Ulas Akgun

There are studies indicating that both statins and Platelet-Rich Plasma (PRP) have effects on inflammation and the arthritis process. The aim of our study was to investigate the effect of statin use on the clinical and functional outcomes of PRP treatment in patients with early-stage knee osteoarthritis. Between January 2018 and August 2020, the medical records of all patients who underwent PRP treatment for stage I–II knee osteoarthritis were retrospectively reviewed. Patients who did not use statins and received PRP treatment for knee osteoarthritis were designated as Group 1, while patients who used statins for hypercholesterolemia and received PRP treatment for knee osteoarthritis were designated as Group 2. Patient demographics, radiological images, and clinical records were retrospectively analyzed. The clinical and functional effects of PRP treatment were compared between the two groups. A total of 70 patients aged 40–70 years with stage I–II knee osteoarthritis were included in the study. In the EQ5D5L quality of life scale, a statistically significant difference was observed between the two groups before PRP treatment (p = 0.036). No statistically significant difference was observed in any other parameters examined. Our study investigated whether statin use had a positive or negative effect on PRP treatment; no significant difference was found in terms of functional and clinical results. Regardless of statin use, PRP treatment was found to improve patients’ clinical and functional scores.

Hallux valgus is a triplanar deformity with rotation being a significant contributing factor. Several methods exist for evaluating rotational deformity of the first ray, one of which involves assessing the shape of the lateral edge of the first metatarsal head. This study aimed to investigate the interobserver and intraobserver reliabilities of circle measurements on weight-bearing anteroposterior radiographs to categorize the shape of the lateral edge of the first metatarsal head. A power analysis determined that a minimum of 128 radiographs was required to assess observer agreement for categorical data (alpha = 0.05, beta = 0.2, power = 80%). Patients diagnosed with hallux valgus at our institution between January 2015 and December 2019 were retrospectively reviewed and 128 radiographs were randomly selected. Two foot and ankle surgeons and 2 radiologists evaluated the radiographs on 2 separate occasions, classifying the first metatarsal head shape into 3 categories (angular, intermediate, and round) using circular measurements. Interobserver reliability was assessed using Fleiss’ kappa, whereas intraobserver reliability was evaluated using Cohen kappa. Interobserver reliability for classifying the shape of the lateral edge of the first metatarsal head was found to be very good in both assessments (Fleiss’ kappa = 0.83 and 0.84, respectively). The subcategory analysis revealed the highest agreement for the angular type, followed by the round type, with the lowest agreement observed for the intermediate type. The intraobserver Cohen kappa values ranged from 0.78 to 0.91. The level of interobserver agreement was found to be very good for the classification of the shape of the first metatarsal, and the intraobserver agreements were substantial to very good. In our opinion, this method is reliable and may be useful in determining the necessity for rotation-correcting surgery and advanced imaging with weight-bearing computed tomography.

Purpose Healthy spinal balance is dependent on spinal sagittal alignment. It is evaluated by several spinopelvic measures. The objective of this study is to investigate the effect of age and body mass index and the bone mineral density on the several vertebral measures and sagittal spinopelvic measurements. Methods In this cross-sectional study, a total of 89 female patients were grouped according to age (> 70, < 70); to BMI (underweight (< 18.5 kg/m²), normal weight (18.5–25 kg/m²), overweight (25–30 kg/m²); and to spine T scores (normal, osteopenia, and osteoporosis). On lateral lumbar X-ray, lumbar lordosis (LL) angle and pelvic incidence (PI) are measured. On sagittal T2 MRI images, anterior and posterior vertebral heights and foraminal height and area of the L1–L5 segments were measured. Results The mean age of the participants was 70.54 ± 6.49. The distribution of the patients in BMI groups and BMD groups were even. Mean lumber lordosis (LL) was 48.27 ± 18.06, and the mean pelvic incidence (PI) was 60.20 ± 15.74. In the younger age group, LL was found to be higher than the older age group. The vertebral and spinopelvic angle measures within the different BMI and BMD groups revealed no difference in between. There were no statistically significant difference in correlation analysis. Conclusion In this cross-sectional study, the results revealed that younger patients have higher lordosis angle, and normal BMD patients have higher foraminal height and area measures than osteoporotic and osteopenic patients. Obesity seemed not to have any influence on vertebral measures. Spinopelvic parameters seem not to be effected by BMD and BMI.

Purpose The aim of this study was to determine the incidence of prolonged wound drainage (PWD) and the amount of drainage fluid after hip hemiarthroplasty (HA) and to investigate the risk factors for the development of PWD associated with the patient, fracture and surgical treatment. Methods Data from 313 patients who underwent HA were prospectively analysed. The mean drainage time and drainage amount of patients with PWD were calculated. Patient demographic data, pre-operative ASA scores and anticoagulation status, presence of diabetes, fracture type, surgical approach, femoral stem type, cable usage, amount of drain output, blood transfusion quantity, time from injury to surgery, time from surgery to discharge and patient blood tests were investigated. Results The incidence of PWD after HA was 8.9% (28 patients). The mean drainage time in patients with PWD was 4.9 ± 1.85 (3–9) days, and the mean collected total fluid volume was 51.1 ± 26.9 (21–132) mL. PWD was more commonly observed in the lateral approach group (p< 0.001) and morbidly obese patients (p< 0.001). In the PWD group, the mean post-operative first-day haemoglobin value was lower (p< 0.001), more blood transfusions were required (p< 0.001) and the amount of drainage output from the closed suction drain (CSD) was higher (p < 0.001). The duration of hospitalization was longer in patients with PWD (p < 0.001). Lateral approach, morbid obesity and increased drainage output were found to be associated with PWD in logistic regression analysis. Conclusion Lateral approach, morbid obesity and increased drainage output were found to be risk factors for the occurrence of PWD.

Amaç: Amacımız komplet atipik femur kırığı nedeniyle cerrahi tedavi uygulanan hastaların karşı femurlarını değerlendirerek inkomplet atipik femur kırığı varlığını araştırmak ve inkomplet kırık saptanan hastalar ile inkomplet kırık gözlenmeyen hastaları karşılaştırmaktır. Gereç ve Yöntemler: Kliniğimizde Ocak 2012 ile Aralık 2018 tarihleri arasında atipik femur kırığı nedeniyle cerrahi tedavi uygulanan hastalar retrospektif olarak incelendi ve 46 hastanın çalışmaya dahil edilme kriterlerine uyduğu görüldü. Tüm hastaların yatışları sırasında karşı femurları inkomplet atipik femur kırığı bakımından değerlendirilmişti. Hastalar karşı femurda inkomplet atipik kırık varlığına göre iki gruba ayrıldı ve iki grubun yaşları, cinsiyetleri, bifosfonat kullanım süreleri, vücut kitle indeks değerleri, kalça ve lomber T skorları, serum parathormon, 25-OH Vitamin D ve alkalen fosfataz düzeyleri karşılaştırıldı. Bulgular: Çalışmada yer alan hastaların hepsi kadındı ve hastaların yaş ortalaması 72,9 ± 5,9 yıl olarak bulundu. Hastaların ortalama bifosfonat kullanım süresi 7,9 ± 1,6 yıl olduğu görüldü. 11 (%23,9) hastada karşı femurda inkomplet atipik kırık ile karşılaşıldı. İki grubun yaşları, bifosfonat kullanım süreleri, vücut kitle indeks değerleri, kalça ve lomber T skorları, serum parathormon, 25-OH Vitamin D ve alkalen fosfataz değerleri arasında anlamlı fark saptanmadı. Sonuç: Atipik femur kırığı olan tüm hastaların karşı femurlarının inkomplet kırık varlığı açısından değerlendirilmesi gerektiği kanaatindeyiz. İnkomplet atipik femur kırıklarının erken fark edilmesinin ve komplet kırığa dönüşme riskinin değerlendirerek uygun tedavinin gerçekleştirilmesinin hastalarda oluşabilecek ciddi morbiditeyi engelleyeceğini düşünüyoruz.

This study aimed to determine the prevalence of incomplete atypical femoral fractures (iAFFs) in postmenopausal women using bisphosphonates and to investigate the potential risk factors for the development of iAFF. The national health-care records system indicated that 2746 postmenopausal women in our region aged ≥50 years were taking bisphosphonates. Using an assumed iAFF prevalence of 10% and levels of 5% α significance and ±5% precision, we calculated that a sample size of 132 participants was needed for this study. The patients were randomly selected and invited to the hospital. Radiographs and bone scans were used to evaluate each patient for iAFF. Bone mineral density, 25-hydroxy vitamin D, parathyroid hormone, and alkaline phosphatase measurements were performed. The mean age of the study population was 72.79 ± 7.35 years, and the mean duration of bisphosphonate use was 7.7 ± 3.4 years. We found iAFF in 14 (10.6%) patients, and 3 patients had bilateral involvement. Of the 17 femurs with iAFF, a proximal third location was seen in 2 patients (11.8%), a mid-third location in 14 (82.4%), and a distal third location in 1 (5.9%). The duration of bisphosphonate use was longer, and parathyroid hormone levels were higher in patients with iAFF compared to those without an incomplete fracture. We found a relatively higher prevalence of iAFF in postmenopausal women using bisphosphonate. Early identification and treatment of iAFF is crucial for reducing potential patient morbidity and hospital costs.

The aim of this study was to evaluate the sensitivity and specificity of radiographs in identifying incomplete atypical femoral fractures and to determine interobserver and intra-observer reliability.

Objective: The aim of this study was to compare single-shot adductor canal block and continuous infusion adductor canal block techniques in total knee arthroplasty patients. Methods: We prospectively randomized 123 patients who were scheduled for unilateral primary total knee arthroplasty surgery into single shot (n ¼ 60; mean age: 67.1 ± 6.9 years) and continuous (n ¼ 63; mean age: 66.9 ± 6.8 years) adductor canal block groups. Postoperative visual analog scale pain scores, need for additional opioids and functional results as; timed up and go test, the 30-s chair stand test, 5 times sit-to-stand test, the 6-min walking test, the time to active straight leg raise, time to walking upstairs, maximal flexion at the time of discharge, duration of stay in hospital were compared between the two groups. Results: Pain scores were lower in the continuous adductor canal block group as compared to the single-shot adductor canal block group throughout the postoperative period (p ¼ 0.001). Rescue analgesia was required for 6 (10%) patients in the single shot group and for 1 (1.59%) patient in the continuous group (p ¼ 0.044). Patients in the continuous adductor canal block group displayed better functional results than the single-shot adductor canal block group with respect to active straight-leg rise time (25.52 ± 4.56 h vs 30.47 ± 8.07 h, p ¼ 0.001), 6-min walking test (74.52 ± 29.38 m vs 62.18 ± 33.32 m, p ¼ 0.035) and maximal knee flexion degree at discharge (104.92 ± 5.35 vs 98.5 ± 7.55, p ¼ 0.001). There was no significant difference between the two groups for other functional and ambulation scores. Conclusion: Pain control following total knee arthroplasty was found to be better in those patients treated with continuous adductor canal block as compared to those treated with single-shot adductor canal block. Patients treated with continuous adductor canal block also displayed better ambulation and functional recovery following total knee arthroplasty. Level of evidence: Level I, Therapeutic Study.