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    Clinical and radiological outcomes of total knee arthroplasty performed with midvastus and medial parapatellar approaches in obese patients
    (Hindawi Limited, 2021) Güler, Olcay; Gümüşsuyu, Gürkan; Sofu, Hakan; Gökçen, Hüseyin Bahadır
    Abstract Abstract Background. The use of total knee arthroplasty (TKA) for primary osteoarthritis of the knee has remarkably increased recently. We aimed to compare the clinical and radiological outcomes of TKA in obese patients (>30 kg/m2) operated with midvastus (MV) or medial parapatellar (MPP) approaches. Methods. This retrospective study was performed using data derived from 80 patients (70 women; 10 men) with an average age of 66.17 ± 5.42 (range: 54 to 77). Patients were allocated into 2 groups as for the type of approach conducted during TKA: group I (n = 41) underwent TKA by MV approach, while the MMP technique was used in group II (n = 39). Results. Demographic, clinical, and radiological parameters included age, side of involvement, sex, BMI, diameters of thigh and calf, length of incision, duration of operation, amount of bleeding and transfusion, duration of hospitalization and follow-up, complications, and range of motion, as well as Knee Society Score (KSS) and Knee Society Function Score (KSFS). Patients with a higher BMI (?35 kg/m2) experienced more profound bleeding and needed more transfusion of erythrocyte suspension. The range of motion was more favorable in groups with BMI <35 kg/m2. The functional outcomes as reflected in KSS and KSFS were much better in patients with BMI <35 kg/m2. Conclusions. Our data indicated that obesity can adversely influence the clinical and radiological outcomes after TKA performed by both MV and MPP approaches. A careful analysis of patient characteristics and selection of appropriate operative procedures is critical. Further randomized, controlled trials on larger series must be designed to elucidate the relationship between obesity and therapeutic outcomes after TKA with different approaches.
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    A comparative overview of metatarsal stress fractures in premenopausal and postmenopausal women: our single-centre experience with eighty-one patients
    (Springer, 2020) Güler, Olcay; Cerci, Mehmet Halis
    Purpose To compare the demographic, clinical, and laboratory features of metatarsal bone stress fractures encountered in premenopausal and postmenopausal women. Methods This retrospective study was carried out in the orthopaedics and traumatology department of our tertiary care centre. Data were collected from the hospital records of a total of 81 women (average age 42.65 +/- 12.97) allocated in premenopausal (n = 36) and postmenopausal (n = 45) groups. These two groups were compared in terms of age, body mass index, side, and level of the metatarsal stress fracture, serum levels of vitamin D, duration of complaint and treatment, and T-scores of femur and vertebra as measured by dual-energy X-ray absorptiometry. Results The average body mass index (BMI) was 27.00 +/- 2.49 kg/m(2)(range 21.8 to 31.2). The right side was involved in 44 cases (54.3%), while the left side was affected in 37 patients. DXA T-scores were significantly high for group 2 for both femur and vertebra (p < 0.001 for both). Two groups did not exhibit any significant differences in terms of BMI, side of the stress fracture, level and location of the fracture, seasonal distribution, smoking habits, comorbidities, serum levels of vitamin D, durations of complaints, and treatment. Conclusion Our results indicated that there was no difference between 2 groups in terms of serum vitamin D levels; however, postmenopausal women had higher T-scores of femur and vertebra. Identification of patients under higher risk for stress fractures and elucidation of the possible role of menopause necessitate further controlled, randomized trials on larger series.
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    Comparison of supine and lateral decubitus positions for total hip arthroplasty with the direct lateral approach in overweight and obese patients
    (Hindawi Ltd, 2020) Güler, Olcay; Öztürk, Sidar; Özgezmez, Ferit Tufan; Cerci, Mehmet Halis
    Background. The purpose of our study is to compare the results of supine and lateral decubitus positions for total hip arthroplasty (THA) with the direct lateral (DL) approach in overweight and obese patients. Methods. Patients who had a THA with the DL approach using the lateral decubitus position (LD group) (n=54) or supine position (S group) (n=45) were retrospectively investigated. Demographic characteristics, age, and body mass indexes were calculated. Blood loss of patients, amount of transfusion, Harris Hip Scores (HHSs) (preop, 6 weeks, 3 months, 6 months, and 12 months), incision size, surgery time, postoperative acetabular cup inclination angle, femoral stem alignment, follow-up period, hospital stay, preoperative-postoperative leg length inequality, and complication rates (infection, wound site problems, and dislocation rates) were compared. Results. Both groups did not differ from each other by means of age, gender, BMI, and affected side (p=0.814, p=0.723, p=0.582, and p=0.833, respectively). The incision length (p<0.001), blood loss (p=0.010), and amount of blood transfused (p=0.002) were significantly higher in the S group than in the LD group. The surgical time was significantly longer in the S group (p<0.001). There were no statistically significant differences between the LD and S groups in terms of pre- and postoperative height, cup inclination, stem alignment, duration of hospital stay, and follow-up period. The change between pre- and postoperative HHS in the LD and S groups was statistically significant. Post hoc binary comparison analysis was conducted to investigate the difference between the groups. The values of HHS were significantly increased from the preoperative period to the final follow-up. Conclusions. The LD and S groups had comparable functional outcomes one year postoperatively. However, the S group was associated with worse intraoperative outcomes than the LD group.
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    Comparison of weight-based versus standard dosing of tranexamic acid for blood loss and transfusion amount in knee arthroplasty without tourniquet
    (ACTA MEDICA BELGICA, 2022) Güler, Olcay; Çarkçı, Engin; Çerçi, Mehmet Halis; Gümüşsuyu, Gürkan; Öztürk, Çağatay
    The aim of the study is to compare weight-based versus standard dosing of intravenous (IV) tranexamic acid (TXA) for blood loss and transfusion amount in total knee arthroplasty (TKA) without a tourniquet. A total of 99 patients were divided into two groups: Group 1 (standard): 1 g of IV TXA 30 min before skin incision, and 1 g at postoperative 30 min and 3 h. Group 2 (weight-based): 10 mg/kg IV TXA 30 min before the skin incision, and 10 mg/kg at postoperative 30 min, and 3 h. Hemoglobin levels, before, and 1, and 2 days after the operation, postoperative amount of decrease in hemoglobin levels, and amount of erythrocyte transfusion were recorded. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Society Score (KSS) were applied in the evaluation of TKA results preoperatively, and at 1., 3., 6., and 12. months, postoperatively. In both study groups, hemoglobin levels in male patients dropped significantly more deeply than female patients. Also, in both study groups, hemoglobin levels were significantly lower in patients with comorbid illnesses. A statistically significant difference was not detected between both groups in terms of pre-and postoperative WOMAC scores, KSS knee scores, and KSS function scores. Our study showed that standard and weight-based dosing of IV TXA treatments were similar in efficacy and safety. Both treatments reduce blood loss and the need for transfusion. Also, there was no significant difference in terms of reliability between two groups.