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    Comparison of pain, muscle strength, and functional status following unicompartmental knee arthroplasty, total knee arthroplasty, and conservative management of gonarthrosis
    (Springer, 2021) Atar, Sevgi; Demírhan, Esma; Çabuk, Haluk; Turan, Kaya; Dedeoğlu, Süleyman Semih
    Background: Treatment options and surgical decision for grade 3–4 gonarthrosis remains controversial. We aimed to compare the pain level, muscle strength, physical performance, lower extremity functions, and other physical activity levels between patients who underwent arthroplasty and those who received conservative management for grade 3–4 gonarthrosis. Methods: This prospective analytical observational study was conducted in a tertiary referral hospital. A total of 30 unicompartmental knee arthroplasty (UKA) and 30 total knee arthroplasty (TKA) patients as two different study groups and 30 patients were treated conservatively as the control group were included. The rehabilitation and complication rates were recorded. The values of the range of motion, quadriceps diameter, were measured and also the isokinetic muscle strength, pick-up, repeated sit-to-stand, stair ascending and descending, straight-line walking, timed up and go, and 20-m walk tests, the knee injury and osteoarthritis-outcome-score (KOOS), the hospital for special-surgery-knee-score (HSS), and Oxford-Knee-Score (OKS) were performed. Results: Postoperative rehabilitation and complication rates were significantly higher in the TKA group compared to the UKA group (p = 0.029 and p = 0.026, respectively). Six months after the treatment, the knee extension muscle strength value at 180°/s, knee flexion degree, total work flexion, stair ascending, VAS at night, all KOOS symptom, pain and daily function and total scores in the UKA group was significantly different than the TKA and the control groups (p < 0.001). Total work extension values, knee flexion degree, in the control group were found to be significantly higher than the TKA group (p = 0.033, p < 0.001, respectively). Conclusions: The UKA was significantly superior to TKA and conservative treatment concerning pain, muscle strength, and quality of life. Level of Evidence: IIa. © 2021, Indian Orthopaedics Association
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    The effect of gluteus maximus tenotomy in primary total hip arthroplasty with posterior approach: kinematic analysis of hip extensor strength
    (SAGE Publications Ltd, 2021) Ímren, Yunus; Karslıoğlu, Bülent; Dedeo?lu, Süleyman Semih; Çabuk, Haluk; Atar, Sevgi; Gürbüz, Serhat; Gürbüz, Hakan
    Background: The posterior approach (PA) is the most commonly used surgical approach for total hip arthroplasty (THA), but the proximity of the sciatic nerve may increase the likelihood of sciatic nerve injury (SNI). Gluteus maximus tenotomy can be performed to prevent SNI because tenotomy increases the distance between the femoral neck and sciatic nerve and prevents compression of the sciatic nerve by the gluteus maximus tendon (GMT) during hip movements. We aimed to kinematically compare the postoperative hip extensor forces of patients who have and have not undergone gluteus maximus tenotomy to determine whether there is a difference in hip extensor strength. Methods: Seventy-two patients who underwent gluteus maximus tenotomy during THA were included in the group 1, and 86 patients who did not undergo tenotomy were included in group 2. The Harris hip score, body mass index and hip extensor forces were measured both preoperatively, and 6 months after surgery with an isokinetic dynamometer and compared. Results: The mean age was 64.6 ± 2.3 years in group 1 and 63.8 ± 2.1 in group 2. Mean body mass index was 25.7 ± 1.1 in group 1, and 25.5 ± 1.3 in group 2. Baseline Harris hip score (HHS) was 42.36 ± 12 in group 1 and 44.07 ± 9.4 in group 2 (p = 0.31), whereas it was 89.1 ± 7.8 and 88.4 ± 8.1 at 6 months after surgery, respectively. Baseline hip extensor force (HEF) was 2 ± 0.4 Nm/kg in group 1, and 2.1 ± 0.7 Nm/kg in group 2 (p = 0.28), while it was 2.4 ± 0.6 Nm/kg, and 2.5 ± 0.5 Nm/kg, respectively at 6 month follow-up (p = 0.87). Both groups had significantly improved HHS and HEF when comparing baseline and postoperative measurements (p < 0.0001). No cases of sciatic nerve palsy were noted in group 1, whereas there were two (2.32%) cases in group 2, postoperatively. Conclusion: The release of the GMT during primary hip arthroplasty performed with the PA did not lead to significant decrease in hip extension forces. Hip extensor strength improves after THA regardless of tenotomy. Gluteus maximus tenotomy with repair does not reduce muscle strength and may offer better visualization.
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    Proprioception analysis of patients with anterior cruciate ligament reconstruction
    (2023) Erkurt, Nazım; Yerli, Mustafa; Yüce, Ali; Bayraktar, Tahsin Olgun; Atar, Sevgi; Turan, Kaya; Çabuk, Haluk
    Objectives: This study evaluates the effect of tibial stump mechanoreceptor preservation on proprioception, muscle strength, recovery and functional outcomes after arthroscopic anterior cruciate ligament surgery (ACLS). Methods: Patients undergoing ACLS between January-July 2019 were evaluated by a single surgeon. The HUMAC NORM 2 device measured patients' proprioceptive sensation and muscle strength before and after surgery; KOOS and Oxford scales were used to score patients’ functional results. The patients were divided into two groups: those who underwent stump-preserving surgery (SP group) and those who underwent conventional surgery (C group). Results: Our study evaluated 27 patients, 11 in the SP and 16 in the C groups. The two groups had no statistical difference in muscle strength, proprioception, and functional scores in the first and third postoperative months. In the sixth-month evaluation, significantly better functional scores were found in the C group. Further, the athletic function was better in patients with good proprioception recovery, regardless of the group comparison. Conclusions: Preserving the stump and mechanoreceptors on the tibial face was not determined to provide additional benefit to the patients in the first six months after surgery. Returning to sports was faster and functional scores were better in patients with good proprioception recovery.