Necmettin Turgut

Total knee arthroplasty (TKA) is a widely used surgical intervention for advanced osteoarthritis, with evolving surgical techniques aiming to reduce blood loss and hospital stay. The minimally invasive midvastus (MMV) approach is hypothesized to minimize soft tissue damage and promote faster recovery compared to the classic medial parapatellar (MPP) approach. This study aimed to compare clinical and radiological outcomes, including perioperative blood loss and hospital discharge timing, between the MMV and MPP approaches. A total of 99 patients with advanced osteoarthritis who underwent primary TKA between 2013 and 2019 were prospectively analyzed. Patients were divided into MMV (n = 50) and MPP (n = 49) groups. All surgeries were performed by the same experienced surgeon using the same prosthetic system and perioperative protocols. Clinical outcomes included hemoglobin (Hb), hematocrit (Hct), discharge timing, range of motion (ROM), Visual Analog Scale (VAS), and Oxford Knee Score (OKS). Radiological outcomes included alignment and component positioning. Statistical analysis was conducted with significance set at p < 0.05. There were no significant differences between groups in demographic characteristics, surgical duration, alignment parameters (mechanical medial proximal tibial angle, mechanical lateral distal femoral angle, component tibial angle, component femoral angle), VAS, OKS, or final ROM. Postoperative (day 0 and day 3) Hb and Hct values did not differ significantly, and no blood transfusions were required in either group. However, same-day discharge was significantly more common in the MMV group (p = 0.02). One wound complication occurred in the MPP group; one patient from each group required postoperative manipulation under anesthesia. While both surgical approaches provided comparable clinical and radiological outcomes with no differences in blood loss, the MMV approach was associated with a higher rate of same-day discharge, suggesting an advantage in early recovery and reduced hospital stay.

Background: Osteoid osteoma (OO) is a benign osteogenic tumor that causes severe pain despite its small size. Minimally invasive image-guided thermal ablation has replaced surgery as the treatment of choice. While radiofrequency ablation (RFA) is considered the gold standard, microwave ablation (MWA) offers faster and more homogeneous heating, though comparative evidence remains limited. Methods: We retrospectively analyzed 53 patients with OO treated with RFA (n = 27) or MWA (n = 26) between 2014 and 2023. All procedures were CT-guided. Technical success, clinical success, recurrence, complications, and prognostic factors—including the nidus diameter and eccentricity index—were evaluated over a minimum 24-month follow-up period. Results: Technical success was achieved in all cases. Overall clinical success was 94.3% (96.2% MWA vs. 92.6% RFA, p = 1.000). Two recurrences (4%) occurred, unrelated to device type. One major complication (1.9%, third-degree skin burn after MWA) was noted. Median nidus diameter was 7 mm; lesions ≥10 mm were significantly linked to failure (p = 0.009). Logistic regression identified nidus size as the strongest outcome predictor, with the eccentricity index showing a borderline effect. Conclusions: Both RFA and MWA are safe and effective for OO, with comparable outcomes and low recurrence rates. Treatment selection should prioritize lesion-specific factors—particularly nidus size ≥ 10 mm and geometry—rather than device type. Lesion size (≥10 mm) and geometry—not ablation modality—were the principal determinants of treatment success. Individualized modality selection based on these features may optimize outcomes.

Technological innovations in medicine are increasingly expected to replicate the diagnostic, decision-making, and procedural skills of experienced physicians. This review explores the evolution, current status, and limitations of artificial intelligence (AI) and robotic surgery in clinical practice. Radiology and pathology have led the way in digital transformation, enabling AI applications through standardized datasets and electronic health records. However, limitations such as algorithmic opacity, legal-ethical uncertainties, and fragmented digital infrastructures continue to hinder broader implementation. In robotic surgery, soft tissue procedures have not yet demonstrated significant advantages over conventional laparoscopy in terms of cost or operative efficiency. Orthopedic applications, particularly in arthroplasty, are promising but still lack long-term validation. Importantly, for any technology to create true value in healthcare, its benefits must clearly outweigh its costs. As healthcare systems face mounting pressure from aging populations and rising procedural demand, particularly for cholecystectomy, prostatectomy, and arthroplasty, the development of efficient and scalable technologies becomes inevitable. While neither AI nor robotic surgery has yet fulfilled its transformative promise, historical trends suggest that innovation will persist toward overcoming these barriers.

Objective: This study aimed to investigate the impact of varus deformity correction on functional and clinical outcomes following unicompartmental knee surgery. Materials and Methods: A total of 71 medial unicompartmental knee arthroplasties (UKA) in 51 patients were included in this study. The knees were categorized based on the degree of correction observed in standing orthoroentgenograms post-surgery (Group 1: 0-4.9° correction, Group 2: 5-9.9° correction, and Group 3: 10° or more correction). Functional knee evaluation was assessed using range of motion measurements, posterior tibial slope angles, visual analogue score (VAS), Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Oxford Knee Score (OKS) questionnaires. Results: Following UKA surgery, there was a significant improvement in all patient-reported outcome scores, posterior tibial slope angles, visual analogue scores, and range of motion measurements across all groups. However, no significant differences were observed when comparing postoperative scores between the groups. Conclusion: Patients with varus deformities of up to 15 degrees can safely undergo UKA surgery without compromising clinical and functional outcomes.

Introduction: Achilles tendon rupture is a common and debilitating injury that significantly impacts mobility and quality of life. Effective treatment options that promote faster and more complete healing are needed. Fibroblast growth factor-2 (FGF-2) has shown potential in enhancing tendon repair. This study aims to investigate the efficacy of FGF-2 in promoting tendon healing in a rat model of Achilles tendon rupture, providing insights into its potential as a therapeutic option.Materials and methods: Forty-eight rat hind legs with complete Achilles tendon ruptures were divided into four equal groups: the Sham (S) group (tendon repair only), the Polymer (P) group (tendon repair with scaffold wrapping), the Produced FGF-2 (PF) group (scaffold coated with lab-produced FGF-2), and the Commercial FGF-2 (CF) group (scaffold coated with commercially sourced FGF-2). Histological analyses at two and four weeks post-surgery evaluated healing based on nuclear morphology, vascularity, fibril organization, inflammation, and adipogenesis.Results: At the end of the second week, no macroscopic healing was observed in one rat each from the S and P groups. By the end of the fourth week, macroscopic healing was observed in all groups. The S and P groups exhibited similarly severe fibril disorganization, pathological adipogenesis, and sustained inflammation, particularly at the fourth week. In contrast, the CF group demonstrated improved tendon healing with increased vascularity and extracellular matrix, lower inflammatory cell infiltration, and better fibril organization. Pathological adipogenesis was absent in the CF group, especially at the fourth week. The PF group showed comparable improvements at the second week but experienced a relapse by the 4th week, with increased inflammation and adipogenesis.Conclusion: FGF-2 coated scaffolds significantly enhanced tendon healing in a rat Achilles tendon rupture model by improving fibril organization, increasing vascularity, and reducing inflammation and pathological adipogenesis. These findings suggest that FGF-2 could be a promising therapeutic option for accelerating tendon repair. Future perspectives on tendon repair will focus on enhancing FGF-2 delivery using innovative scaffolds, paving the way for more effective therapies and improved patient outcomes.

Background: This bibliometric study aimed to identify and analyze the top 100 articles related to artificial intelligence in the field of orthopedics.Methods: The articles were assessed based on their number of citations, publication years, countries, journals, authors, affiliations, and funding agencies. Additionally, they were analyzed in terms of their themes and objectives. Keyword co-occurrence, co-citation of authors, and co-citation of references analyses were conducted using VOSviewer (version 1.6.19).Results: The number of citations of these articles ranged from 32 to 272, with six papers having more than 200 citations The years of 2019 (n: 37) and 2020 (n: 19) together constituted 56% of the list. The USA was the leading contributor country to this field (n: 61). The most frequently used keywords were “machine learning” (n: 26), “classification” (n: 18), “deep learning” (n: 16), “artificial intelligence” (n: 14), respectively. The most common themes were decision support (n: 25), fracture detection (n: 24), and osteoarthrtitis staging (n: 21). The majority of the studies were diagnostic in nature (n: 85), with only two articles focused on treatment.Conclusions: This study provides valuable insights and presents the historical perspective of scientific development on artificial intelligence in the field of orthopedics. The literature in this field is expanding rapidly. Currently, research is generally done for diagnostic purposes and predominantly focused on decision support systems, fracture detection, and osteoarthritis classification.

This study reports the results of surgical anatomic reconstruction of torn coracoclavicular ligaments with an autogenous semitendinosus graft and temporary Kirschner wires (K-wires) in chronic acromioclavicular (AC) joint dislocations. Nineteen shoulders underwent surgical anatomic reconstruction of torn coracoclavicular (CC) ligaments with an autogenous semitendinosus tendon graft and temporary K-wires for Rockwood grade III, IV and V chronic AC joint dislocations. Pre-operative data included patients’ demographic characteristics, injury characteristics and surgical histories. The primary outcome measures were the University of California Los Angeles (UCLA) shoulder rating scale and visual analogue pain scoring (VAS), and the complications were noted for each patient. Surgical anatomic reconstruction of torn CC ligaments was performed in 19 patients with a mean age of 41.6±16 years (range 21–72 years). All of the patients were satisfied and felt better after CC ligament reconstruction. The average UCLA shoulder rating scale score was good/excellent: 29.4 (range 23–34) out of 35 points. The average pre-operative VAS score was 7.7 points out of 10 and improved to 1.1 points post-operatively (p<0.05). None of the patients experienced failure during the follow-up. One patient had a mild subluxation, but the patient was satisfied with the result. This technique is simple, reliable, and biologic without major complications. It is also a cost-effective procedure since it can be performed with Kirschner wires and autogenous grafts. It has a major advantage of leaving no implants inside the joint, which can lead to hardware complications, and it can be performed in basic operating room settings.

Objective: This study aimed to analyze the original articles published in Acta Orthopaedica et Traumatologica Turcica (AOTT) between 2013 and 2022 using bibliometric methods to identify their characteristics and examine the changing trends over the last 10 years. Methods: The articles were analyzed in terms of publication year, authors, countries, affiliations, citations, study design, subspecialty of orthopedics, sample size, study outcome, presence of statistical methods, time elapsed from submission date to acceptance date, and presence of funding. Periods (2003-2012 and 2013-2022) were compared for trend analysis in the journal. Advanced bibliometric analysis was done using VOSviewer software (version 1.6.19). Results: A total of 976 articles were included in the analysis. The journal’s self-citation rate was 2.94%. Retrospective observational studies remained the most frequently published article design, as observed over 2003-2012 (n=411, 42.1%). No review articles were published in the previous period, while 35 review articles were published in this period. Publications from countries outside Türkiye exhibited a significantly higher number of case reports and reviews (P = .001), whereas articles from Türkiye had a significantly greater number of basic science and cross-sectional studies (P = .007, P=.017, respectively). Trauma (n=207), general orthopedics (n=144), and spine (n=105) were identified as the most prominent subspecialties. Spine surgery and adult reconstruction/arthroplasty publications significantly increased, while hand and microsurgery publications significantly decreased (P < .001). Article types were compared regarding citation counts, revealing that case reports and technical notes had significantly lower citation counts (P = .001). There was a significant increase observed in the number of author affiliations (n=2.57 ± 1.40) (P < .001). Management” (n=83), “fixation” (n=78), and “surgery” (n=65) were the most occurring keywords. There was a significant increase in articles with 1 or 2 authors in the latter 2017-2022 period compared to 2013-2016 (P=.001). A significant increase was observed in publications from private clinics and other clinical facilities (P < .001). Conclusion: Acta Orthopaedica et Traumatologica Turcica (AOTT) has emerged as one of the leading journals in orthopedics, with a notable increase in international publications in the last decade. Being in the Science Citation Index Expanded (SCI-Expanded) database, increasing impact factor, and having low self-citation rates highlight its high standards and global impact. Acta Orthopaedica et Traumatologica Turcica (AOTT) is a valuable platform for researchers worldwide to share their work and advance orthopedic knowledge. Level of Evidence: N/A. Cite this article as: Turgut N, Beyaz S. Bibliometric analysis of the acta orthopaedica et traumatologica turcica from 2013 to 2022. Acta Orthop Traumatol Turc., 2024;58(5):255-262.