Non-tuberculous thoracic and lumbar spondylodiscitis: single-stage anterior debridement and reconstruction, combined with posterior instrumentation and grafting.

Debridement is warranted for the treatment of nontuberculous spondylodiscitis in case of neurological compromise, deformity, instability, abscess formation, extensive destruction, intractable pain or failure of medical management. The additional use of instrumentation is still controversial, but might fight infection and yield stability. The purpose of this retrospective study was to evaluate the outcome of 16 cases of non-tuberculous thoracic or lumbar spondylodiscitis treated with anterior debridement and reconstruction (tricortical graft or titanium mesh cage), combined with single-stage posterior instrumentation and grafting. The pathogens identified were: Brucella (5), coagulase-negative Staphylococcus aureus (4), Staphylococcus aureus (3), unidentified (4). All 16 infections resolved without recurrence. Bony union was obtained in all cases. Fourteen out of 16 patients (87.5%) were completely relieved of pain and fully active, an excellent result according to Macnab's criteria; the other two patients obtained a good result. All 7 patients who had a neurological deficit improved. There were two superficial infections, which healed with debridement and antibiotics. A single iliac vein injury was primarily repaired. In conclusion, the proposed technique is an effective and safe treatment for pyogenic spondylodiscitis, if surgery is mandatory.

Spinal Metastatic Disease: Survival Analysis of 146 Patients and Evaluation of 4 Different Preoperative Scoring Systems.

STUDY DESIGN: This was a retrospective analysis. OBJECTIVE: The objective of this study was to evaluate the predictive value of the 4 different scoring systems Tomita, Bauer modified, Tokuhashi revised, and Van der Linden and some parameters that are used in these scoring systems. SUMMARY AND BACKGROUND DATA: Prediction of the survival period before treatment for spinal metastasis is extremely important. A lot of scoring systems have been described to predict the survival periods and to select the ideal treatment modality in the literature. MATERIALS AND METHODS: Retrospectively 146 patients with spinal metastasis were investigated between 2002 and 2011. The following parameters were analyzed: age, pathologic vertebra fracture, neurological deficit, visceral metastasis, diagnosis of primary tumor and its spinal metastasis interval, other skeletal metastasis, involved region of vertebra, and undergone spinal surgery. Patients were also scored by the 4 different scoring systems. The survival period was calculated from date of diagnosis of the spinal metastasis to the date of death or last follow-up (minimum: 12 mo). Cox regression, Kaplan-Meier survival test, and Cronbach α tests were performed for statistical analysis. RESULTS: Median overall survival for all patients was 13 months (range: 1-68 mo). The primary tumor (P=0.015), existence of visceral metastasis (P=0.017), presence of pathologic vertebra fracture (P=0.009), and undergone spinal surgery (P=0.047) showed significant influence on survival. Each scoring system was reliable and concordant with the other scoring systems (Cronbach α=80%); however, after 2 years, Modified Bauer score appeared to be the most reliable system for predicting survival (Cronbach α=25%). CONCLUSIONS: According to this analysis, lung cancer, visceral metastasis, pathologic vertebra fracture, and undergone spinal surgery have shown a negative effect on survival. All 4 scoring systems were reliable for predicting survival of patients with spinal metastatic disease. However, modified Bauer scoring system seems to be more predictive after 2 years. LEVEL OF EVIDENCE: Level III.

Comparison of Clinical and Radiological Parameters with Two Different Surgical Methods for Anterior Cruciate Ligament Reconstruction.

This study compared the clinical and radiological findings of nonanatomic transtibial (TT) technique with intraspongious fixation and anatomical anteromedial portal (AMP) technique with extracortical button implant in anterior cruciate ligament (ACL) reconstruction. A total of 54 patients with isolated ACL rupture were included in this prospective study. The patients who had the intraspongious fixation by nonanatomical TT technique were allocated to Group 1 (n = 27). The patients with extracortical fixation by anatomical AMP technique were placed in Group 2 (n = 27). The clinical scores of the patients were evaluated with the International Knee Documentation Committee Evaluation Form, Tegner activity score, and Lysholm II Functional Scoring. The tibial and femoral tunnels were evaluated with three-dimensional computed tomography. The kinematic examinations were performed with a Biodex System 3 Pro isokinetic dynamometer. There was no significant difference between the groups in terms of demographic data (p > 0.05). The postoperative clinical scores improved significantly in both the groups compared with the preoperative levels (p = 0.001), but there was no significant difference in the postoperative clinical scores between the groups (p > 0.05). In the extension and flexion of 60 to 180 degrees/s, the peak torque and the peak torque/body weight values of the repaired knee to intact knee ratios showed significant differences in favor of Group 2 (p = 0.001). In both the groups, no significant difference was found between the mean extent of the tunnel enlargement (p > 0.05). The mean tunnel height was significantly greater in Group 1 (45% ± 9.86 vs. 34.11% ± 10.0%) (p = 0.001). When the localization of the tunnel enlargements (proximal-middle-distal) was examined, a significant difference was found between the groups (p = 0.001). Although the AMP technique, which is a more anatomic reconstruction, had an advantage with regard to tunnel enlargement and the isokinetic muscle studies, there was no difference between the two techniques in terms of the clinical results.

Remodeling potentials of biphasic calcium phosphate granules in open wedge high tibial osteotomy.

INTRODUCTION: Biphasic calcium phosphate (BCP) has proved to be an effective bone substitute, but it's effectiveness and remodeling potential in open wedge high tibial osteotomy (OWHTO) has not been analyzed yet. This study sought to evaluate the bone healing and remodeling potentials of BCP granules using a radiographic rating system in biplanar OWHTO. MATERIALS AND METHODS: Fifteen patients (15 knees) underwent biplanar OWHTO. Bone gaps were filled with BCP granules. For radiographic evaluation, remodeling was divided into four phases. Phase 1 was accepted as rounded osteotomy sites, with clear distinction between BCP and bone, phase 2 was accepted as whitened osteotomy sites, with distinction between BCP and bone still visible, phase 3 was accepted as distinction between BCP and bone not visible and cloudy bone formation and phase 4 was accepted as full reformation of BCP granules (4A-BCP visible, 4B-disappearence of BCP) with no sign of osteotomy. Bone union was confirmed with clinical (full weight bearing without pain) and radiographic evaluation (cortical bridging callus on radiographs and phase 3 or greater remodeling). The time to full remodeling and the starting point of the consolidation on anteroposterior radiographs were noted. Complications were also noted at each clinical follow-up. RESULTS: Mean follow-up was 27.2 months. The mean age was 55.8 years. At clinical follow-up, there were no wound healing problems, no loss of corrections, no infections, and no complications. All osteotomies successfully healed. According to the radiologic classification system, at the 6th week, 73.3% (11/15) of patients were in phase 1 and the remaining 26.7% (4/15) were in phase 2. At 12-month follow-up, 46.7 (7/15) of the patients were still in phase 3. After 2 years, all radiographs showed to be in phase 4A. Radiographic union was noted to progress from lateral to medial and finally central. CONCLUSIONS: BCP can be successfully used as a bone substitute. The radiographic remodeling and consolidation process of BCP was found to be different from that of beta-tricalcium phosphate. In our patients with more than 2 years of follow-up, BCP granules did not completely remodel. As a result, this clinical study demonstrated that calcium phosphate granules containing hydroxyapatite had a long period of "creeping substitution" that lasts longer than 2 years.

Posterior epidural mass: can a posteriorly migrated lumbar disc fragment mimic tumour, haematoma or abscess?

A 60-year-old woman complained of low back pain radiating to both buttocks and to the anterior aspect of the left thigh. MRI showed a left posterolateral epidural mass at the L1-L2 level. An epidural abscess was suspected, but the biochemistry was normal. Excision yielded complete relief of symptoms. Pathological examination demonstrated that the specimen was a migrated disc fragment. The authors found 29 other cases of disc migration to the posterior epidural space; two of these were at the thoracic level. Eleven of the 27 lumbar cases (40%) were complicated with Cauda Equina Syndrome (CES). MRI is the method of choice to make the diagnosis. The differential diagnosis includes tumour, haematoma and abscess.

Effect of PLIF and TLIF on sagittal spinopelvic balance of patients with degenerative spondylolisthesis.

OBJECTIVE: The aim of this study was to evaluate the effects of PLIF and TLIF on sagittal spinopelvic balance and to compare radiological results of two surgical procedures with regard to spinopelvic parameters. METHODS: Thirty-five patients (34 female and 1 male; mean age: 52.29 ± 13.08 (range: 35-75)) with degenerative spondylolisthesis cases were included in the study. Patients were divided into two groups according to surgical technique: PLIF and TLIF. The level and the severity of listhesis according to Meyerding classification were assessed and spinopelvic parameters including sacral slope, pelvic tilt, pelvic incidence (PI), lumbar lordosis, and segmental lumbar lordosis were measured on digital X-rays. All preoperative and postoperative parameters and the results were compared between two groups. RESULTS: The age distribution was similar in both groups (p = 0.825) and there was no difference between the mean PI of the groups (p = 0.616). In 15 patients, spondylolisthesis level were at the L5-S1 level (PLIF: 8, TLIF: 7), in 16 patients at the L4-L5 level (PLIF: 6, TLIF: 10) and in 4 patients at the L3-L4 level (PLIF: 2, TLIF: 2). According to Meyerding classification, before the operation, the sliding grades were 0 in 4 patients, 1 in 21 patients, 2 in 7 patients, and 3 in 3 patients. The grades changed into 0 in 28 patients, 1 in 5 patients, and 2 in 2 patients after surgery. There were no differences in the grade of listhesis between PLIF and TLIF groups preoperatively (p = 0.190) and postoperatively (p = 0.208). In both groups, the spondylolisthesis-related deformities of patients were significantly corrected after surgery (p < 0.001). CONCLUSION: PLIF and TLIF techniques have similar radiological results in restoring the sagittal spinopelvic balance in patients with degenerative spondylolisthesis. Both techniques are good options to achieve reduction and fusion in patients with degenerative spondylolisthesis, but have no advantage over each other for restoring spinopelvic balance. LEVEL OF EVIDENCE: Level III, Therapeutic study.

Analysis of outcomes for surgically treated hip fractures in patients undergoing chronic hemodialysis.

BACKGROUND: Hip fractures in patients with end-stage renal disease are associated with frequent complications. This study analyzed clinical outcomes for patients on chronic hemodialysis who sustained hip fractures and were treated with a variety of fracture repair methods. METHODS: Twenty-nine patients with thirty-two hip fractures were analyzed in three groups. Group 1 consisted of eleven hips in eleven patients with an intertrochanteric fracture that was treated with internal fixation; Group 2, thirteen hips in ten patients with a femoral neck fracture that was treated with screw fixation; and Group 3, eight hips in eight patients with a femoral neck fracture that was treated with hemiarthroplasty. The outcomes and early and late complications were recorded for each group. Survivorship analysis was performed, and the mortality and complication rates for the groups were compared. RESULTS: In Group 1, eight complications occurred in six hips and nonunion developed in five hips. In Group 2, sixteen complications developed in eleven hips. Union was achieved in two of the thirteen hips, nine hips had nonunion, and two hips had osteonecrosis develop. In Group 3, only one hip had early complications, there were no late complications, and three patients died. The mean duration of follow-up was twenty-three months, and the overall mortality rate was 45%. There were no significant differences among the groups with respect to the cumulative survival proportions. Regression analysis of age, sex, and total hemodialysis duration in relation to mortality risk revealed that only age had a significant influence on mortality (p = 0.019). CONCLUSIONS: Surgical treatment of hip fractures in patients with end-stage renal disease who are on chronic hemodialysis is associated with frequent complications and a high mortality rate. Osteosynthesis is an acceptable option for treating intertrochanteric fractures and nondisplaced femoral neck fractures, but displaced femoral neck fractures should be treated with hemiarthroplasty.

Necrotizing soft-tissue infection of a limb: clinical presentation and factors related to mortality.

BACKGROUND: Necrotizing fasciitis is a rare and often fatal soft-tissue infection. Prompt diagnosis and immediate aggressive surgical debridement of all compromised tissues are critical to reducing morbidity and mortality in these rapidly progressive infections. The purpose of this study was to analyze the clinical presentation and evaluate factors that determine mortality associated with this uncommon surgical emergency. METHODS: The study retrospectively investigated the medical records of 22 patients who were diagnosed and treated for necrotizing fasciitis of the lower extremity, 14 of whom had involvement of the foot (nine patients) or foot and ankle (five patients) at our hospital. The data collected for each of the 22 patients were age, sex, underlying systemic factors, location of infection, duration of symptoms, portal of entry of infection, initial diagnosis on admission, physical, radiographic and laboratory findings, microbiological cultures, the type of therapy used (debridement or amputation), treatment outcome, and number of days in the hospital. RESULTS: A total of 23 extremities of 22 consecutive patients with necrotizing fasciitis who underwent surgical debridement or amputation were retrospectively reviewed. Radical surgical debridement was done in 16 extremities initially, and this treatment was repeated a mean of two times (range one to four debridements) to completely remove all the necrotic tissue. Nine patients (41%) required below-knee or above-knee amputation. There were three deaths, one related directly to sepsis and organ failure, one due to gastrointestinal hemorrhage, and one caused by pulmonary embolism. There were no significant differences between patients who had the amputations and those who did not with respect to mortality rate or age (p = 0.538 and p = 0.493, respectively). Those who died were significantly older than the survivors (p = 0.038). CONCLUSIONS: The diagnosis of necrotizing fasciitis should be considered for any individual who has unexplained limb pain, especially if that person has diabetes mellitus or chronic liver disease. There was no difference in mortality rates between patients with or without amputation. The primary treatment is early and aggressive debridement of involved skin, subcutaneous fat, and fascia.

Mechanical strength of four different biceps tenodesis techniques.

PURPOSE: The aim of this study was to compare the biomechanical properties of 4 different biceps tenodesis techniques. TYPE OF STUDY: Biomechanical experiment. METHODS: Four groups of fresh sheep shoulders (28 total) with similar shape characteristics were used. Biceps tenodesis was performed using the following techniques: group 1 (n = 7), tunnel technique; group 2 (n = 7), interference screw technique; group 3 (n = 7), anchor technique; and group 4 (n = 7), keyhole technique. Each construct was loaded to failure and the groups were compared with respect to maximum load in Newtons and deflection at maximum load in millimeters. The results were statistically analyzed with 1-way analysis of variance, the Bonferroni post hoc test and the Student t test or the nonparametric Mann-Whitney U test. RESULTS: The calculated average maximum loads were 229.2 +/- 44.1 N for the tunnel technique, 243.3 +/- 72.4 N for the interference screw, 129.0 +/- 16.6 N for the anchor technique, and 101.7 +/- 27.9 N for the keyhole technique. Statistical testing showed no statistically significant differences between groups 1 and 2, groups 3 and 4, or groups 2 and 3 with respect to maximum load and deflection at maximum load (P = .09/P = .49, P = .41/P = .79, and P = .06/P = .82 for load/deflection in the 3 comparisons, respectively). However, all other group comparisons revealed significant differences for both parameters (group 1 v group 4 [P < .01/P < .01]; group 1 v group 3[P < .01/P = .01]; and group 2 v group 4 [P = .007/P = .003]). CONCLUSIONS: The strongest construct was made with the interference screw technique, followed by the tunnel, anchor, and keyhole techniques. There were no statistically significant differences between the interference screw and tunnel techniques with respect to maximum load or deflection at maximum load. CLINICAL RELEVANCE: Although it is difficult to extrapolate in vitro data to the clinical situation, the interference screw technique has better initial biomechanical properties and may produce improved clinical outcomes.

Arthroscopic debridement and grafting of an intraosseous talar ganglion.

We report the case of a 41-year-old man with right ankle pain and swelling who had an intraosseous talar ganglion in the medial part of talar dome. A surgical procedure was performed using the 3-portal arthroscopic approach. The softened chondral surface was removed and the content of the cyst was discharged arthroscopically. The sclerotic rim was abraded until the bleeding spongious layer was seen. A grafting procedure was also performed arthroscopically. A trocar was introduced into the defect from the superomedial portal. Autografts were impacted using a cylindrical rod through the trocar into the defect. The clinical and radiologic results at the 1-year follow-up were satisfactory. We encountered no complications postoperatively. We conclude that arthroscopic debridement and grafting of an intraosseous ganglion adjacent to the articular surface may be a better option compared with open surgery.

Arthroscopic treatment of solitary benign intra-articular lesions of the knee that cause mechanical symptoms.

PURPOSE: Most cases of knee locking and giving-way are caused by meniscal tears, loose bodies, or chondral lesions. Intra-articular benign tumors or tumor-like lesions can present with symptoms that resemble acute mechanical derangement. From a database of 2,200 arthroscopic interventions, 19 cases of intra-articular masses that presented with catching and locking symptoms in the knee were retrospectively analyzed. TYPE OF STUDY: Case series. METHODS: Our review revealed 33 patients with benign intra-articular masses in the knee joint. Nineteen of these individuals had sought medical attention for mechanical symptoms of catching or locking. The other 14 patients had a variety of symptoms including pain, swelling, and limitation of knee motion, but did not have mechanical symptoms. Age, sex, history of trauma, knee pain and effusion, medical illnesses, physical examination, arthroscopic findings, and pathologic findings were noted. RESULTS: The average age of the 6 male and 13 female patients was 37.5 years (range, 18 to 58 years). Preoperative magnetic resonance imaging confirmed the diagnosis in 7 cases and 12 cases were diagnosed during knee arthroscopy. The mean follow-up time after surgery was 52.5 months (range, 6 to 120 months). Pathologic examination of the lesions revealed 15 cases of localized pigmented villonodular synovitis (79%), 1 lipoma arborescens (5%), 1 pseudocyst (5%), and 2 nonspecific synovial masses (11%). None of the lesions showed malignant transformation. CONCLUSIONS: Solitary benign intra-articular lesions should be considered a rare cause of mechanical knee symptoms. Localized pigmented villonodular synovitis originating from the extensor mechanism or fat pad is the most common solitary intra-articular mass lesion in the knee and usually arises in the patellofemoral compartment. Recurrence has not occurred in our series, which includes 14 of 19 patients with greater than 24 months follow-up. LEVEL OF EVIDENCE: Level IV.

Hallucal sesamoid osteonecrosis: an overlooked cause of forefoot pain.

Four cases of osteonecrosis of hallucal sesamoids are reported here. Surgical excision of necrotic sesamoid tissue yielded satisfactory results, with the patients reporting no residual pain. Although it has not been frequently addressed in the literature, avascular necrosis of the sesamoid bones should be considered in the differential diagnosis of persistent forefoot pain.

Avascular necrosis and nonunion after osteosynthesis of femoral neck fractures: effect of fracture displacement and time to surgery.

This study assessed the effect of fracture displacement and elapsed time before surgery on the development of avascular necrosis and nonunion after internal fixation of femoral neck fractures. Twenty-eight patients with 30 femoral neck fractures who underwent internal fixation and completed a minimum of 2 years' follow-up were retrospectively analyzed. The rates of avascular necrosis and nonunion were 12.5% and 25%, respectively, among patients who underwent surgery before 12 hours had elapsed and 14% and 27% among those who underwent surgery after that time. The rates of avascular necrosis and nonunion associated with fracture displacement were 6% and 18%, respectively, among patients with undisplaced (Garden stages 1 and 2) fractures and 23% and 38% among those with displaced (Garden stages 3 and 4) fractures. Nonunion and avascular necrosis led to the necessity for additional surgery in 11 of 30 (36%) hips. Internal fixation of femoral neck fractures is associated with a high initial complication rate, but if successful, the procedure ensures an excellent long-term outcome. Internal fixation should be considered the treatment of choice in young patients with nondisplaced fractures.

Tunnel enlargement after arthroscopic anterior cruciate ligament reconstruction: comparison of bone-patellar tendon-bone and hamstring autografts.

Bone tunnel enlargement associated with anterior cruciate ligament (ACL) reconstruction has recently become a topic of interest in the literature. This association was examined, along with the effect of femoral and tibial tunnel enlargement on the clinical results of ACL reconstruction performed with either bone-patellar tendon-bone (BPTB) or hamstring (HST) autografts. Forty-six patients underwent arthroscopic ACL reconstruction (23 receiving BPTB autograft and 23 HST) between March 1999 and July 2001. Thirty patients (13 receiving BPTB autograft and 17 HST) completed the last clinical and radiologic evaluations and were included in the study. The mean age of patients in the HST group was 29.8 years (range 18-39) and that in the BPTB group was 27.6 years (range 20-37). The mean follow-up period was 24.6 months (range 12-36) in HST group and 18.5 months (range 12-40) in BPTB group. The effect of tunnel enlargement on the clinical results was evaluated by comparing preoperative and postoperative Lysholm, Tegner, and International Knee Documentation Committee scores and ligament laxity measurements between and within the groups. Postoperative femoral and tibial tunnel diameters in both groups were significantly larger than their corresponding preoperative tunnel diameters. In an intergroup evaluation, the enlargement of the tibial tunnel was similar in both groups (P=.556), but the femoral tunnel diameter was significantly larger in the HST group than in the BPTB group (P>.001). Preoperative laxity of the knees significantly improved after the operations in both groups, but no difference between the groups was evident at the final follow-up visit. No correlation between tunnel widening and the clinical results of the BPTB and HST procedures was observed.

Bilobed flaps for nonhealing ulcer treatment.

Healing of round ulcers may be difficult particularly in the plantar area. Rigidity and thickness of the plantar skin do not allow fusiform excision and primary suturing. The bilobed flap is a simple reconstructive technique principally used to repair substantial defects in the facial region. The authors' experience with this local flap in the foot is presented with good short-term results. Between 1995 and 1998, five female and seven male neuropathic foot patients with round plantar ulcers were treated with bilobed flaps. The average age of the patients was 50 (range, 15-76). The average size of the ulcers was 1.6 cm (1-3.2 cm). Debridement and orthotic insoles were used at least for 3 months before considering bilobed flaps. Seven patients were diagnosed as type II diabetes mellitus, four patients had cerebral palsy, and another patient had meningomyelocele. The minimal follow-up period was 1 year (average, 19.5 months). The only complication was wound dehiscence at the lateral side of the heel in a type II diabetic. Subsequently, this complicated ulcer was managed with a sliding flap and skin graft without further problem. The study concluded that nonhealing foot ulcers can be effectively treated with a bilobed skin flap of healthy tissues rotated from nonweightbearing parts of the sole.

[Suprascapular nerve entrapment at the spinoglenoid notch secondary to a ganglion cyst]. / Spinoglenoid çentik ganglionuna bagli gelisen supraskapular sinir sikismasi: Olgu sunumu.

Suprascapular neuropathy may occur as a result of traction, direct trauma, repetitive microtraumas, and extrinsic compression. A thirty-one-year-old man presented with non-traumatic complaints of right shoulder pain and stiffness. After exclusion of other causes associated with shoulder pain, a diagnosis of suprascapular nerve entrapment was considered. Electromyographic activity of the right shoulder was compared with that of the left side and involvement of the infraspinatus muscle was detected, with the supraspinatus muscle appearing normal. Magnetic resonance imaging revealed a ganglion cyst around the spinoglenoid notch. The patient underwent arthroscopic examination and open cyst excision. Arthroscopy did not show any labral tears. Pathological diagnosis was made as a cystic ganglion. On follow-up examinations, the patient's complaints disappeared and only minimal infraspinatus muscle atrophy was observed. Suprascapular nerve entrapment should be considered in the differential diagnosis of posterior shoulder pain.

[A comparison between single- and two-staged bilateral total knee arthroplasty operations in terms of the amount of blood loss and transfusion, perioperative complications, hospital stay, and cost-effectiveness]. / Iki tarafli total diz artroplastisini tek veya iki seansta uygulamanin kanama ve transfüzyon miktari, perioperatif komplikasyon, hastanede kalis süresi ve maliyet açisindan karsilastirilmasi.

OBJECTIVES: We compared bilateral total knee arthroplasty (TKA) operations performed at a single session or at two separate sessions with respect to perioperative complications, the amount of blood loss and transfusion, the length of hospital stay, and the overall cost. METHODS: The study included 39 patients (34 females, 5 males; mean age 68.1 years; range 52 to 88 years) and 16 patients (13 females, 3 males; mean age 66.8 years; range 52 to 83 years) who underwent bilateral TKA for osteoarthritis at a single session and at two separate sessions, respectively. Staged operations were interspersed with a mean interval of 8.3 months (range 2 to 24 months). The two groups were compared with respect to perioperative complications, the amount of blood loss and transfusion, the length of hospitalization, and the overall cost. RESULTS: The amount of blood loss and transfusion, the length of intensive care unit stay, and the occurrence of perioperative complications did not differ significantly between single- and two-staged operations (p>0.05). However, the mean length of hospital stay (10.48 days versus 17.19 days; p=0.01) and the mean overall cost (p=0.03) were significantly less in single-staged operations. Perioperative complications accounted for 12.8% (n=5) and 25% (n=4) in single- and two-staged operations, respectively, all of which developed in patients who had a preexisting cardiologic disease. CONCLUSION: In view of its advantages, single-staged bilateral TKA seems to be an appropriate alternative in selected patients.

[Arthroscopic treatment of rotator cuff calcifying tendinitis]. / Rotator mansetin kalsifiye tendinitinin artroskopik tedavisi.

OBJECTIVES: We evaluated the effectiveness of arthroscopic treatment in patients with rotator cuff calcifying tendinitis unresponsive to conservative treatment. METHODS: Arthroscopic treatment was performed in 10 patients (6 females, 4 males; mean age 46 years; range 34 to 53 years) in whom pain and functional disability persisted for more than a year despite conservative therapy for rotator cuff calcifying tendinitis. Arthroscopic bursectomy was also carried out. One patient underwent repair for rotator cuff tear. The patients were evaluated before and after surgery with the use of Constant scores and direct radiographs. The mean follow-up period was 12 months (range 6 to 19 months). RESULTS: The mean Constant scores were 66 (range 45 to 70) and 93 (range 89 to 96) before surgery and on final examinations, respectively. Postoperative radiographs demonstrated incomplete removal of calcifications in four patients; however, complaints of pain disappeared in these patients and radiologic controls showed that residual deposits underwent spontaneous resorption. CONCLUSION: Arthroscopic removal of calcium deposits together with bursectomy seems to be effective and reliable in patients with chronic calcifying tendinitis unresponsive to conservative treatment.

[Arthroscopic assisted biceps tenodesis]. / Artroskopi yardimli biseps tenodezi.

OBJECTIVES: Functional results of arthroscopic assisted biceps tenodesis were evaluated in patients with chronic biceps tendinitis. METHODS: The study included six patients (4 women, 2 men, mean age 55 years, range 47 to 60 years) who underwent arthroscopic assisted biceps tenodesis with a diagnosis of chronic biceps tendinitis. During tenodesis, the biceps tendon was secured with the use of key-hole technique in one patient, and with suture anchors in five patients. The patients were evaluated by the Constant shoulder scoring system. The mean follow-up was 12 months (range 6 to 36 months). RESULTS: All the patients had shoulder impingement syndrome, five patients had rotator cuff lesions, and one patient had os acromiale. The mean preoperative and postoperative Constant scores were 62 (range 60 to 65) and 84.2 (range 82 to 87), respectively. All patients returned to work within a mean of six weeks. No complications were observed during follow-up. CONCLUSION: Arthroscopic assisted biceps tenodesis may give successful results in patients with chronic biceps tendinitis with coexistent shoulder impingement syndrome or rotator cuff lesions.

[Arthroscopic capsular release for frozen shoulder]. / Donmus omuz hastaliginin tedavisinde artroskopik kapsüler gevsetme.

OBJECTIVES: This study was designed to evaluate the results and technical considerations of arthroscopic capsular release of the glenohumeral joint in frozen shoulder disease. METHODS: Arthroscopic capsular release was performed in 16 patients (11 women, 5 men; mean age 51 years; range 40 to 60 years) unresponsive to physical therapy. The affected shoulder was on the right in 10 patients, and on the left in six, being on the dominant side in 12 patients. The duration of the patients' complaints ranged from six to 24 months. Preoperatively, the mean forward flexion was 92 degrees, external rotation was 14 degrees; the ranges of internal rotation were the trochanter in four patients, the gluteal region in seven patients, the lumbosacral region in one patient, the L3 level in one patient, and T12 level in three patients. Functional evaluations were made according to the Constant scoring system. The mean follow-up was 17.3 months (range 12 to 30 months). RESULTS: Postoperatively, the mean forward flexion and external rotation increased to 135 and 27 degrees, respectively. Internal rotation reached the gluteal region in two patients, the lumbosacral region in two patients, the L3 level in two patients, T12 level in nine patients, and the interscapular region in one patient. The mean Constant score improved by 47 points. CONCLUSION: Arthroscopic capsular release is a safe and effective surgical procedure in the management of frozen shoulder disease unresponsive to conservative treatment.