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Öğe Comparison of Arthrodesis, Resurfacing Hemiarthroplasty, and Total Joint Replacement in the Treatment of Advanced Hallux Rigidus(ELSEVIER SCIENCE INC, 2013) Erdil, Mehmet; Elmadag, Nuh Mehmet; Polat, Gokhan; Tuncer, Nejat; Bilsel, Kerem; Ucan, Vandet; Erkocak, Omer FarukThe purpose of the present study was to compare the functional results of arthrodesis, resurfacing hemiarthroplasty, and total joint replacement in hallux rigidus. The data from patients treated from 2006 to 2010 for advanced stage hallux rigidus were retrospectively reviewed. A total of 38 patients who had at least 2 years (range 24 to 66 months, mean 31.1) of follow-up were included in the present study. Of the 38 patients, 12 were included in the total joint replacement group (group A), 14 in the resurfacing hemiarthroplasty group (group B), and 12 in the arthrodesis group (group C). At the last follow-up visit, the functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Society-Hallux Metatarsophalangeal Interphalangeal (AOFAS-HMI) scale, visual analog scale (VAS), and metatarsophalangeal range of motion. Significant improvements were seen in the AOFAS-HMI score, with a decrease in the VAS score in all 3 groups. According to the AOFAS-HMI score, no significant difference was found between groups A and B. However, in group C, the AOFAS-HMI scores were significantly lower than in the other groups owing to the lack of motion. According to the final VAS scores, no significant difference was found between groups A and B; however, the VAS score had decreased significantly more in group C than in the other groups. No major complications occurred in any of the 3 groups. After 2 years of follow-up, all the groups had good functional outcomes. Although arthrodesis is still the most reliable procedure, implant arthroplasty is also a good alternative for advanced stage hallux rigidus. (C) 2013 by the American College of Foot and Ankle Surgeons. All rights reserved.Öğe Does femoral back wall failure affect the functional results of arthroscopic anterior cruciate ligament surgery?(EDIZIONI MINERVA MEDICA, 2013) Elmadağ, Mehmet; Erdil, Mehmet; Bilsel, Kerem; Acar, Mehmet Ali; Tuncay, I.; Yel, M.Aim. The aim of the study was to evaluate the effects of femoral back wall failure (FBWF) due to tunnel enlargement after anterior cruciate ligament (ACL) surgery on clinical outcomes. Methods. The functional results of 40 ACL reconstructions were evaluated prospectively. The study includes ACL reconstructions with transtibial single bundle technique with hamstring autografts whereas those with concomitant knee ligament injuries were excluded. Tunnel enlargements were measured with CT scan at the end of the 12th month after surgery Functional results were evaluated at the first year follow-up by an anterior drawer test, Lachman test, rollimeter, IKDC, and Lysholm Knee Scale. Results. Femoral and tibial tunnel enlargement was measured in all of our patients with 39% mean enlargement in femoral tunnels and 48% in tibial tunnels. No significant correlation between amount of tunnel enlargement and clinical outcomes was obtained. Additionally, no significant correlation between tibial fixation type and tibial tunnel enlargement was found (P>0.05). In nine patients (22.5%), FBWF was evaluated. These nine patients did not show any significant difference in clinical outcomes than the other 31 patients (P>0.05). Conclusion. Excessive femoral tunnel enlargements after ACL surgeries may lead FBWF. This pathology does not affect clinical outcomes. However, FBWF with bone defect may cause more complicated ACL revision surgery. This fact must be kept in mind by orthopedic surgeons.Öğe Evaluation of mobile bearing unicompartmental knee arthroplasty, opening wedge, and dome-type high tibial osteotomies for knee arthritis(TURKISH ASSOC ORTHOPAEDICS TRAUMATOLOGY, 2015) Tuncay, Ibrahim; Bilsel, Kerem; Elmadag, Mehmet; Erkocak, Omer Faruk; Asci, Murat; Sen, CengizObjective: Three methods of surgery used in the treatment of knee osteoarthritis (OA) are mobile bearing unicompartmental knee arthroplasty (Oxford UKA), opening wedge high tibial osteotomy (HTO), and dome-type HTO. This article aimed to retrospectively compare these three methods in terms of outcomes for health status, patient satisfaction, and function. Methods: Between 2003 and 2010, 255 knees of 235 patients underwent operations for medial knee OA. Three types of surgery were performed. Group 1 consisted of 109 knees of 94 patients who underwent Oxford UKA. Group 2 was made up of 36 knees of 36 patients who underwent HTO using circular external fixation, and Group 3 comprised 57 knees of 52 patients on whom opening wedge type HTO using locking plate fixation was performed. SF-36 and HSS knee scores were used to compare the functional outcomes among groups. Results: Statistically significant differences were found between the preoperative and postoperative measures in all 3 of the treatment groups for physical function, physical role, pain, general health, vitality, social function, emotional role, and mental health according to SF-36 and HSS scores. In the 2nd group, the average correction of the mechanical axis deviation (MAD) was 38 mm with 11.7 degrees along the femorotibial axis and 6.2 degrees along the medial proximal tibial angle (MPTA). In the 3rd group, the average correction in the MAD was 28 mm with 9.7 degrees along the femorotibial axis and 5.6 degrees along the MPTA. All 3 of the treatment alternatives were observed to be sufficient. Satisfactory postoperative results were achieved in the UKA group in terms of social function and mental health, and the patients were able to achieve early rehabilitation and return to their previous life activities. Conclusion: UKA is the ideal option for patients who wish for the earliest possible return to social and recreational activities.Öğe The olecranon osteotomy provides better outcome than the triceps-lifting approach for the treatment of distal humerus fractures(2014) Elmadağ, Nuh Mehmet; Erdil, Mehmet; Bilsel, Kerem; Acar, Mehmet Ali; Tuncer, Nejat; Tuncay, İbrahimIntroduction: Intra-articular distal humeral fractures can be approached in a variety of ways. The purpose of this study is to evaluate and compare the functional outcomes of two approaches: approach with olecranon osteotomy and triceps-lifting approach for the treatment of intra-articular distal humeral fractures. Methods: This study shows a consecutive series of 54 intra-articular distal humeral fractures of 54 patients who were treated with open reduction and internal fixation with anatomic plating. Lateral plating was performed in 10 (45.5 %) patients, and medial and lateral parallel plating was performed in 12 (54.5 %) patients in olecranon osteotomy group, while lateral plating was performed in 8 (25 %) patients, and medial and lateral parallel plating was performed in 24 (75 %) patients in triceps-lifting group. Results: Mean follow-up was 38.3 months for olecranon osteotomy group and 41.4 months for triceps-lifting group. Functional outcomes according to MAYO elbow score and extension-flexion motion arc values were significantly better in olecranon osteotomy group (p < 0.05). Conclusion: Approach with olecranon osteotomy provided better functional outcomes than triceps-lifting approach. Additionally, intra-articular distal humerus fractures can be safely treated with olecranon osteotomy which provides more control over the elbow joint and better visualisation and allows early postoperative rehabilitation. Level of evidence: IV. © 2012 Springer-Verlag France.
