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Item Does an infra pectineal plate alone provide adequate fixation in anterior column posterior hemitransverse acetabular fractures? A comparative biomechanical study(2022) Simsek, Ekin Kaya; Haberal, Bahtiyar; Mahmuti, Ates; Balcik, Bedi Cenk; Demirors, Huseyin; 0000-0002-1668-6997; 35920432; W-9080-2019BACKGROUND: The purpose of this study is to compare biomechanical properties of suprapectineal (SP) plate fixation, infrapectineal (IP) plate fixation, and both SP and IP plate fixation in anterior column posterior hemitransverse (ACPHT) fractures of the acetabulum using posterior and anterior column screws. METHODS: In 21 hard plastic left hemipelvis models, ACPHT fractures of the acetabulum were created, and in three different fixation groups, the methods were compared: Group 1: SP plating using a 3.5 mm reconstruction plate and cortical screw fixation, Group 2: Infrapectineal plating using 3.5 mm reconstruction plate and cortical screws combined with posterior and anterior column screws, and Group 3: Combined fixation with SP and IP plating using 3.5 mm reconstruction plates and cortical screws. Maximum load to failure (strength) of these three groups was compared between groups. RESULTS: The mean maximum load of failure for three groups was 2921 N, 2018 N, and 3658 N, respectively. When strength was compared considering the force that causing implant failure, it was determined that the strongest fixation was achieved when SP and IP fixation method were applied together, followed by SP only fixation and IP fixation supported by anterior and posterior column screws, respectively. CONCLUSIONS: The combined application of SP and IP fixation provides the most stable fixation of the ACPHT acetabular fractures, and IP fixation does not provide comparable biomechanical stability despite reinforcement with three-column screws placed away from the plate. Although IP fixation supported by anterior and posterior column screws with the limited combined approach is less invasive approach for patients, SP fixation should be included in the surgical treatment method to ensure adequate stability.Item Impact of radial extracorporeal shock wave therapy in post-laminectomy epidural fibrosis in a rat model(2021) Haberal, Bahtiyar; Simsek, Ekin Kaya; Akpinar, Koray; Simsek, Duygu Turkbey; Sahinturk, Fikret; https://orcid.org/0000-0002-1668-6997; https://orcid.org/0000-0003-3438-1633; https://orcid.org/0000-0002-0471-3177; 33463432; W-9080-2019; AAV-8821-2021; AAI-7972-2021Objectives: This study aims to investigate the effect of radial extracorporeal shock wave therapy (rESWT) treatment in the prevention of epidural fibrosis after laminectomy in rats. Materials and methods: Eighteen 16-month-old male Sprague-Dawley rats weighing 300 g were used in this experimental study between November 2019 and February 2020. The rats were randomly divided into two groups as the control group (L3-L4 total laminectomy without any treatment) and the study group (L3-L4 total laminectomy plus rESWT). The rats were sacrificed at the postoperative sixth week and the lumbar spine was excised en bloc, fixed, and decalcified. Sections were stained with hematoxylin-eosin to evaluate epidural fibrosis, acute inflammation, chronic inflammation, and vascular proliferation. Results: The median value and standard deviations were obtained based on histological examinations. Accordingly, epidural fibrosis decreased significantly in the study group compared to the control group. There was no statistically significant difference between the groups in terms of acute and chronic inflammation response and vascular proliferation. Conclusion: The rESWT application immediately after surgery is effective in preventing epidural fibrosis after laminectomy in rats.Item Analysis of Risk Factors for Ultrasonographic Graf Type IIa (-) Hips in Developmental Dysplasia: A Hospital-Based Case-Control Study with Follow-Up Outcomes(2021) Haberal, Bahtiyar; Sahin, Orcun; Tuncay, Ismail Cengiz; 0000-0002-1668-6997; 0000-0002-6035-6258; W-9080-2019; AAF-4032-2021Objective: To examine the association of Graf type IIa(-) hips with maternal and infant risk factors in newborns and to evaluate the follow-up outcomes. Materials and Methods: Two different risk analyses were performed. In the first analysis, Graf type I hips were grouped as "controls," and Graf type II were grouped as "cases." In the second analysis, all the Graf type I and Type IIa(+) hips were grouped as "controls," and all Graf type IIa (-) hips were considered as "cases." Maternal age, presence of consanguinity, pregnancy, and smoking were considered as maternal risk factors. Sex, birth weight, gestational age, associated congenital anomalies, and family history were considered as infant risk factors. Further, we determined the risk factors for Graf type IIa and type IIa (-) hips. Results: The study population included 73 cases (11.4%) and 569 controls (88.6%), including 322 (50.2%) male and 320 (49.8%) female infants. Graf type IIa hips revealed significant differences for gestational age (>42 wk), birthweight (>3500 g), and maternal age (<= 20 y). At follow-up, all Graf type IIa(+) hips became Graf type I mature hips. In contrast, three Graf type IIa(-) hips (3/12, 25%) required additional treatment. Conclusion: Significant risk factors for Graf type IIa(-) hips were female sex, gestational age of >42 wk, and birthweight of >3500 g. Almost one-quarter of Graf type IIa (-) hips may require additional treatment. Thus, significant risk factors for Graf type IIa(-)should be remembered in clinical practice.Item Effects of Orthopedic Instruments Breakage During Surgery: A Minimum Five-Year Follow-Up(2021) Haberal, Bahtiyar; Beyaz, Salih; 0000-0002-1668-6997; 0000-0002-5788-5116; W-9080-2019; K-8820-2019Aim: The present study aims to investigate the the long-term effect of metallic orthopedic instruments that were broken and not removed during surgery on the health status of patients. Material and Methods: Radiographs of 12,601 patients (5765 females and 6836 males; mean age: 48.9 years; range: 0-105) who underwent orthopedic surgery in our clinic between January 2009 and January 2015 were screened. Thirty-six patients (13 females and 23 males; mean age: 45.3 years; range: 12-82) with metallic instruments, broken and not removed during surgery, were included in the study and minimum five-year follow-up radiographs of the patients were examined. Results: The rate of orthopedic instrument breakage during surgery was 0.28%. This was 0.64% in trauma cases and 0.08% in elective surgery cases. The broken instrument was a Kirschner wire (K-wire) in 16 (44.4%) cases, a screw in 14 (38.9%), and a drill bit in 6 (16.6%). The rate of instrument breakage was 7.44 times higher in trauma cases than in elective surgery cases, which was statistically significant (p = 0.001). Only 1 patient required reoperation for the broken instrument 7 years later. No surgical notes regarding broken implants were identified in patient files. Discussion: Instruments that are broken and not removed during surgery do not cause any complication if they are entirely within the bone. Nevertheless, any instance of instrument breakage should be documented, and the patient should be informed about the condition and followed closely.Item The Correlation Between Knee Osteoarthritis and the ABO Blood Group System in A Turkish Population(2021) Yaradilmis, Yuksel Ugur; Haberal, Bahtiyar; Demirkale, Ismail; Altay, Murat; 0000-0002-1668-6997; W-9080-2019Aim: This study aimed to determine the validity of the relationship between primary knee osteoarthritis and the ABO blood group system in the Turkish population and whether ABO group system could be a risk factor for early-onset knee osteoarthritis or revision surgery. Material and Methods: A retrospective examination of the data of 2752 patients who underwent knee arthroplasty surgery in our clinic between 2011 and 2019 was carried out. A total of 2436 primary knee osteoarthritis (PKO) patients underwent total knee arthroplasty (TKA) surgery and 206 patients underwent revision knee arthroplasty (RKA). A control group was formed of 22350 individuals aged >40 years from the same geographical region. The frequency of the ABO subgroups (A, B, O, AB) was compared between the primary knee osteoarthritis group and the control group. In addition, ABO subgroups (A, B, O, AB) were determined in the group of patients aged <65 with knee osteoarthritis (early-onset knee osteoarthritis) or revision group. Results: In the PKO group, the female to male ratio was 8:1, and the mean age was 67.2 +/- 8 years. The most significant relationship between blood groups and osteoarthritis was found in Group A (p=0.001). Group AB had a significant but low relationship (p=0.002). However, no statistically significant difference was found between age <65 years and >65 years of age (p=0.642). In comparison with the PKO group and RKA, Group A in the revision group was seen at a statistically significantly higher rate (p=0.043). Discussion: Group A blood group was found to be associated with both primary knee osteoarthritis and revision knee arthroplasty.Item Lack of association between MMP13 (rs3819089), ADAM12 (rs3740199-rs1871054) and ADAMTS14 (rs4747096) genotypes and advanced-stage knee osteoarthritis(2021) Haberal, Bahtiyar; Simsek, Ekin Kaya; Cebi, Hatice Pinar Baysan; Tuc, Ozer; Verdi, Hasibe; Atac, Fatma Belgin; 0000-0002-1668-6997; 0000-0002-9141-9987; 0000-0002-2228-6893; 0000-0003-0591-009X; 34145804; W-9080-2019Objectives: The aim of this study was to investigate the relationship between MMP13 rs3819089, ADAM12 rs3740199 and rs1871054, and ADAMTS14 rs4747096 genotypes in patients with radiologically diagnosed knee osteoarthritis (OA). Patients and methods: A total of 300 patients (68 males, 232 females; mean age: 61.6 years; range, 25 to 89 years) who were admitted to the orthopedics and traumatology clinic and diagnosed with knee OA according to the 2000 American College of Rheumatology (ACR) criteria between October 2018 and March 2019 were prospectively analyzed. Patients with Grades III-IV OA according to the KellgrenLawrence (K-L) grading system were included in the patient group (n=150) and those without radiological features of knee OA (K-L Grades I-II) were included in the control group (n=150) voluntarily. The presence of single nucleotide polymorphisms (SNPs) in the targeted genes in both groups was assessed by real-time polymerase chain reaction in the peripheral blood sample. Results: The most common nucleotides in both the control and patient groups were CG for rs3740199 and CT for rs1871054 in the ADAM12 gene, and the most common nucleotides in alleles were GG for MMP13 rs3819089 and AA for ADAMTS14 rs4747096. No statistically significant relationship was detected between the gene polymorphisms and advanced OA. Conclusion: The study results suggest that ADAM12 rs3740199 and rs1871054, MMP13 rs3819089, and ADAMTS14 rs4747096 polymorphisms have no relationship with knee OA susceptibility in the Turkish population. However, as this is the first study to investigate the relationship between the SNPs of ADAM12, ADAMTS14, and MMP13 genes and the development of OA in the Turkish population, it would contribute to our understanding of the molecular bases of OA.Item Biomechanical Comparison of Polymethylmethacrylate Augmentation Methods in Failed Pedicle Screw Revision(2021) Haberal, Bahtiyar; Temiz, Abdulaziz; Tuncay, Ismail Cengiz; 0000-0002-1668-6997; 34374983; W-9080-2019AIM: To compare biomechanical results between different polymethylmethacrylate (PMMA) augmentation methods on failed lumbar pedicle screw models of animal vertebrae. MATERIAL and METHODS: Thirty lumbar vertebrae were harvested from six calves, and their bone mineral density was measured. 60 Polyaxial pedicle screws were inserted to all vertebrae. Pull-out tests were performed to all specimens on an Instron machine. The specimens were randomly divided into four groups. The same screws used in primary screwing process were labeled and used in revision. Screws in the first group were augmented by injecting PMMA into the failed screw hole with a syringe; screws in the second group by inserting bone graft and roll-shaped PMMA, screws in the third group by inserting bone graft and injecting PMMA with a syringe; and the fourth group by inserting bone graft and injecting PMMA through a fenestrated pedicle screw. The pull-out strength (POS) results of all specimens were recorded and compared with statistical analyses. RESULTS: The mean BMD of the vertebrae was 1.31 +/- 0.225 g/cm2 and no significant difference was found between the groups (p>0.05). The mean POS of the primary screws in the first, second, third, and fourth groups were 2166,5 N/m2, 2183,5 N/m2, 2508,5 N/m2, and 2005c N/m2 respectively. After the augmentation, the mean POS in the first, second, third and fourth groups were 3839 N/m2, 2874 N/m2, 2929 N/m2 and 3826 N/m2 respectively. No statistical difference was found between the groups in post-revision POS values (p>0.05). CONCLUSION: There was no significant statistical difference found in POS between the augmentation methods.Item Persistent infection of Mycobacterium tuberculosis in a patient with Behcet's disease after rotator cuff repair surgery: A case report(2021) Haberal, Bahtiyar; Simsek, Duygu Turkbey; Kuru, Ilhami; 0000-0002-1668-6997; 34842115; W-9080-2019Tuberculosis (TB) infection is a common health problem in low socioeconomic populations in developing countries. Osteoarticular TB is a disease that rarely occurs outside the vertebral column and is often diagnosed late or misdiagnosed, particularly in non-weight bearing joints. A 51-year-old female patient with Behcet's disease presented with shoulder TB following rotator cuff repair surgery, leading to joint resection as a result of recurrent infections with no reproduction in culture samples due to delayed diagnosis. Surgical excision was proposed for the treatment of draining a mass with a sinus tract opening into the joint on the anterior aspect of the right shoulder. A diagnosis was able to be reached after 13 operations, based on the presence of TB bacilli in the pathological examination of the samples. In conclusion, TB should be considered in the absence of reproduction in culture samples taken during persistent post-surgical infections.Item Could radial extracorporeal shock wave therapy have an effect on wound healing in clinical practice by creating genotoxic damage? An in-vitro study in mouse fibroblasts(2021) Simsek, Ekin Kaya; Haberal, Bahtiyar; Kasap, Yesim Korkmaz; Yurtcu, Erkan; 0000-0003-3438-1633; 0000-0002-1668-6997; 34842098; AAV-8821-2021; W-9080-2019Objectives: This study aims to evaluate wound healing effects of in vitro radial extracorporeal shock wave (rESW) application on mouse fibroblasts and whether the cytotoxic effect of extracorporeal shock wave (ESW) was due to a possible genotoxic effect. Patients and methods: After creating an in vitro wound healing model in L929 mouse fibroblast culture, fibroblasts were stimulated with a frequency of 3 Hz, and 100, 250, 500, 1,000 and 1,500 pulses shock waves were applied. Energy flux densities ranging from 0.01 to 0.23 mJ/mm2 (14.3 MPa) at a constant pressure level of 0.5 and 1 bar were applied. Wound healing, cell viability, and genotoxicity were evaluated at 24 and 48 h. Results: All shot numbers for both pressures significantly reduced cell viability (p<0.05). For both 0.5 and 1 bar pressures, in both intervals, the rate of wound healing decreased, regardless of the number of shots (p<0.05). In vitro genotoxic damage was detected at both 0.5 and 1 bar pressures, in both time intervals, regardless of the number of shots. The genotoxic damage increased from 24 h to 48 h. Conclusion: The study results suggest that, when ESWT is applied in this in vitro experimental setup, cell viability decreases and wound healing is delayed under all conditions. Furthermore, genotoxic damage can be prevented by using shots below 1,000 pulses. Therefore, while investigating the therapeutic effect of ESW therapy in vitro, the upper limit for the number of shots should be 1,000 pulses.Item Treatment of Full-Thickness Cartilage Defects with Pedunculated and Free Synovial Grafts: A Comparative Study in an Animal Model(2020) Haberal, Bahtiyar; Sahin, Orcun; Terzi, Aysen; Simsek, Ekin Kaya; Mahmuti, Ates; Tuncay, Ismail Cengiz; 0000-0002-6035-6258; 0000-0001-5856-8895; 0000-0002-1668-6997; 32850038; AAF-4032-2021; AAF-3988-2021; W-9080-2019Aims and Objectives The purpose of this study was to compare the potential effects of pedunculated and free synovial grafts in the repair of full-thickness articular cartilage defects on an animal model with histological and immunohistochemical analysis. Materials and Methods A comparative study in an animal model was performed with 24 rabbits, divided into two groups. Full-thickness cartilage defects were created bilaterally on the knees of all rabbits. Pedunculated and free synovial grafts were applied to the right knees of Group 1 and Group 2, respectively. Left knees were left as the control group. Six rabbits from each group were randomly selected for euthanasia 4 and 8 weeks postoperatively. All samples were examined histologically with a cartilage scoring system. For immunohistochemical analysis, the degree of collagen 2 staining was determined using a staging system. All data were statistically compared between the study groups with Student's t-test or Mann-Whitney U-test. The correlations between categorical variables were analyzed with Fisher's exact test and Chi-square test. Results In Group 1, the mean defect size had significantly decreased at 8 weeks postsurgery. It was also significantly smaller than that of Group 2. Both pedunculated and free synovial grafts had significantly better histological and immunohistochemical outcomes compared with the controls. Contrastingly, the results of comparison between the study groups (Group 1 vs. 2) at the 4th and 8th week were not statistically significant with regard to histological scores and immunohistochemical staining. Conclusion Synovial tissue, whether pedunculated or free, provided much better cartilage recovery compared with the control. It can be used as a mesenchymal stem cell (MSC) source, and synovium-derived MSCs have the chondrogenic potential for the in vivo treatment of full-thickness cartilage defects.