Publications by authors named "Mazhar Tokgozoglu"

25 Publications

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Vancomycin prophylaxis for revision hip arthroplasty in penicillin and cephalosporin sensitive patients: Is dose adjustment necessary in accordance with blood loss and fluid replacement?

Acta Orthop Traumatol Turc 2021 Jan;55(1):53-56

Department of Orthopaedics and Traumatology, Hacettepe University, School of Medicine, Ankara, Turkey.

Objective: The aims of this study were (1) to investigate the changes in the serum concentration of prophylactically administrated vancomycin in the perioperative period of revision hip arthroplasty in penicillin/cephalosporin-allergic patients, (2) to assess whether the postoperative re-administration of vancomycin is needed, and (3) to determine the relationships of vancomycin serum concentration with blood loss, body weight, and fluid replacement in such patients.

Methods: This study consisted of 29 patients (20 females, 9 males; mean age=63.3 years; age range=45-79 years) with a history of penicillin/cephalosporin allergy undergoing revision hip arthroplasty secondary to aseptic loosening or periprosthetic fractures. Serum vancomycin levels were measured (1) before administration of vancomycin, (2) at the time of skin incision, (3) every 1,5 hours thereafter until the end of the operation, (4) during the skin closure, and (5) after three and 12 hours from the initial dosage. Data regarding body weight, amounts of intraoperative blood loss, fluid and blood replacements and postoperative wound drainage were recorded.

Results: The average blood loss, fluid replacement, and drain volume were 1280.3±575.8 (500-2700) mL, 2922.6±768.8 (1700-4600) mL, and 480.2±163.7 (200-850) mL, respectively. The mean levels of serum vancomycin were 46.3±21.8 (14.1-80.7) mg/L at the time of skin incision, 17.9±4.7 (9.4-30.9) and 9.8±2.2 (4.3-13.8) mg/L after 1.5 and 3 hours from the beginning of the surgery and 5.1±1.1 (2.9-6.8)mg/L after 12th hour postoperatively. The measured vancomycin levels were below the effective serum concentrations (< 5 mg/L) for 18 patients at 12 hours the administration of the first dose. A moderate level negative correlation between the blood loss/body weight ratio and vancomycin levels was found (p=0.004, r=-0.493). Predictive ROC curve analysis resulted in determining a blood loss volume higher than 1150 ml and a blood loss/body weight ratio higher than 18,5 is significant to estimate the vancomycin level below the minimum effective serum level at 12th hour postoperatively (AUC=0.793±0.16, p=0.009, AUC=0.753) 26±0.12, p=0.025, respectively).

Conclusion: Evidence from this study has indicated vancomycin concentration at 12th hour is below the effective level in most patients. Thus, earlier repetitive infusion of vancomycin seems to be necessary in penicillin/cephalosporin-allergic patients undergoing revision hip arthroplasty, especially in those with high blood loss.

Level Of Evidence: Level III, Therapeutic Study.
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http://dx.doi.org/10.5152/j.aott.2021.20019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7932734PMC
January 2021

Low-dose vancomycin-loaded cement spacer for two-stage revision of infected total hip arthroplasty.

Jt Dis Relat Surg 2020 ;31(3):449-455

Hacettepe Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı, 06100 Sıhhiye, Ankara, Türkiye.

Objectives: This study aims to evaluate the success rate in terms of eradication of infection and long-term outcomes of two- stage revision arthroplasty with spacers loaded with low-dose vancomycin alone for the treatment of an infected hip arthroplasty.

Patients And Methods: The records of 42 two-stage exchange arthroplasty patients (16 males, 26 females; mean age 61 years; range, 30 to 80 years) treated between January 1999 and January 2009 were included in this retrospective study. In the first stage, following removal of the prosthesis and debridement, a spacer consisting of 1 g of vancomycin per 40 g of cement was placed in the infected joint space. Patients received six weeks of intravenous antibiotics according to intraoperative cultures. After cessation of systemic antibiotic treatment, with normal C-reactive protein and erythrocyte sedimentation rate levels, second stage surgery with cementless components was performed.

Results: The mean follow-up duration was seven (range, 3 to 13) years. Two patients (4.7%) developed re-infection after two-stage reimplantation and one patient underwent a resection arthroplasty after repeated debridements. Five years of survival was 92.9% with Kaplan-Meier survival analysis.

Conclusion: For chronic infected total hip revisions, two-stage revision arthroplasty with low-dose vancomycin impregnated cement spacers have comparable re-infection and success rates. Low-dose vancomycin promotes effective infection control and reduces antibiotic toxicity.
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http://dx.doi.org/10.5606/ehc.2020.76108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607947PMC
February 2021

Sagittal spinal alignment after total hip arthroplasty for neglected high hip dysplasia: does changing the distorted mechanics of the hip normalize spinal alignment?

Spine Deform 2021 Jan 14;9(1):221-229. Epub 2020 Sep 14.

Department of Orthopaedics and Traumatology, Faculty of Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Purpose: The false acetabulum lies more laterally and posteriorly compared with the true acetabulum. Spatial orientation of the pelvis is significantly altered in patients with neglected high hip dysplasia. There has been no study to investigate how pelvic or sagittal spinal alignment change after true acetabulum gains function with hip arthroplasty. The aim of this study was to investigate the effect of total hip arthroplasty with femoral shortening on spinopelvic parameters in patients with neglected high hip dysplasia.

Methods: Twenty patients with Crowe type 3 or 4 hip dysplasia, who underwent total hip arthroplasty with femoral shortening in our institution were evaluated preoperatively after completion of rehabilitation and return to their normal daily life. Sagittal alignment (sacral slope, pelvic incidence, global tilt, segmental lordosis, segmental kyphosis, GAP score) and coronal alignment angles (coronal tilt, Cobb angle) of patients were measured by two independent observers.

Results: Twenty patients underwent hip arthroplasty with femoral shortening followed up for a minimum of 12 months. We found higher preoperative global lordosis (68.7 ± 9.7) and sacral slope (52.1 ± 8.8) angles, but the pelvic incidences (57.9 ± 10.1) were in the normal range. No statistically significant difference in any sagittal spinopelvic parameters between pre- and postoperative measurements was detected. GAP scores also did not change significantly (p = 0.231). Coronal plane parameters (Cobb angle, coronal pelvic tilt) were the only parameters in which a statistical change was observed (p = 0.02, p = 0.05, respectively).

Conclusion: Lumbar lordosis and sacral slope values are outside standard ranges in patients with neglected dysplasia of the hip. The reconstruction of the distorted mechanics of the hip joint does not normalize sagittal pelvic and spine anatomy however improvements in coronal alignment were observed. Disease specific values of sagittal spinal alignment should be used in the treatment of lumbar degenerative problems in patients with neglected high hip dysplasia.

Level Of Evidence: IV.
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http://dx.doi.org/10.1007/s43390-020-00204-3DOI Listing
January 2021

An oblique osteotomy is better for subtrochanteric shortening in total hip arthroplasty for high hip dislocation: a mechanical comparison of four techniques.

Hip Int 2020 Sep 13:1120700020957990. Epub 2020 Sep 13.

Mechanical Engineering Faculty, Istanbul Technical University, Turkey.

Background: Subtrochanteric femoral shortening is used during total hip arthroplasty for high hip dislocation in developmental dysplasia of hip patients.

Methods: We mechanically tested the stability of various commonly used subtrochanteric osteotomy techniques. As the equivalent of a femoral stem placed in a shortened femur without any stable fixation at the osteotomy line, 2 polyvinylchloride pipes were loosely intertwined. 4 different osteotomies (Z-subtrochanteric osteotomy, oblique-45° osteotomy, double Chevron-90° and 120° subtrochanteric osteotomy) were simulated. Torsional and axial loads were applied, and torsional stiffness was calculated for each test model.

Results: Z, double Chevron-90° and 120° subtrochanteric osteotomy models demonstrated lower mean torsional stiffness than oblique-45° osteotomy. With the highest torsional stiffness oblique-45° provides the best stability for treatment of high dislocation hips when a subtrochanteric osteotomy is added.

Conclusions: This matches our previous clinical experience. Oblique osteotomy may also provide higher contact surfaces in the osteotomy lines to promote bone healing.
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http://dx.doi.org/10.1177/1120700020957990DOI Listing
September 2020

Proximal Humerus Tumors: Higher-than-Expected Risk of Revision With Constrained Reverse Shoulder Arthroplasty.

Clin Orthop Relat Res 2020 Nov;478(11):2585-2595

M. Ayvaz, R. M. Cetik, S. Bakircioglu, A. M. Tokgozoglu, Hacettepe University Hospitals by the Hacettepe University Faculty of Medicine, Department of Orthopedics and Traumatology Musculoskeletal Oncology Group, Ankara, Turkey.

Background: The treatment of proximal humerus tumors with endoprostheses is associated with a high risk of implant-related surgical complications. Because of extensive soft-tissue resection and muscular detachment during surgery, instability is the most common serious complication. A reverse total shoulder arthroplasty with a highly constrained design is one option to mitigate instability, but few studies have reported the results of this prosthesis for proximal humerus tumor resections.

Questions/purposes: (1) What are the short-term functional results of the constrained reverse total shoulder prosthesis in terms of Musculoskeletal Tumor Society (MSTS), DASH, and Constant-Murley scores and ROM values? (2) What is the frequency of revision, using a competing-risks estimator to assess implant survival, and what were the causes of the revisions that occurred? (3) What proportion of patients experienced dislocations at short-term follow-up?

Methods: Between January 2014 and June 2017, we treated 55 patients with proximal humeral resections and reconstructions for malignant tumors. Of those, 33% (18) of patients were treated with the constrained, reverse total shoulder arthroplasty implant under study here. During that period, no other constrained reverse total shoulder implant was used; however, 13% (seven) of patients were treated with conventional (unconstrained) reverse total shoulder implants, 27% (15) had hemiarthroplasties, 15% (eight) of patients had biologic reconstructions with auto- or allografts and 13% (seven) underwent amputation. During the period in question, our general indications for use of the constrained device under study here were resection of the deltoid muscle/axillary nerve or the deltoid insertion on the humerus due to tumor invasion, or extensive rotator cuff and surrounding soft tissue resection that might result in shoulder instability. During this period, these indications were adhered to consistently. Four of 18 patients treated with the study implant died (three died with the implant intact) and none were lost to follow-up before 2 years, leaving 14 patients (seven women and seven men) for study at a median (range) follow-up of 35 months (25 to 65). Two authors evaluated the clinical and functional status of each patient with ROM (flexion, extension, internal and external rotation, abduction, and adduction) and MSTS, (range 0% to 100%), Constant-Murley (range 0% to 100%), and DASH (range 0 points to 100 points) scores. For the MSTS and Constant-Murley scores, higher percentage scores mean better functional outcome; and for the DASH score, a higher score means more severe disability. Radiographs were obtained at each visit and were used to look for signs of loosening, which we defined as progressive radiolucencies between visits, prosthetic component migration, and fragmentation/fracture of the cement. The Sirveaux classification was used to determine scapular notching. A competing risks analysis with 95% confidence intervals was performed to estimate the cumulative incidence of revision surgery, which we defined as any reoperation in which the implant was removed or changed for any reason, with patient mortality as a competing event.

Results: At the most recent follow-up, the median (range) MSTS score was 78% (50 to 90), the DASH score was 20 (8 to 65), and the Constant-Murley score was 53% (26 to 83). The median ROM was 75° in forward flexion (40 to 160), 78° in abduction (30 to 150), 35° in internal rotation (10 to 80), and 33° in external rotation (0 to 55). Postoperatively, two of 14 patients underwent or were supposed to undergo revision surgery, and the cumulative incidence of revision surgery was 18% for both 30 and 48 months (95% CI 2 to 45). During the study period, no patients reported instability, and no dislocations occurred.

Conclusions: Our findings are concerning because the revision risk with this constrained reverse total shoulder implant was higher than has been reported by others for other proximal humerus prostheses. The highly constrained design that helps prevent instability might also transmit increased stresses to the humeral component-bone interface, therefore making it susceptible to loosening. We believe that any other implant with a similar degree of constraint will have the same problem, and changing the indications for patient selection may not solve this issue. These theories need to be tested biomechanically, but our desire is to warn surgeons that while trying to prevent instability, one might trade one complication (instability) for another: aseptic loosening.

Level Of Evidence: Level IV, therapeutic study.
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http://dx.doi.org/10.1097/CORR.0000000000001245DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571930PMC
November 2020

Dislocation after total hip arthroplasty: does head size really matter?

Hip Int 2021 May 8;31(3):320-327. Epub 2020 Jan 8.

Department of Orthopaedics and Traumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Introduction: Recent advances in polyethylene and ceramic technologies has allowed us to use larger sized heads without compromising the wear properties of a total hip arthroplasty (THA). 1 benefit of this change has been proposed to be a lower incidence of dislocation.

Methods: We retrospectively evaluated the dislocation rate in 913 THAs performed using the same standardised surgical technique employed by a single team of surgeons at our institution between 1995 and 2015. Patients were assigned to 2 groups: small (⩽28 mm), large diameter heads (⩾36 mm and larger). The cup position was measured and plotted to determine its status according to the Lewinnek's safe zone (15° ± 10° for anteversion, 40° ± 10° for inclination).

Results: 16 of the 472 small heads dislocated (3.4%) while 5 of the 441 in large head group (1.1%) ( = 0.04). In all of the large head patients that dislocated the cup position was in the safe range of Lewinnek. However, in the large head group only 64.5% of the cups were in the safe zone.

Conclusions: By changing the head size to 36 mm, we were able to decrease the dislocation rate significantly. Errors of cup positioning according to Lewinnek became oblivious when using large heads. In our opinion, using large heads in THA makes a difference in terms of dislocation.
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http://dx.doi.org/10.1177/1120700019898404DOI Listing
May 2021

Titanium cage reconstruction of acetabular defects in revision hip arthroplasty results in favourable outcomes: up to 17 years follow-up.

Hip Int 2020 Sep 11;30(5):617-621. Epub 2019 Jun 11.

Orthopaedics and Traumatology Department, Hacettepe University, Ankara, Turkey.

Introduction: Titanium cages are valuable implant solutions in management of severe acetabular defects during total hip revisions. We aimed to report clinical and radiological results of our cases in which we used titanium cages for reconstruction of acetabular defects.

Methods: Patients underwent titanium cage reconstruction and bone grafting for their acetabular defects with minimum 2 year-follow-up are included to the study. Analysis of patient records, modified Hospital for Special Surgery hip score and radiological examinations on plain X-rays were evaluated. Acetabular defects are classified according to Paprosky's classification.Kaplan Meier survival analysis is performed.

Results: Fifty-six hips of 54 patients (2 bilateral) aged between 29-79 (mean 57 years ) are followed up for 7.06 years ±3.72 (2-17 years).Five patients required revision surgeries at a mean of 2.6±2.2 years. Kaplan Meier's analysis revealed a survival rate of 91,5 % and mean revision free duration was 15,66±0,56 years.HSS scores of the patients before revision surgery yielded a mean score of 27,9 ± 4,9 (14-38). HSS scores at final follow up showed a significant improvement at a mean score of 45,9 ± 7 (28-56) differences were statistically significant, p<0,001).

Discussion: Titanium cages are successful for restoring bone stock in severe acetabular defects. It is critical to pay attention on meticulous bone grafting of the presented defects and obtain good hip mechanics during cage insertion. Mechanical reasons are the leading cause of failure in long term but restoration of the bone stock and improvement in defect severity were regularly observed even in failed cages.
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http://dx.doi.org/10.1177/1120700019855870DOI Listing
September 2020

Titanium mesh cage as an alternative reconstruction method for epiphyseal-sparing tumour resections in children.

J Pediatr Orthop B 2018 Jul;27(4):350-355

Department of Orthopaedics and Traumatology, Hacettepe University School of Medicine.

In this study, we introduced an alternative reconstruction option for epiphysis-sparing tumour resection in children. Eight patients with a malignant tumour in the diaphysis or metaphysis-diaphysis junction of a long bone underwent epiphysis-sparing intercalary resection. Reconstruction was performed using a titanium mesh cage filled with impacted cancellous bone allograft and autograft. A plate and screws were used to supplement the fixation. At the last follow-up, union was achieved in seven patients. Limb-length discrepancy occurred in three patients. Functional scores revealed a good functional outcome. This technique may be an alternative method for epiphyseal-sparing tumour resections in children.
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http://dx.doi.org/10.1097/BPB.0000000000000482DOI Listing
July 2018

Modular cementless prosthetic reconstruction after resection of lower extremity malignant tumor.

Acta Orthop Traumatol Turc 2016 Dec 10;50(6):674-680. Epub 2016 Dec 10.

Hacettepe University, Faculty of Medicine, Ankara, Turkey.

Introduction: The aim of the study is to report the preliminary clinical and functional outcomes of a modular cementless tumor resection prosthesis system (Megasystem-C, Waldemar Link GmbH&Co. KG, Hamburg, Germany) in patients undergoing limb salvage surgery with wide resection in a lower extremity primary or metastatic malignant bone tumor.

Material And Methods: Fifty-two consecutive patients (33 male and 19 female; mean age 37.1 years (range, 16 to 79) with primary or metastatic lower extremity malignant bone tumor who underwent wide resection and reconstruction with cementless Megasystem-C system were included in the study. Patients were analyzed for age at diagnosis, gender, type and localization of the tumor, time of follow-up, patient and prosthesis survival, complications, oncological and functional outcomes.

Results: Mean follow-up time was 43.2 months (range, 8 to 66). Cumulative patient survival rate was 92.3 percent and cumulative prosthetic survival rate was 65.4 percent. 18 complications were recorded and 9 of them required revision (17.3 percent). Mean overall Musculoskeletal Tumor Society score score was 72.7 percent (range, 52 to 86). Subgroup analyzes demonstrated no difference in complication rates, overall patient or prosthetic survivals. Functional scores according to age, diagnosis and location of the reconstruction also were not significantly different.

Conclusion: The preliminary short-term follow-up results revealed that, the new generation modular cementless endoprosthetic system offers promising clinical and functional outcomes with reasonable complication rates.

Level Of Evidence: Level IV, Therapeutic study.
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http://dx.doi.org/10.1016/j.aott.2016.05.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6197450PMC
December 2016

Risk factors for cut-out of double lag screw fixation in proximal femoral fractures.

Injury 2017 Feb 19;48(2):414-418. Epub 2016 Nov 19.

Hacettepe University Faculty of Medicine Department of Orthopaedics and Traumatology, Ankara, Turkey.

Objective: We assessed factors associated with cut-out after internal fixation of proximal femoral fractures using double lag screw nails.

Design: Retrospective cohort study.

Setting: A university hospital.

Patients And Methods: Patients with non-pathological intertrochanteric femur fractures and a minumum 90days follow-up who underwent internal fixation with dual lag screw nails were included. Potential risk factors for lag screw cut-out investigated by our study were: age, gender, body mass index, comorbidities (American Society of Anesthesiologists [ASA] classification), type of fracture (AO/OTA classification), fracture stability, side, operation time, implant length, reduction quality, tip-apex distance (TAD), and lag screw configuration. Logistic regression was used to investigate potential predictors of screw cut-out.

Results: Eighty-five of the 118 patients with hip fractures treated between February 2010 and November 2013 at our institution met the inclusion criteria for the study. Fifty-eight patients were female (68.2%), mean age was 77.4 (range: 50-95 years), mean follow up was 380days (range: 150days-2.5 years), and cut of was observed in 9 patients (10.5%). The following variables identified through univariate analysis with p<0.2 were included in multivariant logistic regression model: age, side, reduction quality, implant length, TAD and ASA score. Only TAD (p=0.003) was found to be significant in the multivariant model.

Conclusions: Our study confirmed that risk factors for cut-out with single-lag screw devices are also applicable to dual-lag screw implants. We found that TAD was a significant factor for cut-out in dual-lag screw implants. Thus, screw cut-out can be minimized by optimizing screw position.
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http://dx.doi.org/10.1016/j.injury.2016.11.018DOI Listing
February 2017

Iliac bone cysts adjacent to the sacroiliac joint: an unusual cause of sacroiliac pain.

Acta Orthop Traumatol Turc 2014 ;48(5):495-9

Hacettepe University, Faculty of Medicine, Department of Orthopedics and Traumatology, Ankara, Turkey.

Objective: The aim of this study was to describe cystic bone lesions involving the sacroiliac region of the iliac bone as a rare cause of sacroiliac joint-related pain.

Methods: The study included 9 patients with benign cystic bone lesion in Zone 1 according to Enneking and Dunham with a minimum of 2 years follow-up. Detailed radiological examination was performed using magnetic resonance imaging or computed tomography. Extended curettage, adjuvant treatment with phenol and thermal cauterization and bone grafting with auto/allografts were performed. Patients were analyzed for age of onset, side of involvement, clinical and radiological findings, tumor stage, complications and clinical/radiological findings at the final follow-up.

Results: Female to male ratio was 4 to 5. Average age at the time of diagnosis was 40.3 (range: 27 to 54) years. Average diameter of the lesion was 6.6 (range: 4 to 11) cm. Superficial infection was detected in one patient and hypoesthesia around the site of incision in two. Clinical improvement in pain and limp was reported in all patients. No radiological recurrence was detected after an average follow-up time of 30.7 (range: 21 to 40) months.

Conclusion: Benign tumor-like cystic lesions should be kept in mind in the differential diagnosis of sacroiliac joint-related pain. Such lesions can be safely and effectively managed with intralesional curettage, local adjuvant methods and bone grafting.
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http://dx.doi.org/10.3944/AOTT.2014.14.0039DOI Listing
August 2015

Two-staged revision with custom made prosthesis in septic failure of massive allograft reconstruction after type II-III pelvic resection.

Eklem Hastalik Cerrahisi 2014 ;25(3):182-5

Department of Orthopedics and Traumatology, Dr. Sami Ulus Training and Research Hospital, 06080 Altındağ, Ankara, Turkey.

Reconstruction of defects occurring during periacetabular resections of pelvic tumors is required particularly in young and functionally active persons. Allograft reconstruction provides good functional outcomes in restoration of normal pelvic anatomy. A 24-year-old male patient was reconstructed with an allograft-prosthesis composite after periacetabular resection due to pelvic chondrosarcoma. After four years, a two-staged revision with a custom-made pelvic prosthesis was performed due to septic failure. Successful radiographic and functional outcomes were achieved at two-year follow-up. In conclusion, we suggest a two-staged revision with a custom-made pelvic prosthesis as a satisfactory option in case of septic failure of allograft reconstruction after periacetabular resection.
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http://dx.doi.org/10.5606/ehc.2014.39DOI Listing
February 2016

Evaluation of vacuum-assisted closure in patients with wound complications following tumour surgery.

Int Wound J 2016 Jun 26;13(3):394-7. Epub 2014 Jun 26.

Orthopaedics and Traumatology Department, Hacettepe University School of Medicine, Ankara, Turkey.

Covering the reconstructed area with a healthy soft-tissue envelope is a major challenge after limb-sparing surgery in patients with malignant bone and soft-tissue tumours. Negative pressure wound therapy (NPWT) of open wounds hastens healing and minimises the requirement for complex reconstructive soft-tissue surgery. The aim of this study was to investigate the effectiveness and safety of NPWT in bone and soft-tissue malignant tumour patients with postoperative wound complications. Between January 2006 and November 2009, at a single institution, 13 patients with malignant bone and soft-tissue tumours who had undergone wide resection were retrospectively analysed. NPWT was performed in all patients to temporarily close the soft-tissue defects. After obtaining the culture negativity and normal infection markers, definitive soft-tissue reconstruction was performed to close the wound with primary suturisation in two patients, split thickness grafts in four patients, full thickness grafts in two patients, rotational flaps in three patients and free flaps in two patients. Mean duration of hospitalisation was 20 (range 8-48) days and mean follow-up period was 57·3 (range 50-74) months. There was no tumour recurrence or skip metastasis in the follow-up period. In addition, there was no periprosthetic infection or complication associated with NPWT. In conclusion, NPWT therapy seems to be a safe and effective option in the management of local wound problems and secondary surgical site infections after musculoskeletal tumour surgery.
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http://dx.doi.org/10.1111/iwj.12318DOI Listing
June 2016

Long-term results of reconstruction with pelvic allografts after wide resection of pelvic sarcomas.

ScientificWorldJournal 2014 27;2014:605019. Epub 2014 Jan 27.

Department of Orthopaedics and Traumatology, Faculty of Medicine, Hacettepe University, 06100 Ankara, Turkey.

Reconstruction after the resection of a pelvic tumor is a challenging procedure in orthopedic oncology. The main advantage of allograft reconstruction is restoration of the bony architecture of the complex pelvic region. However, high complication rates such as infection and allograft resorption had been reported in the literature. In this study, we aimed to retrospectively review nine patients treated with pelvic resection and structural pelvic allograft reconstruction. Functional results, complications, and survival of the patients and the allografts were evaluated. At a mean follow-up of 79 months, three patients were dead. Major complications were detected in eight of the nine patients. Infection (four of the nine patients) and allograft resorption (three of the nine patients) were the most common causes of failure. The cumulative survival of the patients was 66.7 percent at 70 months. However, allograft survival was only 26.7 percent at 60 months. Mean MSTS score was 69. In conclusion, we suggest that other reconstruction options should be preferred after pelvic resections because of the high complication rates associated with massive allograft reconstruction.
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http://dx.doi.org/10.1155/2014/605019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3925599PMC
March 2015

Gait analysis in adults with severe hip dysplasia before and after total hip arthroplasty.

Hip Int 2010 Oct-Dec;20(4):466-72

Hacettepe University, Faculty of Medicine, Department of Orthopaedic Surgery, Ankara, Turkey.

Anatomical reconstruction of high riding hips by total hip arthroplasty (THA) and subtrochanteric shortening osteotomy aims to normalise gait pattern and improve functional hip scores. We present the medium-term clinical results of a group of patients with high riding dislocated hips in whom a cementless THA and subtrochanteric shortening osteotomy had been performed. We compared them with their preoperative status, with patients who had undergone a cementless THA for primary osteoarthritis, and also with a group of healthy gender and age-matched controls. Prospective computerized, three-dimensional gait analyses were performed in 8 female patients with uni-/ or bilateral severe developmental dysplasia of the hip (Group I). Gait analysis was performed preoperatively and at a mean of 12.5 months postoperatively. A group of 8 individuals who received cementless hip replacement for primary osteoarthritis (Group II), and a control group of 8 able-bodied individuals (Group III) were recruited for comparison. Patients in Group I improved and approached the values of Group II. However both were behind Group III. Limb length discrepancy was reduced from a mean of 4.3 cm (range, 1 - 8 cm) to a mean of 0.8 cm (range, 0 - 2 cm) at the latest follow-up. Pain was reliably relieved and activities of daily living were improved in patients with high riding developmental dysplasia of the hip, but they were still behind the normal population average. Nevertheless, the results can be as satisfactory as those in patients who undergo a THA for primary osteoarthritis.
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http://dx.doi.org/10.1177/112070001002000409DOI Listing
April 2011

Hip fractures in a developing country: osteoporosis frequency, predisposing factors and treatment costs.

Arch Gerontol Geriatr 2010 May-Jun;50(3):e13-8. Epub 2009 May 28.

Hacettepe University Faculty of Medicine, Department of Internal Medicine, Section of General Internal Medicine, 06100, Sihhiye, Ankara, Turkey.

Hip fractures are a burden to both society and the individual. The aim of this study was to describe the frequency of osteoporosis and the in-hospital treatment costs of patients with hip fractures admitted to Hacettepe University Faculty of Medicine Hospital. Patients with a hip fracture who were admitted to the Orthopedics and Traumatology wards between April 2003 and December 2006 were interviewed and 50 of them were enrolled prospectively in the study protocol. Patient characteristics, predisposing factors for fractures and hospital costs were recorded as well as laboratory test results and bone mineral density measurements. The mean age was 74.2 years and 72% of the patients were women. Sixty-four percent of them presented with an intertrochanteric fracture. The patient population was significantly debilitated with a high prevalence of vitamin D insufficiency and secondary hyperparathyroidism. No association was shown with T scores and dietary habits and lifestyle characteristics of patients. In 34% of patients in whom measurements were available, no osteoporosis could be documented. The mean hospital expenditure was $5983. Factors affecting the total cost were age and functional status of the patient and the duration of hospital stay, independent of the type of fracture and surgical procedure used.
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http://dx.doi.org/10.1016/j.archger.2009.04.010DOI Listing
June 2010

The effect of collar on aseptic loosening and proximal femoral bone resorption in hybrid total hip arthroplasty.

Orthopedics 2008 03;31(3):227

Department of Orthopedics and Traumatology, Hacettepe University Faculty of Medicine, 06100, Sihhiye, Ankara, Turkey.

This study compared proximal femoral bone resorption in hybrid total hip arthroplasty cases that had poor or good contact between the collar and proximal medial femoral neck. A total of 94 patients (102 hips) comprised the study group. Mean patient age was 52 years, and mean follow-up was 4.86 years. Bone resorption of the proximal femur was evaluated with immediate postoperative and follow-up anteroposterior and lateral radiographs. Statistical analysis using the Mann-Whitney test showed no significant difference between the groups that had good or poor contact. The collar did not prevent calcar resorption even when ideal contact was achieved.
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http://dx.doi.org/10.3928/01477447-20080301-05DOI Listing
March 2008

[Osteometry of the femora in Turkish individuals: a morphometric study in 114 cadaveric femora as an anatomic basis of femoral component design].

Acta Orthop Traumatol Turc 2007 ;41(1):64-8

Hacettepe Universitesi Tip Fakültesi Ortopedi ve Travmatoloji Anabilim Dali.

Objectives: Clinical and experimental studies of total hip arthroplasty have demonstrated that a close geometric fit between the femoral component and supporting bone is essential for durable implant fixation. Long-term success of total hip prostheses depends on appreciation of the proximal femur anatomy and identification of mean reference values of critical landmarks. Current data on dimensions of prostheses and implantation are based on osteometric measurements of the femora in Western populations. This study was designed to evaluate osteometric features of femora in Turkish individuals and to establish a national database for future studies.

Methods: We conducted morphometric measurements of proximal femoral anatomy and its angular configuration on conventional radiograms of 114 cadaveric adult femora of Turkish individuals who did not have any developmental bone abnormality. Measurements were made according to the parameters defined by Noble et al. For comparison, we used morphometric data reported on Western populations by the same investigators.

Results: Several femoral features were found to be different in Turkish individuals. Although femur head size and offset were similar to Western values, Turkish subjects had a higher femoral head due to valgus position of the femoral head-neck angle, a narrower proximal femoral metaphysis, and a narrower medullary canal with a longer isthmic segment.

Conclusion: Our data revealed diverse features of femoral geometry in Turkish individuals compared to Western populations. These differences should be taken into account in the design and development of hip prostheses.
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November 2007

Single-injection femoral nerve block. Effects on the independence level in functional activities in the early postoperative period in patients with total knee arthroplasty.

Neurosciences (Riyadh) 2006 Jul;11(3):175-9

Department of Physiotherapy and Rehabilitation, (Formerly from the School of Physical Therapy and Rehabilitation, Hacettepe University) Mugla School of Health, Mugla 48000, Turkey. Tel. +90 (252) 2141243. Fax. +90 (252) 2124755. E-mail:

Objective: To investigate the efficacy of single injection femoral nerve block (FNB) on the independence level in functional activities in the early postoperative period in patients with total knee arthroplasty (TKA).

Methods: We conducted this prospective, randomized, blinded trial in the Department of Orthopedics and Traumatology, Hacettepe University Hospital Ankara, Turkey, between June 2003 and April 2004. Twenty-three patients scheduled for elective TKA were randomly divided into 3 groups. Group I received preemptive single injection FNB, group II received postoperative single injection FNB, and group III served as a control group. Intravenous morphine patient controlled analgesia (PCA) was used following surgery in all groups. Morphine dose and pain score defined by the visual analog scale (VAS) were recorded postoperatively at the 15th minute, 30th minute, 1st, 4th, 6th, 12th, 24th, and 48th hours. A standard rehabilitation protocol was applied for all patients. The independence level in functional activities was assessed during the first 2 postoperative days and at discharge with the Iowa Level of Assistance Scale (ILAS) and the Iowa Ambulation Speed Scale (IASS). Physical therapists that enrolled in the study were blinded to the groups.

Results: Pain scores were significantly different between the groups (p<0.05). The preemptive and postoperative FNB group`s VAS scores were both significantly lower than the control group (p<0.05). However, there was no significant difference in VAS scores between preemptive and postoperative FNB groups (p>0.05). There was no statistically significant difference between the groups in any of the functional scores in the first 2 postoperative days, and at discharge (p>0.05).

Conclusion: Single injection FNB provided effective analgesia in patients undergoing TKA. However, the independence level in functional activities in the early postoperative period was not influenced by the analgesia method.
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July 2006

Proliferating cell nuclear antigen index and nm23 expression in osteosarcoma in relation to disease- free survival and tumor grade.

Saudi Med J 2005 Sep;26(9):1475-7

Orthopedics and Traumatology Clinic, Ankara NumuneTraining and Research Hospital, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

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September 2005

Distraction osteogenesis (callotasis) for pelvic closure in bladder exstrophy.

Clin Orthop Relat Res 2004 Jan(418):231-6

Hacettepe University, Faculty of Medicine, Department of Orthopaedics, Ankara, Turkey.

The success of urogenital reconstruction in bladder exstrophy is dependent on how successfully the pelvic ring can be closed. In patients with this disorder, the pubic bones are short and separated. A two-component plate-rod combination was designed to widen the pelvic ring using distraction osteogenesis (callotasis). After a middiagonal iliac osteotomy, two components of the implant are connected with two bolts passing through the iliac bone. After 10 days, the rods outside the skin are approximated gradually. When the pubic bones get close, they are fixed by heavy nonabsorbable sutures. The current study included 14 patients who were operated on between 1990 and 1996. The mean followup was 6 years. No neurologic or vascular complications developed. Successful tension-free closure of the abdominal wall was achieved in all but one patient. Urogenital reconstruction was done in the second stage. In all but one patient, the bladder was closed in one stage of urogenital reconstruction. In one patient (7%), a deep infection developed for which the patient needed early implant removal resulting in failure of the urogenital reconstruction. The described method addresses the pathoanatomy of the pelvic ring. The diameter of the pelvic ring can be widened and the pubic bones can be approximated without a significant increase in tension.
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http://dx.doi.org/10.1097/00003086-200401000-00040DOI Listing
January 2004

Closure of central defects of the forefoot with external fixation: a case report.

J Foot Ankle Surg 2004 Jan-Feb;43(1):56-9

Department of Orthopaedics and Traumatology, Hacettepe University, Ankary, Turkey.

Excision of 1 or more central rays of the foot may complicate soft tissue coverage because large defects may result. The authors presents a technique in which an Ilizarov external fixator was used to narrow the forefoot after resection of the central rays in a patient with diabetes. After external fixator application for 8 weeks, the central defect healed uneventfully and has not shown any recurrence of ulceration after 4 years of follow-up.
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http://dx.doi.org/10.1053/j.jfas.2003.11.006DOI Listing
April 2004

An unusual pattern of arthritis in a child with Kawasaki syndrome.

Clin Rheumatol 2004 Feb 8;23(1):73-5. Epub 2004 Jan 8.

Department of Pediatrics, Hacettepe University Faculty of Medicine, Sihhiye, 06100 Ankara, Turkey.

Arthritis is reported in one-third of cases with Kawasaki syndrome. It may have an early or a late onset form. We present a 15-month-old-girl who had been referred with complaints of pain and swelling in her left shoulder. Physical examination revealed bulbar conjunctival injection, erythematous lips and pharynx, strawberry tongue, erythematous rash, edema and erythema of the left shoulder, left knee, right elbow and right wrist, and moderate distress in the left shoulder and left hip. She was diagnosed with Kawasaki syndrome, and intravenous immunoglobulin infusion (IVIG) 2 g/kg and aspirin (100 mg/kg/day) were instituted. The patient had two additional episodes of arthritis involving the hip joint on the 8th day, and the shoulder and metacarpophalangeal (MCP) and interphalangeal (IP) joints of her right hand on the 15th day. Turbid material was aspirated in both instances; Gram and Wright's staining of this material showed many leukocytes but no bacteria. A second dose of IVIG (1 g/kg) was given. At the end of the third week all extremities were painless, with a normal range of motion. Arthritis in our patient was the presenting sign, having a 'septic arthritis mimicking' and 'biphasic' pattern. Although the patient presented with severe and recurrent arthritis, which is significantly correlated with severe multisystem disease and the presence or development of coronary artery aneurysm, the response to IVIG was excellent.
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http://dx.doi.org/10.1007/s10067-003-0828-9DOI Listing
February 2004

Posteromedial approach and posterior plating of the tibia.

J Trauma 2002 Oct;53(4):722-4

Department of Orthopaedics and Traumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

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http://dx.doi.org/10.1097/00005373-200210000-00017DOI Listing
October 2002

Scintigraphic evaluation of impaction grafting for total hip arthroplasty revision.

Arch Orthop Trauma Surg 2000 ;120(7-8):416-9

Department of Orthopaedics and Traumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

To determine the fate of an impacted allograft after a minimum follow-up of 1 year, we examined 9 of 40 patients who underwent revision arthroplasty with the impaction grafting technique. The allograft used in this study was morselized cancellous freeze-dried allograft. We examined these 9 patients with technetium-99 m methylene diphosphonate bone scintigraphy at an average of 14 (range 12-20) months after surgery. All of them had a good clinical outcome, with an average postoperative Hip Society Score of 89 (range 65-98) and no evidence of radiolucency or subsidence on direct radiography. Scintigraphic examination demonstrated that the area corresponding to the allograft had a remarkable radioactivity accumulation suggesting new bone formation. The allograft in total hip revision using the impaction grafting technique undergoes a significant neovascularization and new bone formation. This study suggests than when vigorous impaction is used, freeze-dried cancellous allograft can be used for impaction grafting.
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http://dx.doi.org/10.1007/pl00013773DOI Listing
January 2001