Bilge Kağan Yılmaz

Background and Objectives: Total knee arthroplasty (TKA) reduces coronal malalignment, but whether this correction redistributes load at the foot early after surgery is unknown. We evaluated static plantar load distribution before and one month after TKA and tested whether the magnitude of axial correction predicted the magnitude of load change. Materials and Methods: Sixty-four consecutive patients undergoing unilateral TKA for advanced knee osteoarthritis were enrolled prospectively; 60 completed both assessments. Hip–knee–ankle (HKA) angle, Q angle, and passive extension deficit were recorded preoperatively and at a mean of 30.9 ± 3.3 days postoperatively, together with static pedobarography of both feet in a bilateral stance under an instruction to load both limbs symmetrically. The primary outcome was the relative bilateral load share of the operative foot. Change scores were analyzed with paired tests, two one-sided equivalence tests (TOSTs), correlation, multivariable regression, and a linear mixed model. Results: The HKA angle improved from 10.79 ± 4.24° to 3.31 ± 3.51° of varus (p < 0.001), although residual varus persisted in 47 of 60 patients. Load share of the operative foot did not change significantly (−1.74 percentage points, 95% CI −4.92 to +1.45; p = 0.247), and equivalence was demonstrated within the primary ±5-percentage point margin (TOST p = 0.022) but not within an exploratory ±3-point margin (p = 0.216). In a sensitivity analysis excluding seven patients with comorbidities or previous osteotomy (n = 53), equivalence within ±5 points was not demonstrated (p = 0.094). Regional load share and mean pressure were likewise unchanged. No statistically significant relationship was demonstrated between correction magnitude and the change in load share (r = 0.222, p = 0.088; adjusted β = 0.428 percentage points per degree, 95% CI −0.598 to 1.455; p = 0.407), although the confidence interval was wide. Conclusions: One month after TKA for advanced, predominantly varus osteoarthritis, static bilateral plantar load sharing measured under an instruction to load both limbs symmetrically was equivalent to its preoperative state within ±5 percentage points. This equivalence may in part reflect the standardized instructions rather than the absence of a biological effect. No relationship between the degree of coronal correction and load redistribution was demonstrated. These findings are confined to the first postoperative month and to an instructed symmetrical static stance. Dynamic loading, gait, and later adaptation were not assessed.

Pneumatic tourniquet use during total knee arthroplasty (TKA) remains controversial. Although it reduces intraoperative blood loss, tourniquet-induced isch

Leg length discrepancy is a common and clinically important complication following total hip arthroplasty. It may lead to patient dissatisfaction, altered gait, and functional impairment. Although radiographic assessment is widely used, existing measurement methods can be affected by pelvic rotation and anatomical variations. This study aimed to evaluate the reliability and validity of a novel radiographic method based on the distance between the greater trochanter and the ischial tuberosity for assessing leg length discrepancy after hip arthroplasty. This retrospective cohort study included 56 patients who underwent hip arthroplasty between 2020 and 2023 and had appropriate postoperative standing pelvic radiographs. Leg length was measured clinically using the anterior superior iliac spine–medial malleolus distance, and radiographically using 3 different methods: teardrop to lesser trochanter, greater trochanter to ischial tuberosity, and anterior superior iliac spine to ankle. All radiographic measurements were performed twice, 2 weeks apart, by 2 orthopedic surgeons. Intraobserver and interobserver reliability were assessed using the intraclass correlation coefficient (ICC). Pearson correlation analysis was used to evaluate the relationship between the measurement methods. Receiver operating characteristic (ROC) analysis was used to assess the diagnostic performance of each method in identifying leg length discrepancy of ≥ 10 mm. The mean age of the patients was 66.8 ± 9.1 years. The greater trochanter–ischial tuberosity method showed excellent intraobserver and interobserver reliability (ICC > 0.84). A strong positive correlation was found between this method and the anterior superior iliac spine–ankle measurement ( P < .001). The novel method also demonstrated the highest diagnostic accuracy in detecting leg length discrepancies ≥ 10 mm (AUC: 0.96). The greater trochanter–ischial tuberosity distance is a reliable, reproducible, and practical radiographic measurement method for assessing leg length discrepancy after hip arthroplasty. Its reduced sensitivity to pelvic rotation and anatomical variation makes it a promising alternative to traditional methods, especially in clinical settings where full-limb imaging is not available.

ASSESSING THE ADEQUACY OF ARTIFICIAL INTELLIGENCE MODELS IN ANSWERING SPINE SURGERY QUESTIONS FROM THE ORTHOPEDIC RESIDENCY TRAINING AND DEVELOPMENT EXAMINATION - The Journal of Turkish Spinal Surgery

Traumatic hip dislocation is an orthopedic emergency that requires rapid evaluation and reduction. It may cause severe morbidities like avascular necrosis and posttraumatic osteoarthritis in the long term. This case report discusses a traumatic hip dislocation treated with open reduction using trochanteric osteotomy. A 50-year-old female driver experienced a posterior superior right hip dislocation following a traffic accident. Under sedation in an emergency room, closed reduction was attempted, but the reduction of the hip was not achieved. Under general anesthesia, closed reduction was reattempted, but then performing an open surgery was decided because of the unsuccessful reduction. It was understood that the femoral head tore the posterior labrum and passed out by penetrating the posterior capsule causing the buttonhole phenomenon; therefore, closed reduction was not accomplished. Irreducible traumatic hip dislocations are rare cases in the literature. The buttonhole phenomenon should be considered unless closed reduction can be achieved, and open surgical methods should be preferred.

OBJECTIVE: Informed consent forms are almost a contract between the patient and his/her physician before surgery. Consent forms should be readable and understandable by the patient. The level of readability is important for understandability of all texts.In this study, we investigated the readability level of orthopaedic surgical consent forms obtained in a tertiary care hospital. MATERIAL AND METHODS: The number of words, syllables, letters and characters in 28 consent forms used before orthopedic surgery in a tertiary medical faculty hospital were determined. Readability scores were determined with Ateşman and Bezirci-Yılmaz formulae. Statistical analyses were performed with SPSS 26.0 package programme. RESULTS: RS=51.35 ± 4.62 according to Ateşman scale and RS= 11.16 ± 1.81 according to Bezirci-Yılmaz scale. According to Ateşman scale, 11-12 years of high school level education is required for the readability of consents, while according to Bezirci-Yılmaz scale, secondary (high school) level education is required. CONCLUSIONS: It was determined that orthopedic surgery consent forms used in tertiary hospitals required high school education level knowledge. We recommend that these consent forms be simplified to the level that requires approximately 6 years of education, which is the average number of years of education in Turkey.

Osteochondral defect (OCD) regeneration is difficult due to the different properties and repair potentials of bone and cartilage tissues. This study aimed to compare cartilage tissue healing by applying in vitro produced double-layered and single-layered scaffolds to osteochondral defects. Ninety male Wester Albino rats with an age of over twelve weeks and a weight of 300–350 g were included in study. Group A was the control group (isolated OCD), Group B received a cellular double-layered scaffold, Group C received a cell-free double-layered scaffold, Group D received a cellular single-layered scaffold, and Group E received a cell-free single-layered scaffold. Biodegradable double-layered and single-layered scaffolds were obtained using L-lactide-co-glycolide (PLGA) and hydroxyapatite (HA) in the bone layer, PLGA and polyethylene glycol methyl ether methacrylate (PEGMEMA) in the cartilage layer. The resulting tissues were stained with Hematoxylin-Eosin and Masson’s Tricrom. Improvement was evaluated at week 4, week 8, and week 12 according to the Modified Mankin and O’Driscol scales. The positive impact of scaffold-based cellular applications on morphological field changes was demonstrated. Groups B and C exhibited higher morphological field scores compared to groups D and E. In both scoring systems, group E showed a significant long-term increase. Although the vitality of chondrocyte cells in the scaffolds was confirmed, their desired effects diminished over time. The lowest cell population scores were observed in groups B and D. Although chondrocyte cells demonstrated sustained viability in the double-layered scaffold during the early period, this effect was not observed in the mid and late periods. The double-layered scaffold had a limited effect in enhancing osteochondral regeneration. The single-layered scaffold was more effective in enhancing regeneration in the late period. Given the favorable late period outcomes associated with the single-layered scaffold, we propose that further clinical and laboratory studies focus on its long-term results.

AMAÇ: Akut septik artrit (SA) kıkırdak yıkımını, sepsisi ve hatta ölümü önlemek için hızlı müdahale gerektiren ortopedik acildir. SA'de bazı durumlarda re-operasyonlar gerekebilir. Amacımız, erişkinlerdeki akut diz SA için tek bir cerrahi debridmanın yetersizliğinde yaşın etkisini değerlendirmek ve olası risk faktörlerini belirlemektir. GEREÇ VE YÖNTEM: 01.01.2017 - 01.11.2023 arasında kurumumuzda akut SA nedeniyle opere edilen hastaların verileri retrospektif olarak tarandı. Verileri eksiksiz olan, 18 yaşından büyük, izole diz eklemi etkilenen hastalar dahil edildi. 18 yaş altı, diz harici eklemlerde gelişen SA olan, daha önce aynı eklemde artroplasti geçiren, aynı eklemde SA öyküsü olan, malignite, lenfoma veya immün yetmezlik tanısı alan ve verileri eksik olan hastalar çalışmadan çıkarıldı. Yaş, cinsiyet, ek hastalık, preoperatif-postoperatif fizik muayene bulguları, eritrosit sedimantasyon hızı (ESH), C-reaktif protein (CRP), beyaz kan hücresi sayısı (WBC), sinoviyal sıvı hücre sayımı ve kültürü, hastanede kalış süresi,kan kültürü, antibiyoterapi süresi re-operasyon ve komplikasyon kaydedildi. Çalışmaya dahil edilen tüm hastalar, yaşlarına göre, %50’lik dilimde median değer olan 59 yaş altı ve üstü olarak iki gruba ayrıldı. BULGULAR: SA ön tanısıyla opere edilen 197 hastadan izole diz eklemi tutulan 151 hasta çalışmaya dahil edildi. Hastaların ortalama yaşı 58,66±16,90 olarak bulundu. 59 yaş üstü grupta; ek hastalık, preoperatif ESH ve postoperatif ESH değerleri 59 yaş altı gruba göre daha yüksekti (sırasıyla; p<0,001, p=0,008, p=0,016). Hastalarda %19,2 re-operasyon uygulandığı görüldü. Re-operasyon olan ve olmayan gruplar arasında yaş, cinsiyet, operasyon tarafı ve ek hastalık varlığı oranları benzerdi (sırasıyla; p=0,654, p=0,682, p=0,468, p=0,224). Preoperatif ESH, preoperatif CRP, postoperatif ESH değerleri re-operasyon gerçekleştirilen grupta istatistiksel anlamlı olarak daha yüksekti (sırasıyla; p=0,001, p<0,001, p=0,018). SONUÇ: Erişkinlerdeki izole akut diz SA’in yetersiz tedavisinde yaşın izole etkisi olmadığı görüldü. Preoperatif ESH ve CRP ile postoperatif ESH değerleri re-operasyon açısından değerli bilgiler verebilir. Preoperatif sinoviyal kültür pozitifliği re-operasyon ihtimalinde 6.1 kat artışa neden olmaktadır.

Medical students are influenced by many different factors when choosing the specialty they will do throughout their lives. These are factors such as professional comfort, financial gain, malpractice, and shifts. Orthopedics and traumatology is a challenging specialty during and after the specialty training process. In our study, we aimed to investigate whether medical faculty students are knowledgeable about the department of orthopedics and traumatology and what factors affect their specialty preferences. A total of 1085 students were administered a questionnaire via Google forms on the basis of volunteerism to all grades of medical faculty students except the 1st grade. A questionnaire consisting of 24 open-ended and multiple-choice questions about the department of orthopedics and traumatology, including demographic data and factors affecting specialty preference was applied to 506 students who accepted the study. The data obtained were analyzed with IBM SPSS Statistics 20.0. A total of 506 (46.6%) students participated in the study. 303 (59.9%) students were female and 203 (40.1%) were male. Most of the students had knowledge about the department of orthopedics and traumatology. Students especially considered professional comfort while choosing specialization, and financial gain was the second most important factor. Although female students generally did not prefer surgical departments, they stated that orthopedics and traumatology was at the bottom of their preferences. In this study, it was determined that the level of knowledge of orthopedics and traumatology department of medical faculty students was sufficient regardless of gender. It was found that students primarily preferred departments that were comfortable and with high financial gain. It was found that female students did not prefer orthopedics and traumatology because of the perception that it is a male-dominated department and that working conditions may be harsh for women.