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Hogendoorn S, Duijnisveld BJ, van Duinen SG, Stoel BC, van Dijk JG, Fibbe WE, Nelissen RGHH. Local injection of autologous bone marrow cells to regenerate muscle in patients with traumatic brachial plexus injury: a pilot study. Bone Joint Res 2014; 3:38-47. [PMID: 24565688 PMCID: PMC3942869 DOI: 10.1302/2046-3758.32.2000229] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives Traumatic brachial plexus injury causes severe functional impairment
of the arm. Elbow flexion is often affected. Nerve surgery or tendon
transfers provide the only means to obtain improved elbow flexion.
Unfortunately, the functionality of the arm often remains insufficient.
Stem cell therapy could potentially improve muscle strength and
avoid muscle-tendon transfer. This pilot study assesses the safety
and regenerative potential of autologous bone marrow-derived mononuclear
cell injection in partially denervated biceps. Methods Nine brachial plexus patients with insufficient elbow flexion
(i.e., partial denervation) received intramuscular escalating doses
of autologous bone marrow-derived mononuclear cells, combined with
tendon transfers. Effect parameters included biceps biopsies, motor
unit analysis on needle electromyography and computerised muscle tomography,
before and after cell therapy. Results No adverse effects in vital signs, bone marrow aspiration sites,
injection sites, or surgical wound were seen. After cell therapy
there was a 52% decrease in muscle fibrosis (p = 0.01), an 80% increase
in myofibre diameter (p = 0.007), a 50% increase in satellite cells
(p = 0.045) and an 83% increase in capillary-to-myofibre ratio (p
< 0.001) was shown. CT analysis demonstrated a 48% decrease in
mean muscle density (p = 0.009). Motor unit analysis showed a mean
increase of 36% in motor unit amplitude (p = 0.045), 22% increase
in duration (p = 0.005) and 29% increase in number of phases (p
= 0.002). Conclusions Mononuclear cell injection in partly denervated muscle of brachial
plexus patients is safe. The results suggest enhanced muscle reinnervation
and regeneration. Cite this article: Bone Joint Res 2014;3:38–47.
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van der Weegen W, Brakel K, Horn RJ, Hoekstra HJ, Sijbesma T, Pilot P, Nelissen RGHH. Asymptomatic pseudotumours after metal-on-metal hip resurfacing show little change within one year. Bone Joint J 2014; 95-B:1626-31. [PMID: 24293591 DOI: 10.1302/0301-620x.95b12.32248] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The aim of this study was to establish the natural course of unrevised asymptomatic pseudotumours after metal-on-metal (MoM) hip resurfacing during a six- to 12-month follow-up period. We used repeated metal artefact reduction sequence (MARS)-magnetic resonance imaging (MRI), serum metal ion analysis and clinical examination to study 14 unrevised hips (mean patient age 52.7 years, 46 to 68, 5 female, 7 male) with a pseudotumour and 23 hips (mean patient age 52.8 years, 38 to 69, 7 female, 16 male) without a pseudotumour. The mean post-operative time to the first MARS-MRI scan was 4.3 years (2.2 to 8.3), and mean time between the first and second MARS-MRI scan was eight months (6 to 12). At the second MRI scan, the grade of severity of the pseudotumour had not changed in 35 hips. One new pseudotumour (Anderson C2 score, moderate) was observed, and one pseudotumour was downgraded from C2 (moderate) to C1 (mild). In general, the characteristics of the pseudotumours hardly changed. Repeated MARS-MRI scans within one year in patients with asymptomatic pseudotumours after MoM hip resurfacing showed little or no variation. In 23 patients without pseudotumour, one new asymptomatic pseudotumour was detected. This is the first longitudinal study on the natural history of pseudotumours using MARS-MRI scans in hip resurfacing, and mirrors recent results for 28 mm diameter MoM total hip replacement.
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Kraal T, van der Heide HJL, van Poppel BJ, Fiocco M, Nelissen RGHH, Doets HC. Long-term follow-up of mobile-bearing total ankle replacement in patients with inflammatory joint disease. Bone Joint J 2014; 95-B:1656-61. [PMID: 24293596 DOI: 10.1302/0301-620x.95b12.32146] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Little is known about the long-term outcome of mobile-bearing total ankle replacement (TAR) in the treatment of end-stage arthritis of the ankle, and in particular for patients with inflammatory joint disease. The aim of this study was to assess the minimum ten-year outcome of TAR in this group of patients. We prospectively followed 76 patients (93 TARs) who underwent surgery between 1988 and 1999. No patients were lost to follow-up. At latest follow-up at a mean of 14.8 years (10.7 to 22.8), 30 patients (39 TARs) had died and the original TAR remained in situ in 28 patients (31 TARs). The cumulative incidence of failure at 15 years was 20% (95% confidence interval (CI) 11 to 28). The mean American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score of the surviving patients at latest follow-up was 80.4 (95% CI 72 to 88). In total, 21 patients (23 TARs) underwent subsequent surgery: three implant exchanges, three bearing exchanges and 17 arthrodeses. Neither design of TAR described in this study, the LCS and the Buechel-Pappas, remains currently available. However, based both on this study and on other reports, we believe that TAR using current mobile-bearing designs for patients with end-stage arthritis of the ankle due to inflammatory joint disease remains justified.
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Peter WF, Nelissen RGHH, Vlieland TPMV. Guideline recommendations for post-acute postoperative physiotherapy in total hip and knee arthroplasty: are they used in daily clinical practice? Musculoskeletal Care 2014; 12:125-31. [PMID: 24497426 DOI: 10.1002/msc.1067] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND In a Dutch guideline on physiotherapy (PT) in hip and knee osteoarthritis, a number of recommendations on post-acute (i.e. after discharge from hospital) PT following total hip (THA) and total knee (TKA) arthroplasty were included. Little is known about the uptake of these recommendations in daily clinical practice. OBJECTIVE The aim of the present study was to determine the extent to which the guideline recommendations regarding post-acute PT after THA and TKA are followed in daily clinical practice. METHODS An online pilot survey on the delivery of post-acute, postoperative PT was sent to a random sample of 957 Dutch physiotherapists. The survey included questions on the application of recommended, neither recommended nor advised against, and advised against treatment modalities and various treatment modalities for which there were no formulated recommendations. RESULTS A total of 219 physiotherapists completed the questionnaire, with a mean age of 40 years (standard deviation 12.6), 55% female and 95% working in primary care. The vast majority reported the use of the recommended exercise modalities (muscle strengthening exercises (96%), and functional exercises (99%). Continuous passive motion, which was neither recommended nor advised against, and electrical muscle stimulation, which was not recommended, were provided by 1%. Reported treatment modalities for which there were no formulated recommendations included patient education (99%), gait training (95%), active range of motion (ROM) exercises (93%), balance exercises (86%), passive ROM exercises (58%), aerobic exercises (50%), massage (18%) and cold therapy (11%). CONCLUSIONS The vast majority of physiotherapists reported adhering to recommendations on post-acute postoperative PT in THA and TKA patients after discharge from hospital. Although yet to be confirmed in a larger nationwide survey, the relatively high frequency of use of many other treatment modalities, for which there were no formulated recommendations, suggests the need to extend the current set of recommendations to include evidence-based statements on additional treatment modalities.
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Keurentjes JC, Van Tol FR, Fiocco M, So-Osman C, Onstenk R, Koopman-Van Gemert AWMM, Pöll RG, Nelissen RGHH. Patient acceptable symptom states after totalhip or knee replacement at mid-term follow-up: Thresholds of the Oxford hip and knee scores. Bone Joint Res 2014; 3:7-13. [PMID: 24421318 PMCID: PMC3928564 DOI: 10.1302/2046-3758.31.2000141] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objectives To define Patient Acceptable Symptom State (PASS) thresholds
for the Oxford hip score (OHS) and Oxford knee score (OKS) at mid-term
follow-up. Methods In a prospective multicentre cohort study, OHS and OKS were collected
at a mean follow-up of three years (1.5 to 6.0), combined with a
numeric rating scale (NRS) for satisfaction and an external validation
question assessing the patient’s willingness to undergo surgery
again. A total of 550 patients underwent total hip replacement (THR)
and 367 underwent total knee replacement (TKR). Results Receiver operating characteristic (ROC) curves identified a PASS
threshold of 42 for the OHS after THR and 37 for the OKS after TKR.
THR patients with an OHS ≥ 42 and TKR patients with an OKS ≥ 37
had a higher NRS for satisfaction and a greater likelihood of being
willing to undergo surgery again. Conclusions PASS thresholds appear larger at mid-term follow-up than at six
months after surgery. With- out external validation, we would advise
against using these PASS thresholds as absolute thresholds in defining
whether or not a patient has attained an acceptable symptom state
after THR or TKR. Cite this article: Bone Joint Res 2014;3:7–13.
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Tilbury C, Schaasberg W, Plevier JWM, Fiocco M, Nelissen RGHH, Vliet Vlieland TPM. Return to work after total hip and knee arthroplasty: a systematic review. Rheumatology (Oxford) 2013; 53:512-25. [DOI: 10.1093/rheumatology/ket389] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Keurentjes JC, Fiocco M, So-Osman C, Ostenk R, Koopman-Van Gemert AWMM, Pöll RG, Nelissen RGHH. Hip and knee replacement patients prefer pen-and-paper questionnaires: Implications for future patient-reported outcome measure studies. Bone Joint Res 2013; 2:238-44. [PMID: 24203164 PMCID: PMC3834769 DOI: 10.1302/2046-3758.211.2000219] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives Electronic forms of data collection have gained interest in recent
years. In orthopaedics, little is known about patient preference
regarding pen-and-paper or electronic questionnaires. We aimed to
determine whether patients undergoing total hip (THR) or total knee
replacement (TKR) prefer pen-and-paper or electronic questionnaires
and to identify variables that predict preference for electronic
questionnaires. Methods We asked patients who participated in a multi-centre cohort study
investigating improvement in health-related quality of life (HRQoL)
after THR and TKR using pen-and-paper questionnaires, which mode
of questionnaire they preferred. Patient age, gender, highest completed
level of schooling, body mass index (BMI), comorbidities, indication
for joint replacement and pre-operative HRQoL were compared between
the groups preferring different modes of questionnaire. We then
performed logistic regression analyses to investigate which variables
independently predicted preference of electronic questionnaires. Results A total of 565 THR patients and 387 TKR patients completed the
preference question. Of the THR patients, 81.8% (95% confidence
interval (CI) 78.4 to 84.7) preferred pen-and-paper questionnaires
to electronic questionnaires, as did 86.8% (95% CI 83.1 to 89.8)
of TKR patients. Younger age, male gender, higher completed level
of schooling and higher BMI independently predicted preference of
electronic questionnaires in THR patients. Younger age and higher
completed level of schooling independently predicted preference
of electronic questionnaires in TKR patients. Conclusions The majority of THR and TKR patients prefer pen-and-paper questionnaires.
Patients who preferred electronic questionnaires differed from patients
who preferred pen-and-paper questionnaires. Restricting the mode
of patient-reported outcome measures to electronic questionnaires
might introduce selection bias. Cite this article: Bone Joint Res 2013;2:238–44.
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van der Voort P, Pijls BG, Nouta KA, Valstar ER, Jacobs WCH, Nelissen RGHH. A systematic review and meta-regression of mobile-bearing versus fixed-bearing total knee replacement in 41 studies. Bone Joint J 2013; 95-B:1209-16. [PMID: 23997134 DOI: 10.1302/0301-620x.95b9.30386] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Mobile-bearing (MB) total knee replacement (TKR) was introduced to reduce the risk of aseptic loosening and wear of polyethylene inserts. However, no consistent clinical advantages of mobile- over fixed-bearing (FB) TKR have been found. In this study we evaluated whether mobile bearings have an advantage over fixed bearings with regard to revision rates and clinical outcome scores. Furthermore, we determined which modifying variables affected the outcome. A systematic search of the literature was conducted to collect clinical trials comparing MB and FB in primary TKR. The primary outcomes were revision rates for any reason, aseptic loosening and wear. Secondary outcomes included range of movement, Knee Society score (KSS), Oxford knee score (OKS), Short-Form 12 (SF-12) score and radiological parameters. Meta-regression techniques were used to explore factors modifying the observed effect. Our search yielded 1827 publications, of which 41 studies met our inclusion criteria, comprising over 6000 TKRs. Meta-analyses showed no clinically relevant differences in terms of revision rates, clinical outcome scores or patient-reported outcome measures between MB and FB TKRs. It appears that theoretical assumptions of superiority of MB over FB TKR are not borne out in clinical practice.
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de Witte PB, van der Zwaal P, van Arkel ERA, Nelissen RGHH, de Groot JH. Pathologic deltoid activation in rotator cuff tear patients: normalization after cuff repair? Med Biol Eng Comput 2013; 52:241-9. [DOI: 10.1007/s11517-013-1095-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 06/21/2013] [Indexed: 11/30/2022]
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Duijnisveld BJ, Saraç C, Malessy MJA, Brachial Plexus Advisory Board TI, Vliet Vlieland TPM, Nelissen RGHH. Developing core sets for patients with obstetricbrachial plexus injury based on the International Classificationof Functioning, Disability and Health. Bone Joint Res 2013; 2:116-21. [PMID: 23836476 PMCID: PMC3693181 DOI: 10.1302/2046-3758.26.2000153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Symptoms of obstetric brachial plexus injury (OBPI) vary widely
over the course of time and from individual to individual and can
include various degrees of denervation, muscle weakness, contractures,
bone deformities and functional limitations. To date, no universally
accepted overall framework is available to assess the outcome of patients
with OBPI. The objective of this paper is to outline the proposed
process for the development of International Classification of Functioning,
Disability and Health (ICF) Core Sets for patients with an OBPI. Methods The first step is to conduct four preparatory studies to identify
ICF categories important for OBPI: a) a systematic literature review
to identify outcome measures, b) a qualitative study using focus
groups, c) an expert survey and d) a cross-sectional, multicentre
study. A first version of ICF Core Sets will be defined at a consensus
conference, which will integrate the evidence from the preparatory
studies. In a second step, field-testing among patients will validate this
first version of Core Sets for OBPI. Discussion The proposed method to develop ICF Core Sets for OBPI yields
a practical tool for multiple purposes: for clinicians to systematically
assess and evaluate the individual’s functioning, for researchers
to design and compare studies, and for patients to get more insight
into their health problems and their management.
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Claessen KMJA, Kloppenburg M, Kroon HM, Bijsterbosch J, Pereira AM, Romijn JA, van der Straaten T, Nelissen RGHH, Hofman A, Uitterlinden AG, Duijnisveld BJ, Lakenberg N, Beekman M, van Meurs JB, Slagboom PE, Biermasz NR, Meulenbelt I. Relationship between the functional exon 3 deleted growth hormone receptor polymorphism and symptomatic osteoarthritis in women. Ann Rheum Dis 2013; 73:433-6. [DOI: 10.1136/annrheumdis-2012-202713] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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De Lange-Brokaar BJE, Ioan-Facsinay A, Yusuf E, Visser AW, Kroon HM, van Osch GJVM, Zuurmond AM, Stojanovic-Susulic V, Bloem JL, Nelissen RGHH, Huizinga TWJ, Kloppenburg M. OP0025 Different Patterns of Synovitis Present in OA Patients Associate Differentially with Pain. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Henseler JF, Nagels J, van der Zwaal P, Nelissen RGHH. Teres major tendon transfer for patients with massive irreparable posterosuperior rotator cuff tears: Short-term clinical results. Bone Joint J 2013; 95-B:523-9. [PMID: 23539705 DOI: 10.1302/0301-620x.95b4.30390] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Surgical repair of posterosuperior rotator cuff tears has a poorer outcome and a higher rate of failure compared with repairs of supraspinatus tears. In this prospective cohort study 28 consecutive patients with an irreparable posterosuperior rotator cuff tear after failed conservative or surgical treatment underwent teres major tendon transfer. Their mean age was 60 years (48 to 71) and the mean follow-up was 25 months (12 to 80). The mean active abduction improved from 79° (0° to 150°) pre-operatively to 105° (20° to 180°) post-operatively (p = 0.011). The mean active external rotation in 90° abduction improved from 25° (0° to 70°) pre-operatively to 55° (0° to 90°) post-operatively (p < 0.001). The mean Constant score improved from 43 (18 to 78) pre-operatively to 65 (30 to 86) post-operatively (p < 0.001). The median post-operative VAS (0 to 100) for pain decreased from 63 (0 to 96) pre-operatively to 5 (0 to 56) post-operatively (p < 0.001). In conclusion, teres major transfer effectively restores function and relieves pain in patients with irreparable posterosuperior rotator cuff tears and leads to an overall clinical improvement in a relatively young and active patient group with limited treatment options.
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Henseler JF, de Witte PB, de Groot JH, van Zwet EW, Nelissen RGHH, Nagels J. Cranial translation of the humeral head on radiographs in rotator cuff tear patients: the modified active abduction view. Med Biol Eng Comput 2013; 52:233-40. [PMID: 23543305 DOI: 10.1007/s11517-013-1057-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 03/05/2013] [Indexed: 01/02/2023]
Abstract
Cranial translation of the humeral head is related to massive rotator cuff tears; however, it may be unapparent in early-stage tears. The goal of this study was to investigate whether active abduction leads to increased active cranial humeral translation in early-stage tears. We assessed 20 consecutive patients (9 full-thickness supraspinatus tears, 11 posterosuperior tears) using the newly introduced modified active abduction view: acromiohumeral (AH) distance was measured on radiographs acquired during rest and active isometric abduction and adduction tasks with the arm alongside the body. Rest AH was 7.5 mm (SD = 1.53); during abduction and adduction, it decreased to 2.1 mm (95 % CI 1.28-3.01, p < 0.001) and 1.1 mm (95 % CI 0.46-1.65, p = 0.001), respectively. Cranial translation during abduction was more severe in shoulders with posterosuperior cuff tears (∆AH = 3 mm, SD = 1.5) compared to supraspinatus tears (∆AH = 1 mm, SD = 1.6), with a mean difference of 2 mm (95 % CI 0.64-3.58, p = 0.007). Both active isometric abduction and adduction leads to active cranial translation in cuff tear patients. Cranial translation is largest during active abduction. Furthermore, there is significant more cranial translation in posterosuperior cuff tear patients compared to supraspinatus cuff tear patients. Possibly, radiographs combined with active tasks offer new possibilities in diagnosing early-stage rotator cuff tears.
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Klein-Wieringa IR, Andersen SN, Kwekkeboom JC, Giera M, Lange-Brokaar BJED, Osch GJVMV, Zuurmond AM, Stojanovic-Susulic V, Nelissen RGHH, Huizinga TWJ, Kloppenburg M, Toes REM, Ioan-Facsinay A. A4.3 Adipocytes Modulate the Phenotype of Macrophages through Secreted Lipids. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-203217.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wolterbeek N, Garling EH, Mertens BJA, van der Linden HMJ, Nelissen RGHH, Valstar ER. Kinematics of a highly congruent mobile-bearing total knee prosthesis. Knee Surg Sports Traumatol Arthrosc 2012; 20:2487-93. [PMID: 22426852 DOI: 10.1007/s00167-012-1936-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 02/20/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Limited or absent axial rotation of the mobile insert of total knee prostheses could lead to high contact stresses and stresses at the bone-implant interface, which in turn might lead to implant loosening. The aim of this study was to assess knee kinematics and muscle activation and their possible change over time in patients with a highly congruent, mobile-bearing total knee prosthesis. METHODS A prospective series of 11 rheumatoid arthritis patients was included to participate in this fluoroscopic and EMG study; only 7 patients completed the study. Kinematic evaluations took place 7 months, 1 and 2 years post-operatively. Repeated measurements ANOVA and linear mixed-effects model for longitudinal data were used to compare the differences between the follow-ups. RESULTS There are no significant changes in axial rotations between follow-up moments for the femoral component as well as the mobile insert. The insert remained mobile and followed the femoral component from 0° until approximately 60° of knee flexion. Diverging and reversed axial rotations and translations were seen during the dynamic motions. CONCLUSIONS Knee kinematics and muscle activation do not appear to change in the first 2 post-operative years. Reversed and divergent axial rotations with increasing knee flexion indicate that as soon as the congruency decreases, the femoral component is no longer forced in a certain position by the insert and moves to a self-imposed position. At lower knee flexion angles, the femoral component might be obstructed by the highly congruent insert and therefore might not be able to move freely. LEVEL OF EVIDENCE Therapeutic study, Level IV.
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Keurentjes JC, Fiocco M, Schreurs BW, Pijls BG, Nouta KA, Nelissen RGHH. Revision surgery is overestimated in hip replacement. Bone Joint Res 2012; 1:258-62. [PMID: 23610656 PMCID: PMC3629447 DOI: 10.1302/2046-3758.110.2000104] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 08/16/2012] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The Kaplan-Meier estimation is widely used in orthopedics to calculate the probability of revision surgery. Using data from a long-term follow-up study, we aimed to assess the amount of bias introduced by the Kaplan-Meier estimator in a competing risk setting. METHODS We describe both the Kaplan-Meier estimator and the competing risk model, and explain why the competing risk model is a more appropriate approach to estimate the probability of revision surgery when patients die in a hip revision surgery cohort. In our study, a total of 62 acetabular revisions were performed. After a mean of 25 years, no patients were lost to follow-up, 13 patients had undergone revision surgery and 33 patients died of causes unrelated to their hip. RESULTS The Kaplan-Meier estimator overestimates the probability of revision surgery in our example by 3%, 11%, 28%, 32% and 60% at five, ten, 15, 20 and 25 years, respectively. As the cumulative incidence of the competing event increases over time, as does the amount of bias. CONCLUSIONS Ignoring competing risks leads to biased estimations of the probability of revision surgery. In order to guide choosing the appropriate statistical analysis in future clinical studies, we propose a flowchart.
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van der Steenhoven TJ, Schaasberg W, de Vries AC, Valstar ER, Nelissen RGHH. Cyclic loading of fractured cadaveric femurs after elastomer femoroplasty: an in vitro biomechanical study. Clin Biomech (Bristol, Avon) 2012; 27:819-23. [PMID: 22682558 DOI: 10.1016/j.clinbiomech.2012.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 05/14/2012] [Accepted: 05/15/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Elastomer femoroplasty is a novel and experimental approach in the prevention of hip fracture surgery. Previously, we published the results of an in vitro cadaveric experiment in which we showed a significant reduction of fracture displacement in treated femurs. The aim of the present study was to establish the failure loads and inter-fragmentary movement of fractured, elastomer femoroplasty treated femurs during cyclic loading. METHODS 16 cadaveric femurs were treated with elastomer femoroplasty and fractured in a simulated fall configuration. Each specimen underwent 10 cycles with a preload of 50 N, starting with a peak load of 250 N followed by 10 cycles of 500 N and continued with 500 N increments. The crosshead speed was 2 mm/s. The failure load, the number of completed cycles, and crosshead extensions were recorded. FINDINGS The mean failure load was 2709 N (SD 1094). The number of completed cycles until failure was 60 (SD 22). The mean translation during maximum loading was 5.25 mm (SD 0.9). At 1500 N (two times the bodyweight of a 75 kg individual) the extension was 3.16 mm. INTERPRETATION Preventive elastomer femoroplasty leads to the stabilization of the proximal femur after fracture. In a single leg stance configuration, cyclic loading with mean failure loads that well exceed the peak loads during normal gait is feasible.
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69
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Pijls BG, Valstar ER, Kaptein BL, Nelissen RGHH. Differences in long-term fixation between mobile-bearing and fixed-bearing knee prostheses at ten to 12 years’ follow-up. ACTA ACUST UNITED AC 2012; 94:1366-71. [DOI: 10.1302/0301-620x.94b10.28858] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This single-blinded randomised controlled trial investigated whether one design of mobile-bearing (MB) total knee replacement (TKR) has any advantage over a fixed-bearing (FB) design on long-term fixation as measured by radiostereometry. The amount of wear underneath the mobile bearing was also evaluated. A series of 42 knees was randomised to MB or FB tibial components with appropriate polyethylene inserts and followed for between ten and 12 years, or until the death of the patient. The polyethylene in the MB group was superior in that it was gamma-irradiated in inert gas and was calcium-stearate free; the polyethylene in the FB group was gamma-irradiated in air and contained calcium stearate. In theory this should be advantageous to the wear rate of the MB group. At final follow-up the overall mean migration was 0.75 mm (sd 0.76) in the MB group and 0.66 mm (sd 0.4) in the FB group, with the FB group demonstrating more posterior tilt and the MB group more internal rotation. In the FB group there was one revision for aseptic loosening, but none in the MB group. There were no significant differences in clinical or radiological scores. For the MB group, the mean linear wear rate on the under-surface was 0.026 mm/year (sd 0.014). This was significantly smaller than the wear rate of 0.11 mm/year (sd 0.06) in the MB between femur and polyethylene (p < 0.001). Nevertheless, even in a best-case setting the mobile bearings of this TKR design had no apparent advantage in terms of fixation over the FB knee prosthesis at ten to 12 years. The wear underneath the mobile bearing was small and is unlikely to be clinically relevant.
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Liem ISL, Kolling C, Marks M, Nelissen RGHH, Goldhahn J. Development of a score set to measure function and quality of life in patients suffering from elbow pathology. Arch Orthop Trauma Surg 2012; 132:831-7. [PMID: 22323059 DOI: 10.1007/s00402-012-1472-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Daily function plays an important role in the quality of life for patients suffering from pathology of the upper extremity. The recovery of functions of daily living determines the success or failure of the treatment for the patient. The goal of this study was to establish and validate a score set measuring quality of life, and objective and subjective function in general elbow pathologies. METHODS A literature review was performed, in order to find a patient-based elbow specific questionnaire. The score set was tested and validated in a cross-sectional setting. RESULTS The patient-rated elbow evaluation (PREE) was chosen as the patient-based elbow specific questionnaire. For measuring general health and subjective arm function, the short form-36 mental health (SF-36 MH) and the shortened disabilities of the arm, shoulder and hand questionnaire (quick DASH) were chosen, respectively. To measure objective function, several clinical tests were implemented. The score set was tested in 66 patients, of which 56.1% had function restrictions due to pain. The correlation between the PREE-function and quick DASH was found to be the highest (r = 0.74*). Between the PREE and quick DASH, the correlation was good (r = 0.70*) and between the PREE-pain and quick DASH, the correlation was moderate (r = 0.58*). The lowest correlation (r = 0.18) was found between the PREE and SF-36 MH (*p < 0.01). CONCLUSION General health, subjective and objective function can be measured in elbow pathology patients using a score set containing the SF-36 MH, quick DASH, PREE, and several clinical tests. Further testing of the score set needs to be executed in a prospective study.
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Wolterbeek N, Garling EH, Mertens BJ, Nelissen RGHH, Valstar ER. Kinematics and early migration in single-radius mobile- and fixed-bearing total knee prostheses. Clin Biomech (Bristol, Avon) 2012; 27:398-402. [PMID: 22055272 DOI: 10.1016/j.clinbiomech.2011.10.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 10/15/2011] [Accepted: 10/17/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND The mobile-bearing variant of a single-radius design is assumed to provide more freedom of motion compared to the fixed-bearing variant because the insert does not restrict the natural movements of the femoral component. This would reduce the contact stresses and wear which in turn may have a positive effect on the fixation of the prosthesis to the bone and thereby decreases the risk for loosening. The aim of this study was to evaluate early migration of the tibial component and kinematics of a mobile-bearing and fixed-bearing total knee prosthesis of the same single-radius design. METHODS Twenty Triathlon single-radius posterior-stabilized knee prostheses were implanted (9 mobile-bearing and 11 fixed-bearing). Fluoroscopy and roentgen stereophotogrammetric analysis (RSA) were performed 6 and 12 months post-operatively. FINDINGS The 1 year post-operative RSA results showed considerable early migrations in 3 out of 9 mobile-bearing patients and 1 out of 11 fixed-bearing patients. The range of knee flexion was the same for the mobile-bearing and fixed-bearing group. The mobile insert was following the femoral component during motion. INTERPRETATION Despite the mobile insert following the femoral component during motion, and therefore performing as intended, no kinematic advantages of the mobile-bearing total knee prosthesis were seen. The fixed-bearing knee performed as good as the mobile-bearing knee and maybe even slightly better based on less irregular kinematics and less early migrations.
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Biermasz NR, van 't Klooster R, Wassenaar MJE, Malm SH, Claessen KMJA, Nelissen RGHH, Roelfsema F, Pereira AM, Kroon HM, Stoel BC, Romijn JA, Kloppenburg M. Automated image analysis of hand radiographs reveals widened joint spaces in patients with long-term control of acromegaly: relation to disease activity and symptoms. Eur J Endocrinol 2012; 166:407-13. [PMID: 22170798 DOI: 10.1530/eje-11-0795] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Arthropathy is an invalidating complication of acromegaly. Although acromegalic arthropathy shares features with primary osteoarthritis, joint spaces are widened rather than narrowed in patients with long-term cure of acromegaly. The late effects of acromegaly on hand joints have not been characterized. Therefore, the objective of the current study was to assess joint space widths (JSWs) of hand joints in patients with long-term control of acromegaly and to identify factors associated with JSW. METHODS A cross-sectional study was carried out in 89 patients (age 58 ± 12 years, 49% women) with long-term controlled acromegaly and 471 controls without hand symptoms (age 46 ± 12 years, 42% women). Radiological JSWs of individual hand joints were measured by automated image analysis. RESULTS Patients had wider mean joint spaces than controls: metacarpo-phalangeal (MCP) joints were ~24%, proximal interphalangeal joints ~21%, and distal interphalangeal joints were ~20% wider (patients vs controls; P < 0.001 for all joints). Mean JSW exceeded the 95th percentile of the values obtained in controls in 64% of patients. Higher IGF1 and GH concentrations at diagnosis were associated with larger JSWs (adjusted β for pretreatment GH in tertiles: 0.09 (95% confidence interval (CI) 0.03-1.84) and for IGF1 in tertiles: 0.14 (95% CI 0.05-0.23) at the MCP joints in acromegalic patients. In male patients, but not in female patients, increased JSWs were associated with more self-reported pain (P = 0.02). CONCLUSIONS Using a new semi-automated image analysis of hand radiographs, acromegalic patients with long-term disease control appeared to have increased joint spaces of all hand joints. JSWs were positively related to disease activity at diagnosis, but not to duration of follow-up, suggesting irreversible cartilage hypertrophy. Irreversible cartilage hypertrophy may partly explain persisting hand complaints despite long-term disease control.
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de Lange-Brokaar BJE, Ioan-Facsinay A, Visser AW, Andersen SN, van Toorn L, van Osch GJVM, Zuurmond AM, Stojanovic-Susulic V, Reijnierse M, Nelissen RGHH, Huizinga TW, Kloppenburg M. Degree of synovitis on MRI is correlated with histological and macroscopic features of synovial tissue inflammation in knee osteoarthritis. Ann Rheum Dis 2012. [DOI: 10.1136/annrheumdis-2011-201239.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wolterbeek N, Nelissen RGHH, Valstar ER. No differences in in vivo kinematics between six different types of knee prostheses. Knee Surg Sports Traumatol Arthrosc 2012; 20:559-64. [PMID: 21761233 PMCID: PMC3281997 DOI: 10.1007/s00167-011-1605-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 07/01/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to compare a broad range of total knee prostheses with different design parameters to determine whether in vivo kinematics was consistently related to design. The hypothesis was that there are no clear recognizable differences in in vivo kinematics between different design parameters or prostheses. METHODS At two sites, data were collected by a single observer on 52 knees (49 subjects with rheumatoid arthritis or osteoarthritis). Six different total knee prostheses were used: multi-radius, single-radius, fixed-bearing, mobile-bearing, posterior-stabilized, cruciate retaining and cruciate sacrificing. Knee kinematics was recorded using fluoroscopy as the patients performed a step-up motion. RESULTS There was a significant effect of prosthetic design on all outcome parameters; however, post hoc tests showed that the NexGen group was responsible for 80% of the significant values. The range of knee flexion was much smaller in this group, resulting in smaller anterior-posterior translations and rotations. CONCLUSION Despite kinematics being generally consistent with the kinematics intended by their design, there were no clear recognizable differences in in vivo kinematics between different design parameters or prostheses. Hence, the differences in design parameters or prostheses are not distinct enough to have an effect on clinical outcome of patients. LEVEL OF EVIDENCE Therapeutic study, Level III.
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Prins AH, Kaptein BL, Stoel BC, Nelissen RGHH, Reiber JHC, Valstar ER. Integrated contour detection and pose estimation for fluoroscopic analysis of knee implants. Proc Inst Mech Eng H 2011; 225:753-61. [PMID: 21922952 DOI: 10.1177/0954411911407669] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
With fluoroscopic analysis of knee implant kinematics the implant contour must be detected in each image frame, followed by estimation of the implant pose. With a large number of possibly low-quality images, the contour detection is a time-consuming bottleneck. The present paper proposes an automated contour detection method, which is integrated in the pose estimation. In a phantom experiment the automated method was compared with a standard method, which uses manual selection of correct contour parts. Both methods demonstrated comparable precision, with a minor difference in the Y-position (0.08 mm versus 0.06 mm). The precision of each method was so small (below 0.2 mm and 0.3 degrees) that both are sufficiently accurate for clinical research purposes. The efficiency of both methods was assessed on six clinical datasets. With the automated method the observer spent 1.5 min per image, significantly less than 3.9 min with the standard method. A Bland-Altman analysis between the methods demonstrated no discernible trends in the relative femoral poses. The threefold increase in efficiency demonstrates that a pose estimation approach with integrated contour detection is more intuitive than a standard method. It eliminates most of the manual work in fluoroscopic analysis, with sufficient precision for clinical research purposes.
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