Objectives: Total hip arthroplasty by minimal invasive anterolateral exposure is a technique which causes minimal damage on skin, muscles and bone and lead to early recovery. Current study compared the clinical and radiological results of total hip arthroplaties performed with two different exposure- minimal invasive anterolateral (MIA) and standard anterolateral exposure (SA).

Methods: Several parameters of total hip arthroplasty patients managed with two different exposures between 2005 and 2008 were evaluated retrospectively from medical records. First group was consisted of total hip arthroplasty patients managed with SA exposure. 26 hip of 25 patients were operated in this cohort. Mean age, follow up and body mass index was 57±12.45 year, 25.23±8.71 months and 32.52±5.77 respectively. Second group was consisted of total hip arthroplasty patients managed with MIA exposure.15 patients were operated in this cohort. Mean age, follow up and body mass index was 68.93±5.51year, 26.07±7.21 months and 28.69±2.72 respectively. Intraoperative, postoperative, total blood loss, operation time, blood transfusions, length of hospital stay were evaluated. Preoperative; postoperative 1,6,12,24 th hours VAS scores and Harris Hip Score (HHS) in preoperative; postoperative 1,6,12 th months and last controls were evaluated. Femoral component position (varus or valgus), inclination of acetabular component and signs of loosening were evaluated from the last follow up radiographies.

Results: Intraoperative, postoperative, total blood loss, blood transfusions, length of hospital stay were significantly reduced in MIA group as compared to SA group (p< 0.05). Average operation times were not different (p=0.259). Improving in VAS scores and HHS was significantly better in MIA group (p< 0.001). Postoperative SF-36 scores were significantly higher in both groups as compared to preoperative scores (p< 0.05). No sign of looseing, osteolysis, superficial or deep wound infection were detected in both groups.

Conclusion: Total hip arthroplasty by MIA exposure reduces length of hospital stay, leads to better pain control and rehabilitation in early period, causes less blood loss and leads to significant improvement in SF 36 scores. We suggest that after completion of learning curve, total hip arthroplasty by MIA exposure can be performed more effectively and with less complication.

Introduction: Treatment of defected pseudoarthrosis tibia remains controversial due to bone loss with/without infection arises from previous interventions. In the present study we evaluated the results of acute shortening and distraction osteogenesis in the treatment of tibia pseudoarthrosis with bone loss.

Material and Methods: Eleven patients were treated with acute shortening and distraction osteogenesis. Mean age and bone loss was 27.5 years (range 10–44) and 8.9 cm (range 3.5–12) respectively. 7 of eleven patients is infected pseudoarthrosis. Enfected patients were type 4A according to Chierny-Mader classification. The 4 of infected patients were treated with two staged procedure. In the first stage antibiotic (teicoplanin) impregnated polymethylmetacrilate beads were placed to the space occurred as a result of excision of sclerotic bone segment and fixation was performed by external fixator or braces. Second stage composed of acute compression (shortening) and distraction osteogenesis. Other 3 infected and noninfected patients were treated with resection, acute shortening and distraction osteogenesis in one stage. In six cases docking site were grafted with autografts. Defects greater than 4 cm were gradually shortened 2mm/day in addition to acute shortening. Limb length inequality was solved with lengthening from proximal tibial corticotomy and achieving union of both sites about the same time.

Results: Mean follow up, external fixator time and external fixator index was 48.3 months (21–80), 8.9 months (6–13) and 1,3 month/cm respectively. results were evaluated according to Paley’s bone and functional evaluation scoring. Eleven patient revealed excellent results with regard to bone evaluation and 10 patient revealed excellent and 1 patient revealed good results in terms of functional evaluation. In one patient fracture at the pseudoartrosis site occurred due to new trauma after removal of the fixator which was treated with circular external fixator. In the another patient, the lengthening regenerate side was low quality bone which need intra-medullary fixation and grafted with autograft.

Conclusion: Acute shortening and distraction osteogenesis is a safe and successful procedure in the treatment of defected tibia pseudoarthrosis and is alternative to other treatments. Acute shortening and distraction osteogenesis was found to be successful and safe with regard to functional results in the treatment of defected tibia pseudoarthrosis. Besides we suggest it as an alternative due to lower rate of complications and less external fix-ator time compared to other Methods:

Coblation is supposed to enhance healing due to increasing vascularity in the degenerated tendon. In the present study the effect of coblation treatment on tendon degeneration was investigated.

A total of 32 New Zealand rabbit were enrolled in the current study. Experimental degeneration was performed by injecting prostaglandin E1 (PGE1) to bilateral achilles tendons of rabbits. Four rabbits were excluded by different reasons. Coblation and control groups were composed of 12 rabbits in each. Coblation device only touched to tendon in the control group whereas in the coblation group coblation treatment was performed through 2 cm segment to form grids with 0.5 mm apart with level four energy lasted for 500 ms. 6 rabbits in control and coblation groups were sacrificed in 6th and 12th weeks. Achilles tendons were evaluated histopathologically by modified Movin scale and immunohistopathologic examination was performed using vascular endothelial growth factor (VEGF) and type 4 collagen.

After injection of PGE1, findings similiar to chronic tendinosis were revealed. Coblation group revealed significant increment in vascularity with histopathological and immunohistochemical examination. However difference regarding healing of tendon degeneration was not significant between control and coblation group.

Coblation treatment increases vascularity in degenerated tendon, but doesn’t increase healing process.

Introduction: Reactive oxygen species (ROS) have important roles in the pathogenesis of ischemia reperfusion injury (I/R) of skeletal muscles Melatonin was proved to be an antioxidant agent and many experimental models showed that it reduces I/R injury in many tissues. The objective of present study was to detect protective antioxidant effect of melatonin on I/R injury of skeletal muscles.

Material and Methods: Albimino wistar rats were randomly allocated into 3 groups. There were 8, 10, 10 rats in sham, I/R and I/R + melatonin (Mel) groups respectively. Right hind limb ischemia was achieved by clamping femoral arteries in all groups except for control group. Melatonin (10 mg/kg) was administered intraperitoneally in I/R + Mel group 48, 24, 1 hour before reperfusion. After a period of 2 hour ischemia followed by 1.5 hour reperfusion, muscles and venous blood samples were collected for biochemical analysis and histopathological examination. Plasma antioksidant enzyme activities of süperoxide dismutase (SOD), glutathion peroxidase (GSH-Px), and levels of MDA and NO. were investigated. Enzyme activities of catalase (CAT), protein carbonyl (PC), SOD, GSH-Px and levels of MDA and NO. were analysed in muscle tissues.

Results: Antioxidant enzyme activities and levels of MDA and NO. in plasma were significantly higher in I/R group compared to control group (p< 0,001). Muscle tissues of I/R groups revealed significant higher antioxidant enzyme activity and MDA, NO. levels with respect to control group (p< 0,001). Levels of these parameters in muscle and plasma revealed significant reduction in I/R + Mel group with respect to I/R group (p< 0.001). Histopathological examination of ischemic muscles in I/R group showed significant degeneration and inflammation compared to control group whereas melatonin administered ischemic muscles showed significant reduction of degeneration and inflammation with respect to I/R group (p< 0.001).

Conclusions: Levels of NO. and MDA and antioxidant enzyme activity were significantly higher and also revealed significant degeneration and inflammation in I/R group. These results support the opinion that ROS is an important factor in the pathogenesis of I/R injury in skeletal muscles. We attribute the increasing enzyme activities in I/R group to a compensatory mechanism against ROS. Levels of NO. and MDA and antioxidant enzyme activity in tissue and plasma of I/R + Mel group were significantly lower and additionally revealed significant improvement in inflammation and degenaration. This proves the potential ROS scavenging effect of melatonin in reduction of I/R injury. In conclusion we suggest that melatonin may be used in the treatment of I/R injury due extremity injuries with vascular compromise, extremity surgery with prolonged tourniquet time and compartment syndrome.

Introduction: Medial laxity is an important problem in knees with mono-compartmental gonarthrosis. Medial laxity can cause the progression of the gonarthrosis if it is left uncorrected. Therefore, managing of medial laxity during high tibial osteotomy is very important. In this study, the effect of openning focal-dome type osteotomy on the medial laxity was investigated.

Materials-Methods: Four knees of two cadavers (74-year-old male and 52-year-old female) were used in this study. For the creating pseudo-medial laxity in the knee, while total medial menisectomy was performed in two knees of male cadaver, 5 mm osteochondral resection of both joint surfaces of the medial femoral condyle and medial tibial plateau was performed in two knees of female cadaver.

Results: After creation of the pseudo-medial laxity, opening focal-dome type osteotomy extending to proximal to the insertion of superficial medial collateral ligament was applied with circular fixator in all knees and 15° valgus effect was applied on the osteotomy line by motor unit of the circular fixator. By applying 15° valgus effect on the osteotomy, average reduction of medial laxity was measured as 70% in all knees.

Conclusions: Opening focal-dome type osteotomy decreases medial laxity effectively by tightening the superficial medial collateral ligament.