Objectives: We investigated risk factors for venous thromboembolism (VTE), prophylaxis measures employed, and incidence of symptomatic deep venous thrombosis (DVT) and pulmonary embolism (PE) in patients undergoing major orthopaedic surgery (MOS).\r\nMethods: An open, multicenter, prospective, observational study was conducted in 21 medical centers, comprising 899 patients. Of these, 316 patients (35.2%) underwent total hip arthroplasty (THA), 328 patients (36.5%) underwent total knee arthroplasty (TKA), and 255 patients (28.4%) underwent surgery for hip fractures (HF). Pharmacologic prophylaxis was employed in all the patients.\r\nResults: Risk factors for VTE were seen in 73.2% of the patents, the most common being obesity (72%) and prolonged immobilization (36.3%). Low-molecular-weight heparin (91.1%) and fondaparinux (8.9%) were used for prophylaxis, which was short-term in 273 patients (30.4%) and long-term in 626 patients (69.6%). Mechanical prophylaxis was performed with compression stockings in 610 patients (67.9%) and by intermittent pneumatic compression in 67 patients (7.5%). During three-months of follow-up, symptomatic DVT and PE were seen in eight (0.9%) and four patients (0.4%), respectively. Mortality occurred in 10 patients (1.1%). Complications of major and minor bleeding were seen in eight (0.9%) and 40 (4.5%) patients, respectively.\r\nConclusion: Effective VTE prophylaxis is associated with low risk of clinically apparent DVT and PE in MOS. Özet Amaç: Ülkemizde majör ortopedik cerrahi (MOC) için farmakolojik profilaksi uygulanan hastalarda venöz tromboembolizm (VTE) risk faktörleri, kullanılan profilaksi yöntemleri ve klinik bulgu veren derin ven trombozu (DVT) ve pulmoner emboli (PE) sıklığı araştırıldı.\r\nÇalışma planı: Prospektif, çokmerkezli, açık, müdahalesiz bir gözlem çalışması planlanarak, 21 merkezden 899 hasta çalışmaya alındı. Olguların 316’sında (%35.2) total kalça protezi (TKP), 328’inde (%36.5) total diz protezi (TDP), 255’inde (%28.4) kalça kırığı (KK) cerrahisi uygulandı. Tüm hastalarda farmakolojik DVT profilaksisine başvuruldu. \r\nSonuçlar: Olguların %73.2’sinde VTE risk faktörleri vardı. En sık görülen risk faktörleri obezite (%72) ve uzamış immobilizasyon (%36.3) idi. Profilaksi için olguların %91.1’inde düşük molekül ağırlıklı heparin, %8.9’unda fondaparinuks kullanıldı. Olguların 273’üne (%30.4) kısa dönem, 626’sına (%69.6) uzun dönem profilaksi uygulandı. Mekanik profilaksi 610 olguda (%67.9) elastik çorap ile, 67 olguda (%7.5) aralıklı hava basınç cihazı ile uygulandı. Üç aylık takip sonucunda sekiz olguda (%0.9) klinik bulgu veren DVT, dört olguda (%0.4) PE gelişti. Mortalite 10 olguda (%1.1) görüldü. Kanama komplikasyonu sekiz olguda (%0.9) majör, 40 olguda (%4.5) minör idi.\r\nÇıkarımlar: Etkin VTE profilaksi yapıldığında MOC’de klinik bulgu veren DVT ve PE oranları düşük olmaktadır.

Background/Objectives: Developmental dysplasia of the hip (DDH), defined by the malalignment of the femoral head and acetabulum, is a major precursor to coxarthrosis, posing substantial challenges during total hip arthroplasty (THA). Patients with coxarthrosis secondary to DDH often exhibit acetabular bone insufficiency, which makes challenging surgical reconstruction difficult. This study aimed to compare the radiologic and functional outcomes of robotically assisted and conventional manual THA techniques in patients with coxarthrosis secondary to Crowe type III–IV DDH. Methods: This prospective study included 40 patients divided into robotically assisted (n = 20) and conventional manual (n = 20) THA groups. Evaluations encompassed hip pain (Visual Analogue Scale, VAS), function (Harris hip score and University of California, Los Angeles, activity scale), quality of life (Short Form-12), and prosthesis sensation (Forgotten Joint Score-12). Radiologic outcomes included acetabular inclination and anteversion angles. Femoral shortening, operative duration, and follow-up times were also analyzed. Results: Demographic characteristics did not differ between groups (p > 0.05). Robotically assisted THA exhibited a significantly longer operative time (171.40 ± 11.96 vs. 150.30 ± 14.67 min; p = 0.001) but a shorter follow-up (29.3 ± 8.51 vs. 52.95 ± 18.96 months; p = 0.001), without a difference in the amount of femoral shortening (p = 0.947). Despite the extended surgical duration, the two techniques achieved comparable radiologic outcomes, with no significant differences in acetabular inclination or anteversion angles (p > 0.05). Functional assessments, including Harris hip scores (73.85 vs. 73.95; p = 0.978), UCLA activity scores, and VAS, indicated similar efficacy between groups. SF-12 physical and mental quality of life and Forgotten Joint Score-12 prosthesis sensation did not differ between groups (p > 0.05). Conclusions: This study concludes that robotically assisted and conventional manual THA present similar radiologic and functional outcomes in patients with coxarthrosis secondary to Crowe type III–IV DDH, as displayed by comparable acetabular anteversion and inclination alignment, femoral shortening, hip function, pain, quality of life, and prosthesis sensation scores. While robotically assisted THA requires a longer operative time, its precision in implant placement may hold potential advantages for long-term outcomes, demanding further investigation in extended follow-up studies.

Core decompression of the femoral head is a standard surgical procedure used in the early stages of the femoral head avascular necrosis (AVN) (Steinberg I to III). This study aimed to determine whether the advantages of osseoscopy-assisted core decompression using a standard arthroscopic set up in the early stages of AVN of the femoral head. Twelve hips of 12 patients who underwent osseoscopy-assisted core decompression and debridement with the diagnosis of AVN of the femoral head were reviewed between 2019 and 2021. The etiology was idiopathic in 2 patients; ten had a history of steroid use. The preoperative and postoperative first month Harris Hip Score (HHS) and visual analogue scale (VAS) were recorded. Standard X-rays, computerized tomography, and magnetic resonance imaging (MRI) were noted at preoperatively and sixth month follow-ups. In a 1-year follow-up, X-rays and MRIs were reviewed. All patients significantly improved in the VAS and HHS after the osseoscopy-assisted core decompression ( P = .002). Two of the 12 patients with an initial stage of Steinberg IIC and IIB and one with Steinberg IA had a progressive femoral collapse and, therefore, had a total hip replacement at the end of the follow-up. Nine patients (75%) had satisfactory functional and radiological results in 1-year of follow-up. However, 3 patients (25%) culminated in total hip arthroplasty in a 1-year follow-up. Using an arthroscopic set up during osseoscopy-assisted core decompression surgery of the femoral head AVN has the benefits of direct visualization and accurate debridement of the involved area. The osseoscopy-assisted core decompression technique avoids excessive debridement of the healthy bone tissue adjacent to the necrotic area.

Background and Objectives: Intertrochanteric fractures of the femur are common in the elderly due to the increase in longer life expectancy. However, unstable intertrochanteric fractures in the elderly population were still a significant concern for the postsurgical period after total hip arthroplasty (THA). This study aimed to compare the demographics, operative time, dislocation rate, and length of stay of the novel interfragmentary technique (IFT) and the conventional posterolateral approach (CPA) for unstable intertrochanteric femoral fractures treated with THA in the elderly. Materials and Methods: This retrospective study investigated community-dwelling elderly patients with type III, IV, and V unstable femoral intertrochanteric fractures according to the Evans–Jensen classification, treated with THA by a well-experienced single surgeon. The patients were separated into IFT (n = 74) and CPA (n = 67) groups. Patient demographics (age, gender, and body mass index), total surgical duration, dislocation rates, length of stay and follow-up, and complication rates were recorded. Results: The mean age was 80.37 years in the IFT and 80.14 in the CPA groups (p = 0.838). Body mass index, gender, complication, and revision rates did not differ between groups (p > 0.05). The mean follow-up of the IFT group was 4.15 years, and 10.25 years in the CPA group (p = 0.001). Total surgical duration was comparable, with 69.98 min in the IFT group and 69.55 min in the CPA group (p = 0.697). The dislocation rate was 2.7% (n = 2) in the IFT group and 9% (n = 6) in the CPA group (p = 0.109). The mean length of stay was 66.97 h in the IFT group and 67.83 h in the CPA group (p = 0.729). Conclusions: The interfragmentary surgical technique, a novel technique for unstable intertrochanteric fracture surgery, shows promising clinical outcomes. Preserving the short rotator muscles and posterior capsule utilizing the novel IFT can be advantageous for the risk of dislocation without increasing surgical duration. It can be concluded that performing THA using IFT emerges as a practical and viable procedure for treating unstable intertrochanteric fractures in elderly patients.

Background and Objectives: The posterior approach in total hip arthroplasty (THA) is widely used among surgeons. This study compares dislocation rates and functional outcomes between patients using a piriformis tendon-sparing posterior approach (PSPA) and those using a conventional posterior approach (CPA). Materials and Methods: 350 patients who underwent THA between 2016 and 2020 were retrospectively reviewed, with 163 patients receiving a PSPA and 187 receiving a CPA. Dislocation complication and the functional outcomes including the baseline and postoperative sixth-week pain and Oxford Hip Score, sixth-week Ranawat internal rotation test, and sixth-month acetabular inclination and anteversion angle were recorded. Hospital stay and the duration of surgery were also noted. Results: Implant dislocation occurred in three (1.6%) patients only in the CPA group at six weeks postoperatively (p = 0.104). No differences were noted in surgery time, baseline and postoperative pain, or hip function (p < 0.05). The Ranawat internal rotation test was positive in 89.6% of the PSPA group and 40.1% of the CPA group at six weeks (p = 0.001). The inclination angle was better in the PSPA group (p = 0.001), but there was no difference in anteversion angle (p = 0.523) at the sixth month postoperatively. The PSPA group had a shorter hospital stay (mean = 2.14 days) compared to the CPA group (mean = 2.47 days) (p = 0.006). Conclusions: The absence of dislocation cases in the piriformis-sparing approach suggests that the preservation of the piriformis tendon, especially in the early period, may have reduced the risk of prosthesis dislocation by increasing joint stability from a clinical perspective. Further research is needed to evaluate the long-term impact of the piriformis-sparing posterior approach regarding the dislocation rates and functional outcomes.