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- ArticleYalnız künye2018Operative Treatment of the Ingrown Toenail With a Less-Invasive Technique: Flashback to the Original Winograd Technique
Camurcu, Yalkin; Sofu, Hakan; Issin, Ahmet; Kockara, Nizamettin; Saygili, Hakan
Objective: The aim of this study was to evaluate the results of the partial nail plate excision and curettage of nail bed and matrix (the original Winograd technique) in patients with ingrown toenail. Materials and methods:Patients with ingrown toenail who were treated surgically from May 2014 to June 2015, with a minimum follow-up of 1 year were included in this study. Those who had previous ingrown toenail surgery were excluded. Partial nail plate excision with curettage of nail bed and nail matrix was performed for all patients. Rifampicin soaked sterile gauze was placed onto the wounds after the procedure. Results:The study population included 100 males and 89 females with a mean age of 30 years. Eight patients (4.2%) had stage 1, 71 patients (37.6%) had stage 2, and 110 patients (58.2%) had stage 3 ingrown toenails. The mean operation time was 4.8 minutes. No complication occurred during the procedure. It was found that 15 patients (7.9%) had recurrence during the follow-up. Conclusion:The original Winograd technique is an efficient and less-invasive technique for the treatment of ingrown toenail, with lower rates of recurrence and complications. Levels of Evidence: Therapeutic Case Series Study, Level IV.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2018Predictors of the clinical outcome and survival without degenerative arthritis after surgical treatment of femoroacetabular impingement
Kockara, Nizamettin; Sofu, Hakan; Issin, Ahmet; Çamurcu, Yalkın; Bursali, Aysegul
Background The main purposes of the present study were to evaluate the functional improvement, to identify the predictors of the clinical outcome after open surgical management of femoroacetabular impingement (FAI) in mid-term, and to determine 5-year survival rate. Methods In this retrospective study, the clinical data of 33 patients (34 hips) were evaluated. Sex, age, body mass index (BMI), type of FAI, duration of symptoms up to surgical treatment, internal rotation of the affected hip, improvement of the Harris hip score (HHS) in the first 2 years, joint space narrowing evaluated radiographically and classified according to Kellgren–Lawrence classification, and any labral tear were the independent variables. Harris hip score and degenerative arthritic changes at the latest follow-up were identified as outcome measures. Univariate and multivariate analyses were performed. The mean post-operative follow-up was 6 years. Results Harris hip scores at the latest follow-up were significantly worse in patients with a pre-operative age >35 years, BMI ≥25 kg/m2, internal rotation of the hip ≤10° grade 1 or 2 joint space narrowing, labral tear, and <15 points improvement of the HHS at the first 2 years follow-up. According to multivariate analysis; major predictors of the outcome were BMI, labral tear, and improvement of the HHS at the first 2 years. Conclusions A pre-operative BMI ≥25 kg/m2, labral tear, and <20 points improvement of the HHS in the first 2 years of surgery should be considered as the major predictors of the clinical outcome after open surgical management of idiopathic FAI.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2018Single-dose intra-articular corticosteroid injection prior to platelet-rich plasma injection resulted in better clinical outcomes in patients with knee osteoarthritis: A pilot study
Camurcu, Yalkin; Sofu, Hakan; Ucpunar, Hanifi; Kockara, Nizamettin; Cobden, Adem; Duman, Serda
BACKGROUND: The synergistic and protective effect of platelet-rich plasma (PRP) added to methlyprednisolone (MP) has been demonstrated via in-vitro studies. However, there is no report in the literature about this issue. OBJECTIVE: The aim of this study was to evaluate clinical outcomes of intra-articular (IA) MP injection prior to PRP injection in comparison with single-dose MP and PRP injections alone in patients with knee osteoarthritis (OA). METHODS: The treatment groups were "PRP group" (n= 37) who underwent single-dose IA PRP injection, "PRP + MP group" (n= 40) who underwent MP injection one week prior to single-dose PRP injection, and "MP group" (n= 38) who underwent single-dose MP injection. Visual Analog Scale (VAS) and The Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were applied at first admission and at 1st, 3rd, 6th, and 12th month follow-ups. RESULTS: At the end of the 1st month, WOMAC score in PRP + MP group was significantly lower than PRP group. At the 3rd month, WOMAC score in PRP + MP group was significantly lower than PRP and MP groups. At the 6th month, VAS and WOMAC score in PRP + MP group was significantly lower than MP group. At the end of the 12th month, no significant difference was observed among three groups in VAS and WOMAC scores. CONCLUSION: According to our results, IA MP injection prior to PRP injection resulted in significantly better clinical outcomes compared to PRP and MP injections alone in patients who had mild to moderate knee OA.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2018Evaluation of risk factors for osteoporosis and osteopenia in male patients aged over 60 years of age; [Altmiş yaş üzeri erkek hastalarda osteoporoz ve osteopeni risk faktörlerinin değerlendirilmesi]
Çöbden, Adem; Çamurcu, İsmet Yalkın; Üçpunar, Hanifi; Sofu, Hakan; Duman, Serda
Introduction: Osteoporosis in men is often underdiagnosed and neglected compared to postmenopausal women. Major risk factors should be determined to prevent this disease, which has potential risk of mortality and morbidity for elder men. This study’s purpose was to determine the risk factors for osteoporosis and osteopenia in male patients aged >60 years. Materials and Method: Between January 2015 and June 2017, male patients aged >60 years admitted to our centers who underwent dual energy x-ray absorptiometry (DXA) were included in this retrospective study. Patients’ age, body mass index, site of residence (village/ city), smoking status, and systemic diseases were examined through our records. Patients were divided into control, osteopenia, and osteoporosis groups according to DXA measurements. Serum vitamin D measurements also were evaluated. Multivariate analysis was performed to determine major risk factors for osteoporosis and osteopenia. Results: Compared with the control group, patients in the group categorized as having osteoporosis or osteopenia had a significantly lower body mass index and more commonly resided in the city (p<0.001 and p<0.005, respectively). Serum vitamin D levels were significantly lower in the osteoporosis and osteopenia groups than in the control group (p=0.001). According to multivariate analysis, insufficient or deficient serum vitamin D levels were determined to be a major risk factor for osteoporosis and osteopenia (p=0.001). Conclusion: According to our results, men aged >60 years with deficient serum vitamin D levels (<20 ng/mL) were six times more likely to have osteopenia and 80 times more likely to have osteoporosis.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2017Predictive factors for early hospital readmission and 1-year mortality in elder patients following surgical treatment of a hip fracture
Gürsu, Şükrü Sarper; Sofu, Hakan; Çamurcu, İsmet Yalkın; Üçpunar, Hanifi; Şahin, Vedat; Konya, Mehmet Nuri; Duman, Serda
BACKGROUND: Early hospital readmission after surgically treated hip fracture is a common entity, often involving an adverse event and causing strains on an already overburdened healthcare system. The main purposes of the present study were to determine the 30-day readmission rate, analyze the predictive factors for early hospital readmissions, and assess 1-year mortality following surgical treatment of hip fracture in elderly patients. Retrospective case-control study. METHODS: In total, 517 patients with a mean age of 74 years were evaluated. The rate of early readmission, age, gender, body mass index, fracture type, pre-fracture mobility status, preoperative time to surgery, American Society of Anesthesiologists score, implant type, postoperative intensive care unit stay, total length of postoperative hospital stay, comorbidities, and the main reasons for readmission were the criteria for data collection. Multivariate analysis was performed to determine the main predictors of early hospital readmission. Mortality within the first year after surgery was also assessed.RESULTS: A higher prevalence of chronic obstructive pulmonary disease, cardiac arrhythmia or ischemic heart disease, diabetes, and dementia or Parkinson’s disease was detected in readmitted patients. Advanced age, American Society of Anesthesiologists (ASA) grade ≥3, postoperative intensive care unit (ICU) stay, and pre-existing cardiac arrhythmia or ischemic heart disease were identified as the main predictors. The 1-year mortality rate for the readmitted group was 53.9%, whereas it was 24% for those patients who were not readmitted.CONCLUSION: The readmission rate following surgical treatment of hip fracture in elder patients was 12%, and its main predictive factors were advanced age, ASA grade ≥3, postoperative ICU stay, and pre-existing cardiac arrhythmia or ischemic heart disease. Hospital readmission within the first 30-day period following initial discharge was significantly correlated with an increased 1-year mortality rate
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2017Konjenital idyopatik talipes ekinovarus artmış gelişimsel kalça displazisi sıklığı için risk faktörü müdür?
Sofu, Hakan; Şenaran, Hakan; Aydin, Bahattin Kerem
Amaç: Gelişimsel kalça displazisi (GKD) ve idyopatik talipes ekinovarus (PEV)en sık görülen çocukluk çağı ortopedik deformitelerindendir. Bu çalışmanın temel amacı ülkemizde PEV deformitesi nedeniyle tedavi edilen pediatrik hasta grubunda GKD sıklığını ve PEV deformitesinin GKD sıklığı açısından bir risk faktörü olup olmadığını araştırmaktır.Gereç ve Yöntem: Konjenital idiopatik pes ekinovarus tanısı ile Ponseti metodu uygulanarak tedavi edilmiş 113 çocuk (Grup 1) ve ulusal rutin GKD tarama programı kapsamında kalça ultrasonografisi uygulanmış fakat PEV deformitesi olmayan 129 sağlıklı çocuk (Grup 2) çalışmaya dahil edildi. Çocukların ultrasonografi esnasında ortalama yaşı Grup 1'de 3.8 hafta ve Grup 2'de 4.6 hafta olarak saptandı. Grup 1'de 65 kız ve 48 erkek, Grup 2'de 69 kız ve 60 erkek vardı. Her iki grupta Graf sınıflamasına göre GKD sıklığı mukayeseli olarak değerlendirildi.Bulgular: Ultrasonografi uygulanan toplam 484 kalçanın 20 tanesinde (%4.1) GKD görüldü. Grup 1'de 10 çocuk (%8.8) ve Grup 2'de 6 çocuğa (%4.6) GKD tanısı kondu. Grup 1'deki 13 kalçanın 4 tanesi Tip 2A, 1 tanesi Tip 2B, 4 tanesi Tip 3 ve 4 tanesi Tip 4 olarak sınıflandırıldı. Grup 2'de ise 6 kalçada Tip 2A ve 1 kalçada Tip 3 displazi saptandı. Graf sınıflamasına göre GKD teşhisi konmuş kalçalar içinde Tip 3 veya Tip 4 displazi oranı ve aynı zamanda bilateral GKD oranı PEV grubunda anlamlı olarak daha yüksekti.Sonuç: Gruplar arasında displazik kalça sıklığı bakımından anlamlı farklılık gözlemlenmemiş olmasına rağmen, GKD teşhisi konmuş kalçalar içinde Tip 3 veya Tip 4 displazi oranı ve aynı zamanda bilateral GKD oranı PEV grubunda anlamlı olarak daha yüksekti.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2017-
Sofu, Hakan; Çamurcu, İsmet Yalkın
Objective: The purpose of this study was to define the 'sensitivity' and 'specifity' of ESR and CRP values for the diagnosis of periprosthetic joint infection by comparing them with positive and negative microbiological cultures. Materials and Methods: We retrospectively analysed the data of 80 patients with the diagnosis of infected primary hip or knee arthroplasty, and noted ESR and CRP levelsas well as intraoperative microbiological culture results. ESR rates over 30 mm/h and CRP rates over 10 mg/dl were defined as positive test, and rates under these values defined as negative test. Culture results were also divided as negative (sterile) and positive.Results: According to our results, CRP had 98% sensitivity (ranges, 88% to 99 %) and 0 % specificity (ranges, 0 % to 15%) for the diagnosis periprosthetic infection; ESR had 98% sensitivity (ranges, 88% to 99 %) and 7 % specificity (ranges, 1% to 25 %) for the diagnosis periprosthetic infection. Conclusion: CRP and ESR tests are valuable and sensitive tests for the diagnosis of periprosthetic infection. On the other hand, orthopedic surgeons must be aware of false positive results of these tests and further investigation should be added for the definite diagnosis if needed.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2017Fondaparinuksun kırık iyileşmesine gerçekten pozitif etkisi var mıdır? sıçanlar üzerinde yapılan deneysel bir çalışma
Sofu, Hakan; Mercan, Ahmet Şükrü; Şahin, Vedat; Konya, Mehmet Nuri; Aydin, Bahattin Kerem; Yilmaz, Ertan
AMAÇ: Antiembolik ajanlar ortopedi ve travmatoloji kliniklerin-de özellikle artroplasti, tümör ve travma cerrahilerinde embolizm problemlerini azaltmak için rutin olarak kullanılmaktadır. Fonda-parinuks’un kırık iyileşmesi üzerine etkisi belirsizdir. Bu çalışmanın amacı sıçan modeli kullanarak fondaparinuksun kırık iyileşmesi üzerine etkisinin incelenmesi ve enoksaparinin etkisi ile karşılaş-tırılmasıdır.GEREÇ VE YÖNTEM: 64 adet Wistar-Albino sekiz gruba randomize olarak ayrıldı. Genel anestezi altında sol femur kapalı standart kırıkları oluşturuldu. Kontrol grupları (A, B), heparin grupları (C, D), enoksaparin grupları (E, F), ve fondaparinuks grupları (G, H), sırasıyla izotonik NaCl (1cc/gün), heparin (1000 anti Xa IU/kg/gün), enoksaparin (100 anti Xa IU/kg/gün) ve fondaparinuks (0.2mg/kg/ gün) olacak şekilde 14 gün süre ile uygulandı. A, C, E, G gruplarındaki sıçanlar postoperatif 14. günün, B, D, F, H gruplarındakiler ise 28. günün sonunda sakrifiye edildiler. Tüm femurların radyolojik incelemesi standart ön-arka ve yan grafiler kullanılarak Goldberg sınıflamasına göre yapıldı. Histolojik inceleme ise Huo histolojik iyileşme sınıflamasına göre yapıldı. Bu çalışmanın istatiksel analizleri GraphPad Prisma V.3 paket programı kullanılarak yapıldı. Sonuçlarda anlamlılık p<0.05 düzeyi olarak belirlendi.BULGULAR: Radyolojik incelemede, ikinci ve dördüncü hafta so-nundaki sonuçlar incelendiğinde, gruplar arasında istatiksel olarak anlamlı fark saptanmadı. Histolojik incelemede ise heparin almış olan H grubundaki iyileşme sonuçları diğer gruplarla karşılaştırıldı-ğında istatiksel olarak anlamlı şekilde kötü olarak saptandı. Diğer gruplar arasında histolojik açıdan, heparin grubu hariç, istatiksel olarak anlamlı bir fark saptanmadı. Ayrıca histolojik ve radyolojik olarak fondaparinuks ve enoksaparin grupları arasında kırık iyileş-mesi üzerine etkileri arasında istatiksel olarak anlamlı fark saptan-madı (p>0.05).SONUÇ: Çalışmamızda fondaparinuksun enoksaparin ile karşılaş-tırıldığında kırık iyileşmesi üzerine herhangi ekstra olumlu etkisini saptamadık. Fondaparinuks uygulamasının kırık iyileşmesi üzerine negatif bir etkisi saptanmamış olması nedeniyle travma vakaların-da embolizm problemlerini önlemede kullanılabileceği kanaatin-deyiz.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2017Effects of the change in the metatarsal length on the clinical outcome after surgical treatment hallux valgus
Sofu, Hakan; Çamurcu, İsmet Yalkın; Konya, Mehmet Nuri; Aydin, Bahattin Kerem; Kockara, Nizamettin
OBJECTIVE: The main purpose of the present study was to evaluate to what degree the change in metatarsal length can affect the clinical outcomes in patients who underwent either a distal chevron or a proximal cres-centic metatarsal osteotomy for hallux valgus. MATERIALS AND METHODS: Sixty-two patients were included in this study. Nine of the patients were male and 53 were fe-male. The mean age of the patients during the surgical intervention was 45.9 years. Thirty patients underwent crescentic proximal metatarsal osteotomy and 32 un-derwent distal chevron metatarsal osteotomy as the treatment of hallux valgus. The mean follow-up was 24.3 months. Postoperatively, clinical as well as the radiographic evaluation was carried-out at the end of the forth week, third, sixth and twelfth months, and annually thereafter. The American Orthopedic Foot and Ankle Society forefoot (AOFAS) score, Visual Analo-gue Scale (VAS), metatarsal length, hallux valgus angle (HVA), and intermetatarsal angle (IMA) were evaluated. RESULTS: The mean HVA as well as the mean IMA improved significantly in both group of patients. The mean change in the length of the first metatarsal was -2.8 mm in distal chevron group and -1.2 mm in cres-centic proximal osteotomy group. The mean correc-tion of hallux valgus angle was 13.6 degrees in distal chevron osteotomy whereas it was 20.4 degrees in crescentic proximal osteotomy. The patients with >3 mm of shortening had significantly worse VAS scores. We did not observe any non-union or avascular nec-rosis of the metatarsal head. At the latest follow-up, 8 patients from DCMO group and 5 patients from CPMO group mentioned that they would not recommend surgery to others with similar complaints. CONCLUSION: Distal chevron osteotomy lead shorte-ning of the first metatarsal bone resulting in transfer metatarsalgia and worse pain scores more commonly than crescentic proximal metatarsal osteotomy.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2017Pregabalin does not affect fracture healing adversely
Koçkara, Nizamettin; Sofu, Hakan; Issin, Ahmet; çetinkaya, Mehmet; Tayfur, Mahir; Süleyman, Bahadir
Objectives: This study aims to assess the radiographic, histological, and biomechanical effects of pregabalin on fracture healing in a rat model of femur fracture. Materials and methods: A total of 32 female Wistar- Albino rats (mean age 12±1 weeks; mean body weight 236±12 grams) were randomized into four groups with eight rats in each group. Groups A and B were the control groups whereas C and D were the treatment groups. Drugs were delivered by oral gavage. Radiographic, histological and biomechanical evaluations were performed after sacrificing the rats in groups A and C on 15th postoperative day and the rats in groups B and D on 30th postoperative day. Results: Although radiographic results were better in groups A and B than groups C and D at the end of 15th day, no significant difference was detected at the end of 30th day. No statistically significant differences were observed between the groups on 15th a nd 3 0th days in terms of histological or biomechanical evaluation. Conclusion: Administration of pregabalin did not affect fracture healing process adversely in rats.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2017What Are the Determinants of Mortality After Cemented Bipolar Hemiarthroplasty for Unstable Intertrochanteric Fractures in Elderly Patients?
Camurcu, Yalkin; Cobden, Adem; Sofu, Hakan; Saklavci, Nuh; Kis, Mehmet
Background Primary hemiarthroplasty is proposed for the treatment of unstable intertrochanteric fractures in elderly patients with the advantages of early mobilization, acceptable functional results, and lower failure rates. The 1-year mortality rates demonstrated high variance in the literature, whereas, the factors related to 1-year mortality were not widely investigated. The main purpose of the present study was to determine predictive factors related to 1-year mortality after primary cemented calcar-replacement bipolar hemiarthroplasty performed for unstable intertrochanteric fracture. Methods One hundred six patients with the mean age of 80.7 years were included in this retrospective study. Age, gender, body mass index, comorbid diseases, American Society of Anesthesiologists score, total hospitalization time, time from injury to surgery, operation time, estimated blood loss, postoperative mobilization time, and decrease in Koval ambulatory categories were evaluated. Univariate and multivariate analyses were performed to determine major predictors of 1-year mortality. The Kaplan-Meier survival analysis was used to construct the cumulative survival rate. Results Three or more American Society of Anesthesiologists scores, presence of ≥3 comorbid diseases, and postoperative mobilization time of ≥2 days were significantly correlated with 1-year mortality. Presence of ≥3 comorbid systemic diseases was identified as the major predictive factor for 1-year mortality. The overall 5-year cumulative survival rate was 5.6%. Conclusion Having three or more comorbid systemic diseases has been detected as the major determinant of 1-year mortality after primary cemented calcar-replacement bipolar hemiarthroplasty performed for unstable intertrochanteric fracture in elderly patients.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2017Posterior-only approach with pedicle screws for the correction of Scheuermann's kyphosis
Cobden, Adem; Albayrak, Akif; Camurcu, Yalkin; Sofu, Hakan; Tacal, Temel; Kaygusuz, Mehmet Akif
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 anteriorposterior 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.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2017Predictive factors for early hospital readmission and 1-year mortality in elder patients following surgical treatment of a hip fracture; [Cerrahi olarak tedavi edilmiş ileri yaş kalça kırığı hastalarında taburculuk sonrası erken dönem hastane başvurusu ve bir yıllık mortalitenin belirleyici faktörleri]
Sofu, Hakan; Üçpunar, Hanifi; Çamurcu, Yalkın; Duman, Serda; Konya, Mehmet Nuri; Gürsu, Sarper; Şahin, Vedat
BACKGROUND: Early hospital readmission after surgically treated hip fracture is a common entity, often involving an adverse event and causing strains on an already overburdened healthcare system. The main purposes of the present study were to determine the 30-day readmission rate, analyze the predictive factors for early hospital readmissions, and assess 1-year mortality following surgical treatment of hip fracture in elderly patients. Retrospective case-control study. METHODS: In total, 517 patients with a mean age of 74 years were evaluated. The rate of early readmission, age, gender, body mass index, fracture type, pre-fracture mobility status, preoperative time to surgery, American Society of Anesthesiologists score, implant type, postoperative intensive care unit stay, total length of postoperative hospital stay, comorbidities, and the main reasons for readmission were the criteria for data collection. Multivariate analysis was performed to determine the main predictors of early hospital readmission. Mortality within the first year after surgery was also assessed. RESULTS: A higher prevalence of chronic obstructive pulmonary disease, cardiac arrhythmia or ischemic heart disease, diabetes, and dementia or Parkinson’s disease was detected in readmitted patients. Advanced age, American Society of Anesthesiologists (ASA) grade ≥3, postoperative intensive care unit (ICU) stay, and pre-existing cardiac arrhythmia or ischemic heart disease were identified as the main predictors. The 1-year mortality rate for the readmitted group was 53.9%, whereas it was 24% for those patients who were not readmitted. CONCLUSION: The readmission rate following surgical treatment of hip fracture in elder patients was 12%, and its main predictive factors were advanced age, ASA grade ≥3, postoperative ICU stay, and pre-existing cardiac arrhythmia or ischemic heart disease. Hospital readmission within the first 30-day period following initial discharge was significantly correlated with an increased 1-year mortality rate.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2017Can Teicoplanin Be an Effective Choice for Antibiotic-Impregnated Cement Spacer in Two-Stage Revision Total Knee Arthroplasty?
Buyuk, Abdul Fettah; Sofu, Hakan; Camurcu, Ismet Yalkin; Ucpunar, Hanifi; Kaygusuz, Mehmet Akif; Sahin, Vedat
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.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2017Is talon tibial intramedullary nailing clinically superior compared to conventional locked nailing?
Çamurcu, Yalkin; Sofu, Hakan; Issin, Ahmet; Koçkara, Nizamettin; Genç, Erdinç; Çetinkaya, Mehmet
Objectives: This study aims to compare the results of talon tibial intramedullary (IM) nailing with the results of conventional distal locked tibial IM nailing. Patients and methods: The study included 60 patients (37 males, 23 females; mean age 42.2 years; range 18 to 92 years) who underwent tibial IM nailing with the diagnosis of unilateral, closed or open (Gustilo-Anderson type 1) tibial diaphyseal fracture (Orthopaedic Trauma Association 42) between January 2013 and January 2016. Patients were separated into two groups as talon tibial IM nailing group (group 1, n=30) and distal locked tibial IM nailing group (group 2, n=30). All patients' operative and total radiation exposure times were recorded. At last control, American Orthopaedic Foot and Ankle Society and Tegner Lysholm scores were evaluated for clinical outcomes. All complications were recorded. Results: Mean operative time was 43.8 minutes in group 1 and 50.2 minutes in group 2. Mean radiation exposure time in group 1 was 5.4 minutes, which was three times shorter than the time of group 2, which was 17.5 minutes. Mean time until union was 16.9 weeks in group 1 and 12.2 weeks in group 2. Statistically significant differences were present between two groups in operative, radiation exposure time and time until union (p=0.019, p=0.001, p=0.001, respectively). When American Orthopaedic Foot and Ankle Society and Tegner Lysholm scores were compared, there were no statistically significant differences (p=0.951 and p=0.896). Conclusion: Talon tibial IM nailing is an easier and safer alternative to conventional distal locked tibial IM nailing with shorter operative and radiation exposure times. However, it should be kept in mind that the time until radiographic union may be longer compared to conventional tibial IM nailing.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2017Results of Hyaluronic Acid–Based Cell-Free Scaffold Application in Combination With Microfracture for the Treatment of Osteochondral Lesions of the Knee: 2-Year Comparative Study
Sofu, Hakan; Kockara, Nizamettin; Oner, Ali; Camurcu, Yalkin; Issın, Ahmet; Sahin, Vedat
Purpose To determine the clinical and radiographic efficacy of hyaluronic acid–based cell-free scaffold applied in combination with microfracture versus microfracture alone in patients with focal osteochondral lesion of the knee joint. Methods Clinical data of 43 patients between 24 and 55 years of age were evaluated. Hyaluronic acid–based cell-free scaffold was applied in combination with microfracture for 19 knees (group 1), whereas microfracture alone was the surgical intervention for 24 knees (group 2). All lesions were Outerbridge grade III or IV with a mean size of 3.6 ± 1.3 cm2. The mean follow-up time was 25.7 months. Visual analog scale (VAS), Lysholm knee score, and Tegner activity scale were the instruments used to evaluate the clinical status. Magnetic resonance observation of cartilage repair tissue (MOCART) system was used to analyze the characteristics of repair tissue. Results Better VAS and Lysholm scores were detected in group 1 at 12 and 24 months (P =.019 and P =.025). According to the Tegner activity scale, group 1 had also better activity level at the end of 24 months after surgery (P =.020). The mean time from surgery to return to nonimpact sports activities was 7.8 months in group 1, whereas it was 9.2 months in group 2 (P =.013). Complete repair with the filling of the defect was achieved in 7 (36.8%) of the knees in group 1, whereas it was 4 (16.6%) of the knees in group 2 according to the MOCART system at 24 months. Conclusions Single-stage regenerative cartilage surgery using hyaluronic acid–based cell-free scaffold in combination with microfracture for focal osteochondral lesions of the knee revealed promising clinical outcomes at 24 months of follow-up, but the clinical significance of the differences seen is simply not known. Level of Evidence Level III, retrospective comparative study.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2017Can flexor tenosynovectomy and microsurgical epineurectomy improve clinical outcomes following open carpal tunnel release?
Duman, Serda; Sahin, Vedat; Sofu, Hakan; Camurcu, Yalkin; Ucpunar, Hanifi
Introduction: The purpose of this study was to comparatively evaluate the clinical outcomes of open carpal tunnel release with or without flexor tenosynovectomy and epineurectomy for the treatment of idiopathic carpal tunnel syndrome. Methods: In this prospective single-blinded study, 61 wrists of 47 patients randomized to open carpal tunnel release without (Group-1) or with (Group-2) flexor tenosynovectomy and microsurgical epineurectomy. Physical examination including Phalen and Tinel's signs, visible thenar atrophy, two-point discrimination, and grip strength measurement was performed. Visual Analogue Scale (VAS), Quick Disability of Arm Shoulder Hand (DASH) Questionnaire, Symptoms Severity Scale, Functional Status Scale, and electrophysiological study were assessed. Results: The increase in the grip strength and Quick Disability of Arm Shoulder Hand Questionnaire score were significantly better in flexor tenosynovectomy and microsurgical epineurectomy group. The average pre-operative two-point discrimination was 6.3 ± 2 mm in Group-1 and 5.8 ± 1.7 mm in Group-2. Post-operatively at the end of 12 months, the mean two-point discrimination was measured as 5.9 ± 1.6 mm in Group-1 and 5.6 ± 1.3 mm in Group-2. When we compare the two groups according to the changes in VAS, Quick-DASH, symptoms severity scale, and functional status scale, only Quick-DASH score improvement was significantly better in Group-2 (p < 0.05). Improvements in VAS, symptoms severity scale, and functional status scale did not differ significantly. Conclusion: We do not recommend routine flexor tenosynovectomy and microsurgical epineurectomy during open carpal tunnel release in patients with idiopathic carpal tunnel syndrome.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2016The prevalence of femoroacetabular impingement as an aetiologic factor for end-stage degenerative osteoarthritis of the hip joint: Analysis of 1,000 cases
Oner, Ali; Koksal, Alper; Sofu, Hakan; Aykut, Umit S.; Yıldırım, Timur; Kaygusuz, Mehmet A.
Objective: The main purpose of the present study was to determine the prevalence of FAI among patients who underwent total hip arthroplasty (THA) with the diagnosis of end-stage osteoarthritis (OA) of the hip joint in a tertiary referral centre. Design: A retrospective search of the institutional archive database for patients who had undergone THA between the years 2005 and 2010 was conducted with the analysis of the recorded radiographic images. A total of 1,004 patients including 690 (68.7%) females and 314 (31.3%) males were identified. All radiographs were reviewed by 3 of the authors. Intra- and interobserver consistencies were calculated. The prevalence of femeroacetabular impingement (FAI) as a predisposing diagnosis resulting in end-stage degenerative joint disease treated with THA was determined. Results: The most common diagnosis was developmental dysplasia of the hip (DDH). The predisposing aetiologic factor leading to end-stage degenerative hip disease treated with THA was undetermined for 26 patients (2.6%). The number of patients who were diagnosed as cam-type FAI by all of the observers was 83, whereas it was 16 for pincer-type FAI. Interobserver agreement was very high in the evaluation of the stated ethiologies of hip osteoarthritis. The contingency coefficient for the diagnosis of FAI was 0.71 between observers. Conclusions: Our study may be a reference for further investigations to develop a better understanding of the underlying pathological factors in patients undergoing THA due to end-stage OA of the hip joint.
RDL Kalıcı Kaydıİncele - LetterYalnız künye2016Predicting the need for surgical intervention in patients with idiopathic clubfoot
Aydin, Bahattin K.; Sofu, Hakan
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2016Pure elbow dislocation in the paediatric age group
Sofu, Hakan; Gursu, Sarper; Camurcu, Yalkin; Yildirim, Timur; Sahin, Vedat
Purpose: The main purpose of the present study was to evaluate the clinical results and prognosis of pure elbow dislocations in the paediatric age group following non-surgical treatment. Methods: Acute traumatic pure elbow dislocations treated between January 2008 and January 2013 were evaluated. The median age was eight years. The mean follow-up time was 46 months. Active and passive range of motion (ROM), elbow stability, neurovascular status, functional status and any early or late complications were evaluated and recorded at the latest follow-up. Results: The mean flexion-extension ROM was measured as 119.5 degrees. The mean pronation and supination were 67 and 79 degrees. Moderate instability was diagnosed in four cases. The mean Mayo Elbow Performance Score (MEPS) score was 91.6 points; the clinical outcome was excellent in nine patients, good in two and fair in one. Conclusions: Acute traumatic pure elbow dislocation in childhood is a very rarely seen emergency that can be treated safely with closed reduction combined long-arm plaster splinting and physical rehabilitation.
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