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- ArticleAçık Erişim2016Does previous hip surgery effect the outcome of tönnis triple periacetabular osteotomy? mid-term results
Konya, Mehmet Nuri; Aydín, Bahattin Kerem; Yíldírím, Timur; Sofu, Hakan; Gürsu, Sarper
Hip dysplasia (HD) is 1 of the major reasons of coxarthrosis. The goal of the treatment of HD by Tönnis triple pelvic osteotomy (TPAO) is to improve the function of hip joint while relieving pain, delaying and possibly preventing end-stage arthritis. The aim of this study is to compare the clinical and radiological results of TPAO to determine if previous surgery has a negative effect on TPAO. Patients operated with TPAO between 2005 and 2010, included in this study. Patients divided into 2 groups: primary acetabular dysplasia (PAD) and residual acetabular dysplasia (RAD). Prepostoperatively, hip range of motion, Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) hip score, visual analog scores (VAS), impingement tests, and also the presence of Trendelenburg sign (TS) were investigated for clinical evaluation. For radiological analysis pre-postoperative, anterior-posterior (AP) pelvis and faux profile radiographs were used. Acetabular index, lateral center edge (LCE) angle, and Sharp angles were measured by AP pelvis anterior center edge (ACE) angle were measured by faux profile radiography. All the clinical and radiological data of the groups were analyzed separately for the pre-postoperative scores also the amount of improvement in all parameters were analyzed. SPSS20 (SPSS Inc., Chicago, IL) was used for statistical analysis. Wilcoxon test, McNemar test, paired t tests, and Mann-Whitney U tests were used to compare the groups. P<0.05 were defined as statistically significant. Study included 27 patients: 17 patients were in PAD and 10 patients were in RAD. The mean follow-up period was 6.2 years (5.2-10.3 years). In all patients, the radiological and the clinical outcomes were better after TPAO except the flexion of the hip parameter. When the patient groups were evaluated as pre-postoperatively, more statistically significant parameters were found in the PAD group when compared with RAD group. Extension, impingement, TS, VAS, HHS, WOMAC score parameters in clinical outcome and LCE, ACE, Sharp angle, coverage ratio in radiological results were significantly better in PAD group postoperatively but in RAD group; only extension, VAS, HHS, and WOMAC parameters were clinically and LCE and Coverage ratio were significantly different compared with the preoperative measurements. The change of the parameters that used for the evaluation of clinical and radiological results did not show a significant difference between groups. Our data suggest that TPAO can be performed on patients with HD for both groups. Although there were fewer parameters which changed significantly after TPAO in RAD patients; the improvement of radiological and clinical results was similar for groups. Further long-term follow-up studies with large number of patients are needed to determine the proper results of TPAO.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2016Should orthopedic surgeons consider the effects of gabapentin administration on bone healing while treating a long bone fracture: Experimental study in a rat model
Sofu, Hakan; Kockara, Nizamettin; Aydin, Bahattin Kerem; Suleyman, Bahadir; Tayfur, Mahir; Malkoc, Ismail
Objective: The main purpose of the present study was to assess the radiographic, histological, and mechanical effects of gabapentin on fracture healing in a rat model of femur fracture. Materials and methods: A standard transverse fracture of the mid-diaphysis was created. A total of 60 female Wistar-Albino rats with the mean age of 13.5 ± 1.2 weeks were used for this experimental trial. The rats were randomized into four groups with 15 animals included in each group. Group A and B were the control groups whereas C and D were the treatment groups. Drugs were delivered by oral gavage twice a day with the daily dosage calculated according to body surface area conversion to the human equivalent dosing regimen of 1200 mg/day. Radiographic, histological, and biomechanical evaluation was performed. Results: We could not detect any statistically significant difference between the control and gabapentin treatment groups according to the comparative assessment of radiographic scores on the 15th and 30th days. Although no significant differences were found between the groups on the 15th day, histological scores were better in the control group on the 30th day. According to the results of biomechanical testing, the fractured femurs resected from the control group exhibited significantly more strength on the 30th day. Conclusions: According to the data we acquired during the present study, administration of gabapentin negatively affects the fracture healing process especially in the aspects of histological progression as well as the biomechanical strength of the callus in a rat model.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2016Clinical and radiographic outcomes after femoral varus derotation osteotomy for Legg-Calvé-Perthes disease at 25 years follow-up: What are the determinants of outcome in the long term?
Aydin, Bahattin K.; Sofu, Hakan; Konya, Mehmet N.; Er, Turgay; Sahin, Vedat
Objective: The main purposes of the present study were to analyse the long-term clinical and radiographic results of femoral varus derotation osteotomy performed in a group of patients with the diagnosis of Legg-Calvé-Perthes (LCP) disease and to compare the effects of age, lateral pillar classification, radiographic stage according to Waldenström’s classification, and the amount of varisation obtained on long-term results. Design: The study group consisted of 21 hips. The mean postoperative follow-up time was 25.1 years. The effect of age at the time of surgery, preoperative lateral pillar classification, Waldenström’s classification, and the amount of varisation on Merle d’Aubigne score, Stulberg class, and presence of degenerative arthritis of the hip joint were assessed at the final follow-up. Results: Better clinical and radiographic outcomes were detected in patients operated younger than 10 years. The hips with lateral pillar group C involvement preoperatively were found to be significantly associated with worse clinical scores, worse radiographic outcome, and higher rate of degenerative arthritis. The overall rate of the hips with good radiologic outcome was 52.4%. 7 hips had degenerative arthritis at the final follow-up. Conclusions: Femoral varus derotation osteotomy revealed a congruent joint in half of the operated hips and arthritis-free hip joint in 2/3 at 25 years follow-up. Age at the time of surgery and preoperative lateral pillar classification were the main determinants of the radiographic outcome whereas the factors significantly correlated with progression to degenerative arthritis were determined preoperative lateral pillar classification and Stulberg group at maturity.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2016Predictors of the Clinical Outcome after Arthroscopic Partial Meniscectomy for Acute Trauma-Related Symptomatic Medial Meniscal Tear in Patients More Than 60 Years of Age
Sofu, Hakan; Oner, Ali; Camurcu, Yalkin; Gursu, Sarper; Ucpunar, Hanifi; Sahin, Vedat
Purpose To determine predictors of the clinical outcome after arthroscopic partial meniscectomy performed for acute trauma-related medial meniscal tear leading to mechanical symptoms in patients more than 60 years of age. Methods In this retrospective study with 4.1 years' follow-up, the clinical data of 154 arthroscopic partial medial meniscectomies were evaluated. The body mass index (BMI), duration of symptoms, the hip-knee-ankle angle, type of the meniscal tear, presence of any chondral lesions, degenerative changes in the patellofemoral joint, the status of the cruciate ligaments and lateral meniscus, and the presence of any plica or synovitis were the independent variables. Visual Analog Scale (VAS) and Lysholm Knee Scoring Scale were the instruments used as outcome measures. Multivariate analysis was performed to determine the major predictors. Results The mean VAS score for 154 knees evaluated in this study improved from 5.6 points preoperatively to 2.3 points at the latest follow-up. The mean Lysholm score improved from 43 points to 72.7 points. VAS and Lysholm scores at the latest follow-up were significantly worse in patients with a preoperative BMI ≥ 26 kg/m2, hip-knee-ankle angle > 5°, grade III or IV chondral lesion of the medial compartment according to Outerbridge classification, degenerative changes in patellofemoral joint surfaces, and an anterior cruciate ligament that was either partially ruptured or degenerative with increased laxity. Conclusions A preoperative BMI ≥ 26 kg/m2, Outerbridge grade III or IV chondral lesion of the medial compartment of the operated knee joint diagnosed during arthroscopic intervention, degenerative changes in patellofemoral joint surfaces, and the presence of an anterior cruciate ligament either partially ruptured or degenerative with increased laxity should be considered as the major predictors of the clinical outcome after arthroscopic partial meniscectomy performed for acute trauma-related symptomatic medial meniscal tear in patients more than 60 years of age. Level of Evidence Level IV, prognostic case series.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2016Effects of total knee arthroplasty on ankle alignment in patients with varus gonarthrosis: Do we sacrifice ankle to the knee?
Gursu, Sarper; Sofu, Hakan; Verdonk, Peter; Sahin, Vedat
Purpose: Total knee arthroplasty is one of the most commonly preferred surgical methods in the treatment of patients with varus gonarthrosis. In this study, we aimed to evaluate the radiological changes observed in the ankles after total knee arthroplasty. Methods: Between May 2012 and June 2013, 80 knees of 78 patients with varus deformity over 10° underwent total knee arthroplasty. For each patient, full-leg standing radiographs were obtained pre- and post-operatively. Mechanical and anatomical axes (HKA and AA), lateral distal femoral angle, medial proximal tibial angle, lateral distal tibial angle (LDTA), ankle joint line orientation angle (AJOA), tibial plafond talus angle (PTA) and talar shift were measured for each patient both pre- and post-operatively. Results: Pre-operatively, the mean HKA was 16.6° and the mean AA was 10.41°, both in favour of varus alignment. Post-operatively, the mean HKA decreased to 3.6° and the mean AA to −2.1. The mean LDTA was 87.3°. Before the operation, the mean AJOA was −7.6°, opening to the medial aspect of the ankle, and it was 0.04° after the operation and opening to the lateral aspect (p < 0.05). Conclusion: Our study reveals the changes occurring in the ankle after acute correction of long-standing varus deformity of the knee using total knee arthroplasty. In cases undergoing knee arthroplasty, effect of the acute change in the alignment of the knee on the ankle should be taken into consideration and the amount of correction should be calculated carefully in order not to damage the alignment of the ankle. Level of evidence: IV.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2015Two-Stage Cementless Revision Total Hip Arthroplasty for Infected Primary Hip Arthroplasties
Camurcu, Yalkin; Sofu, Hakan; Buyuk, Abdul Fettah; Gursu, Sarper; Kaygusuz, Mehmet Akif; Sahin, Vedat
The main purpose of the present study was to analyze the clinical features, the most common infective agents, and the results of two-stage total hip revision using a teicoplanin-impregnated spacer. Between January 2005 and July 2011, 41 patients were included. At the clinical status analysis, physical examination was performed, Harris hip score was noted, isolated microorganisms were recorded, and the radiographic evaluation was performed. The mean Harris hip score was improved from 38.9 ± 9.6 points to 81.8 ± 5.8 points (P< 0.05). Infection was eradicated in 39 hips. Radiographic evidence of stability was noted in 37 acetabular revision components, and all femoral stems. Two-stage revision of the infected primary hip arthroplasty is a time-consuming but a reliable procedure with high rates of success.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2015Pediatric fractures through the eyes of parents: An observational study
Sofu, Hakan; Gursu, Sarper; Kockara, Nizamettin; Issin, Ahmet; Oner, Ali; Camurcu, Yalkin
The present study is an observational cross-sectional study. The main purpose of this research was to analyze the perception and behaviors of parents in a series of pediatric upper extremity fracture cases.Hundred and seventeen patients younger than 12 years who were conservatively treated for the upper extremity fracture were included in our study. Parents of the patients were requested to answer a family-centered questionnaire related to their child's fracture and its treatment.When the parents were asked whether they believe casting would be sufficient or not as the treatment of their child's fracture, 84.6% answered 'yes', 13.7% answered 'I am not sure,' and 1.7% answered 'no.' Sixty-four of the parents were not worried about any residual defect in joint or extremity functions related to fracture, whereas 21 were worried and 32 were not sure on this. The rate of searching further information about the child's fracture was 34.2% and the mostly used source was the Internet. Twenty-eight of the 117 respondents (23.9%) emphasized that they would reduce the time their child spend outside the home at least for a while after the removal of cast.When conservatively treating a child's fracture, physicians dealing with traumatology should always consider the parents' perception and behaviors as critically important.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2015Isolated subtalar arthrodesis
Yildirim, Timur; Sofu, Hakan; Çamurcu, Yalkin; Özcan, Çaʇri; Öner, Ali; Şahin, Vedat
The aim of this study is to review the results of isolated subtalar arthrodesis in adults and to make a comparative analysis of the clinical outcomes between the patients with posttraumatic subtalar arthritis and the ones with other etiologic factors, and to evaluate the effects of grafting. This study included 19 men and 12 women. The mean postoperative follow-up was 36.8 months. The mean AOFAS hindfoot score improved from a mean of 46 preoperatively to a mean of 77.3 postoperatively. Thirty-one of 33 arthrodeses achieved bony union at a mean time of 15.7 weeks. The mean increase in the talocalcaneal height was 3.8 mm in the feet operated without grafting, whereas it was 8.1 mm in the feet for which grafting was performed. Improvement in talocalcaneal angle was significantly better in the feet operated with bone grafting. The feet with posttraumatic subtalar arthritis were more prone to Reflex Sympathetic Dystrophy.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2015Surgical Treatment of Hip Instability in Patients With Lower Lumbar Level Myelomeningocele: Is Muscle Transfer Required?
Yildirim, Timur; Gursu, Sarper; Bayhan, İlhan Avni; Sofu, Hakan; Bursali, Aysegul
Background: Treatment of hip instability in patients with lower lumbar level myelomeningocele is clinically challenging. Muscle transfer procedures, release of contractures, and intertrochanteric varus-rotation osteotomies have been described to restore weak or absent abductor strength as well as relocation of the hip. However, controlled trials evaluating hip instability in lower lumbar myelomeningocele are limited in the current literature. Questions/purposes: The purposes of this study were to compare the (1) radiographic evidence for joint stability; (2) clinical outcomes (including abductor strength, ambulatory ability, and residual use of orthoses); and (3) complications between patients undergoing combined periarticular contracture releases and bony procedures with and without external oblique abdominal muscle transfers. Methods: Between 2004 and 2013, 14 pediatric patients (16 hips) were treated for hip instability secondary to myelomeningocele using releases with or without muscle transfer. From those, 13 patients (15 hips) with a mean age of 6 years who had L3 to L5 level involvement were evaluated retrospectively. The patients were separated into two groups. Nine hips (in eight patients) were treated by performing a combination of external oblique abdominal muscle transfer to the greater trochanter, periarticular release of contractures, and bony procedures. These were compared with six hips (five patients) treated by performing a combination of periarticular release of contractures and bony procedures without external oblique abdominal muscle transfer. This study compared the results between two surgeons, one of whom always performed these muscle transfers in this setting and the other who never performed muscle transfer during the study period. The patients were clinically followed up at a mean of 41 months (range, 14–122 months); none of the patients was lost to followup. Radiographic evaluation criteria included Reimer’s migration index, acetabular index, femoral neck-shaft angle, pelvic obliquity, and the presence of scoliosis. Clinical evaluation included muscle strength examination, periarticular contractures, necessity for using orthoses as walking aids, and Hoffer criteria of mobility. All complications were also noted from a chart review. Results: There were no differences between the two groups regarding postoperative femoral head localization, reflecting the presence or absence of residual subluxation, according to Reimer’s index (Reimer’s index = 32%; range, 10%–40%, in the muscle transfer group compared with 27%; range, 15%–43%, in the no-transfer group at latest followup; p = 0.723). Postoperatively, abductor strength improved in the group treated with external oblique transfer compared with the group treated without muscle transfer (median improvement of 2 versus 0, p = 0.02), but this improvement neither resulted in a clinically important difference in Hoffer criteria of mobility (no change was detected in either group) nor decreased the need for use of an orthosis (no change was detected in either group). With the numbers available, there was no difference with respect to complications between the two groups (two complications versus one). Conclusions: External oblique abdominal muscle transfer did not provide a clinically important improvement in functional recovery when compared with patients with L3 to L5 myelomeningocele and hip instability who were treated without it. We therefore do not recommend a routine muscle transfer procedure during the operative management of hip instability in patients with lower lumbar level myelomeningocele. Level of Evidence: Level III, therapeutic study.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2015Treatment of clubfoot with ponseti method using semirigid synthetic softcast
Aydin, Bahattin Kerem; Sofu, Hakan; Senaran, Hakan; Erkocak, Omer Faruk; Acar, Mehmet Ali; Kirac, Yunus
Randomized controlled clinical trial. The main purpose of the present study was to comparatively analyze the effectiveness, advantages, and the complications of using semirigid synthetic softcast with respect to plaster of Paris (POP) during the treatment of clubfoot deformity. The study group consisted of 196 babies (249 feet). A total of 133 feet treated by an orthopedic referral center using semirigid synthetic softcast were included in group A whereas the other 116 feet treated by another orthopedic clinic using POP cast were included in group B. The Pirani scores, number of cast applications, time period until Achilles tenotomy, any skin problems due to the cast itself, and/or cast removal were recorded. A final parent satisfaction score was also obtained. The mean Pirani sores were significantly improved from the first administration to the time before Achilles tenotomy in both groups. There was no significant difference according to the number of casts applied until tenotomy. The slippage of the cast and skin lesions was significantly more common in group B. Higher parent satisfaction levels were detected in group A. Semirigid softcast has been found as superior to POP in the aspects of parent satisfaction and cast-related complication rates.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2015Short-term effects of partial meniscectomy on the clinical results of anterior cruciate ligament reconstruction
Sofu, Hakan; Yildirim, Timur; Gürsu, Sarper; Issin, Ahmet; Şahin, Vedat
Purpose: This study aims to analyse the short-term effects of partial meniscectomy on the clinical results of anterior cruciate ligament reconstruction surgery.; Methods: Clinical outcomes of 19 patients who had partial medial meniscectomy and anterior cruciate ligament reconstruction during the same surgery (Group 1) were compared with the outcomes of 25 patients who had also reconstruction but did not have any meniscal lesion (Group 2). Median follow-up time was 29 months (range 12–67 months) in Group 1 and 27 months (range 12–70 months) in Group 2. Feeling of apprehension in sports activities, International Knee Documentation Committee (IKDC) score, KT-2000 Arthrometer® measurements and post-operative time to return to sports activity were the criteria for data analysis.; Level of evidence: IV.; Results: Eight patients (42 %) in Group 1 and 5 patients (20 %) in Group 2 stated feeling of apprehension in sports activities. IKDC score improved to A in 11 patients (58 %) from Group 1, and 18 patients (72 %) from Group 2. Mean anterior translation according to KT-2000 arthrometer measurements was 5.2 ± 1.3 mm in Group 1, and 4.6 ± 1.3 mm in Group 2. Post-operative time to return to sports activity was 8.5 ± 3.0 months in Group 1, and 6.5 ± 2.2 months in Group 2.; Conclusion: Partial meniscectomy for irreparable medial meniscal tears, applied during the same surgery with anterior cruciate ligament reconstruction, negatively affects the clinical outcomes in the short-term follow-up. This study may be a reference for long-term clinical trials and also future investigations of new methods in the treatment of similar cases.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2015Transverse Subtrochanteric Shortening Osteotomy During Cementless Total Hip Arthroplasty in Crowe Type-III or IV Developmental Dysplasia
Sofu, Hakan; Kockara, Nizamettin; Gursu, Sarper; Issin, Ahmet; Oner, Ali; Sahin, Vedat
The purpose of this study was to review the outcomes of transverse subtrochanteric shortening osteotomy during cementless total hip arthroplasty in Crowe Type-III or IV developmental dysplasia. Seventy-three osteotomies were included in our study. Mean follow-up was 61. months. Harris hip score, leg length discrepancy, neurological status, union status of the osteotomy, and femoral component stability were the criteria for evaluation. All complications were noted. The mean Harris hip score improved from 38.6 points to 83.7 points. The mean leg length discrepancy decreased from 56.5. mm to 10.7 at the latest follow-up. The mean union time was 5.2. months. We observed 4 non-unions. Transverse subtrochanteric shortening osteotomy is an effective and reliable method in restoration of a more normal limb.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2015Giant cell tumor of the capitate: An unusual case with 10 years follow-up
Duman, Serda; Sofu, Hakan; Camurcu, Yalkin; Gursu, Sarper; Oke, Ramadan
Giant cell tumor of the small bones, particularly the carpal bones of the hand, is exceedingly rare. We present a case report of giant cell tumor of the capitate in a 24 year-old female with 10 years postoperative follow-up. Although carpal bones are extremely unusual location, orthopedic surgeons should always keep in mind that differential diagnosis must include giant cell tumor of bone whenever an expansile osteolytic lesion with well-defined but nonsclerotic margins is identified in a young adult with closed physes.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2014Ortoröntgenogramlar varus diziliminin düzeltme miktarı tespitinde ne kadar güvenilirdir?
Gürsu, Şükrü Sarper; Sofu, Hakan; Yildirim, Timur; Şahin, Vedat; Issin, Ahmet
Amaç: Bu çalışmada ortoröntgenogramlarda bacakların orta hatta olan uzaklığının alt ekstremite dizilimi ve açıları üzeri- ne olan etkileri incelendi. Hastalar ve yöntemler: Mart 2012 - Nisan 2013 tarihleri arasında, eklemdeki laksite miktarının anlaşılabilmesi ama- cıyla farklı iki pozisyonda ortoröntgenogram çekilmiş olan 56 hastanın varus deformitesi olan 95 ekstremitesi çalışmaya dahil edildi. İlk grafi, ayak bilekleri birbirine değecek şekilde çekilirken, ikinci grafinin, ayaklar hastanın omuz genişliği mesafesi kadar açık olacak şekilde çekildi. Her bir ortorönt- genogramda, ortalama mekanik aks açıları, anatomik akslar ve eklem hattı oryantasyon açıları ölçüldü. Varus deformitesi >10° olan 43 ekstremite için ölçümler ayrıca tekrarlandı. Bulgular: Ayakların bitişik olduğu pozisyonda çekilen orto- röntgenogramlarda, ortalama mekanik aks değeri 9.58°±5.7°, (0.20°; 26.0°), ortalama anatomik aks 3.65°±6.14°, (-9.0°; 21.0°) ve ortalama eklem hattı oryantasyon açısı -3.41°±2.52°, (-12.0°; 1.60°) olarak hesaplandı. Ayakların omuz mesafesinde açık olduğu pozisyonda çekilen ortoröntgenogramlarda ise; orta- lama mekanik aks değeri 7.73°±5.58°, (-3.0°; 23.0°), ortalama anatomik aks 2.62°±5.87°, (-11.0°; 18.30°) ve ortalama eklem hattı oryantasyon açısı -2.44°±2.41°, (-13.0°; 3.0°) olarak hesaplandı. İki pozisyon arasındaki açısal farklar istatistiksel olarak anlamlı bulundu (p<0.005). Sonuç: Çalışma bulgularımız, varus gonartrozlu hastalarda, ayaklar bitişik pozisyonda çekilen ortoröntgenogramlarda, meka- nik aks, anatomik aks ve eklem hattı oryantasyon açılarının ortalama değerlerinin ayakların omuz mesafesinde açık olduğu pozisyonda çekilen grafiye göre daha büyük olduğunu gösterdi. Bu durumun ameliyat öncesi planlamada hatalara yol açabileceği kanısındayız. Muhtemel sorunları en aza indirmek için bacakların durması gereken ideal pozisyonların standardize edilmesi gerekir.
RDL Kalıcı Kaydıİncele - Review ArticleAçık Erişim2014Recurrent anterior shoulder instability: Review of the literature and current concepts
Sofu, Hakan; Gürsu, Sarper; Kockara, Nizamettin; Öner, Ali; Issin, Ahmet; Çamurcu, Yalkin
The purpose of this review article is to discuss the clinical spectrum of recurrent traumatic anterior shoulder instability with the current concepts and controversies at the scientific level. Because of increasing participation of people from any age group of the population in sports activities, health care professionals dealing with the care of trauma patients must have a thorough understanding of the anatomy, patho-physiology, risk factors, and management of anterior shoulder instability. The risk factors for recurrent shoulder dislocation are young age, participation in high demand contact sports activities, presence of Hill-Sachs or osseous Bankart lesion, previous history of ipsilateral traumatic dislocation, ipsilateral rotator cuff or deltoid muscle insufficiency, and underlying ligamentous laxity. Achieving the best result for any particular patient depends on the procedure that allows observation of the joint surfaces, provides the anatomical repair, maintains range of motion, and also can be applied with low rates of complications and recurrence. Although various surgical techniques have been described, a consensus does not exist and thus, orthopedic surgeons should follow and try to improve the current evidence-based treatment modalities for the patients. (c) 2014 Baishideng Publishing Group Inc. All rights reserved.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2014How safe are orthoroentgenograms in determining the amount of correction for varus deformities?
Gürsu, Sarper; Yildirim, Timur; Issin, Ahmet; Sofu, Hakan; Sahin, Vedat
Objectives: In this study, we evaluated the effects of the distance of the legs from the midline on alignment and angles of the lower extremities in orthoroentgenograms. Patients and methods: Between March 2012 and April 2013, 95 limbs of 56 patients with varus deformity who underwent orthoroentgenogram to identify the amount of joint laxity in two positions were included in this study. The initial X-ray was performed with the feet in contact, while the other was performed as the legs were abducted to be in line with the shoulders. For each orthoroentgenogram, the mean mechanical axis angle, anatomical axis, and joint line orientation angles were measured retrospectively. These measurements were repeated for 43 limbs with varus deformity > 10 degrees. Results: In the orthoroentgenograms with the feet in contact, the mean mechanical axis angle was 9.58 degrees +/- 5.7 degrees, (0.20 degrees; 26.0 degrees), the mean anatomical axis angle 3.65 degrees +/- 6.14 degrees, (-9.0 degrees; 21.0 degrees), and the mean joint line orientation angle -3.41 degrees +/- 2.52 degrees, (-12.0 degrees; 1.60 degrees). In the orthoroentgenograms with the legs abducted, the mean mechanical axis angle was 7.73 degrees +/- 5.58 degrees, (-3.0 degrees; 23.0 degrees), the mean anatomical axis angle 2.62 degrees +/- 5.87 degrees, (-11.0 degrees; 18.30 degrees), and mean joint line orientation angle was -2.44 degrees +/- 2.41 degrees, (-13.0 degrees; 3.0 degrees). The differences in the angles between the two positions were statistically significant (p < 0.005). Conclusion: Our study results showed that the mean values of mechanical axis angle, anatomical axis and the joint line orientation angle were higher in orthoroentgenograms with the feet in contact than the orthoroentgenograms with the legs abducted in patients with yarns gonarthrosis. We suggest that this may lead to mistakes in the preoperative planning. Ideal positions should be standardized to minimize possible problems.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2014Evaluation of satisfaction levels of patients undergoing high tibial osteotomy
Gürsu, Sarper; Yıldırım, Timur; Çamurcu, Yalkın; Sofu, Hakan; Demir, Bilal; Issın, Ahmet; Şahin, Vedat
Objective: High tibial osteotomy (HTO) is a surgical treatment method applied for isolated-medial gonarthrosis. Successful results were reported in different studies. We have evaluated the satisfaction levels of the patients and the clinical results of HTO. Materials and Methods: Ninety-nine patients who underwent open wedge osteotomy as the surgical treatment of medial gonarthrosis between the years 2002 and 2006 were included in our study. The mean age at the time of surgery was 54.9 years, and the mean follow-up time was 6.8 years. Results: Patients were asked whether they were satisfied with the operation or not; 41 of them (41.4%) were completely satisfied, 30 patients (30.3%) were partially satisfied, and 28 of them (28.3%) were dissatisfied. Fifteen patients (15.1%) underwent secondary total knee arthroplasty. and for 2 other patients, arthroplasty was planned. When patients were asked whether they would recommend HTO to others, 74 of them (74.7%) said they would, but 25 patients (25.3%) said they would not. Conclusion: High tibial osteotomy is a very successful surgical treatment. However, patient satisfaction levels may not be as high as expected. In this regard, when assessing the clinical outcomes of HTO, better methods that include the patients’ feedback should be taken into consideration.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2013Use of quadriceps tendon versus hamstring tendon autograft for arthroscopic anterior cruciate ligament reconstruction: A comparative analysis of clinical results
Sofu, Hakan; Şahin, Vedat; Gürsu, Sarper; Yildirim, Timur; Issin, Ahmet; Ordueri, Mehmet
Objectives: This study aims to evaluate midterm clinical results of the use of two autogenous graft types. Patients and methods: Between June 2005 and November 2010, clinical data of 44 patients who were operated were retrospectively analyzed. Quadriceps tendon-patellar bone autograft was used for reconstruction surgery in 23 patients (QT-PB group), while quadrupled hamstring tendon autograft was used in 21 patients (HT group). The Tegner's activity scale, Lysholm scoring system, single-leg-hop test and KT-2000 arthrometric measurements were used for data collection. Results: The mean length of follow-up was 37.6 months. Although the mean Lysholm score increased in both groups, excellent results in HT group were two-fold higher compared to QT-PB group. The mean laxity for the operated knee joint was 5.65 mm (3.5 to 8.0 mm) in QT-PB group and 3.67 mm (3.0 to 5.5 mm) in HT group. Head-to-head analysis using KT-2000 arthrometer demonstrated that 12 patients (52.1%) in QT-PB group and two patients (9.6%) in HT group had more than 3 mm of anterior laxity difference. Conclusion: Quadrupled hamstring tendon autograft is superior to central quadriceps tendon-patellar bone in arthroscopic anterior cruciate ligament reconstruction surgery.
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