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Liukkonen R, Honkanen M, Eskelinen A, Reito A. KLIC Score Does Not Predict Failure After Early Prosthetic Joint Infection: An External Validation With 153 Knees and 130 Hips. J Arthroplasty 2024; 39:1563-1568.e2. [PMID: 38092159 DOI: 10.1016/j.arth.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND A preoperative risk score, the KLIC score (chronic renal failure [K], liver cirrhosis [L], indication of the index surgery [I], cemented prosthesis [C], and C-reactive protein >115 mg/L), has been developed to predict the risk of treatment failure after early prosthetic joint infection (PJI). This study aimed to validate the KLIC score for the debridement, antibiotics, and implant retention (DAIR) procedure and one-stage revisions in a Northern European cohort. METHODS Revisions due to early PJI of the hip or knee between January 1, 2008, and September 12, 2021, were identified retrospectively. The primary outcome was early failure, which was considered when the patient needed an unscheduled surgery, the patient died, or the patient was prescribed long-term suppressive antibiotics. To examine the association between KLIC score and failure risk, univariable logistic regression with area under the curve (AUC) was used. In addition, models were calibrated to assess prognostic ability and clinical utility was examined with decision-curve analyses. RESULTS An increase in KLIC score had a moderate predictive value for early failure after DAIR (odds ratio [OR] 1.45; confidence interval [CI] 1.13 to 1.90). For one-stage revision, it was only slightly predictive of failure (OR 1.20; CI 0.93 to 1.56). After 60 days, the AUC for DAIR was 0.63 (CI 0.55 to 0.72) and 0.56 (CI 0.46 to 0.66) for one-stage revisions, indicating poor discriminative ability. The decision-curve analyses revealed that the model did not offer a remarkable net benefit across a range of threshold probabilities. CONCLUSIONS We demonstrated that the KLIC score is not a reliable predictor of early failure after early PJI in a Northern European cohort. Using the model to guide treatment decisions does not provide any additional clinical utility beyond the baseline strategies.
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Affiliation(s)
- Rasmus Liukkonen
- Coxa Hospital for Joint Replacement, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Meeri Honkanen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Aleksi Reito
- Coxa Hospital for Joint Replacement, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Pyörny J, Luukinen P, Sletten IN, Reito A, Leppänen OV, Jokihaara J. Is Replantation Associated With Better Hand Function After Traumatic Hand Amputation Than After Revision Amputation? Clin Orthop Relat Res 2024; 482:843-853. [PMID: 37921614 PMCID: PMC11008649 DOI: 10.1097/corr.0000000000002906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 09/29/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Replantation is an established treatment for traumatic upper extremity amputation. Only a few studies, however, have assessed the patient-reported outcomes of replantation, and the findings of these studies have been conflicting. QUESTIONS/PURPOSES (1) Is replantation associated with better hand function than revision amputation? (2) Is replantation associated with better health-related quality of life, less painful cold intolerance, and more pleasing hand esthetics than revision amputation after a traumatic hand amputation? METHODS In this retrospective, comparative study, we collected the details of all patients who sustained a traumatic upper extremity amputation and were treated at the study hospital. Between 2009 and 2019, we treated 2250 patients, and we considered all patients who sustained a traumatic amputation of two or more digital rays or a thumb as potentially eligible. Based on that, 15% (334 of 2250) were eligible; a further 2% (8 of 334) were excluded because of a subsequent new traumatic amputation or bilateral amputation, and another 22% (72 of 334) refused participation, leaving 76% (254 of 334) for analysis here. The primary outcome was the DASH score. Secondary outcomes included health-related quality of life (EuroQOL-5D [EQ-5D-5L] Index), painful cold intolerance (the Cold Intolerance Symptom Severity score), and hand esthetics (the Michigan Hand Questionnaire aesthetic domain score). The minimum follow-up time for inclusion was 18 months. Patients were classified into two treatment groups: replantation (67% [171 of 254], including successful replantation in 84% [144 of 171] and partially successful replantation in 16% [27 of 171], in which some but not all of the replanted tissue survived), and revision (complete) amputation (33% [83 of 254], including primary revision amputation in 70% [58 of 83] and unsuccessful replantation followed by secondary amputation in 30% [25 of 83]). In this cohort, replantation was performed if possible, and the reason for choosing primary revision amputation over replantation was usually an amputated part that was too severely damaged (15% [39 of 254]) or was unattainable (2% [4 of 254]). Some patients (3% [8 of 254]) refused to undergo replantation, or their health status did not allow replantation surgery and postoperative rehabilitation (3% [7 of 254]). Gender, age (mean 48 ± 17 years in the replantation group versus 50 ± 23 years in the revision amputation group; p = 0.41), follow-up time (8 ± 4 years in the replantation group versus 7 ± 4 years in the revision amputation group; p = 0.18), amputation of the dominant hand, smoking, extent of tissue loss, or presence of arterial hypertension did not differ between the groups. Patients in the replantation group less frequently had diabetes mellitus (5% [8 of 171] versus 12% [10 of 83]; p = 0.03) and dyslipidemia (4% [7 of 171] versus 11% [9 of 83]; p = 0.04) than those in the revision group and more often had cut-type injuries (75% [129 of 171] versus 60% [50 of 83]; p = 0.02). RESULTS After controlling for potential confounding variables such as age, injury type, extent of tissue loss before treatment, and accident of the dominant hand, replantation was not associated with better DASH scores than revision amputation (OR 0.82 [95% confidence interval (CI) 0.50 to 1.33]; p = 0.42). After controlling for potential cofounding variables, replantation was not associated with better EQ-5D-5L Index scores (OR 0.93 [95% CI 0.56 to 1.55]; p = 0.55), differences in Cold Intolerance Symptom Severity scores (OR 0.85 [95% CI 0.51 to 1.44]; p = 0.79), or superior Michigan Hand Questionnaire esthetic domain scores (OR 0.73 [95% CI 0.43 to 1.26]; p = 0.26) compared with revision amputation. CONCLUSION Replantation surgery was conducted, if feasible, in a homogenous cohort of patients who underwent amputation. If the amputated tissue was too severely damaged or replantation surgery was unsuccessful, the treatment resulted in revision (complete) amputation, which was not associated with worse patient-reported outcomes than successful replantation. These results contradict the assumed benefits of replantation surgery and indicate the need for credible evidence to better guide the care of these patients. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Joonas Pyörny
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Patrick Luukinen
- Center for Musculoskeletal Diseases, Tampere University Hospital, Tampere, Finland
| | | | - Aleksi Reito
- Center for Musculoskeletal Diseases, Tampere University Hospital, Tampere, Finland
| | - Olli V. Leppänen
- Center for Musculoskeletal Diseases, Tampere University Hospital, Tampere, Finland
| | - Jarkko Jokihaara
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Center for Musculoskeletal Diseases, Tampere University Hospital, Tampere, Finland
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Savolainen A, Nietosvaara Y, Sirola J, Hytönen M, Reito A, Heikkinen N, Räisänen MP. Skin closUre in carPal tunnEl Release (SUPER): protocol for a blinded randomised controlled trial comparing absorbable and non-absorbable sutures in carpal tunnel release. BMJ Open 2024; 14:e082289. [PMID: 38626975 PMCID: PMC11029360 DOI: 10.1136/bmjopen-2023-082289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Carpal tunnel syndrome is a common disorder affecting a substantial portion of the general population. Surgical intervention is often deemed necessary, with the median nerve release being one of the most frequent operations. Optimising all the aspects of this procedure can enhance patient satisfaction with the treatment. METHODS AND ANALYSIS We aim to determine the differences in the aesthetic outcome of the scar as well as the pain experienced during the healing process between the use of absorbable and non-absorbable sutures. The primary outcome measure will be the patients' subjective satisfaction with the aesthetic appearance of the scar 1 year after the operation. Secondary outcomes will include a similar evaluation of the aesthetics performed by a blinded outcome assessor, as well as pain experienced by the patients during the 2 weeks postoperatively. The severity and improvement of the patients' symptoms will also be measured by a Finnish version of the Boston Carpal Tunnel Questionnaire. Costs will be evaluated for both groups. Safety of the wound closure will be followed and reported. ETHICS AND DISSEMINATION This protocol was approved by the Research Ethics Committee of the Northern Savo Hospital District (2319/2021). The trial will be conducted in accordance with the principles of Good Clinical Practice and the Declaration of Helsinki. The results will be disseminated through publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05503719.
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Affiliation(s)
| | - Yrjänä Nietosvaara
- University of Eastern Finland School of Medicine, Kuopio, Finland
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Joonas Sirola
- University of Eastern Finland School of Medicine, Kuopio, Finland
- Kuopio University Hospital, Kuopio, Finland
| | - Mikael Hytönen
- University of Eastern Finland School of Medicine, Kuopio, Finland
| | - Aleksi Reito
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Noora Heikkinen
- University of Eastern Finland School of Medicine, Kuopio, Finland
| | - Mikko Petteri Räisänen
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
- Tampere Universities, Tampere, Finland
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Kärnä L, Launonen AP, Luokkala T, Reito A. Routine follow-up imaging is not necessary in uneventful early recovery after distal radius fractures treated with volar locking plate in working-aged patients: A retrospective single-center cohort study. Scand J Surg 2024:14574969241234740. [PMID: 38618994 DOI: 10.1177/14574969241234740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
BACKGROUND AND OBJECTIVE The purpose of our study was to evaluate whether routine follow-up radiographs after distal radius fracture (DRF) treated with volar locking plate (VLP) influenced clinical decision-making and treatment in working-aged patients (18-65 years). We evaluated the possible correlation between clinical status and problems with follow-up radiographs and analyzed the overall reoperation rate. METHODS The study population of this retrospective cohort study consisted of working-aged (18-65 years) patients with DRF who were treated with VLP between January 2010 and December 2020. Baseline data, follow-up visits, and radiographs were collected. Radiographs were classified as either routinely assigned or according to clinical findings. Patients were divided into four groups based on abnormal radiographic findings or major symptoms leading to reoperation. Patients also received patient-rated wrist evaluation (PRWE) questionnaire, which were analyzed. RESULTS A total of 861 patients were included in this study. Routine follow-up radiographs were available for 844 (98%) patients. In 7.0% of patients, 6-week radiographs led to a change of standard treatment protocol, most commonly additional imaging and/or clinical follow-up. Nine (1.1%) patients underwent an urgent reoperation, and 15 (1.8%) patients underwent reoperation later in the follow-up period. All these patients were exceptionally painful/symptomatic. In addition, 33 (3.9%) patients who underwent additional imaging and follow-up after abnormal radiograph, but did not undergo reoperation, were asymptomatic or suffered only mild pain. A total of 89 (10.5%) patients had reoperation for any reason during the follow-up period. CONCLUSIONS Routine follow-up radiographs after the treatment of DRF with VLP in the working-aged population rarely leads to changes in treatment strategy or reoperation in asymptomatic patients suggesting that it would be safe and cost-effective to reduce routine follow-up radiographs and focus instead on those patients with moderate-to-severe symptoms.
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Affiliation(s)
- Laura Kärnä
- Tampere University Hospital Elämänaukio 2 Tampere 33521 Finland
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Rajamäki A, Lehtovirta L, Niemeläinen M, Reito A, Parkkinen J, Peräniemi S, Vepsäläinen J, Eskelinen A. Mild aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL)-type reactions also present in patients with failed knee prostheses. Bone Joint Res 2024; 13:149-156. [PMID: 38569600 PMCID: PMC10990634 DOI: 10.1302/2046-3758.134.bjr-2023-0255.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Aims Metal particles detached from metal-on-metal hip prostheses (MoM-THA) have been shown to cause inflammation and destruction of tissues. To further explore this, we investigated the histopathology (aseptic lymphocyte-dominated vasculitis-associated lesions (ALVAL) score) and metal concentrations of the periprosthetic tissues obtained from patients who underwent revision knee arthroplasty. We also aimed to investigate whether accumulated metal debris was associated with ALVAL-type reactions in the synovium. Methods Periprosthetic metal concentrations in the synovia and histopathological samples were analyzed from 230 patients from our institution from October 2016 to December 2019. An ordinal regression model was calculated to investigate the effect of the accumulated metals on the histopathological reaction of the synovia. Results Median metal concentrations were as follows: cobalt: 0.69 μg/g (interquartile range (IQR) 0.10 to 6.10); chromium: 1.1 μg/g (IQR 0.27 to 4.10); and titanium: 1.6 μg/g (IQR 0.90 to 4.07). Moderate ALVAL scores were found in 30% (n = 39) of the revised knees. There were ten patients with an ALVAL score of 6 or more who were revised for suspected periprosthetic joint infection (PJI), aseptic loosening, or osteolysis. R2 varied between 0.269 and 0.369 for the ordinal regression models. The most important variables were model type, indication for revision, and cobalt and chromium in the ordinal regression models. Conclusion We found that metal particles released from the knee prosthesis can accumulate in the periprosthetic tissues. Several patients revised for suspected culture-negative PJI had features of an ALVAL reaction, which is a novel finding. Therefore, ALVAL-type reactions can also be found around knee prostheses, but they are mostly mild and less common than those found around metal-on-metal prostheses.
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Affiliation(s)
- Anni Rajamäki
- Coxa Hospital for Joint Replacement and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Lari Lehtovirta
- Coxa Hospital for Joint Replacement and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Mika Niemeläinen
- Coxa Hospital for Joint Replacement and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Aleksi Reito
- Coxa Hospital for Joint Replacement and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Sirpa Peräniemi
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | | | - Antti Eskelinen
- Coxa Hospital for Joint Replacement and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Liukkonen R, Honkanen M, Skyttä E, Eskelinen A, Karppelin M, Reito A. Clinical Outcomes After Revision Hip Arthroplasty due to Prosthetic Joint Infection-A Single-Center Study of 369 Hips at a High-Volume Center With a Minimum of One Year Follow-Up. J Arthroplasty 2024; 39:806-812.e3. [PMID: 37661070 DOI: 10.1016/j.arth.2023.08.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/22/2023] [Accepted: 08/27/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Prosthetic joint infection (PJI) treatment decisions are traditionally based on treatment algorithms. There is, however, a lack of evidence to support the choice of these treatment algorithms. Therefore, we aimed to assess the one-year survival after PJI revision and compared different surgical strategies in a single-center setting. METHODS Revisions of the hip due to PJI performed at our institution between January 2008 and September 2021 with at least one-year of follow-up were identified. In total, 134 debridement, antibiotics, and implant retentions (DAIRs), 114 one-stage revisions, and 121 two-stage revisions were performed. Infections were classified as early, acute hematogenous, and chronic. Survival was calculated using the Kaplan-Meier method and cumulative incidence function. Predictors of outcomes were examined with Fine-Gray regressions and Cox proportional hazards regressions. Subdistribution hazard ratios and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. RESULTS At one-year follow-up, 26.6% (CI 22.2 to 31.2%) of the patients had undergone reoperation and 7.9% (CI 5.4 to 10.9%) had died. The risk for reoperation was highest after DAIR (36.6%, CI 28.5 to 44.7%) and lowest after one-stage revision (20.2%, CI 13.4 to 28%). Within the early infections, the one-stage revision almost halved the risk of reoperation (HR 0.51, CI 0.31 to 0.84) with no added mortality risk (HR 1.05, CI 0.5 to 2.2), when compared to DAIR. CONCLUSION By utilizing 1-stage revision over DAIR in early infections, it might be possible to improve the prognosis by decreasing the risk of reoperation without increasing mortality. However, as the patient selection is undeniably difficult, more research is warranted.
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Affiliation(s)
- Rasmus Liukkonen
- Coxa Hospital for Joint Replacement, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Meeri Honkanen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Eerik Skyttä
- Coxa Hospital for Joint Replacement, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Matti Karppelin
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Aleksi Reito
- Coxa Hospital for Joint Replacement, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Räisänen MP, Leppänen OV, Soikkeli J, Reito A, Malmivaara A, Buchbinder R, Kautiainen H, Kaivorinne A, Stjernberg-Salmela S, Lappalainen M, Luokkala T, Pönkkö A, Taskinen HS, Pääkkönen M, Jaatinen K, Juurakko J, Karjalainen VL, Karjalainen T. Surgery, Needle Fasciotomy, or Collagenase Injection for Dupuytren Contracture : A Randomized Controlled Trial. Ann Intern Med 2024; 177:280-290. [PMID: 38346307 DOI: 10.7326/m23-1485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Surgery, needle fasciotomy, and collagenase injection are used to treat Dupuytren contracture. The treatment decision requires balancing initial morbidity and costs of surgery against its potential long-term benefits over needle fasciotomy and collagenase. OBJECTIVE To compare the effectiveness of surgery, needle fasciotomy, and collagenase injection at 3 months and 2 years (secondary time points of the trial). DESIGN A multicenter, randomized, outcome assessor-blinded, superiority trial. (ClinicalTrials.gov: NCT03192020). SETTING 6 public hospitals in Finland. PARTICIPANTS 302 persons with treatment-naive Dupuytren contracture (contracture angle <135°). INTERVENTION Surgery (n = 101), needle fasciotomy (n = 101), or collagenase (n = 100). MEASUREMENTS The primary outcome was the success rate, defined as greater than 50% contracture release and patients reaching the patient acceptable symptom state. Secondary outcomes included hand function, pain, quality of life, patient satisfaction, residual contracture angle, finger flexion, risk for retreatment, and serious adverse events. RESULTS A total of 292 (97%) and 284 (94%) participants completed the 3-month and 2-year follow-ups. Success rates were similar at 3 months: 71% (95% CI, 62% to 80%) for surgery, 73% (CI, 64% to 82%) for needle fasciotomy, and 73% (CI, 64% to 82%) for collagenase. At 2 years, surgery had superior success rates compared with both needle fasciotomy (78% vs. 50%; adjusted risk difference [aRD], 0.30 [CI, 0.17 to 0.43]) and collagenase (78% vs. 65%; aRD, 0.13 [CI, 0.01 to 0.26]). Secondary analyses paralleled with the primary analysis. LIMITATION Participants were not blinded. CONCLUSION Initial outcomes are similar between the treatments, but at 2 years success rates were maintained in the surgery group but were lower with both needle fasciotomy and collagenase despite retreatments. PRIMARY FUNDING SOURCE Research Council of Finland.
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Affiliation(s)
- Mikko Petteri Räisänen
- Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, and Tampere University, Tampere, Finland (M.P.R.)
| | - Olli V Leppänen
- Department of Hand and Microsurgery, Tampere University Hospital, Tampere, Finland (O.V.L., A.K.)
| | - Janne Soikkeli
- Department of Hand Surgery and Orthopedics, Oulu University Hospital, Oulu, Finland (J.S., A.P.)
| | - Aleksi Reito
- Department of Orthopedics, Tampere University Hospital, Tampere, Finland (A.R.)
| | - Antti Malmivaara
- Finnish Institute for Health and Welfare and Orton Orthopedic Hospital, Helsinki, Finland (A.M.)
| | - Rachelle Buchbinder
- Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (R.B.)
| | | | - Antti Kaivorinne
- Department of Hand and Microsurgery, Tampere University Hospital, Tampere, Finland (O.V.L., A.K.)
| | - Susanna Stjernberg-Salmela
- Department of Musculoskeletal and Plastic Surgery, Helsinki University Hospital, Helsinki, Finland (S.S.)
| | | | - Toni Luokkala
- Department of Surgery, Wellbeing Services County of Central Finland/Hospital Nova of Central Finland, Jyväskylä, Finland (T.L., K.J., J.J.)
| | - Annele Pönkkö
- Department of Hand Surgery and Orthopedics, Oulu University Hospital, Oulu, Finland (J.S., A.P.)
| | - Hanna-Stiina Taskinen
- Department of Orthopedic and Traumatology, Turku University Hospital, Turku, Finland (H.-S.T., M.P.)
| | - Markus Pääkkönen
- Department of Orthopedic and Traumatology, Turku University Hospital, Turku, Finland (H.-S.T., M.P.)
| | - Kati Jaatinen
- Department of Surgery, Wellbeing Services County of Central Finland/Hospital Nova of Central Finland, Jyväskylä, Finland (T.L., K.J., J.J.)
| | - Joona Juurakko
- Department of Surgery, Wellbeing Services County of Central Finland/Hospital Nova of Central Finland, Jyväskylä, Finland (T.L., K.J., J.J.)
| | | | - Teemu Karjalainen
- Department of Hand Surgery and Microsurgery, Tampere University Hospital, Tampere, Finland, and Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (T.K.)
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Tapper V, Reito A, Pamilo K, Ylitalo A, Toom A, Paloneva J. Complications and secondary operations after non-operative and operative treatment of tibial plateau fractures: a population-based study of 562 patients with mean follow-up of 7 years. Arch Orthop Trauma Surg 2024; 144:269-280. [PMID: 37921992 DOI: 10.1007/s00402-023-05102-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/10/2023] [Indexed: 11/05/2023]
Abstract
INTRODUCTION The incidence of tibial plateau fractures (TPF) is 1% of all fractures and increases with age. Whether non-operatively or operatively treated, complications (infection, malalignment, loss of reduction and delayed union or nonunion) and post-traumatic osteoarthritis are not uncommon, and the risk for complications has generally been assumed to rise with age. This study investigated all post-TPF complications and secondary surgery after non-operative and operative treatment. Secondary aims were to determine the incidence and epidemiology of TPF in the population of the Central Finland region. MATERIALS AND METHODS All patients over age 18 years with a TPF, including incidence, etiology, fracture type, and possible complications and reoperations, sustained during the period 1998-2019 were retrospectively identified from hospital records. RESULTS The annual mean incidence of TPF was 14.4/100,000, with older women at highest risk. The proportions of non-operative and operatively treated patients who had undergone at least one additional surgical operation were 6% and 26%, respectively. Age and female gender were identified as risk factors for complications and secondary operations. The risk peaked in patients aged 60-65 years, decreasing thereafter. Non-operative treatment showed low risk for both non-union and loss of reduction. CONCLUSIONS Older women were at the highest risk for TPF and for subsequent complications and secondary operations after TPF. Secondary operations after operatively treated TPF were not uncommon and patients aged 60-65 years were at highest risk. Given the low rates of complications and re-operations, non-operative treatment may be a safe option in cases of all minimally displaced TPF.
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Affiliation(s)
- Valtteri Tapper
- Department of Surgery, Hospital Nova, Wellbeing Services County of Central Finland, Keskussairaalantie 19, 40620, Jyvaskyla, Finland.
| | - Aleksi Reito
- Department of Surgery, Tampere University Hospital, Tampere, Finland
| | - Konsta Pamilo
- Coxa Hospital for Joint Replacement, Tampere, Finland
| | - Antti Ylitalo
- Department of Surgery, Tampere University Hospital, Tampere, Finland
| | - Alar Toom
- Department of Surgery, Hospital Nova, Wellbeing Services County of Central Finland, Keskussairaalantie 19, 40620, Jyvaskyla, Finland
| | - Juha Paloneva
- Department of Surgery, Hospital Nova, Wellbeing Services County of Central Finland, Keskussairaalantie 19, 40620, Jyvaskyla, Finland
- University of Eastern Finland, Kuopio, Finland
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Aavikko A, Bister V, Reito A, Lindahl J. Meniscal allograft transplantation improves patient-reported outcomes in both minimal and moderate knee osteoarthritis at 1 and 2 years postoperatively. Knee Surg Sports Traumatol Arthrosc 2023; 31:5765-5772. [PMID: 37935798 PMCID: PMC10719142 DOI: 10.1007/s00167-023-07625-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 10/09/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE Severe cartilage damage and advanced knee osteoarthritis (OA) might be associated with poor outcomes of meniscal allograft transplantation (MAT). The purpose of this prospective follow-up study was to explore MAT survivorship and patient satisfaction among young patients with symptomatic meniscal deficiency and radiological OA of different Kellgren-Lawrence (K-L) grades. METHODS Thirty-five consecutive MAT patients were prospectively followed up for 2 years. The lateral meniscus was replaced in 29 patients and the medial meniscus in 6 patients. Outcomes were assessed using the KOOS4 composite score, KOOS subscales, Lysholm knee score, and OA K-L grade progression from weight-bearing knee radiographs. For the outcome analysis, patients were categorized into two groups: 19 in Group A (K-L classification 0-1) and 16 in Group B (K-L classification 2). RESULTS In terms of KOOS4 and Lysholm scores, the patients showed a clinically significant improvement from baseline to the 1-year follow-up (22.2 points, 95% CI 16.6-27.8 for KOOS4 and 16.8 points, 95% CI 8.9-24.6 for Lysholm), and the improvement remained at 2 years (20.6 points, 95% CI 13.2-28.1 for KOOS4 and 21.5, 95% CI 12.5-30.7 for Lysholm). At the 6-month follow-up, this improvement was not yet observed. Minor between-group differences were observed in the KOOS4 and Lysholm scores for the K-L 0-1 and K-L 2 OA groups, but the estimates were imprecise with wide confidence intervals. A clinically relevant difference between these two study groups could not be found at any timepoint. The reoperation rate was higher in the K-L 2 group than in the K-L 0-1 group (31% vs. 11%). CONCLUSIONS MAT yielded improved patient-reported outcomes and subjective satisfaction at 1 and 2 years postoperatively. The differences from baseline exceeded the minimal clinically important difference (MCID) at all timepoints. The severity of cartilage damage and knee OA in terms of the K-L grade at the time of surgery did not affect the KOOS and Lysholm scores after the MAT procedure. Knee OA progression in terms of K-L grade worsening was not observed in any patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Anni Aavikko
- Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland.
- University of Helsinki, Helsinki, Finland.
| | - Ville Bister
- Department of Surgery, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Aleksi Reito
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Jan Lindahl
- Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Launonen AP, Sumrein BO, Reito A, Lepola V, Paloneva J, Berg HE, Felländer-Tsai L, Kask K, Rahnel T, Tootsi K, Märtson A, Jonsson KB, Wolf O, Ström P, Døssing K, Østergaard HK, Mechlenburg I, Mattila VM, Laitinen MK. Surgery with locking plate or hemiarthroplasty versus nonoperative treatment of 3-4-part proximal humerus fractures in older patients (NITEP): An open-label randomized trial. PLoS Med 2023; 20:e1004308. [PMID: 38015877 PMCID: PMC10683994 DOI: 10.1371/journal.pmed.1004308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/04/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Proximal humerus fractures (PHFs) are common fractures, especially in older female patients. These fractures are commonly treated surgically, but the consensus on the best treatment is still lacking. METHODS AND FINDINGS The primary aim of this multicenter, randomized 3-arm superiority, open-label trial was to assess the results of nonoperative treatment and operative treatment either with locking plate (LP) or hemiarthroplasty (HA) of 3- and 4-part PHF with the primary outcome of Disabilities of the Arm, Shoulder, and Hand (DASH) at 2-year follow-up. Between February 2011 and December 2019, 160 patients 60 years and older with 3- and 4-part PHFs were randomly assigned in 1:1:1 fashion in block size of 10 to undergo nonoperative treatment (control) or operative intervention with LP or HA. In total, 54 patients were assigned to the nonoperative group, 52 to the LP group, and 54 to the HA group. Five patients assigned to the LP group were reassigned to the HA group perioperatively due to high comminution, and all of these patients had 4-part fractures. In the intention-to-treat analysis, there were 42 patients in the nonoperative group, 44 in the LP group, and 37 in the HA group. The outcome assessors were blinded to the study group. The mean DASH score at 2-year follow-up was 30.4 (standard error (SE) 3.25), 31.4 (SE 3.11), and 26.6 (SE 3.23) points for the nonoperative, LP, and HA groups, respectively. At 2 years, the between-group differences were 1.07 points (95% CI [-9.5,11.7]; p = 0.97) between nonoperative and LP, 3.78 points (95% CI [-7.0,14.6]; p = 0.69) between nonoperative and HA, and 4.84 points (95% CI [-5.7,15.4]; p = 0.53) between LP and HA. No significant differences in primary or secondary outcomes were seen in stratified age groups (60 to 70 years and 71 years and over). At 2 years, we found 30 complications (3/52, 5.8% in nonoperative; 22/49, 45% in LP; and 5/49, 10% in HA group, p = 0.0004) and 16 severe pain-related adverse events. There was a revision rate of 22% in the LP group. The limitation of the trial was that the recruitment period was longer than expected due to a high number of exclusions after the assessment of eligibility and a larger exclusion rate than anticipated toward the end of the trial. Therefore, the trial was ended prematurely. CONCLUSIONS In this study, no benefit was observed between operative treatment with LP or HA and nonoperative treatment in displaced 3- and 4-part PHFs in patients aged 60 years and older. Further, we observed a high rate of complications related to operative treatments. TRIAL REGISTRATION ClinicalTrials.gov NCT01246167.
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Affiliation(s)
- Antti P. Launonen
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Bakir O. Sumrein
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Aleksi Reito
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Vesa Lepola
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Juha Paloneva
- Department of Surgery, Hospital Nova, Wellbeing Services County of Central Finland, Jyväskylä, Finland
- University of Eastern Finland, Kuopio, Finland
| | - Hans E. Berg
- Division of Orthopedics and Biotechnology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopedics, Karolinska University Hospital, Huddinge, Sweden
| | - Li Felländer-Tsai
- Division of Orthopedics and Biotechnology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopedics, Karolinska University Hospital, Huddinge, Sweden
| | - Kristo Kask
- Department of Orthopaedics, North Estonia Medical Centre, Tallinn, Estonia
| | - Timo Rahnel
- Department of Orthopaedics, North Estonia Medical Centre, Tallinn, Estonia
| | - Kaspar Tootsi
- Department of Traumatology and Orthopaedics, Tartu University, Tartu, Estonia
- Orthopaedics clinic, Tartu University Hospital, Tartu, Estonia
| | - Aare Märtson
- Department of Traumatology and Orthopaedics, Tartu University, Tartu, Estonia
- Orthopaedics clinic, Tartu University Hospital, Tartu, Estonia
| | - Kenneth B. Jonsson
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Olof Wolf
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Peter Ström
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Kaj Døssing
- Department of Orthopaedic Surgery, Viborg Regional Hospital, Viborg, Denmark
| | - Helle K. Østergaard
- Department of Orthopaedic Surgery, Viborg Regional Hospital, Viborg, Denmark
| | - Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ville M. Mattila
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Minna K. Laitinen
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
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Liukkonen R, Honkanen M, Skyttä E, Eskelinen A, Karppelin M, Reito A. Trends in Revision Knee Arthroplasty for Prosthetic Joint Infection: A Single-Center Study of 384 Knees at a High-Volume Center Between 2008 and 2021. J Arthroplasty 2023; 38:2447-2454. [PMID: 37236284 DOI: 10.1016/j.arth.2023.05.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Prosthetic joint infection (PJI) is one of the most devastating complications after total knee arthroplasty (TKA), and comorbidities increase the risk. We examined whether a temporal change has occurred in the demographics, especially regarding comorbidities, of patients who have PJI and were treated at our institution over a 13-year study period. In addition, we assessed the surgical methods used and the microbiology of the PJIs. METHODS Revisions (n = 384, 377 patients) due to PJI of the knee performed at our institution between 2008 and September 2021 were identified. All included PJIs fulfilled the 2013 International Consensus Meeting diagnostic criteria. The surgeries were categorized into one of the following categories: debridement, antibiotics, and retention (DAIR), 1-stage revision, and 2-stage revision. Infections were classified as early, acute hematogenous, and chronic. RESULTS No changes in the median age of the patients nor comorbidity burden were observed during the study period. However, the proportion of 2-stage revisions decreased remarkably from 57.6% in 2008 to 2009 to 6.3% in 2020 to 2021. A DAIR was the most used treatment strategy, but the proportion of 1-stage revisions increased the most. In 2008 to 2009, 12.1% of the revisions were 1-stage, but in 2020 to 2021, the proportion was 43.8%. The most common pathogen was Staphylococcus aureus (27.8%). CONCLUSION The comorbidity burden remained at the same level with no trends. A DAIR was the most used strategy, but the proportion of 1-stage revisions rose to almost the same level. The incidence of PJI varied between the years, but remained relatively low.
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Affiliation(s)
- Rasmus Liukkonen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Meeri Honkanen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Eerik Skyttä
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Matti Karppelin
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Aleksi Reito
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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12
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Liukkonen R, Vaajala M, Mattila VM, Reito A. Prevalence of post-traumatic osteoarthritis after anterior cruciate ligament injury remains high despite advances in surgical techniques. Bone Joint J 2023; 105-B:1140-1148. [PMID: 37907079 DOI: 10.1302/0301-620x.105b11.bjj-2023-0058.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Aims The aim of this study was to report the pooled prevalence of post-traumatic osteoarthritis (PTOA) and examine whether the risk of developing PTOA after anterior cruciate ligament (ACL) injury has decreased in recent decades. Methods The PubMed and Web of Science databases were searched from 1 January 1980 to 11 May 2022. Patient series, observational studies, and clinical trials having reported the prevalence of radiologically confirmed PTOA after ACL injury, with at least a ten-year follow-up, were included. All studies were analyzed simultaneously, and separate analyses of the operative and nonoperative knees were performed. The prevalence of PTOA was calculated separately for each study, and pooled prevalence was reported with 95% confidence intervals (CIs) using either a fixed or random effects model. To examine the effect of the year of injury on the prevalence, a logit transformed meta-regression analysis was used with a maximum-likelihood estimator. Results from meta-regression analyses were reported with the unstandardized coefficient (β). Results The pooled prevalence of PTOA was 37.9% (95% CI 32.1 to 44) for operatively treated ACL injuries with a median follow-up of 14.6 years (interquartile range (IQR) 10.6 to 16.7). For nonoperatively treated ACL injuries, the prevalence was 40.5% (95% CI 28.9 to 53.3), with a median of follow-up of 15 years (IQR 11.7 to 20.0). The association between the year of operation and the prevalence of PTOA was weak and imprecise and not related to the choice of treatment (operative β -0.038 (95% CI -0.076 to 0.000) and nonoperative β -0.011 (95% CI -0.101 to 0.079)). Conclusion The initial injury, irrespective of management, has, by the balance of probability, resulted in PTOA within 20 years. In addition, the prevalence of PTOA has only slightly decreased during past decades. Therefore, further research is warranted to develop strategies to prevent the development of PTOA after ACL injuries.
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Affiliation(s)
- Rasmus Liukkonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Matias Vaajala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Aleksi Reito
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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13
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Hytönen M, Nietosvaara Y, Reito A, Sirola J, Heikkinen N, Savolainen A, Räisänen MP. Protocol for a double-blinded randomised controlled trial investigating the use of adjunct bicarbonate in carpal tunnel release: a single-centre study. BMJ Open 2023; 13:e071488. [PMID: 37723109 PMCID: PMC10510898 DOI: 10.1136/bmjopen-2022-071488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 08/24/2023] [Indexed: 09/20/2023] Open
Abstract
INTRODUCTION This study aims to compare the effectiveness of buffered and non-buffered long-acting local anaesthetics in pain relief during and after carpal tunnel release (CTR) surgery. Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome. Surgical treatment of CTS, CTR, is the most common hand surgical operation. CTR is usually performed under local anaesthesia, the application of which is often the most painful event during the procedure. One important aspect of patient satisfaction is adequate pain management during and after CTR. Long-acting local anaesthetics provide good postoperative pain control. Adjunct bicarbonate has been shown to reduce pain during injection of local anaesthetic and to prolong its analgesic effect. To date, no published randomised controlled trial has compared buffered to non-buffered long-acting local anaesthetic during CTR. METHODS AND ANALYSIS The study will randomly assign 116 patients with CTS to receive buffered or non-buffered mixtures of lidocaine and bupivacaine with epinephrine before CTR. The primary outcome is overall pain experienced during the injection of local anaesthetic, assessed with the Visual Analogue Scale. The secondary outcomes are pain intensity from the injection and during CTR, use of painkillers and pain intensity every 4 hours until third postoperative night, symptom severity and functional status preoperatively and at 3 months after surgery, and patient-rated outcome measures at 3 months after surgery. ETHICS AND DISSEMINATION This protocol was approved by the Research Ethics Committee of the Northern Savo Hospital District (2311/2021). The study will be performed according to the principles of good clinical practice and the Declaration of Helsinki. The results are expected to be presented in an international hand surgical conference and the manuscript to be sent to a hand surgery-orientated peer-reviewed journal during 2024. TRIAL REGISTRATION NUMBER This study is registered to clinicaltrials.gov, study ID NCT05328180.
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Affiliation(s)
- Mikael Hytönen
- School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Yrjänä Nietosvaara
- School of Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Paediatric Surgery, Kuopio University Hospital, Kuopio, Finland
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Aleksi Reito
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Joonas Sirola
- School of Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Noora Heikkinen
- School of Medicine, University of Eastern Finland, Kuopio, Finland
| | | | - Mikko P Räisänen
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
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14
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Reito A, Lainiala O, Berryman F, Dunlop DJ, Eskelinen A, Matharu GS. Long-term changes in blood metal ion levels in patients with hip resurfacing implants: implications for patient surveillance after 10 years follow-up. Hip Int 2023; 33:864-871. [PMID: 35848136 DOI: 10.1177/11207000221104396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Studies investigating changes in blood metal ion levels during the second decade of the implant lifetime in MoM hip resurfacing patients are scarce. METHODS Patients implanted with either Birmingham Hip Resurfacing (BHR) or Articular Surface Replacement (ASR) hip resurfacings with >10 years follow-up and repeated blood metal ion measurements were identified at 2 large specialist European arthroplasty centres. After excluding patients with initial metal ion levels >7 ppb, the proportion of patients with an increase in blood metal ion levels above previously validated implant-specific thresholds (cobalt 2.15 ppb for unilateral implants, cobalt or chromium 5.5 ppb for bilateral) was assessed. RESULTS We included 2743 blood metal ion measurements from 457 BHR patients (555 hips) and 216 ASR patients (263 hips). Of patients with initial metal ion levels below implant specific thresholds, increases in cobalt or chromium level, respectively, to above these thresholds during the second decade were seen as follows: unilateral BHR (cobalt = 15.6%), unilateral ASR (cobalt = 13.8%), bilateral BHR (cobalt = 8.2%, chromium = 11.8%), bilateral ASR (cobalt = 8.5%, chromium = 4.3%). Measurement-to-measurement changes exceeding +2.15 ppb or +5.5 ppb were, however, uncommon during the second decade. Subgroup results with small diameter (<50 mm) implants were similar. CONCLUSIONS We recommend less frequent blood metal ion measurements are needed (every 3 to 5 years) for hip resurfacing patients if initial values were below 7ppb.
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Affiliation(s)
- Aleksi Reito
- Coxa Hospital for Joint Replacement, Tampere, Finland and Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland
| | - Olli Lainiala
- Coxa Hospital for Joint Replacement, Tampere, Finland and Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland
| | | | | | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, Tampere, Finland and Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland
| | - Gulraj S Matharu
- The Royal Orthopaedic Hospital, Birmingham, UK
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, UK
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15
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Sainio H, Rämö L, Reito A, Silvasti-Lundell M, Lindahl J. Prediction of fracture nonunion leading to secondary surgery in patients with distal femur fractures. Bone Jt Open 2023; 4:584-593. [PMID: 37580052 PMCID: PMC10425244 DOI: 10.1302/2633-1462.48.bjo-2023-0077.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
Aims Several previously identified patient-, injury-, and treatment-related factors are associated with the development of nonunion in distal femur fractures. However, the predictive value of these factors is not well defined. We aimed to assess the predictive ability of previously identified risk factors in the development of nonunion leading to secondary surgery in distal femur fractures. Methods We conducted a retrospective cohort study of adult patients with traumatic distal femur fracture treated with lateral locking plate between 2009 and 2018. The patients who underwent secondary surgery due to fracture healing problem or plate failure were considered having nonunion. Background knowledge of risk factors of distal femur fracture nonunion based on previous literature was used to form an initial set of variables. A logistic regression model was used with previously identified patient- and injury-related variables (age, sex, BMI, diabetes, smoking, periprosthetic fracture, open fracture, trauma energy, fracture zone length, fracture comminution, medial side comminution) in the first analysis and with treatment-related variables (different surgeon-controlled factors, e.g. plate length, screw placement, and proximal fixation) in the second analysis to predict the nonunion leading to secondary surgery in distal femur fractures. Results We were able to include 299 fractures in 291 patients. Altogether, 31/299 fractures (10%) developed nonunion. In the first analysis, pseudo-R2 was 0.27 and area under the receiver operating characteristic curve (AUC) was 0.81. BMI was the most important variable in the prediction. In the second analysis, pseudo-R2 was 0.06 and AUC was 0.67. Plate length was the most important variable in the prediction. Conclusion The model including patient- and injury-related factors had moderate fit and predictive ability in the prediction of distal femur fracture nonunion leading to secondary surgery. BMI was the most important variable in prediction of nonunion. Surgeon-controlled factors had a minor role in prediction of nonunion.
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Affiliation(s)
- Heini Sainio
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lasse Rämö
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Aleksi Reito
- Centre for Musculoskeletal Diseases, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Marja Silvasti-Lundell
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jan Lindahl
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Liukkonen R, Aarnikko H, Stenman P, Ovaska S, Reito A. Association of Nighttime Speed Limits and Electric Scooter-Related Injuries. JAMA Netw Open 2023; 6:e2320868. [PMID: 37382959 DOI: 10.1001/jamanetworkopen.2023.20868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2023] Open
Affiliation(s)
- Rasmus Liukkonen
- Center for Musculoskeletal Diseases, Tampere University Hospital, Tampere, Finland
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Heljä Aarnikko
- Unit of Traffic System Planning, City of Tampere, Tampere, Finland
| | - Pekka Stenman
- Unit of Traffic System Planning, City of Tampere, Tampere, Finland
| | - Sanna Ovaska
- Unit of Traffic System Planning, City of Tampere, Tampere, Finland
| | - Aleksi Reito
- Center for Musculoskeletal Diseases, Tampere University Hospital, Tampere, Finland
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
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Khair RM, Stenroth L, Cronin NJ, Ponkilainen V, Reito A, Finni T. Exploration of muscle-tendon biomechanics one year after Achilles tendon rupture and the compensatory role of flexor hallucis longus. J Biomech 2023; 152:111586. [PMID: 37080080 DOI: 10.1016/j.jbiomech.2023.111586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/30/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
Achilles tendon (AT) rupture leads to long-term structural and functional impairments. Currently, the predictors of good recovery after rupture are poorly known. Thus, we aimed to explore the interconnections between structural, mechanical, and neuromuscular parameters and their associations with factors that could explain good recovery in patients with non-surgically treated AT rupture. A total of 35 patients with unilateral rupture (6 females) participated in this study. Muscle-tendon structural, mechanical, and neuromuscular parameters were measured 1-year after rupture. Interconnections between the inter-limb differences (Δ) were explored using partial correlations, followed by multivariable linear regression to find associations between the measured factors and the following markers that indicate good recovery: 1) tendon length, 2) tendon non-uniform displacement, and 3) flexor hallucis longus (FHL) normalized EMG amplitude difference between limbs. Δmedial gastrocnemius (MG) (β = -0.12, p = 0.007) and Δlateral gastrocnemius (β = -0.086, p = 0.030) subtendon lengths were associated with MG tendon Δstiffness. MG (β = 11.56, p = 0.003) and soleus (β = 2.18, p = 0.040) Δsubtendon lengths explained 48 % of variance in FHL EMG amplitude. Regression models for tendon length and non-uniform displacement were not significant. Smaller inter-limb differences in Achilles subtendon lengths were associated with smaller differences in the AT stiffness between limbs, and a smaller contribution of FHL muscle to the plantarflexion torque. In the injured limb, the increased contribution of FHL appears to partially counteract a smaller contribution from MG due to the elongated tendon, however the role of FHL should not be emphasized during rehabilitation to allow recovery of the TS muscles.
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Affiliation(s)
- Ra'ad M Khair
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland.
| | - Lauri Stenroth
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Neil J Cronin
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland; School of Sport and Exercise, University of Gloucestershire, UK
| | | | - Aleksi Reito
- Central Finland Central Hospital Nova, Jyväskylä, Finland
| | - Taija Finni
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland
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Siren J, Rämö L, Rantasalo M, Komulainen O, Skants N, Reito A, Kosola J, Lindahl J. Unicompartmental knee arthroplasty vs. high tibial osteotomy for medial knee osteoarthritis (UNIKORN): a study protocol of a randomized controlled trial. Trials 2023; 24:256. [PMID: 37016454 PMCID: PMC10074655 DOI: 10.1186/s13063-023-07263-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/18/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Medial knee osteoarthritis (OA) is a common health problem resulting in knee pain and limiting patients' physical activity. After failed conservative treatment, unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) are possible surgical treatment options for this condition. There is a paucity of high-quality evidence in the literature comparing objective and subjective outcomes of these procedures. Also, there is no common agreement on whether these procedures provide comparable results in late-stage medial knee OA patients. METHODS We will perform a prospective randomized controlled trial comparing HTO and UKA in patients with late-stage medial knee OA. 100 patients with isolated medial knee OA (KL III-IV) are assigned to either UKA (n = 50) or HTO (n = 50) procedure in patients 45-65 years of age. Our primary outcome will be KOOS5 at one year postoperatively. Secondary outcomes include OARSI physical assessment, length of stay, wearable activity watch, radiographs (OA progression according to Kellgren-Lawrence classification), patient-reported outcomes (KOOS subscales, pain visual analog scale [VAS], Lysholm, and Oxford knee scores), and adverse events (conversion to total knee arthroplasty, surgery-related complications, need for revision surgery) outcomes. Our hypothesis is that neither of the interventions is superior as measured with KOOS5 at 12 months. ETHICS AND DISSEMINATION The institutional review board of the Helsinki and Uusimaa Hospital District has approved the protocol. We will disseminate the findings through peer-reviewed publications. TRIAL REGISTRATION ClinicalTrials.gov/TooloH NCT05442242. Registered on 7/1/2022.
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Affiliation(s)
- Juuso Siren
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland.
| | - Lasse Rämö
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland
| | - Mikko Rantasalo
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland
| | - Olli Komulainen
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland
| | - Noora Skants
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Peijas Hospital, HUS Helsinki University Hospital, Sairaalakatu 1, 01400, Vantaa, Finland
| | - Aleksi Reito
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Elämänaukio 2, 33520, Tampere, Finland
| | - Jussi Kosola
- Department of Orthopaedics and Traumatology, Kanta-Häme Central Hospital, Ahvenistontie 20, 13530, Hämeenlinna, Finland
| | - Jan Lindahl
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland
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19
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Ax M, Reito A, Hevonkorpi TP, Palola V, Kukkonen J, Luokkala T, Laitinen MK, Launonen AP, Mattila VM. A comparison of the functional results and costs of functional cast and volar-flexion ulnar deviation cast at 2-year follow-up in 105 patients aged 65 and older with dorsally displaced distal radius fracture: A randomized controlled trial. PLoS One 2023; 18:e0283946. [PMID: 37023069 PMCID: PMC10079055 DOI: 10.1371/journal.pone.0283946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 03/21/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND AND PURPOSE Non-operative treatment is the most common treatment option for older patients with distal radius fracture (DRF). Traditionally, wrists have been placed in volar-flexion and ulnar deviation position (VFUDC). In recent years, there has been a trend towards using a functional position cast (FC). However, long-term results for these different casting positions are lacking. PATIENTS AND METHODS This randomized, controlled, prospective study evaluates the functional results and costs of the 2 casting positions in patients 65 and older with DRF. Primary end point in this study was Patient-Reported Wrist Evaluation (PRWE) at 24 months, and secondary end points were cost-effectiveness of treatment, health-related quality of life measurement (15D), short version of Disabilities of arm, shoulder and hand score (QuickDASH), and VAS at 24 months. The trial was registered in ClinicalTrials.gov (NCT02894983, https://clinicaltrials.gov/ct2/show/NCT02894983). RESULTS We enrolled 105 patients, of which 81 (77%) continued until 24-month follow-up. 8 patients (18%) were operated in the VFUDC group and 4 (11%) in the FC group. Patients in the VFUDC group also received more frequent physical therapy. The difference in PRWE score between the VFUDC and FC groups at 24 months was -4.31. The difference in the cost of treatment per patient was €590. Both findings favored FC. INTERPRETATION We found a slight, but consistent difference in the functional results between groups. These results suggest that VFUDC is not superior to FC when treating Colles' type DRF. Cost analysis revealed overall costs in the VFUDC group are nearly double those in the FC group, mostly due to more physical therapy, additional visits to hospital, and additional examinations. Therefore, we recommend FC in older patients with Colles' type DRF.
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Affiliation(s)
- Maarit Ax
- Faculty of Medicine and Health Sciences, University of Tampere, Tampere, Finland
| | - Aleksi Reito
- Faculty of Medicine and Health Sciences, University of Tampere, Tampere, Finland
- Department of Orthopedics and Traumatology, Tampere University Hospital Tampere, Tampere, Finland
| | - Teemu P Hevonkorpi
- Faculty of Medicine and Health Sciences, University of Tampere, Tampere, Finland
- Department of Surgery, Central Finland Central Hospital Nova, Jyväskylä, Finland
| | - Vili Palola
- Faculty of Medicine and Health Sciences, University of Tampere, Tampere, Finland
| | - Juha Kukkonen
- Department of Orthopedics and Traumatology, Satakunta Central Hospital, Pori, Finland
| | - Toni Luokkala
- Department of Surgery, Central Finland Central Hospital Nova, Jyväskylä, Finland
| | - Minna K Laitinen
- Department of Orthopedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Antti P Launonen
- Faculty of Medicine and Health Sciences, University of Tampere, Tampere, Finland
- Department of Orthopedics and Traumatology, Tampere University Hospital Tampere, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Sciences, University of Tampere, Tampere, Finland
- Department of Orthopedics and Traumatology, Tampere University Hospital Tampere, Tampere, Finland
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Saikko V, Neuvonen P, Reito A. Performance of thin Vivacit-E hip liners: no relevant wear during ex vivo testing at high acetabular inclination angle. Acta Orthop 2022; 93:901-905. [PMID: 36477346 DOI: 10.2340/17453674.2022.5359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND PURPOSE There is concern among clinicians regarding the performance of thin, highly cross-linked polyethylene acetabular liners at high inclination angles that cause edge contact and high contact stresses. We studied ex vivo wear performance of thin, vitamin-E grafted, highly cross-linked polyethylene (Vivacit-E) liners in relation to high acetabular inclination angle. MATERIALS AND METHODS Wear of Vivacit-E acetabular liners (thickness 4.0-5.7 mm) was studied with a validated hip joint simulator at 2 different acetabular inclination angles, 40° (optimal) and 65° (high). The test simulated walking. Wear was evaluated gravimetrically and dimensionally. RESULTS At the optimal inclination angle, slight weight gain occurred. At the high angle, the liners lost weight slightly. Due to the minimal weight loss, gravimetric wear rates were difficult to determine. Linear wear was below the detection limit of 0.01 mm. CONCLUSION Even with the high acetabular inclination angle, the prostheses performed well in the present test conditions. The wear rates of the liners were estimated to be clearly below the osteolysis threshold of 0.05 mm/year, below which osteolysis is absent. Since the present hip joint simulator has been shown to produce clinically relevant wear, these ex vivo results are likely to reflect the in vivo behavior of the design.
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Affiliation(s)
| | | | - Aleksi Reito
- Coxa Hospital for Joint Replacement, Tampere, Finland
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21
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Kärnä L, Launonen AP, Karjalainen T, Luokkala T, Ponkilainen V, Halonen L, Helminen M, Mattila VM, Reito A. LIMPER trials: immediate mobilisation versus 2-week cast immobilisation after distal radius fracture treated with volar locking plate - a study protocol for a prospective, randomised, controlled trial. BMJ Open 2022; 12:e064440. [PMID: 36368761 PMCID: PMC9660569 DOI: 10.1136/bmjopen-2022-064440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Open reduction and internal fixation with volar locking plate has become the most common fixation method in the treatment of unstable distal radius fracture (DRF). There is, however, no consensus as to whether or for how long a wrist should be immobilised after operative treatment. To date, there have been relatively few studies that have evaluated the effect of immediate postoperative mobilisation on functional outcomes. The aim of postoperative rehabilitation is to obtain a good function and to reduce impairment, recovery time, socioeconomical costs and absence from work. Therefore, there is a need for studies that evaluate the optimal method of postoperative rehabilitation to optimise wrist function and return to work. METHODS AND ANALYSIS This study is a prospective, randomised, controlled trial in which a total of 240 working-age patients who undergo volar plating for DRF will be randomly assigned to either an early mobilisation group or a postoperative 2-week casting group. The aim of the study will be to compare early postoperative outcomes between the study groups. The primary outcome will be patient-rated wrist evaluation at 2 months after operation. A coprimary outcome will be the total length of sick leave. Our follow-up period will be 1 year, and secondary outcomes will include pain, patient satisfaction, perceived ability to work and complications identified at different time points. We expect those patients who undergo immediate mobilisation will have at least as rapid a return to work and function as those patients who undergo postoperative immobilisation, indicating/meaning that there will be no need for postoperative casting. ETHICS AND DISSEMINATION This study will be conducted according to the Standard Protocol Items: Recommendations for Interventional Trials statement. The Ethics committee of Tampere University Hospital has approved the protocol. Ethics committee approval number is R21111, and it is accepted on 7 September 2021. The results of this study will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05150925.
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Affiliation(s)
- Laura Kärnä
- Tampere University Hospital, Tampere, Finland
| | | | | | - Toni Luokkala
- Central Finland Central Hospital, Jyvaskyla, Finland
| | | | - Lauri Halonen
- South Karelia Central Hospital, Lappeenranta, Finland
| | - Mika Helminen
- Health Sciences, Research Services, Tampere, Finland
- Health Sciences, Tampere University, Tampere, Finland
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22
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Ponkilainen V, Kuitunen I, Liukkonen R, Vaajala M, Reito A, Uimonen M. The incidence of musculoskeletal injuries: a systematic review and meta-analysis. Bone Joint Res 2022; 11:814-825. [DOI: 10.1302/2046-3758.1111.bjr-2022-0181.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aims The aim of this systematic review and meta-analysis was to gather epidemiological information on selected musculoskeletal injuries and to provide pooled injury-specific incidence rates. Methods PubMed (National Library of Medicine) and Scopus (Elsevier) databases were searched. Articles were eligible for inclusion if they reported incidence rate (or count with population at risk), contained data on adult population, and were written in English language. The number of cases and population at risk were collected, and the pooled incidence rates (per 100,000 person-years) with 95% confidence intervals (CIs) were calculated by using either a fixed or random effects model. Results The screening of titles yielded 206 articles eligible for inclusion in the study. Of these, 173 (84%) articles provided sufficient information to be included in the pooled incidence rates. Incidences of fractures were investigated in 154 studies, and the most common fractures in the whole adult population based on the pooled incidence rates were distal radius fractures (212.0, 95% CI 178.1 to 252.4 per 100,000 person-years), finger fractures (117.1, 95% CI 105.3 to 130.2 per 100,000 person-years), and hip fractures (112.9, 95% CI 82.2 to 154.9 per 100,000 person-years). The most common sprains and dislocations were ankle sprains (429.4, 95% CI 243.0 to 759.0 per 100,000 person-years) and first-time patellar dislocations (32.8, 95% CI 21.6 to 49.7 per 100,000 person-years). The most common injuries were anterior cruciate ligament (17.5, 95% CI 6.0 to 50.2 per 100,000 person-years) and Achilles (13.7, 95% CI 9.6 to 19.5 per 100,000 person-years) ruptures. Conclusion The presented pooled incidence estimates serve as important references in assessing the global economic and social burden of musculoskeletal injuries. Cite this article: Bone Joint Res 2022;11(11):814–825.
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Affiliation(s)
- Ville Ponkilainen
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
| | - Ilari Kuitunen
- University of Eastern Finland, Institute of Clinical Medicine, Kuopio, Finland
| | - Rasmus Liukkonen
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Matias Vaajala
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Aleksi Reito
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Mikko Uimonen
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
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23
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Reito A. Letter to the Editor: Editorial: Chance Encounters, Overdiagnosis, and Overtreatment. Clin Orthop Relat Res 2022; 480:2275-2276. [PMID: 36094543 PMCID: PMC9556130 DOI: 10.1097/corr.0000000000002399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 08/19/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Aleksi Reito
- Associate Professor, Tampere University Hospital, Center for Musculoskeletal Diseases, Tampere, Finland
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24
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Ylitalo AAJ, Dahl KA, Reito A, Ekman E. Changes in operative treatment of tibia fractures in Finland between 2000 and 2018: A nationwide study. Scand J Surg 2022; 111:65-71. [PMID: 36000729 DOI: 10.1177/14574969221111612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Incidences of different tibia fractures are not well reported. Possible changes in the operative treatment methods have also not been studied. The aim of this nationwide registry study is to determine the incidence of operatively treated tibia fractures and investigate the possible changes in treatment methods in Finland between 2000 and 2018. METHODS All patients aged 16 years or older with operatively treated tibia fractures in Finland from 2000 to 2018 were included. The incidence of operatively treated proximal, diaphyseal, and distal tibia fractures per 100,000 person years by age, sex, mechanism of injury, and study year was calculated. Data were extracted from the Finnish National Hospital Discharge Register. RESULTS A total of 5996 proximal, 6874 diaphyseal, and 5658 distal tibia fractures were reported during the 18-year study period, resulting in incidences of 7.2/100,000, 8.1/100,000, and 6.9/100,000 person years for operatively treated proximal, diaphyseal, and distal tibia fractures, respectively. Over the study period, a clear change in fixation method in distal tibia fractures was found as plating became popular in the beginning of the 21st century. During the last 5 years of the study period, nailing and plating were equally used. CONCLUSIONS Operatively treated proximal tibia fractures are most common among older females while diaphyseal fractures are most frequent in young male patients. Distal tibia fractures occur most often among middle-aged people.
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Affiliation(s)
- Antti A J Ylitalo
- Department of Orthopedic Surgery Tampere University Hospital University of Tampere PL 2000 Elämänaukio 2 33521 Tampere Finland
| | - Kalle A Dahl
- Department of Orthopaedic Surgery, Turku University Hospital, Turku, Finland
| | - Aleksi Reito
- Department of Orthopaedic Surgery, Tampere University Hospital, Tampere, Finland
| | - Elina Ekman
- Department of Orthopaedic Surgery, Turku University Hospital, Turku, Finland
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25
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Ponkilainen V, Koukkula T, Uimonen M, Mattila VM, Kuitunen I, Reito A. Daylight savings time transition and the incidence of femur fractures in the older population: a nationwide registry-based study. PeerJ 2022; 10:e13672. [PMID: 36003308 PMCID: PMC9394509 DOI: 10.7717/peerj.13672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/12/2022] [Indexed: 01/17/2023] Open
Abstract
Background Daylight Savings Time (DST) transition is known to cause sleep disruption, and thus may increase the incidence of injuries and accidents during the week following the transition. The aim of this study was to assess the incidence of femur fractures after DST transition. Methods We conducted retrospective population-based register study. All Finnish patients 70 years or older who were admitted to hospital due to femur fracture between 1997 and 2020 were gathered from the Finnish National Hospital Discharge Register. Negative binomial regression with 95% confidence intervals (CI) was used to evaluate the incidence of femur fractures after DST transition. Results The data included a total of 112,658 femur fractures during the study period between 1997 and 2020, with an annual mean (SD) of 4,694 (206) fractures. The incidence of femur fractures decreased at the beginning of the study period from 968 to 688 per 100,000 person-years between 1997 and 2007. The weekly mean of femur fractures remained lower during the summer (from 130 to 150 per 100,000 person-weeks) than in winter (from 160 to 180 per 100,000 person-weeks). Incidence rate ratio for the Monday following DST transition was 1.10 (CI [0.98-1.24]) in spring and 1.10 (CI [0.97-1.24]) in fall, and for the whole week 1.07 (CI [1.01-1.14]) in spring and 0.97 (CI [0.83-1.13]) in fall. Conclusion We found weak evidence that the incidence of femur fractures increases after DST transition in the spring.
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Affiliation(s)
- Ville Ponkilainen
- Department of Surgery, Central Finland Hospital, Jyväskylä, Tampere, Finland
| | - Topias Koukkula
- Center for Musculoskeletal Diseases, Tampere University Hospital, Tampere, Finland,Faculty of Medicine and Health Technology, Tampere Univeristy, Tampere, Finland
| | - Mikko Uimonen
- Department of Surgery, Central Finland Hospital, Jyväskylä, Tampere, Finland
| | - Ville M. Mattila
- Center for Musculoskeletal Diseases, Tampere University Hospital, Tampere, Finland,Faculty of Medicine and Health Technology, Tampere Univeristy, Tampere, Finland
| | - Ilari Kuitunen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland,Emergency Department, Mikkeli Central Hospital, Mikkeli, Finland
| | - Aleksi Reito
- Center for Musculoskeletal Diseases, Tampere University Hospital, Tampere, Finland,Faculty of Medicine and Health Technology, Tampere Univeristy, Tampere, Finland
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Liukkonen RJ, Ponkilainen VT, Reito A. Revision Rates After Primary ACL Reconstruction Performed Between 1969 and 2018: A Systematic Review and Metaregression Analysis. Orthop J Sports Med 2022; 10:23259671221110191. [PMID: 35958290 PMCID: PMC9358584 DOI: 10.1177/23259671221110191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Numerous studies, including randomized controlled trials (RCTs), have been published on the optimal graft choice for primary anterior cruciate ligament (ACL) reconstruction. Purpose: To review existing studies to investigate whether advances in orthopaedics have affected revision rates after primary ACL reconstruction. Study Design: Systematic review; Level of evidence, 4. Methods: The PubMed database was searched from inception to December 31, 2020, using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Patient series, observational studies, clinical trials, and registry-based studies investigating primary ACL reconstruction were included, as were high-quality RCTs from an additional study. The minimum required follow-up time for inclusion was 1 year. The primary outcome measure was the pooled prevalence of revision ACL reconstruction. The effect of the year the surgery was performed on revision rates was evaluated with metaregression analysis. All graft types were analyzed simultaneously, and all analyses were repeated separately for each graft type. Results: Overall, 330 articles with 52,878 patients were included, with a median patient age of 28 years (range, 15-57 years). The primary ACL reconstructions were performed between 1969 and 2018. At a median of 2.3 years of follow-up, the overall revision rate was 3.14% (95% CI, 2.76% to 3.56%); it was 2.71% (95% CI, 2.25% to 3.27%) for hamstring autografts, 2.38% (95% CI, 1.82% to 3.11%) for bone–patellar tendon–bone (BPTB) autografts, and 5.24% (95% CI, 4.02% to 6.80%) for other graft types. For hamstring grafts, the revision rate increased over time (year of surgery), with a 0.0434 (95% CI, 0.0150 to 0.0718) increase effect in the logit-transformed scale for every additional year. There was a slight decrease in revision rates for BPTB (β = –0.0049; 95% CI, –0.0352 to 0.0254) and other graft types (β = –0.0306; 95% CI, –0.0608 to −0.0005) over time; however, confidence intervals for BPTB included the zero change. Conclusion: Based on this systematic review and meta-analysis, ACL reconstruction is a reliable procedure with overall low historical revision rates. BPTB autograft had the lowest revision rate and a slightly decreasing trend of failures during the past 45 years, although both BPTB and hamstring autografts are reliable graft choices.
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Affiliation(s)
- Rasmus J. Liukkonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Aleksi Reito
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Reito A, Mattila V, Karjalainen T. Operative vs Nonoperative Treatment of Achilles Tendon Ruptures Using Early Functional Rehabilitation: Critical Analysis of Evidence. Foot Ankle Int 2022; 43:887-890. [PMID: 35382647 DOI: 10.1177/10711007221083691] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Nonoperative treatment with functional rehabilitation of Achilles tendon ruptures (ATRs) has become more common because of claim of "equivalent" risk of rerupture compared to operative treatment. We investigated how current evidence corroborates the often-claimed "equal" or "nondifferent" complication rates. METHODS A search of meta-analyses in PubMed, CENTRAL, and Scopus was performed. Meta-analyses including randomized controlled trials (RCTs) comparing open operative repair of ATR and nonoperative treatment with functional rehabilitation regarding reruptures and other complications were identified. RESULTS Four separate meta-analyses with 6 pooled treatment comparisons were identified. One of the 6 treatment effects (for risk ratio [RR]) showed a reduced risk of rerupture favoring operative treatment, whereas in the remaining analyses the null hypothesis assuming equal risk or an RR of 1 could not be rejected. The smallest RR (benefit in favor of surgery) that could be rejected based on the 95% CI was 0.28. The smallest risk difference that could be rejected in favor of surgery was 6.4%, indicating that nonoperative may have up to 6.4% higher rerupture rate. Treatment effects for complications other than rerupture had very large variability and imprecision. CONCLUSION The literature comparing surgery with nonoperative treatment using functional rehabilitation in ATR have been interpreted in favor of nonoperative treatment as the rerupture rates were falsely considered "equivalent." None of the published meta-analyses excluded a relative risk that is likely to affect the course of treatment in many cases. Increasing incidence of nonoperative treatment in ATRs is not clearly supported by current evidence.
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Affiliation(s)
- Aleksi Reito
- Department of Orthopaedics and Traumatology, Faculty of Medicine and Health Technology, Tampere University Hospital, University of Tampere, Tampere, Finland
| | - Ville Mattila
- Department of Orthopaedics and Traumatology, Faculty of Medicine and Health Technology, Tampere University Hospital, University of Tampere, Tampere, Finland
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28
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Honkonen EE, Sillanpää PJ, Reito A, Mäenpää H, Mattila VM. A Randomized Controlled Trial Comparing a Patella-Stabilizing, Motion-Restricting Knee Brace Versus a Neoprene Nonhinged Knee Brace After a First-Time Traumatic Patellar Dislocation. Am J Sports Med 2022; 50:1867-1875. [PMID: 35438588 PMCID: PMC9160951 DOI: 10.1177/03635465221090644] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A traumatic lateral patellar dislocation is a common injury in adolescents and young adults. The majority of first-time dislocations can be treated nonoperatively. Various types of knee braces are used for nonoperative treatment, but evidence on the most preferable bracing method is lacking. PURPOSE To evaluate the efficacy of a patella-stabilizing, motion-restricting knee brace versus a neoprene nonhinged knee brace for the treatment of a first-time traumatic patellar dislocation at 3 years of follow-up. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 101 skeletally mature patients with a first-time traumatic patellar dislocation were enrolled in the study. After exclusion criteria were applied, 79 patients with a first-time traumatic patellar dislocation were randomized and allocated into 2 study groups: group A, with a patella-stabilizing, motion-restricting knee brace (hinged to allow knee range of motion [ROM] of 0°-30°) and group B, with a neoprene nonhinged knee brace (not restricting any knee motion). Both groups received similar physical therapy instructions and were advised to use the brace continuously for 4 weeks. Overall, 64 patients completed the trial. RESULTS The redislocation rate in group A was 34.4% (11/32) and in group B it was 37.5% (12/32) (risk difference, -3.1% [95% CI, -26.6% to 20.3%]; P = .794). Patients in group A had less knee ROM than those in group B at 4 weeks (90° vs 115°, respectively; P < .001) and 3 months (125° vs 133°, respectively; P = .028). Patients in group A had more quadriceps muscle atrophy than patients in group B at 4 weeks (24/32 vs 16/32, respectively; P = .048) and 3 months. At 6 months, patients in group B reported better functional outcomes than patients in group A (Kujala score mean difference, 4.6; P = .012), although no clinically relevant difference was found at 3 years. CONCLUSION The use of a patella-stabilizing, motion-restricting knee brace for 4 weeks after a first-time traumatic patellar dislocation did not result in a statistically significant reduction in redislocations versus a neoprene nonhinged knee brace, although this trial was underpowered to detect more modest differences. Knee immobilization was associated with quadriceps muscle atrophy, less knee ROM, and worse functional outcomes in the first 6 months after the injury. REGISTRATION NCT01344915 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Essi E. Honkonen
- Unit of Musculoskeletal Surgery, Department of Orthopaedics, Tampere University Hospital, Tampere, Finland,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,Essi E. Honkonen, MD, Unit of Musculoskeletal Surgery, Department of Orthopaedics, Tampere University Hospital, Elämänaukio 2, PL2000, Tampere, 33520, Finland (emails: ; )
| | - Petri J. Sillanpää
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,Pihlajalinna Hospital, Tampere, Finland
| | - Aleksi Reito
- Unit of Musculoskeletal Surgery, Department of Orthopaedics, Tampere University Hospital, Tampere, Finland
| | - Heikki Mäenpää
- Unit of Musculoskeletal Surgery, Department of Orthopaedics, Tampere University Hospital, Tampere, Finland,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ville M. Mattila
- Unit of Musculoskeletal Surgery, Department of Orthopaedics, Tampere University Hospital, Tampere, Finland,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,Coxa Hospital for Joint Replacement, Tampere, Finland
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Khair RM, Stenroth L, Cronin NJ, Reito A, Paloneva J, Finni T. In vivo localised gastrocnemius subtendon representation within the healthy and ruptured human Achilles tendon. J Appl Physiol (1985) 2022; 133:11-19. [PMID: 35546126 DOI: 10.1152/japplphysiol.00084.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The Achilles tendon (AT) is composed of three distinct in-series elastic subtendons, arising from different muscles in the triceps surae. Independent activation of any of these muscles is thought to induce sliding between the adjacent AT subtendons. We aimed to investigate displacement patterns during voluntary contraction (VOL) and selective transcutaneous stimulation of medial (MGstim) and lateral (LGstim) gastrocnemius between ruptured and healthy tendons, and to examine the representative areas of AT subtendons. Twenty-eight patients with unilateral AT rupture performed bilateral VOL at 30% of the maximal isometric un-injured plantarflexion torque. AT displacement was analysed from sagittal B-mode ultrasonography images during VOL, MGstim and LGstim. Three-way ANOVA revealed a significant two-way interaction of contraction type*location on the tendon displacement (F(10-815)=3.72, p<0.001). The subsequent two-way analysis revealed a significant contraction type*location interaction for tendon displacement (F(10-410)=3.79, p<0.001) in the un-injured limb only, where LGstim displacement pattern was significantly different from MGstim (p=0.008) and VOL (p=0.005). When comparing contraction types between limbs the there were no difference in the displacement patterns, but displacement amplitudes differed. There was no significant difference in the location of maximum or minimum displacement between limbs. The displacement pattern was not different in non-surgically treated compared to un-injured tendons one-year post rupture. Our results suggest that near the calcaneus, LG subtendon is located in the most anterior region adjacent to medial gastrocnemius. However, free tendon stiffness seems to be lower in the injured AT, leading to more displacement during electrically-induced contractions compared to the un-injured.
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Affiliation(s)
- Raad M Khair
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Lauri Stenroth
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Neil J Cronin
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland.,School of Sport and Exercise, University of Gloucestershire, United Kingdom
| | - Aleksi Reito
- Central Finland Health Care District, Finland and University of Eastern Finland, Finland
| | - Juha Paloneva
- Central Finland Health Care District, Finland and University of Eastern Finland, Finland
| | - Taija Finni
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland
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Reito A. Letter to the Editor: The New AAOS Guidelines on Knee Arthroscopy for Degenerative Meniscus Tears are a Step in the Wrong Direction. Clin Orthop Relat Res 2022; 480:832-833. [PMID: 35258492 PMCID: PMC8923569 DOI: 10.1097/corr.0000000000002160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/08/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Aleksi Reito
- Associate professor, Tampere University Hospital, Center for Musculoskeletal Diseases, Tampere, Finland
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Reito A, Öljymäki E, Franssila M, Mattila VM. Incidence of Electric Scooter-Associated Injuries in Finland From 2019 to 2021. JAMA Netw Open 2022; 5:e227418. [PMID: 35420666 PMCID: PMC9011127 DOI: 10.1001/jamanetworkopen.2022.7418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This cross-sectional study examines the incidence of injuries associated with the use of electric scooters in Finland.
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Affiliation(s)
- Aleksi Reito
- Center for Musculoskeletal Diseases, Tampere University Hospital, Tampere, Finland
- School of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Elina Öljymäki
- Center for Musculoskeletal Diseases, Tampere University Hospital, Tampere, Finland
- School of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Mikko Franssila
- Emergency Division, Tampere University Hospital, Tampere, Finland
| | - Ville M. Mattila
- Center for Musculoskeletal Diseases, Tampere University Hospital, Tampere, Finland
- School of Medicine and Health Technology, Tampere University, Tampere, Finland
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Ikonen J, Lähdeoja T, Ardern CL, Buchbinder R, Reito A, Karjalainen T. Persistent Tennis Elbow Symptoms Have Little Prognostic Value: A Systematic Review and Meta-analysis. Clin Orthop Relat Res 2022; 480:647-660. [PMID: 34874323 PMCID: PMC8923574 DOI: 10.1097/corr.0000000000002058] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/05/2021] [Accepted: 10/27/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tennis elbow is a common painful enthesopathy of the lateral elbow that limits upper limb function and frequently results in lost time at work. Surgeons often recommend surgery if symptoms persist despite nonsurgical management, but operations for tennis elbow are inconsistent in their efficacy, and what we know about those operations often derives from observational studies that assume the condition does not continue to improve over time. This assumption is largely untested, and it may not be true; meta-analyzing results from the control arms of tennis elbow studies can help us to evaluate this premise, but to our knowledge, this has not been done. QUESTIONS/PURPOSES The aims of this systematic review were to describe the course of (1) global improvement, (2) pain, and (3) disability in participants who received no active treatment (placebo or no treatment) in published randomized controlled trials (RCTs) on tennis elbow. We also assessed (4) whether the duration of symptoms or placebo effect is associated with differences in symptom trajectories. METHODS We searched MEDLINE, Embase, and CENTRAL from database inception to August 12, 2019, for trials including participants with tennis elbow and a placebo or a no-treatment arm and a minimum follow-up duration of 6 months. There were no language restrictions or exclusion criteria. We extracted global improvement, pain, and disability outcomes. We used the Cochrane Risk of Bias tool to assess the risk of bias of included trials. To estimate the typical course of tennis elbow without active treatment, we pooled global improvement (the proportion of participants who reported feeling much better or completely recovered), mean pain, and mean disability using baseline, 1-month, 3-month, 6-month, and 12-month follow-up data. We transformed pain and disability data from the original papers so that at each timepoint the relevant outcome was expressed as change relative to baseline to account for different baseline values. We used meta-regression to assess whether the placebo effect or duration of symptoms before enrollment was associated with differences in symptom trajectories. We included 24 trials with 1085 participants who received no active treatment. RESULTS The number of patients who were not improved decreased exponentially over time. The half-life of global improvement was between 2.5 and 3 months (that is, every 2.5 to 3 months, 50% of the remaining symptomatic patients reported complete recovery or greatly improved symptoms). At 1 year, 89% (189 of 213; 95% CI 80% to 97%) of patients experienced global improvement. The mean pain and disability followed a similar pattern, halving every 3 to 4 months. Eighty-eight percent of pain (95% CI 70% to 100%) and 85% of disability (95% CI 60% to 100%) had resolved by 1 year. The mean duration of symptoms before trial enrollment was not associated with differences in symptom trajectories. The trajectories of the no-treatment and placebo arms were similar, indicating that the placebo effect of the studied active treatments likely is negligible. CONCLUSION Based on the placebo or no-treatment control arms of randomized trials, about 90% of people with untreated tennis elbow achieve symptom resolution at 1 year. The probability of resolution appears to remain constant throughout the first year of follow-up and does not depend on previous symptom duration, undermining the rationale that surgery is appropriate if symptoms persist beyond a certain point of time. We recommend that clinicians inform people who are frustrated with persisting symptoms that this is not a cause for apprehension, given that spontaneous improvement is about as likely during the subsequent few months as it was early after the symptoms first appeared. Because of the high likelihood of spontaneous recovery, any active intervention needs to be justified by high levels of early efficacy and little or no risk to outperform watchful waiting. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- Joona Ikonen
- Department of Hand Surgery, Turku University Hospital, Turku, Finland
| | - Tuomas Lähdeoja
- Finnish Centre for Evidence-Based Orthopedics, Department of Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Clare L. Ardern
- Department of Family Practice, University of British Columbia, Vancouver, Canada
- Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University and Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia
| | - Aleksi Reito
- Department of Orthopaedics, Tampere University Hospital, Tampere, Finland
| | - Teemu Karjalainen
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University and Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia
- Unit of Hand Surgery, Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
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Kuitunen I, Jokihaara J, Ponkilainen V, Reito A, Paloneva J, Mattila VM, Launonen AP. Emergency department visits due to hand trauma and subsequent emergency hand surgery in three Finnish hospitals during the first and second waves of COVID-19 pandemic. PLoS One 2022; 17:e0263435. [PMID: 35108329 PMCID: PMC8809559 DOI: 10.1371/journal.pone.0263435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 01/19/2022] [Indexed: 11/18/2022] Open
Abstract
Introductions
The rate of acute hand trauma visits to emergency departments (ED) and surgeries decreased during the COVID-19 lockdown. Our aim was to analyze the influence of national lockdown during the first wave and the regional restrictions during the second wave on the rate of visits to the ED and urgent hand surgeries in Finland.
Methods
Material for this retrospective study was gathered from three Finnish hospitals All ED visits and urgent or emergency surgeries from January 2017 to December 2020 were included. Incidences per 100 000 persons with 95% confidence intervals (CI) were calculated and compared by incidence rate ratios (IRR).
Results
The incidence of hand injury was lower after the beginning of the lockdown in March 2020 (IRR 0.70 CI 0.63–0.78). After lockdown ended in May, the monthly incidences of ED visits returned to the reference level. During the lockdown, the incidence of fractures and dislocations was 42% lower in March (IRR 0.58 CI 0.50–0.68) and 33% lower in April 2020 (IRR 0.67 CI 0.57–0.80). The incidence of fracture repair surgeries was 43% lower in March 2020 (IRR 0.57 CI 0.35–0.93) and 41% lower in July 2020 (IRR 0.59 CI 0.36–0.98). Incidence of replantation was 49% higher in March 2020 (IRR 1.49 CI 0.53–4.20) and 200% higher in July 2020 (IRR 3.00 CI 0.68–13.2) but these increases had high uncertainty.
Conclusions
The rate of ED visits due to hand injuries decreased while the rate of emergency hand operations remained unchanged during the national COVID-19 lockdown in spring. After the lockdown, the incidences returned to reference level and were unaffected by regional restrictions during the second wave of pandemic.
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Affiliation(s)
- Ilari Kuitunen
- School of Medicine, University of Eastern Finland, Kuopio, Finland
- Mikkeli Central Hospital, Mikkeli, Finland
- * E-mail:
| | - Jarkko Jokihaara
- Department of Hand- and Microsurgery, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland
| | - Ville Ponkilainen
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Aleksi Reito
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Juha Paloneva
- School of Medicine, University of Eastern Finland, Kuopio, Finland
- Central Finland Hospital, Jyväskylä, Finland
| | - Ville M. Mattila
- Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Antti P. Launonen
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
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Khair RM, Stenroth L, Cronin NJ, Reito A, Paloneva J, Finni T. Muscle-tendon morphomechanical properties of non-surgically treated Achilles tendon 1-year post-rupture. Clin Biomech (Bristol, Avon) 2022; 92:105568. [PMID: 35066440 DOI: 10.1016/j.clinbiomech.2021.105568] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 10/12/2021] [Accepted: 12/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Achilles tendon rupture appears to alter stiffness and length of the tendon. These alterations may affect the function of tendon in force transmission and in energy storage and recovery. We studied the mechanical properties of the Achilles' tendon post-rupture and their association with function. METHODS Twenty-four (20 males, 4 females) participants (mean age: 43 y, 176 cm, 81 kg) were recruited. Ultrasonography and dynamometry were used to assess the muscle-tendon unit morphological and mechanical properties of non-surgically treated patients 1-year post rupture. FINDINGS Injured tendons were longer with difference of 1.8 cm (95%CI: 0.5-1.9 cm; P < 0.001), and thicker by 0.2 mm (0.2-0.3 mm; P < 0.01). Medial gastrocnemius cross-sectional area was 1.0 cm2 smaller (0.8-1.1 cm2; P < 0.001), fascicles were 0.6 cm shorter (0.5-0.7 cm; P < 0.001) and pennation angle was 2.5° higher (1.3-3.6°; P < 0.001) when compared to the uninjured limb. We found no differences between injured and uninjured tendon stiffness 1-year post-rupture (mean difference: 29.8 N/mm, -7.7-67.3 N/mm; P = 0.170). The injured tendon showed 1.8 mm (1.2-2.4 mm; P < 0.01) lower elongation during maximal voluntary isometric contractions. Patient-reported functional outcome was related to the tendon resting length (β = 0.68, r(10) = 4.079, P = 0.002). Inter-limb differences in the medial gastrocnemius fascicle length were related to inter-limb differences in maximum contractions (β = 1.17, r(14) = 2.808, P = 0.014). INTERPRETATION Longer Achilles tendon resting length was associated with poorer self-evaluated functional outcome. Although the stiffness of non-surgically treated and uninjured tendons was similar 1-year post rupture, plantar flexion strength deficit was still present, possibly due to shorter medial gastrocnemius fascicle length.
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Affiliation(s)
- Ra'ad M Khair
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland.
| | - Lauri Stenroth
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Neil J Cronin
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland; School of Sport & Exercise, University of Gloucestershire, UK
| | | | - Juha Paloneva
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Central Finland Health Care District, Finland
| | - Taija Finni
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland
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Pakarinen O, Lainiala O, Reito A, Neuvonen P, Mäkelä K, Eskelinen A. Implant survival of 662 dual-mobility cups and 727 constrained liners in primary THA: small femoral head size increases the cumulative incidence of revision. Acta Orthop 2021; 92:658-664. [PMID: 34238130 PMCID: PMC8641668 DOI: 10.1080/17453674.2021.1939597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - In total hip arthroplasty (THA), the risk for dislocation can be reduced using either dual-mobility cups (DMCs) or constrained liners (CLs). There are few studies comparing these concepts in primary THA. Therefore, we compared the cumulative incidence of revision in primary THA patients treated with DMC or CL with varying head sizes with conventional THA patients as reference group.Patients and methods - We performed a cohort study based on the Finnish arthroplasty register, comparing DMCs and CLs operated over the period 2000-2017. DMCs were divided into 2 groups based on the implant design: "DMC Trident" group (n = 399) and "DMC Others" group (n = 263). CLs were divided based on the femoral head size: "CL 36 mm" group (n = 425) and "CL < 36 mm" group (n = 302). All conventional primary THAs operated on in 2000-2017 with 28-36 mm femoral head were included as control group ("Conventional THA" group, n = 102,276). Implant survival was calculated by the corresponding cumulative incidence function with revision as the endpoint and death as competing event. Also, the prevalence of different reasons for revision was compared.Results - The 6-year cumulative incidence function estimates for the first revision were 6.9% (95% CI 4.0-9.7) for DMC Trident, 5.0% (CI 1.5-8.5) for DMC Others, 13% (CI 9.3-17) for CL < 36 mm, 6.3% (3.7-8.9) for CL 36 mm, and 4.7% (CI 4.5-4.8) for control group (conventional THA). The prevalence of dislocation revision was high (5.0%, CI 2.9-8.2) in the CL < 36 mm group compared with other groups.Interpretation - The DMC and CL 36 mm groups had promising mid-term survival rates, comparable to those of primary conventional THA group. The revision rate of CLs with < 36 mm head was high, mostly due to high prevalence of dislocation revisions. Therefore, CLs with 36 mm femoral head should be preferred over smaller ones.
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Affiliation(s)
- Oskari Pakarinen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technology, University of Tampere, Tampere,Correspondence: Oskari Pakarinen Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technology, University of Tampere, Tampere
| | - Olli Lainiala
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technology, University of Tampere, Tampere,Department of Radiology, Tampere University Hospital, Tampere
| | - Aleksi Reito
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technology, University of Tampere, Tampere
| | - Perttu Neuvonen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technology, University of Tampere, Tampere
| | - Keijo Mäkelä
- Department of Orthopedics and Traumatology, Turku University Hospital, and University of Turku, Turku, Finland
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technology, University of Tampere, Tampere
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Reito A, Launonen AP. Paradigm shift in orthopaedics: From objective superiority to shared decision making. Injury 2021; 52:3549. [PMID: 33685644 DOI: 10.1016/j.injury.2021.02.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/21/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Aleksi Reito
- Department of Orthopaedics, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Antti P Launonen
- Department of Orthopaedics, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Theivendran K, Arshad F, Hanif UK, Reito A, Griffin X, Foote CJ. Carbon fibre reinforced PEEK versus traditional metallic implants for orthopaedic trauma surgery: A systematic review. J Clin Orthop Trauma 2021; 23:101674. [PMID: 34777991 PMCID: PMC8577430 DOI: 10.1016/j.jcot.2021.101674] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/16/2021] [Accepted: 10/25/2021] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION There is no literature review comparing outcomes of fixation using carbon-fibre-reinforced polyetheretherketone (CFR PEEK) compared to metal implants used in orthopaedic extremity trauma surgery. A systematic review was performed to compare CFR PEEK to metal implants for clinically-important fracture outcomes. METHODS A search of the online databases of PubMed/Medline, EMBASE and Cochrane Database was conducted. A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A meta-analyses was performed for functional outcomes in proximal humerus fractures converting the score differences to standard mean difference units. GRADE approach was used to determine the level of certainty of the estimates. RESULTS Two prospective randomised controlled trials and seven comparative observational studies with a total of 431 patients were included. Of the nine studies included, four compared the use of CFR PEEK against metal plates in proximal humerus fractures. Aggregated functional scores across the proximal humerus studies, there was a small signal of better improvement with CFR PEEK (SMD 0.22, 95% CI -0.03 to 0.47, p = 0.08, low certainty). Greater odds of adverse events occurred in the metal group (OR 2.34, 95% CI 0.73 to 7.55, p = 0.15, low certainty). CONCLUSIONS Low to very low certainty evidence suggests a small improvement in functional recovery with CFR PEEK in proximal humerus fractures. This may be mediated through a small reduction in major adverse events related to fracture healing and stability. There is currently insufficient evidence to support the widespread use of CFR PEEK implants in fracture fixation. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Kanthan Theivendran
- Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK,Aston University, Birmingham, UK,Corresponding author. Trauma & Orthopaedic Department, Sandwell & West Birmingham Hospitals NHS Trust, West Bromwich, B71 4HJ, UK.
| | - Faizan Arshad
- Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | - Aleksi Reito
- Tampere University Hospital (TAUH), Tampere, Finland
| | - Xavier Griffin
- Division of Trauma & Orthopaedic Surgery, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
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Reito A, Harris IA, Karjalainen T. Arthroscopic partial meniscectomy: did it ever work? Acta Orthop 2021; 93:1. [PMID: 34678122 PMCID: PMC8788727 DOI: 10.1080/17453674.2021.1994233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Aleksi Reito
- Department of Orthopaedics and Traumatology, Tampere University Hospital, and Faculty of Medicine and Health Technology, Tampere University, Finland
| | - Ian A Harris
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Australia
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Abstract
Arthroscopic partial meniscectomy (APM) is one the most common orthopedic surgical procedures. The most common indication for APM is a degenerative meniscal tear (DMT). High-quality evidence suggests that APM does not provide meaningful benefits in patients with DMTs and may even be harmful in the longer term. This narrative review focuses on a fundamental question: considering the history and large number of these surgeries, has APM ever actually worked in patients with DMT? A truly effective treatment needs a valid disease model that would biologically and plausibly explain the perceived treatment benefits. In the case of DMT, effectiveness requires a credible framework for the pain-generating process, which should be influenced by APM. Basic research, pathoanatomy, and clinical evidence gives no support to these frameworks. Moreover, treatment of DMT with an APM does not align with the traditional practice of medicine since DMT is not a reliable diagnosis for knee pain and no evidence-based indication exists that would influence patient prognosis from APM. A plausible and robust explanation supported by both basic research and clinical evidence is that DMTs are part of an osteoarthritic disease process and do not contribute to the symptoms independently or in isolation and that symptoms are not treatable with APM. This is further supported by the fact that APM as an intervention is paradoxical because the extent of procedure and severity of disease are both inversely associated with outcome. We argue that arthroscopic treatment of DMT is largely based on a logical fallacy: post hoc ergo propter hoc.
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Affiliation(s)
- Aleksi Reito
- Department of Orthopaedics and Traumatology, Tampere University Hospital, and Faculty of Medicine and Health Technology, Tampere University, Finland
| | - Ian A Harris
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Australia
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Manninen E, Lainiala O, Karsikas M, Reito A, Jämsä P, Eskelinen A. Do cobalt or chromium accumulate in metal-on-metal hip arthroplasty patients who have mild, moderate, or severe renal insufficiency? Bone Joint J 2021; 103-B:1231-1237. [PMID: 34192941 DOI: 10.1302/0301-620x.103b7.bjj-2020-0836.r2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To find out if there is an inverse association between estimated glomerular filtration rate (eGFR) and whole blood cobalt (Co) and chromium (Cr) levels in patients with metal-on-metal (MoM) hip arthroplasties and renal insufficiency, suggesting that renal insufficiency could cause accumulation of Co and Cr in blood. METHODS Out of 2,520 patients with 3,013 MoM hip arthroplasties, we identified 1,244 patients with whole blood Co, Cr, and creatinine measured within no more than a one-year interval. We analyzed the correlation of blood metal ion levels and eGFR to identify a potential trend of accumulating Co or Cr with decreasing eGFR. RESULTS Of the 1,244 patients, 112 had normal renal function (eGFR > 90 ml/min/1.73 m2), 715 had mild renal insufficiency (eGFR 60 to 89), 384 had moderate renal insufficiency (eGFR 30 to 59), 27 had severe renal insufficiency (eGFR 15 to 29), and six had end-stage renal insufficiency (eGFR < 15). Median eGFR was 68 ml/min/1.73 m2 (interquartile range (IQR) 56 to 82), median whole blood Co was 3.3 µg/l (IQR 1.1 to 9.9), and median Cr was 2.0 µg/l (IQR 1.2 to 3.6). We did not observe an association between decreased eGFR and increased whole blood Co and Cr concentrations, but instead both increased Co and Cr were associated with higher eGFR, indicating better kidney function. CONCLUSION As patients with MoM hip arthroplasties get older, the prevalence of renal insufficiency among them will increase, and orthopaedic surgeons will increasingly have to evaluate whether or not this affects patient follow-up. The USA Food and Drug Administration suggests that closer follow-up may be needed for MoM patients with renal insufficiency. We did not observe accumulation of blood Co or Cr in MoM hip arthroplasty patients with mild to severe renal insufficiency. Cite this article: Bone Joint J 2021;103-B(7):1231-1237.
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Affiliation(s)
- Eveliina Manninen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland
| | - Olli Lainiala
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland.,Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - Mari Karsikas
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland.,Center For Life Course Health Research, University of Oulu, Oulu, Finland
| | - Aleksi Reito
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland
| | - Pyry Jämsä
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland
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Reito A. Past, Present and Future With p-Values, Confidence Intervals and Effect Sizes. J Foot Ankle Surg 2021; 60:642-643. [PMID: 33958041 DOI: 10.1053/j.jfas.2020.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Aleksi Reito
- Adjunct Professor, Department of Orthopedics, Tampere University, Faculty of Medicine and Health Technology and Tampere University Hospital, Tampere, Finland; Department of Surgery, Central Finland Hospital, Jyväskylä, Finland.
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Kurisunkal V, Laitinen MK, Kaneuchi Y, Kapanci B, Stevenson J, Parry MC, Reito A, Fujiwara T, Jeys LM. Is 2 mm a wide margin in high-grade conventional chondrosarcomas of the pelvis? Bone Joint J 2021; 103-B:1150-1154. [PMID: 34058869 DOI: 10.1302/0301-620x.103b6.bjj-2020-1869.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AIMS Controversy exists as to what should be considered a safe resection margin to minimize local recurrence in high-grade pelvic chondrosarcomas (CS). The aim of this study is to quantify what is a safe margin of resection for high-grade CS of the pelvis. METHODS We retrospectively identified 105 non-metastatic patients with high-grade pelvic CS of bone who underwent surgery (limb salvage/amputations) between 2000 and 2018. There were 82 (78%) male and 23 (22%) female patients with a mean age of 55 years (26 to 84). The majority of the patients underwent limb salvage surgery (n = 82; 78%) compared to 23 (22%) who had amputation. In total, 66 (64%) patients were grade 2 CS compared to 38 (36%) grade 3 CS. All patients were assessed for stage, pelvic anatomical classification, type of resection and reconstruction, margin status, local recurrence, distant recurrence, and overall survival. Surgical margins were stratified into millimetres: < 1 mm; > 1 mm but < 2 mm; and > 2 mm. RESULTS The disease--specific survival (DSS) at five years was 69% (95% confidence interval (CI) 56% to 81%) and 51% (95% CI 31% to 70%) for grade 2 and 3 CS, respectively (p = 0.092). The local recurrence-free survival (LRFS) at five years was 59% (95% CI 45% to 72%) for grade 2 CS and 42% (95% CI 21% to 63%) for grade 3 CS (p = 0.318). A margin of more than 2 mm was a significant predictor of increased LRFS (p = 0.001). There was a tendency, but without statistical significance, for a > 2 mm margin to be a predictor of improved DSS. Local recurrence (LR) was a highly significant predictor of DSS, analyzed in a competing risk model (p = 0.001). CONCLUSION Obtaining wide margins in the pelvis remains challenging for high-grade pelvic CS. On the basis of our study, we conclude that it is necessary to achieve at least a 2 mm margin for optimal oncological outcomes in patients with high-grade CS of the pelvis. Cite this article: Bone Joint J 2021;103-B(6):1150-1154.
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Affiliation(s)
| | - Minna K Laitinen
- Dept of Orthopaedic and Traumatology, Helsinki University Central Hospital, Helsinki, Finland
| | - Yoichi Kaneuchi
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Bilal Kapanci
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK
| | | | - Michael C Parry
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Aleksi Reito
- Department of Musculoskeletal Surgery and Diseases, Tampere University Hospital and University of Tampere, Faculty of Medicine and Life Sciences, Tampere, Finland
| | | | - Lee M Jeys
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK.,Dept of Health and Life Sciences, Aston University, Birmingham, UK
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44
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Riuttanen A, Ponkilainen V, Kuitunen I, Reito A, Sirola J, Mattila VM. Severely injured patients do not disappear in a pandemic: Incidence and characteristics of severe injuries during COVID-19 lockdown in Finland. Acta Orthop 2021; 92:249-253. [PMID: 33538233 PMCID: PMC8231355 DOI: 10.1080/17453674.2021.1881241] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - COVID-19 lockdowns have resulted in noteworthy changes in trauma admissions. We report and compare the incidence and characteristics of severe injuries (New Injury Severity Score [NISS] > 15) during the COVID-19 lockdown in Finland with earlier years.Methods - We retrospectively analyzed incidence rate, injury severity scores, injury patterns, and mechanisms of injury of all severely injured patients (NISS >15) in 4 Finnish hospitals (Tampere University Hospital, Kuopio University Hospital, Central Finland Hospital, Mikkeli Central Hospital) during the 11-week lockdown period (March 16-May 31, 2020) with comparison with a matching time period in earlier years (2016-2018). These 4 hospitals have a combined catchment area of 1,150,000 people or roughly one-fifth of the population of Finland.Results - The incidence rate of severe injuries during the lockdown period was 4.9/105 inhabitants (95% CI 3.7-6.4). The incidence rate of severe injuries during years 2016-2018 was 5.1/105 inhabitants (CI 3.9-6.5). We could not detect a significant incidence difference between the lockdown period and the 3 previous years (incidence rate difference -0.2 (CI -2.0 to 1.7). The proportion of traffic-related accidents was 55% during the lockdown period and 51% during previous years. There were no detectable differences in injury patterns. During the lockdown period, the mean age of patients was higher (53 years vs. 47 years, p = 0.03) and the rate of severely injured elderly patients (aged 70 or more) was higher (30% vs. 16%).Interpretation - Despite heavy social restrictions, the incidence of severe injuries during the lockdown period was similar to previous years. Notably, a decline in road use and traffic volumes did not reduce the number of severe traffic accidents. Although our data is compatible with a decrease of 2.0 to an increase of 1.7 severely injured patients per 105 inhabitants, we conclude that severely injured patients do not disappear even during pandemic and stabile hospital resources are needed to treat these patients.
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Affiliation(s)
- Antti Riuttanen
- Department of Orthopedics, Tampere University, Faculty of Medicine and Health Technology and Tampere University Hospital, Tampere; ,Correspondence:
| | | | - Ilari Kuitunen
- Mikkeli Central Hospital, Mikkeli, University of Eastern Finland, School of Medicine, Kuopio;
| | - Aleksi Reito
- Department of Orthopedics, Tampere University, Faculty of Medicine and Health Technology and Tampere University Hospital, Tampere;
| | - Joonas Sirola
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, University Hospital, Department of Orthopedics, Traumatology and Hand Surgery, Kuopio;
| | - Ville M Mattila
- Department of Orthopedics, Tampere University, Faculty of Medicine and Health Technology and Tampere University Hospital, Tampere, Finland
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Abstract
AIMS To investigate whether chronic kidney disease (CKD) is associated with the risk of all-cause revision or revision due to a periprosthetic joint infection (PJI) after primary hip or knee arthroplasty. METHODS This retrospective cohort study comprised 18,979 consecutive hip and knee arthroplasties from a single high-volume academic hospital. At a median of 5.6 years (interquartile range (IQR) 3.5 to 8.1), all deaths and revisions were counted. To overcome the competing risk of death, competing risk analysis using the cumulative incidence function (CIF) was applied to analyze the association between different stages of CKD and revisions. Confounding factors such as diabetes and BMI were considered using either a stratified CIF or the Fine and Gray model. RESULTS There were 2,111 deaths (11.1%) and 677 revisions (3.6%) during the follow-up period. PJI was the reason for revision in 162 cases (0.9%). For hip arthroplasty, 3.5% of patients with CKD stage 1 (i.e. normal kidney function, NKF), 3.8% with CKD stage 2, 4.2% with CKD stage 3, and 0% with CKD stage 4 to 5 had undergone revision within eight years. For knee arthroplasty, 4.7% with NKF, 2.7% with CKD stage 2, 2.4% with CKD stage 3, and 7% of CKD stage 4 to 5 had had undergone revision. With the exception of knee arthroplasty patients in whom normal kidney function was associated with a greater probability of all-cause revision, there were no major differences in the rates of all-cause revisions or revisions due to PJIs between different CKD stages. The results remained unchanged when diabetes and BMI were considered. CONCLUSION We found no strong evidence that CKD was associated with an increased risk of all-cause or PJI-related revision. Selection bias probably explains the increased amount of all-cause revision operations in knee arthroplasty patients with normal kidney function. The effect of stage 4 to 5 CKD was difficult to evaluate because of the small number of patients. Cite this article: Bone Joint J 2021;103-B(4):689-695.
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Affiliation(s)
- Pyry Jämsä
- Coxa Hospital for Joint Replacement, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Aleksi Reito
- Coxa Hospital for Joint Replacement, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Niku Oksala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland.,Cardiovascular Research Center, Tampere, Finland
| | | | - Esa Jämsen
- Coxa Hospital for Joint Replacement, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Raittio L, Launonen A, Mattila VM, Reito A. Estimates of the mean difference in orthopaedic randomized trials: obligatory yet obscure. BMC Med Res Methodol 2021; 21:59. [PMID: 33761900 PMCID: PMC7992936 DOI: 10.1186/s12874-021-01249-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 03/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Randomized controlled trials in orthopaedics are powered to mainly find large effect sizes. A possible discrepancy between the estimated and the real mean difference is a challenge for statistical inference based on p-values. We explored the justifications of the mean difference estimates used in power calculations. The assessment of distribution of observations in the primary outcome and the possibility of ceiling effects were also assessed. Methods Systematic review of the randomized controlled trials with power calculations in eight clinical orthopaedic journals published between 2016 and 2019. Trials with one continuous primary outcome and 1:1 allocation were eligible. Rationales and references for the mean difference estimate were recorded from the Methods sections. The possibility of ceiling effect was addressed by the assessment of the weighted mean and standard deviation of the primary outcome and its elaboration in the Discussion section of each RCT where available. Results 264 trials were included in this study. Of these, 108 (41 %) trials provided some rationale or reference for the mean difference estimate. The most common rationales or references for the estimate of mean difference were minimal clinical important difference (16 %), observational studies on the same subject (8 %) and the ‘clinical relevance’ of the authors (6 %). In a third of the trials, the weighted mean plus 1 standard deviation of the primary outcome reached over the best value in the patient-reported outcome measure scale, indicating the possibility of ceiling effect in the outcome. Conclusions The chosen mean difference estimates in power calculations are rarely properly justified in orthopaedic trials. In general, trials with a patient-reported outcome measure as the primary outcome do not assess or report the possibility of the ceiling effect in the primary outcome or elaborate further in the Discussion section.
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Affiliation(s)
- Lauri Raittio
- The Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland.
| | - Antti Launonen
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Teiskontie 35, 33520, Tampere, Finland
| | - Ville M Mattila
- The Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland.,Department of Orthopaedics and Traumatology, Tampere University Hospital, Teiskontie 35, 33520, Tampere, Finland
| | - Aleksi Reito
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Teiskontie 35, 33520, Tampere, Finland
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Foote CJ, Tornetta P, Reito A, Al-Hourani K, Schenker M, Bosse M, Coles CP, Bozzo A, Furey A, Leighton R. A Reevaluation of the Risk of Infection Based on Time to Debridement in Open Fractures: Results of the GOLIATH Meta-Analysis of Observational Studies and Limited Trial Data. J Bone Joint Surg Am 2021; 103:265-273. [PMID: 33298796 DOI: 10.2106/jbjs.20.01103] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Open fractures are one of the leading causes of disability worldwide. The threshold time to debridement that reduces the infection rate is unclear. METHODS We searched all available databases to identify observational studies and randomized trials related to open fracture care. We then conducted an extensive meta-analysis of the observational studies, using raw and adjusted estimates, to determine if there was an association between the timing of initial debridement and infection. RESULTS We identified 84 studies (18,239 patients) for the primary analysis. In unadjusted analyses comparing various "late" time thresholds for debridement versus "early" thresholds, there was an association between timing of debridement and surgical site infection (odds ratio [OR] = 1.29, 95% confidence interval [CI] = 1.11 to 1.49, p < 0.001, I2 = 30%, 84 studies, n = 18,239). For debridement performed between 12 and 24 hours versus earlier than 12 hours, the OR was higher in tibial fractures (OR = 1.37, 95% CI = 1.00 to 1.87, p = 0.05, I2 = 19%, 12 studies, n = 2,065), and even more so in Gustilo type-IIIB tibial fractures (OR = 1.46, 95% CI = 1.13 to 1.89, p = 0.004, I2 = 23%, 12 studies, n = 1,255). An analysis of Gustilo type-III fractures showed a progressive increase in the risk of infection with time. Critical time thresholds included 12 hours (OR = 1.51, 95% CI = 1.28 to 1.78, p < 0.001, I2 = 0%, 16 studies, n = 3,502) and 24 hours (OR = 2.17, 95% CI = 1.73 to 2.72, p < 0.001, I2 = 0%, 29 studies, n = 5,214). CONCLUSIONS High-grade open fractures demonstrated an increased risk of infection with progressive delay to debridement. LEVEL OF EVIDENCE Prognostic Level IV. See Instruction for Authors for a complete description of the levels of evidence.
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Affiliation(s)
| | - Paul Tornetta
- Department of Orthopedics, Boston University Medical Center, Boston, Massachusetts
| | - Aleksi Reito
- Tampere University Hospital (TAUH), Tampere, Finland
| | - Khalid Al-Hourani
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Mara Schenker
- Orthopedic Trauma Research Unit, Emory University, Atlanta, Georgia
| | - Michael Bosse
- Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Chad P Coles
- Division of Orthopaedics, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Andrew Furey
- Division of Orthopaedics, Memorial University, St. John's, Newfoundland, Canada
| | - Ross Leighton
- Division of Orthopaedics, Dalhousie University, Halifax, Nova Scotia, Canada
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M Khair R, Stenroth L, Péter A, Cronin NJ, Reito A, Paloneva J, Finni T. Non-uniform displacement within ruptured Achilles tendon during isometric contraction. Scand J Med Sci Sports 2021; 31:1069-1077. [PMID: 33464638 DOI: 10.1111/sms.13925] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 01/08/2021] [Accepted: 01/12/2021] [Indexed: 01/21/2023]
Abstract
The purpose of this study was investigate tendon displacement patterns in non-surgically treated patients 14 months after acute Achilles tendon rupture (ATR) and to classify patients into groups based on their Achilles tendon (AT) displacement patterns. Twenty patients were tested. Sagittal images of AT were acquired using B-mode ultrasonography during ramp contractions at a torque level corresponding to 30% of the maximal isometric plantarflexion torque of the uninjured limb. A speckle tracking algorithm was used to track proximal-distal movement of the tendon tissue at 6 antero-posterior locations. Two-way repeated measures ANOVA for peak tendon displacement was performed. K-means clustering was used to classify patients according to AT displacement patterns. The difference in peak relative displacement across locations was larger in the uninjured (1.29 ± 0.87 mm) than the injured limb (0.69 ± 0.68 mm), with a mean difference (95% CI) of 0.60 mm (0.14-1.05 mm, P < .001) between limbs. For the uninjured limb, cluster analysis formed 3 groups, while 2 groups were formed for the injured limb. The three distinct patterns of AT displacement during isometric plantarflexion in the uninjured limb may arise from subject-specific anatomical variations of AT sub-tendons, while the two patterns in the injured limb may reflect differential recovery after ATR with non-surgical treatment. Subject-specific tendon characteristics are a vital determinant of stress distribution across the tendon. Changes in stress distribution may lead to variation in the location and magnitude of peak displacement within the free AT. Quantifying internal tendon displacement patterns after ATR provides new insights into AT recovery.
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Affiliation(s)
- Ra'ad M Khair
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Lauri Stenroth
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Annamária Péter
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Neil J Cronin
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland.,Department for Health, University of Bath, Bath, UK
| | - Aleksi Reito
- Central Finland Health Care District, Jyväskylä, Finland
| | - Juha Paloneva
- Central Finland Health Care District, Jyväskylä, Finland
| | - Taija Finni
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland
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49
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Kuitunen I, Ponkilainen VT, Launonen AP, Reito A, Hevonkorpi TP, Paloneva J, Mattila VM. The effect of national lockdown due to COVID-19 on emergency department visits. Scand J Trauma Resusc Emerg Med 2020; 28:114. [PMID: 33276799 PMCID: PMC7716110 DOI: 10.1186/s13049-020-00810-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/24/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND COVID-19 outbreak lead to nationwide lockdown in Finland on the March 16th, 2020. Previous data regarding to the patient load in the emergency departments during pandemics is scarce. Our aim is to describe the effect of national lockdown and social distancing on the number and reasons for emergency department (ED) visits and inpatient admissions in three large volume hospitals prior to and after the outbreak of the COVID-19 epidemic in Finland. METHODS Data for this register-based retrospective cohort study were collected from three large ED's in Finland, covering 1/6 of the Finnish population. All patients visiting ED's six weeks before and six weeks after the lockdown were included. Pediatric and gynecological patients were excluded. Numbers and reasons for ED visits and inpatient admissions were collected. Corresponding time period in 2019 was used as reference. RESULTS A total of 40,653 ED visits and 12,226 inpatient admissions were analyzed. The total number of ED visits decreased 16% after the lockdown, whereas the number of inpatient admissions decreased 15% (p < 0.001). This change in inpatient admissions was similar in all participating hospitals. Visits due to back or limb pain decreased 31% and infectious diseases 28%. The visit rate and inpatient admissions due to acute myocardial infarction and strokes remained stable throughout the study period. Interestingly, the rate of inpatient admissions due to psychiatric diagnoses remained unchanged, although the ED visit rate decreased by 19%. The number of ED visits (n = 282) and inpatient admissions (n = 55) due to COVID-19 remained low in the participating hospitals. CONCLUSIONS Changes in ED visits and inpatient admissions prior to and during the early phase of the COVID-19 outbreak were unpredictable, and our results may help hospitals and especially ED's focus their resources better. Surprisingly, there was a major decrease in the rate of ED visits due to back or limb pain and not so surprisingly in infectious diseases. Rates of acute myocardial infarctions and cerebral strokes remained stable. In summary, stabile resources for the treatment of patients with severe diseases will be needed in hospitals and ED's.
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Affiliation(s)
- Ilari Kuitunen
- University of Eastern Finland, School of Medicine, Yliopistonranta 1, PL 1627, 70211, Kuopio, Finland.
- Mikkeli Central Hospital, Porrassalmenkatu 35-37, 50100, Mikkeli, Finland.
| | - Ville T Ponkilainen
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland
| | - Antti P Launonen
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland
| | - Aleksi Reito
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland
| | - Teemu P Hevonkorpi
- Department of Surgery, Central Finland Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juha Paloneva
- University of Eastern Finland, School of Medicine, Yliopistonranta 1, PL 1627, 70211, Kuopio, Finland
- Department of Surgery, Central Finland Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland
| | - Ville M Mattila
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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50
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Honkasaari N, Lainiala O, Laine O, Reito A, Eskelinen A. No association between blood count levels and whole-blood cobalt and chromium levels in 1,900 patients with metal-on-metal hip arthroplasty. Acta Orthop 2020; 91:711-716. [PMID: 33003969 PMCID: PMC8023953 DOI: 10.1080/17453674.2020.1827191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The accelerated wear of poorly functioning metal-on-metal (MoM) hip implants may cause elevated whole-blood cobalt (Co) and chromium (Cr) levels. Hematological and endocrinological changes have been described as the most sensitive adverse effects due to Co exposure. We studied whether there is an association between whole-blood Co/Cr levels and leukocyte, hemoglobin, or platelet levels. Patients and methods - We analyzed whole-blood Co and Cr values and complete blood counts (including leukocytes, hemoglobin, platelets) from 1,900 patients with MoM hips. The mean age at the time of whole-blood metal ion measurements was 67 years (SD 10). The mean time from primary surgery to whole-blood metal ion measurement was 8.2 years (SD 3.0). The mean interval between postoperative blood counts and metal ion measurements was 0.2 months (SD 2.7). Results - The median Co value was 1.9 µg/L (0.2-225), Cr 1.6 µg/L (0.2-125), mean leukocyte count 6.7 × 109/L (SD 1.9), hemoglobin value 143 g/L (SD 13), and platelet count 277 × 109/L (SD 70). We did not observe clinically significant correlations between whole-blood Co/Cr and leukocyte, hemoglobin, or platelet counts. Interpretation - Elevated whole-blood Co and Cr values are unlikely to explain abnormal blood counts in patients with MoM hips and the reason for possible abnormal blood counts should be sought elsewhere.
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Affiliation(s)
- Noora Honkasaari
- Coxa Hospital for Joint Replacement, Tampere,University of Tampere, Faculty of Medicine and Life Sciences, Tampere
| | - Olli Lainiala
- Coxa Hospital for Joint Replacement, Tampere,University of Tampere, Faculty of Medicine and Life Sciences, Tampere,Correspondence:
| | - Outi Laine
- University of Tampere, Faculty of Medicine and Life Sciences, Tampere,Tampere University Hospital, Department of Internal Medicine, Tampere, Finland
| | - Aleksi Reito
- Coxa Hospital for Joint Replacement, Tampere,University of Tampere, Faculty of Medicine and Life Sciences, Tampere
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, Tampere,University of Tampere, Faculty of Medicine and Life Sciences, Tampere
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