,80, 0,90, 0,91 para homens e 0,93, 0,89, 0,88, 0,86, 0,80, 0,82, 0,90, 0,89 para mulheres. As MAs tiveram excelente correlação em ambos os sexos (p < 0,0001). A análise de regressão foi estatisticamente significativa em todas as fórmulas. As correlações mais compatíveis em homens foram JT-direita e JT-esquerda; nas mulheres, foram TM-esquerda, TM-direita, e JT-direita. Conclusão: As correlações mais compatíveis com CIH foram JT em homens e TM e JT em mulheres. A OM pode ser usada em FDT bilateral, edema, feridas e obesidade. As MAs são úteis no pré-operatório. As fórmulas podem ser usadas para garantir o CIH e reduzir erros, tempo e radiação. Nível de evidência: Nível I, Desenvolvimento de critérios diagnósticos em pacientes consecutivos (com padrão de referência "ouro" aplicado).

Complications, Additional Surgery, and Joint Survival Analysis After Medial Open-Wedge High Tibial Osteotomy.

The reported incidence of complications following medial open-wedge high tibial osteotomy (MOWHTO) varies. The authors sought to assess the complications, additional surgeries, and joint survival following MOWHTO in patients with isolated medial compartment arthrosis during a mean follow-up of 10 years. This retrospective study involved patients implanted with spacer plates, angle adjustable plates, or inverse L-type plates with wedges between 2000 and 2010. A total of 504 knees from 441 patients were examined. Mean age of the study population was 52.6±7.0 years, with 56 (11.1%) knees from men and 448 (88.9%) from women. The 10-year Kaplan-Meier joint survival rate was 94.8%. Overall complication rate for MOWHTO was 63.7%, with complications in 20.3% of treated knees requiring additional surgery. In this population, although the overall complication rate and the need for additional surgery were high, the need for additional surgery resulting from serious complications was low (2.6%). The high joint survival rate and low rate of additional surgery for serious complications indicate that MOWHTO can be safely applied in patients with isolated medial gonarthrosis. [Orthopedics. 2020;43(5):303-314.].

Change of Sagittal Spinopelvic Parameters after Selective and Non-Selective Fusion in Lenke Type 1 Adolescent Idiopathic Scoliosis Patients.

AIM: To compare the postoperative changes of both sagittal spinal and spinopelvic parameters in patients with Lenke Type 1 adolescent idiopathic scoliosis (AIS) who underwent selective and non-selective fusion surgery. MATERIAL AND METHODS: We conducted a retrospective study among 53 Lenke Type 1 AIS patients who underwent corrective surgery at our centre between 2006 and 2012. Patients were classified as group 1 if they underwent selective surgery and as group 2 if they underwent non-selective surgery. Surgical results of preoperative and postoperative sagittal and spinopelvic measurements, pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL) and thoracic kyphosis (TK) values were analysed using the SURGIMAP© Software (Nemaris Inc. USA) measurement system. RESULTS: In both groups, a comparison of pre- and postoperative sagittal spinal parameters did not show a statistically significant difference. In both groups, pre- and postoperative measurements of LL and TK did not show a statistically significant difference. CONCLUSION: After selective and non-selective surgery, sagittal spinal and spinopelvic parameters are not affected in the middle term. We think that the long-term studies to be done in this regard will increasingly require the necessity of keeping the pelvis in mind while evaluating the sagittal plan in AIS surgery.

The Effect of Previous Hip Surgery on the Outcome of Hip Arthroplasty in Young Patients.

BACKGROUND: The incidence of total hip arthroplasty (THA) is increasing in all age groups, especially in young patients. The outcome of THA is believed to be affected by morphological deformities created by previous pelvic or femoral procedures performed in childhood. The aim of the present study was to assess whether previous hip surgery impaired the functional outcome in young patients who underwent THA. METHODS: Data were collected from the records of patients aged less than 30 years who had undergone THA between 2002 and 2011. Thirty-five patients (44 hips) were included. The Western Ontario and McMaster Universities Osteoarthritis Index and Harris Hip Scores were collected as primary functional outcome measures. The secondary outcome measures were the major and minor complications. Patients were divided into 2 groups: those who had not undergone hip surgery before THA (group I, 17 patients, 24 hips) and those with a history of prior hip surgery (group II, 18 patients, 20 hips). RESULTS: The mean age at the time of surgery was 25 ± 4 years in group I and 23 ± 4 years in group II. The mean Harris Hip Score was slightly higher in group I (90 ± 7) than in group II (87 ± 7) (P = .2). The mean Western Ontario and McMaster Universities Osteoarthritis Index scores were similar in both groups (in group I 14 ± 7 and in group II 14 ± 6, P = .9). Complication rates were also similar in both groups (P = .7). CONCLUSIONS: It is often difficult to decide whether to perform THA in young patients. One potential risk factor for complications is hip surgery before THA. Our study revealed that young patients with or without a history of previous hip surgery achieved satisfactory functional outcomes with similar complication rates after THA.

Posterior-Only Approach with Pedicle Screws for the Correction of Scheuermann's Kyphosis.

STUDY DESIGN: Retrospective study (level of evidence: level 3). PURPOSE: The purpose of this study was to evaluate the clinical and radiological results of the posterior-only approach with pedicle screws for the treatment of Scheuermann's kyphosis (SK). OVERVIEW OF LITERATURE: The correction of SK with instrumentation can be performed using posterior-only or combined anterior-posterior procedures. With the use of all-pedicle screw constructs in spine surgery, the posterior-only approach has become a popular option for the definitive treatment of SK. In a nationwide study involving 2,796 patients, a trend toward posterior-only fusion with lower complication rates was reported. METHODS: We retrospectively reviewed the data of patients who underwent posterior-only correction for SK between January 2005 and May 2013. Patients with a definite diagnosis of SK who fulfilled the minimum follow-up criterion of 24 months were included. The thoracic kyphosis (T5-T12), lumbar lordosis (L1-S1), and thoracolumbar junction (T10-L2) angles were measured from preoperative, postoperative, and last control radiographs. Sagittal balance, thoracic length, thoracic diameter, Voutsinas index and the sacral slope, pelvic tilt, proximal junction kyphosis, and distal junction kyphosis angles were also measured. RESULTS: Forty-five patients underwent surgery for the treatment of SK between 2005 and 2013. After applying the exclusion criteria, 20 patients (18 males and 2 females) with a mean age of 19 years were included. The mean thoracic kyphosis angle was 79.8 degrees preoperatively, 44.6 degrees postoperatively, and 44.9 degrees at the last control. There were statistically significant differences between preoperative and postoperative values in the thoracic kyphosis and lumbar lordosis angles, thoracic length, thoracic diameter, and Voutsinas index (p<0.05). CONCLUSIONS: The clinical and radiological results of the current study suggest that posterior-only fusion is an efficient technique for the treatment of SK.

Analysis of complications following posterior vertebral column resection for the treatment of severe angular kyphosis greater than 100°.

OBJECTIVE: The aim of this study was to evaluate the complications, efficacy and safety of posterior vertebral column resection (PVCR) in severe angular kyphosis (SAK) greater than 100°. METHODS: The medical records of 17 patients (mean age 17.9 (range, 9-27) years) with SAK who underwent PVCR, were reviewed. Mean follow-up period was 32.2 (range, 24-64) months. Diagnosis of the patients included congenital kyphosis in 11 patients, post-tuberculosis kyphosis in 3 patients and neurofibromatosis in 3 patients. The sagittal plane parameters (local kyphosis angle, lumbar lordosis, sagittal vertical axis, pelvic tilt, sacral slope and pelvic incidence) were measured in the preoperative and the early postoperative periods and during the last follow-up on the lateral radiographs. RESULTS: The mean preoperative localized kyphosis angle was 121.8° (range, 101°-149°). The mean local kyphosis angle (LKA) was 71.5° at postoperatively evaluation (p < 0.05). Complications were detected in 12 patients (70.6%) with spinal shock in 4 patients, hemothorax in 3 patients, postoperative infection in 2 patients, dural laceration in 2 patients, neurological deficit in 2 patients (1 paraplegia and 1 root injury), the shifted cage in 2 patients and rod fracture in 2 patients. Neurological events occurred in six patients (35%) with temporary neurological deficit in 5 patients and permanent neurological deficit in 1 patient. CONCLUSION: PVCR is an efficient and a successful technique for the correction of SAK. However, it can lead to a large number of major complications in SAK greater than 100°. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Can Teicoplanin Be an Effective Choice for Antibiotic-Impregnated Cement Spacer in Two-Stage Revision Total Knee Arthroplasty?

The main purpose of this study was to evaluate the clinical results of two-stage revision total knee arthroplasty using a teicoplanin-impregnated cement spacer for infected primary total knee replacements. Twenty-five patients operated between 2005 and 2012 were included in this study. At the clinical status analysis, rate of infection eradication was assessed, physical examination was performed, Knee Society Score (KSS) was noted, isolated microorganisms were recorded, and the radiographic evaluation was performed. The mean KSS improved from 40 (range, 25-69) preoperatively to 77 (range, 32-96) at the latest follow-up (p < 0.05). Methicillin-resistant Staphylococcus epidermidis was isolated in 9 of 25 patients as the most frequently isolated pathogen, and the other isolated pathogens were methicillin-susceptible S. epidermidis, methicillin-resistant Staphylococcus aureus, and methicillin-susceptible S. aureus. Infection was successfully eradicated in 24 of 25 patients. Two-stage revision of the infected primary knee replacement is a time-consuming but a reliable procedure with high rates of success. Teicoplanin was found to be an effective choice for antibiotic-impregnated cement spacer applied for the eradication of the infection.

Tibiotalocalcaneal arthrodesis by using proximal humeral locking plate.

OBJECTIVES: The aim of this study was to evaluate the short-term clinical and radiological results of tibiotalocalcaneal arthrodesis (TTCA) with proximal humeral locking plate. MATERIAL AND METHODS: Eight patients (7 female, 1 male; average age 53 years (range: 24-67)) who underwent TTCA with proximal humeral locking plate between 2009 and 2011, were retrospectively evaluated with AOFAS hindfoot scale and Maryland foot score system. The mean follow up was 32.6 months (range: 23-54). RESULTS: Complete fusion was achieved in 7 patients. Soft tissue infection was observed in 2 patients and reflex sympathetic dystrophy in 3 patients. All patients recovered with medical treatment. At the final follow-up, mean AOFAS Hindfoot score was 60 (range: 41-81) and Maryland Foot Score was 67.8 (range: 41-85). The satisfactory rates of AOFAS and MFS were found as 12.5% (1/8) and 50% (4/8), respectively. One patient had an incomplete union with 5 degrees of heel varus deformity and 5 degrees of equinus deformity was observed in another. There were no implant failure or deformation of the plate during the follow-up period. CONCLUSION: Our study suggests that proximal humeral plate may be an alternative for fixation in tibiotalocalcaneal fusion surgery.

The effect of simple local resection on pain and scoliotic curve in patients with scoliosis secondary to osteoid osteoma and osteoblastoma in the spine.

OBJECTIVE: The aim of this study was assess the results of local resection without instrumentation in patients with scoliosis secondary to spinal osteoid osteoma and osteoblastoma. METHODS: The review of our database revealed 176 cases of osteoid osteomas and 18 of osteoblastomas. Painful scoliosis was seen in 5 out of 6 cases. The lesion was found on the posterior part of the apical vertebra in the concave side of the scoliotic curve. Surgical treatment consisted of simple en bloc excision. Mean period between diagnosis and operation was 2.6 years, mean age at the time of surgery was 12.5 years, and mean preoperative major Cobb angle was 37.2°. RESULTS: Four patients with a mean follow-up of 4.3 years were included in the study. At final follow-up, Cobb angle was 7.6°, and the average percentage of correction was 79.6%. Coronal decompensation was corrected by 87.7%. Pelvic tilt and shoulder imbalance were corrected by 15% and 74.5%, respectively. The preoperative mean Visual Analog Scale score was 9 before the treatment and 0 at the final follow-up. CONCLUSION: Our results suggested that simple en bloc resection may be a safe and effective treatment option in patients with scoliosis secondary to spinal osteoid osteoma and osteoblastoma, if patient less than 16 years, with major Cobb angle less than 40°, and duration of complaint less than 22 months.

Preoperative and Postoperative Photographs and Surgical Outcomes of Patients With Kyphosis.

STUDY DESIGN: A retrospective clinical study was performed. OBJECTIVE: The aim of the study was to show patients their pre- and postoperative body photographs, and determine the effect on postoperative patient satisfaction for thoracic and thoracolumbar sharp and round angular kyphosis. SUMMARY OF BACKGROUND DATA: Previous studies have reported the normative values of pelvic sagittal parameters and the classification of normal patterns of sagittal curvature, but no study has investigated and compared the clinical photographs of sharp and round kyphosis. METHODS: In patients who underwent surgery for thoracic and thoracolumbar sharp and round angular kyphosis, whole spine anteroposterior and lateral radiographs, and clinical photographs were obtained preoperatively and at the final follow-up. Pelvic and spinal parameters were measured, and the pre- and postoperative photographs were shown to patients. The Scoliosis Research Society 22r (SRS22r) and Short Form 36 surveys were administered to all patients, and the scores were analyzed. RESULTS: Thirty-eight patients diagnosed with kyphosis (mean age 19.6 yr, mean follow-up duration 26.4 mo) were divided into two groups: sharp (18 patients, mean age 20.1 yr) and round (20 patients, mean age 19.6 yr) kyphosis. There was no difference between values in the sharp and round groups in terms of age, follow-up duration, and Risser score (P > 0.05). In both groups, the subscores for pain, self-image, mental health, and satisfaction, except for the function/activity score, and the total score of the SRS22r survey were, however, significantly different between pre- and postoperative photographs. In addition, there was no significant difference between the two groups in any SRS22r domain and Short Form 36 scores. CONCLUSION: The surgical treatment of kyphosis was uniformly associated with improved quality of life, regardless of the kyphosis type. Thus, showing patients their pre- and postoperative photographs may enhance patient satisfaction, as measured by SRS22r scores. LEVEL OF EVIDENCE: 4.

Two level pedicle substraction osteotomies for the treatment of severe fixed sagittal plane deformity: computer software-assisted preoperative planning and assessing.

PURPOSE: To evaluate the efficacy of two level pedicle substraction osteotomies (PSOs) planned preoperatively with a computer software, in the patients with severe fixed sagittal plane deformities. METHODS: In the literature, there are studies indicating that two level PSOs may be required in severe cases. However, the results of two level PSOs preoperatively planned with computer software-assistance have not yet been reported in the English literature. Severe fixed sagittal plane deformities of 11 patients are described. Preoperative surgical planning was done with the aid of a computer software. Two level PSOs were indicated after the process. After the application of the indicated surgical technique, clinical and radiological results were evaluated in the preoperative, the early postoperative periods and during the last follow-up. RESULTS: The mean sagittal vertical axis was found as 190.5 (range 161-220) mm in the preoperative period, 23.5 (range -27 to 61) mm in the early postoperative period (P < 0.001) (87.7 % correction) and 34.5 (range -3 to 55) mm during the last follow-up (P < 0.001). The mean pelvic tilt (PT) significantly decreased from 38.3° (range 21°-63°) preoperatively to 23.8° (range 18°-42°) postoperatively (P = 0.008) and to 27.5° (range 17°-42°) during the last follow-up (P = 0.042). The mean lumbar lordosis (LL) was 2.8° (range -29° to 20°) preoperatively, -35.6° (range -54° to 23°) early postoperatively (P < 0.001) and -33.6° (range -52° to 20°) during the last follow-up (P < 0.001). The average amount of bleeding was 5345 (range 2600-7415) ml. CONCLUSION: Although a statistically significant correction was obtained, the mean PT and PI-LL value could not be restored in physiological limits during the last follow-up. Thus, two level PSOs performed after computer software (surgimap) assisted preoperative planning failed to correct severe fixed sagittal plane deformities. Besides, this procedure is of possible risks for major complications such as a result of excessive bleeding. We recommend that two level PSOs should be rarely indicated, but preferred as an alternative technique only in the most severe cases.

The effect of vertical expandable prosthetic titanium rib on growth in congenital scoliosis.

AIMS: In the treatment of thoracic insufficiency syndrome, the main aim is to maintain spinal and thoracic growth in order to continue respiratory functions. Vertical expandable prosthetic titanium rib (VEPTR) device application is a method of choice especially in the congenital cases with a thoracic deformity. In our study, we evaluated the effect of VEPTR on growth in congenital scoliosis. MATERIALS AND METHODS: Four female patients in whom VEPTR was applied were retrospectively evaluated. Anteroposterior (AP) and lateral Cobb angles that were measured preoperatively and during the last control, space available for lung (SAL), T1-S1 and T1-T12 distances, coronal and sagittal balances were compared. RESULTS: Four female patients in whom VEPTR was applied were retrospectively evaluated. AP and lateral Cobb angles that were measured preoperatively and during the last control, SAL, T1-S1, and T1-T12 distances, coronal and sagittal balances were compared. CONCLUSIONS: VEPTR may provide a good correction, and we observed a growth in the spine height and SAL following the treatment of congenital deformities. Long-term, multicenter, prospective studies that compare the spinal height, respiratory functions, the severity of the deformity, and the spinal balance are required in order to evaluate the efficacy of VEPTR.

Mid term results of Pemberton pericapsular osteotomy.

BACKGROUND: Treatment for developmental dysplasia of the hip (DDH) varies according to the age of the patient. For children under 3 months, the preferred treatment is Pavlik bandaging and/or dynamic hip orthosis;for children of 3-18 months (with/without arthrography), closed and open reductions (ORs) are most common; and for children 18 months and older, pelvic osteotomies are used. Radiological and functional outcomes of patients between 16 months and 7 years of age who underwent Pemberton pericapsular osteotomy (PPO) were evaluated. MATERIALS AND METHODS: Twelve patients with developmental dysplasia of the hip (DDH) received treatment on 14 hips between 2001 and 2006. All patients with DDH had PPO as pelvic osteotomy. PPO was done solely in 3 hips, PPO and open reduction (OR) in and OR + PPO + femoral shortening in 6. The average age was 39.85 months (range 16-83 months). All had 1-stage surgery. Acetabular index (AI) and the grade of displacement were determined according to Tönnis'. Center-edge (CE) angle was evaluated. Clinical evaluations were made as described by McKay, radiological assessments by Severin's criteria and femoral head avascular necrosis measurements by Kalamchi-MacEwen's criteria. Average followup periods were 83.35 months (range 48-115 months). RESULTS: Preoperative and postoperative average AI levels were 41.92° (range 30-50°) and 19,5° (range 5-34°), respectively (P < 0.001). According to Severin's classification, 11 (78.57%) patients were Ia, 1 (7.14%) was Ib, 1 (7.14%) was II and 1 (7.14%) was III. According to Kalamchi-McEven criteria, 12 (85.71%) patients were type I, 2 (14.28%) patients were type II. CE postoperatively was measured as 24.24° (range 12-41°). Clinically (McKay), the functional results in 13 (92.85%) patients were very good (I) and in 1 (7.14%) was good (II). CONCLUSIONS: Functional and radiological mid term outcomes were found to be comparable in most of the patients with DDH undergoing PPO between the ages of 16 months and 7 years.