Yapıcı, Furkan

Background: Artificial intelligence (AI) is transitioning from proof-of-concept prototypes to clinically utilized tools in orthopedics. The key translational question is whether AI will replace surgeons or, more realistically, augment human expertise. Methods: A structured narrative review was conducted using PubMed/MEDLINE, Web of Science, and Google Scholar (completed 31 January 2026). Peer-reviewed English-language studies that utilized AI for orthopedic clinical problems were eligible. To synthesize the 73 included papers without forced quantitative pooling, evidence was qualitatively charted and organized using a four-axis framework: clinical task, data modality, validation maturity, and intended user/setting. Results: The evidence base was dominated by retrospective, imaging-centered AI studies (predominantly LOE III). Radiograph-based fracture detection and automated measurements were frequently reported to achieve high discrimination, though performance degraded in complex or “edge” cases. Predictive models for arthroplasty and spine outcomes demonstrated variable actionability and inconsistent reporting of calibration. Common translational barriers across subspecialties included limited external validation, dataset shift, and a scarcity of prospective impact studies. Conclusions: Current evidence supports an augmentation paradigm rather than a replacement paradigm. AI acts as a “co-surgeon,” improving triage and standardizing quantification. However, safe clinical translation requires representative external validation, rigorous failure analysis, and human-in-the-loop workflows where surgeons retain ultimate accountability.

Kandefer, Sami; Gür, Volkan; Gökgöz, Mehmet Burak; Can, Muhammet Ali; Taş, Metin; Memiş, Kemal Buğra; Kantarcı, Mecit; Koçkara, Nizamettin; Yapıcı, Furkan

Background/Objectives: The magnetic resonance imaging (MRI)-derived scapular superomedial angle (SMA) may serve as a continuous descriptor of scapular geometry. We evaluated whether SMA is associated with acromial morphology, examined SMA and subacromial space (SAS) across acromial categories, and quantified measurement reliability. Methods: In this retrospective cross-sectional study, 306 shoulders from 279 patients (27 bilateral) were analyzed after screening 353 examinations. SMA and SAS were measured independently by two orthopedic observers, and acromial morphology was classified independently by two radiologists, all in blinded sessions. Reliability, group comparisons, receiver operating characteristic (ROC) analyses, and patient-level clustered generalized estimating equations were performed. Results: Interobserver reliability was excellent for SMA (intraclass correlation coefficient [ICC], 0.960) and SAS (ICC, 0.926), and intraobserver reliability was excellent for SMA and good for SAS (ICC, 0.944 and 0.848); acromial classification agreement was almost perfect (linear-weighted kappa, 0.980). SMA increased stepwise across Type I to III acromia (128.7°, 133.9°, 137.2°; p < 0.001), whereas SAS decreased (7.5, 6.8, 6.3 mm; p < 0.001). Each 1° SMA increase was independently associated with Type III morphology (adjusted odds ratio, 1.18; p < 0.001). SMA was not independently associated with rotator-cuff severity (p = 0.842). Because adjacent Type II–III differences approached the minimum detectable change, individual-level discrimination was limited. Conclusions: MRI-derived SMA is a reproducible descriptor associated with acromial morphology at the group level, but adjacent-category differences approached measurement error. SMA should not substitute for direct acromial classification, and external validation is required before clinical thresholds are considered.

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.

Kuru, Muhammed; Koçkara, Nizamettin; Gökgöz, Mehmet Burak; Gür, Volkan; Yapıcı, Furkan

Background/Objectives: Because patella alta frequently accompanies objective patellar instability, separating trochlear morphology from patellar height is difficult. We evaluated whether the trochlear facet asymmetry ratio was associated with instability among knees with patella alta. Methods: This retrospective case-control MRI study included 123 knees: 43 with objective patellar instability, 43 normal-height controls, and 37 patella alta-positive controls without instability identified by re-screening the eligible control pool. Nine morphologic parameters were measured. The primary analysis compared the instability group with patella alta-positive controls; a supportive analysis used the full cohort. Results: The facet asymmetry ratio showed a graded pattern across groups (instability, 42.7 ± 12.4%; patella alta-positive controls, 59.2 ± 10.7%; normal-height controls, 70.3 ± 11.4%; p < 0.001). In the primary comparison, it had the highest observed apparent area under the curve (0.855), although its confidence interval overlapped with those of quantitative trochlear depth and tibial tubercle-trochlear groove (TT-TG) distance; the Insall–Salvati ratio showed weaker discrimination (0.679). After adjustment for the Insall–Salvati ratio and age, a lower facet asymmetry ratio remained associated with instability (odds ratio per 1-percentage-point increase, 0.903; 95% confidence interval, 0.854–0.956; p < 0.001). This association was attenuated after additional adjustment for quantitative trochlear depth or for tibial tubercle-trochlear groove distance together with Wiberg type. Interobserver reliability was excellent (intraclass correlation coefficient, 0.994). Conclusions: In this selected cohort, a lower trochlear facet asymmetry ratio was associated with objective patellar instability after adjustment for patellar height and age. The internally derived 49% threshold is exploratory and requires external validation before clinical use.

Aydin, Yalcin; Borku, Mehmet Kazim; Ugur, Kader; Eroksuz, Yesari; Emre, Elif; Incili, Canan Akdeniz; Sahin, İbrahim; Acarturk, İlknur Zeynep; Aydin, Suleyman; Lee, Do-Youn

Background/Objectives: Sepsis remains one of the leading causes of mortality, yet its etiopathogenesis is still not fully understood. This study aimed to investigate the effects of cetirizine and dexamethasone (alone and in combination) on serum levels of Maresin-1 (MaR-1), TNF-α, IFN-γ, IL-1, IL-2, IL-6, IL-8, and IL-10 in a rat model of sepsis induced by the cecal ligation and puncture (CLP) method. Methods: Male Sprague Dawley rats aged 8–10 weeks were used and randomly divided into 7 groups, each containing 7 rats: Group 1 (Control), Group 2 (Sham), Group 3 (Sepsis), Group 4 (Sepsis + Saline), Group 5 (Sepsis + Cetirizine), Group 6 (Sepsis + Dexamethasone), and Group 7 (Sepsis + Cetirizine + Dexamethasone). Sepsis was induced via CLP in all groups except Control and Sham. Results: In the sepsis groups (G3–G7), neutrophil and white blood cell counts increased while lymphocyte counts decreased (p < 0.05). In groups treated with cetirizine and/or dexamethasone (G5–G7), a significant decrease in neutrophils and an increase in lymphocytes were observed. MaR-1 levels significantly decreased (p < 0.05) in all sepsis-induced groups compared to controls, while interleukin levels significantly increased. Cetirizine and dexamethasone supplementation significantly increased MaR-1 levels and decreased interleukin levels (p < 0.05). The combined treatment was more effective. Conclusions: This study is the first to highlight the potential of MaR-1 as a critical biomarker in sepsis diagnosis and monitoring, and cetirizine and dexamethasone, especially in combination, may represent a promising therapeutic option in sepsis management.

Yapıcı, Furkan

Background/Objectives: Total knee arthroplasty (TKA) relieves pain and restores function for most patients with end-stage knee disease; yet, a clinically important minority are left with persistent pain, stiffness or both despite well-fixed, well-aligned implants. These “hidden failures” are poorly captured by implant survivorship but drive disability, dissatisfaction and disproportionate cost—stiff knees incur roughly 1.5–7.5 times the two-year treatment costs of non-stiff knees. This review integrates three usually separate studies within one phenotype-based framework. Methods: A structured comprehensive narrative review and thematic synthesis was undertaken; PubMed/MEDLINE, Web of Science and Google Scholar were searched between 30 October 2025 and 1 May 2026, identifying 467 records, of which 239 met the eligibility criteria and informed the synthesis. Results: Clinically meaningful chronic pain affects roughly 10–30% of recipients and stiffness approximately 1–7%, with high-impact chronic pain persisting in about one-in-five and neuropathic features in a third to a half of those affected. Contemporary dissatisfaction estimates appear closer to 7–14% than the historical “one-in-five” paradigm, with persistent pain and stiffness the dominant drivers of residual dissatisfaction. Symptoms arise from interacting mechanical, fibrotic, infective, neuropathic, central and psychosocial mechanisms. Six practical phenotypes are proposed—pain-dominant with preserved motion, stiffness-dominant, combined stiff-and-painful, neuropathic-dominant, centrally sensitized, and arthrofibrosis with true mechanical block—and diagnosis, prevention and management are organized around them, spanning risk stratification, surgical technique, manipulation under anesthesia (mean gains ~30–47°, ~6% failure), arthrolysis, revision and multidisciplinary pain care. Conclusions: Chronic pain and stiffness are the quiet arithmetic of arthroplasty success—rare on the survivorship curve, common in the clinic. Matching treatment to phenotype and reserving the operating theater for a knee with a mechanical fault to fix rather than a nervous system to calm, offers the clearest path from a technically successful operation to a genuinely successful recovery.

Mıdık, Mustafa Murat; Şahin, Gökhan; Durukan, Bekir Mert; Kuş, Fatih; Haşimoğlu Gürün, Kübra; Ünal, Sinan; Mirili, Cem; Karan, Canan; Hendem, Engin; Şakalar, Teoman

Background: Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide. Although the STRIDE regimen (durvalumab plus tremelimumab) has demonstrated an overall survival benefit in clinical trials, real-world evidence remains limited, particularly in Turkish clinical practice. This study aimed to evaluate the effectiveness and safety of first-line STRIDE therapy in patients with unresectable HCC treated in routine clinical practice. Methods: We conducted a retrospective multicenter study including patients with unresectable HCC who received first-line durvalumab plus tremelimumab through the Turkish national Early Access Program across 18 oncology centers. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method, and exploratory Cox regression analyses were performed to evaluate baseline prognostic factors. Results: Thirty-two patients were included. The median PFS was 7.25 months (95% CI, 3.68–22.29), and the median OS was 11.43 months (95% CI, 4.50–not reached). The underlying liver disease etiology was non-viral in 53.1% of patients, hepatitis B virus in 40.6%, and hepatitis C virus in 6.3%. Grade ≥ 3 treatment-related adverse events occurred in fewer than 10% of patients. Conclusions: In this multicenter real-world cohort, first-line durvalumab plus tremelimumab appeared to be a feasible treatment option and was generally well tolerated in patients with unresectable HCC. However, given the retrospective design, small sample size, and absence of a control group, these findings should be interpreted cautiously and require confirmation in larger prospective comparative studies.

İşsever, Kubilay; Oral, Alihan; Genç, Ahmed Cihad; Solmaz, Ihsan; Koca, Nizameddin; Topaloglu, Ulas Serkan; Demir, Ismail; Dundar, Ahmet; Kirik, Ali; Basci, Ozge Kama

Objectives: Although obesity is known to cause low-grade chronic inflammation, the extent to which body mass index (BMI) reflects this remains questionable. To investigate this, we classified a national obesity cohort by BMI and evaluated its association with complete blood count (CBC)-derived systemic inflammatory indices. Methods: This retrospective, multi-center study included 6499 adults from the OBREDI-TR cohort with available laboratory data. Patients were categorized by BMI into Class I (30.0–34.9 kg/m2, n = 2751), Class II (35.0–39.9 kg/m2, n = 1804), and Class III (≥40.0 kg/m2, n = 1944) obesity. We compared demographic, clinical, and laboratory parameters, especially in terms of CBC-derived inflammation parameters: neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI). Results: The Class III group was younger (42.73 ± 13.21 vs. 45.14 ± 14.12 in Class I) and predominantly female (p < 0.001 for both). None of the evaluated inflammatory indices showed significant differences across the groups (NLR, p = 0.435; PLR, p = 0.141; LMR, p = 0.520; SII, p = 0.326; SIRI, p = 0.459). Interestingly, hypertension was less common in the Class III obesity group (49.0% vs. 53.5% in Class I, p = 0.009). Conclusions: The failure of increasing inflammatory indices to parallel BMI, creating a “ceiling effect,” reflects the inadequacy of BMI in determining inflammatory burden. Evaluating the inflammatory burden of obesity through visceral adiposity and metabolic phenotyping (metabolically healthy (MHO) vs. metabolically unhealthy obesity (MUO) rather than BMI will provide a more accurate basis for objective clinical evaluation and personalized treatment.

Karatas, Talha; Akyol, Fethi; Tas, Hakan Gokalp; Karakurt, Tulay Ceren Olmezturk; Aydin, Seyma Selin; Isik, Onur; Otugen, Taha Emre; Kuyrukluyildiz, Ufuk

Background/Objectives: Following total knee arthroplasty (TKA), adductor canal block (ACB) is usually used for postoperative analgesia; however, the optimal injection level is yet unclear. This study tried to determine how the injection level of the ACB had an impact on postoperative analgesic efficacy and functional results after total knee arthroplasty. Methods: A total of 108 patients undergoing unilateral total knee arthroplasty under spinal anesthesia were included in this prospective observational study and were categorized according to the level of ultrasound-guided adductor canal block performed (proximal [Group I], mid [Group II], or distal [Group III]). The visual analog scale (VAS) was used to measure postoperative pain at 1, 4, 8, 12, and 24 h. Additionally, functional pain throughout 24-h standardized static and dynamic tests was assessed. We noted 24-h opioid consumption, motor strength levels, and sensory and motor block features. Results: During each time point, the distal group’s VAS scores were considerably higher than those of the proximal and mid groups (e.g., 8th hour: 40.69 ± 10.50 vs. 26.94 ± 8.72 and 23.47 ± 7.64, p < 0.001), whereas there was no difference between the proximal and mid groups (p > 0.05). At 24 h, the distal group had significantly higher functional pain scores on all dynamic and static measures (p < 0.001). The proximal and mid groups had longer sensory block durations (5.38 ± 1.33 and 5.03 ± 1.29 h) than the distal group (2.95 ± 0.95 h, p < 0.001). While mid-level ACB maintained motor function, 13.9% of patients receiving proximal ACB experienced transient motor block. Conclusions: After TKA, injection level has a major impact on postoperative analgesia. Mid-level ACB supports the employment of multimodal analgesia techniques by offering the best possible compromise between efficient pain management and motor function maintenance.

Aydin, Ahmet; Pasali Kilit, Turkan; Kir, Seher; Arac, Esref; Ozudogru, Osman; Bicer, Nazmiye Serap; Cetinkaya, Gulbin Seyman; Mamis, Mehmet Selim; Arslan, Kadem; Bas, Suleyman

Background: Osteoporosis has a rising global incidence and social burden. Serum uric acid’s dual roles in oxidative stress and inflammation may influence bone health, but findings are inconsistent and require further research. This study aimed to evaluate the relationship between SUA levels and osteoporosis in a multicenter cohort obtained from different regions of Türkiye. Methods: This multi-center retrospective study included 3280 individuals, postmenopausal women and men aged 45 and older, from 16 centers in Türkiye. Individuals were excluded if they recently consumed alcohol, had severe renal dysfunction, certain hormonal or mineral disorders, specific medications, or certain menopausal statuses. Bone mineral density (BMD) at the hip and lumbar spine was measured using dual-energy X-ray absorptiometry (DXA), and participants were classified as normal or having osteopenia or osteoporosis based on T-score thresholds. Results: Overall, 34.8% were male, and 65.2% were female. For the lumbar spine, 36.8% had osteopenia, and 13.5% had osteoporosis; similarly, for the total hip, 40.8% had osteopenia, and 7.9% had osteoporosis. ROC analysis identified a threshold of 3.9 mg/dL serum uric acid (SUA) (AUC 0.374; p < 0.001), which was positively associated with both lumbar and total hip BMD. Osteoporosis rates were higher in patients with SUA < 3.9 mg/dL compared to those with SUA ≥ 3.9 mg/dL at the lumbar spine (29.1% vs. 14.2%, p < 0.001) and total hip sites (23.6% vs. 15.9%, p = 0.003). After adjustment for potential confounders, SUA was a significant independent predictor of osteoporosis in the lumbar spine (OR 0.70; p < 0.001) and the hip (OR 0.80; p < 0.001). Conclusions: Serum uric acid levels are inversely linked to bone mineral density and osteoporosis risk, indicating a potential role in bone health. However, due to study limitations, causal relationships remain unproven, and further research is needed.