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Magnusson J, Karlsson J, Sköldenberg O, Albert J, Frostell C, Jakobsson JG. Difference in early all-cause mortality among patients having hip arthroplasty a Swedish perioperative registry study 2013-2022. J Orthop Surg Res 2024; 19:295. [PMID: 38750567 PMCID: PMC11094893 DOI: 10.1186/s13018-024-04752-6] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/19/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION Hip arthroplasty is a common orthopaedic procedure worldwide. There is an ongoing debate related to the fixation and anaesthesia impact on the 30-day mortality, particularly in the aging population with higher American Society of Anaesthesiology (ASA) Physical-Status. AIM To study the 30-day all-cause mortality in patients undergoing primary hip arthroplasty, with regards to the impact of age, ASA-class, anaesthesia techniques, indication for surgery and fixation techniques. MATERIALS AND METHODS Perioperative data for primary hip arthroplasty procedures for osteoarthritis and hip fractures registered in the Swedish Perioperative Registry (SPOR) between 2013 and June 2022 were collected. Binary logistic regressions were performed to assess the impact of age, ASA-class, anaesthetic technique, indication for surgery and fixation on odds ratio for 30-day mortality in Sweden. RESULTS In total, 79,114 patients, 49,565 with osteoarthritis and 29,549 with hip fractures were included in the main study cohort. Mortality was significantly higher among hip fracture patients compared with osteoarthritis, cumulative 8.2% versus 0.1% at 30-days respectively (p < 0.001). Age above 80 years (OR3.7), ASA 3-5 (OR3.3) and surgery for hip fracture (OR 21.5) were associated with significantly higher odds ratio, while hybrid fixation was associated with a significantly lower odds ratio (OR0.4) of 30-day mortality. In the same model, for the subgroups of osteoarthritis and hip fracture, only age (OR 3.7) and ASA-class (OR 3.3) had significant impact, increasing the odds ratio for 30-day mortality. Hemi arthroplasty was commonly used among the hip fracture patients 20.453 (69.2%), and associated with a significantly higher odds ratio for all-cause 30-day mortality as compared to total hip arthroplasty when adjusting for age and ASA-class and fixation 2.3 (95%CI 1.9-2.3, p < 0.001). CONCLUSIONS All-cause 30-day mortality associated with arthroplasty differed significantly between the two cohorts, hip fracture, and osteoarthritis (8.2% and 0.1% respectively) and mortality expectedly increased with age and higher ASA-class. Anaesthetic method and cement-fixation did not impact the odds ratio for all-cause 30-day mortality after adjustment for age and ASA-class.
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Affiliation(s)
| | - J Karlsson
- Sahlgrenska Academy, Institute of Clinical Sciences, Gothenburg University, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - O Sköldenberg
- Unit of Orthopaedics, Department of clinical sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - J Albert
- Department of clinical sciences at Danderyd Hospital, Unit of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, SE-182 88, Sweden
| | - C Frostell
- Department of clinical sciences at Danderyd Hospital, Unit of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, SE-182 88, Sweden
| | - J G Jakobsson
- Department of clinical sciences at Danderyd Hospital, Unit of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, SE-182 88, Sweden.
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Persson A, Sköldenberg O, Mohaddes M, Eisler T, Gordon M. Increased mortality after total hip prosthetic joint infection is mainly caused by the comorbidities rather than the infection itself. Acta Orthop 2023; 94:484-489. [PMID: 37753559 PMCID: PMC10523631 DOI: 10.2340/17453674.2023.18619] [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: 10/17/2022] [Accepted: 08/07/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND AND PURPOSE Periprosthetic joint infection (PJI) is a feared complication of arthroplasty surgery. There is controversy as to whether PJI also correlates with increased mortality. Our aim was to investigate in a nationwide cohort if PJI is an independent risk factor for dying. PATIENTS AND METHODS We performed a retrospective cohort study based on data from the Swedish Hip Arthroplasty Register (SHAR). All patients with a revision THA performed between 1998 and 2017 were included. The outcome is mortality; exposure is PJI according to SHAR. The control group was study participants who underwent aseptic revision. Confounders were age, sex, diagnosis, and comorbidity according to the Elixhauser index. The outcome was analyzed with a Cox proportional hazards model. RESULTS 4,943 PJI revisions and 12,529 non-infected revisions were included in the analysis. The median follow-up time was 4.1 years. In the PJI group, 1,972 patients died and in the control group, 4,512. The incidence rate ratio was 1.19 (95% confidence interval [CI] 1.13-1.25), the crude hazard ratio (HR) 1.19 (CI 1.13-1.25), and the adjusted HR 1.05 (CI 0.99-1.12) for the exposed versus the unexposed group. The strongest confounder was comorbidity. CONCLUSION The increased mortality risk after revision due to PJI is mainly caused by the comorbidity of the patient, rather than by the infection itself.
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Affiliation(s)
- Anders Persson
- Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Stockholm.
| | - Olof Sköldenberg
- Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Stockholm
| | - Maziar Mohaddes
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden, and The Swedish Arthroplasty Register, Gothenburg, Sweden
| | - Thomas Eisler
- Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Stockholm
| | - Max Gordon
- Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Stockholm
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Becher C, Megaloikonomos PD, Lind M, Eriksson K, Brittberg M, Beckmann J, Verdonk P, Högström M, Konradsen L, Holz J, Franz A, Feucht MJ, Kösters C, van Buul G, Sköldenberg O, Emans PJ, Boutefnouchet T, Nathwani D, McNicholas MJ, O'Donnell T, Spalding T, Stålman A, Ostermeier S, Imhoff AB, Shearman AD, Hirschmann M. High degree of consensus amongst an expert panel regarding focal resurfacing of chondral and osteochondral lesions of the femur with mini-implants. Knee Surg Sports Traumatol Arthrosc 2023; 31:4027-4034. [PMID: 37173573 DOI: 10.1007/s00167-023-07450-8] [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: 11/06/2022] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION The rationale for the use of mini-implants for partial resurfacing in the treatment of femoral chondral and osteochondral lesions is still under debate. The evidence supporting best practise guidelines is based on studies with low-level evidence. A consensus group of experts was convened to collaboratively advance towards consensus opinions regarding the best available evidence. The purpose of this article is to report the resulting consensus statements. METHODS Twenty-five experts participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted via an online survey of two rounds, for initial agreement and comments on the proposed statements. An in-person meeting between the panellists was organised during the 2022 ESSKA congress to further discuss and debate each of the statements. A final agreement was made via a final online survey a few days later. The strength of consensus was characterised as: consensus, 51-74% agreement; strong consensus, 75-99% agreement; unanimous, 100% agreement. RESULTS Statements were developed in the fields of patient assessment and indications, surgical considerations and postoperative care. Between the 25 statements that were discussed by this working group, 18 achieved unanimous, whilst 7 strong consensus. CONCLUSION The consensus statements, derived from experts in the field, represent guidelines to assist clinicians in decision-making for the appropriate use of mini-implants for partial resurfacing in the treatment of femoral chondral and osteochondral lesions. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Christoph Becher
- International Centre for Orthopedics, ATOS Clinic Heidelberg, Bismarckstr. 9-15, 69115, Heidelberg, Germany.
| | | | - Martin Lind
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
| | - Karl Eriksson
- Department of Orthopaedic Surgery, Stockholm South Hospital, Department of Clinical Science and Education Karolinska Institutet, Stockholm, Sweden
| | - Mats Brittberg
- Cartilage Research Unit, Region Halland Orthopaedics, Varberg Hospital, University of Gothenburg, Varberg, Sweden
| | - Johannes Beckmann
- Department of Orthopaedics and Traumatology, Barmherzige Brüder Hospital, Munich, Germany
| | | | - Magnus Högström
- Department of Surgical and Perioperative Sciences, Sports Medicine Umeå and Orthopedics, Umeå University, Umeå, Sweden
| | - Lars Konradsen
- Department of Orthopedic Surgery, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
| | | | - Alois Franz
- Hospital for Orthopedic Surgery and Sports Medicine, Siegen, Germany
| | - Matthias J Feucht
- Orthopaedic Clinic Paulinenhilfe, Diakonie-Hospital, Stuttgart, Germany
| | - Clemens Kösters
- Department of Traumatology and Orthopedics, Maria-Josef-Hospital Greven, Greven, Germany
| | - Gerben van Buul
- Department of Orthopaedics, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Olof Sköldenberg
- Department of Clinical Sciences at Danderyd Hospital, Division of Orthopaedics, Karolinska Institute, Stockholm, Sweden
| | - Pieter J Emans
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tarek Boutefnouchet
- University Hospitals Birmingham NHS Trust, Mindelsohn Way, Edgbaston, Birmingham, UK
| | | | | | | | - Tim Spalding
- Cleveland Clinic London, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Anders Stålman
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institute, Stockholm, Sweden
| | | | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Alexander D Shearman
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Michael Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland
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Magnéli M, Kelly-Pettersson P, Rogmark C, Gordon M, Sköldenberg O, Unbeck M. Timing of adverse events in patients undergoing acute and elective hip arthroplasty surgery: a multicentre cohort study using the Global Trigger Tool. BMJ Open 2023; 13:e064794. [PMID: 37295831 PMCID: PMC10277118 DOI: 10.1136/bmjopen-2022-064794] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/16/2022] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVE To explore timing in relation to all types of adverse events (AEs), severity and preventability for patients undergoing acute and elective hip arthroplasty. DESIGN A multicentre cohort study using retrospective record review with Global Trigger Tool methodology in combination with data from several registers. SETTING 24 hospitals in 4 major regions of Sweden. PARTICIPANTS Patients ≥18 years, undergoing acute or elective total or hemiarthroplasty of the hip, were eligible for inclusion. Reviews of weighted samples of 1998 randomly selected patient records were carried out using Global Trigger Tool methodology. The patients were followed for readmissions up to 90 days postoperatively throughout the whole country. RESULTS The cohort consisted of 667 acute and 1331 elective patients. Most AEs occurred perioperatively and postoperatively (n=2093, 99.1%) and after discharge (n=1142, 54.1%). The median time from the day of surgery to the occurrence of AE was 8 days. The median days for different AE types ranged from 0 to 24.5 for acute and 0 to 71 for elective patients and peaked during different time periods. 40.2% of the AEs, both major and minor, occurred within postoperative days 0-5 and 86.9% of the AEs occurred within 30 days. Most of the AEs were deemed to be of major severity (n=1370, 65.5%) or preventable (n=1591, 76%). CONCLUSIONS A wide variability was found regarding the timing of different AEs with the majority occurring within 30 days. The timing and preventability varied regarding the severity. Most of the AEs were deemed to be preventable and/or of major severity. To increase patient safety for patients undergoing hip arthroplasty surgery, a better understanding of the multifaceted nature of the timing of AEs in relation to the occurrence of differing AEs is needed.
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Affiliation(s)
- Martin Magnéli
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
- Department of Orthopaedics, Danderyd University Hospital, Danderyd, Sweden
| | - Paula Kelly-Pettersson
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
- Department of Orthopaedics, Danderyd University Hospital, Danderyd, Sweden
| | - Cecilia Rogmark
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Lund, Sweden
- Department of Orthopaedics, Skåne University Hospital Malmö Orthopedics Clinic, Malmo, Sweden
| | - Max Gordon
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
- Department of Orthopaedics, Danderyd University Hospital, Danderyd, Sweden
| | - Olof Sköldenberg
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
- Department of Orthopaedics, Danderyd University Hospital, Danderyd, Sweden
| | - Maria Unbeck
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
- Högskolan Dalarna, Falun, Sweden
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Pihl E, Skorpil M, Sköldenberg O, Hedbeck CJ, Jonsson KB. At mid- to long-term follow-up after proximal hamstring tendon avulsion; there was greater fatty infiltration, muscle atrophy and strength deficit in the hamstring muscles of the injured leg than in the uninjured leg. J Orthop Surg Res 2023; 18:114. [PMID: 36797740 PMCID: PMC9933258 DOI: 10.1186/s13018-023-03582-2] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/06/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Proximal hamstring tendon avulsions (PHAs) may be treated nonoperatively or operatively. Little is known about the result of the injury, and its treatment, on the quality and function of the hamstring muscle after healing and rehabilitation. We hypothesized that the injured leg would have greater fatty infiltration and atrophy than the uninjured leg at follow-up and that these findings would correlate to muscle weakness. METHODS In a cross-sectional cohort study, 48 patients treated for PHA, either operatively or nonoperatively, were re-examined 2-11 years post-treatment. We measured muscle strength with isokinetic strength tests, and muscle volume and fatty infiltration with MRI. Primary outcomes were hamstring muscle quality, quantified by outlining the cross-sectional area slice-by-slice, and the degree of fatty infiltration estimated using the Goutallier grading method. Secondary outcome was concentric isokinetic hamstring muscle strength measured using BioDex at 60°/sec and tendon attachment assessed on MRI. Comparisons with the outcomes of the uninjured leg were made. RESULTS The total hamstring muscle volume was on average reduced by 9% (SD ± 11%, p < 0.001) compared to that of the uninjured leg. Fatty infiltration was significantly more severe in the injured hamstrings than in the uninjured hamstrings (p < 0.001). This was also true when only analyzing operatively treated patients. The reduction in muscle volume and increase in fatty infiltration correlated significantly (r = 0.357, p = 0.013), and there was also a statistically significant correlation with muscle atrophy and reduction in isokinetic strength (r = 494, p < 0.001). CONCLUSION PHA injuries result in fatty infiltration and muscle atrophy and the muscle quality impairment correlates with residual muscle weakness.
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Affiliation(s)
- Elsa Pihl
- Unit of Orthopeadics, Department of Clinical Sciences at Danderyds Hospital, Karolinska Institutet, Ortopedmottagningen Danderyds Sjukhus, 182 88, Stockholm, Sweden. .,Danderyd University Hospital Corp, Stockholm, Sweden.
| | - Mikael Skorpil
- grid.4714.60000 0004 1937 0626Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Olof Sköldenberg
- grid.4714.60000 0004 1937 0626Unit of Orthopeadics, Department of Clinical Sciences at Danderyds Hospital, Karolinska Institutet, Ortopedmottagningen Danderyds Sjukhus, 182 88 Stockholm, Sweden ,grid.412154.70000 0004 0636 5158Danderyd University Hospital Corp, Stockholm, Sweden
| | - Carl Johan Hedbeck
- grid.4714.60000 0004 1937 0626Unit of Orthopeadics, Department of Clinical Sciences at Danderyds Hospital, Karolinska Institutet, Ortopedmottagningen Danderyds Sjukhus, 182 88 Stockholm, Sweden ,grid.412154.70000 0004 0636 5158Danderyd University Hospital Corp, Stockholm, Sweden
| | - Kenneth B. Jonsson
- grid.412354.50000 0001 2351 3333Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
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Südow H, Severin S, Wilcke M, Saving J, Sköldenberg O, Navarro CM. Non-operative treatment or volar locking plate fixation for dorsally displaced distal radius fractures in patients over 70 years - a three year follow-up of a randomized controlled trial. BMC Musculoskelet Disord 2022; 23:447. [PMID: 35549696 PMCID: PMC9097389 DOI: 10.1186/s12891-022-05394-7] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/03/2022] [Indexed: 02/02/2023] Open
Abstract
Background Surgical treatment of displaced distal radius fractures (DRF) in older patients has increased, despite lacking evidence of its superiority over non-operative treatment. How treatment choice affects these patients after the initial 12-month period remains unknown. This study presents a clinical and radiographic follow up at an average of 3 years after treatment in the context of a randomized clinical trial comparing outcomes in patients aged ≥70 years, with a dorsally displaced distal radius fracture treated either surgically with volar locking plate or non-operatively. Methods Between 2009 and 2017, 140 patients aged ≥70 years with dorsally displaced DRF were randomized to surgery with volar locking plate (VLP) or non-operative treatment. At an average of 3 years after inclusion the participants were invited to an additional follow-up. The primary outcome was Patient Rated Wrist Evaluation (PRWE). Secondary outcomes included additional Patient Reported Outcome Measures (PROM), grip strength, range of motion, complications and radiological results. Results Sixty six patients were available for a 3 year follow-up, 33 in the non-operatively treated group and 33 in the VLP-group. The mean age at injury was 77 years. At 3 years the median PRWE was better (0 points) in the VLP-group than in the non-operative treatment group (9 points) p-value: 0.027. No statistically significant difference was found in Disabilities of the Arm, Hand, and Shoulder (DASH), EuroQol 5 Dimensions (EQ-5D) or grip strength. Total arc of range of motion was larger in the operatively treated group. No significant difference in osteoarthritis was found. Both groups had regained grip strength. The complication rate was similar. Outcomes improved from the 1 year to the 3 year follow-up. Conclusions Surgery with volar locking plate gave less long-term disability compared to non-operative treatment for severely displaced distal radius fractures in patients aged ≥70 years. Our findings were statistically significant but in the lower range of clinical importance. Trial registration The study was registered at : NCT02154620 03/06/2014 and NCT01268397 30/12/2010. Ethical approval was obtained from Ethical Committee in Stockholm, Sweden (2009/37–31/3, 2013/105–31/2, 2014/1041–32, 2017/611–32).
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Affiliation(s)
- Hanna Südow
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, SE-118 83, Stockholm, Sweden. .,Department of Orthopedics, Södersjukhuset Hospital, Stockholm, Sweden.
| | - Sara Severin
- Karolinska Institute, Department of Clinical Science, Danderyd Hospital, Stockholm, Sweden.,Department of Orthopedics, Danderyd University Hospital Corp, Stockholm, Sweden
| | - Maria Wilcke
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, SE-118 83, Stockholm, Sweden.,Department of Hand Surgery, Södersjukhuset Hospital, Stockholm, Sweden
| | - Jenny Saving
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, SE-118 83, Stockholm, Sweden.,Capio Artro Clinic, Stockholm, Sweden
| | - Olof Sköldenberg
- Karolinska Institute, Department of Clinical Science, Danderyd Hospital, Stockholm, Sweden.,Department of Orthopedics, Danderyd University Hospital Corp, Stockholm, Sweden
| | - Cecilia Mellstrand Navarro
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, SE-118 83, Stockholm, Sweden.,Department of Hand Surgery, Södersjukhuset Hospital, Stockholm, Sweden
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Sundkvist J, Sjöholm P, Pejic A, Wolf O, Sköldenberg O, Rogmark C, Mukka S. Clinical outcomes of patients with Garden I and II femoral neck fractures as verified on MRI: a retrospective case series. BMC Musculoskelet Disord 2022; 23:144. [PMID: 35151282 PMCID: PMC8840676 DOI: 10.1186/s12891-022-05088-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 02/03/2022] [Indexed: 11/12/2022] Open
Abstract
Background Between 2 to 10% of non-displaced femoral neck fractures (nFNF) cannot be diagnosed on plain radiographs and require further imaging investigation to be detected or verified. These fractures are referred to as occult hip fractures. This study aimed to report treatment failures, reoperations and mortality in a consecutive series of occult femoral neck fractures (FNF) treated with internal fixation (IF). Methods A retrospective multicenter study was performed based on a consecutive series of patients aged ≥ 60 years with an occult magnetic resonance imaging (MRI) verified Garden I and II FNF sustained after a trauma and treated with primary IF. We included 93 patients with a minimum 2-year follow-up. Radiographic assessment encompassed pre- and postoperative tilt, implant inclination, MRI and treatment failure. Data on reoperation and mortality were collected. Treatment failure was defined as fixation failure, nonunion, avascular necrosis or posttraumatic osteoarthritis. Results The study comprised of 93 patients (72% women, 67/93) with a mean age of 82 (range, 60–97) years. Overall, 6 (6%) patients had major reoperations. 2 (2%) had minor reoperations. One-month mortality was 7%, 1-year mortality was 20% and 2-year mortality was 31%. Conclusion This multicenter cohort study identifies a subgroup of elderly patients with MRI verified Garden I and II FNFs sustained after trauma, i.e. occult fractures. These fractures seem to have a lower complication rate compared to nFNF identified on plain radiographs. Level of evidence Prognostic Level V. See Instructions to Authors for a complete description of levels of evidence.
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Persson A, Atroshi I, Tyszkiewicz T, Hailer N, Lazarinis S, Eisler T, Brismar H, Mukka S, Kernell PJ, Mohaddes M, Sköldenberg O, Gordon M. EPOS trial: the effect of air filtration through a plasma chamber on the incidence of surgical site infection in orthopaedic surgery: a study protocol of a randomised, double-blind, placebo-controlled trial. BMJ Open 2022; 12:e047500. [PMID: 35115346 PMCID: PMC8814745 DOI: 10.1136/bmjopen-2020-047500] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION There is controversy regarding the importance of air-transmitted infections for surgical site infections (SSIs) after orthopaedic surgery. Research has been hindered by both the inability in blinding the exposure, and by the need for recruiting large enough cohorts. The aim of this study is to investigate whether using a new form of air purifier using plasma air purification (PAP) in operating rooms (ORs) lowers the SSI rate or not. METHODS AND ANALYSIS Multicentre, double-blind, cluster-randomised, placebo-controlled trial conducted at seven hospitals in 2017-2022. All patients that undergo orthopaedic surgery for minimum 30 min are included. Intervention group: patients operated in OR with PAP devices turned on. CONTROL GROUP patients operated in OR with PAP devices turned off. Randomisation: each OR will be randomised in periods of 4 weeks, 6 weeks or 8 weeks to either have the devices on or off. PRIMARY OUTCOME any SSI postoperatively defined as a composite endpoint of any of the following: use of isoxazolylpenicillin, clindamycin or rifampicin for 2 days or more, International Classification of Diseases codes or Nordic Medico-Statistical Committee codes indicating postoperative infection. In a second step, we will perform a chart review on those patients with positive indicators of SSI to further validate the outcome. Secondary outcomes are described in the Methods section. Power: we assume an SSI rate of 2%, an SSI reduction rate of 25% and we need approximately 45 000 patients to attain a power of 80% at a significance level of 0.05. ETHICS AND DISSEMINATION The study is approved by the Swedish Ethical Review Authority. The interim analysis results from the study will be presented only to the researchers involved unless the study thereafter is interrupted for whatever reason. Publication in a medical journal will be presented after inclusion of the last patient. TRIAL REGISTRATION NUMBER NCT02695368.
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Affiliation(s)
- Anders Persson
- Karolinska Institutet Institutionen för kliniska vetenskaper Danderyds sjukhus, Danderyd, Sweden
| | - Isam Atroshi
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Orthopaedics, Hässleholm-Kristianstad Hospitals, Kristianstad, Sweden
| | - Thomas Tyszkiewicz
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Orthopaedics, Hässleholm-Kristianstad Hospitals, Kristianstad, Sweden
| | - Nils Hailer
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Orthopaedics, Uppsala University Hospital, Uppsala, Sweden
| | - Stergios Lazarinis
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Orthopaedics, Uppsala University Hospital, Uppsala, Sweden
| | - Thomas Eisler
- Karolinska Institutet Institutionen för kliniska vetenskaper Danderyds sjukhus, Danderyd, Sweden
| | - Harald Brismar
- Department of Clinical Science Intervention and Technology, Karolinska Institute, Huddinge, Sweden
- Department of Orthopaedics and Biotechnology, Karolinska Universitetsjukhuset i Huddinge, Huddinge, Sweden
| | - Sebastian Mukka
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
- Umeå University Hospital, Umeå, Sweden
| | - Per-Juan Kernell
- GHP Ortho Center Stockholm, Löwenströmska Hospital, Upplands Väsby, Sweden
| | - Maziar Mohaddes
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University Of Gothenburg, Gothenburg, Sweden
| | - Olof Sköldenberg
- Karolinska Institutet Institutionen för kliniska vetenskaper Danderyds sjukhus, Danderyd, Sweden
| | - Max Gordon
- Karolinska Institutet Institutionen för kliniska vetenskaper Danderyds sjukhus, Danderyd, Sweden
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Sjöholm P, Sundkvist J, Wolf O, Sköldenberg O, Gordon M, Mukka S. Preoperative Anterior and Posterior Tilt of Garden I-II Femoral Neck Fractures Predict Treatment Failure and Need for Reoperation in Patients Over 60 Years. JB JS Open Access 2021; 6:JBJSOA-D-21-00045. [PMID: 34746632 PMCID: PMC8568471 DOI: 10.2106/jbjs.oa.21.00045] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 12/13/2022] Open
Abstract
The purpose of the present study was to estimate the effect of preoperative fracture tilt and to scrutinize the effect of anterior tilt on the risk of treatment failure in patients with Garden Type-I and II femoral neck fractures that are treated with internal fixation.
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Affiliation(s)
- Pontus Sjöholm
- Department of Surgical and Perioperative Sciences, Orthopaedics, Umeå University, Umeå, Sweden
| | - Jonas Sundkvist
- Department of Surgical and Perioperative Sciences, Orthopaedics, Umeå University, Umeå, Sweden
| | - Olof Wolf
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Olof Sköldenberg
- Division of Orthopedics, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Max Gordon
- Division of Orthopedics, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Sebastian Mukka
- Department of Surgical and Perioperative Sciences, Orthopaedics, Umeå University, Umeå, Sweden
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10
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Brodén C, Sandberg O, Olivecrona H, Emery R, Sköldenberg O. Precision of CT-based micromotion analysis is comparable to radiostereometry for early migration measurements in cemented acetabular cups. Acta Orthop 2021; 92:419-423. [PMID: 33821746 PMCID: PMC8381926 DOI: 10.1080/17453674.2021.1906082] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - CT (computed tomography) based methods have lately been considered an alternative to radiostereometry (RSA) for assessing early implant migration. However, no study has directly compared the 2 methods in a clinical setting. We estimated the precision and effective radiation dose of a CT-based method and compared it with marker-based RSA in 10 patients with hip arthroplasty.Patients and methods - We included 10 patients who underwent total hip replacement with a cemented cup. CT and RSA double examinations were performed postoperatively, and precision and effective dose data were compared. The CT data was analyzed with CT micromotion analysis (CTMA) software both with and without the use of bone markers. The RSA images were analyzed with RSA software with the use of bone markers.Results - The precision of CTMA with bone markers was 0.10-0.16 mm in translation and 0.31°-0.37° in rotation. Without bone markers, the precision of CTMA was 0.10-0.16 mm in translation and 0.21°-0.31° in rotation. In comparison, the precision of RSA was 0.09-0.26 mm and 0.43°-1.69°. The mean CTMA and RSA effective dose was estimated at 0.2 mSv and 0.04 mSv, respectively.Interpretation - CTMA, with and without the use of bone markers, had a comparable precision to RSA. CT radiation doses were slightly higher than RSA doses but still at a considerably low effective dose.
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Affiliation(s)
- Cyrus Brodén
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, UK
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden
| | | | - Henrik Olivecrona
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Roger Emery
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, UK
| | - Olof Sköldenberg
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden
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11
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Pihl E, Jonsson KB, Berglöf M, Brodin N, Sköldenberg O, Hedbeck CJ. Exploring the Perth Hamstring Assessment Tool and Lower Extremity Functional Scale in a Proximal Hamstring Avulsion Cohort: A Cross-sectional Study. Am J Sports Med 2021; 49:1732-1740. [PMID: 33909488 DOI: 10.1177/03635465211008568] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The goal of treatment for a proximal hamstring avulsion (PHA) is an objectively restored muscle and a subjectively satisfied, pain-free patient at follow-up. Different self-reported and performance-based outcome measures have been used to evaluate recovery, but their validity is poorly investigated. PURPOSE To investigate (1) the correlation between the commonly used self-reported outcome measurements, the Perth Hamstring Assessment Tool (PHAT) and the Lower Extremity Functional Scale (LEFS); (2) to what extent these scores can be explained by physical dysfunction as measured by performance-based tests; (3) whether performance-based tests can discriminate between the injured and uninjured extremity; and (4) which activity limitations are perceived by patients several years after the injury. STUDY DESIGN Cohort study (Diagnosis); Level of evidence, 3. METHODS We included a consecutive series of patients treated for or diagnosed with PHA in our department between 2007 and 2016 having at least 2 tendons avulsed from the ischial tuberosity. Participants attended 2 study visits, answered questionnaires (PHAT, LEFS, and Patient-Specific Functional Scale [PSFS]), and performed physical performance-based tests (single-leg hop tests, single-step down test, and isometric and isokinetic strength tests). RESULTS A total of 50 patients were included (26 men [52%], 24 women [48%]; mean age, 50.9 years [SD, 9.8 years]). The mean follow-up time was 5.5 years (SD, 2.7 years), and 74% had been surgically treated. The correlation between PHAT and LEFS was strong (r = 0.832) and statistically significant (P < .001). Seven of the performance-based tests exhibited a statistically significant but weak correlation with LEFS (0.340-0.488) and 3 of the tests to PHAT (-0.304 to 0.406). However, only peak torque could significantly discriminate between the extremities. The activity limitation most commonly mentioned in PSFS was running (16 patients [32%]). CONCLUSION Although PHAT and LEFS correlated strongly, the correlations between functional tests and the patient-reported outcome scores were weak, and most functional tests failed to discriminate between the injured and uninjured lower extremity in patients with PHA 5 years after injury. In general, patients alleged few activity limitations, but running difficulty was a common sequela after PHA.
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Affiliation(s)
- Elsa Pihl
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden.,Danderyd University Hospital Corp, Department of Orthopaedics, Stockholm, Sweden
| | - Kenneth B Jonsson
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Mida Berglöf
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.,Södersjukhuset, Department of Hand Surgery, Stockholm, Sweden
| | - Nina Brodin
- Danderyd University Hospital Corp, Department of Orthopaedics, Stockholm, Sweden.,Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Stockholm, Sweden
| | - Olof Sköldenberg
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden.,Danderyd University Hospital Corp, Department of Orthopaedics, Stockholm, Sweden
| | - Carl Johan Hedbeck
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden.,Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
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12
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Chammout G, Kelly-Pettersson P, Hedbeck CJ, Bodén H, Stark A, Mukka S, Sköldenberg O. Primary hemiarthroplasty for the elderly patient with cognitive dysfunction and a displaced femoral neck fracture: a prospective, observational cohort study. Aging Clin Exp Res 2021; 33:1275-1283. [PMID: 32705584 PMCID: PMC8081713 DOI: 10.1007/s40520-020-01651-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/07/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND At least one-third of hip fracture patients have some degree of impaired cognitive status, which may complicate their postoperative rehabilitation. AIM We aimed to describe the outcome for elderly patients with cognitive dysfunction operated with hemiarthroplasty (HA) for a femoral neck fracture and to study the impact postoperative geriatric rehabilitation has on functional outcome up to 1 year after surgery. METHODS 98 patients with a displaced femoral neck fracture with a mean age of 86 years were included and followed up to 1 year. The outcomes were hip-related complications and reoperations, the capacity to return to previous walking ability, health-related quality of life, hip function and mortality. RESULTS The prevalence of hip complications leading to a major reoperation was 6% and the 1-year mortality rate was 31%. The lack of geriatric rehabilitation was correlated with poorer outcomes overall and those who receive geriatric rehabilitation were less likely to be confined to a wheelchair or bedridden at the 1-year follow-up. CONCLUSIONS Hemiarthroplasty is an acceptable option for elderly patients with a displaced femoral neck fracture and cognitive dysfunction. A lack of structured rehabilitation is associated with a significant deterioration in walking ability despite a well-functioning hip. However, the causality of this could be due to selection bias of healthier patients being sent to geriatric rehabilitation.
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13
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Tyson Y, Hillman C, Majenburg N, Sköldenberg O, Rolfson O, Kärrholm J, Mohaddes M, Hailer NP. Uncemented or cemented stems in first-time revision total hip replacement? An observational study of 867 patients including assessment of femoral bone defect size. Acta Orthop 2021; 92:143-150. [PMID: 33176549 PMCID: PMC8159203 DOI: 10.1080/17453674.2020.1846956] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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 - Uncemented stems are gradually replacing cemented stems in hip revision surgery. We compared the risk of re-revision between uncemented and cemented revision stems and assessed whether the different fixation methods are used in similar femoral bone defects.Patients and methods - 867 patients operated on with uncemented or cemented stems in first-time hip revision surgery due to aseptic loosening performed 2006-2016 were identified in the Swedish Hip Arthroplasty Register. Preoperative femoral bone defect size was assessed on radiographs of all patients. Cox regression models were fitted to estimate the adjusted risk of re-revision during different postoperative time periods. Re-revision of any component for any reason, and stem re-revision, as well as risk of cause-specific re-revision was estimated.Results - Most patients in both fixation groups had Paprosky class IIIA femoral bone defects prior to surgery, but there were more severe bone defects in the cemented group. The adjusted risk of re-revision of any component for any reason was higher in patients with uncemented compared with those with cemented revision stems during the first 3 years after index surgery (hazard ratio [HR] 4, 95% confidence interval [CI] 2-9). From the 4th year onward, the risk of re-revision of any component for any reason was similar (HR 0.5, CI 0.2-1.4). Uncemented revision stems conferred a higher risk of dislocation compared with cemented stems (HR 5, CI 1.2-23) during the first 3 years.Interpretation - Although not predominantly used in more complex femoral defects, uncemented revision stem fixation confers a slightly higher risk of re-revision during the first years, but this risk is attenuated after longer follow-up.
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Affiliation(s)
- Yosef Tyson
- Section of Orthopaedics, Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden; ,The Swedish Hip Arthroplasty Register, Gothenburg, Sweden; ,Correspondence:
| | - Christer Hillman
- Department of Orthopaedics, Danderyd University Hospital Corp, Stockholm, Sweden; ,Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden;
| | - Norbert Majenburg
- Section of Orthopaedics, Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden; ,University of Groningen, Groningen, The Netherlands;;
| | - Olof Sköldenberg
- Department of Orthopaedics, Danderyd University Hospital Corp, Stockholm, Sweden; ,Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden;
| | - Ola Rolfson
- The Swedish Hip Arthroplasty Register, Gothenburg, Sweden; ,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Johan Kärrholm
- The Swedish Hip Arthroplasty Register, Gothenburg, Sweden; ,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Maziar Mohaddes
- The Swedish Hip Arthroplasty Register, Gothenburg, Sweden; ,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Nils P Hailer
- Section of Orthopaedics, Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden; ,The Swedish Hip Arthroplasty Register, Gothenburg, Sweden;
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14
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Kruse M, Mohammed J, Sayed-Noor A, Wolf O, Holmgren G, Nordström R, Crnalic S, Sköldenberg O, Mukka S. Peri-implant femoral fractures in hip fracture patients treated with osteosynthesis: a retrospective cohort study of 1965 patients. Eur J Trauma Emerg Surg 2021; 48:293-298. [PMID: 33484277 DOI: 10.1007/s00068-020-01596-7] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/27/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE There are few studies on incidence rates, treatment and outcomes for peri-implant femoral fractures (PIFF) in the proximity of osteosynthesis. The purpose of this study was to investigate the incidence of PIFF following osteosynthesis of proximal femoral fractures. PATIENTS AND METHODS This retrospective cohort study comprised a consecutive series of hip fracture patients aged 50 years or older and operated with osteosynthesis between 2003 and 2015. Patients were followed-up until 2018, removal of implants or death, for a mean of 4 years (range 0-15). Data on age, sex, housing, hip complications, and reoperations were recorded. The risk of PIFFs was assessed using Cox proportional hazards regression analysis. In patients with two fractures during the study period, only the first fracture was included. RESULTS A total of 1965 osteosynthesis procedures were performed, of which 382 were cephalomedullary nails (CMN), 933 sliding hip devices (SHD) and 650 pins. Mean age was 80 years (range 50-104), 65% of patients were women. A total of 41 PIFFs occurred during the study period. The cumulative incidence of peri-implant fractures was 0.8% for CMN, 2.7% (HR 2.995% CI, 0.87-9.6, p = 0.08) for SHD and 2.0% (HR 2.3 95% CI, 0.6-8.1, p = 0.2) for pins. PIFFs occurred after a mean of 27 months (range 0-143). The 1-year mortality was 34% following PIFF. The majority was treated surgically (66%, 27/41) and the reoperation rate was 15% (4/27). CONCLUSION In this retrospective cohort study, in contrast to previous reports, we found a tendency to a higher cumulative incidence of PIFFs for SHD compared to modern CMN. Our results show cumulative incidences of PIFFs comparable to those described for periprosthetic femur fractures after hip arthroplasty for femoral neck fracture.
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Affiliation(s)
- Mark Kruse
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
| | - Jabbar Mohammed
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Arkan Sayed-Noor
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Solna, Sweden
| | - Olof Wolf
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden
| | - Gunnar Holmgren
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Robin Nordström
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Sead Crnalic
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Olof Sköldenberg
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Solna, Sweden
| | - Sebastian Mukka
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
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15
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Bachar-Wikstrom E, Manchanda M, Bansal R, Karlsson M, Kelly-Pettersson P, Sköldenberg O, Wikstrom JD. Endoplasmic reticulum stress in human chronic wound healing: Rescue by 4-phenylbutyrate. Int Wound J 2020; 18:49-61. [PMID: 33225583 PMCID: PMC7949014 DOI: 10.1111/iwj.13525] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 08/28/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/16/2022] Open
Abstract
During wound healing, cells have a high rate of protein synthesis and many proteins need to be folded post‐translationally to function, which occurs in the endoplasmic reticulum (ER). In addition to proliferation, several cellular stress conditions, such as hypoxia, in the wound micro‐environment lead to the accumulation of unfolded or misfolded proteins in the ER, causing ER stress. Eukaryotic cells have a signalling system to manage ER stress called the unfolded protein response (UPR). Mild UPR activation has a beneficial homeostatic effect; however, excessive UPR induces cell death. Herein, we examined venous leg ulcer biopsies versus normal acute incisional wounds in age‐matched elderly subjects and found a large increase in ER stress markers. To study the underlying mechanism, we established several cell cultures from amputated legs from the elderly that showed inherent ER stress. While both keratinocytes and fibroblasts migration was impaired by ER stress, migration of elderly leg skin keratinocytes was markedly improved after treatment with the chemical chaperone and clinically established drug 4‐phenylbutyrate (4‐PBA) and demonstrated a reduction in ER stress markers. In a full‐thickness human skin wound healing model, 4‐PBA improved the reepithelialisation rate, which suggests it as a promising drug repurposing candidate for wound healing.
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Affiliation(s)
- Etty Bachar-Wikstrom
- Dermatology and Venereology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Mansi Manchanda
- Dermatology and Venereology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Ritu Bansal
- Dermatology and Venereology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | | | - Paula Kelly-Pettersson
- Department of Clinical Sciences, Danderyd Hospital, Division of Orthopaedics, Karolinska Institutet, Stockholm, Sweden
| | - Olof Sköldenberg
- Department of Clinical Sciences, Danderyd Hospital, Division of Orthopaedics, Karolinska Institutet, Stockholm, Sweden
| | - Jakob D Wikstrom
- Dermatology and Venereology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden.,Dermato-Venereology Clinic, Karolinska University Hospital, Stockholm, Sweden
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16
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Svensson K, Rolfson O, Nauclér E, Lazarinis S, Sköldenberg O, Schilcher J, Johanson PE, Mohaddes M, Kärrholm J. Exchange of Modular Components Improves Success of Debridement, Antibiotics, and Implant Retention: An Observational Study of 575 Patients with Infection After Primary Total Hip Arthroplasty. JB JS Open Access 2020; 5:e20.00110. [PMID: 33376927 PMCID: PMC7757835 DOI: 10.2106/jbjs.oa.20.00110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 02/03/2023] Open
Abstract
Debridement, antibiotics, and implant retention (DAIR) is a surgical treatment for periprosthetic joint infection (PJI). DAIR is a desirable treatment option from an economic and patient perspective, if successful. The aim of this observational study was to compare the rates of success, defined as no additional reoperations due to PJI, between DAIR with exchange of modular components and DAIR without exchange in patients who had first-time PJI after primary total hip arthroplasty (THA). METHODS Patients with PJI at the site of a primary THA who were treated with DAIR in Sweden between January 1, 2009, and December 31, 2016, were identified in the Swedish Hip Arthroplasty Register. Supplementary questionnaires were sent to orthopaedic departments for additional variables of interest related to PJI. The primary end point was another reoperation due to PJI within 2 years after the first-time DAIR. DAIR with exchange was compared with DAIR without exchange using Kaplan-Meier survival analysis and Cox regression analysis. RESULTS A total of 575 patients treated with DAIR for a first-time PJI at the site of a primary THA were analyzed; 364 underwent component exchange and 211 did not. The exchange of components was associated with a lower rate of reoperations due to PJI after DAIR (28.0%) compared with non-exchange (44.1%). The Kaplan-Meier implant survival estimate for exchange was 71.4% (95% confidence interval [CI] = 66.9% to 76.3%) compared with 55.5% (95% CI = 49.1% to 62.7%) for non-exchange. With the analysis adjusted for confounders, DAIR with exchange was associated with a significantly decreased risk of another reoperation due to PJI compared with non-exchange (hazard ratio [HR] = 0.51 [95% CI = 0.38 to 0.68]). CONCLUSIONS In patients with a first-time PJI at the site of a primary THA, DAIR with exchange of modular components was superior to non-exchange DAIR. Surgeons should strive to exchange components when they perform DAIR, but there is a need to further identify how DAIR best should be practiced and which patients benefit from it. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Karin Svensson
- Department of Orthopedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- The Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Ola Rolfson
- Department of Orthopedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- The Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Emma Nauclér
- The Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Stergios Lazarinis
- Department of Orthopedics, Institute of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Olof Sköldenberg
- Division of Orthopedics, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Jörg Schilcher
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Per-Erik Johanson
- Department of Orthopedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- The Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Maziar Mohaddes
- Department of Orthopedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- The Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Johan Kärrholm
- Department of Orthopedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- The Swedish Hip Arthroplasty Register, Gothenburg, Sweden
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17
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Thörling J, Ljungqvist O, Sköldenberg O, Hammarqvist F. No association between preoperative impaired glucose control and postoperative adverse events following hip fracture surgery - A single-centre observational cohort study. Clin Nutr 2020; 40:1348-1354. [PMID: 32896447 DOI: 10.1016/j.clnu.2020.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/06/2019] [Revised: 07/31/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022]
Abstract
RATIONALE Observational studies have shown an association between hyperglycaemia and increased complications in orthopaedic patients. The aim of the study was to investigate if impaired preoperative glycaemic control, reflected by elevated HbA1c, was associated with adverse postoperative events in hip fracture patients. METHODS 160 patients (116 women and 44 men; age 80 ± 10 and BMI 24 ± 4; mean ± SD) with hip fractures were included in a prospective observational cohort study. The patients were divided into two groups, normal glycaemic control (NGC) and impaired glycaemic control (IGC) HbA1c ≥ 42 mmol/mol. The patients were also characterized according to BMI and nutritional status using MNA-SF (Minimal Nutritional Assessment Short Form). Complications within 30 days of surgery were classified according to Clavien-Dindo and 1-year mortality was compared between the groups. RESULTS Out of 160 patients, 18 had diabetes and 4 more had likely occult diabetes (HbA1c ≥ 48). Impaired glycaemic control (IGC) was seen in 29 patients (18.1%) and normal glycaemic control (NGC) in 131 (81.9%). In patients with NGC and IGC, no postoperative complications (Clavien-Dindo Grade 0) were seen in 64/131 vs. 14/29 (48.9 vs. 48.3%), Grade 1-3a in 54/131 vs. 14/29 (41.2 vs. 48.3%) and Grade 3b-5 in 13/131 vs. 1/29 (9.9 vs. 3.4%) respectively, p = NS. There were no differences in 30-day complications (p = 0.55) or 1-year mortality (p = 0.35) between the groups. CONCLUSION Elevated HbA1c at admission is not associated with increased complications or mortality after hip fracture surgery.
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Affiliation(s)
- John Thörling
- Department of Emergency Medicine, Karolinska University Hospital, Sweden; Department of Clinical Science, Intervention and Technology, (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
| | - Olle Ljungqvist
- Faculty of Medicine and Health, School of Health and Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden
| | - Olof Sköldenberg
- Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Division of Orthopaedics, Sweden; Danderyd University Hospital Corp., Department of Orthopaedics, Stockholm, Sweden
| | - Folke Hammarqvist
- Department of Emergency Surgery and Trauma, Karolinska University Hospital, Sweden; Department of Clinical Science, Intervention and Technology, (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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18
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Hailer NP, Garland A, Gordon M, Kärrholm J, Sköldenberg O, Eriksson N, Garmo H, Holmberg L. No generally increased risk of cancer after total hip arthroplasty performed due to osteoarthritis. Int J Cancer 2020; 147:76-83. [PMID: 31595487 PMCID: PMC7317978 DOI: 10.1002/ijc.32711] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 09/09/2019] [Accepted: 09/11/2019] [Indexed: 11/08/2022]
Abstract
Previous studies on the risk of cancer after total hip arthroplasty (THA) contradict each other, and many are hampered by small cohort sizes, residual confounding, short observation times or a mix of indications underlying the THA procedure. We evaluated the risk of cancer after total hip arthroplasty due to osteoarthritis in a nationwide cohort by comparing cancer incidences in individuals exposed to total hip arthroplasty due to osteoarthritis and in unexposed, sex-, age- and residence matched individuals. To address some previous studies' shortcomings, information on comorbidity and socioeconomic background were obtained and adjusted for. We included 126,276 patients exposed to a cemented THA between 1992 and 2012, and 555,757 unexposed individuals. Follow-up started on the day of surgery for exposed individuals and respective date for matched, unexposed individuals, and ended on the day of death, emigration, censuring or December 31st, 2012, whichever came first. The Swedish Hip Arthroplasty Registry (SHAR), the Swedish Cancer Registry, the Swedish National Patient Registry and Statistics Sweden were accessed to obtain information on procedural details of the THA, cancer diagnoses, comorbidities, and socioeconomic background. The primary outcome measure was the occurrence of any cancer after the index date. Exposed individuals had a slightly lower adjusted risk of developing any cancer than unexposed individuals (hazard ratio [HR] 0.97; CI 0.95-0.99). The only cancer with a statistically significant risk increase in exposed individuals was skin melanoma (HR 1.15; CI 1.05-1.24). We attained similar risk estimates in analyses stratified by sex, in individuals with minimum 5 years of follow-up, in an analysis including individuals with a history of previous cancer, and in patients with cementless THA. In this study on a large and well-defined population with long follow-up, we found no increased overall risk of cancer after THA. These reassuring findings could be included in the guidelines on preoperative information given to THA patients.
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Affiliation(s)
- Nils P Hailer
- Section of Orthopaedics, Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.,Swedish Hip Arthroplasty Register, Goteborg, Sweden
| | - Anne Garland
- Section of Orthopaedics, Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.,Swedish Hip Arthroplasty Register, Goteborg, Sweden
| | - Max Gordon
- Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden.,Danderyd University Hospital Corporation, Department of Orthopaedics, Stockholm, Sweden
| | - Johan Kärrholm
- Swedish Hip Arthroplasty Register, Goteborg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Olof Sköldenberg
- Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden.,Danderyd University Hospital Corporation, Department of Orthopaedics, Stockholm, Sweden
| | - Niclas Eriksson
- Uppsala Clinical Research Center, Uppsala Science Park, Uppsala, Sweden
| | - Hans Garmo
- Section of Orthopaedics, Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.,King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology & Urology Research (TOUR), London, United Kingdom
| | - Lars Holmberg
- Section of Orthopaedics, Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.,King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology & Urology Research (TOUR), London, United Kingdom
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19
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Brodén C, Sandberg O, Sköldenberg O, Stigbrand H, Hänni M, Giles JW, Emery R, Lazarinis S, Nyström A, Olivecrona H. Low-dose CT-based implant motion analysis is a precise tool for early migration measurements of hip cups: a clinical study of 24 patients. Acta Orthop 2020; 91:260-265. [PMID: 32056507 PMCID: PMC8023951 DOI: 10.1080/17453674.2020.1725345] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Early implant migration is known to be a predictive factor of clinical loosening in total hip arthroplasty (THA). Radiostereometric analysis (RSA) is the gold standard used to measure early migration in patients. However, RSA requires costly, specialized imaging equipment and the image process is complex. We determined the precision of an alternative, commercially available, CT method in 3 ongoing clinical THA studies, comprising 3 different cups.Materials and methods - 24 CT double examinations of 24 hip cups were selected consecutively from 3 ongoing prospective studies: 2 primary THA (1 cemented and 1 uncemented) and 1 THA (cemented) revision study. Precision of the CT-based implant motion analysis (CTMA) system was calculated separately for each study, using both the surface anatomy of the pelvis and metal beads placed in the pelvis.Results - For the CTMA analysis using the surface anatomy of the pelvis, the precision ranged between 0.07 and 0.31 mm in translation and 0.20° and 0.39° for rotation, respectively. For the CTMA analysis using beads the precision ranged between 0.08 and 0.20 mm in translation and between 0.20° and 0.43° for rotations. The radiation dose ranged between 0.2 and 2.3 mSv.Interpretation - CTMA achieved a clinically relevant and consistent precision between the 3 different hip cups studied. The use of different hip cup types, different CT scanners, or registration method (beads or surface anatomy) had no discernible effect on precision. Therefore, CTMA without the use of bone markers could potentially be an alternative to RSA to measure early migration.
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Affiliation(s)
- Cyrus Brodén
- Department of Surgery and Cancer, Imperial College London, London, UK; ,Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; ,Correspondence:
| | | | - Olof Sköldenberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden;
| | - Hampus Stigbrand
- Department of Orthopedic Surgery, Länssjukhuset, Gävle, Sweden; Center for Research and Development, Uppsala University/County Council of Gävleborg, Sweden;
| | - Mari Hänni
- Department of Surgical Sciences, Section of Radiology, Uppsala University Hospital, Uppsala, Sweden;
| | - Joshua W Giles
- Department of Mechanical Engineering, University of Victoria, Victoria, BC, Canada;
| | - Roger Emery
- Department of Orthopaedic Surgery, St Mary’s Hospital, London, UK;
| | - Stergios Lazarinis
- Department of Orthopedics, Institute of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden;
| | - Andreas Nyström
- Department of Orthopedics, Institute of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden;
| | - Henrik Olivecrona
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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20
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Brodén C, Giles JW, Popat R, Fetherston S, Olivecrona H, Sandberg O, Maguire GQ, Noz ME, Sköldenberg O, Emery R. Accuracy and precision of a CT method for assessing migration in shoulder arthroplasty: an experimental study. Acta Radiol 2020; 61:776-782. [PMID: 31684750 DOI: 10.1177/0284185119882659] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 11/16/2022]
Abstract
BACKGROUND Radiostereometric analysis (RSA) is the gold standard to measure early implant migration which is a predictive factor for implant survival. PURPOSE To validate an alternative computed tomography (CT) technique to measure implant migration in shoulder arthroplasty. MATERIAL AND METHODS A cadaver proximal humerus and a scapula, which had tantalum beads incorporated within them, were prepared to accept a short-stemmed humeral component and a two-pegged glenoid component of a commercial total shoulder arthroplasty (TSA) system. A five degree of freedom micrometer and goniometer equipped rig was used to translate and rotate the implant components relative to the respective bone to predetermined positions. Double CT examinations were performed for each position and CT motion analysis software (CTMA) was used to assess these movements. The accuracy and precision of the software was estimated using the rig's micrometers and goniometers as the gold standard. The technique's effective dose was also assessed. RESULTS The accuracy was in the range of 0.07-0.23 mm in translation and 0.22-0.71° in rotation. The precision was in the range of 0.08-0.15 mm in translation and 0.23-0.54° in rotation. The mean effective dose for the CT scans was calculated to be 0.27 mSv. CONCLUSION In this experimental setting, accuracy, precision, and effective dose of the CTMA technique were found to be comparable to that of RSA. Therefore, we believe clinical studies are warranted to determine if CTMA is a suitable alternative to traditional RSA for migration measurements in TSA.
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Affiliation(s)
- Cyrus Brodén
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, UK
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden
| | - Joshua W Giles
- Department of Mechanical Engineering, University of Victoria, Victoria, BC, Canada
- Mechatronics in Medicine Laboratory, Mechanical Engineering, Imperial College London, London, UK
| | - Ravi Popat
- Department of Bioengineering, Imperial College London, London, UK
| | - Shirley Fetherston
- Department of Radiology, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Henrik Olivecrona
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Gerald Q Maguire
- School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Marilyn E Noz
- Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Olof Sköldenberg
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden
| | - Roger Emery
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, UK
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21
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Mellner C, Hedström M, Hommel A, Sköldenberg O, Eisler T, Mukka S. The Sernbo score as a predictor of 1-year mortality after hip fracture: a registry study on 55,716 patients. Eur J Trauma Emerg Surg 2020; 47:2043-2048. [PMID: 32363412 PMCID: PMC8629894 DOI: 10.1007/s00068-020-01375-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 08/09/2019] [Accepted: 04/10/2020] [Indexed: 12/04/2022]
Abstract
Purpose Patients sustaining a hip fracture have a high mortality rate during the first postoperative year and the Sernbo score may stratify patients into a high, intermediate and low risk of death during this period. We assessed its predictive properties on patients from the National Swedish Hip Fracture Register. Patients and methods 55,716 hip fracture patients, 69% women older than 65 years at surgery (registered between 2010 and 2015) with complete Sernbo scores and mortality data were studied. Receiver-operating characteristics analyses (ROC) were used. Validation of Sernbo score was performed. Results The overall 1-year mortality rate was 26%—and 17%, 27.4% and 55.6% in the low, intermediate and high-risk groups, respectively. The ROC analysis indicated a predictive ability of the Sernbo score, with an AUC of 0.69 (CI 0.68–0.69). Conclusion In this registry-based study, the easy-to-use Sernbo scoring system proved to be appropriate and useful way to identify hip fracture patients with a high-risk mortality during the first postoperative year. Electronic supplementary material The online version of this article (10.1007/s00068-020-01375-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carl Mellner
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
| | - Margareta Hedström
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Ami Hommel
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Olof Sköldenberg
- Department of Clinical Sciences at Danderyd Hospital (KIDS), Division of Orthopaedics, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Eisler
- Department of Clinical Sciences at Danderyd Hospital (KIDS), Division of Orthopaedics, Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Mukka
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
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22
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Pettersson PK, Sköldenberg O, Samuelsson B, Stark A, Muren O, Unbeck M. The identification of adverse events in hip fracture patients using the Global Trigger Tool: A prospective observational cohort study. Int J Orthop Trauma Nurs 2020; 38:100779. [PMID: 32439319 DOI: 10.1016/j.ijotn.2020.100779] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/26/2020] [Accepted: 04/07/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Hip fracture is common in the elderly and is associated with high comorbidity, mortality and complication rates. There has been an increase in the investigation of healthcare-related adverse events (AEs) in some patient groups but there is limited knowledge about hip fracture patients. The aim was to explore the incidence, preventability and nature of AEs in hip fracture patients. METHODS One hundred and sixty three hip fracture patients participated. A record review was conducted of prospectively collected data using Global Trigger Tool methodology to identify AEs up to 90 days after surgery. RESULTS Sixty two (38.0%) of 163 patients had at least one AE (range 1-7). One hundred and two AEs were identified and 62 (60.8%) were deemed preventable. Healthcare-associated infections e.g. pneumonia, urinary tract infections and pressure ulcers were common. AEs were more common in older patients and those with pre-existing health conditions. Fifty eight (56.9%) AEs caused temporary harm and 4 (3.9%) contributed to patient death. CONCLUSION AEs are common in hip fracture patients and most are preventable. If the focus is on improving healthcare for these patients, we should be concentrating our efforts on reducing the number of these preventable AEs, with a particular emphasis on improving the care of older patients with pre-existing health conditions.
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Affiliation(s)
- Paula Kelly Pettersson
- Department of Orthopaedics, Danderyd Hospital, Stockholm, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - Olof Sköldenberg
- Department of Orthopaedics, Danderyd Hospital, Stockholm, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Bodil Samuelsson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Acute and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Andreas Stark
- Department of Orthopaedics, Danderyd Hospital, Stockholm, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Olav Muren
- Department of Orthopaedics, Danderyd Hospital, Stockholm, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Maria Unbeck
- Acute and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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23
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Kelly-Pettersson P, Samuelsson B, Unbeck M, Muren O, Magnéli M, Gordon M, Stark A, Sköldenberg O. The influence of depression on patient-reported outcomes for hip-fracture patients 1 year after surgery: a prospective cohort study. Aging Clin Exp Res 2020; 32:247-255. [PMID: 31028625 PMCID: PMC7033144 DOI: 10.1007/s40520-019-01207-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 12/13/2018] [Accepted: 04/13/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Depression is common in elderly hip-fracture patients and together with cognitive impairment is associated with increased risk of mortality. AIM We aimed to examine the influence depression has on patient-reported outcome up to 1 year after acute hip fracture. METHODS 162 hip-fracture patients participated in the prospective observational cohort study and were followed up at baseline, and 3 and 12 months using patient-reported outcome scores. Patients with cognitive impairment were excluded. Depression was defined as a score ≥ 8 on the depression subscale of the Hospital Anxiety Depression Scale (HADS D), having a diagnosis of depression or being treated with anti-depressant medication. Hip function was assessed using Harris Hip Score (HHS), EQ-5D was used to assess health status and Quality of life, and the Pain Numerical Rating Scale (PRNS) was used to assess pain levels. A linear regression model adjusted for group, age, sex, and ASA class was used to identify risk factors for functional outcome 12 months after fracture. RESULTS 35 patients were included in the depression group versus 127 in the control group. No statistical differences were found in the demographic data (age, sex, ASA class, fracture type, operation method, living situation, activities of daily living ADL and clinical pathway) between the groups. In the regression model, we found no correlation between depression and the patient-reported outcome. CONCLUSION In young elderly hip fracture patients without cognitive dysfunction, depression may not be of major importance for the rehabilitation of hip function in the short term.
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Affiliation(s)
- Paula Kelly-Pettersson
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Bodil Samuelsson
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Maria Unbeck
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Olav Muren
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Martin Magnéli
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Max Gordon
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - André Stark
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Olof Sköldenberg
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
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24
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Magnéli M, Unbeck M, Samuelsson B, Rogmark C, Rolfson O, Gordon M, Sköldenberg O. Only 8% of major preventable adverse events after hip arthroplasty are filed as claims: a Swedish multi-center cohort study on 1,998 patients. Acta Orthop 2020; 91:20-25. [PMID: 31615309 PMCID: PMC7006721 DOI: 10.1080/17453674.2019.1677382] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Hip arthroplasty is one of the most performed surgeries in Sweden, and the rate of adverse events (AEs) is fairly high. All patients in publicly financed healthcare in Sweden are insured by the Mutual Insurance Company of Swedish County Councils (Löf). We assessed the proportion of patients that sustained a major preventable AE and filed an AE claim to Löf.Patients and methods - We performed retrospective record review using the Global Trigger Tool to identify AEs in a Swedish multi-center cohort consisting of 1,998 patients with a total or hemi hip arthroplasty. We compared the major preventable AEs with all patient-reported claims to Löf from the same cohort and calculated the proportion of filed claims.Results - We found 1,066 major preventable AEs in 744 patients. Löf received 62 claims for these AEs, resulting in a claim proportion of 8%. 58 of the 62 claims were accepted by Löf and received compensation. The claim proportion was 13% for the elective patients and 0.3% for the acute patients. The most common AE for filing a claim was periprosthetic joint infection; of the 150 infections found 37 were claimed.Interpretation - The proportion of filed claims for major preventable AEs is very low, even for obvious and serious AEs such as periprosthetic joint infection.
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Affiliation(s)
- Martin Magnéli
- Department of Clinical Sciences at Danderyd Hospital, Division of Orthopaedics, Karolinska Institutet, Stockholm
| | - Maria Unbeck
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm
| | - Bodil Samuelsson
- Department of Clinical Sciences at Danderyd Hospital, Division of Orthopaedics, Karolinska Institutet, Stockholm
| | - Cecilia Rogmark
- Department of Clinical Sciences Malmö, Lund University Clinical and Molecular Osteoporosis Research Unit, Malmö
| | - Ola Rolfson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Max Gordon
- Department of Clinical Sciences at Danderyd Hospital, Division of Orthopaedics, Karolinska Institutet, Stockholm
| | - Olof Sköldenberg
- Department of Clinical Sciences at Danderyd Hospital, Division of Orthopaedics, Karolinska Institutet, Stockholm
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Sjöholm P, Otten V, Wolf O, Gordon M, Karsten G, Sköldenberg O, Mukka S. Posterior and anterior tilt increases the risk of failure after internal fixation of Garden I and II femoral neck fracture. Acta Orthop 2019; 90:537-541. [PMID: 31269853 PMCID: PMC6844400 DOI: 10.1080/17453674.2019.1637469] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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 - Preoperative posterior tilt of the femoral head as seen on lateral radiographs has been reported to affect the risk of fixation failure in cases of minimally displaced femoral neck fractures (Garden I-II). We investigated radiological risk factors of treatment failure.Patients and methods - We included 417 patients (68% women, median age: 78 years (50-108) with a minimally displaced femoral neck fracture (Garden I-II) treated with internal fixation in a retrospective cohort study. The patients were followed for 3.4 years (2-14). Data on age, sex, housing, cognitive impairment, implant angulation, pre- and postoperative tilt, hip complications, and reoperations were recorded. The risk of fixation failure was assessed using Cox proportional hazards regression analysis.Results - The overall reoperation rate was 17%, and the rate of treatment failure (fixation failure, nonunion, avascular necrosis, or posttraumatic osteoarthritis) was 13%. Cox proportional hazard analysis revealed an increased risk of treatment failure with a preoperative posterior tilt of at least 20° and a preoperative anterior tilt greater than 10°. A failure occurred in 13 of the 65 patients with a posterior tilt of at least 20° and in 5 of the 9 patients with an anterior tilt greater than 10°.Interpretation - A preoperative posterior tilt of 20° and an anterior tilt greater than 10° in cases of Garden I and II femoral neck fractures increase the risk of fixation failure necessitating additional surgery. In this group of patients, there is a need for future interventional studies regarding the feasibility of primary hip arthroplasty.
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Affiliation(s)
- Pontus Sjöholm
- Department of Surgical and Perioperative Sciences at Umeå University, Umeå; ,Correspondence:
| | - Volker Otten
- Department of Surgical and Perioperative Sciences at Umeå University, Umeå;
| | - Olof Wolf
- Section of Orthopaedics, Department of Surgical Sciences, Uppsala University, Uppsala;
| | - Max Gordon
- Departments of Orthopedics and Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Gustav Karsten
- Department of Surgical and Perioperative Sciences at Umeå University, Umeå;
| | - Olof Sköldenberg
- Departments of Orthopedics and Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Sebastian Mukka
- Department of Surgical and Perioperative Sciences at Umeå University, Umeå;
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26
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Mohammed J, Mukka S, Hedbeck CJ, Chammout G, Gordon M, Sköldenberg O. Reduced periprosthetic fracture rate when changing from a tapered polished stem to an anatomical stem for cemented hip arthroplasty: an observational prospective cohort study with a follow-up of 2 years. Acta Orthop 2019; 90:427-432. [PMID: 31154885 PMCID: PMC6746294 DOI: 10.1080/17453674.2019.1624339] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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 - Straight collarless polished tapered stems have been linked to an increased risk for periprosthetic femur fractures in comparison with anatomically shaped stems, especially in elderly patients. Therefore, we evaluated the effect of an orthopedic department's full transition from the use of a cemented collarless, polished, tapered stem to a cemented anatomic stem on the cumulative incidence of postoperative periprosthetic fracture (PPF). Patients and methods - This prospective single-center cohort study comprises a consecutive series of 1,077 patients who underwent a cemented hip arthroplasty using either a collarless polished tapered stem (PTS group, n = 543) or an anatomic stem (AS group, n = 534). We assessed the incidence of PPF 2 years postoperatively and used a Cox regression model adjusted for age, sex, ASA class, cognitive impairment, BMI, diagnosis, and surgical approach for outcome analysis. Results - Mean age at primary surgery was 82 years (49-102), 73% of the patients were female, and 75% underwent surgery for a femoral neck fracture. The PPF rate was lowered from 3.3% (n = 18) in the PTS group to 0.4% (n = 2) in the AS group. The overall complication rate was also lowered from 8.8% in the PTS group to 4.5% in the AS group. In the regression model only cognitive dysfunction (HR 3.8, 95% CI 1.4-10) and the type of stem (PTS vs AS, HR 0.1, CI 0.0-0.5) were correlated with outcome. Interpretation - For elderly patients with poor bone quality use of cemented anatomic stems leads to a substantial reduction in periprosthetic fracture rate without increasing other complications.
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Affiliation(s)
- Jabbar Mohammed
- Department of Surgical and Perioperative Sciences, Umeå University; ,Correspondence:
| | - Sebastian Mukka
- Department of Surgical and Perioperative Sciences, Umeå University;
| | - Carl-Johan Hedbeck
- Department of Clinical Sciences, Division of Orthopedics, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
| | - Ghazi Chammout
- Department of Clinical Sciences, Division of Orthopedics, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
| | - Max Gordon
- Department of Clinical Sciences, Division of Orthopedics, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
| | - Olof Sköldenberg
- Department of Clinical Sciences, Division of Orthopedics, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
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27
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Pihl E, Kristoffersen MH, Rosenlund AM, Laszlo S, Berglöf M, Ribom E, Eriksson K, Frihagen F, Mattila VM, Schilcher J, Eklund M, Snellman G, Skorpil M, Sköldenberg O, Hedbeck CJ, Jonsson K. The proximal hamstring avulsion clinical trial (PHACT)-a randomised controlled non-inferiority trial of operative versus non-operative treatment of proximal hamstrings avulsions: study protocol. BMJ Open 2019; 9:e031607. [PMID: 31519683 PMCID: PMC6747659 DOI: 10.1136/bmjopen-2019-031607] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The treatment of proximal hamstring avulsions is controversial. While several trials have investigated the outcome for patients treated surgically, there is today no prospective trial comparing operative treatment with non-operative treatment. This protocol describes the design for the proximal hamstring avulsion clinical trial (PHACT)-the first randomised controlled trial of operative versus non-operative treatment for proximal hamstring avulsions. METHODS AND ANALYSIS PHACT is a multicentre randomised controlled trial conducted across Sweden, Norway and Finland. Eligible patients (60 participants/treatment arm) with a proximal hamstring avulsion of at least two of three tendons will be randomised to either operative or non-operative treatment. Participants allocated to surgery will undergo reinsertion of the tendons with suture anchors. The rehabilitation programme will be the same for both treatment groups. When patient or surgeon equipoise for treatment alternatives cannot be reached and randomisation therefore is not possible, patients will be invited to participate in a parallel observational non-randomised cohort. The primary outcome will be the patient-reported outcome measure Perth hamstring assessment tool at 24 months. Secondary outcomes include the Lower Extremity Functional Score, physical performance and muscle strength tests, patient satisfaction and MR imaging. Data analysis will be blinded and intention-to-treat analysis will be preformed. ETHICS AND DISSEMINATION Ethical approval has been granted by the Ethical Committee of Uppsala University (DNR: 2017-170) and by the Norwegian ethical board (REC: 2017/1911). The study will be conducted in agreement with the Helsinki declaration. The findings will be disseminated in peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT03311997.
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Affiliation(s)
- Elsa Pihl
- Karolinska Institutet Danderyds Sjukhus, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Sofia Laszlo
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Mida Berglöf
- Karolinska Institutet Danderyds Sjukhus, Karolinska Institutet, Stockholm, Sweden
| | - Eva Ribom
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Karl Eriksson
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Frede Frihagen
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Ville M Mattila
- Department of Orthopeadics, Tampere University Hospital, Tampere, Finland, Tampere, Finland
| | - Jörg Schilcher
- Department of Orthopeadic Surgery, Linköping University Hospital, Linkoping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University Hospital, Linköping, Sweden
| | | | - Greta Snellman
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Mikael Skorpil
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Olof Sköldenberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Carl Johan Hedbeck
- Karolinska Institutet Danderyds Sjukhus, Karolinska Institutet, Stockholm, Sweden
| | - Kenneth Jonsson
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
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Mukka S, Sjöholm P, Chammout G, Kelly-Pettersson P, Sayed-Noor AS, Sköldenberg O. External Validity of the HOPE-Trial: Hemiarthroplasty Compared with Total Hip Arthroplasty for Displaced Femoral Neck Fractures in Octogenarians. JB JS Open Access 2019; 4:e0061. [PMID: 31334467 PMCID: PMC6613851 DOI: 10.2106/jbjs.oa.18.00061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 11/30/2022] Open
Abstract
Background: Randomized controlled trials (RCTs) are the most reliable way of evaluating the effect of new treatments by comparing them with previously accepted treatment regimens. The results obtained from an RCT are extrapolated from the study environment to the general health care system. The ability to do so is called external validity. We sought to evaluate the external validity of an RCT comparing the results of total hip arthroplasty with those of hemiarthroplasty for the treatment of displaced femoral neck fractures in patients ≥80 years of age. Methods: This prospective, single-center cohort study included 183 patients ≥80 years of age who had a displaced femoral neck fracture. All patients were screened according to the inclusion and exclusion criteria for an RCT comparing total hip arthroplasty and hemiarthroplasty. The population for this study consisted of patients who gave their informed consent and were randomized into the RCT (consenting group, 120 patients) as well as those who declined to give their consent to participate (non-consenting group, 63 patients). The outcome measurements were mortality, complications, and patient-reported outcome measures. Follow-up was carried out postoperatively with use of a mailed survey that included patient-reported outcome questionnaires. Results: We found a statistically significant and clinically relevant difference between the groups, with the non-consenting group having a higher risk of death compared with the consenting group. (hazard ratio, 4.6; 95% confidence interval, 1.9 to 11.1). No differences were found between the groups in terms of patient-reported outcome measures or surgical complications. Conclusions: This cohort study indicates a higher mortality rate but comparable hip function and quality of life among eligible non-consenters as compared with eligible consenters when evaluating the external validity of an RCT in patients ≥80 years of age with femoral neck fracture. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sebastian Mukka
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Pontus Sjöholm
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Ghazi Chammout
- Departments of Orthopedics and Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Paula Kelly-Pettersson
- Departments of Orthopedics and Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Arkan S Sayed-Noor
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Olof Sköldenberg
- Departments of Orthopedics and Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
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Saving J, Severin Wahlgren S, Olsson K, Enocson A, Ponzer S, Sköldenberg O, Wilcke M, Mellstrand Navarro C. Nonoperative Treatment Compared with Volar Locking Plate Fixation for Dorsally Displaced Distal Radial Fractures in the Elderly: A Randomized Controlled Trial. J Bone Joint Surg Am 2019; 101:961-969. [PMID: 31169572 DOI: 10.2106/jbjs.18.00768] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [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 The usage of volar locking plate fixation for distal radial fractures has increased in older patient populations, despite the fact that surgical treatment in the elderly population has not clearly been proven to be superior to nonoperative treatment. The purpose of the present study was to compare nonoperative treatment with volar locking plate fixation with regard to clinical outcome for elderly patients with dorsally displaced distal radial fractures. METHODS In this study, 140 patients were randomly allocated to nonoperative treatment with a plaster splint (n = 72) or volar locking plate fixation (n = 68). The outcome variables were the Patient-Rated Wrist Evaluation (PRWE) score, Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire score, EuroQol-5 Dimensions (EQ-5D) score, range of motion, grip strength, radiographic outcomes, and complications. Evaluation was performed at 3 and 12 months by unblinded observers. RESULTS At 3 months, 122 patients were evaluated, and at 12 months, 119 patients were evaluated. At 3 months, the volar locking plate group, compared with the nonoperative treatment group, had a better median PRWE score (10.3 compared with 35.5 points; p = 0.002), DASH score (14.4 compared with 29.2 points; p = 0.016), and grip strength (71.0% of the uninjured hand compared with 53.9%; p < 0.001). Significant differences in favor of the volar locking plate group remained at 12 months; compared with the nonoperative treatment group, the volar locking plate group had a better median PRWE score (7.5 points compared with 17.5 points; p = 0.014), DASH score (8.3 points compared with 19.9 points; p = 0.028), and grip strength (96.8% compared with 80.0%; p = 0.001). Radiographic measurements favored volar locking plate fixation at 3 and 12 months. Complication rates were similar, with 11% major complications in the nonoperative group compared with 14% major complications in the volar locking plate group (p = 0.606) and 11% minor complications in the nonoperative group compared with 20% minor complications in the volar locking plate group (p = 0.197). CONCLUSIONS The PRWE scores, DASH scores, and grip strength were better for the volar locking plate group compared with the nonoperative group at 3 and 12 months. The complication rates were similar. Our results imply that there is a benefit for the elderly patient with an unstable dorsally displaced distal radial fracture to be treated with a volar locking plate. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jenny Saving
- Department of Clinical Science and Education, Södersjukhuset Hospital, Karolinska Institute, Stockholm, Sweden.,Unit of Orthopaedics (J.S. and S.P.) and Department of Hand Surgery (M.W. and C.M.N.), Södersjukhuset Hospital, Stockholm, Sweden
| | - Sara Severin Wahlgren
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.,Department of Orthopaedics, Danderyd University Hospital Corp, Stockholm, Sweden
| | | | - Anders Enocson
- Department of Clinical Science and Education, Södersjukhuset Hospital, Karolinska Institute, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Sari Ponzer
- Department of Clinical Science and Education, Södersjukhuset Hospital, Karolinska Institute, Stockholm, Sweden.,Unit of Orthopaedics (J.S. and S.P.) and Department of Hand Surgery (M.W. and C.M.N.), Södersjukhuset Hospital, Stockholm, Sweden
| | - Olof Sköldenberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.,Department of Orthopaedics, Danderyd University Hospital Corp, Stockholm, Sweden
| | - Maria Wilcke
- Department of Clinical Science and Education, Södersjukhuset Hospital, Karolinska Institute, Stockholm, Sweden.,Unit of Orthopaedics (J.S. and S.P.) and Department of Hand Surgery (M.W. and C.M.N.), Södersjukhuset Hospital, Stockholm, Sweden
| | - Cecilia Mellstrand Navarro
- Department of Clinical Science and Education, Södersjukhuset Hospital, Karolinska Institute, Stockholm, Sweden.,Unit of Orthopaedics (J.S. and S.P.) and Department of Hand Surgery (M.W. and C.M.N.), Södersjukhuset Hospital, Stockholm, Sweden
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Krupic F, Westin O, Hagelberg M, Sköldenberg O, Samuelsson K. The Influence of Age, Gender and Religion on Willingness to be an Organ Donor: Experience of Religious Muslims Living in Sweden. J Relig Health 2019; 58:847-859. [PMID: 30006834 PMCID: PMC6522646 DOI: 10.1007/s10943-018-0670-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The transplantation of organs is one of the most successful medical advances in recent decades, and transplantation is the treatment of choice for severe organ failure worldwide. Despite this situation and the general acknowledgment of organ donation (OD) as a global priority, the demand for organs outstrips the supply in virtually every country in the world. The study aims to elucidate whether age, gender and religion influence decision-making about organ donation in religious Muslims living in Sweden Data were collected through three group interviews using open-ended questions and qualitative content analysis. Twenty-seven participants, 15 males and 12 females from four countries, participated in the focus group interviews. The analysis of the collected data resulted in three main categories: "Information and knowledge about organ donation," "The priorities when deciding about organ donation" and "The religious aspects of organ donation," including a number of subcategories. Good information about and knowledge of OD, priorities in OD, importance of the fact that religion must be studied and taught daily and religious education were only a few of the factors informants emphasized as predictors of the total and successful donation of organs. Age, gender or religion did not have an impact on organ donation. High levels of education through religious education and good information via various media, as well as a good knowledge of the Swedish language, are predictors of improved OD. In order to overcome religious ideology as a source of misinformation relating to OD and to promote increased OD in the future, specific intervention studies and the improved involvement of religious communities and education in schools and the healthcare system are vital and must be a starting point for improved OD.
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Affiliation(s)
- Ferid Krupic
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, 431 80, Mölndal, Sweden.
| | - Olof Westin
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, 431 80, Mölndal, Sweden
| | - Mårten Hagelberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Olof Sköldenberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, 431 80, Mölndal, Sweden
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Chammout G, Kelly-Pettersson P, Hedbeck CJ, Stark A, Mukka S, Sköldenberg O. HOPE-Trial: Hemiarthroplasty Compared with Total Hip Arthroplasty for Displaced Femoral Neck Fractures in Octogenarians: A Randomized Controlled Trial. JB JS Open Access 2019; 4:e0059. [PMID: 31334466 PMCID: PMC6613852 DOI: 10.2106/jbjs.oa.18.00059] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 01/31/2023] Open
Abstract
Background The choice of primary hemiarthroplasty or total hip arthroplasty in patients ≥80 years of age with a displaced femoral neck fracture has not been adequately studied. As the number of healthy, elderly patients ≥80 years of age is continually increasing, optimizing treatments for improving outcomes and reducing the need for secondary surgery is an important consideration. The aim of the present study was to compare the results of hemiarthroplasty with those of total hip arthroplasty in patients ≥80 years of age. Methods This prospective, randomized, single-blinded trial included 120 patients with a mean age of 86 years (range, 80 to 94 years) who had sustained an acute displaced femoral neck fracture <36 hours previously. The patients were randomized to treatment with hemiarthroplasty (n = 60) or total hip arthroplasty (n = 60). The primary end points were hip function and health-related quality of life at 2 years. Secondary end points included hip-related complications and reoperations, mortality, pain in the involved hip, activities of daily living, surgical time, blood loss, and general complications. The patients were reviewed at 3 months and 1 and 2 years. Results We found no differences between the groups in terms of hip function, health-related quality of life, hip-related complications and reoperations, activities of daily living, or pain in the involved hip. Hip function, activities of daily living, and pain in the involved hip deteriorated in both groups compared with pre-fracture values. The ability to regain previous walking function was similar in both groups. Conclusions We found no difference in outcomes after treatment with either hemiarthroplasty or total hip arthroplasty in active octogenarians and nonagenarians with a displaced femoral neck fracture up to 2 years after surgery. Hemiarthroplasty is a suitable procedure in the short term for this group of patients. Level of Evidence Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ghazi Chammout
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Paula Kelly-Pettersson
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Carl-Johan Hedbeck
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - André Stark
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Mukka
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Olof Sköldenberg
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Magnéli M, Unbeck M, Rogmark C, Rolfson O, Hommel A, Samuelsson B, Schildmeijer K, Sjöstrand D, Gordon M, Sköldenberg O. Validation of adverse events after hip arthroplasty: a Swedish multi-centre cohort study. BMJ Open 2019; 9:e023773. [PMID: 30850403 PMCID: PMC6429990 DOI: 10.1136/bmjopen-2018-023773] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Preventing adverse events (AEs) after orthopaedic surgery is a field with great room for improvement. A Swedish instrument for measuring AEs after hip arthroplasty based on administrative data from the national patient register is used by both the Swedish Hip Arthroplasty Register and the Swedish Association of Local Authorities and Regions. It has never been validated and its accuracy is unknown. The aim of this study was to validate the instrument's ability to detect AEs, and to calculate the incidence of AEs following primary hip arthroplasties. DESIGN Retrospective cohort study using retrospective record review with Global Trigger Tool methodology in combination with register data. SETTING 24 different hospitals in four major regions of Sweden. PARTICIPANTS 2000 patients with either total or hemi-hip arthroplasty were recruited from the SHAR. We included both acute and elective patients. PRIMARY AND SECONDARY OUTCOME MEASURES The sensitivity and specificity of the instrument. Adjusted cumulative incidence and incidence rate. RESULTS The sensitivity for all identified AEs was 5.7% (95% CI: 4.9% to 6.7%) for 30 days and 14.8% (95% CI: 8.2 to 24.3) for 90 days, and the specificity was 95.2% (95% CI: 93.5% to 96.6%) for 30 days and 92.1% (95% CI: 89.9% to 93.8%) for 90 days. The adjusted cumulative incidence for all AEs was 28.4% (95% CI: 25.0% to 32.3%) for 30 days and 29.5% (95% CI: 26.0% to 33.8%) for 90 days. The incidence rate was 0.43 AEs per person-month (95% CI: 0.39 to 0.47). CONCLUSIONS The AE incidence was high, and most AEs occurred within the first 30 days. The instrument sensitivity for AEs was very low for both 30 and 90 days, but the specificity was high for both 30 and 90 days. The studied instrument is insufficient for valid measurements of AEs after hip arthroplasty.
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Affiliation(s)
- Martin Magnéli
- Department of Clinical Sciences at Danderyd Hospital, Division of Orthopaedics, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Danderyd University Hospital Corp., Stockholm, Sweden
| | - Maria Unbeck
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Trauma and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden
| | | | - Ola Rolfson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ami Hommel
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
- Department of Orthopaedics, Skåne University Hospital, Lund, Sweden
| | - Bodil Samuelsson
- Department of Clinical Sciences at Danderyd Hospital, Division of Orthopaedics, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Max Gordon
- Department of Clinical Sciences at Danderyd Hospital, Division of Orthopaedics, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Danderyd University Hospital Corp., Stockholm, Sweden
| | - Olof Sköldenberg
- Department of Clinical Sciences at Danderyd Hospital, Division of Orthopaedics, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Danderyd University Hospital Corp., Stockholm, Sweden
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Galea VP, Connelly JW, Shareghi B, Kärrholm J, Sköldenberg O, Salemyr M, Laursen MB, Muratoglu O, Bragdon C, Malchau H. Evaluation of in vivo wear of vitamin E-diffused highly crosslinked polyethylene at five years. Bone Joint J 2018; 100-B:1592-1599. [DOI: 10.1302/0301-620x.100b12.bjj-2018-0371.r1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 01/09/2023]
Abstract
Aims The primary aim of this study was to compare the wear properties of vitamin E-diffused, highly crosslinked polyethylene (VEPE) and one formulation of moderately crosslinked and mechanically annealed ultra-high molecular weight polyethylene (ModXLPE) in patients five years after primary total hip arthroplasty (THA). The secondary aim was to assess the clinical results of patients treated with VEPE by evaluating patient-reported outcome measures (PROMs), radiological evidence of fixation, and the incidence of mechanical failure. Patients and Methods A total of 208 patients (221 THAs) from four international centres were recruited into a prospective study involving radiostereometric analysis (RSA) and the assessment of clinical outcomes. A total of 193 hips (87%) were reviewed at the five-year follow-up. Of these, 136 (70%) received VEPE (vs ModXLPE) liners and 68 (35%) received ceramic (vs metal) femoral heads. PROMs and radiographs were collected preoperatively and at one, two, and five years postoperatively. In addition, RSA images were collected to measure PE wear postoperatively and at one, two, and five years after surgery. Results We observed similar bedding in one year postoperatively and wear two years postoperatively between the two types of liner. However, there was significantly more penetration of the femoral head in the ModXLPE cohort compared with the VEPE cohort five years postoperatively (p < 0.001). The only variables independently predictive of increased wear were ModXLPE (vs VEPE) liner type (β = 0.22, p = 0.010) and metal (vs ceramic) femoral head (β = 0.21, p = 0.013). There was no association between increased wear and the development of radiolucency (p = 0.866) or PROMs. No patient had evidence of osteolysis. Conclusion Five years postoperatively, patients with VEPE (vs ModXLPE) and ceramic (vs metal) femoral heads had decreased wear. The rates of wear for both liners were very low and have not led to any osteolysis or implant failure due to aseptic loosening.
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Affiliation(s)
- V. P. Galea
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - J. W. Connelly
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - B. Shareghi
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J. Kärrholm
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - O. Sköldenberg
- Department of Clinical Sciences, Danderyd Hospital, Division of Orthopaedics, Karolinska Institutet, Stockholm, Sweden
| | - M. Salemyr
- Department of Clinical Sciences, Danderyd Hospital, Division of Orthopaedics, Karolinska Institutet, Stockholm, Sweden
| | - M. B. Laursen
- Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | - O. Muratoglu
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - C. Bragdon
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - H. Malchau
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Rysinska A, Sköldenberg O, Garland A, Rolfson O, Aspberg S, Eisler T, Garellick G, Stark A, Hailer N, Gordon M. Aseptic loosening after total hip arthroplasty and the risk of cardiovascular disease: A nested case-control study. PLoS One 2018; 13:e0204391. [PMID: 30427844 PMCID: PMC6235257 DOI: 10.1371/journal.pone.0204391] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 09/07/2018] [Indexed: 11/18/2022] Open
Abstract
Background Patients with surgically treated osteoarthritis of the hip have an increased risk of cardiovascular morbidity and mortality many years after the operation compared with controls. Our hypothesis is that this increased risk after total hip arthroplasty (THA) is mediated by development of periprosthetic osteolysis leading to aseptic loosening of the implant. Methods We conducted a nation-wide, nested, case-control study consisting of patients receiving a cemented THA due to osteoarthritis between the years 1992 and 2005. Our study population included a total of 14,430 subjects identified in the Swedish hip arthroplasty register and linked to the Swedish National Patient Register. The case group consisted of patients (n = 2,886) who underwent reoperation of the treated hip due to osteolysis or aseptic loosening at any time within five years after the index surgery. Each case was matched with four controls (n = 11,544) who had not undergone reoperation. The main outcomes were cardiovascular events i.e. myocardial infarction, heart failure and cerebral infarction according to ICD-codes and time to the first cardiovascular event during the exposure period. Outcomes were subgrouped into cardiac and cerebral events. We used regression models to calculate the incidence rates and adjusted our results for confounders. Findings Overall, 5.1% of patients had cardiac events, with slightly more overall cardiovascular events occurring in the control group (8.1% vs. 6.7%, odds ratio 0.8, 95% confidence interval (CI) 0.7 to 1.0). After adjusting for confounders, the case group had an increased relative risk of 1.3 (95% confidence interval (CI) 1.1 to 1.3) for total number of cardiovascular events. Similar effect sizes were observed for time to first event. Interpretation Patients with osteoarthritis who received THA and subsequently underwent a revision operation due to loosening had a higher relative risk of developing cardiovascular events than controls. Thus there is an association which could be explained by a common inflammatory disease pathway that requires further experimental research.
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Affiliation(s)
- Agata Rysinska
- Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Stockholm, Stockholm, Sweden
- * E-mail:
| | - Olof Sköldenberg
- Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Stockholm, Stockholm, Sweden
| | - Anne Garland
- Department of Orthopaedics, Institute of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Ola Rolfson
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, University of Gothenburg, Gothenburg, Sweden
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston MA, United States of America, and Harvard Medical School, Boston, MA, United States of America
| | - Sara Aspberg
- Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Stockholm, Stockholm, Sweden
| | - Thomas Eisler
- Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Stockholm, Stockholm, Sweden
| | - Göran Garellick
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, University of Gothenburg, Gothenburg, Sweden
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston MA, United States of America, and Harvard Medical School, Boston, MA, United States of America
| | - Andreas Stark
- Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Stockholm, Stockholm, Sweden
| | - Nils Hailer
- Department of Orthopaedics, Institute of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Max Gordon
- Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Stockholm, Stockholm, Sweden
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Hallin K, Gordon M, Sköldenberg O, Henriksson P, Kiessling A. Readmission and mortality in patients treated by interprofessional student teams at a training ward compared with patients receiving usual care: a retrospective cohort study. BMJ Open 2018; 8:e022251. [PMID: 30341125 PMCID: PMC6196845 DOI: 10.1136/bmjopen-2018-022251] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE This study aimed to compare the rate of patient readmissions and mortality between care provided at an orthopaedic interprofessional training ward (IPTW) and usual care. DESIGN Retrospective cohort study. SETTING Orthopaedic wards at a level II trauma centre at a Swedish university teaching hospital between 2006 and 2011. PARTICIPANTS Two cohorts were identified: (1) a control cohort that had not received care at the IPTW, and (2) patients who had been treated for at least 1 day at the IPTW. MAIN OUTCOME MEASURES Readmission at 90 days and 1-year mortality. RESULTS We included 4652 controls and 1109 in the IPTW group. The mean age was 63 years, and 58% were women. The groups did not differ in any of the outcomes: the readmission rate in the control and IPTW groups was 13.5% and 14.0%, respectively, while mortality was 5.2% and 5.3%, respectively. This lack of difference remained after adjusting for confounders. CONCLUSION Interprofessional undergraduate training in patient-based settings can be performed in a level II trauma hospital with satisfactory patient safety.
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Affiliation(s)
- Karin Hallin
- Division of Orthopaedics, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Max Gordon
- Division of Orthopaedics, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Olof Sköldenberg
- Division of Orthopaedics, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Peter Henriksson
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Anna Kiessling
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Persson A, Eisler T, Bodén H, Krupic F, Sköldenberg O, Muren O. Revision for Symptomatic Pseudotumor After Primary Metal-on-Polyethylene Total Hip Arthroplasty with a Standard Femoral Stem. J Bone Joint Surg Am 2018; 100:942-949. [PMID: 29870445 DOI: 10.2106/jbjs.17.00616] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 02/01/2023]
Abstract
BACKGROUND Pseudotumor formation following total hip arthroplasty (THA) is a well-known complication mainly associated with metal-on-metal (MoM) bearings and taper corrosion on modular-neck femoral stems. The purpose of this study was to determine the prevalence of revision surgery for symptomatic pseudotumors in a large cohort of patients treated with primary THA with a standard stem and a non-MoM articulation. METHODS We included 2,102 patients treated with a total of 2,446 THAs from 1999 until May 2016 in a prospective, observational cohort study. All patients underwent THA with the same uncemented, non-modular-neck femoral stem and metal-on-polyethylene (MoP) (n = 2,409) or ceramic-on-polyethylene (n = 37) articulation. All patients were followed by means of a combination of surgical and medical chart review, follow-up visits, and the Swedish Hip Arthroplasty Register. Metal artifact reduction sequence magnetic resonance imaging (MARS MRI) was used for diagnosis of the pseudotumors, and serum metal ion levels and inflammatory marker levels were measured for all patients who underwent a revision due to pseudotumor. RESULTS The prevalence of revision for symptomatic pseudotumor formation was 0.5% (13 cases) at a mean follow-up time of 7 years. The incidence rate was 0.9 case per 1,000 person-years. All 13 revisions were done in patients with an MoP articulation. CONCLUSIONS This study demonstrated a 0.5% prevalence of revision due to symptomatic pseudotumor formation in a cohort of patients who underwent THA with a non-MoM construct. Surgeons should be aware that symptomatic pseudotumor formation requiring revision surgery is a tangible complication even after standard MoP THA. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Anders Persson
- Department of Orthopaedics, Danderyd University Hospital, Karolinska Institute at Danderyd University Hospital, Stockholm, Sweden
| | - Thomas Eisler
- Department of Orthopaedics, Danderyd University Hospital, Karolinska Institute at Danderyd University Hospital, Stockholm, Sweden
| | - Henrik Bodén
- Department of Orthopaedics, Danderyd University Hospital, Karolinska Institute at Danderyd University Hospital, Stockholm, Sweden
| | - Ferid Krupic
- Department of Orthopaedics and Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Olof Sköldenberg
- Department of Orthopaedics, Danderyd University Hospital, Karolinska Institute at Danderyd University Hospital, Stockholm, Sweden
| | - Olav Muren
- Department of Orthopaedics, Danderyd University Hospital, Karolinska Institute at Danderyd University Hospital, Stockholm, Sweden
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Olczak J, Fahlberg N, Maki A, Razavian AS, Jilert A, Stark A, Sköldenberg O, Gordon M. Artificial intelligence for analyzing orthopedic trauma radiographs. Acta Orthop 2017; 88:581-586. [PMID: 28681679 PMCID: PMC5694800 DOI: 10.1080/17453674.2017.1344459] [Citation(s) in RCA: 223] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 06/06/2017] [Indexed: 02/06/2023] Open
Abstract
Background and purpose - Recent advances in artificial intelligence (deep learning) have shown remarkable performance in classifying non-medical images, and the technology is believed to be the next technological revolution. So far it has never been applied in an orthopedic setting, and in this study we sought to determine the feasibility of using deep learning for skeletal radiographs. Methods - We extracted 256,000 wrist, hand, and ankle radiographs from Danderyd's Hospital and identified 4 classes: fracture, laterality, body part, and exam view. We then selected 5 openly available deep learning networks that were adapted for these images. The most accurate network was benchmarked against a gold standard for fractures. We furthermore compared the network's performance with 2 senior orthopedic surgeons who reviewed images at the same resolution as the network. Results - All networks exhibited an accuracy of at least 90% when identifying laterality, body part, and exam view. The final accuracy for fractures was estimated at 83% for the best performing network. The network performed similarly to senior orthopedic surgeons when presented with images at the same resolution as the network. The 2 reviewer Cohen's kappa under these conditions was 0.76. Interpretation - This study supports the use for orthopedic radiographs of artificial intelligence, which can perform at a human level. While current implementation lacks important features that surgeons require, e.g. risk of dislocation, classifications, measurements, and combining multiple exam views, these problems have technical solutions that are waiting to be implemented for orthopedics.
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Affiliation(s)
- Jakub Olczak
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital
| | | | - Atsuto Maki
- Department of Robotics, Perception and Learning (RPL), School of Computer Science and Communication, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Ali Sharif Razavian
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital
- Department of Robotics, Perception and Learning (RPL), School of Computer Science and Communication, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Anthony Jilert
- Radiology clinic, Danderyd Hospital, Danderyd Hospital AB
| | - André Stark
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital
| | - Olof Sköldenberg
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital
| | - Max Gordon
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital
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Thörling J, Ljungqvist O, Sköldenberg O, Hammarqvist F. OR03: No Association Between Impaired Glycemic Control and Adverse Outcome in HIP Fracture Patients. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30784-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Thune A, Hagelberg M, Nåsell H, Sköldenberg O. The benefits of hardware removal in patients with pain or discomfort after fracture healing of the ankle: a systematic review protocol. BMJ Open 2017; 7:e014560. [PMID: 28801390 PMCID: PMC5724201 DOI: 10.1136/bmjopen-2016-014560] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION For any orthopaedic surgeon working with trauma; ankle fractures are one of the most common injuries treated. The treatment of ankle fractures can be conservative, using external fixation, but more commonly the fractures are treated with open reduction and internal fixation. Residual pain and discomfort are common in patients after surgical treatment of fractures of the ankle. Sometimes it is difficult to determine whether the pain or discomfort is due to the implants left in situ or the primary injury itself. In many cases, the decision is made to remove the implants. Extraction of internal fixation material from the ankle is a common procedure in many orthopaedic clinics. There are no evidence-based guidelines or consensus regarding the effect of hardware removal from the ankle. The aim of this protocol is to describe the method that will be used to collect, describe and analyse the current evidence regarding hardware removal after fracture healing of the ankle. METHODS AND ANALYSIS We will conduct a systematic review of studies that were published after 1967 regarding the benefits of hardware removal in patients with pain or discomfort after fracture healing of the ankle. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We will make a predefined search strategy and use it in several databases. We will include both randomised controlled trials (RCTs) and non-RCT studies. We will use descriptive statistics to summarise the studies collected. If more than one RCT is collected then a meta-analysis will be conducted. The quality of evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation guidelines. ETHICS AND DISSEMINATION No ethics approval is required as no primary data will be collected. Once complete, the results will be made available by peer-reviewed publication. TRIAL REGISTRATION NUMBER PROSPERO registration number CRD42016039186.
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Affiliation(s)
- Alexandra Thune
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Danderyd, Stockholm, Sweden
| | - Mårten Hagelberg
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Danderyd, Stockholm, Sweden
| | - Hans Nåsell
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Danderyd, Stockholm, Sweden
| | - Olof Sköldenberg
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Danderyd, Stockholm, Sweden
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Chammout G, Muren O, Laurencikas E, Bodén H, Kelly-Pettersson P, Sjöö H, Stark A, Sköldenberg O. More complications with uncemented than cemented femoral stems in total hip replacement for displaced femoral neck fractures in the elderly. Acta Orthop 2017; 88:145-151. [PMID: 27967333 PMCID: PMC5385108 DOI: 10.1080/17453674.2016.1262687] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [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 - Total hip replacement (THR) is the preferred method for the active and lucid elderly patient with a displaced femoral neck fracture (FNF). Controversy still exists regarding the use of cemented or uncemented stems in these patients. We compared the effectiveness and safety between a modern cemented, and a modern uncemented hydroxyapatite-coated femoral stem in patients 65-79 years of age who were treated with THR for displaced FNF. Patients and methods - In a single-center, single-blinded randomized controlled trial, we included 69 patients, mean age 75 (65-79) and with a displaced FNF (Garden III-IV). 35 patients were randomized to a cemented THR and 34 to a reverse-hybrid THR with an uncemented stem. Primary endpoints were: prevalence of all hip-related complications and health-related quality of life, evaluated with EuroQol-5D (EQ-5D) index up to 2 years after surgery. Secondary outcomes included: overall mortality, general medical complications, and hip function. The patients were followed up at 3, 12, and 24 months. Results - According to the calculation of sample size, 140 patients would be required for the primary endpoints, but the study was stopped when only half of the sample size was included (n = 69). An interim analysis at that time showed that the total number of early hip-related complications was substantially higher in the uncemented group, 9 (among them, 3 dislocations and 4 periprosthetic fractures) as compared to 1 in the cemented group. The mortality and functional outcome scores were similar in the 2 groups. Interpretation - We do not recommend uncemented femoral stems for the treatment of elderly patients with displaced FNFs.
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Krupic F, Sköldenberg O, Samuelsson K, Eisler T. Nurses' Experience of Patient Care in Multibed Hospital Rooms: Results From In-Depth Interviews With Nurses After Further Education in Anesthesia. J Perianesth Nurs 2017; 33:78-86. [PMID: 29362050 DOI: 10.1016/j.jopan.2016.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 08/24/2016] [Accepted: 09/04/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to investigate and explore nurse's previous experiences of patient care in MBRs before their further education in anesthesia. DESIGN Qualitative research. METHODS Data were collected through three focus group interviews using content data analysis. FINDINGS Maintaining patient privacy, providing conditions for communication between health care professionals and patients, and undertaking daily practical care were stated as the main problems in MBR care. Inferior conditions for providing sensitive information and communication with proxies, especially in association with language problems, were frequently encountered. Patient's proxies could facilitate several problematic issues in MBR care. CONCLUSIONS The present study characterized well-defined and easily recognizable clinical problems experienced in the care of patients in an MBR setting from a nurse's perspective. The opinion shared by most nurses was that the inability to implement privacy, dignity, and sound communication with patients should be taken into account in future hospital designs. General dissatisfaction with work environment, increased stress, and the risk of errors in care may otherwise follow.
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Kelly-Pettersson P, Samuelsson B, Muren O, Unbeck M, Gordon M, Stark A, Sköldenberg O. Waiting time to surgery is correlated with an increased risk of serious adverse events during hospital stay in patients with hip-fracture: A cohort study. Int J Nurs Stud 2017; 69:91-97. [PMID: 28189926 DOI: 10.1016/j.ijnurstu.2017.02.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 04/14/2016] [Revised: 01/30/2017] [Accepted: 02/02/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hip fractures are common in the elderly and are associated with a high adverse event and mortality rate. Time to surgery is one of the major modifiable risk factors influencing adverse outcomes in hip-fracture patients. National guidelines and recommendations have been introduced which advocate specific time frames in which surgery should be performed i.e. within 24-48h. These time constraints have been arbitrarily set without being modelled on the linear assumption i.e. that risk increases continually over time and not within specific cut-off times. OBJECTIVES To investigate how waiting time to surgery influenced the risk of serious adverse events in hip-fracture patients during the hospital stay and to examine how the risk increased over time. DESIGN An observational single cohort study Participants 576 patients (72.4% females, mean [SD] age 82 [10]) years, with a hip fracture were included in the cohort study. METHODS The outcomes of the study were the occurrence of serious adverse events during hospital stay, length of stay and one-year mortality. A structured medical record review was carried out to identify outcomes and mortality data was obtained from the Swedish National Death Registry. Waiting time to surgery was used as the exposure variable and age, sex, type of fracture, comorbidities using the American Society of Anaesthesiologists classification score and the presence of cognitive dysfunction were identified as confounders. A logistic regression analysis was performed to identify risk factors influencing outcomes. RESULTS A total of 119 patients (20.6%) suffered 397 (range 1-5) serious adverse events during hospital stay. Every 10h of waiting time to surgery increased the risk of serious adverse events by 12% (odds ratio 1.12 [95% confidence interval 1.02-1.23]). We found no optimal cut-off times for waiting time to surgery. For every 24h of waiting time, the length of stay from surgery was increased by 0.6days (95% CI 0.1-1.1). We found no correlation between waiting time to surgery and one-year mortality. CONCLUSIONS A large proportion of patients suffered from at least one serious adverse event after hip-fracture surgery and there are no safe limits for waiting time to surgery for hip-fracture patients. As the risk increases with every hour of waiting time, patients with higher American Society of Anesthesiologists classification scores, males and those with subtrochanteric fractures should be prioritized for surgery.
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Affiliation(s)
- Paula Kelly-Pettersson
- Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Stockholm, Sweden
| | - Bodil Samuelsson
- Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Stockholm, Sweden
| | - Olle Muren
- Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Stockholm, Sweden
| | - Maria Unbeck
- Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Stockholm, Sweden
| | - Max Gordon
- Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Stockholm, Sweden
| | - André Stark
- Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Stockholm, Sweden
| | - Olof Sköldenberg
- Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Stockholm, Sweden.
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Hagelberg M, Thune A, Krupic F, Salomonsson B, Sköldenberg O. Functional outcome after Mason II-III radial head and neck fractures: study protocol for a systematic review in accordance with the PRISMA statement. BMJ Open 2017; 7:e013022. [PMID: 28132003 PMCID: PMC5278296 DOI: 10.1136/bmjopen-2016-013022] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Fractures of the radial head and neck are the most common fractures of the elbow, and account for approximately one-third of all elbow fractures. Depending on the fracture type the treatment is either conservative or surgical. There is no absolute consensus regarding optimal treatment for different fracture types. The aim of this protocol is to present the method that will be used to collect, describe and analyse the current evidence regarding the treatment of Mason II-III radial head and neck fractures. METHOD AND ANALYSIS We will conduct a systematic review in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol (PRISMA-P) guidelines statement. We will search a number of databases with a predefined search strategy to collect both randomised and non-randomised studies. The articles will be summarised with descriptive statistics. If applicable a meta-analysis will be conducted. ETHICS AND DISSEMINATION Ethical approval is not required since this is a protocol for a systematic review and no primary data will be collected. The authors will publish findings from this review in a peer-reviewed scientific journal. TRIAL REGISTRATION NUMBER CRD42016037627.
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Affiliation(s)
- Mårten Hagelberg
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Alexandra Thune
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Ferid Krupic
- University of Gothenburg Institute of Clinical Sciences, Sahlgrenska Akademy, University of Gothenburg, Mölndal, Sweden
| | - Björn Salomonsson
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Olof Sköldenberg
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
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Garland A, Gordon M, Garellick G, Kärrholm J, Sköldenberg O, Hailer NP. Risk of early mortality after cemented compared with cementless total hip arthroplasty. Bone Joint J 2017; 99-B:37-43. [DOI: 10.1302/0301-620x.99b1.bjj-2016-0304.r1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 04/27/2016] [Accepted: 09/01/2016] [Indexed: 12/21/2022]
Abstract
Aims It has been suggested that cemented fixation of total hip arthroplasty (THA) is associated with an increased peri-operative mortality compared with cementless THA. Our aim was to investigate this through a nationwide matched cohort study adjusting for age, comorbidity, and socioeconomic background. Patients and Methods A total of 178 784 patients with osteoarthritis who underwent either cemented or cementless THA from the Swedish Hip Arthroplasty Register were matched with 862 294 controls from the general population. Information about the causes of death, comorbidities, and socioeconomic background was obtained. Mortality within the first 90 days after the operation was the primary outcome measure. Results Patients who underwent cemented THA had an increased risk of death during the first 14 days compared with the controls (hazard ratio (HR) 1.3, confidence interval (CI) 1.11 to 1.44), corresponding to an absolute increase in risk of five deaths per 10 000 observations. No such early increase of risk was seen in those who underwent cementless THA. Between days 15 and 29 the risk of mortality was decreased for those with cemented THA (HR 0.7, CI 0.62 to 0.87). Between days 30 and 90 all patients undergoing THA, irrespective of the mode of fixation, had a lower risk of death than controls. Patients selected for cementless fixation were younger, healthier and had a higher level of education and income than those selected for cemented THA. A supplementary analysis of 16 556 hybrid THAs indicated that cementation of the femoral component was associated with a slight increase in mortality up to 15 days, whereas no such increase in mortality was seen in those with a cemented acetabular component combined with a cementless femoral component. Conclusion This nationwide matched cohort study indicates that patients receiving cemented THA have a minimally increased relative risk of early mortality that is reversed from day 15 and thereafter. The absolute increase in risk is very small. Our findings lend support to the idea that cementation of the femoral component is more dangerous than cementation of the acetabular component. Cite this article: Bone Joint J 2017;99-B:37–43.
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Affiliation(s)
- A. Garland
- Uppsala University, Institute
of Surgical Sciences, Uppsala, Sweden
| | - M. Gordon
- Swedish Hip Arthroplasty Register, and
Karolinska Institute, Danderyds Hospital, Stockholm, Sweden
| | - G. Garellick
- Swedish Hip Arthroplasty Register, and,
University of Gothenburg, Gothenburg, Sweden
| | - J. Kärrholm
- Swedish Hip Arthroplasty Register, and,
University of Gothenburg, Gothenburg, Sweden
| | - O. Sköldenberg
- Swedish Hip Arthroplasty Register, and
Karolinska Institute, Danderyds Hospital, Stockholm, Sweden
| | - N. P. Hailer
- Uppsala University, Institute
of Surgical Sciences, Uppsala, Sweden
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Mukka S, Mahmood S, Kadum B, Sköldenberg O, Sayed-Noor A. Direct lateral vs posterolateral approach to hemiarthroplasty for femoral neck fractures. Orthop Traumatol Surg Res 2016; 102:1049-1054. [PMID: 27863919 DOI: 10.1016/j.otsr.2016.08.017] [Citation(s) in RCA: 8] [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: 02/28/2016] [Revised: 06/27/2016] [Accepted: 08/29/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Adopting the direct lateral (DL) instead of the posterolateral (PL) approach in hip arthroplasty for femoral neck fracture (FNF) patients could lower the rate of prosthetic dislocation. However, little is known about how the approach influences the functional outcome. HYPOTHESIS We hypothesized that both approaches would give comparable results. MATERIAL AND METHODS In a prospective cohort study, we enrolled 185 hips (183 patients, 128 women, median age 84 years) with a displaced FNF. Subjects were assigned to treatment using DL (n=102) or PL approach (n=83) with a hemiarthroplasty (HA). Functional outcome was assessed by Harris Hip Score (HHS), Western Ontario and McMaster Universities Arthritis (WOMAC) index, pain numeric rating scale (PNRS) for pain, mortality and hip complications. Patients were followed-up after 1 year. RESULTS The HHS was 71 (SD 18) in the DL group and 72 (SD 17) in the PL group (P=0.59). We found no difference in WOMAC, PNRS and mortality. Seven patients (6.9%) in the DL group and 11 patients (13.3%) in the PL group had undergone a major reoperation (adjusted OR 0.51; 95% CI, 0.18-2.07; P=0.23). DISCUSSION In this prospective cohort study, patients treated with HA for FNF using either the DL or PL approaches had comparable functional outcome after 1 year. The PL approach had a tendency towards a higher reoperation rate. TYPE OF STUDY Prospective cohort study. LEVEL OF PROOF Level 2.
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Affiliation(s)
- S Mukka
- Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, Sundsvall Teaching Hospital, 85186 Sundsvall, Sweden
| | - S Mahmood
- Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, Sundsvall Teaching Hospital, 85186 Sundsvall, Sweden
| | - B Kadum
- Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, Sundsvall Teaching Hospital, 85186 Sundsvall, Sweden
| | - O Sköldenberg
- Department of Orthopaedics at Danderyd Hospital and Karolinska Institute, Department of Clinical Sciences at Danderyd Hospital (KIDS), Stockholm, Sweden
| | - A Sayed-Noor
- Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, Sundsvall Teaching Hospital, 85186 Sundsvall, Sweden.
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Garellick G, Kärrholm J, Lindahl H, Chatziagorou G, Mukka S, Mellner C, Knutsson B, Sayed-Noor A, Sköldenberg O. Substantially higher prevalence of postoperative periprosthetic fractures in octogenarians with hip fractures operated with a cemented, polished tapered stem rather than an anatomic stem: A prospective cohort study involving 979 hips. Acta Orthop 2016; 87:653. [PMID: 27784189 PMCID: PMC5119452 DOI: 10.1080/17453674.2016.1247561] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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
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Chammout G, Muren O, Bodén H, Salemyr M, Sköldenberg O. Cemented compared to uncemented femoral stems in total hip replacement for displaced femoral neck fractures in the elderly: study protocol for a single-blinded, randomized controlled trial (CHANCE-trial). BMC Musculoskelet Disord 2016; 17:398. [PMID: 27646142 PMCID: PMC5028918 DOI: 10.1186/s12891-016-1253-y] [Citation(s) in RCA: 8] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 09/13/2016] [Indexed: 11/22/2022] Open
Abstract
Background Total hip replacement (THR) is the preferred method for the active and lucid elderly patient with a displaced femoral neck fracture (FNF). But controversy still exists regarding using cemented or uncemented stem in these patients. The aim of this study is to compare a cemented and uncemented femoral stem in patients 65–79 years treated surgically with THR for displaced FNF. Methods/design In a single-centre, single-blinded, randomized controlled trial, we will include 140 patients aged 65-79 years with an acute displaced FNF and randomize them in a 1:1 ratio to a cemented tapered or a uncemented tapered hydroxyapatite - coated femoral stem. A cemented cup will be used in both groups. The patients will be blinded for allocation. The primary endpoints will be the incidence of all hip-related complications and health-related quality of life evaluated with EuroQol-5D (EQ-5D) index up to 2 years after surgery. Secondary outcomes will be overall mortality, general medical complications and hip function. The follow-up will be at 3 months, 1 and 2 years. Further follow-ups after end of study will be at 4 and 10 years. Results will be analysed using 95 % CI’s for the effect size. A regression model will also be used to adjust for stratification factor. Discussion The ethical committee at Karolinska Institutet has approved the study. An interim analysis on the primary endpoints will be performed when half the sample size is included. The results from the study will be disseminated to the medical community via presentations and publications in relevant medical journals. The study will provide evidence if a cemented or uncemented femoral stem is preferable in THR for elderly patients with a displaced FNF. Trial registration The trial is registered at clinicaltrials.gov (NCT02247791), October 21, 2013.
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Affiliation(s)
- Ghazi Chammout
- Karolinska Institute, Department of Clinical Sciences at Danderyd hospital, Stockholm, S-182 88, Sweden
| | - Olle Muren
- Karolinska Institute, Department of Clinical Sciences at Danderyd hospital, Stockholm, S-182 88, Sweden
| | - Henrik Bodén
- Karolinska Institute, Department of Clinical Sciences at Danderyd hospital, Stockholm, S-182 88, Sweden
| | - Mats Salemyr
- Karolinska Institute, Department of Clinical Sciences at Danderyd hospital, Stockholm, S-182 88, Sweden
| | - Olof Sköldenberg
- Karolinska Institute, Department of Clinical Sciences at Danderyd hospital, Stockholm, S-182 88, Sweden.
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Thelaus Å, Pettersson T, Gordon M, Krupic F, Sköldenberg O. A Prospective Observational Cohort Study on Orthopaedic and Anaesthetic Registrars Performing Femoral Nerve Block on Patients with an Acute Hip Fracture. Surg Res Pract 2016; 2016:7512360. [PMID: 27704039 PMCID: PMC5040792 DOI: 10.1155/2016/7512360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/22/2016] [Accepted: 08/28/2016] [Indexed: 12/05/2022] Open
Abstract
We investigated if a femoral nerve block (FNB) for patients with a proximal femoral fracture (PFF) and administered by an orthopaedic registrar (OR) instead of an anaesthesiology registrar (AR) lowers the lead time to block and reduces the total amount of rescue analgesics during the preoperative phase. 205 patients were included in a prospective observational cohort study. The main outcome variable was rescue analgesics as total intravenous morphine prior to surgery. All results were adjusted for confounding using age, sex, cognitive dysfunction, and ASA classification. The OR group (n = 135) was over 2 hours faster in performing the block compared to the AR group (n = 70) but was nonetheless correlated with an increased amount of rescue analgesics during the study, 2.4 mg morphine (95% CI 0.0-4.9) more compared to the AR group. We found no difference between the groups in the risk of adverse events. We conclude that, for patients with an acute PFF and with morphine consumption as end point, how soon from arrival to hospital the patients receive a FNB is of lesser importance than who is administering it. Based on our results we recommend that emergency hospitals should have routines for anaesthesiologists performing FNB on this frail patient group.
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Affiliation(s)
- Åsa Thelaus
- Division of Orthopaedics, Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Tobias Pettersson
- Division of Anesthesiology, Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Max Gordon
- Division of Orthopaedics, Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Ferid Krupic
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Olof Sköldenberg
- Division of Orthopaedics, Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Sköldenberg O, Rysinska A, Chammout G, Salemyr M, Muren O, Bodén H, Eisler T. Migration and head penetration of Vitamin-E diffused cemented polyethylene cup compared to standard cemented cup in total hip arthroplasty: study protocol for a randomised, double-blind, controlled trial (E1 HIP). BMJ Open 2016; 6:e010781. [PMID: 27388352 PMCID: PMC4947731 DOI: 10.1136/bmjopen-2015-010781] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION In vitro, Vitamin-E-diffused, highly cross-linked polyethylene (PE) has been shown to have superior wear resistance and improved mechanical properties when compared to those of standard highly cross-linked PE liners used in total hip arthroplasty (THA). The aim of the study is to evaluate the safety of a new cemented acetabular cup with Vitamin-E-doped PE regarding migration, head penetration and clinical results. METHODS AND ANALYSIS In this single-centre, double-blinded, randomised controlled trial, we will include 50 patients with primary hip osteoarthritis scheduled for THA and randomise them in a 1:1 ratio to a cemented cup with either argon gas-sterilised PE (control group) or Vitamin-E-diffused PE (vitamin-e group). All patients and the assessor of the primary outcome will be blinded and the same uncemented stem will be used for all participants. The primary end point will be proximal migration of the cup at 2 years after surgery measured with radiostereometry. Secondary end points include proximal migration at other follow-ups, total migration, femoral head penetration, clinical outcome scores and hip-related complications. Patients will be followed up at 3 months and at 1, 2, 5 and 10 years postoperatively. RESULTS Results will be analysed using 95% CIs for the effect size. A regression model will also be used to adjust for stratification factors. ETHICS AND DISSEMINATION The ethical committee at Karolinska Institutet has approved the study. The first results from the study will be disseminated to the medical community via presentations and publications in relevant medical journals when the last patient included has been followed up for 2 years. TRIAL REGISTRATION NUMBER NCT02254980.
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Affiliation(s)
- Olof Sköldenberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Agata Rysinska
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Ghazi Chammout
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Mats Salemyr
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Olle Muren
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Bodén
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Eisler
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Mukka S, Mellner C, Knutsson B, Sayed-Noor A, Sköldenberg O. Substantially higher prevalence of postoperative peri-prosthetic fractures in octogenarians with hip fractures operated with a cemented, polished tapered stem rather than an anatomic stem. Acta Orthop 2016; 87:257-61. [PMID: 27045318 PMCID: PMC4900095 DOI: 10.3109/17453674.2016.1162898] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 01/31/2023] Open
Abstract
Background and purpose - Recent studies have demonstrated a high incidence of postoperative periprosthetic femoral fracture (PPF) in elderly patients treated with 2 commonly used cemented, polished tapered stems. We compared the prevalence and incidence rate of PPF in a consecutive cohort of octagenerians with femoral neck fractures (FNFs) treated with either a collarless, polished tapered (CPT) stem or an anatomic matte stem (Lubinus SP2). Patients and methods - In a multicenter, prospective cohort study, we included 979 hips in patients aged 80 years and above (72% females, median age 86 (80-102) years) with a femoral neck fracture as indication for surgery. 69% of the patients were classified as ASA class 3 or 4. Hip-related complications and repeat surgery were assessed at a median follow-up of 20 (0-24) months postoperatively. Results - 22 hips (2.2%) sustained a PPF at a median of 7 (0-22) months postoperatively; 14 (64%) were Vancouver B2 fractures. 7 of the 22 surgically treated fractures required revision surgery, mainly due to deep infection. The cumulative incidence of PPFs was 3.8% in the CPT group, as compared with 0.2% in the SP2 group (p < 0.001). The risk ratio (RR) was 16 (95% CI: 2-120) using the SP2 group as denominator. Interpretation - The CPT stem was associated with a higher risk of PPF than the SP2 stem. We suggest that the tapered CPT stem should not be used for the treatment of femoral neck fractures in patients over 80 years.
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Affiliation(s)
- Sebastian Mukka
- Department of Orthopedics, Sundsvall Hospital, Sundsvall, and Department of Surgical and Perioperative Sciences, Umeå University, Umeå;;,Correspondence:
| | - Carl Mellner
- Department of Orthopedics, Sundsvall Hospital, Sundsvall, and Department of Surgical and Perioperative Sciences, Umeå University, Umeå;;
| | - Björn Knutsson
- Department of Orthopedics, Sundsvall Hospital, Sundsvall, and Department of Surgical and Perioperative Sciences, Umeå University, Umeå;;,Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala;
| | - Arkan Sayed-Noor
- Department of Orthopedics, Sundsvall Hospital, Sundsvall, and Department of Surgical and Perioperative Sciences, Umeå University, Umeå;;
| | - Olof Sköldenberg
- Department of Orthopedics, Danderyd Hospital and Karolinska Institutet, Stockholm, and Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
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