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UZER, GÖKÇER

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GÖKÇER
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  • PublicationOpen Access
    Comparison of Small-diameter-hole and Traditional Microfracture in Cartilage Repair and the Effect of Adding a Hyaluronic Acid-based Acellular Matrix Scaffold: An Animal Study
    (2021-03-01T00:00:00Z) UÇAN, VAHDET; YILDIZ, FATİH; ELMADAĞ, Nuh Mehmet; UZER, GÖKÇER; GÜZEL, YUNUS; TOK, OLGU ENİS; Mukaddes, E.; UÇAN, VAHDET; YILDIZ, FATİH; ELMADAĞ, NUH MEHMET; UZER, GÖKÇER; TOK, OLGU ENİS; EŞREFOĞLU, MUKADDES
    Objective: Since, there is no standardized technique for the treatment of focal cartilage defects that can recreate original cartilage tissue; researchers continue to explore and evaluate various treatment modalities. This study compared post-operatke healing of cartilage defects after treatment with small-diameter-hole microfracture (SDHM) technique with that of traditional microfracture technique. The effects of the hole density and augmentation with hyaluronic acid-based acellular matrix (HA-based AM) on cartilage healing were also investigated. Methods: Articular cartilage defects measuring 5 mm in diameter and 3 mm in depth were created in each femoral trochlear groove of 21 New Zealand rabbits. Rabbits were assigned to seven groups comprising six knees each. The rabbits were sacrificed 12 weeks later, and the regenerated cartilage was harvested for histological evaluation using the Wakitani scoring system. Results: All defects were filled with regenerated tissue macroscopically. Group I (14; range 10-14 points) had significantly higher Wakitani score than in groups VI (6; range 1-11 points) and VII (5; range 3-10 points) (p=0.043 and p=0.016, respectively). No significant differences were observed among the other groups. Augmentation with HA-based AM did not contribute to cartilage healing. Conclusion: Improved cartilage healing was observed with increasing SDHM density than with traditional microfracture technique. SDHM combined with HA-based AM implantation did not improve the quality of the regenerated cartilage.
  • PublicationOpen Access
    Treatment of unusual proximal humeral fractures using unilateral external fixator: a case series
    (2015-05-01) UZER, GÖKÇER; YILDIZ, FATİH; Elmadağ, Mehmet; Bilsel, Kerem; PULATKAN, Anil; UZER, GÖKÇER; YILDIZ, FATİH; BİLSEL, İSMAIL KEREM
    Objective To report the functional and radiological results of unusual comminuted fractures of the proximal humerus, treated with ‘closed reduction and external fixation’ (CREF) using hybrid-type unilateral external fixators (EFs). Patients and methods Between January 2012 and June 2013, eight patients (mean age 62.6; range 48–84 years) with comminuted proximal humeral fractures extending to the humeral head and one-third proximal diaphysis were treated with CREF using hybrid-type EFs. Functional results were evaluated in terms of shoulder ranges of movement, Constant, DASH, and VAS scores, and radiological results were evaluated using antero-posterior and lateral radiograms of the treated humerus. Results The mean follow-up was 16.6 (range 12–28) months. The mean fixator time was 84 (range 63–118) days. The mean range of forward flexion, internal rotation, external rotation, and abduction were 145°, 61.2°, 65°, and 115°, respectively. The mean Constant, DASH, and VAS scores were 79.8, 10, and 1.75, respectively. Seven of the eight patients (87.5 %) healed radiologically. Two complications were observed in two patients: non-union and superficial pin site infection. Conclusions In the treatment of unusual, comminuted proximal diaphyseal humeral fractures, CREF using a hybrid-type EF is a minimally invasive, advantageous procedure with acceptable rates of healing, low risk of surgical site infection, and early range of motion. Level of evidence Level IV, case series.
  • PublicationOpen Access
    Reply to Letter to Editor: Safety of one-stage bilateral total knee arthroplasty-one-surgeon sequential vs. two surgeons simultaneous: a randomized controlled study
    (2020-08-01T00:00:00Z) Gungoren, Nurdan; UZER, GÖKÇER; ALIYEV, ORKHAN; YILDIZ, FATİH; ELMALI, NURZAT; TUNCAY, İBRAHİM; UZER, GÖKÇER; ALIYEV, ORKHAN; YILDIZ, FATİH; GÜNGÖREN, NURDAN; ELMALI, NURZAT; TUNCAY, İBRAHİM
  • PublicationOpen Access
    Comparison of two types of proximal femoral hails in the treatment of intertrochanteric femur fractures
    (2015-09-01) Uzer, GÖKÇER; Elmadag, NUH MEHMET; Yildiz, FATİH; Bilsel, Kerem; Erden, TUNAY; Toprak, HÜSEYİN; UZER, GÖKÇER; ELMADAĞ, NUH MEHMET; YILDIZ, FATİH; BİLSEL, İSMAIL KEREM; ERDEN, TUNAY; TOPRAK, HÜSEYİN
    Background: Hip nailing is frequently used to treat unstable intertrochanteric femoral fractures (ITF) in elderly patients. In this retrospective study, we compared the functional and radiological results, and the complications, of patients treated using proximal femoral nails (PFN) with an integrated, interlocking, compression lag screw, or two separate lag screws, which allow linear compression at the fracture site. Methods: A total of one hundred and eighteen patients were operated on for AO/OTA 31-A2 ITF between May 2010 and April 2012, and eighty-two of these patients, for whom sufficient follow-up data and documentation were available, were included into the study. PFNs with interlocking, integrated lag screws (Group I) were used in forty-four patients, and PFNs with two separate lag screws (Group II) in thirty-eight. Outcome parameters were the extent of varus collapse and leg length discrepancy on radiographs, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Harris hip scores (HHS) as functional results. Results: Mean follow-up duration was 20 months (range, 12-36 months); fractures healed in all patients. Mean varus collapse values were 2.03±5.68° and 5.21±5.27° (p=0.01), Harris hip scores 73.2±11.65 and 74.72±11.15 (p=0.54), and WOMAC scores 70.78±11.41 and 71.78±11.19 (p=0.69) in Groups I and II, respectively. No difference was detected between the groups in terms of outcome parameters or complication rate. Conclusion: In the treatment of ITF, PFNs with an integrated, interlocking, compression lag screw, or two separate lag screws did not differ in terms of functional and radiological results or complication rate.
  • PublicationOpen Access
    Onlay fibula autografting technique and its comparison with cortical allograft for the reconstruction of periprosthetic bone defects around the femur
    (2020-11-01T00:00:00Z) TUNCAY, İBRAHİM; Tozun, Remzi; ALIYEV, ORKHAN; Dikmen, Goksel; UZER, GÖKÇER; ÖZDEN, Vahit Emre; YILDIZ, FATİH; TUNCAY, İBRAHİM; ALIYEV, ORKHAN; UZER, GÖKÇER; YILDIZ, FATİH
    Background Bone defect around the femur related to revisions or periprosthetic fractures (PFF) is an issue. We present a bone defect reconstruction technique in femoral revisions and/or PFF using fibula autograft and compared our radiological and clinical results to that of allograft. Methods A total of 53 patients who underwent revision hip arthroplasty and/or PFF fixation with the use of cortical fibula autograft (FG group) or cortical allograft (CG group) were evaluated. After exclusions, 20 patients who had minimum two years of follow-up were investigated for each group, for their radiological and clinical outcomes. Results In FG and CG groups, the median ages were 69.5(44-90) and 62(38-88) years, follow-ups were 59(28-72) and 120(48-216) months, defect lengths were seven (1-10) and ten (1-17) cm, and grafts lengths were 16.5(10-30) and 20(12-37) cm, respectively. The rate of graft incorporation was 90% in each group and median time to incorporations were seven (4-12) and 12(6-24) months (p < 0.001), and graft resorption (moderate and severe) rates were 10% and 25% (p = 0.41), respectively. Median Harris Hip (77.6 vs 78.0), WOMAC (23.2 vs 22), SF-12 physical (50.0 vs 46.1), and SF-12 mental (53.8 vs 52.5) scores were similar between the groups, respectively. Kaplan-Meier survivorship analyses revealed an estimated mean survival of 100% at six years in FG group and 90% at 14 years in CG group. Conclusion In the reconstruction of periprosthetic bone defects after femoral revision or PPF, onlay cortical fibula autografts provide comparable clinical and radiological outcomes to allografts. Its incorporation is faster, it is cost-effective and easy to obtain without apparent morbidity.
  • PublicationOpen Access
    Safety of modified Stoppa approach for Ganz periacetabular osteotomy: A preliminary cadaveric study
    (2016-08-01T00:00:00Z) Elmadag, Mehmet; Uzer, GÖKÇER; Yildiz, FATİH; CEYLAN, Hasan H.; Acar, Mehmet A.; ELMADAĞ, NUH MEHMET; UZER, GÖKÇER; YILDIZ, FATİH
    Objective: The aim of this cadaveric study was to investigate the efficacy of the modified Stoppa approach in Ganz periacetabular osteotomy (PAO). Methods: The Ganz PAO was performed on 10 hemipelvises with normal hips, from 5 cadavers using the modified Stoppa approach through the Pfannenstiel incision. All of the osteotomies were performed under fluoroscopic control and direct visualizing the osteotomy site from the same incision. After the osteotomy, the acetabulum was medialized and redirected anterolaterally, and fixed with 2 screws. The neurovascular structures and the joints were examined by dissecting the soft tissues after fixation of the osteotomies. Outcome parameters were center-edge (CE) angle, the distances between the osteotomy and anterior superior iliac spine (ASIS), and between the osteotomy and the sciatic notch, neurovascular and joint penetrations. Results: After the osteotomy, the mean CE angle was improved from 19.8 degrees to 25.2 degrees, mean distance between the osteotomy and ASIS was 3.1 cm, and the mean distance between the osteotomy and the sciatic notch was 10.2 mm. The neurovascular structures and the joints were examined by dissecting the soft tissues after fixation of the osteotomies. No damage to the joint, surrounding arteries, veins or nerves was detected in any of the cadavers. Conclusions: Bilateral dysplastic hips can be treated with a 10 cm, cosmetically more acceptable incision in the same session using this approach. Quadrilateral surface of the acetabulum can be directly seen using this approach and the osteotomy can be safely performed. (C) 2016 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V.
  • PublicationOpen Access
    Cytotoxicity of a new antimicrobial coating for surgical screws: an in vivo study
    (2017-01-01) Guzel, Yunus; Elmadag, Mehmet; Uzer, GÖKÇER; Yildiz, FATİH; Bilsel, Kerem; Tuncay, Ibrahim; ELMADAĞ, NUH MEHMET; UZER, GÖKÇER; YILDIZ, FATİH; BİLSEL, İSMAIL KEREM; TUNCAY, İBRAHİM
    he risk of surgery-related infection is a persistent problem in orthopaedics and infections involving implants are particularly difficult to treat. This study explored the responses of bone and soft tissue to antimicrobialcoated screws. We investigated whether such screws, which have never been used to fix bony tissues, would result in a cytotoxic effect. We hypothesised that the coated screws would not be toxic to the bone and that the likelihood of infection would be reduced since bacteria are not able to grow on these screws. METHODS Titanium screws were inserted into the left supracondylar femoral regions of 16 rabbits. The screws were either uncoated (control group, n = 8) or coated with a polyvinylpyrrolidone-polyurethane interpolymer with tertiary amine functional groups (experimental group, n = 8). At Week 6, histological samples were obtained and examined. The presence of necrosis, fibrosis and inflammation in the bony tissue and the tissue surrounding the screws was recorded. RESULTS Live, cellular bone marrow was present in all the rabbits from the experimental group, but was replaced with connective tissue in four rabbits from the control group. Eight rabbits from the control group and two rabbits from the experimental group had necrosis in fatty bone marrow. Inflammation was observed in one rabbit from the experimental group and five rabbits from the control group. CONCLUSION Titanium surgical screws coated with polyvinylpyrrolidone-polyurethane interpolymer were associated with less necrosis than standard uncoated screws. The coated screws were also not associated with any cytotoxic side effect.
  • PublicationOpen Access
    Functional and Radiographic Results of Hemiarthroplasty in the Treatment of Hallux Rigidus of the First Metatarsophalangeal Joint
    (2018-07-01T00:00:00Z) UZER, GÖKÇER; YILDIZ, FATİH; ALİ, JOTYAR
    Objective: The purpose of this study was to evaluate changes in the radiological, clinical, and functional results following the application of hemiarthroplasty in patients with grade 3 or 4 first metatarsophalangeal joint osteoarthritis. Methods: Twenty-one feet of nineteen patients who were who were diagnosed as grade 3 or 4 hallux rigidus and treated with hemiarthroplasty, between January 2013 and December 2015, were retrospectively evaluated. Functional results [visual analog scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) scores, Short Form-12 (SF12) physical and mental scores], clinical results (ranges of dorsiflexion and plantar flexion), and radiological results (osteolysis, loosening, hallux valgus angles (HVA), and intermetatarsal angles (IMA)) were evaluated at their follow-up. Results: The mean follow-up period was 24 (range: 12-66) months. The mean ranges of flexion was increased from 6 degrees (range: 0 degrees-20 degrees) to 8 degrees (range: 0 degrees-20 degrees) and ranges of extension from 4 degrees (range; 0 degrees-10 degrees) to 7 degrees (range: 0 degrees-30 degrees), postoperatively. Preoperative and postoperative values of the mean IMA (9 degrees vs. 11 degrees) and HVA (18 degrees vs. 13 degrees) did not change significantly. The mean AOFAS scores increased from 72 to 96 (p=0.003). The mean VAS, SF12-MCS, and SF12-PCS scores were 7.8 (range: 4-10), 42.7 (range: 33.8-55.7), and 51.1 (range, 36.7-61.2), postoperatively and comparisons to their preoperative values were not significant. Radiographic follow-up did not show findings of osteolysis around the prosthesis or loosening in any patient. Conclusion: In the treatment of hallux rigidus with hemiarthroplasty, although postoperative range of movement was found to be limited, patient satisfaction and pain levels were improved in all patients.
  • PublicationOpen Access
    Comparison of Intravenous, Intra-articular, and Combined Tranexamic Acid Use in Primary Total Knee Arthroplasty without a Tourniquet and a Drain
    (2020-04-01T00:00:00Z) Binlaksar, Ruwais; Ali, Jotyar; UZER, GÖKÇER; YILDIZ, FATİH; UÇAN, VAHDET; TUNCAY, İBRAHİM
    Objective: We assessed the effect of tranexamic acid (TXA) route of administration on the estimated blood loss (EBL) in patients undergoing primary total knee arthroplasty (TKA) without tourniquet and drain use. Methods: One hundred fifty three patients who underwent primary TKA with use of TXA, between December 2012 and February 2016 were evaluated retrospectively. The patients were divided into three groups according to the route of TXA use: group I, 2 g of intravenous (IV; n=50); group II, 2 g of intraarticular (IA, n=50); and group III, 1 g of IV and 1 g IA combined use (n=53). We recorded the body mass indexes, the platelet counts, haemoglobin, haematocrit levels, prothrombin time, partial thromboplastin time, and international normalised ratio, preoperatively and at 1st and 7th days, postoperatively. EBL was calculated using Meunier's formula. Results: On the first day, the mean EBLs for groups I to III were 286.3 +/- 128.8 mL, 342.7 +/- 176.0 mL, and 379.7 +/- 228.9 mL, respectively (p=0.029 for group I vs. group III). On 7th day postoperatively, they were calculated as 823 +/- 619.3 mL, 1175.1 +/- 970.5 mL, and 1092.2 +/- 766.7 mL (p=0.073) During the first 90 days postoperatively, we did not see any symptomatic thromboembolic complications, delayed haemorrhage, or surgical site or periprosthetic infections. Conclusion: IV, IA or combined uses of TXA are effective and safe for reducing blood loss and transfusion requirements in primary TKA without a tourniquet and drain.
  • PublicationOpen Access
    Comparison of Clinical Outcomes and Safety of Single-stage Bilateral and Unilateral Unicompartmental Knee Arthroplasty
    (2019-01-01T00:00:00Z) YILDIZ, FATİH; Erden, Tunay; UZER, GÖKÇER; TUNCAY, İBRAHİM; YILDIZ, FATİH; ERDEN, TUNAY; UZER, GÖKÇER; TUNCAY, İBRAHİM
    Objective To evaluate the effectiveness and safety of bilateral Oxford medial unicompartmental knee arthroplasty (UKA) in the patients under a single anesthetic procedure. Methods: Between October 2013 and December 2015, 225 knees of 181 (age 67.5 years) patients with at least two years of follow-up were evaluated. They were divided into two groups as unilateral group (group 1, n=137) and one stage simultaneous bilateral group (group 2, n=44) for the comparisons. The outcome parameters were femoral and tibial component positions measured on the full-length radiographs, clinical outcomes using Oxford Knee Score (OKS), International Knee Documentation Committee Score (IKDC), patient reported satisfaction and complications. Results: Between the groups, the mean follow-up periods (p=0.125), age (p=0.447), preoperative body mass index (p=0.288), OKS (p=0.314) and IKDC (p=0.127) scores were not significantly different. Postoperatively, the mean flexion of the femoral component (p=0.544), posterior slope (p=0.511), varus-valgus angulation of the tibial components (p=0.358) were statistically similar berwcen groups. Although the mcan varus-valgus angulation of the femoral components (p=0.033) was statistically different between groups, the difference was too small to make clinical significance. The mean postoperative OKS (p=0.272) and IKDC (p=0.106) were similar between the groups. In group 1, 21 (16.0%) patients reported excellent, 91 (69.5%) good and 4 (3.1%) moderate satisfaction. Fifteen (11.5%) patients reported non-satisfaction. In group 2, patients reported excellent satisfaction in 20 (24.4%) knees, good in 50 (61.0%) knees patients moderate in 2(2.4%) knees. Patients reported non-satisfaction in 10 (12.2%) knees (p>0.05). Eight (5.8%) complications in group 1 and, 3 (3.4%) complications in group 2 were observed. The number of complications was not statistically different between the groups (p=0.535). Conclusion: One-stage simultaneous bilateral Oxford medial UKA is a safe and effective method with acceptable complication rates compared to unilateral surgery.