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Objective: Numerous factors affect abductor strength after Total hip arthroplasty (THA), including surgical technique, prosthesis type, postoperative rehabilitation program, and preoperative patient condition. We prospectively investigated the effects of the modified Hardinge approach on hip muscle strength, which was evaluated using the isokinetic test, functional results, and gait function of patients who underwent primary THA. Methods: The hip muscles strength were measured using an isokinetic dynamometer. The primary outcomes of the present study were measurement of isokinetic strength of hip abductor muscle strengths using an isokinetic evaluator and gait analyses preoperatively and at 6 months postoperatively in 27 patients. Results: Isokinetic muscle strength test, abductor and other hip circumference groups achieved the preoperative muscle strength at 3 months postoperatively, and the postoperative sixth month values showed a statistically significant improvement compared with the preoperative and third month values. In gait analyze, our temporospatial data showed a slight regression at postoperative 3 months but reached the same values at 6 months postoperatively. Kinematic data showed a significant regression, but the data were not compared with those in the preoperative period. Conclusions: Adequate muscle strength and physiological gait pattern, similar to the preoperative status, can be achieved at 6 months postoperatively. Level of evidence: Level III. [ABSTRACT FROM AUTHOR]

Background: This study aims to determine the efficacy of both tranexamic acid (TXA) and tourniquet on the tibial cement mantle thickness in total knee arthroplasty (TKA). Methods: We retrospectively reviewed the recorded data of patients with primary end-stage knee osteoarthritis who underwent TKA procedure during 2014–2016 at a single institution to evaluate the tibial cement mantle. Patients were categorized in two groups based on the use of tourniquet (groups 1 and 2). In addition, these groups were categorized into two different subgroups based on the use of TXA in groups 1 and 2 (group 1-A, B and group 2-A, B). Four zones at the tibial baseplate on the anteroposterior view and two zones on the lateral view were measured at the 4–6-week postoperative visit. Results: A total of 28 patients (30 knees) were operated using tourniquet and TXA (group 1-A), 29 (30 knees) using tourniquet without TXA (group 1-B), 24 (28 knees) using TXA without tourniquet (group 2-A), and 38 (42 knees) without using TXA and tourniquet (group 2-B). Although a significant difference was found in the cumulative cement mantle penetration on postoperative X-rays between groups 1 and 2, no significant differences were found between groups A and B in both groups. Conclusions: This study reports that tourniquet use in TKA increased cement mantle penetration of the tibial component in primary TKA. The main strength of this study was that the TXA use alone exhibited no significant effect on the cement thickness. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to analyze the prognostic factors affecting the survival of patients over 90 years with intertrochanteric fractures treated with proximal femoral nailing. Materials: Records of 53 patients over 90 years old treated in our clinic between 2009 and 2018 for intertrochanteric fractures with proximal femoral nailing were retrospectively reviewed. Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) were analyzed for validity as prognostic factors. Kaplan–Meier test was used to estimate overall survival. A multivariate Cox algorithm was used to determine independent factors associated with survival. The minimum follow-up duration was one year. Results: The average age at the time of surgery was 92.8 years. There were 39 women and 14 men. The right femur was involved in 29 (54.7%) patients and the left in 24 (45.3%) patients. At the time of this study, 32 (60.3%) patients were deceased. There were 21 (39.7%) surviving patients with a mean survival of 41.2 months (range 12–113). Survival rates at first month, 6 months and 1 year after surgery were 90.6%, 88.6% and 86.7%, respectively. The mean survival after surgery was 29.6 (2 days–95 months) months for deceased patients. Among all the parameters, ASA score and delay to surgery were independently associated with worse overall survival. Conclusion: An ASA score of 4 increased mortality by a factor of 26 and delay to surgery increased mortality by a factor of 1.3. Both were prognostic factors influencing overall survival. [ABSTRACT FROM AUTHOR]