Background: The determination of muscle pathologies in lumbar disc herniation (LDH) and other conditions with low back pain is important for understanding low back problems and determining appropriate treatment methods. In patients with lumbar disc herniation with radiculopathy, elucidating the effect of root compression on the severity of muscle degeneration may predict the importance of alleviating root compression. For this purpose, magnetic resonance imaging (MRI) was used to compare the degeneration and asymmetries of the lumbar musculus multifidus (MF) and lumbar musculus erector spinae (ES) muscles in patients with lumbar discopathy without root compression (radiculopathy) and in patients with lumbar discopathy with root compression (radiculopathy). Methods: The patients were examined in two groups: 56 patients with lumbar discopathy and no radiculopathy (Non-rad group) and 51 patients with lumbar discopathy and radiculopathy (Rad group). On axial MRI sections passing through the centre of the disc at the L3-S1 level, the asymmetry, cross-sectional area (CSA), fat infiltration, and total CSA (TCSA = MF + ES) of the MF and ES muscles were measured and compared. Results: No difference was seen between the groups with respect to the CSA values of the right and left MF and left ES, but a significant difference was found in the right ES CSA (p = 0.021). The CSA and TCSA of the MF and ES showed no asymmetry according to group. Severe fat infiltration of > 50% in the right and left MF and left ES was found in the Rad group at a higher rate than in the Non-rad group. Fat infiltration was significantly positively correlated with age, body mass index, and the duration of pain (p < 0.001, p < 0.001, p = 0.004, respectively). Conclusions: The study results showed a correlation between LDH and paraspinal muscle degeneration, while no correlation was found with asymmetry. Severe (> 50%) fat infiltration is associated with root compression, and the severity of fat filtration increases in the presence of root compression. The development of more severe degeneration due to denervation associated with root compression plays a role in the emergence of this situation. Therefore, in patients with lumbar disc herniation with radiculopathy, it can be foreseen that to stop and correct severe fat infiltration and muscle degeneration, first, nerve root compression should be corrected with appropriate medical treatment methods, and in patients in whom there is no response, the pressure should be alleviated with appropriate surgical methods.

Background: The deficiency of the commonly used 3-grade fat infiltration system is discussed by comparing it with the 4-grade fat infiltration system, newly presented to the literature. The aim of this study was to evaluate the efficacy of a semi-quantitative simplified 4-grade fat infiltration measurement system, described for the first time in literature, through comparison with the existing simplified 3-grade fat infiltration system in the prediction of lumbar disc herniation. Methods: The study included 51 patients diagnosed with lumbar disc hernia and 50 healthy individuals as the control group. The patients were evaluated in respect of fat infiltration of the right and left lumbar multifidus and erector spina muscles on axial magnetic resonance imaging slices passing through the centre of the disc at L3-S1 level using the 3 and 4-grade fat infiltration measurement systems. Results: The 3-grade fat infiltration system was found to be insufficient in the prediction of lumbar disc herniation (p > 0.05) and the 4-grade fat infiltration system was determined to be effective in the prediction of lumbar disc herniation (p < 0.001). Conclusion: The 4-grade fat infiltration system was seen to be more effective than the 3-grade fat infiltration system in the determination of the level of fat infiltration in the paraspinal muscles and the prediction of lumbar disc herniation. The 4-grade fat infiltration system is a more effective semi-quantitative grading system which can be used instead of the simplified 3-grade system.

Variations of the popliteal artery are uncommon but often associated with popliteal artery injuries. Thus, in cases of popliteal artery injury, popliteal artery variations should be one of the primary differential diagnoses. Due to the poor prognosis that may result in amputation or mortality, such injuries are serious complications that can lead to medical malpractice cases. This report presents a case of a 77-year-old woman with bilateral knee osteoarthritis who sustained a popliteal artery injury during total knee arthroplasty due to the highly uncommon type II-C popliteal artery variation. In light of the current literature, the pathology, diagnosis, and treatment of this case of popliteal artery injury, as well as the necessary precautions, have been discussed. The terminal branching pattern of the popliteal artery is essential for surgical planning and the ability to treat accidental artery injuries. To reduce the risk of popliteal artery injury, it is important to discuss the need for preoperative arterial color Doppler ultrasonography and magnetic resonance imaging to reveal the branching pattern and structure (arteriosclerosis and obstruction) of the popliteal artery (arteriosclerosis and obstruction). Cite this article as: Yazıcı A. Popliteal artery injury following total knee arthroplasty due to a very rare variant of the popliteal artery: A case report of an unusual complication. Acta Orthop Traumatol Turc., 2023;57(3):116-119.

Objective: This study aimed to analyze the incidence and multifactorial causes of dislocation following primary total hip arthroplasty (THA) and to evaluate current surgical strategies for the prevention and management of this complication. Methods: This retrospective study included 1066 hips (median age 57 years; 805 females and 261 males) that underwent primary THA performed by a single surgeon between 1996 and 2025. The median follow-up duration of the patients was 46 months (min: 6, max: 357 months), and 68.9% had primary coxarthrosis, while 31.1% had secondary coxarthrosis. In this study, the effects of dislocation causes, age, gender, femoral head size, liner angle, posterior capsular repair, type of anesthesia, fixation method of the prosthesis, etiology, and surgical experience (distribution by years) on dislocation were statistically analyzed. Results: The analysis revealed that 44 of the 1066 hips (4.1%) developed a dislocation. The most common causes of dislocation were identified as femoral offset error (40.91%) and acetabular component malposition (31.82%). A statistically significant correlation was found between dislocation development and gender (p < 0.001) and femoral head diameter (p = 0.006); the dislocation rate was higher in male patients (8.0%) than in female patients (2.9%). A marked reduction in dislocation rates (1.6%) was observed following the routine use of large-diameter femoral heads (32–36 mm). The highest dislocation rate was observed during the early years of surgical experience (1996–2000, 6.8%). No statistically significant differences were found between dislocation development and age (p = 0.055), type of anesthesia, type of prosthesis, liner angle, and secondary etiological factors (p > 0.05). Conclusions: Instability developing after primary THA is a multifactorial complication. In our study, inadequate femoral offset restoration and acetabular component malposition were identified as the most common mechanical causes of dislocation. Male gender was significantly associated with an increased risk of dislocation, whereas the use of larger femoral head diameters was associated with lower dislocation rates. Our findings suggest that meticulous preoperative planning, accurate component positioning, increased surgical expertise, and the use of larger femoral head diameters may play important roles in reducing the risk of instability.

Background: The determination of appropriate treatment methods for patients with chronic low back pain may be possible with the determination of the cause of the pain. Therefore, it can be considered that identification of the morphological changes of the paraspinal muscles in patients with chronic low back pain and comparison with control subjects is necessary to explain the relationship of these with pain. The aim of this study was to examine degeneration in the lumbar musculus multifidus (LMF) and lumbar musculus erector spinae (LES) in patients with mechanical chronic low back pain, patients with chronic low back pain with lumbar herniated disc and no radiculopathy, and healthy individuals, and through comparison of the results according to gender, pain and lumbar segments, to examine the relationship with low back pain. Material and Method: The study included 35 patients with mechanical low back pain, 38 patients with lumbar herniated disc and no radiculopathy, and a control group of 36 healthy subjects. The patients were evaluated in respect of LMF and LES cross-sectional area (CSA), total CSA (TCSA=LMF+LES), fat infiltration and asymmetry on axial magnetic resonance imaging (MRI) slices at the L3-S1 level. Results: The mean CSA values of the right and left LMF and LES showed significant differences between the groups (p<0.001, p=0.002, p=0.002, p=0.010, respectively). The mean values obtained in the healthy control group were lower than those of the other two groups. Fat infiltrations showed a difference between the right-left LMF and left LES groups (p=0.007, p<0.001, p=0.026, respectively). Asymmetry was not observed between the CSA and TCSA of the right and left sides. No significant relationship was determined between the duration of low back pain and the CSA and TCSA values and fat infiltration. Conclusıon: A relationship was determined between fat infiltration in LMF and mechanical low back pain and LDH. The low CSA and TCSA values in the healthy control group suggest that it is due to a pseudohyertrophy mechanism. This shows that when evaluating muscle mass, rather than CSA and TCSA, the functional cross-sectional area (FCSA) or muscle atrophy associated with fat infiltration should be measured.

Aim: This study aimed to assess complications and the presence of late deep infection in patients with rheumatoid arthritis (RA) who underwent primary and revision total knee arthroplasty (TKA). Materıial and Method: Between June 1997 and October 2022, cemented TKA that cut the posterior cruciate ligament (PCL) was applied to 50 knees of 34 patients with RA, and posterior-stabilized (PS) revision TKA was applied to 7 knees of 5 patients. All the patients enclosed in this study were adults diagnosed with RA by a rheumatology or physical therapy physician according to the RA diagnostic criteria recommended by the American College of Rheumatology in 1987. The diagnosis of infection was based on the Periprosthetic Infection Diagnostic Criteria of the 2018 International Periprosthetic Joint Infections Consensus Meeting. Results: Complications were found in 9 (18%) of the 50 knees who underwent primary TKA. Postoperative serous discharge was observed in 3 (6%) knees, serous discharge and late partial rupture of the quadriceps tendon in 1 (2%), early deep infection in 1 (2%), late deep infection in 3 (6%), and hematoma in 1 (2%). Revision surgery was performed on 3 (6%) knees due to infection and on 4 (8%) knees due to aseptic loosening. Complications developed in 2 of these knees who underwent revision TKA, 1 (14.3%) knee with periprosthetic fracture in the femur in the first postoperative year, and 1 (14.3%) knee with early deep infection. Deep vein thrombosis (DVT), pulmonary emboli (PE) and heterotopic ossification (HO) were not observed in any patient. Conclusion: In patients with rheumatoid arthritis, total knee arthroplasty increased chronic late deep infection and the associated need for revision surgery, and decreased the rates of DVT, PE, HO.