Obective The aim of this study was to evaluate the effect of combined intravenous and topical use of tranexamic acid (TXA) on total blood loss and transfusion rate in total hip arthroplasty. Methods This prospective randomized study included 57 patients who had undergone total hip arthroplasty between September 2016 and September 2017. The IV administration group (Group 1) consisted of 26 patients (mean age: 63.73 ± 10.29 years), while the IV and topical administiration group (Group 2) consisted of 22 patients (62.82 ± 8.31 years). Demographic data and outcomes were obtained through a review of individual medical records. Medical comorbidities, body mass index (BMI), ASA and CCI, preoperative and postoperative hemoglobin levels, postoperative transfusion records and 90-day joint-related (implant subsidence, dislocation, postoperative anemia, deep infection, hematoma and/or wound problem, postoperative periprosthetic fracture) readmission rate and complication rate were compared between the groups. Results No significant differences were observed between the 2 groups in terms of age, gender, height, weight, body mass index (BMI), the level of preoperative Hb values, and the American Society of Anesthesiologists (ASA) and Charleson Comorbidty Index (CCI) rating (p > 0.05). The mean postoperative Hgb in the group 2 was higher by a small amount compared to the group 1. No statistically significant difference was determined between the groups in respect of the Hgb values (p = 0.562). Hgb Delta in the group 2 was lower than that of the group 1. The difference between the groups in the Hgb Delta values was not statistically significant (p = 0.268). The mean total blood loss was lower in the group 2 than in the group 1 but the difference was not statistically significant (p = 0.788). There was no significant difference observed in terms of any adverse complications among the 2 groups (p > 0.05). Conclusion The combined administration of IV and topical TXA compared with IV alone can decrease total blood loss and the number of blood transfusions required without increasing the risk of DVT or/and PE in total hip arthroplasty. But the statistical analysis and clinical relevance is not significant. Level of Evidence Level I Therapeutic Study. ER -

OBJECTIVE: Knee Osteoarthritis, a prevalent degenerative joint condition, poses a significant global burden, while proximal femur fractures are increasingly common among the geriatric population. Understanding the relationship between these entities remains crucial for effective clinical management. This study aims to investigate the association between knee osteoarthritis severity and the nature of proximal femur fractures in geriatric patients undergoing proximal femoral nailing for intertrochanteric femoral fractures. MATERIAL AND METHODS: A retrospective cohort study was conducted on 420 geriatric patients who underwent proximal femoral nailing (PFN) for femoral fracture between 2016 and 2021. Data on demographic characteristics, osteoarthritis severity (Kellgren-Lawrence classification), fracture type (AO/OTA classification), and clinical outcomes were collected. Statistical analysis was performed to evaluate the correlation of the hip fracture type with mild (Kellgren-Lawrence grades I/II) and severe (grades III/IV) knee osteoarthritis. RESULTS: Significant associations were observed between osteoarthritis severity and fracture type (p = 0.001). Patients with mild osteoarthritis predominantly exhibited AO/OTA type 1 fracture (74.7%), whereas those with severe osteoarthritis had a higher prevalence of AO/OTA type-2 (67.9%) and AO/OTA type 3 (18.6%) fractures. However, no significant difference was found in overall survival (p = 0.138) or revision rates (p = 0.978) between patients with mild and severe osteoarthritis. CONCLUSIONS: As the severity of osteoarthritis increased, the fracture type changed and was associated with a more comminuted fracture pattern.

SUMMARY OBJECTIVE: Accurate identification of the anatomical femoral head center is critical in total hip arthroplasty for optimal implant positioning and long-term survival. The Ranawat triangle method is widely used for this purpose, but its applicability may vary across populations. The aim of this study was to evaluate the accuracy and suitability of the Ranawat triangle method in estimating the anatomical femoral head center in a Turkish population. METHODS: Standardized anteroposterior pelvic radiographs of 260 non-fractured hips from 312 patients aged 60–90 were retrospectively analyzed. Pelvic height, pelvic width, and femoral head diameter were measured. The coordinates of the anatomical femoral head center were calculated anatomically and using the Ranawat triangle method. Deviations between the two were assessed in both axes, with <5 mm considered acceptable error. RESULTS: Anatomical femoral head center estimated by the Ranawat triangle method was positioned an average of 4.7±1.5 mm medially and 1.0±0.8 mm cranially in men, and 4.8±1.1 mm medially and 1.1±0.7 mm cranially in women, relative to the anatomical center. While 100% of Y-axis errors and 58.1% of X-axis errors were within 5 mm. Strong positive correlations were found between pelvic height and Cy (r=0.59), and pelvic width and Cx (r=0.82). CONCLUSION: The Ranawat triangle method method demonstrated excellent accuracy in predicting the vertical (Y-axis) position of the anatomical femoral head center but showed moderate lateral (X-axis) deviations in over 40% of cases. Despite its limitations in lateral offset prediction, it may serve as a practical reference method for preoperative planning, particularly for estimating the vertical position of the hip rotation center in Turkish total hip arthroplasty patients.

Objectives: Colistin is frequently used as a last-line treatment option for periprosthetic joint infections (PJIs) caused by multidrug-resistant (MDR) Gram-negative pathogens, and mortality rates are high in this patient group. This study aimed to evaluate 90-day mortality and its associated clinical factors in MDR Gram-negative PJI cases treated with colistin, with particular attention to the American Society of Anesthesiologists (ASA) score and changes in renal function during therapy. Methods: Patients diagnosed with MDR Gram-negative PJI and treated with intravenous colistin at a single center between 2010 and 2024 were retrospectively reviewed. Demographic data, infection localization, comorbidities, American Society of Anesthesiologists (ASA) score, causative pathogens, presence of sepsis, intensive care unit (ICU) admission, duration of colistin therapy, pre- and post-treatment renal function parameters, and mortality were all recorded. Survivors and non-survivors were compared using univariate analysis. Results: The cohort included 44 patients with a mean age of 72 years (23 women and 21 men). Infections involved the hip in 33 patients (75.0%) and the knee in 11 (25.0%). Twenty-two patients (50.0%) were in the high-ASA group (ASA ≥ III group). Within 90 days of initiating colistin therapy, 25 patients died and 19 survived. A high ASA score was significantly more common among non-survivors than among survivors (18/25 (72.0%) vs. 4/19 (21.1%); p < 0.001), and dialysis requirement was also more common among non-survivors [20/25 (80.0%) vs. 8/19 (42.1%); p = 0.013]. End-of-treatment renal parameters were significantly worse among non-survivors, including urea [71.2 (50.9–78.8) vs. 38.5 (34.8–42.5) mg/dL; p = 0.003], creatinine [2.29 (1.75–2.64) vs. 0.93 (0.72–1.60) mg/dL; p = 0.003], urea delta [42.8 (38.0–48.6) vs. −5.4 (−7.9 to −2.0) mg/dL; p = 0.006], and creatinine delta [0.78 (0.33–1.57) vs. 0.16 (0.10–0.57) mg/dL; p = 0.008] levels. In contrast, age, sepsis, ICU admission, and colistin treatment duration were not significantly associated with 90-day survival. Conclusions: In this high-risk cohort of patients with MDR Gram-negative PJI treated with colistin, the 90-day mortality rate was high and was associated with higher American Society of Anesthesiologists scores, dialysis requirements, and worsening renal function during treatment. No significant association was observed between treatment duration and response in this cohort. These findings should be interpreted cautiously, given the retrospective design and the limited sample size.