BACKGROUND Pulsed radiofrequency of genicular nerves in the management of osteoarthritis related chronic knee pain has recently become a promising treatment. Ultrasonography has replaced fluoroscopic guidance in pain medicine. The aim of this study was to investigate the effect of ultrasound-guided genicular pulsed radiofrequency on knee pain and function in patients who had severe knee osteoarthritis or who had previous knee arthroplasty. MATERIAL AND METHODS The retrospective study included a total of 23 patients with chronic knee pain, of which 17 patients were included in Group I (non-operated), and 6 patients were included in Group II (post-arthroplasty). Treatment was based on ultrasound-guided pulsed radiofrequency of the superior medial, superior lateral, and inferior medial genicular nerves. The Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) scores were assessed before treatment, and at 3 weeks and at 3 months following the procedure. RESULTS Pulsed radiofrequency of the genicular nerves significantly reduced perceived pain and disability in the majority of the patients. The proportion of the patients with improvement of ≥50% in pretreatment VAS scores at 3 weeks and 3 months following treatment were 14 out of 17 patients (82%) and 15 out of 17 patients (88%) in Group 1, and 4 out of 6 patients (67%), 4 out of 6 patients (67%) in Group 2, respectively. CONCLUSIONS Our study results suggest that ultrasound-guided pulsed radiofrequency of genicular nerves is a safe and minimally invasive procedure that significantly alleviates pain and disability in patients with severe degenerative disease or with previous knee arthroplasty.

BACKGROUND In the present study, we aimed to evaluate early clinical and biochemical outcomes of direct anterior approach (DAA) versus posterolateral approach (PLA) for hemiarthroplasty in the treatment of displaced femoral neck fractures in geriatric patients. MATERIAL AND METHODS Between September 2012 and September 2017, a total of 110 patients who underwent hemiarthroplasty for displaced femoral neck fractures were retrospectively analyzed. The patients were divided into 2 groups according to the surgical technique PLA (Group 1, n=54) and DAA (Group 2, n=56). Clinical and biochemical results were compared. RESULTS There was no significant difference in the demographic characteristics of the patients, fixation type, and follow-up (P>0.05). However, there was a significant difference in the duration of surgery, amount of blood transfusion, change from baseline in postoperative hemoglobin levels, amount of intraoperative gauze dressing, amount of drainage fluid from the surgical wound, postoperative VAS scores, incision length, length of hospital stay, and Barthel Index scores in favor of DAA group (P0.05). None of the patients had postoperative complications in Group 1, while 3 patients in Group 2 developed a lateral femoral cutaneous nerve lesion and one patient had a missed iatrogenic fracture of the greater trochanter. CONCLUSIONS Our study results suggest that early clinical and biochemical outcomes are better in DAA than PLA with early return to daily living activities in patients undergoing hemiarthroplasty for displaced femoral neck fractures.

In this study, we aimed to examine the effect of tranexamic acid (TXA) on hidden blood loss in total hip arthroplasty (THA) patients. Between June 2015 and June 2021, a total of 120 patients (45 males, 75 females; mean age 57.2±4.9 years; range, 45 to 67 years) with primary osteoarthritis who underwent THA without the use of TXA and 53 patients who received TXA were retrospectively analyzed. Demographic data, amount of transfusion, early complications, preoperative and postoperative hemoglobin and hematocrit values, total blood loss, visible blood loss, and hidden blood loss values were compared. There was a significant difference between the groups with and without the use of TXA in terms of intraoperative bleeding, amount of blood in the drain, total blood loss, hidden blood loss, and blood transfusion (p<0.05). A significant positive correlation was found between intraoperative blood loss and hidden blood loss (r=0.325 p<0.01), while no significant correlation was found between postoperative drainage volume and hidden blood loss (r=-0.006 p=0.946). The use of TXA in patients undergoing THA reduces blood loss, including hidden blood loss, thereby reducing the need for blood transfusion after hip arthroplasty. However, there seems to be no linear relationship between postoperative blood loss and hidden blood loss. Considering these results, the routine use of TXA can be recommended in THA, unless there is a contraindication.

The complexity of femoral and acetabular anatomy and restoring anatomic center of hip rotation in Crowe type IV developmental dysplasia of the hip (DDH) complicates standard reconstruction. The aim of this study is to evaluate surgical techniques and clinical outcomes of subtrochanteric transverse shortening osteotomy with the use of cementless rectangular cross-section femoral implants in Crowe IV dysplastic hips. A total of 26 hips of 25 consecutive patients with Crowe type IV DDH who underwent cementless total hip arthroplasty with subtrochanteric femoral transverse shortening osteotomy were retrospectively analyzed. The Harris Hip Score, Visual Analog Scale-pain, leg length discrepancy, and vertical and lateral migration of hip rotation center were recorded. Mean age, follow-up, and time of union were 41 ± 9.7 years, 7.1 ± 1.2 years, and 3.7 ± 1.1 months, respectively. Mean Harris Hip Score significantly improved from 38 ± 5.7 to 86 ± 6.1 points postoperatively (P < .01). Mean leg length discrepancy and Visual Analog Scale significantly decreased from 4.3 ± 1.3 to 1.2 ± 0.6 cm, and 6.4 ± 1.2 to 1.8 ± 0.8 points, respectively (P < .01). One female patient had a dislocation due to acetabular liner wear, which was managed by liner and head change. One patient had Sudeck's atrophy, while another had pain on the lateral thigh, both of which were resolved with conservative management. Combined transverse subtrochanteric femoral osteotomy and cementless total hip arthroplasty with rectangular cross-section femoral implants is technically demanding, effective, and safe in femoral shortening for treatment of Crowe type IV DDH.

The aim of this study was to report the clinical and radiological results of 11 patients with Judet type 3 severely displaced radial neck fractures, who were treated with intramedullary elastic nail fixation with the help of percutaneous K-wire reduction maneuver (Métaizeau technique). A total of 11 children (4 boys and 7 girls with a mean age of 7.7 (6–10) years) with Judet type 3 radial neck fractures were treated in our clinic between February 2013 and August 2015. The fractures were evaluated according to Judet classification system modified by Métaizeau. Reduction and fixation was performed within the first 24 h after injury in all patients. All fractures were treated by closed reduction using distal elastic intramedullary nail. Clinical evaluation was performed by measuring elbow range of motion (ROM) with goniometer, radiological evaluation by assessing fracture healing and functional evaluation by using Mayo Elbow Performance Score (MEPS). The mean MEPS score increased from 15 points preoperatively to 88 points postoperatively (range, 12–95 points). Radiological evaluation revealed that all fractures healed with excellent or good alignment. The mean flexion was 150° (range, 145–154°), extension 1° (range, 0–2°), supination 82° (range, 80–86°), and pronation 83° (range, 80–85°). Reduction and osteosynthesis of radial neck fractures by intramedullary nailing with the help of percutaneous K-wire manipulation appears to be a simple, safe and effective treatment method in children. Level IV, Therapeutic study. ER - Keywords Radial neck fracture Elastic intramedullary nailing Pediatric

Osteoporosis is a common musculoskeletal disease of the elderly population characterized by decreased bone mineral density and subsequent fractures. Bisphosphonates are a widely accepted drug therapy which act through inhibition of bone resorption and prevent fractures. However, in long-term use, atypical bisphosphonate induced fractures may occur, particularly involving the lower weight bearing extremity. Atypical ulna fracture associated with long-term bisphosphonate use is rarely reported in current literature. We present a 62-year-old woman with atypical ulna due to long-term alendronate therapy without a history of trauma or fall. Clinicians should be aware of stress fracture in a patient who has complaints of upper extremity pain and history of long-term bisphosphonate therapy.