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Ali J, Pulatkan A, Kara D, Tezgel O, Misir A, Ucan V, Bozdag E, Yildirim AN, Yildiz F, Tuncay I, Kapicioglu M, Bilsel K. Fibroblast Growth Factor Soaked Collagen Membrane Shows No Biomechanical or Histological Advantages in the Treatment of Chronic Rotator Cuff Tears in a Rabbit Model. Arthroscopy 2024; 40:683-691. [PMID: 37394152 DOI: 10.1016/j.arthro.2023.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/04/2023] [Accepted: 06/16/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE To investigate the histological and biomechanical effects of a fibroblast growth factor (FGF-2)-soaked collagen membrane used to treat a full-thickness chronic rotator cuff (RC) rupture in a rabbit model. METHODS Forty-eight shoulders from 24 rabbits were used. At the beginning of the procedure, 8 rabbits were killed to assess the control group (Group IT) with intact tendons. To establish a chronic RC tear model, a full-thickness subscapularis tear was created on both shoulders of the remaining 16 rabbits and left for 3 months. The transosseous mattress suture technique was used to repair tears in the left shoulder (Group R). The tears in the right shoulder (Group CM) were treated using the same approach, with an FGF-soaked collagen membrane inserted and sutured over the repair site. Three months after the procedure, all rabbits were killed. Biomechanical testing was performed on the tendons to determine failure load, linear stiffness, elongation intervals, and displacement. Histologically, the modified Watkins score was used to evaluate tendon-bone healing. RESULTS There was no significant difference among the three groups in terms of failure load, displacement, linear stiffness, and elongation (P > .05). The total modified Watkins score was not affected by applying the FGF-soaked collagen membrane to the repair site (P > .05). Fibrocytes, parallel cells, large-diameter fibers, and the total modified Watkins score were significantly lower in both repair groups when compared to the intact tendon group (P < .05). CONCLUSIONS In addition to tendon repair, FGF-2 soaked collagen membrane -application at the repair site provides neither biomechanical nor histological advantages in the treatment of chronic RC tears. CLINICAL RELEVANCE FGF-soaked collagen membrane augmentation provides no impact on the chronic RC tear healing tissue. The need to investigate alternative methods that may have a positive effect on healing in chronic RC repairs continues.
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Affiliation(s)
- Jotyar Ali
- Department of Orthopedics and Traumatology, Yeni Yuzyil University School of Medicine, Zeytinburnu, Istanbul, Turkey
| | - Anil Pulatkan
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey.
| | - Deniz Kara
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Okan Tezgel
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | | | - Vahdet Ucan
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Ergun Bozdag
- Biomechanics Laboratory, Department of Mechanical Engineering, Istanbul Technical University, Taksim, Istanbul, Turkey
| | - Ayse Nur Yildirim
- Department of Pathology, Medeniyet University Goztepe Research and Training Hospital), Istanbul, Turkey
| | - Fatih Yildiz
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Ibrahim Tuncay
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Mehmet Kapicioglu
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Kerem Bilsel
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
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Uzer G, Demirel M, Kara D, Toker B, Yildiz F, Ucan V. Talonavicular-cuneiform arthrodesis in the management of Mueller-Weiss Syndrome: a retrospective case series. Acta Orthop Belg 2024; 90:154-159. [PMID: 38669667 DOI: 10.52628/90.1.10628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Mueller-Weiss Syndrome (MWS), characterized by spontaneous adult-onset tarsal navicular osteonecrosis, is an uncommon cause of chronic midfoot pain that can lead to functional impairment and progressive deformities. This study aimed to present clinical and radiological outcomes of talonavicular-cuneiform (TNC) arthrodesis in the treatment of patients with MWS. A retrospective study was performed on 8 consecutive patients (6 female, 2 male; mean age = 50 years; range = 33-64) who underwent TNC arthrodesis using plate fixation with autologous bone grafting for the treatment of MWS. To evaluate clinical status, the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Midfoot Score was performed immediately preoperatively and at the final follow-up. In radiographic evaluation, talus-first metatarsal angle (Meary's angle) was measured preoperatively and at the final follow-up. Solid fusion was also examined on postoperative radiographs and computerised tomography. The mean follow-up was 35 months (range = 24-52). The mean AOFAS improved from 37 (range = 24-53) preoperatively to 85 (range = 80-93) at the final follow-up (p < 0.001). No major intra- operative complications were observed in any of the patients. According to the Maceira and Rochera radiological staging system, 5 feet was stage 3, and 3 feet was stage 4. The mean union time was 10 months (range = 5-15). Radiographic solid fusion was achieved in all but one foot that developed talonavicular non-union. TNC arthrodesis using plate fixation with autologous bone grafting seems to be an effective surgical method for reconstruction of MWS.
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Atay M, Toprak H, Yilmaz TF, Sari L, Balsak S, Ucan V, Mehdi E. Patellar height: an important parameter in knee MRI associated with tendinopathy, quadriceps fat pad edema (QFPE), anterior cruciate ligament mucoid degeneration (ACL-MD), and lateral cartilage damage. Acta Radiol 2024:2841851231223003. [PMID: 38193150 DOI: 10.1177/02841851231223003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
BACKGROUND Some pathologies associated with abnormal patellar height have been reported in the literature. However, its relationship with some pathologies, such as anterior cruciate ligament mucoid degeneration (ACL-MD) and focal cartilage defect, has not been investigated. PURPOSE To investigate the relationship between patellar height with patellar-quadriceps tendinopathy, quadriceps fat pad edema, ACL-MD, and focal cartilage defect. MATERIAL AND METHODS Magnetic resonance imaging of the knees of 261 patients were classified into three groups as normal, patella alta, and patella baja, and evaluated in terms of patellar-quadriceps tendinopathy, quadriceps fat pad edema, ACL-MD, and focal cartilage defect. RESULTS There were 261 patients (140 men, 121 women; age range = 18-60 years; mean age = 30 ± 4.7 years). Of the 261 patients, 181 (69.3%) were normal, 56 (21.4%) were patella alta, and 24 were patella baja (9.1%). Patellar-quadriceps tendinopathy, quadriceps fat pad edema, and ACL-MD rates were significantly higher compared to the normal group (P <0.05). While a moderate positive correlation was found between patellar height shift and patellar-quadriceps tendinopathy and ACL-MD, there was a small correlation between patellar height shift and quadriceps fat pad edema. The rate of focal cartilage defect was significantly higher in the middle part of the lateral femoral condyle and lateral knee joint only in patella alta. CONCLUSION The risk of patellar-quadriceps tendinopathy, quadriceps fat pad edema, ACL-MD, and lateral focal cartilage defect is higher in patients with alta-baja. The radiologist should evaluate these pathologies more carefully, especially subtle ones, in patients with abnormal patellar height.
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Affiliation(s)
- Musa Atay
- Department of Radiology, Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Huseyin Toprak
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Temel Fatih Yilmaz
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Lutfullah Sari
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Serdar Balsak
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Vahdet Ucan
- Department of Orthopedics and Traumatology, Bezmialem Foundation University School of Medicine, Istanbul, Turkey
| | - Elnur Mehdi
- Nuclear Medicine Department, Azerbaijan National Center of Oncology, Baku, Azerbaijan
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Ziroglu N, Balin H, Ucan V, Bozdag E, Kapicioglu M, Bilsel K. Three-Dimensional Finite Element Analysis of a Notched Insert Design for Reverse Total Shoulder Arthroplasty to Prevent Scapular Notching. Indian J Orthop 2023; 57:1874-1880. [PMID: 37881288 PMCID: PMC10593628 DOI: 10.1007/s43465-023-00975-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 08/06/2023] [Indexed: 10/27/2023]
Abstract
Purpose Reverse total shoulder arthroplasty (RSA) is an effective treatment option for rotator cuff arthropathy. Scapular notching following RSA remains a major complication and has a high incidence. This finite element analysis (FEA) study provides a future reference for the optimal design of the insert component of RSA. This study aims to clarify the effect of a new design RSA with a notched insert on the range of adduction, scapular notching, and stress variation of its insert component using three-dimensional (3D) FEA. Methods 3D nominal Grammont-type monobloc RSA implant components are modeled on the sawbones glenohumeral joint. The polyethylene insert is redesigned with notching of the inferior part. The comparison of standard and notched designs was performed by FEA for stress pressure of scapular notching and the degree of adduction. 3D mesh models are created for stress analysis to compare the results between standard and notched inserts for the adduction. Results The redesigned notched inserts had an additional ~ 11.2° on adduction and prevented scapular notching. The stress analysis results for the notched insert design were lower than the standard ones (4.7 vs 22.4 Kpa). Conclusions Notched insert design of Grammont-type RSA could provide additional adduction with lower stress on the glenoid, leading to less scapular notching. Further experimental and clinical studies on different RSA types are needed to verify this effect. Study Design Basic Science Study; Biomechanics and Computer Modeling.
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Affiliation(s)
- Nezih Ziroglu
- Department of Orthopedics and Traumatology, Acibadem University, Acibadem Atakent Hospital, Halkalı Merkez, Turgut Özal Bulvari No:16, 34303 Küçükçekmece/Istanbul, Turkey
| | - Hüseyin Balin
- Mechanical Engineer, Mechanical Engineering, Istanbul Technique University, Istanbul, Turkey
| | - Vahdet Ucan
- Department of Orthopedics and Traumatology, Bezmialem Vakif University, Istanbul, Türkiye
| | - Ergun Bozdag
- Mechanical Engineer, Mechanical Engineering, Istanbul Technique University, Istanbul, Turkey
| | - Mehmet Kapicioglu
- Department of Orthopedics and Traumatology, Bezmialem Vakif University, Istanbul, Türkiye
| | - Kerem Bilsel
- Department of Orthopedics and Traumatology, Bezmialem Vakif University, Istanbul, Türkiye
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Kara D, Pulatkan A, Ucan V, Orujov S, Elmadag M. Traumatic coccydynia patients benefit from coccygectomy more than patients undergoing coccygectomy for non-traumatic causes. J Orthop Surg Res 2023; 18:802. [PMID: 37891674 PMCID: PMC10605957 DOI: 10.1186/s13018-023-04098-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/14/2023] [Indexed: 10/29/2023] Open
Abstract
PURPOSE Conservative treatment is the first step in the management of coccydynia. However, surgical treatment is required in cases where conservative treatment fails. The aim of this study was to compare the effect of traumatic and atraumatic etiologies on functional outcomes in patients who underwent coccygectomy for chronic coccydynia. METHODS Ninety-seven patients who underwent partial coccygectomy between October 2010 and December 2018 for the diagnosis of chronic coccygodynia were evaluated retrospectively. The patients were divided into two groups according to etiologies as atraumatic (group AT) and traumatic (group T). Concomitant disorders of the patients were recorded as psychiatric and musculoskeletal diseases. Visual Analog Scale (VAS) for low back pain, the Oswestry Disability Index (ODI) scale, Short Form-36 Physical Component Summary and Short Form-36 Mental Component Summary were used to evaluate the clinical outcomes pre- and postoperative at the last follow-up. RESULTS The mean follow-up time was 67.3 ± 13.9 (range; 44-115) months. Group AT and group T included 48 (mean age 37.1 ± 11.3 and 36 (75%) female) and 49 patients (mean age 36 ± 11 and 35 (71.4%) female), respectively. The groups were statistically similar in terms of age (p = 0.614), gender (p = 0.691), body mass index (p = 0.885), tobacco usage (p = 0.603) and duration of pain (p = 0.073). However, the rate of musculoskeletal and total concomitant disorders was higher in the Group AT than in Group T (p < 0.05). The average preoperative SF-36 MCS and SF-36 PCS scores improved at the last follow-up from 43.3 ± 6.2 and 35.6 ± 4.9 to 72 ± 14.1 and 58.3 ± 10.9, respectively. The preoperative VAS and ODI decreased from 8 ± 1.4 and 39.8 ± 8.5 to 2.6 ± 1.8 and 13.4 ± 8.9 at the last follow-up, respectively. CONCLUSION Successful results were obtained with surgical treatment in chronic coccygodynia. In addition, functional outcomes in patients with traumatic etiology are better than in atraumatic ones. Levels of evidence Level III; Retrospective Comparative Study.
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Affiliation(s)
- Deniz Kara
- Orthopaedic Department, Washington University School of Medicine, Saint Louis, MO, USA.
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey.
| | - Anil Pulatkan
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Vahdet Ucan
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Said Orujov
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Mehmet Elmadag
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
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Tuncay I, Ucan V, Agir M, Anwar W, Elmali N. Is Only Peripheral Hip Arthroscopy Enough for Selected Patients with Femoroacetabular Impingement Syndrome? Arch Bone Jt Surg 2022; 10:1044-1048. [PMID: 36721648 PMCID: PMC9846731 DOI: 10.22038/abjs.2022.53954.2698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/09/2022] [Indexed: 02/02/2023]
Abstract
Background Peripheral compartment hip arthroscopy has gained popularity over central compartment hip arthroscopy as peripheral compartment arthroscopy does not cause perineal post compression, prolonged lower extremity traction and thus complications such as acetabular labrum and articular cartilage injuries. The study, in essence, aims to emphasize that peripheral hip arthroscopy (OPHA) alone is sufficient without an additional surgical method in the treatment of femoroacetabular impingement syndrome (FAI). Methods A total of 35 patients, being 21 female and 14 male, among a group of patients who were suffering from FAI syndrome and applied to private hip conservatory centers and has undergone hip arthroscopy at a later stage by a senior surgeon (I.T.) were selected from the medical-based software of the hospital. Patients with intra-articular pathology as a result of magnetic resonance imaging (MRI) were excluded from the study. The group had a mean age of 40.6, youngest being 17 and oldest 69, while the mean observation period was 26.6 months, varying between shortest 6 months and longest 63. In order to assess the patient satisfaction as well as clinical outcomes, Postel Merle d'Aubigné (PMA) score was used. Results When patient satisfaction was evaluated, overall decrease in pain was found and when gait characteristics were evaluated together with movement, an increase in overall satisfaction was found (P<0.05). Secondary arthroscopic procedures was not required in any of the patients included in this study. A group of three patients only needed some additional surgical interventions like stem cell therapy, hip arthroplasty and pelvic osteotomy. Conclusion OPHA can provide adequate treatment in selected FAI patients as it allows us to avoid critical complications such as damage to the cartilage, avascular necrosis, complications caused by traction and prolonged operation times seen in central compartment arthroscopy.
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Affiliation(s)
- Ibrahim Tuncay
- Department of Orthopedics and Traumatology, Bezmialem Foundation University School of Medicine, Istanbul, Turkey
| | - Vahdet Ucan
- Department of Orthopedics and Traumatology, Bezmialem Foundation University School of Medicine, Istanbul, Turkey
| | - Muzaffer Agir
- Department of Orthopedics and Traumatology, Bezmialem Foundation University School of Medicine, Istanbul, Turkey
| | - Wasim Anwar
- Department of Orthopedics and Spine Surgery, Medical Teaching Institue, Hayatabad Medical Complex Pashawar, Pakistann
| | - Nurzat Elmali
- Department of Orthopedics and Traumatology, Bezmialem Foundation University School of Medicine, Istanbul, Turkey
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Irem Demir A, Pulatkan A, Ucan V, Yilmaz B, Tahmasebifar A, Tok OE, Tuncay I, Elmali N, Ozturk BY, Uzer G. Comparison of 3 Cell-Free Matrix Scaffolds Used to Treat Osteochondral Lesions in a Rabbit Model. Am J Sports Med 2022; 50:1399-1408. [PMID: 35354059 DOI: 10.1177/03635465221074292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Various cell-free scaffolds are already in use for the treatment of osteochondral defects (OCDs); however, a gold standard material has not yet been defined. PURPOSE This study compared the macroscopic, histological, and scanning electron microscopy (SEM) characteristics of Chondro-Gide (CG), MaioRegen (MA), and poly-d,l-lactide-co-caprolactone (PLCL) cell-free scaffolds enhanced with small-diameter microfractures (SDMs) for OCDs in a rabbit model. STUDY DESIGN Controlled laboratory study. METHODS In total, 54 knees from 27 rabbits were used in this study. Three rabbits were sacrificed at the beginning of the study to form an intact cartilage control group (group IC). An OCD model was created at the center of the trochlea, and SDMs were generated in 24 rabbits. Rabbits with OCDs were divided into 4 groups (n = 12 knees per group) according to the cell-free scaffold applied: CG (group CG), MA (group MA), PLCL (group PLCL), and a control group (group SDM). Half of the rabbits were sacrificed at 1 month after treatment, while the other half were sacrificed at 3 months after treatment. Healed cartilage was evaluated macroscopically (using International Cartilage Regeneration & Joint Preservation Society [ICRS] classification criteria) and histopathologically (using modified O'Driscoll scores and collagen staining). Additionally, cell-free scaffold morphologies were compared using SEM analysis. RESULTS ICRS and modified O'Driscoll classification and staining with collagen type 1 and type 2 demonstrated significant differences among groups at both 1 and 3 months after treatment (P < .05). The histological characteristics of the group IC samples were superior to those of all other groups, except group PLCL, at 3 months after treatment (P < .05). In addition, the histological properties of group PLCL samples were superior to those of group SDM samples at both 1 and 3 months after treatment in terms of the modified O'Driscoll scores and type 1 collagen staining (P < .05). Concerning type 2 collagen staining intensity, the groups were ranked from highest to lowest at 3 months after treatment as follows: group PLCL (30.3 ± 2.6) > group MA (26.6 ± 1.2) > group CG (23.3 ± 2.3) > group SDM (18.9 ± 0.9). CONCLUSION OCDs treated with enhanced SDM using cell-free PLCL scaffolds had superior histopathological and microenvironmental properties, more hyaline cartilage, and more type 2 collagen compared with those treated using CG or MA scaffolds. CLINICAL RELEVANCE OCDs treated with PLCL cell-free scaffolds may have superior histopathological properties and contain more type 2 collagen than do OCDs treated with CG or MA cell-free scaffolds.
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Affiliation(s)
- Ahder Irem Demir
- Department of Orthopaedics and Traumatology, Istanbul Beykoz State Hospital, Istanbul, Turkey
| | - Anil Pulatkan
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Vahdet Ucan
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Bengi Yilmaz
- Department of Biomaterials, University of Health Sciences Turkey, Istanbul, Turkey
| | - Aydin Tahmasebifar
- Department of Biomaterials, University of Health Sciences Turkey, Istanbul, Turkey
| | - Olgu Enis Tok
- Department of Histology and Embryology, Medipol University Medical Faculty Regenerative and Restorative Medicine Research Center, Istanbul, Turkey
| | - Ibrahim Tuncay
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Nurzat Elmali
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Gokcer Uzer
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
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Bilgin E, Tezgel O, Ucan V, Kapıcıoğlu M, Turgut A, Bilsel K. Clinical Outcomes of Two-Stage Implantation in Reverse Shoulder Arthroplasty for Postinfectious End-Stage Glenohumeral Arthritis in Native Shoulders: A Single-Center Cohort Study with a Minimum 2-Year Follow-up. Clin Orthop Surg 2022; 15:272-280. [PMID: 37008966 PMCID: PMC10060767 DOI: 10.4055/cios21275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/01/2022] [Accepted: 04/16/2022] [Indexed: 11/06/2022] Open
Abstract
Background Septic arthritis of the shoulder is a rare but devastating condition that may lead to joint destruction. There are few studies and limited outcome data on shoulder arthroplasty for infected native shoulders with end-stage glenohumeral arthritis (GHA). Hence, this study aimed to demonstrate the clinical outcomes of two-stage implantation in reverse shoulder arthroplasty (RSA) using an antibiotic spacer in the first stage for this challenging condition. Methods We conducted a retrospective study on two-stage implantation in RSA in infected shoulders. Patients were diagnosed with end-stage GHA due to primary shoulder sepsis or infection following non-arthroplasty shoulder surgery. Laboratory data, range of motion (ROM), and functional scores including American Shoulder and Elbow Surgeons score, Constant score, and Disabilities of the Arm, Shoulder and Hand score were assessed prior to spacer placement and at the latest follow-up. Furthermore, intraoperative and postoperative complications were recorded. Results In this study, 10 patients with a mean age of 54.8 ± 15.8 years (range, 30-77 years) were included. The mean follow-up period was 37.3 ± 9.1 months (range, 25-56 months). All postoperative ROM measurements and functional scores were improved significantly. Although no reinfection was observed, a total of 5 complications including 2 hematomas, 1 intraoperative humeral fracture, 1 humeral stem loosening, and 1 anterior deltoid dysfunction were observed in 4 patients after a follow-up period of at least 2 years after RSA. Conclusions Two-stage implantation in RSA is an effective method for improving the function and controlling the infection in postinfectious end-stage GHA in native shoulders.
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Affiliation(s)
- Emre Bilgin
- Department of Orthopaedics and Traumatology, Health Science University Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Okan Tezgel
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
| | - Vahdet Ucan
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Kapıcıoğlu
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
| | - Ali Turgut
- Department of Orthopaedics and Traumatology, Health Science University Tepecik Training and Research Hospital, Izmir, Turkey
| | - Kerem Bilsel
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
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Pulatkan A, Kapicioglu M, Ucan V, Masai MN, Ozdemir B, Akpinar S, Bilsel K. Do Techniques for Hill-Sachs Remplissage Matter in Terms of Functional and Radiological Outcomes? Orthop J Sports Med 2021; 9:23259671211008152. [PMID: 34262976 PMCID: PMC8243109 DOI: 10.1177/23259671211008152] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Different techniques are used for the remplissage procedure, including the
double-pulley and mattress suture techniques. Both techniques have shown
good results; however, it is unclear if one technique is superior. Hypothesis: The remplissage procedure using the double-pulley technique with 2 anchors
would have superior functional and radiological outcomes compared with the
mattress suture technique with a single anchor. Study Design: Cohort study; Level of evidence, 3. Methods: This study included patients with anterior shoulder instability who were
treated using arthroscopic Bankart repair combined with remplissage between
2012 and 2017. A structured questionnaire was used to gather information on
the following metrics: Instability Severity Index Score, hyperlaxity, Sugaya
index, presence of a Hill-Sachs defect, number of dislocations before
surgery, sports participation, radiological measurement of the Hill-Sachs
lesion, postoperative range of motion in both shoulders, Rowe score,
Walch-Duplay score, American Shoulder and Elbow Surgeons score, and Filling
Index Score of Remplissage grade according to magnetic resonance imaging
scans at the last follow-up. Results: There were 41 patients included with a mean age of 30 ± 7 years who underwent
the Hill-Sachs remplissage procedure using the double-pulley technique with
2 anchors (n = 21; group DA) or the mattress suture technique with a single
anchor (n = 20; group SA). At the final follow-up, there were no significant
differences between the groups regarding the Instability Severity Index
Score (P = .134), the Sugaya index (P =
.538), sports participation (P = .41), the radiological
measurement of the Hill-Sachs lesion (P = .803), or the
Rowe score (P = .182). However, there were significant
differences between the groups in the Walch-Duplay score (P
= .012), American Shoulder and Elbow Surgeons score (P =
.005), and Filling Index Score of Remplissage grade (P =
.015), favoring group DA, as well as differences in external rotation in a
neutral position (external rotation loss: 9° ± 3° [group SA] vs 12° ± 3°
[group DA]; P = .003) and at 90° of abduction (external
rotation loss: 8° ± 3° [group SA] vs 11° ± 3° [group DA]; P
= .006), favoring group SA. Conclusion: In the remplissage procedure, the double-pulley technique provided better
filling of the lesion and improvement in functional scores, but external
rotation was limited compared with the mattress suture technique.
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Affiliation(s)
- Anil Pulatkan
- Department of Orthopedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Mehmet Kapicioglu
- Department of Orthopedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Vahdet Ucan
- Department of Orthopedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
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Ucan V, Pulatkan A, Tuncay I. Unicompartmental knee arthroplasty combined with high tibial osteotomy in anteromedial osteoarthritis: A case report. Int J Surg Case Rep 2021; 81:105746. [PMID: 33756167 PMCID: PMC8020433 DOI: 10.1016/j.ijscr.2021.105746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/06/2021] [Accepted: 03/09/2021] [Indexed: 11/28/2022] Open
Abstract
Anteromedial osteoarthritis is a common knee pathology. Spontaneous osteonecrosis of the knee causing anteromedial osteoarthritis can be treated with different surgical options. Although high tibial osteotomy and unicompartmental knee arthroplasty are alternative treatments for anteromedial osteoarthritis, successful results can be obtained using both in individual cases.
Introduction and importance Anteromedial osteoarthritis (AMOA) is a common knee pathology. However, the best treatment of AMOA remains unclear. Unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) are surgical options for AMOA patients who do not benefit from conservative treatment. We aimed to show an unusual treatment option where UKA and HTO are performed simultaneously. Case presentation We present a 52-year-old man with AMOA secondary to spontaneous osteonecrosis of the knee (SONK) and metaphyseal tibial varus malalignment, who was successfully treated with a combined UKA and HTO. His functional scores were excellent at the 5-year follow-up. Clinical discussion Advanced SONK that causes AMOA can be treated with osteochondral autograft transplantation (OAT), HTO, UKA, or total knee arthroplasty (TKA). Although good results have been reported selecting appropriate patients for all of these methods, the best treatment method remains unclear. Conclusion Although HTO and UKA are alternative treatments for AMOA, successful results can be obtained using both in individual cases.
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Affiliation(s)
- Vahdet Ucan
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Vatan Cd, Fatih, 34093, Istanbul, Turkey.
| | - Anil Pulatkan
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Vatan Cd, Fatih, 34093, Istanbul, Turkey
| | - Ibrahim Tuncay
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Vatan Cd, Fatih, 34093, Istanbul, Turkey
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Yildiz F, Sari A, Pulatkan A, Ucan V, Kochai A, Bilsel K. Effect of nonoperative concomitant intraarticular pathologies on the outcome of arthroscopic capsular release for adhesive capsulitis of the shoulder. Acta Orthop Traumatol Turc 2018; 52:245-248. [PMID: 29699862 PMCID: PMC6145969 DOI: 10.1016/j.aott.2018.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 01/30/2018] [Accepted: 04/11/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to investigate whether coexistent intraarticular lesions are negative prognostic factors for the results of arthroscopic capsular release in frozen shoulder patients. METHODS Seventy-two patients who met inclusion criteria and underwent arthroscopic capsular release between March 2011 and August 2015 for the frozen shoulder were retrospectively evaluated. The patients were divided into two groups according to existence of concomitant intraarticular pathologies detected during arthroscopy. Preoperative and postoperative functional results were assessed with Constant score and shoulder ranges of motion; and the amount of pain was evaluated using visual analog scale (VAS). RESULTS Group I consisted of 46 patients (mean age 47.2 years and mean follow-up 26 months) without concomitant shoulder pathologies and group II consisted of 26 patients (mean age 48.6 years and mean follow-up 15 months) with coexistent lesions (SLAP lesions, n = 8; SLAP and partial rupture of the RC, n = 4; SLAP, partial rupture of RC and impingement, n = 10; SLAP and impingement, n = 2; and AC arthritis and impingement, n = 2). Preoperatively, the mean ranges of forward flexion (p = 0.221), abduction (p = 0.065), internal rotation (p = 0.564), Constant (p = 0.148) and VAS (p = 0.365) scores were similar between the groups. After a minimum 12 months of follow-up, all patients significantly improved but no statistically significant difference was detected in the mean ranges of forward flexion (152 vs 150; p = 0.902), abduction (137 vs 129; p = 0.095), external rotation (45 vs 40; p = 0.866), internal rotation (5 vs 5 point; p = 0.474), Constant (82 vs 82.3; p = 0.685) and VAS (1.2 vs 1.2; p = 0.634) scores between the groups. CONCLUSION The presence of concomitant shoulder pathologies does not appear to affect the clinical outcomes in patients undergoing arthroscopic capsular release for frozen shoulder. LEVEL OF EVIDENCE Level III, Therapeutic study.
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Affiliation(s)
- Fatih Yildiz
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey.
| | - Abdulkadir Sari
- Department of Orthopedics and Traumatology, Namık Kemal University School of Medicine, Tekirdag, Turkey
| | - Anil Pulatkan
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Vahdet Ucan
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Alauddin Kochai
- Department of Orthopedics and Traumatology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Kerem Bilsel
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
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