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Öğe 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, ÇağatayThe 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.Öğe Correlation between patient-reported outcome scores and objective functional assessments following surgical treatment of achilles tendon ruptures(Galenos Yayınevi, 2021) Gümüşsuyu, Gürkan; Asoğlu, Mehmet Melih; Ertan, Mehmet Barış; Kılıçaslan, Ömer Faruk; Köse, ÖzkanThe purpose of this retrospective study was to investigate the correlation between patient-reported outcome scores and objective functional assessments following surgical treatment of Achilles tendon ruptures (ATR). Methods: A retrospective review of 53 patients with acute ATR who underwent primary surgical repair was performed. Patient-reported functional outcomes were evaluated with the ATR score (ATRS). Calf atrophy was assessed using the difference between the maximum calf circumference on the involved and healthy sides. The objective functional capacity of the lower leg was assessed using a single-leg standing heel-rise fatigue test. The limb symmetry index (LSI) was calculated as the ratio between the injured and uninvolved limbs. The correlation between variables was tested using the Spearman correlation test. Results: There were 53 patients (50 males and three females) with a mean age of 40.8±7.7 years (range, 27-59 years). The mean follow-up duration was 35.6±16.6 months (range, 12-80 months). The mean ATRS ranged from 88 to 100 points with a mean of points. There was a mean of 1.15±0.6 cm (range, 0-2 cm) calf circumference difference between the limbs. Calf atrophy was present in 46 (86.7%) patients. The mean LSI (%) was 87.5%±9.3% (range, 61%-100%). No correlation was detected between the ATRS score and calf atrophy and LSI. Conclusion: The ATRS overestimates the objective functional capacity of the Achilles tendon. New scoring systems that combine both subjective and objective measures are required to assess the overall outcome following an ATR.Öğe Lesion size and varus malalignment are the major determinants leading to poorer clinical outcomes after combined microfracture treatment for focal cartilage lesions during anterior cruciate ligament reconstruction(SPRINGER, 2021) Sofu, Hakan; Gümüşsuyu, Gürkan; Guler, Olcay; Ucpunar, Hanifi; Duman, Serda; Camurcu, YalkinThe purposes of this study were to evaluate the clinical effects of microfracture (MFX) performed for Outerbridge grade 3 or 4 focal cartilage lesion during the same surgery with arthroscopic anterior cruciate ligament (ACL) reconstruction and to analyze the major determinants of these potential effects on the clinical outcome. The clinical and radiographic data of 119 patients were evaluated. The mean follow-up time was 32.6 +/- 6 months. Isolated arthroscopic ACL reconstruction was performed in 70 patients (Group 1), whereas MFX for Outerbridge grade 3 or 4 chondral lesion during ACL surgery was performed in 49 patients (Group 2). Visual analogue scale (VAS) score, Lysholm knee score, and Tegner activity scale were the instruments used as outcome measures to evaluate the clinical status of the patients. Routine X-ray and MRI were also performed for all patients pre-operatively as well as at the latest follow-up visit. Lineer regression analysis was performed to determine major factors predicting the poorer clinical outcome. Clinical outcomes were similar between isolated ACL reconstruction and combined procedure. On the other hand, according to lineer regression analysis, cartilage lesion size > 2 cm(2) and > 5 degrees of varus alignment were detected as the major determinants leading to poorer outcomes in combined ACL reconstruction and MFX. Level of evidence: III - Retrospective Comparative Study.Öğe The reliability and accuracy of radiographs in the assessment of pedicle screw placement; a comparison with computerized tomography(2021) Gümüşsuyu, Gürkan; Kılıçaslan, Ömer Faruk; Nabi, Vugar; Ertan, Mehmet Barış; Köse, ÖzkanObjective: The purpose of this study was to evaluate the reliability and accuracy of radiographic assessment of pedicle screw placement, using computed tomography (CT) as the reference standard. Materials and Methods: Fifteen patients who underwent posterior spinal fusion were retrospectively reviewed. Pedicle screw position was rated using postoperative anteroposterior and lateral radiographs by two independent spinal surgeons twice at least four weeks apart. CT was rated by two other spinal surgeons collectively and reached a consensus decision. Kappa analysis was used to measure the relative agreement between radiographic ratings and CT evaluation. Results: A total of 367 screws were evaluated. According to CT evaluation, 69 (18.8%) pedicle screws were determined as malpositioned. However, in plain radiographs, 53 (14.4%) pedicle screws were rated as malpositioned. The intraobserver reliability of radiographic ratings was almost perfect for both observers at both times (ICC=0.833 and 0.817). On the other hand, the interobserver reliability was substantial at both occasions (ICC=0.722 and 0.808). The agreement between radiographic ratings and CT evaluation (reference standard) was substantial (kappa=0.686, 95% confidence interval=0.586-0.785). The sensitivity and specificity of radiographs to detect a malpositioned screw were 65.2% and 97.3%, respectively. Conclusion: Radiographic ratings showed substantial and almost perfect agreement among observers. However, the accuracy of radiography was low compared to CT evaluation. In case of suspicion, CT should be the choice of the imaging modality to decide on a malpositioned screw.Öğe 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 BahadırAbstract 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.Öğe Comparison of two segment combined instrumentation and fusion versus three segment posterior instrumentation in thoracolumbar burst fractures: a randomized clinical trial with 10 Years of follow up(Turkish Neurosurgical Soc, 2019) Gümüşsuyu, Gürkan; İslam, Nazır Cihangir; Köse, Özkan; Güngör, Mutlu; Özcan, HakanAIM: To compare the clinical and functional outcomes between combined anterior and posterior 2-segment spinal fusion and posterior 3-segment spinal fusion in patients with thoracolumbar (TL) burst fractures at risk for posttraumatic kyphosis without neurological deficit. MATERIAL and METHODS: Twenty-seven patients with TL burst fracture, >20 degrees kyphosis and/or 50% collapse, and posterior ligament injury, but without neurological deficit, were randomly assigned into posterior and combined groups. Posterior treatment was 3-segment (1 level below, fractured level and 2 levels above) posterior spinal fusion. Combined treatment was including 1 cranial and 1 caudal levels posterior spinal fusion, followed by anterior corpectomy, cage, and bone grafting. Patients were followed-up for a mean duration of 117.7 +/- 8.7 months (range, 98-132 months). At the final follow-up, the clinical and functional means of the groups were compared using degree of kyphosis, visual analogue scale (VAS), and Roland-Morris and Oswestry scores. RESULTS: Mean patient age was 38.5 +/- 2.4 years (range: 18-68 years). Fourteen and 13 patients were treated with the combined and posterior approach, respectively. Age (40.0 +/- 10.3 and 37.0 +/- 14.2 years; p=0.519), sex (female/male, 3: 10 and 5: 9; p=0.385), mechanism of injury (p=0.513), fractured levels (p=0.185), type of fracture (p=0.293), degree of kyphosis at initial admission (p=0.616), collapse (p=0.155), canal narrowing (p=0.280), follow-up (p=0.076) and accompanied limb fracture (p=0.374) were similar between groups. Duration of hospital stay was similar between two groups (p=0.102). However, blood loss was higher in combined group (195 ml versus 358ml, p=0.003). A 14.2 degrees correction was achieved in the posterior group and 16.9 degrees in the combined group (p=0.61). Loss of correction at the last follow-up visit was 2.1 degrees with a final kyphosis of 7.2 degrees in the posterior group, and 1.2 degrees with a final kyphosis of 5.5 degrees in the combined group. The differences in the correction of kyphosis (p=0.616), postop kyphosis (p=0.756), loss of correction (p=0.141) and final kyphosis (p=0.085) between the treatment groups were not significant. At the last follow-up visit of the posterior and combined groups, the VAS (16.4 +/- 14.8 vs. 17.6 +/- 16.6; p=0.685), Roland-Morris (27.2 +/- 27.3 vs. 29.6 +/- 20.5; p=0.519), and Oswestry scores (15.0 +/- 13.1 vs. 17.7 +/- 11.5; p=0.302) were similar. CONCLUSION: Both treatment methods are similar in terms of clinical and functional outcomes.Öğe A quality analysis of disc herniation videos on youtube(Elsevier Science Inc, 2019) Gökçen, Hüseyin Bahadır; Gümüşsuyu, GürkanBACKGROUND: An increasing number of patients are investigating health information by using the Internet because of its exponential growth. Therefore, it is important to test the accuracy of the information presented to determine which information should not be shared. This study investigated the information available on YouTube with regard to disc herniation. METHODS: The first 50 videos found after the keyword "disc herniation" was used in the YouTube search engine were included in the study. Video popularity was evaluated with an index called the video power index (VPI). The quality and accuracy of the information were evaluated by 2 independent spinal surgeons using the Journal of American Medical Association (JAMA) score and the DISCERN scoring system. Interobserver agreement and individual correlations of the data of each video were statistically analyzed. RESULTS: Of the 50 videos evaluated, 16 (32%) contained animation and 34 (64%) contained real images. The mean duration was 6.587 minutes, and the mean view was 423.472. The mean DISCERN score was 30.7 (+/- 10.3), and the mean JAMA score was 1.8 (+/- 0.5). There was good agreement between the 2 researchers in terms of DISCERN and JAMA scores. No statistically significant correlation was found between the JAMA and DISCERN scores of both researchers and VPI values, video lengths, animation, or real images. CONCLUSIONS: The quality of the disc herniation information offered on YouTube is low. The evaluation of medical information obtained from the Internet by health professionals is an important step in guiding the correct flow of medical information to patients.Öğe The evaluation of the relation among age, amputation levels and the revisions(Logos Medical Publishing, 2018) Şükür, Erhan; Uyar, Ahmet Çağrı; Özdemir, Uğur; Gökçen, Hüseyin Bahadır; Çiçekli, Özgür; Topçu, Hüseyin NevzatThe aim of the study was to reveal of the risk factors related to the revision surgery of amputations and to evaluate the relationship between age groups and relevant etiologies and the amputation levels. Five hundred and thirty-two amputations in 410 patients (275 male, 135 female) which were performed between January 2012 and November 2017 were retrospectively evaluated in 7 separate age groups. The relation of the age groups with the sex, etiology, the level of the amputation of the cases, revision surgeries performed to increase the level of amputation was evaluated. In all, 20.2% of 532 amputations were revision surgeries. The indications for amputation were diabetes in 57.3%; peripheral vascular disease (PVD) in 20.2%; trauma in 16.4% and other reasons in 5.4% of the cases. The indication due to diabetes was significantly more than the other indications (p<0.001). Diabetes and peripheral vascular disease were significantly more numerous after the 4th and trauma before the 4th decade of life. Traffic accidents have accounted for 7,1%, gunshots for 1% and work place accidents for 8.3% of traumatic amputations. Lower extremity amputations were performed more frequently than upper extremity amputations. Below-knee amputations were performed more frequently (38.3%). Hand-digit amputations were most frequently performed upper extremity amputations (3.7%). The revision rates were as follows; 73.5% in diabetes, 22.9% for PVD and 3.6% in trauma. The factors which were most related with the revisions were age (>56 years) and diabetes. Amputations were most commonly performed due to vascular insufficiency in the elderly. This patient group also carries a higher risk for revision amputations. The accurate determination of the amputation level with detailed preoperative evaluation and the efficacy of medical treatment especially in the diabetics may decrease the number of the amputation and revision amputation cases. © 2018, Logos Medical Publishing. All rights reserved.
