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- ArticleAçık Erişim2026Preoperative Geriatric Nutritional Risk Index (GNRI) and Comorbidity Burden as Mortality Risk Markers After Proximal Femoral Nailing in Older Patients with Pertrochanteric Hip Fractures
Gökgöz, Mehmet Burak; Kahraman, Hamit Çağlayan; Gür, Volkan; Öztürk, Akın; Doğan, İbrahim; Gönbe, Alper; Avcı, Berat; Koçkara, Nizamettin; Sofu, Hakan; Yapıcı, Furkan
Background: Mortality after geriatric hip-fracture surgery remains substantial. This study evaluated whether preoperative GNRI, comorbidity burden, and CBC-derived inflammatory indices were associated with one-year and long-term mortality after PFN for pertrochanteric/intertrochanteric fractures. Methods: In this single-centre retrospective cohort study of prognostic risk markers, 248 PFN records were screened. After excluding six incomplete records and 25 patients aged <65 years, 217 older fracture/surgical episodes formed the time-to-event cohort; 194 were evaluable for binary one-year mortality. Living patients/episodes with <365 days of follow-up were censored in survival analyses. Logistic and Cox models were supported by Firth penalized logistic regression, calibration assessment, and internal validation. Results: Median age was 82 years, 65.0% were female, and 68.7% were ASA III–IV. Overall, 96/217 (44.2%) died during median follow-up of 570 days. Thirty-day, 90-day, and one-year evaluable mortality were 7.4%, 15.2%, and 27.3%. GNRI < 82 identified a small high-risk subgroup: 10/13 evaluable patients/episodes (76.9%) died within one year versus 43/181 (23.8%) with GNRI ≥ 82. GNRI < 82 remained associated with one-year mortality in adjusted logistic regression, although with a wide confidence interval due to sparse subgroup size (OR 6.43, 95% CI 1.50–27.55; p = 0.012), and in Firth penalized sensitivity analysis (OR 5.51, 95% CI 1.34–22.61; p = 0.018). In Cox analysis, age, ASA III–IV, available Charlson-domain comorbidity burden, and lower continuous GNRI were associated with long-term mortality, whereas adding GNRI < 82 and NLR did not materially improve cross-validated discrimination. Conclusions: GNRI < 82 identified a small subgroup with high observed mortality after PFN. Because the subgroup was sparse and biomarker addition did not materially improve internally validated discrimination, GNRI should be treated as an alerting clinical flag rather than a stand-alone basis for patient-level risk prediction. External validation is required.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2020Monoblock polyethylene radial head prosthesis for the treatment of unreconstructable acute radial head fractures with a minimum 1-year follow-up: A retrospective case series
Ucpunar, Hanifi; Camurcu, Yalkin; Altay, Ridvan; Duman, Serda; Cobden, Adem; Sofu, Hakan
Background:Radial head arthroplasty is an alternative treatment for complex radial head fractures that are not appropriate for fixation. No study to date has reported the outcomes of monoblock ultrahigh molecular weight polyethylene (UHMW-PE) radial head prosthesis (RHP) for the treatment of radial head fracture. We aimed to evaluate the functional and radiographic outcomes of patients with unreconstructable acute radial head fractures treated with a monoblock UHMW-PE RHP.Methods:Patients who underwent UHMW-PE RHP placement for the treatment of radial head fracture were included in this retrospective case series. Patients who did not complete follow-up were excluded. Primary outcome measurements were the Mayo Elbow Performance Score (MEPS) and the Disabilities of Arm, Shoulder, and Hand (DASH) score. The latest follow-up physical examination and radiographs were evaluated for loosening, subluxation, and dislocation. Postoperative complications and need for further surgery were noted.Results:Eleven patients (four female and seven male patients) with a mean follow-up of 18.5 mo were evaluated. The mean MEPS was 79.5 (range, 65-100) at 3 mo postoperatively and 85.9 (range, 75-100) at the latest follow-up. The mean DASH score was 10.8 (range, 3-20) at 3 mo postoperatively and 8.7 (0-20) at the latest follow-up. No complications were encountered during follow-up.Conclusions:Radial head arthroplasty with a monoblock UHMW-PE RHP is safe and effective at short-term follow-up for treating acute unreconstructable radial head fractures with satisfactory functional and radiographic outcomes.Level of Evidence:Level IV.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2020Arthroscopic Treatment of Acute Septic Arthritis of the Hip Joint in Pediatric Patients Aged 10 Years or Younger
Duman, Serda; Camurcu, Yalkin; Ucpunar, Hanifi; Çöbden, Adem; Karahan, Nazım; Sofu, Hakan
Purpose: To present the results of arthroscopic treatment of acute septic arthritis of the hip joint in children aged 10 years or younger. Methods: Patients with a minimum follow-up period of 2 years who underwent arthroscopic treatment (anterolateral and medial subadductor 2-portal approach) of acute septic arthritis of the hip joint between January 2014 and January 2017 were included in this retrospective case-series study. The exclusion criteria included fungal infection, late presentation (≥5 days after the onset of the symptoms), presence of concomitant osteomyelitis, osseous pathologic conditions on radiography suggesting osteomyelitis, immunocompromised condition, history of surgery or infection surgery from the affected extremity, immobility owing to neuromuscular pathologic conditions, and identification of inflammatory or reactive arthritis during follow-up. The diagnosis of septic arthritis was confirmed according to the Waldvogel criteria. Clinical outcomes were assessed according to the Bennett score and Harris Hip Score. Results: We evaluated 15 hips in 15 patients (6 female and 9 male patients) with a mean age of 5.2 years (range, 2-10 years) in this study. The mean hospital stay was 4.2 days (range, 3-7 days), and the mean antibiotic-use period was 34 days (range, 26-45 days). The most causative pathogen was Staphylococcus aureus (40%) (including methicillin-sensitive S aureus) and was isolated and cultured in all patients. All patients had full range of motion of the hip joint. All of the Bennett scores were excellent; the mean Harris Hip Score was 96.3 (range, 92.5-100) after a minimum follow-up period of 24 months (mean, 26.1 ± 3.2 months; range, 24-35 months). No patient needed additional surgical intervention. No degenerative changes or avascular necrosis developed. Conclusions: According to our results, arthroscopic treatment is an effective choice for the treatment of acute septic arthritis of the hip joint in children aged 10 years or younger. Level of Evidence: Level IV, retrospective case series.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2020Evaluation of the association between plantar fasciitis and hallux valgus
Cobden, Adem; Camurcu, Yalkin; Sofu, Hakan; Ucpunar, Hanifi; Duman, Serda; Kocabiyik, Ahmet
Background: The windlass mechanism, first described by John Hicks in 1954, defines the anatomical and biomechanical relationship between the hallux and the plantar fascia. Hallux valgus (HV) and plantar fasciitis are the most common foot disorders, and, to date, no study has evaluated the relationship between these disorders. The purpose of this study was to determine the incidence of and factors associated with plantar fasciitis in patients with HV deformity. Methods: In this prospective observational study, 486 patients with HV were divided into three groups according to stage of HV deformity. Patient sex, age, and body mass index were recorded. Presence of accompanying plantar fascii ti s and heel spur was investigated by physical and radiographic examination. First metatarsophalangeal joint dorsiflexion of the affected side was measured. Patients with or without plantar fasciitis were also compared to evaluate factors associated with plantar fasciitis. Results: Mean age and body mass index of the patients were significantly different among the three HV groups. The incidence of plantar fasciitis and heel spur significantly increased in correlation with the severity of HV deformity. Increased age and HV stage and decreased first metatarsophalangeal joint dorsiflexion were significantly associated with presence of plantar fasciitis in HV. Conclusions: In this study, the incidence of plantar fasciitis was significantly increased in correlation with the severity of HV deformity. Significant association was found between plantar fasciitis and HV, which are anatomically and biomechanically related to each other by the windlass mechanism.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2020Does Adductor Tenotomy Need During Closed Reduction Have a Prognostic Value in the Treatment of Developmental Dysplasia of the Hip Between 6 and 12 Months of Age? “Adductor Tenotomy in the Treatment of Developmental Dysplasia’’
Ucpunar, Hanifi; Mert, Muhammed; Camurcu, Yalkin; Sofu, Hakan; Yildirim, Timur; Bayhan, Avni Ilhan
Background: Adductor tenotomy is needed for clinically complex hips with soft-tissue contractures. It may be proposed that the patients who need adductor tenotomy during closed reduction would have poorer prognosis than the ones without need for adductor tenotomy. The main purposes were to compare the normalization of acetabular index angle (AI), to determine the incidence of femoral head avascular necrosis (AVN), and to predict the need for any secondary surgical intervention between the patients who need adductor tenotomy and those who do not during closed reduction for developmental dysplasia of the hip. Materials and Methods: The study group consisted of 65 hips treated between 6 and 12 months of age. The mean age at the time of surgery was 8.1 ± 1.4 (6–12) months and the mean follow-up was 4.2 ± 1.5 years. Improvement of AI, rate and severity of AVN, and need for secondary surgery with its predictors were evaluated. Results: Adductor tenotomy was performed in 22 hips (Group 1), but not in 43 hips (Group 2). Normalization of the AI was − 14.8° ± 3.5° versus − 14.3° ± 3.2°. The overall incidence of AVN was 18.4%. The rate of secondary surgical intervention was higher in Group 1 (63.1% versus 36.9%) (p = 0.014). Conclusions: No significant difference was detected regarding the improvement of AI as well as the incidence of AVN between the groups. The need for adductor tenotomy during closed reduction was one of the main predictors of the possible secondary surgery.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2020Clinical and Magnetic Resonance Imaging Outcomes of Microfracture Plus Chitosan/Blood Implant vs Microfracture for Osteochondral Lesions of the Talus
Camurcu, Yalkin; Ucpunar, Hanifi; Yapici, Furkan; Karakose, Resit; Ozcan, Seckin; Cobden, Adem; Duman, Serda; Sofu, Hakan
Background: The aim of this study was to compare the clinical and magnetic resonance imaging (MRI) outcomes of arthroscopic microfracture (MF) plus chitosan-glycerol phosphate/blood implant and MF alone for the treatment of the osteochondral lesions of the talus (OCLTs). Methods: Patients who underwent either MF plus chitosan (group 1, n = 32) or MF alone (group 2, n = 31) between 2015 and 2019 in 2 separate time periods were retrospectively analyzed. Visual analog scale (VAS) score and American Orthopaedic Foot & Ankle Society (AOFAS) score were used for clinical evaluation. The magnetic resonance observation of cartilage repair tissue (MOCART) system was used for MRI evaluation. The mean follow-up time was 32 ± 13 months (range, 12-61 months). Results: Postoperatively, we detected significant improvements in both groups in terms of VAS and AOFAS scores. However, we observed no statistically significant difference between groups in terms of clinical scores, except the mean VAS function score, which was significantly higher in group 1 (P =.022). According to MOCART scale, complete repair with the filling of the chondral defect and intactness of the surface of the repair tissue were more common in group 1. However, these parameters did not significantly differ between groups (P =.257 and.242, respectively). Conclusion: Arthroscopic MF plus chitosan glycerol phosphate/blood implant did not result in better clinical and MRI outcomes compared with MF alone in the treatment of OCLTs. Level of Evidence: Level III, retrospective comparative study.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2019Effect of graduation centers on the academic career of orthopedic surgeons in Turkey
Üçpunar, Hanifi; Çamurcu, Yalkin; Çöbden, Adem; Özcan, Seckin; Saygili, Hakan; Sofu, Hakan
Purpose: The aim of this study was to assess whether orthopedic surgeons' graduation centers affect their academic career. Materials and Methods: In this observational study, we have reached the education and working information of 1767 orthopedic surgeons currently working in Turkey. Orthopedic surgeons' graduation centre and city, current affiliation, current academic status and duration of practice were investigated through web. According to their graduation centre, orthopedic surgeons were divided into two groups as a university hospital and training and research hospital. Results: Orthopedic surgeons' current affiliations were significantly associated with their graduation centres and cities. Besides, orthopedic surgeons graduated from university hospitals were more likely to have an academic career than those graduated from training and research hospitals; however, no significant association was found between the city of graduation and academic career. According to regression analysis, orthopedic surgeons graduated from university hospitals were more likely to affiliate in university hospitals and private hospitals. Conclusion: Orthopedic surgeons graduated from university hospitals were significantly more likely to affiliate in university hospitals and to have an academic career in Turkey.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2019Comparison of freeze-dried tibialis anterior allograft and four-strand hamstring autograft in anterior cruciate ligament reconstruction
Issın, Ahmet; Öner, Ali; Sofu, Hakan; Yurten, Hakan
Purpose: The aim of this retrospective study was to evaluate the clinical outcomes of the patients who underwent primary anterior cruciate ligament (ACL) reconstruction surgery with either hamstring autograft or freeze-dried tibialis anterior allograft, which performed by the same surgeon using the same fixation technique. Methods: In this retrospective study, patients who had primary ACL reconstruction using either four-strand hamstring autograft (FSH) or freeze-dried irradiated tibialis anterior allograft (FDT) between 2012 and 2015 were evaluated. Patients who were skeletally mature with a minimum follow-up of 24 months and who had no previous surgery from the affected knee were included; patients who had multiple ligament injuries or chondral lesions over Outerbridge grade 2 were excluded from the study. Patients were grouped according to the graft type used in ACL reconstruction. Tegner activity scale and Lysholm knee scoring scale were used to assess patients' activity levels and functional status preoperatively and at the final follow-up. KT-2000 arthrometer measurements were done at the final follow-up to evaluate anterior laxity. Results: There were 27 patients (mean age 27 ± 8.9 years) in the FSH group and 36 patients (mean age 27.1 ± 6.7 years) in the FDT group. The mean follow-up time was 38.2 ± 3.5 months for the FSH group and 41 ± 6.1 months for the FDT group. There were no statistically significant differences between the groups when preoperative and postoperative Tegner-Lysholm scores were compared (Tegner P = 0.583, 0.742; Lysholm P = 0.592, 0.249). The mean anteroposterior laxity and side-to-side differences measured by KT-2000 were 4.1 mm and 2.1 mm for the FSH group, respectively; 4.2 mm and 2.2 mm for the FDT group, respectively. There was not a statistically significant difference (P = 0.745, 0.562 respectively). Conclusions: Primary ACL reconstruction with a single loop freeze-dried irradiated tibialis anterior allograft revealed comparable results with four-strand hamstring autograft in non-athlete patients. Level of evidence: Level III, Therapeutic study.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2019Should orthopedic surgeons consider reducing the negative effects of Outerbridge grade 2 patellofemoral chondral lesion on early postoperative recovery during anterior cruciate ligament reconstruction
Sofu, Hakan; Camurcu, Yalkin; Issin, Ahmet; Ucpunar, Hanifi; Ozcan, Seckin; Duman, Serda
Purpose: The purpose of this study was to comparatively evaluate the effectiveness of intra-articular PRP and HA injections applied as the treatment of Outerbridge grade 2 chondral lesions in patellofemoral joint during arthroscopic ACL reconstruction. Methods: The clinical and radiographic data of 61 patients between 18 and 45 years of age were evaluated. The patients were separated into three groups. Hyaluronic acid injection was applied in 22 knees (Group 1), PRP injection was applied in 18 knees (Group 2), and 21 knees did not have any specific treatment except ACL reconstruction (Group 3). All patients were followed clinically at least for 12 months. Clinical examination of the operated knee, visual analogue scale (VAS) score, Lysholm knee score, and Tegner activity scale were the outcome measures. Routine X-ray and MRI were also performed for all patients at 12-month postoperative follow-up visit. Results: Although the mean VAS and Lysholm scores at 3-month follow-up were better in Group 1 and 2 than Group 3, the efficacy of intra-articular PRP on healing process regarding progression of the mean VAS and Lysholm scores through 6- and 12-month follow-ups was significantly better and longer than HA. No statistically significant differences were detected according to Tegner activity scale between the groups at 3 and 6 months; however, Group 2 had better activity level than both Group 1 (p < 0.001) and 3 (p < 0.001) at the end of 12 months after surgery. Conclusion: Intra-articular PRP injection applied as the treatment of concomitant Outerbridge grade 2 chondral lesion in patellofemoral joint during ACL reconstruction revealed better and durable clinical outcomes via decreasing the potentially negative effects of chondral pathology on postoperative healing with respect to HA injection. Level of evidence: III—retrospective comparative study.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2019Audiometric threshold shifts after total knee arthroplasty by using gentamicin-loaded bone cement
Çöbden, Adem; Çamurcu, Yalkın; Çöbden, Serap Bulut; Sofu, Hakan; Üçpunar, Hanifi; Sevencan, Ahmet; Demirel, Hüseyin
Background/aim: The aim of this study was to investigate postoperative audiometric threshold shifts in patients who underwent primary total knee arthroplasty (TKA) using gentamicin-loaded bone cement (GLBC) in comparison with the ones who underwent TKA without GLBC. Materials and methods: Forty patients (gentamicin group) who underwent primary TKA using GLBC and 29 patients (control group) who underwent primary TKA using standard bone cement were included in this prospective case-control study. Baseline pure-tone audiometric evaluation was performed preoperatively and repeated at the postoperative third day for all patients. Control audiometric evaluation was performed weekly for patients who were diagnosed with ototoxicity according to audiometric threshold shifts. Results: Ototoxicity was diagnosed in 8 of 40 patients (20%) in the gentamicin group according to postoperative audiometric threshold shifts, whereas no ototoxicity was observed in the control group. Patients who were diagnosed with ototoxicity had no permanent audiometric threshold shifts in follow-up audiometric evaluation and these patients had no clinical complaints of difference in hearing. Conclusion: According to our results, audiometric threshold shifts can be detected in patients who undergo primary TKA usingentamicin loaded bone cement. However, no permanent shifts were observed during close follow-up.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2019Clinical and radiographic outcomes of chitosan-glycerol phosphate/blood implant are similar with hyaluronic acid-based cell-free scaffold in the treatment of focal osteochondral lesions of the knee joint
Sofu, Hakan; Camurcu, Yalkin; Ucpunar, Hanifi; Ozcan, Seckin; Yurten, Hakan; Sahin, Vedat
Purpose: To determine the clinical and radiographic efficacy of chitosan-glycerol phosphate/blood implant versus hyaluronic acid-based cell-free scaffold in patients with focal osteochondral lesion of the knee joint. Methods: Clinical data of 46 patients surgically treated using either chitosan-glycerol phosphate/blood implant (25 patients, Group 1) or hyaluronic acid-based cell-free scaffold (21 patients, Group 2) in combination with microfracture were retrospectively evaluated. All lesions were Outerbridge grade III or IV with a mean lesion size of 3.3 ± 0.7 cm 2 . The mean follow-up time was 24.4 months. Visual analogue scale (VAS), Lysholm knee score, and Tegner activity scale were the instruments to evaluate the clinical status. Magnetic resonance observation of cartilage repair tissue (MOCART) system was used to analyze the characteristics of repair tissue. Results: No significant differences were detected between the groups regarding VAS, Lysholm, and Tegner scores at any time interval during the whole follow-up. The mean post-operative VAS and Lysholm scores at the latest follow-up was significantly better in cases with the lesion size ≤ 3 cm 2 in Group 1 (p = 0.001, p < 0.001, respectively). However, no significant differences according to the lesion size were detected in Group 2 (n.s.). Complete repair with the filling of the defect was achieved in 7 (28%) of the knees in Group 1 and it was 7 (33.3%) of the knees in Group 2 according to MOCART system at the latest follow-up. Conclusion: Single-stage regenerative cartilage surgery using chitosan-glycerol phosphate/blood implant combined to microfracture for focal osteochondral lesions of the knee revealed similar clinical and radiographic outcomes with hyaluronic acid-based cell-free scaffold at short-term follow-up. However, clinical outcomes of hyaluronan scaffold were less sensitive to defect size than chitosan. With the advantages of no hypertrophic repair tissue formation as well as no need to arthrotomy during surgery, chitosan is an effective choice especially in patients with the lesion size ≤ 3 cm 2 . Level of evidence: III.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2019Predictors of allocation to surgery in patients older than 50 years with partial-thickness rotator cuff tear
Camurcu, Yalkin; Ucpunar, Hanifi; Ari, Hamza; Duman, Serda; Cobden, Adem; Sofu, Hakan
Background: The purpose of this study was to determine the predictive factors for allocation to surgery in patients older than 50 years with symptomatic chronic partial-thickness rotator cuff tear (PTRCT). Methods: Patients older than 50 years with a confirmed diagnosis of unilateral isolated PTRCT were included in this retrospective study. In the minimum follow-up of 2 years, eventual allocation to surgical or nonsurgical treatment was determined individually. Patients who underwent surgery were defined as failed conservative management and allocation to surgery. Data pertaining to patients' demographics, functional comorbidity index values, duration of symptoms, and American Shoulder and Elbow Surgeons scores were collected from our medical records. Tear side and Ellman classification, subacromial spur, and acromiohumeral intervals were also noted. A regression analysis was performed to determine the major predictors of allocation to surgery. Results: There were 202 patients with a mean age of 62 years in group I (no-surgery group) and 70 patients with a mean age of 57 years in group II (surgery group). The mean age and functional comorbidity index values were significantly higher in group I than in group II (P <.001 and P <.001, respectively). Bursal-sided tears were significantly more common in group II (P =.026). According to the findings of regression analysis, tear side and functional comorbidity index were the major predictors of allocation to surgery (P =.015 and P <.001, respectively). Conclusion: Our study results indicate that in patients older than 50 years with PTRCTs, those with fewer comorbidities and bursal-sided PTRCTs were significantly more likely to undergo surgery.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2019Comparative evaluation of postoperative health status and functional outcome in patients treated with either proximal femoral nail or hemiarthroplasty for unstable intertrochanteric fracture
Ucpunar, Hanifi; Camurcu, Yalkin; Çöbden, Adem; Sofu, Hakan; Kis, Mehmet; Demirel, Huseyin
Purpose: This study aimed to compare functional recovery and change in morbidity status from the preoperative levels among patients who underwent two different surgical treatments for unstable intertrochanteric fracture. Methods: This retrospective comparative study enrolled 140 patients (aged >80 years) who were referred to two hospitals. Of these, 64 were treated using proximal femoral nail (PFN) and 76 were treated using hemiarthroplasty (HA). To evaluate functional recovery, primary outcome measures were cumulative illness rating scale (CIRS) score to evaluate changes in morbidity status, activity of daily living (ADL) index, and mobility scores. Results: The proportion of patients who experienced increased CIRS scores in the HA group was higher at the 3-month follow-up (p = 0.02) but similar at the 6-month follow-up (p = 0.2) in comparison to the PFN group. Treatment with HA, American Society of Anesthesiologists scores of 3–4, and lower, preoperative ADL indexes were the major predictors of increased postoperative CIRS score. Impaired ambulatory ability and the need for walking aids were significantly higher in the PFN group at the 3-month follow-up (p = 0.01 and p = 0.02, respectively) but similar at the 6-month follow-up with respect to the HA group. PFN treatment and high patient body mass index were the major predictors of decreased ambulatory ability at postoperative 3 months. Conclusion: HA has several advantages, including early mobilization and decreased dependency. However, it is associated with greater blood loss, a higher need for blood transfusion, and longer surgical duration than PFN, all of which are predisposing factors for significantly higher risk of reduced CIRS scores.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2019Validity of the alpha angle measurements on plain radiographs in the evaluation of cam-type femoroacetabular impingement in patients with slipped capital femoral epiphysis
Ucpunar, Hanifi; Mert, Muhammed; Camurcu, Yalkin; Buyuk, Abdul Fettah; Cobden, Adem; Sofu, Hakan
Objective: The purpose of the study was to investigate the correlation of two different alpha angle (a-angle) measurements (“anatomical method and “three-point method”) with the anterior offset ratio (AOR), femoral head ratio (FHR), and lateral femoral head ratio (LFHR) in patients with slipped capital femoral epiphysis (SCFE). Materials and methods: We included 39 hips of 26 patients. The a-angles were measured on the frog-leg lateral view (Lat) and anteroposterior (Ap) view, FHR was measured on the Ap view, and LFHR and AOR were measured on the Lat view. A t test was performed to analyze the means of the alpha angles measured using the three-point method and the anatomical method, and also, a correlation was conducted to assess the association of the a-angles among the FHR, LFHR, and AOR. Results: The mean a-angles in the Ap plane in the three-point method and anatomical method were 76° ± 15° and 64° ± 10° respectively (p < 0.001). The mean a-angles in the Lat plane in the three-point method and anatomical method were 67° ± 13° and 56° ± 11° respectively (p < 0.001). The AOR showed a significant correlation only with the anatomical method a-angle values in the Lat plane (p = 0.026). The a-angles in the three-point method in the Lat plane did not show any significant correlation with the AOR, FHR, and LFHR. Both the FHR and LFHR values correlated significantly with the Ap plane a-angles in the three-point method and anatomical method. However, none of these correlations was strong. Conclusions: The a-angle measurement methods described in patients without femoral head–neck axis disruption may not be valid in patients with a disorder such as SCFE.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2019Effects of postoperative osteoporosis treatment on subsequent fracture and the 5-year survival rates after hemiarthroplasty for hip fracture
Cobden, Adem; Cobden, Serap Bulut; Camurcu, Yalkin; Ucpunar, Hanifi; Duman, Serda; Sofu, Hakan
Summary: According to the literature, only 20–30% of patients are screened for osteoporosis after a hip fracture. Osteoporosis treatment may have a potential protective effect on the 5-year mortality rate. Our results demonstrated that 5-year survival is higher in patients who received osteoporosis treatment after hemiarthroplasty for hip fracture compared with those who did not. Purpose: This study aims to investigate the status of osteoporosis treatment in patients who underwent hemiarthroplasty for an osteoporotic hip fracture and to compare subsequent fractures and the 5-year survival rates of these patients with those who did not receive the osteoporosis treatment. Methods: Patients > 65 years of age who underwent hemiarthroplasty for an osteoporotic hip fracture were included in this retrospective multicenter study. Patients who died within 12 months postoperative, who were lost to follow-up, and those with malignancy and secondary osteoporosis were excluded. Group I comprised patients who had no postoperative osteoporosis screening and treatment, and Group II comprised those who received the screening and treatment. Results: A total of 460 of 562 patients (82%) did not receive osteoporosis treatment after hip fracture. No significant difference was observed between the groups in terms of subsequent fracture numbers and fracture sites (p = 0.296 and 0.240, respectively). Mean 5-year survival rate was significantly higher in Group II (p = 0.002). Conclusions: According to our results, elderly patients who underwent hemiarthroplasty for an osteoporotic hip fracture were not commonly screened or treated for osteoporosis. Our results demonstrated no significant difference between the groups in terms of subsequent fracture. However, we observed a significant high 5-year survival rate among patients who received the osteoporosis treatment.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2019Arthroscopic versus open, medial approach, surgical reduction for developmental dysplasia of the hip in patients under 18 months of age
Duman, Serda; Camurcu, Yalkin; Sofu, Hakan; Ucpunar, Hanifi; Akbulut, Deniz; Yildirim, Timur
Background and purpose — The value of arthroscopic surgical reduction in developmental hip dysplasia is poorly known. We compared the clinical and radiographic efficacy of arthroscopic and medial open surgical reduction in patients less than 18 months of age with developmental hip dysplasia. Patients and methods — 54 patients with a mean age of 11 months who were treated by Ludloff’s medial open reduction technique (28 hips, Group L) or arthroscopic surgical reduction technique (26 hips, Group A) were evaluated in this case series. Data on age, sex, preoperative Tönnis grade, operative time, estimated blood loss, residual leg length discrepancy, range of motion (ROM), acetabular index (AI) angle, coverage ratio of the femoral head, continuity of Menard–Shenton line, re-dislocation rate, McKay classification, and Kalamchi–MacEwen avascular necrosis (AVN) classification were collected. Results — Preoperatively, the mean AI angle was 39° in Group L and 37° in Group A. At the latest follow-up, the mean AI was 26° in both groups. The mean femoral head coverage ratio was 79% in Group L and 80% in Group A. The Menard–Shenton line was intact in all patients. Residual leg length discrepancy or limited ROM was not detected in any patients. 4 patients in Group L and 2 in Group A were diagnosed with type 2 AVN. Interpretation — Arthroscopic surgical reduction in patients aged 6–18 months revealed promising clinical and radiographic outcomes similar to medial open reduction using Ludloff’s technique.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2018The relationship between indication and complication of implant removal
Sofu, Hakan; Çamurcu, İsmet Yalkın; Özcan, Seçkin; Üçpunar, Hanifi; Konya, Mehmet Nuri; Duman, Serda
OBJECTIVE: The main purpose of this study was to evaluate the relationship between indications and complications of implant removal surgery. MATERIAL AND METHODS: The data of patients who underwent implant removal surgery between 2011 and 2014 were evaluated from our medical records. Patients’ age, gender, anatomical site of implant and the type of the implant were evaluated. The interval between the fracture treatment and implant removal were recorded for all patients. The indications for implant removal surgery were analyzed and their relationships with complications were evaluated by Pearson Chi-Square test. RESULTS: 276 patients (116 female, 160 male) with the mean age of 36.2 ± 18.4 (range, 5 to 79 years) years underwent removal of 279 implants. The mean interval from initial operation to implant removal operation 27.9 ± 33 months (range, 0.25 to 240 months). The most common anatomical sites of implants were tibia in 93 patients (33.6 %), femur in 63 patients (22.8 %) and fibula in 39 patients (14.1 %). Implant removal was indicated for implant failure in 54 patients (20%), for deep infection in 21 patients (8%), for implant irritation in 167 patients (60%), for pseudoarthrosis in 9 patients (3%), for only patient’s demand in 44 patients (16%) and for only surgeon’s demand in 40 patients (14%). Overall complication rate was 17%. There was a significant correlation between the implant removal due to infection and postoperative refracture and infection (r=0.101 p<0.001 and r=0.273 p<0.001, respectively). Significant correlation was obtained between implant removal due to implant failure and pseudoarthrosis and the need of new implant as expected (r=0.375 p<0.001 and r=0.639 p<0.001, respectively). CONCLUSIONS: Complications related to implant removal surgery has a relationship with implant removal indications such as infection, pseudoarthrosis, and implant failure.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2018Evaluation of Risk Factors For 90-Day Unplanned Readmissions After Total Knee Arthroplasty
Çöbden, Adem; Sofu, Hakan; Demir, Utku; Çamurcu, İsmet Yalkın; Üçpunar, Hanifi; Demirel, Hüseyin; Kış, Mehmet
Purpose: To determine the major predictive factors for 90-day unplanned readmission (UR) in patients whounderwent unilateral, simultaneous bilateral or staged bilateral total knee arthroplasty (TKA).Methods: The data of patients who underwent elective TKA between 2011 and 2016 were evaluated from ourmedical records. Patients were divided into three groups according to the type of TKA procedure as unilateral,staged bilateral and simultaneous bilateral TKA groups. Age, gender, body mass index (BMI), systemic comorbiddiseases, and American Society of Anesthesiologists (ASA) scores, anesthesia technique, total operation time,presence of tranexamic acid administration, total number of blood unit transfused ,and total length of hospitalstay were investigated through medical records. The data of patients with 90-day UR and no 90-day UR werecompared by student t-test, Pearson Chi-Square test, and Fisher’s exact test. Finally, multivariate analysis wasperformed to determine the major predictive factors of 90-day UR.Results: Total operative time, total amount of blood unit transfused, and total length of hospital stay weresignificantly higher in patients who had 90-day UR. No significant difference was observed among TKA groupsin 90-day UR rates. According to multivariate logistic regression analysis, increased total length of hospital staywas determined as the only major predictor of 90-day UR.Conclusion: According to our results, no significant difference was observed among unilateral, simultaneousbilateral and staged bilateral TKA groups in 90-day UR. The increased length of hospital stay was found as themajor predictor of 90-day UR.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2018Obesity-related metabolic and endocrine disorders diagnosed during postoperative follow-up of slipped capital femoral epiphysis
Ucpunar, Hanifi; Camurcu, Ismet Yalkin; Duman, Serda; Ucpunar, Esra; Sofu, Hakan; Bayhan, Avni Ilhan
Background and purpose — Patients with slipped capital femoral epiphysis (SCFE) are phenotypically overweight or obese and may therefore require clinical follow-up of obesity-related disorders. We evaluated obesity-related disorders such as dyslipidemia, type 2 diabetes mellitus (DM), and vitamin-D deficiency during the postoperative period in patients with SCFE. Patients and methods — 51 patients who were operated and followed-up for SCFE and 62 healthy adolescents without SCFE (control group) were included in this retrospective study. Patients’ BMI, serum lipid profile (total cholesterol, LDL-C, HDL-C, triglyceride), fasting blood glucose, HbA1c, and serum vitamin D levels were evaluated. Results — At the time of surgery, 45 patients in the SCFE group were overweight or obese (BMI >25). At the latest follow-up, 42 patients in the SCFE group and 53 patients in the control group were overweight/obese. Abnormal serum lipid profile and ratio of total dyslipidemia were similar between the groups. 8 patients had abnormal HbA1c levels in the SCFE group and mean HbA1c levels were significantly higher in the SCFE group (p = 0.03). All patients and controls had low levels of vitamin D. Interpretation — Although serum lipid profile and vitamin D levels were detected as similar in SCFE and control groups, the potential risk of type 2 DM identified via abnormal HbA1c levels was significantly higher in patients with SCFE. We recommend that patients diagnosed with SCFE should be considered as potential candidates for type 2 DM; thus follow-up after surgical treatment should include not only orthopedic outcomes but also evaluation of future risk for DM.
RDL Kalıcı Kaydıİncele - LetterAçık Erişim2018Letter to the Editor on “Serum and Wound Vancomycin Levels Following Intrawound Administration in Primary Total Joint Arthroplasty”
Duman, Serda; Sofu, Hakan; Çamurcu, İsmet Y.
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