Turkiye Klinikleri Journal of Nursing Sciences

.: ORIGINAL RESEARCH
Experiences of Patients Undergoing Total Knee Arthroplasty: A Qualitative Study
Total Diz Protezi Uygulanan Hastaların Deneyimleri: Kalitatif Bir Çalışma
Ayşegül SAVCIa, Özlem BİLİKb
aDepartment of Surgical Diseases Nursing, Kütahya Health Sciences University Faculty of Health Sciences, Kütahya, TURKEY
bDepartment of Surgical Diseases Nursing, Dokuz Eylül University Faculty of Nursing, İzmir, TURKEY
Turkiye Klinikleri J Nurs Sci. 2019;11(1):7-16
doi: 10.5336/nurses.2018-60774
Article Language: EN
Full Text
ABSTRACT
 Objective: The number of total knee arthroplasty (TKA) surgeries performed has steadily increased in recent years. Patients undergoing total knee arthroplasty experiences various circumstances that effect their quality of life before and after surgery. The aim of this study is to narrate what patients who had TKA went through. Material and Methods: Descriptive qualitative design was used to elicit information for the study. Phenomenological research has been carried out in with Turkish 17 patients who had total knee arthroplasty. Semi-structured interviews has been used and purposeful sampling method. Content analysis followed using verbtaim transcripts. Results: Three themes were determined: (a) the decision making, (b) the early post-operative period (enduring), (c) the adaptation theme. According to the study results, patients experience many problems in decision making phase, intra-operative process, acute care phase, discharge phase and afterwards. Adaptability or inadaptability to the prosthesis is related to many complicated features. Conclusions: The patients may not be able to cope with the difficulties and need multi-dimensional care. In order for the patients to adapt to the prosthesis, besides meeting these necessities, it is necessary to evaluate the effect of cultural factors and many features which are unique to human nature.

Keywords: Total knee arthroplasty; experiences; difficulties; adaptation; qualitative study
ÖZET
 Amaç: Son yıllarda total diz protezi (TDP) cerrahisi artarak uygulanan girişimlerdendir. Total diz protezi uygulanan hastalar ameliyat öncesi ve sonrası yaşam kalitelerini etkileyen birçok durum deneyimlerler. Bu çalışmanın amacı TDP ameliyatı olan hastaların deneyimlerini incelemektir. Gereç ve Yöntemler: Tanımlayıcı kalitatif araştırma tasarımı kullanılmıştır. Fenomonolojik tipteki çalışma, TDP ameliyatı olmuş 17 hasta ile yürütülmüştür. Yarı yapılandırılmış görüşme ve amaçlı örneklem yöntemi kullanılmıştır. Veriler içerik analizi kullanılarak analiz edilmiştir. Bulgular: Üç tema belirlenmiştir; (a) karar verme, (b) erken postoperatif dönem (dayanma) ve (c) adaptasyon. Çalışma sonuçlarına göre, hastalar karar verme aşamasında, intraoperatif süreçte, akut bakım evresinde, taburculuk sırasında ve sonrasında birçok problem yaşamaktadır. Protezin uyumu pek çok karmaşık özellik ile ilgilidir. Sonuç: Hastalar karşılaştıkları güçlüklerle baş etmekte zorluk yaşamakta ve çok boyutlu bir bakıma gereksinim duymaktadırlar. Hastaların proteze uyum sağlayabilmeleri için, gereksinimlerini karşılamanın yanı sıra, kültürel faktörlerin ve insan doğasına özgü birçok özelliğin etkisini değerlendirmek gereklidir.

Anahtar Kelimeler: Total diz artroplastisi; deneyimler; güçlükler; uyum; kalitatif çalışma
REFERENCES:
  1. Barbay K. Research evidence for the use of preoperatif exercise in patients preparing for total hip or total knee arthroplasty. Orthop Nurs. 2009;28(3):127-33. [Crossref] [PubMed]
  2. Bourne BR, Cheswort BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res. 2010;468(1):57-63. [Cross - ref] [PubMed] [PMC]
  3. McGinley A. Factors affecting length of stay following total knee replacement: a clinical practice audit. J Orthop Nurs. 2008;12(3):171-8. [Crossref]
  4. Hayashi K, Kako M, Suzuki K, Takagi Y, Terai C, Yasuda S, et al. Impact of variation in physical activity after total joint replacement. J Pain Res. 2018;11:2399-406. [Crossref] [PubMed] [PMC]
  5. Neuprez A, Delcour JP, Fatemi F, Gillet P, Crielaard JM, Bruyère O, et al. Patients? expectations impact their satisfaction following total hip or knee arthroplasty. PLoS One. 2016;11(12): e0167911. [Crossref] [PubMed] [PMC]
  6. Engström Å, Boström J, Karlsson AC. Women?s experiences of undergoing total knee joint replacement surgery. J Perianesth Nurs. 2017;32(2):86-95. [Crossref] [PubMed]
  7. Kauppila AM, Kyllönen E, Ohtonen P, Hämäläinen M, Mikkonen P, Laine V, et al. Multidisciplinary rehabilitation after primary total knee arthroplasty: a randomized controlled study of its effects on functional capacity and quality of life. Clin Rehabil. 2010;24(5):398-411. [Crossref] [PubMed]
  8. Taşçı S. Cultural factors affecting health and disease. Seviğ Ü, Tanrıverdi G, editörler. Kültürlerarası Hemşirelik. 1st ed. İstanbul: İstanbul Tıp Kitabevi; 2012. p.19-44.
  9. Suarez-Almazor ME, Richardson M, Kroll TL, Sharf BF. A qualitative analysis of decision-making for total knee replacement in patients with osteoarthritis. J Clin Rheumatol. 2010;16(4): 158-63. [Crossref] [PubMed] [PMC]
  10. Slover J, Zuckerman JD. Increasing use of total knee replacement and revision surgery. JAMA. 2012;308(12):1266-8. [Crossref] [PubMed]
  11. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89(4):780-5. [Crossref] [PubMed]
  12. Turkish Statistical Institute (TSI) 2016. Retrieved: November 14.2017. [Link]
  13. Almada P, Archer R. Planning ahead for beter outcomes: preparation for joint replacement surgery begins at home! Orthop Nurs. 2009;28(1):3-8. [Crossref] [PubMed]
  14. Edwards C. Exploration of the orthopaedic patient?s ?need to know?. J Orthop Nurs. 2003;7(1):18-25. [Crossref]
  15. Su HH, Tsai YF, Chen WJ, Chen MC. Health care needs of patients during early recovery after total knee-replacement surgery. J Clin Nurs. 2010;19(5):673-81. [Crossref] [PubMed]
  16. Creswell JW, Hanson WE, Clark VLP, Morales A. Qualitative research designs: selection and implementation. J Couns Psychol. 2007;35(2): 236-64. [Crossref]
  17. Colaizzi P. Psychological research as the phenomenologist views it. In: Valle RS, King M, eds. Existential Phenomenological Alternatives for Psychology. 1 st ed. New York: Oxford University; 1978.
  18. Polit DF, Beck CT. Essentials of Nursing Research: Methods, Appraisal, and Utilization. 6th ed. Philadelphia, PA: Williams & Wilkins; 2006. p.554.
  19. Krepia SD, Psychogiou M, Zafiri V, Krepia P, Fotiou-Kiosses M, Avramika M, et al. Arthritis patients? quality of life before and after knee arthroplasty. Health Science Journal. 2005;2:1-12.
  20. Kutsal YG, Kara M. [Knee osteoarthritis]. Sarıdoğan M, editör. Tanıdan Tedaviye Osteoartrit. 1st ed. İstanbul: Nobel Tıp Kitabevi; 2007. p.149-61.
  21. Litwic A, Edwards MH, Dennison EM, Cooper C. Epidemiology and burden of osteoarthritis. Br Med Bull. 2013;105:185-9. [Crossref] [PubMed] [PMC]
  22. O?Neill T, Jinks C, Ong BN. Decision-making regarding total knee replacement surgery: a qualitative meta-synthesis. BMC Health Serv Res. 2007;7:52. [Crossref] [PubMed] [PMC]
  23. Traumer L, Søransen EE, Kusk HK, Skou ST. Investigating the motives of patients with knee OA undergoing a TKR: a qualitative interview study. Musculoskeletal Care. 2018;16(3):380-7. [Crossref] [PubMed]
  24. Ibrahim SA, Blum M, Lee GC, Mooar P, Medvedeva E, Collier A, et al. Effect of a decision aid on access to total knee replacement for black patients with osteoarthritis of the knee: a randomized clinical trial. JAMA Surg. 2017;152(1):e164225. [Crossref] [PubMed] [PMC]
  25. Clark JP, Hudak PL, Hawker GA, Coyte PC, Mahomed NN, Kreder HJ, et al. The moving target: a qualitative study of erderly patients? decisionmaking regarding total joint replecemant surgery. J Bone Joint Surg Am. 2004;86(7):1366-74. [Crossref] [PubMed]
  26. Gustafsson BA, Ponzer S, Heikkliä K, Ekman SL. The lived body and the periopertive period in replecament surgery: older people?s experiences. J Adv Nurs. 2007;60(1):20-8. [Crossref] [PubMed]
  27. Andersen KV, Bak M, Christensen BV, Harazuk J, Pedersen NA, Søballe K. A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty. Acta Orthop. 2010;81(5):606-10. [Crossref] [PubMed] [PMC]
  28. Pasero C, McCaffery M. Orthopaedic postoperatif pain management. J Perianesth Nurs. 2007;22(3):160-72. [Crossref] [PubMed]
  29. Akyol O, Karayurt O, Salmond S. Experiences of pain and satisfaction with pain management in patients undergoing total knee replacement. Orthop Nurs. 2009;28(2):79-85. [Crossref] [PubMed]
  30. Büyükyilmaz FE, Aşti T. Postoperatif pain characteristics in Turkish orthopedic patients. Pain Manag Nurs. 2010;11(2):76-84. [Crossref] [PubMed]
  31. Joelsson M, Olsson LE, Jakobsson E. Patients? experience of pain and pain relief following hip replacement surgery. J Clin Nurs. 2010;19(1920):2832-8. [Crossref] [PubMed]
  32. Wright JG, Santaguida PL, Young N, Hawker GA, Schemitsch E, Owen JL. Patient preferences before and after total knee arthroplasty. J Clin Epidemiol. 2010;63(7):774-82. [Crossref] [PubMed]
  33. Shakespare D, Kinzel V. Rehabilitation after total knee replacement: time to go home? Knee. 2005;12(3):185-9. [Crossref] [PubMed]
  34. Eti Aslan F. [Postoperative care]. Karadakovan A, Eti Aslan F, editörler. Dahili ve Cerrahi Hastalıklarda Bakım. 1. Baskı. Adana: Nobel Tıp Kitabevi; 2010. p.345-72.
  35. Cremeans-Smith JK, Millington K, Sledjeski E, Greene K, Delahanty DL. Sleep distruptions mediate the relationship between early postoperative pain and later functioning following total replacement surgery. J Behav Med. 2006;29(2): 215-22. [Crossref] [PubMed]
  36. Marcinkowski K, Wong VG, Dignam D. Getting back to the future: a grounded theory study of patient perspective of total knee joint arthroplasty. Orthop Nurs. 2005;24(3):202-9. [Crossref] [PubMed]
  37. Singh JA, O?Byrne M, Harmsen S, Lewallen D. Predictors of moderate-severe functional limitation after primary total knee arthroplasty (TKA): 4701 TKAs at 2-years and 2935 TKAs at 5-years. Osteoarthritis Cartilage. 2010;18(4): 515-21. [Crossref] [PubMed] [PMC]
  38. Özer N, Hacıalioğlu N, Akyıl RÇ, Akpınar R. [The situations of the patients to feel a burden themselves for their relatives who gave the care them]. Journal of Anatolia Nursing and Health Sciences. 2006;9(4):31-7.
  39. Kuğuoğlu S. [Culture and pain]. Seviğ Ü, Tanrıverdi G, editörler. Kültürlerarası Hemşirelik. 1st ed. İstanbul: İstanbul Tıp Kitabevi; 2010. p.395405.

.: Up To Date

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com