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Öğe A new augmentation method for improved screw fixation in fragile bone(Frontiers Media S.A., 2022) Raina, Deepak Bushan; Stravinskas, Mindaugas; Markevi?i?t?, Vetra; Kok, Joeri; Jacobson, Ida; Liu, Yang; Sezgin, Erdem Aras; Isaksson, Hanna; Zwingenberger, Stefan; Tägil, Magnus; Tarasevi?ius, Šar?nas; Lidgren, LarsPertrochanteric fractures (TF) due to osteoporosis constitute nearly half of all proximal femur fractures. TFs are treated with a surgical approach and fracture fixation is achieved using metallic fixation devices. Poor quality cancellous bone in osteoporotic patients makes anchorage of a fixation device challenging, which can lead to failure of the fracture fixation. Methods to reinforce the bone-implant interface using bone cement (PMMA) and other calcium phosphate cements in TFs have been described earlier but a clear evidence on the advantage of using such biomaterials for augmentation is weak. Furthermore, there is no standardized technique for delivering these biomaterials at the bone-implant interface. In this study, we firstly describe a method to deliver a calcium sulphate/hydroxyapatite (CaS/HA) based biomaterial for the augmentation of a lag-screw commonly used for TF fixation. We then used an osteoporotic Sawbones model to study the consequence of CaS/HA augmentation on the immediate mechanical anchorage of the lag-screw to osteoporotic bone. Finally, as a proof-of-concept, the method of delivering the CaS/HA biomaterial at the bone-implant interface as well as spreading of the CaS/HA material at this interface was tested in patients undergoing treatment for TF as well as in donated femoral heads. The mechanical testing results indicated that the CaS/HA based biomaterial increased the peak extraction force of the lag-screw by 4 times compared with un-augmented lag-screws and the results were at par with PMMA. The X-ray images from the patient series showed that it was possible to inject the CaS/HA material at the bone-implant interface without applying additional pressure and the CaS/HA material spreading was observed at the interface of the lag-screw threads and the bone. Finally, the spreading of the CaS/HA material was also verified on donated femoral heads and micro-CT imaging indicated that the entire length of the lag-screw threads was covered with the CaS/HA biomaterial. In conclusion, we present a novel method for augmenting a lag-screw in TFs, which could potentially reduce the risk of fracture fixation failure and reoperation in fragile osteoporotic patients.Öğe Biomaterials a nd their carriers for managing bone disorders(CRC Press, 2024) Sezgin, Erdem ArasBone is often regarded as a prototype for tissue engineering practices with its profound regenerative ability. Developing biological substitutes mimicking the natural composition of the bone and discovering ways to alter the biological pathways of bone regeneration are amongst the most prominent topics in regenerative medicine research. Despite the multitude of in vitro and in vivo research with great potential to improve the management of bone-related disorders, clinical trials on the topic are lagging, partly due to expenses and regulations. Therefore, routine clinical application of promising research may still take years, if not decades. All is not lost however, as there are numerous clinical trials and applications in the field of orthopedics and maxillofacial surgery. This chapter briefly presents an overview of the biomaterials and biomaterial carriers used to reconstruct bone defects as alternatives to natural grafts, utilize mesenchymal progenitor cells with osteogenic potential or platelet-rich plasma, augment the anchorage of inert or bioabsorbable implants, and deliver particular antibiotics to treat osteomyelitis or periprosthetic joint infections as well as anticancer drugs to the bone.Öğe Combined fracture and mortality risk evaluation for stratifying treatment in hip fracture patients: A feasibility study(Turkish Joint Diseases Foundation, 2020) Sezgin, Erdem Aras; Markeviçiute, Vetra; Širka, Aurimas; Tarasevic?ius, Šar?nas; Raina, Deepak Bushan; Isaksson, Hanna; Tägil, Magnus; Lidgren, LarsObjectives: This study aims to test the feasibility of the Fracture and Mortality Risk Evaluation (FAME) Index. Patients and methods: Two academic centers in Lithuania and Turkey participated in this retrospective study conducted between November 2018 and July 2019. A total of 100 consecutive patients (22 males, 78 females; mean age 78.9 years; range, 45 to 100 years) with low energy proximal femur fractures admitted for surgery were included in the study. Fracture Risk Assessment tool (FRAX) and the Sernbo scores were calculated and patients were classified into one of the nine subcategories of the FAME Index. Results: Demographics and FAME Index classifications were similar between centers. Patients with high risk of fracture and low risk of mortality accounted for 18% of all patients, which is the FAME Index subcategory to theoretically benefit from cancellous bone augmentation during internal fixation of a fragility hip fracture the most. Conclusion: The FAME Index was successfully applied in clinical emergency setting utilizing a simple form, and demonstrated promising potential in stratification of hip fractures most suitable for screw and device augmentation. Larger studies with at least one-year of follow-up are warranted to verify the validity of FAME Index.Öğe Comparative effectiveness research on proximal femoral nail versus dynamic hip screw in patients with trochanteric fractures: a systematic review and meta-analysis of randomized trials(BMC, 2022) Xu, Hong; Liu, Yang; Sezgin, Erdem Aras; Tarasevicius, Sarunas; Christensen, Robin; Raina, Deepak Bushan; Tagil, Magnus; Lidgren, LarsBackground The treatments for trochanteric fractures try to regain early mobility and limit morbidity and risk of reoperations. The most currently used dynamic hip screw (DHS) and the proximal femoral nail (PFN) are both with pros and cons. We aimed to assess the comparative effectiveness of these interventions for trochanteric fractures by evaluating the surgical performance and postoperative outcomes. Methods PubMed, Web of Science and Cochrane Central Register were searched for RCTs comparing DHS and PFN for trochanteric fractures. All selected studies and the risk of bias were assessed. Clinical data including operative time, intraoperative blood loss, intraoperative fluoroscopy time, successful closed reduction and complications like nonunion, implant failure and reoperation were recorded. Random-effects models were used in Review Manager software, and GRADE was applied for the interpretation of the evidence. Results From 286 identified trials, twelve RCTs including 1889 patients were eligible for inclusion; six RCTs directly comparing DHS with PFN, while other six compared DHS with proximal femoral nail antirotation (PFNA). Compared to DHS, PFN had shorter operative time and led to less intraoperative blood loss. However, DHS need less intraoperative fluoroscopy time than PFN. No difference was seen for the achievement of closed reduction. For risk of postoperative complications, no difference was seen between PFN and DHS for non-union, risk of implant failure and revision surgery. Conclusions PFN(A) resulted in a shorter operative time and less intraoperative blood loss compared to DHS. However, no difference was seen for postoperative complications.Öğe Comparison of five patellar height measurement methods in a Turkish adult cohort(Annals of Medical Research, 2020) Çapkın, Serap; Güler, Serdar; Sezgin, Erdem ArasAim: The aim of this study was to investigate the correlation between the methods traditionally used for patellar height measurements [Insall-Salvati (IS), Modified Insall-Salvati (MIS), Blackburne-Peel (BP), Caton-Deschamps (CD)] and the plateau-patellar angle (PPA) in Turkish adult population. Material and Methods: A cross-sectional retrospective study was conducted. A total of 100 lateral knee radiographs in 30° flexion were analyzed by two blinded orthopedist independently to each other’s measurements. The average IS ratio, MIS ratio, BP ratio, CD ratio and PPA measurement were calculated by taking the average of the measurement values of both observers. The inter-observer reliability for two observers was determined using intraclass correlation coefficients (ICC). Spearman rank correlation analysis was performed to analyze correlations between mean ratios/angle measurements. Results: The mean age at the time of the radiographs was 30.18 ± 5.78 (range:20-40) years, 60% were female, and 58 radiographs were of the right knee. The mean and standard deviations of the patella height measurements were found 1.05 ± 0.12 according to the IS ratio; 1.66 ± 0.29 according to the MIS ratio; 0.91 ± 0.15 according to the CD ratio; 0.84 ± 0.14 according to the BP ratio; 24.74° ± 2.87° according to PPA measurement. There was highest inter-observer agreement between the two observers with an ICC of 0.926 (95% confidence interval: 0.89-0.950), excellent reliability, for the PPA measurement. Inter-observer agreement between two observers was good reliability for other measurements (IS, MIS, CD, BP). The highest correlation was between CD ratio and BP ratio, strong correlation, with a Pearson's correlation coefficient of 0.790. Conclusion: The PPA appears to be a feasible tool that can assess patellar height with higher reliability compared to the four most commonly used methods, in a Turkish adult populationÖğe Diagnostic role of neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio in patients with enchondroma and low-grade chondrosarcoma(Turkish Joint Diseases Foundation, 2020) Yapar, Ali Ekber; Ulucaköy, Coşkun; Sezgin, Erdem Aras; Atalay, İsmail Burak; Ekşio?lu, Mehmet FatihObjectives: This study aims to evaluate the role of elevated neutrophil-to-lymphocyte ratio (NLR) and monocyte-tolymphocyte ratio (MLR) in differential diagnosis of enchondroma and low-grade chondrosarcoma. Patients and methods: One-hundred-and-one patients (44 males, 57 females; mean age 53.6±11.5 years; range, 21 to 85 years) diagnosed with enchondroma and low-grade chondrosarcoma in Ankara Oncology Training and Research Hospital between January 2010 and December 2019 were included in this retrospective study. Patients' age, gender, location and type of tumor, and pre-treatment complete blood count results were acquired. One-hundred patients (48 males, 52 females; mean age 50.9±13.6 years; range, 19 to 76 years) with complete blood count results admitted to the same center for reasons other than fracture, infection or tumors with similar age and gender to the aforementioned study group were included as healthy controls. Results: Neutrophil-to-lymphocyte ratio and MLR of the study group were found to be significantly higher than the control group (p<0.001). Neutrophil-to-lymphocyte ratio and MLR held diagnostic importance with statistically significant cut-off values. Statistically significant cut-offs for NLR and MLR were =2.0 (sensitivity=73.3%, specificity=67%) and =0.2 (sensitivity=76.2%, specificity=63%), respectively. Multivariate logistic regression analysis was performed adjusting for age and gender and NLR =2 [odds ratio (OR)=3.1] or MLR =0.2 (OR=2.9) were found to be associated with approximately three-fold risk for diagnosis of enchondroma or low-grade chondrosarcoma. Conclusion: The NLR and MLR have diagnostic value in cartilaginous tumors such as enchondroma and low-grade chondrosarcoma. However, our results do not support utilization of NLR and MLR as diagnostic value for differentiation of enchondroma and low-grade chondrosarcoma.Öğe Different microbial and resistance patterns in primary total knee arthroplasty infections - a report on 283 patients from Lithuania and Sweden(BMC Musculoskeletal Disorders, 2021) Sebastian, Sujeesh; Sezgin, Erdem Aras; Stucinskas, Justinas; Tarasevicius, Sarunas; Liu, Yang; Raina, Deepak Bhushan; Tagil, Magnus; Lidgren, Lars; W-Dahl, AnnetteBackground The microbiology and the susceptibility patterns of infected total knee arthroplasties (TKAs) vary depending on demographic, local antimicrobial stewardship, and surgical factors. We wanted to compare the recent microbial profile and antimicrobial resistance pattern in revisions due to infections after primary TKAs in Sweden and Lithuania. Our hypothesis was that there is a difference in bacteriology and resistance pattern based on patient related, societal and local hospital factors as almost similar praxis have been applied for TKA surgery, short term systemic prophylaxis and routine use of local gentamicin containing bone cement. Methods Primary TKAs revised for the first time due to verified or suspected infection were collected nationwide in Sweden during 2018, and in Lithuania between 2011 and 2020 from a single major TKA revision centre in Kaunas. We identified 202 TKAs in Sweden from the Swedish Knee Arthroplasty Register and 84 from Kaunas revised due to infection. We collected available culture reports and evaluated the type of microorganisms with antimicrobial resistance pattern at revision. Results The majority of the infected cases in Sweden were early-type prosthetic joint infection (PJI) (44%), whereas late-type PJI (52%) were more common in the Kaunas cases. Gram-positive bacteria prevailed in both Sweden (55%) and Lithuania (80%). Staphylococcus aureus was the most frequent organism identified in both countries (33% in Sweden and 34% in Lithuania). More polymicrobial infections were observed in Sweden than in Lithuania (16 and 6% respectively). Methicillin resistance in Staphylococcus aureus and coagulase-negative staphylococci were higher in Lithuania (4/28 and 19/29) than in Sweden (1/42 and 9/41). Conclusions The type of infections, microbial profile, and drug resistance pattern differed between Sweden and Lithuania. Societal and local hospitals factors with emerging resistance in Lithuania are the most plausible explanation for the difference. Lack of complete data on a national level in Lithuania underlines the importance of adding microbiology of PJIs in implant registers for national aggregation and allow cross country comparisons.Öğe Does glenoid bone loss accompany posterior shoulder instability with only labral tear? A magnetic resonance imaging–based study(Elsevier Inc., 2023) Orhan, Özlem; Sezgin, Erdem Aras; Özer, Mustafa; Ataoğlu, Muhammet Baybars; Kanatlı, UlunayThe primary aim of this study was to investigate bone loss in the glenoid with magnetic resonance imaging in posterior shoulder instability with only a labral tear. Methods: A total of 76 patients operated on because of posterior and anteroposterior shoulder instability only with a labral tear between 2006 and 2019 (n = 40 and n = 36, respectively) were included in this study. The instability type, a presence of an additional superior labrum anteroposterior (SLAP) lesion, the number of dislocations, and the magnetic resonance imaging–based measurements (the glenoid diameter and the bone defect size in the glenoid, the Hill-Sachs lesion [HSL] and the reverse HSL [rHSL] length, the angle and the arc length of HSL and rHSL, and the humerus head diameter and its area) were analyzed. Results: The size of the anterior glenoid defect, the rHSL measurements (length, angle, and arc length), and the ratio of the anterior glenoid defect size to the glenoid diameter were significantly higher for anteroposterior instability (P < .01) cases. There was no significant difference (P = .49, .64, and .82, respectively) for the presence of an additional SLAP pathology, the glenoid diameter, the posterior glenoid defect, and the ratio of the posterior glenoid defect size to the glenoid diameter in posterior and anteroposterior instability groups. The increased number of dislocations was associated with increased rHSL length and total arc length (P = .04 and .03, respectively). An additional SLAP lesion in posterior shoulder instabilities was not associated with the bone defect size (P = .29). Conclusion: Although the posterior shoulder instability with only a labral tear is likely to cause a bone defect, we have shown that the instability is not expected to be caused by the bone defect. Therefore, this study points out that only soft tissue repair without considering the bone defect could be promising in this patient group.Öğe Interscalene block applied by an experienced anesthesiologist has a good anesthetic effect, a long duration of action, and less postoperative pain after arthroscopic shoulder procedures independent of surgery type and operation duration(Bayçınar Tıbbi Yayıncılık, 2023) Orhan, Özlem; Sezgin, Erdem Aras; Güngör, İrfan; Çetinkaya, Mehmet; Ataoğlu, Muhammet Baybars; Kanatlı, UlunayThis study aims to evaluate the severity of postoperative pain and the time to the onset of pain after arthroscopic surgical treatment of rotator cuff tear or instability under interscalene block. Patients and methods: Between October 2015 and June 2016, a total of 172 patients (82 males, 90 females; mean age: 47.9±16.9 years; range, 15 to 83 years) who underwent shoulder arthroscopy under interscalene block by a single surgeon were retrospectively analyzed. The relationship between the postoperative 24-h Visual Analog Scale (VAS), the time to the onset of pain with the type of surgical procedure (rotator cuff repair, n=101 or instability surgery, n=71), and the duration of surgery (<30 min n=92; ?30 min n=80) was examined. Results: No significant relationship was found between the type of surgical procedure, VAS scores, and the onset of pain after the block (p=0.577 and p=0.780, respectively). No significant relationship was found between the operation duration, and VAS, and the onset of pain after the block (p=0.570 and p=0.408, respectively). The mean duration until the start of postoperative pain was 734±313 (range, 60 to 1,440) min. There was no statistically significant difference in the need for rescue analgesics at the postoperative 24th h and the duration of surgery between the two groups (p=0.393 and p=0.675, respectively). Conclusion: Our study results show no significant difference in the time for the onset of postoperative pain and the VAS scores according to the characteristics of the surgical procedure, operation duration, or age and sex of the patient. Shoulder arthroscopy performed by experienced surgeons under interscalene block eliminates the need for analgesics within the first 12 h postoperatively.Öğe No differences in clinical outcomes or isokinetic performance between cruciate-substituting ultra-congruent and posterior stabilized total knee arthroplasties: a randomized controlled trial(Springer Science and Business Media Deutschland GmbH, 2021) Aktı, Sefa; Karakuş , Dilek; Sezgin, Erdem Aras; Çankaya, DenizPurpose: Whether ultra-congruent (UC) or posterior cruciate ligament-stabilized (PS) inserts should be used in posterior cruciate ligament (PCL)-sacrificing total knee arthroplasty (TKA) remains debatable. Therefore, the aim of this prospective randomized controlled study was to compare the isokinetic performance and clinical outcomes of these inserts in PCL-sacrificing TKA. Methods: Sixty-six patients diagnosed with primary knee osteoarthritis were randomly assigned to either the UC or the PS group. There were no significant differences between the groups in terms of age, body mass index or sex. The Knee Society score (KSS) and isokinetic performance results for each patient were recorded preoperatively and at 3, 6 and 12 months postoperatively. The physiatrist that performed the isokinetic tests and the patients were blinded to the study groups. Results: There were no significant differences between the groups in terms of the preoperative KSS or isokinetic performance. Gradual improvement in the KSS was observed in both groups, but no significant differences were detected between the groups during the whole follow-up period. The UC and PS groups exhibited similar peak extension and flexion torque values normalized to body weight at 3, 6 and 12 months postoperatively (p > 0.05). Conclusion: The use of UC or PS inserts in TKA did not affect the clinical outcomes or isokinetic performance.The clinical relevance of this study is that the potential differences in clinical outcomes and isokinetic performance between UC and PS inserts do not need to be considered when sacrificing the PCL in TKA. Level of evidence: I.Öğe Novel radiographic hip fat thickness ratio correlates with early re-operation following total hip arthroplasty(SAGE Publications Ltd, 2022) Sezgin, Erdem Aras; Ali, Ali Khalil; Ataoğlu, M. Baybars; Orhan, Özlem; Odluyurt, Mustafa; Esen, ErdinçIntroduction: Obesity is thought to lead to increased failure rates following total hip arthroplasty (THA). Site-specific fat distribution has been suggested to be a better indicator of risk, compared to body mass index. Fat thickness measurement methods were developed for total knee arthroplasty, however, there is limited data on the methods for THA. The aim of this study was to assess the interobserver and intraobserver reliability of a newly defined radiographic subcutaneous fat thickness ratio and investigate the correlation of this ratio with early failure following THA. Methods: 321 patients who underwent primary THA at a single institution between 2014 and 2017, with at least 1-year of follow-up and a preoperative pelvis anteroposterior x-ray radiograph were included in this study. A high hip fat thickness ratio (HFTR) was arbitrarily defined as ?2. Early failure was defined as revision or re-operation for any reason and death related to operation first year following THA. Results: The HFTR was shown to have excellent intraobserver and interobserver reliability. High HFTR was associated with higher risk of early failure following THA (odds ratio 3.8, [95% confidence interval, 1.2–12.1], p < 0.05). The same association persisted when HFTR was analysed as a continuous variable (p < 0.01) and in multivariate analysis (p < 0.05). Conclusions: HFTR can be used to assess periarticular soft tissue distribution and may be regarded as a useful and reproducible tool for assessing risk of early failure following THA.Öğe The evolution of publications in the field of scoliosis: A detailed investigation of global scientific output using bibliometric approaches(Turkish Neurosurgery, 2021) Güler, Serkan; Çapkın, Sercan; Sezgin, Erdem ArasAim: To carry out an in-depth bibliometric analysis of scoliosis literature. Material and methods: This study used the Web of Science database to identify relevant articles for analysis. The literature search used the keyword ?scolio*? and focused on the period between 1980-2019. Bibliometric network visualizations and mapping of specific results were done using VOSviewer software. Results: The literature search yielded 9706 publications on scoliosis between 1980 and 2019. Of these, 6975 (71.9%) journal articles were included in the bibliometric summary. Orthopedics was the most common area of research (4581 articles, 65.67%), and the United States of America (USA) exhibited the highest publication productivity (2327 articles, 33.36%). Nanjing University in China had the highest number of publications among institutions (n=219, 3.13% of the total literature), and there were a total of 60130 citations in 6975 articles. Fifty-five articles had a minimum of 100 citations, and the journal with the highest number of publications was ?Spine? (number of article: 1628, 23.3%). Conclusion: This bibliometric analysis may be regarded as a summary and evaluation of global scientific output on scoliosis and can, therefore, be used a guide for researchers, clinicians and students. Furthermore, the keyword analysis can aid professionals in the field when planning new studies.Öğe Total infrapatellar fat pad excision leads to worse isokinetic performance in total knee arthroplasty: a randomized controlled trial(Georg Thieme Verlag, 2022) Çankaya, Deniz; Aktı, Sefa; Yaşar, Niyazi Erdem; Karakuş, Dilek; Ünal, Kazım Onur; Karhan, Taha Eşref; Sezgin, Erdem ArasThere are concerns that total infrapatellar fat pad (IPFP) excision in total knee arthroplasty (TKA) results in patellar tendon shortening due to ischemic contracture, but individual preference of the surgeon is still the main determinant between total or partial excision. The aim of this randomized controlled study was to compare isokinetic performance and clinical outcome of TKAs with total and partial excision of the IPFP. Seventy-two patients scheduled to undergo TKA for primary knee osteoarthritis by a single surgeon were randomly assigned to either total or partial excision group. Patients were evaluated preoperatively and at postoperative 1 year, with Knee Society Score (KSS) and isokinetic measurements. The physiatrist performing isokinetic tests and patients were blinded to the study. There were no significant differences between the groups in respect of age, body mass index, gender, and preoperative KSS and isokinetic performance. Postoperatively, both groups had improved KSS knee and KSS function scores, with no difference determined. Knee extension peak torque was significantly higher postoperatively in the partial excision group at postoperative 1 year (p = 0.036). However, there were no significant differences in knee flexion peak torque following TKA (p = 0.649). The results of this study demonstrated that total excision of the IPFP during TKA is associated with worse isokinetic performance, which is most likely due to changes in the knee biomechanics with the development of patella baja. Partial excision of the IPFP appears to be a valid alternative to overcome this potential detrimental effect without impeding exposure to the lateral compartment. This is a Level I, therapeutic study.Öğe Unicompartmental knee arthroplasty results in a better gait pattern than total knee arthroplasty: Gait analysis with a smartphone application(Turkish Joint Diseases Foundation, 2021) Çankaya, Deniz; Aktı, Sefa; Ünal, Şenay Betül; Sezgin, Erdem ArasObjectives: The aim of this study was to compare the smartphone-based gait analysis data of patients who underwent total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA). Patients and methods: Between January 2016 and April 2019, a total of 51 patients (3 males, 48 females; mean age: 60.92 years; range, 51 to 70 years) who were operated with UKA or TKA in our clinic were retrospectively analyzed. The patients were divided into two groups according to the type of procedure as the UKA group (n=17) and unilateral TKA group (n=34). Gait analysis was made via a smartphone application (Gait Analyzer software version 0.9.95.0) with data acquired from the accelerometer of the smartphone. This analysis was performed using data collected from the Acceleration Sensor LSM6DSO into the Samsung Galaxy Note 10 Plus phone. Gait velocity, step time, step length, cadence, step time symmetry, step length symmetry, and vertical COM (vert-COM) parameters were measured. Results: There were no statistically significant differences between the groups in respect of age, sex, body mass index, operated side, and follow-up duration. Compared to the TKA group, the UKA patients showed a better gait pattern in gait velocity (p=0.03), step time symmetry (p=0.005), and step length symmetry (p=0.024). No significant difference was detected in step time (p=0.807), step length (p=0.302), cadence (p=0.727) and vert-COM parameters (p=0.608). Conclusion: The gait of UKA patients is closer to the physiological pattern with a better gait velocity, step time symmetry, and step length symmetry than TKA patients. The surgical treatment option of UKA for knee medial compartment osteoarthritis leads to a better gait pattern than TKA.
