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    The effect of tourniquet and knee position during wound closure after total knee arthroplasty on early recovery of range of motion: a prospective, randomized study
    (Springer, 2016) Sukur, Erhan; Ozturkmen, Yusuf; Akman, Yunus Emre; Senel, Ahmet; Azboy, Ibrahim
    There is no consensus on the position of the knee joint while performing wound closure after total knee arthroplasty (TKA). Further, there are no studies focusing on the association between early functional outcomes and different wound closure strategies. Therefore, we investigated the effects of tourniquet and knee position during wound closure on early recovery of range of motion (ROM) after primary TKA. To our knowledge, this is the first study to evaluate the influence of both tourniquet and knee position during wound closure in primary TKA. One hundred-twenty eligible patients were consecutively enrolled in this study and randomly divided into four groups according to wound closure strategy. Wound closure was either performed with the knee in flexion at 90A degrees or in full extension, with the combination of an inflated or deflated tourniquet. Visual analogue score (VAS), knee ROM, ROM recovery, knee society score (KSS), and wound complications were evaluated in the early postoperative period. After the first postoperative week, ROM recovery in the group with knee in extension and inflated tourniquet was significantly lesser than the two groups with deflated tourniquets. Between the first and fourth postoperative weeks, ROM recovery in the group with knee inflection and deflated tourniquet was significantly higher than the two groups with knee in extension. After the first postoperative week, the visual analog score (VAS) for pain in the group with knee inflection and deflated tourniquet was significantly lesser than the two groups with inflated tourniquets. The differences in the outcomes between the four groups were not significant after the fourth postoperative week. The incidence of wound complications and KSS were not significantly different between the four groups. Following TKA, wound closure with the knee in flexion and after deflating the tourniquet significantly decreased postoperative pain and promoted the recovery of ROM in the early postoperative period.
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    Intramedullary Titanium Elastic Nailing in the Treatment of Paediatric Diaphyseal Femur Fractures
    (Aves, 2013) Sukur, Erhan; Azboy, Ibrahim; Demirtas, Abdullah; Bulut, Mehmet; Ucar, Bekir Yavuz; Alemdar, Celil
    Objective: We evaluated the clinical and radiographical outcomes in paediatric patients with diaphyseal femur fractures who were treated with intramedullary titanium elastic nails. Methods: Twenty-two patients (15 boys, 7 girls; mean age 7.6 years; range 6 to 12 years) with diaphyseal femur fractures who were treated with retrograde titanium elastic nailing (TEN) were evaluated in the study. 15 of the fractures were located mid-diaphyseally, 4 proximal diaphyseally and 3 distal diaphyseally. Open reduction via lateral incision was applied in cases in which closed reduction could not be achieved. Anterior-posterior and lateral radiographical views of the femur were used in the follow-up period. Gait patterns, range of motion of the knees and the hips, hospitalization time, time to union, limb length discrepancy between the lower extremities, and any complications were evaluated in the patients. Flynn's TEN scoring system was used to evaluate the outcomes. Results: Union was obtained in a mean of 6.8 weeks (range 5 to 11 weeks) in all of the patients. The anterior-posterior radiographs indicated that normal alignment was achieved in 19 patients. Two patients had a 5 degree varus malalignment and one had a 6 degree valgus malalignment. Two patients had a 6 degree anterior malalignment in the lateral radiographical view. Average limb length discrepancies of 7 mm were seen in 2 patients and of 6 mm were seen in 3 patients. Hip and knee motion were mildly restricted in one patient. Gait pattern was symmetric in all but one patient. Superficial wound infection was detected in one patient. None of the patients had nonunion, early closure of the epiphyseal plate or fracture following TEN extraction. Fifteen patients had excellent and 7 had good results according to Flynn's criteria. Mean hospitalization time was 4.2 days (range 3 to 9 days) and mean follow up period was 20.2 months (range 14 to 24 months). Conclusion: Intramedullary TEN is a successful method that yields good results for paediatric diaphyseal femoral fractures.
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    Long-term results of porous-coated cementless total knee arthroplasty with screw fixation
    (Turkish Assoc Orthopaedics Traumatology, 2013) Azboy, Ibrahim; Demirtas, Abdullah; Bulut, Mehmet; Ozturkmen, Yusuf; Sukur, Erhan; Caniklioglu, Mustafa
    Objective: The aim of this study was to evaluate the long-term results of porous-coated, cementless total knee arthroplasty with screw fixation. Methods: This study included 68 knees of 54 patients (43 female, 11 male; mean age: 56.9 years, range 46 to 70 years). Cruciate-retaining cementless total knee prostheses were implanted in all patients diagnosed with primary osteoarthritis. Clinical, functional and radiological evaluations were performed according to the Knee Society's Knee Scoring System (KSS). Prosthesis survival was analyzed using Kaplan-Meier curves. Mean follow-up time was 9.2 (range: 8 to 12) years. Results: Preoperative mean knee and function scores were 42.3 (range: 32 to 61) and 39.1 (range: 35 to 66), respectively, while they were 88.6 (range: 54 to 96) and 82.8 (range: 50 to 100), respectively at the final follow-up (p<0.05). Mean preoperative knee flexion was 98 degrees (range: 80 degrees to 110 degrees) and 112 degrees (range: 85 degrees to 130 degrees) at the final follow-up (p<0.05). Preoperative and postoperative mean alignments were 9.2 degrees varus and 5.4 degrees valgus, respectively. Revisions were performed due to aseptic loosening of the tibial component in one patient, periprosthetic fracture in one and dislocation of the patella in one. Two superficial infections (3%) were observed. There was no osteolysis around the screws during the follow-up period. The overall rate of implant survival was 95.6% (range: 91.56% to 99.60%; 95% CI) at 12 years. Conclusion: Long-term outcomes of porous-coated, cementless total knee arthroplasty with screw fixation were successful in terms of clinical and radiological evaluation and yielded a high survival rate.