Browsing by Author "Unver, Bayram"

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Non-Drainage Offers Faster Proprioceptive and Functional Recovery, and More Clinical Benefits for Patients Following Primary Total Knee Arthroplasty Compared to Drainage
(Thieme Medical Publishing Inc, 2024) Unver, Bayram; Eymir, Musa; Karatosun, Vasfi
Background Although a non-drainage procedure following total knee arthroplasty (TKA) is becoming more acceptable in enhanced recovery after surgery, postoperative drainage is still commonly used in TKA surgeries. This study aimed to compare the non-drainage to the drainage during the early postoperative stage regarding proprioceptive and functional recovery, and postoperative outcomes of TKA patients.Material and Methods A prospective, single-blind, randomized, controlled trial was carried out on 91 TKA patients, who were randomly allocated into the non-drainage group (NDG) or the drainage group (DG). Patients were evaluated regarding knee proprioception, functional outcomes, pain intensity, range of motion, knee circumference, and anesthetic consumption. Outcomes were assessed at the time of charge, at postoperative 7th day, and at postoperative 3rd month.Results There were no differences between groups at baseline (p > 0.05). During the inpatient period, the NDG experienced superior pain relief (p < 0.05), had a higher Hospital for Special Surgery knee score (p = 0.001), demanded lower assistance from a sitting position to a standing position (p = 0.001) and walking for 4.5 m (p = 0.034), and performed the Timed Up and Go test in a shorter duration (p = 0.016) compared to the DG. The NDG gained the actively straight leg raise earlier (p = 0.009), needed lower anesthetic consumption (p < 0.05), and showed improved proprioception (p < 0.05) compared to the DG during the inpatient period.Conclusions Our findings support that a non-drainage procedure would be a better option to provide a faster proprioceptive and functional recovery, and beneficial results for patients following TKA. Therefore, the non-drainage procedure should be the first choice in TKA surgery rather than drainage.
The Outcome Assessment Requires Both Performance-Based and Patient-Reported Measures After Revision Total Knee Arthroplasty
(Dokuz Eylül University Institute Health Sciences, 2025) Eymir, Musa; Unver, Bayram; Karatosun, Vasfi
Purpose: To investigate the correlation between performance-based and patient-reported measures and their relation with knee muscle strength in the assessment of revision total knee arthroplasty (rTKA) patients. Materials and Methods: This cross-sectional study recruited 92 patients with rTKA. The outcome assessment was performed using three performance tests (the Timed Up and Go (TUG), 30-second Chair Stand Test (30CST), and 50-Foot Walking Test (50FWT)) and one patient-reported questionnaire (the Hospital for Special Surgery (HSS)). The maximum isometric muscle strength of knee flexors and knee extensors was assessed with Handheld Dynamometry (HHD). Results: The total HSS knee score showed low significant associations with performance-based tests (all, p< 0.05), but no associations with knee muscles strength. The knee extensor strength showed moderate to strong significant associations with all performance tests, while the knee flexor strength had a low to moderate significant correlation with these performance tests (all, p<0.05). Conclusion: Our findings, which show a low correlation between performance-based tests and patient-reported questionnaire, suggest patient perception fails to accurately capture the functioning at the late follow-up of rTKA. Therefore, performance-based tests should be included in the outcome assessment to determine an appropriate rehabilitation program and exercise training after rTKA. Moreover, the higher associations between functional tests and knee muscle strength than the associations of the questionnaire with these performance measures advocate this assertion. These findings could be crucial in informing the design and implementation of interventions tailored to this population.
Reliability, Concurrent Validity, and Minimal Detectable Change of the Hand-Held Dynamometry for the Assessment of Knee Muscle Strength in Patients with Revision Total Knee Arthroplasty
(W B Saunders Co-Elsevier Inc, 2024) Eymir, Musa; Unver, Bayram; Karatosun, Vasfi
Objective: To determine the concurrent validity, reliability, and minimal detectable change (MDC) of the hand-held dynamometry (HHD) for knee strength measurement in patients with revision total knee arthroplasty (r-TKA). Design: A reliability and validity analysis. Setting: Orthopedic and physical therapy services of university hospital. Participants: The study included 42 patients with r-TKA (N=42). Interventions: Not applicable. Main outcome measures: Knee muscle strength assessments were performed by 2 physiotherapists in 3 different sessions by using HHD. Participants were instructed to exert a maximal force for lasting 5 seconds against HHD. The first examiner performed the strength testing, and after 30-minutes rest, the second examiner performed the same procedure for inter-examiner reliability. One hour after the initial testing, the first examiner reperformed the strength testing for intra-examiner reliability. The correlations of the knee extensors and knee flexors strength with 50-foot walking test and 30-second chair stand test were assessed for concurrent validity. Results: The inter-examiner reliabilities of knee extensors and flexors strength measurements were 0.97 and 0.95, respectively. The SEM and the minimal detectable changes at 95% confidence level (MDC95) for knee extensors were 10.39 and 28.65 Newton-meters (Nm), and SEM and MDC95 for knee flexors were 8.70 and 23.99 Nm, respectively. The intra-examiner reliabilities of knee extensors and flexors strength measurements were 0.96. SEM and MDC95 for knee extensors were 12.00 and 33.09 Nm, and SEM and MDC95 for knee flexors were 7.78 and 21.45 Nm, respectively. The knee muscle strength showed strong significant correlations with physical performance tests (all, PConclusions: The HHD is a reliable and valid method for assessment of static knee strength after r-TKA. The HHD can be used to quantify changes in knee strength and also assists the clinicians to determine the effect of rehabilitation programs on muscle strength following r-TKA surgery.
Reliability, Validity and Minimal Detectable Change of the Quadriceps Angle Assessment in Patients with Knee Osteoarthritis
(2025) Demirkiran, Nihat Demirhan; Unver, Bayram; Erduran, Mehmet; Eymir, Musa
Knee osteoarthritis (OA) is a multifaceted degenerative disease characterized by knee alignment alterations that impact the amplitude of the quadriceps angle (Q-angle). Q-angle is a diagnostic measure of knee alignment, and an indicator of the load distribution of patellofemoral and tibiofemoral joints. However, accurate assessment of this parameter necessitates the implementation of standardized and reliable measures to ensure methodological reproducibility. Thus, this study aimed to examine the concurrent validity, reliability, and minimal detectable change (MDC) of the Q-angle in patients with knee osteoarthritis (OA). The intra-rater and inter- rater reliabilities of each goniometric measurement were determined with the use of intraclass correlations (ICCs). The correlations between goniometric (clinical) and radiography (gold standard) measurements of Q -angle were assessed for concurrent validity. The intra-rater reliabilities of goniometric assessments in the supine and standing positions of the Q-angle were 0.90 and 0.96, respectively. The standard error of measurement (SEM) and minimal detectable change (MDC95) were 1.18 and 3.27 degrees for supine assessment and 0.87 and 2.40 degrees for standing assessment, respectively. The inter-rater reliabilities of goniometric assessments of the supine and standing position of the Q-angle were 0.86 and 0.92, respectively. SEM and MDC95 values were 1.59 and 4.39 degrees for supine assessment and 1.19 and 3.28 degrees for standing assessment, respectively. The radiographic measure showed a strong correlation with supine goniometric assessment (p<0.05, r: 0.777) and a significantly excellent correlation with standing goniometric assessment (p<0.05, r: 0.878). According to the findings of the current study, the goniometric measurement for the Q-angle is a valid and reliable method in patients with knee OA. Also, our results suggest that the goniometric measurement, as an inexpensive and radiation-free alternative, can be used to assess the Q-angle as accurately as radiography, in clinical practice.
Reliability, Validity, and Minimal Detectable Change of the Step Test in Patients with Total Knee Arthroplasty
(Springer London Ltd, 2022) Eymir, Musa; Yuksel, Ertugrul; Unver, Bayram; Karatosun, Vasfi
Background Step Test (ST) is frequently used to assess dynamic balance and locomotor function in clinical practice. Aims This study aimed to determine the concurrent validity, reliability, and minimal detectable change (MDC) of the ST in patients with total knee arthroplasty (TKA). Methods The study included 56 patients with TKA. The intraclass correlation coefficient (ICC) was used to assess the test-retest reliability of the ST. The correlations of the ST with timed up and go (TUG) and 10-m walk test (10MWT) were assessed for concurrent validity. Results Test-retest (ICC 0.90) reliability of the ST was determined to be excellent. The SEM and MDC95 values of test-retest reliability were 0.76 and 2.11, respectively. A significantly moderate correlation was found between the ST and TUG (p < 0.05, r: - 0.69), and 10MWT (p < 0.05, r: - 0.67). Conclusion The ST is a valid and reliable method in the assessment of dynamic balance ability and locomotor function in patients with TKA. The ST can be used to quantify changes in dynamic balance level and locomotor function in patients with TKA.