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Objective: The purpose of this study was to compare long-term clinical and radiographic outcomes of mobile- (MB) and fixed-bearing (FB) total knee arthroplasties (TKA). Methods: A randomized controlled study was conducted to compare the clinical and radiographic outcomes of MB and FB prostheses in 93 consecutive patients who underwent primary TKA for knee osteoarthritis. Mean follow-up of the patients was 100.9 months in the MB group (range: 78–121 months) and 93.7 months (range: 78–120 months) in the FB group. The clinical results were graded according to the Knee Society Knee Score (KSKS) and the Knee Society Functional Score (KSFS). Secondary outcomes included pain, patellofemoral joint function, quality of life (QOL), and radiologic outcomes (Knee Society’s roentgenographic evaluation system). Results: Although there was significant improvement in both groups, there were no significant differences between the groups with respect to mean KSFS and radiologic outcomes. However, mean pain score of the MB group was significantly higher than that of the FB group (48.83±0.62 vs 47.39±0.86, respectively, p=0.011), and mean KSKS was significantly higher than that of the FB group (93.5±6.2 vs 89.7±6.9, respectively, p=0.007). Conclusion: TKA clinical results were satisfactory in both the MB and FB groups. KSKS and pain scores were significantly better in the MB than in the FB group. However, no differences were found in other assessments. Thus, we conclude that the best design is the one with which the surgeon is most comfortable and most able to implant reproducibly.

The aim of this study was to evaluate the effect of SH (sodium hyaluronate—NaHA) on vascular endothelial growth factor (VEGF) and type IV collagen expression during the Achilles-tendon healing process. Adult New Zealand white rabbits (n=32) aged 4 months and weighing 2.7–3.9 kg were used. The rabbits were randomly divided into two groups, and each group was divided into two subgroups and monitored for 6 and 12 weeks. Tendo calcanei were incised transversely and repaired. An injection of 0.5 ml NaHA (15 mg/ml) was administered between the tendon and paratenon of the right leg and repeated twice at one-week intervals. Equal numbers of animals were sacrificed at the 6th and 12th weeks, and the repaired tissue was examined macroscopically and histologically for the presence of VEGF and type IV collagen expression every week. The decrease in the amount of adhesion tissue and the acceleration of tendon healing in the NaHA group were significantly high when compared with control groups at 6 and 12 weeks (p

Using an experimental model of segmental bone defect in the ulna of rabbits we investigated the effect on bone healing of fresh cancellous autograft (FCA), demineralized deep-frozen allograft (DDA), and demineralized deep-frozen allograft covered with free autogenous periosteum (DDAwP). Radiologically, it was found that the results of the FCA and DDAwP groups were superior to those of the DDA group. This superiority was statistically significant after the 3rd to the 9th week for the FCA group, and the 6th to the 9th week for the DDAwP group. However, bone formation and union in the DDA group reached the same level of those in the other groups after 12 weeks. When the all histological findings were compared at the 12th week, the FCA and DDAwP groups were statistically superior to the DDA group in terms of proximal union. On distal union, the FCA group was statistically superior to the DDA group. Biomechanically, the FCA and DDAwP groups were statistically superior to the DDA group in terms of maximum torque and energy absorption. The DDAwP group was superior to the DDA group in term of stiffness. We conclude that ossification could be more easily achieved if demineralized deep-frozen allograft is covered with periosteum when faced with the need for quicker and better quality bone integration.

This study compared pullout strengths of the T-fix device versus horizontal suture toward improving T-fix biomechanical properties. Twenty bovine medial menisci were used for this study. Four groups were tested and mean tearing stress were obtained. In group 1 a standard T-fix suture was performed (50.2±4.2 N); in group 2 horizontal mattress sutures were placed in the meniscus using 2-0 vicryl (54.6±4.2 N); in group 3 three T-fix suture anchors were placed: the central suture a double suture anchor and those on either side single suture anchors, resulting in two horizontal sutures (61.8±3.8 N); in group 4 we modified the technique used in group 3. The double suture anchor was placed the incision, at a 30° angle oblique to the horizontal (71.0±5.9 N). There was a statistically significant difference between groups 3 and 4 but not between groups 1 and 2. In conclusion: Using a T-fix suture anchor in the standard technique has similar biomechanical properties to the horizontal mattress suture. To improve the tensile properties of the T-fix suture a double T-fix suture anchor should be used obliquely to the other two single T-fix sutures on either side.

Seventy-four revisions of the femoral component featuring placement of a Wagner stem in 74 patients operated upon between 1995 and 2003 were reviewed. Clinical evaluation, radiological assessment, and survival analysis of revision stems were conducted. The mean follow-up duration was 14.4 years (range, 11 to 19 years). When failure was defined as stem removal for any reason, 4 of 64 stems had to be further revised during the follow-up period, yielding a cumulative stem survival rate of 93.8% (95% CI: 87.7% to 98.2%) at 18 years. The Wagner revision stem is an effective implant for revision hip surgery when bone stock is lacking. Use of the stem affords mechanical stability even when bone loss is massive.

We asked whether tranexamic acid (TXA) administration could reduce blood loss and blood transfusion requirements after simultaneous bilateral total knee arthroplasty (TKA). This study examined the role of a novel method of TXA administration in TKA.TXA was administered as a bolus dose of 15 mg/kg 10 min before the inflation of the tourniquet on the first side. This was followed by intra-articular administration of 3 grams at 10 min before the deflation of the tourniquet. IV infusion of 10 mg/kg/h was continued for 3h following completion on the second side. We measured volume of drained blood 48 h postoperatively, decrease in hemoglobin levels 12h postoperatively, amount of blood transfused (BT), and number of patients requiring allogenic BT.Median postoperative volume of drained blood was lower in the group receiving TXA (500.00 mL) than in control subjects (900.00 mL) (p0.05) [95% CI (-525.00) to (-300.00)]. The median hemoglobin decrease 12 h postoperatively was lower in patients receiving TXA (2.10 g/dL) than in control subjects (3.10 g/dL) (p0.05) [95% CI (-1.60) to (-0.60)]. The amount of BT and number of patients requiring BT were lower in patients receiving TXA than in control subjects. Nevertheless, the number of allogeneic units of packed red blood cells transfused in the postoperative period was not significantly higher in the control group than in the TXA group (p=0.109) [95% CI (0.101) to (0.117)].This prospective randomized study showed that during simultaneous bilateral TKA, TXA reduced blood loss with negligible side effects.

We reviewed the results of a primary one-stage combined operation in 47 patients (55 hips) who were greater than or equal to 4 years and had congenital dislocation of the hip. At a mean follow-up of 7.5 years (2-16 years), 67% of the whole series had good or excellent clinical results, and 65% were good or excellent radiologically. Avascular necrosis occurred in four patients, and redislocation also occurred in four patients. We concluded that most of the children who are greater than or equal to 4 years and who have congenital dislocation of the hip can successfully be treated with an extensive one-stage operation consisting of open reduction combined with innominate osteotomy and femoral varus, derotation, and shortening osteotomy.

Twenty-seven adolescents with 29 femoral shaft fractures, between the ages of 10 and 16 years, were treated with closed flexible Ender intramedullary nailing from 1989 to 1992 in our clinic. In one patient who had a fracture of the distal third of the femoral shaft, the nail was inserted proximal to distal (antegrade nailing). In the other patients, the nails were inserted distal to proximal (retrograde nailing). Clinical and radiological follow up averaged 32 months (18–56 months). Hospitalization averaged 15 days (7–28 days). All fractures healed with one significant leg length discrepancy of 1.7 cm in a patient who had developed osteomyelitis. There was no significant angulation or malrotation. All patients had a normal gait and were able to participate in full activities. There was one deep wound infection in a patient with an open fracture of the femoral shaft. There were no non-unions, delayed-unions or psychological complications. For this age group, this treatment of femoral shaft fracture should be considered owing to the functional recovery with low morbidity and cost, providing early ambulation, early discharge from hospital and early return to school.

We report a case study of a patient who underwent bone–patellar tendon–bone ACL reconstruction using an Endobutton. Although the fact that the Endobutton did not pass outside the femoral cortex was realized after the operation, Lachman's test was negative. The Endobutton appeared to hang onto the femoral tunnel as an anchor, and it was decided to observe rather than intervene. One year later no laxity had developed, and a second-look arthroscopy showed a good ligament reconstruction. Although it is quite easy to perform, Endobutton fixation in ACL surgery requires that maximum care be taken to ensure that the Endobutton has flipped.

The results following primary and delayed primary repair in zone 2 flexor tendon injuries were evaluated prospectively in 88 fingers of 71 patients using two different early postoperative mobilization programmes. In 33 patients, the Kleinert rubber band passive flexion method was used. In the remaining 38 patients, the early active mobilization programme was used. All patients were reviewed 1 year after operation and the results assessed by the Strickland criteria. During this evaluation maximum grip strength was also measured.The results were excellent or good in 78% of digits and mean grip strength was 84% of the uninjured hand in the Kleinert rubber band passive flexion group. In the early active mobilization group, excellent or good results were achieved in 85% of the digits and the mean grip strength was 90% of the uninjured hand. There were two early ruptures in each group.