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Background Intraoperative irrigation with diluted povidone iodine (PI) can be used to reduce the incidence of infection-related complications in arthroplasty surgeries. Since PI is associated with many interventions, especially skin antisepsis, its systemic effects are being studied. The aim of our study is to evaluate the systemic effects of PI, which we use as an irrigation solution, by means of urine iodine and thyroid function tests. Methods In this case-control study, 96 patients who underwent knee or hip arthroplasty were included and divided into two groups according to the irrigation solution. In the first group, PI was added to the standard irrigation. The second group was considered as the control group and only standard irrigation was applied. Urine iodine, thyroid stimulating hormone, free T3 and free T4 values were compared in the preoperative and postoperative periods of these two groups. In this way, the effect of absorbed iodine on thyroid functions was investigated. Results In the diluted PI group, urinary iodine levels were measured at maximum levels (450 µg/L) in the early postoperative period in most of the patients. The statistically significant difference in urinary iodine levels between the PI group and the control group, which started in the early postoperative period, continued until the last follow-up on the 14th postoperative day. In terms of thyroid functions, the observed differences were not statistically significant. Conclusion Studies to reduce periprosthetic infection show that PI can be preferred for irrigation before the closure of the joint area in total joint arthroplasty. Although the success of this treatment in periprosthetic infection has been investigated, its systemic examination has not been demonstrated. It was determined that PI treatment, which was seen to decrease in the systemic circulation within 14 days, did not show a statistically significant change in terms of thyroid functions when used at the determined concentration and duration. These results should be evaluated with larger and longer-term studies. Trial registration Clinical trials ID no. NCT05599841.

Objectives: We aim was to evaluate the quality and reliability of the information on knee arthroplasty available on YouTube in Turkish. Methods: A systematic search was conducted using the term “diz protezi” (knee prosthesis) on 1 June 2020.Videos were filtered based on their degree of relevance alone. Videos that were not in Turkish, not on knee prosthesis or without audio and/or image were excluded. Copied videos were evaluated as a single video. The first 50 videos that came up in the search were included in the study. Video quality was scored using Global Quality Score (GQS). To assess reliability, modified DISCERN scale was used. Results: The mean view count per video was 31.533 ± 100.921 and the total view count was 1.576.633. The mean duration per video was 337 ± 475 seconds. The median number of likes per video was 13 (0-426). The median number of dislikes per video was 2.5 (0-83). The mean GQS of the videos was 3.25 ± 0.9. When the reliability of the sources was evaluated using DISCERN, the mean score of the videos was 2.18 ± 1.2. It is striking that all videos were prepared by an orthopedic surgeon. Of the medical doctors preparing the resources, 44% had academic titles. Conclusions: It was found that Turkish resources on arthroplasty on YouTube are promising in terms of quality. Content creators must make effort to increase their reliability according to DISCERN.

Objectives: A failed intertrochanteric fixation often leads to functional disability and pain. The most commonly observed complication is “cut-out”, which frequently requires hip arthroplasty in the subsequent period. In this study, we aimed to compare the results of total hip arthroplasty (THA) and hemiarthroplasty (HA) after cut-out complication of proximal femoral nailing (PFN). Materials and Methods: Forty patients who were treated with THA (20 patients) and HA (20 patients) due to cut-out complication following PFN were included in our retrospective study. Age, gender, classification of the pertrochanteric fracture (AO/OTA classification), time to arthroplasty surgery, operative time, total blood loss, and complications were reviewed. The clinical results were evaluated by the ambulatory status, Harris hip score (HHS) and visual analog scale (VAS) score at the second year follow-up. Results: The amount of blood loss and the operative time were significantly higher in the THA group (p=0.001). Post-operative second year VAS score and HHS were similar in both groups (p=0.989 and p=0.820, respectively). There was no significant difference between the two groups in terms of complications rate (p=0.294). Conclusion: Converting to hip arthroplasty is a successful choice in the treatment of cut-out complications following PFN. Both THA and HA groups had similar clinical results, with the HA group being more advantageous regarding cost, operative time, amount of blood loss, and rate of infection. However, the only valid option for those with acetabular defects during cut-out is THA.

Objectives: We aimed to convey our pandemic observations and experience as orthopedics and traumatology clinic in the period from the formal declaration of the first case in Turkey to the descending trend of the number of active cases. Materials and Methods: The first Coronovirus disease-2019 (COVID-19) case in Turkey was seen on March 11 and all elective surgeries were postponed as of March 17th. The number of active cases entered a downward trend with the number of patients recovering daily exceeding the number of new cases daily on April 24. The numbers and categories of surgeries performed in our clinic between March 17 and April 24, 2020 were examined and analyzed by comparing to the same period of 2019. Results: A total of 105 surgical operations were performed in our clinic between March 17 and April 24, 2020. Of these operations, 33.3% were trauma, 25.7% were hand and finger injury, and 14.3% were orthopedic oncology cases. During the same period of 2019, a total of 436 operations were performed, of which 19.3% were trauma, 16.5% were arthroscopy, 12.6% were arthroplasty, 11.9% were hand and finger injuries, and 8.9% were oncological surgery cases. It was seen that the number of surgeries decreased by 76% during the pandemic. Conclusion: The COVID-19 pandemic has profoundly affected daily life and work practice in the field of orthopedics and traumatology. It is important to create an administrative organizational chart during crisis periods like a pandemic and to implement the measures to be taken immediately.

Background: Soft tissue interposition between a suspensory cortical button and the lateral femoral condyle is the most common cause of postoperative suspensory cortical button migration in patients undergoing anterior cruciate ligament reconstruction (ACLR). Purpose: To investigate the effects of soft tissue interposition and suspensory cortical button migration after ACLR on functional outcomes and graft ligamentization. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 249 patients who underwent single-bundle ACLR with hamstring tendon autografts. To measure soft tissue imposition, the patients were divided into 2 groups: those in whom the suspensory cortical button was in contact with (group 1) or at least 1 mm away from (group 2) the lateral femoral condyle on 1-day postoperative radiographs. To measure suspensory cortical button migration, the patients in group 2 were further divided into 2 subgroups: those with button migration (group M) and those without migration (group non-M) as observed on 12-month postoperative radiographs. Ligamentization was evaluated according to Howell classification (grades 1-4) on 12-month follow-up magnetic resonance imaging scans. Also recorded were preoperative and 24-month postoperative Lysholm and Tegner scores and 24-month postoperative arthrometer measurements for anterior knee laxity. Results: There was no significant difference between groups 1 and 2 or between groups M and non-M in terms of demographic characteristics or additional intra-articular pathologies detected intraoperatively. Normal anterior laxity (<3 mm) was detected in 83.7% of the patients postoperatively, and all patients showed statistically significant pre- to postoperative improvement on the Tegner (from 4.1 to 4.3) and Lysholm (from 44.0 to 89.2) scores (P < .05 for both). No significant difference in postoperative functional results or graft ligamentization was found between either the soft tissue interposition groups (groups 1 and 2) or the suspensory cortical button migration groups (groups M and non-M). Conclusion: Differences between patients in soft tissue interposition and suspensory cortical button migration did not significantly affect postoperative clinical or functional outcomes or graft ligamentization after single-bundle ACLR.

Objectives. To examine the effect of fluoroscopy devices with different sizes of image intensifier and C-arm maneuverability on operating time, fluoroscopy time, radiation dose and reduction, and fixation quality at intertrochanteric femoral fractures. Design. Single-center, randomized, prospective study. Setting. Academic Level I trauma hospital. Patients and Intervention. 34 patients treated with cephalomedullary nailing for a stable, intertrochanteric proximal femur fracture (OTA A1). Main Outcome Measurement. The total working time of the fluoroscopy device, the dose-area product (DAP), operating time, reduction quality (cortical continuity, symmetrical collodiaphyseal angle, and shortness), and fixation quality (Bosworth quadrants, the tip-apex distance, TAD). Results. There were no cases of poor reduction; also the placement of the blade was optimal for 14 patients and suboptimal in 3 patients in each group. Superior-posterior placement of the blade or TAD > 25 mm was not seen in any patient. Total operating time was significantly shorter when using device A compared to the use of device B (20.1±3.4 mins versus 25.3±5.4 mins, p<0.001). Total radiation time was significantly shorter with device A compared to the use of device B (58.1±19.4 secs versus 98.9 ± 55.4 secs, p=0.008). The measured radiation dose was lower with the use of device A compared to device B (3.5 ± 1.2 Gy·cm2 versus 7.3 ± 4.5 Gy·cm2, p=0.002). Conclusion. Physical properties of fluoroscopy devices used during the fixation of intertrochanteric fractures could yield significant differences in operating times and the radiation dose while having comparable clinical results.

Objective Fear of falling, anxiety, depression, and pain levels are important risk factors for poor functional outcomes that may potentially be modifiable. We aimed to examine prospective associations between those factors following surgery for intertrochanteric hip fracture. Methods This study is a prospective observational cohort study of patients aged over 65 diagnosed with isolated intertrochanteric hip fracture. Three hundred and seventy patients who underwent intramedullary fixation surgery were screened; 188 cases were included in our final evaluation. Patients with any concomitant fracture, major psychiatric/neurocognitive and neurological disorders and those with any other major disease were excluded from the study. Age, Charlson Comorbidity Index (CCI), Geriatric Depression Scale (GDS), State–Trait Anxiety Inventory (STAI), Falls Efficacy Scale International (FES-I), and Visual Analog Scale (VAS) scores on the day of surgery (baseline) were evaluated as predictors of poor/good outcome at 90 days after surgery, by Harris Hip Score (HHS) with a cut-off score of 70. Results HHS score was significantly predicted at baseline by the full model [χ2 (7) = 18.18, P = .01]. However, only STAI-state scores were significantly added to the model [Exp (B) 95% CI: .92 (.86-.99)]. Conclusions In this prospective cohort study, we found that higher levels of anxiety state on the day of surgery predicts a poor outcome at 90 days following surgery. We did not find significant associations between other variables, including age, GDS, STAI-trait, FES-I, VAS, and CCI. This potentially modifiable psychological factor may inform surgeons and could be a potential mediator. Future prospective studies are needed to replicate these findings. Level of evidence Prognostic level I.

Purpose The rates of unicompartmental knee arthroplasty (UKA) are increasing yet little data exists regarding management of periprosthetic joint infections (PJI) after UKA, particularly utilizing one-stage revision. The aim of this study was to determine the septic and all-cause revision-free survival of UKA PJIs treated with one-stage revision, as well as functional outcomes and risk factors for failure. Methods A retrospective review of one-stage septic revisions with a hinged or rotating hinged implant between 2000 and 2015 at a single institution was performed. Results of 15 patients with a minimum of 3-year follow-up (mean = 93 months; range 37–217) were evaluated by means of infection control, survivorship, patient reported functional score and possible causal factors for a re-revision. Kaplan–Meier curves and Cox regression analysis were used. Results After a mean of 8 years of follow-up infection control rate was 93.3%, the survivorship free of any reoperation, including both septic and aseptic causes, was 80% at 5 years and 64.2% at ten years and average Lysholm score was 72.7 ± 21.3 (33–100). Conclusion One-stage revision for PJI of UKA using a hinged knee design has excellent infection-free survival at mid to long-term follow-up. Likewise, patient reported functional outcomes are promising. However, one-third of patients required aseptic reoperation and aseptic loosening was the dominant etiology.

Abstract Purpose The aim of this study was to compare the injury patterns of orthopaedic trauma patients in the paediatric age group who presented to our hospital during and after lifting the curfew due to the pandemic, with the patients of the same age group who presented to our institution during the same time period last year. Methods Patients, aged 0 years to 18 years, who presented to our clinic between 21 March 2020 and 31 May 2020 (during curfew) (Group A1, n = 111), between 01 June 2020 and 31 August 2020 (Group A2, n = 214) and during the same periods in 2019 Group B1 (n = 220) and Group B2 (n = 211) were included. Patients with pathological fractures, traumas occurring earlier than the aforementioned date range and those consulted while being hospitalized in another department were excluded from study. Patients’ demographics, the department they presented to, the anatomical region affected by trauma, trauma mechanism, the location of trauma, the treatment applied and the length of hospital stay were recorded. Results The prevalence of outdoor traumas (72.9% versus 61.1%), high-energy traumas (40.1% versus 26.5%), the rate of the patients treated with surgery (28% versus 17.1%) and the rate of admission to the emergency department (90.2% versus 58.3%) were significantly higher in Group A2 when compared with Group B2 (p < 0.05). Conclusion The significant increase was observed in the number of outdoor injuries, high-energy traumas and fracture patterns that require surgical treatment during the first three months following the lift of the curfew, in comparison with the corresponding dates from last year. We think that children's lower extremity muscle strength and neuromuscular control was decreased due to staying home for a prolonged period of time. Level of Evidence Level III, Case-control study.

Background: Some patients have a positive pivot-shift finding and rotational instability after anterior cruciate ligament (ACL) reconstruction (ACLR). Three major pathologies known to affect the pivot-shift examination include ACL tear, anterolateral ligament injury, and loss of posterior lateral meniscus root function. Purpose: To describe a surgical algorithm determining indications for lateral extra-articular tenodesis (LET) based on intraoperative pivot-shift examination to prevent postoperative pivot shift and rotational instability and to evaluate the 2-year clinical and functional outcomes. Study Design: Case series; Level of evidence, 4. Methods: The study included 47 consecutive patients (39 men and 8 women) who underwent operative treatment for ACL injury between 2016 and 2017. Pivot-shift examination was performed under anesthesia, and the pivot shift was graded as grade 1 (glide), grade 2 (clunk), or grade 3 (gross). According to the surgical algorithm, single-bundle ACLR was performed in patients with grade 1 pivot shift. In patients with grade 2 with loss of posterior lateral meniscus root function, concurrent lateral meniscal repair was performed, and in patients with grade 2 with an intact lateral meniscus posterior root, concurrent extra-articular iliotibial band tenodesis was performed. Patients with grade 3 underwent ACLR, lateral meniscal repair, and LET. Clinical and radiographic evaluations were performed. Results: The mean age was 27.2 years (range, 16-56 years). In total, 26 (55.3%) patients were evaluated as having pivot-shift grade 1; 16 (34%) patients, grade 2; and 5 (10.6%) patients, grade 3. A total of 7 (14.9%) patients underwent LET in addition to ACLR. Two of these patients had pivot-shift grade 2, and LET was performed since the lateral meniscus posterior root was intact. In 14 of 16 patients with grade 2, lateral meniscus root disruption was detected, and lateral meniscal repair was performed. One patient was excluded from the further follow-up because of graft failure. At a mean postoperative follow-up of 29 months in 46 patients, the pivot-shift examination was negative in all patients. The mean Lysholm and International Knee Documentation Committee subjective scores were 95.35 ± 4.40 and 82.87 ± 9.36, respectively. Radiographic evidence of osteoarthritis was not detected. Conclusion: Only 14.9% of patients needed LET. With proper ACL, lateral meniscal, and anterolateral ligament surgery, it was possible to prevent positive pivot-shift findings postoperatively.