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Korthagen NM, Houtman E, Boone I, Coutinho de Almeida R, Sivasubramaniyan K, Mahdad R, Nelissen RGHH, Ramos YFM, Tessari MA, Meulenbelt I. Thyroid hormone induces ossification and terminal maturation in a preserved OA cartilage biomimetic model. Arthritis Res Ther 2024; 26:91. [PMID: 38664820 PMCID: PMC11044551 DOI: 10.1186/s13075-024-03326-5] [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] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 04/21/2024] [Indexed: 04/29/2024] Open
Abstract
OBJECTIVE To characterize aspects of triiodothyronine (T3) induced chondrocyte terminal maturation within the molecular osteoarthritis pathophysiology using the previously established T3 human ex vivo osteochondral explant model. DESIGNS RNA-sequencing was performed on explant cartilage obtained from OA patients (n = 8), that was cultured ex vivo with or without T3 (10 ng/ml), and main findings were validated using RT-qPCR in an independent sample set (n = 22). Enrichment analysis was used for functional clustering and comparisons with available OA patient RNA-sequencing and GWAS datasets were used to establish relevance for OA pathophysiology by linking to OA patient genomic profiles. RESULTS Besides the upregulation of known hypertrophic genes EPAS1 and ANKH, T3 treatment resulted in differential expression of 247 genes with main pathways linked to extracellular matrix and ossification. CCDC80, CDON, ANKH and ATOH8 were among the genes found to consistently mark early, ongoing and terminal maturational OA processes in patients. Furthermore, among the 37 OA risk genes that were significantly affected in cartilage by T3 were COL12A1, TNC, SPARC and PAPPA. CONCLUSIONS RNA-sequencing results show that metabolic activation and recuperation of growth plate morphology are induced by T3 in OA chondrocytes, indicating terminal maturation is accelerated. The molecular mechanisms involved in hypertrophy were linked to all stages of OA pathophysiology and will be used to validate disease models for drug testing.
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Affiliation(s)
- N M Korthagen
- Department Biomedical Data Sciences, Section of Molecular Epidemiology, LUMC, Einthovenweg 20, Postzone S05-P, 2333 ZC, Leiden, The Netherlands
| | - E Houtman
- Department Biomedical Data Sciences, Section of Molecular Epidemiology, LUMC, Einthovenweg 20, Postzone S05-P, 2333 ZC, Leiden, The Netherlands
| | - I Boone
- Department Biomedical Data Sciences, Section of Molecular Epidemiology, LUMC, Einthovenweg 20, Postzone S05-P, 2333 ZC, Leiden, The Netherlands
| | - R Coutinho de Almeida
- Department Biomedical Data Sciences, Section of Molecular Epidemiology, LUMC, Einthovenweg 20, Postzone S05-P, 2333 ZC, Leiden, The Netherlands
| | - K Sivasubramaniyan
- Galapagos BV, Willem Einthovenstraat 13, Oegstgeest, 2342 BH, The Netherlands
| | - R Mahdad
- Alrijne hospital, Simon Smitweg 1, Leiderdorp, 2353 GA, The Netherlands
| | - R G H H Nelissen
- Department Biomedical Data Sciences, Section of Molecular Epidemiology, LUMC, Einthovenweg 20, Postzone S05-P, 2333 ZC, Leiden, The Netherlands
| | - Y F M Ramos
- Department Biomedical Data Sciences, Section of Molecular Epidemiology, LUMC, Einthovenweg 20, Postzone S05-P, 2333 ZC, Leiden, The Netherlands
| | - M A Tessari
- Galapagos BV, Willem Einthovenstraat 13, Oegstgeest, 2342 BH, The Netherlands
| | - I Meulenbelt
- Department Biomedical Data Sciences, Section of Molecular Epidemiology, LUMC, Einthovenweg 20, Postzone S05-P, 2333 ZC, Leiden, The Netherlands.
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Gadgaard NR, Varnum C, Nelissen RGHH, Vandenbroucke-Grauls C, Sørensen HT, Pedersen AB. Comorbidity and risk of infection among patients with hip fracture: a Danish population-based cohort study. Osteoporos Int 2023; 34:1739-1749. [PMID: 37330437 PMCID: PMC10511604 DOI: 10.1007/s00198-023-06823-6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/06/2023] [Indexed: 06/19/2023]
Abstract
Impact of comorbidity on infection risk among hip fracture patients is unclear. We found high incidence of infection. Comorbidity was an important risk factor for infection up to 1 year after surgery. Results indicates a need for additional investment in pre- and postoperative programs that assist patients with high comorbidity. PURPOSE Comorbidity level and incidence of infection have increased among older patients with hip fracture. The impact of comorbidity on infection risk is unclear. We conducted a cohort study examining the absolute and relative risks of infection in relation to comorbidity level among hip fracture patients. METHODS Utilizing Danish population-based medical registries, we identified 92,600 patients aged ≥ 65 years undergoing hip fracture surgery between 2004 and 2018. Comorbidity was categorized by Charlson comorbidity index scores (CCI): none (CCI = 0), moderate (CCI = 1-2), or severe (CCI ≥ 3). Primary outcome was any hospital-treated infection. Secondary outcomes were hospital-treated pneumonia, urinary tract infection, sepsis, reoperation due to surgical-site infection (SSI), and a composite of any hospital- or community-treated infection. We calculated cumulative incidence and hazard ratios (aHRs) adjusted for age, sex, and surgery year, including 95% confidence intervals (CIs). RESULTS Prevalence of moderate and severe comorbidity was 40% and 19%, respectively. Incidence of any hospital-treated infection increased with comorbidity level within 0-30 days (none 13% vs. severe 20%) and 0-365 days (none 22% vs. 37% severe). Patients with moderate and severe comorbidity, compared to no comorbidity, had aHRs of 1.3 (CI: 1.3-1.4) and 1.6 (CI: 1.5-1.7) within 0-30 days, and 1.4 (CI: 1.4-1.5) and 1.9 (CI: 1.9-2.0) within 0-365, respectively. Highest incidence was observed for any hospital- or community-treated infection (severe 72%) within 0-365 days. Highest aHR was observed for sepsis within 0-365 days (severe vs. none: 2.7 (CI: 2.4-2.9)). CONCLUSION Comorbidity is an important risk factor for infection up to 1 year after hip fracture surgery.
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Affiliation(s)
- N R Gadgaard
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Olof Palmes Allé 43, 8200, Aarhus, Denmark.
| | - C Varnum
- Department of Orthopedic Surgery, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - R G H H Nelissen
- Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands
| | - C Vandenbroucke-Grauls
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Olof Palmes Allé 43, 8200, Aarhus, Denmark
- Department of Medical Microbiology and Infection Control, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - H T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Olof Palmes Allé 43, 8200, Aarhus, Denmark
| | - A B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Olof Palmes Allé 43, 8200, Aarhus, Denmark
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Tuerlings M, Janssen GMC, Boone I, van Hoolwerff M, Rodriguez Ruiz A, Houtman E, Suchiman HED, van der Wal RJP, Nelissen RGHH, Coutinho de Almeida R, van Veelen PA, Ramos YFM, Meulenbelt I. WWP2 confers risk to osteoarthritis by affecting cartilage matrix deposition via hypoxia associated genes. Osteoarthritis Cartilage 2023; 31:39-48. [PMID: 36208715 DOI: 10.1016/j.joca.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/12/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To explore the co-expression network of the osteoarthritis (OA) risk gene WWP2 in articular cartilage and study cartilage characteristics when mimicking the effect of OA risk allele rs1052429-A on WWP2 expression in a human 3D in vitro model of cartilage. METHOD Co-expression behavior of WWP2 with genes expressed in lesioned OA articular cartilage (N = 35 samples) was explored. By applying lentiviral particle mediated WWP2 upregulation in 3D in vitro pellet cultures of human primary chondrocytes (N = 8 donors) the effects of upregulation on cartilage matrix deposition was evaluated. Finally, we transfected primary chondrocytes with miR-140 mimics to evaluate whether miR-140 and WWP2 are involved in similar pathways. RESULTS Upon performing Spearman correlations in lesioned OA cartilage, 98 highly correlating genes (|ρ| > 0.7) were identified. Among these genes, we identified GJA1, GDF10, STC2, WDR1, and WNK4. Subsequent upregulation of WWP2 on 3D chondrocyte pellet cultures resulted in a decreased expression of COL2A1 and ACAN and an increase in EPAS1 expression. Additionally, we observed a decreased expression of GDF10, STC2, and GJA1. Proteomics analysis identified 42 proteins being differentially expressed with WWP2 upregulation, which were enriched for ubiquitin conjugating enzyme activity. Finally, upregulation of miR-140 in 2D chondrocytes resulted in significant upregulation of WWP2 and WDR1. CONCLUSIONS Mimicking the effect of OA risk allele rs1052429-A on WWP2 expression initiates detrimental processes in the cartilage shown by a response in hypoxia associated genes EPAS1, GDF10, and GJA1 and a decrease in anabolic markers, COL2A1 and ACAN.
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Affiliation(s)
- M Tuerlings
- Dept. of Biomedical Data Sciences, Section Molecular Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - G M C Janssen
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, the Netherlands.
| | - I Boone
- Dept. of Biomedical Data Sciences, Section Molecular Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - M van Hoolwerff
- Dept. of Biomedical Data Sciences, Section Molecular Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - A Rodriguez Ruiz
- Dept. of Biomedical Data Sciences, Section Molecular Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - E Houtman
- Dept. of Biomedical Data Sciences, Section Molecular Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - H E D Suchiman
- Dept. of Biomedical Data Sciences, Section Molecular Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - R J P van der Wal
- Dept. Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands.
| | - R G H H Nelissen
- Dept. Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands.
| | - R Coutinho de Almeida
- Dept. of Biomedical Data Sciences, Section Molecular Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - P A van Veelen
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, the Netherlands.
| | - Y F M Ramos
- Dept. of Biomedical Data Sciences, Section Molecular Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - I Meulenbelt
- Dept. of Biomedical Data Sciences, Section Molecular Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
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Pijls BG, Sanders IMJG, Kuijper EJ, Nelissen RGHH. Effectiveness of mechanical cleaning, antibiotics, and induction heating on eradication of Staphylococcus aureus in mature biofilms. Bone Joint Res 2022; 11:629-638. [PMID: 36047617 PMCID: PMC9533241 DOI: 10.1302/2046-3758.119.bjr-2022-0010.r1] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims Here we used a mature seven-day biofilm model of Staphylococcus aureus, exposed to antibiotics up to an additional seven days, to establish the effectiveness of either mechanical cleaning or antibiotics or non-contact induction heating, and which combinations could eradicate S. aureus in mature biofilms. Methods Mature biofilms of S. aureus (ATCC 29213) were grown on titanium alloy (Ti6Al4V) coupons for seven days and were subjected to the following treatments or their combinations: antibiotics, mechanical cleaning, or heat shock by induction heating of 60°C for one minute. Experiments were repeated at least five times. Results In the untreated biofilm, growth up to 1.8×1011 colony-forming units (CFU)/cm2 was observed. Treatment with ciprofloxacin, flucloxacillin, vancomycin, cefuroxime, and amoxicillin all with rifampicin gave 6.0 log, 6.1 log, 1.4 log, 4.8 log, and 3.6 log reduction in CFU/cm2, respectively. Mechanical cleaning alone resulted in 4.9 log reduction and induction heating in 7.3 log reduction. There was an additional effect of ciprofloxacin, flucloxacillin, and induction heating when used in combinations. There was no additional effect for mechanical cleaning. No bacterial growth could be detected after induction heating followed by seven days of ciprofloxacin with rifampicin. Conclusion Mechanical cleaning, antibiotics, and non-contact induction heating reduced the bacterial load of mature S. aureus biofilms with approximately 5 log or more as a single treatment. The effect of mechanical cleaning on mature S. aureus biofilms was limited when used in combination with antibiotics and/or induction heating. Cite this article: Bone Joint Res 2022;11(9):629–638.
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Affiliation(s)
- B G Pijls
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Ingrid M J G Sanders
- Department of Medical Microbiology, Section Experimental Bacteriology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ed J Kuijper
- Department of Medical Microbiology, Section Experimental Bacteriology, Leiden University Medical Center, Leiden, The Netherlands
| | - R G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
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Op de Coul LS, Bleeker S, de Groot JH, Nelissen RGHH, Steenbeek D. Elbow flexion contractures in neonatal brachial plexus palsy: A one-year comparison of dynamic orthosis and serial casting. Clin Rehabil 2022; 37:72-85. [PMID: 36004384 DOI: 10.1177/02692155221121011] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Elbow flexion contractures are common complications of neonatal brachial plexus palsy, but evidence on how to treat these contractures is weak. This study compared the treatment of elbow flexion contractures using a dynamic orthosis or serial circular casting. METHODS A randomized controlled trial was conducted with one-year follow-up. Children with an elbow flexion contracture of ≥30° were treated with either a night-worn dynamic orthosis for one year or serial casting for four weeks followed by night splinting. For pragmatic reasons, some participants were included in an open part of this study, this group was also analyzed separately. Degree of contracture and goal attainment scaling was evaluated at baseline and after 8, 20 and 54 weeks. RESULTS 55 patients were analyzed in this trial, 32 of whom were randomized to treatment. At one-year follow-up of the randomized group, both dynamic splinting (median -8.5°, interquartile range [IQR] -13.5, -5) and serial casting (median -11.0°, IQR -16, -5) resulted in significant reduction of contracture (P < 0.001). The reduction was significantly greater with serial casting in the first 20 weeks, but not at one-year follow-up (P = 0.683). In the entire cohort, the individual functional goals had been reached in 24 out of 32 cases (80%) of dynamic splinting and 18 out of 23 cases (82%) of serial casting, respectively. CONCLUSION The dynamic night orthosis is comparable to serial casting for treating elbow flexion contractures in children with brachial plexus birth injury. We recommend selecting one of these treatment modalities in close consultation with parents and patients.
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Affiliation(s)
- L S Op de Coul
- Department of Rehabilitation, 4501Leiden University Medical Center, Leiden, Netherlands
| | - S Bleeker
- Department of Rehabilitation, Hand & Pols Centrum, Den Haag, Netherlands
| | - J H de Groot
- Department of Rehabilitation, 4501Leiden University Medical Center, Leiden, Netherlands
| | - R G H H Nelissen
- Department of Orthopedics, 4501Leiden University Medical Center, Leiden, Netherlands
| | - D Steenbeek
- Department of Rehabilitation, 4501Leiden University Medical Center, Leiden, Netherlands
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Vrouwe JPM, Meulenberg JJM, Klarenbeek NB, Navas-Cañete A, Reijnierse M, Ruiterkamp G, Bevaart L, Lamers RJ, Kloppenburg M, Nelissen RGHH, Huizinga TWJ, Burggraaf J, Kamerling IMC. Administration of an adeno-associated viral vector expressing interferon-β in patients with inflammatory hand arthritis, results of a phase I/II study. Osteoarthritis Cartilage 2022; 30:52-60. [PMID: 34626797 DOI: 10.1016/j.joca.2021.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 09/17/2021] [Accepted: 09/30/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Inflammatory hand arthritis (IHA) results in impaired function. Local gene therapy with ART-I02, a recombinant adeno-associated virus (AAV) serotype 5 vector expressing interferon (IFN)-β, under the transcriptional control of nuclear factor κ-B responsive promoter, was preclinically shown to have favorable effects. This study aimed to investigate the safety and tolerability of local gene therapy with ART-I02 in patients with IHA. METHODS In this first-in-human, dose-escalating, cohort study, 12 IHA patients were to receive a single intra-articular (IA) injection of ART-I02 ranging 0.3 × 1012-1.2 × 1013 genome copies in an affected hand joint. Adverse events (AEs), routine safety laboratory and the clinical course of disease were periodically evaluated. Baseline- and follow-up contrast enhanced magnetic resonance images (MRIs), shedding of viral vectors in bodily fluids, and AAV5 and IFN-β immune responses were evaluated. A data review committee provided safety recommendations. RESULTS Four patients were enrolled. Long-lasting local AEs were observed in 3 patients upon IA injection of ART-I02. The AEs were moderate in severity and could be treated conservative. Given the duration of the AEs and their possible or probable relation to ART-I02, no additional patients were enrolled. No systemic treatment emergent AEs were observed. The MRIs reflected the AEs by (peri)arthritis. No T-cell response against AAV5 or IFN-β, nor IFN-β antibodies could be detected. Neutralizing antibody titers against AAV5 raised post-dose. CONCLUSION Single IA doses of 0.6 × 1012 or 1.2 × 1012 ART-I02 vector genomes were administered without systemic side effects or serious AEs. However, local tolerability was insufficient for continuation. TRIAL REGISTRATION NCT02727764.
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Affiliation(s)
- J P M Vrouwe
- Centre for Human Drug Research, Zernikedreef 8, Leiden, 2333 CL, the Netherlands; Leiden University Medical Center (LUMC), Albinusdreef 2, Leiden, 2333 ZA, the Netherlands
| | - J J M Meulenberg
- Department of Oncology, Arthrogen B.V., Meibergdreef 45, Amsterdam, 1005BA, the Netherlands
| | - N B Klarenbeek
- Centre for Human Drug Research, Zernikedreef 8, Leiden, 2333 CL, the Netherlands; Leiden University Medical Center, Department of Internal Medicine, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands
| | - A Navas-Cañete
- Leiden University Medical Center, Department of Radiology, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands.
| | - M Reijnierse
- Leiden University Medical Center, Department of Radiology, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands
| | - G Ruiterkamp
- Department of Oncology, Arthrogen B.V., Meibergdreef 45, Amsterdam, 1005BA, the Netherlands
| | - L Bevaart
- Department of Oncology, Arthrogen B.V., Meibergdreef 45, Amsterdam, 1005BA, the Netherlands
| | - R J Lamers
- Department of Oncology, Arthrogen B.V., Meibergdreef 45, Amsterdam, 1005BA, the Netherlands
| | - M Kloppenburg
- Leiden University Medical Center, Department of Rheumatology, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands
| | - R G H H Nelissen
- Leiden University Medical Center, Department of Orthopaedics, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands
| | - T W J Huizinga
- Leiden Academic Centre for Drug Research, PO box 9500, Leiden, 2300 RA, the Netherlands
| | - J Burggraaf
- Centre for Human Drug Research, Zernikedreef 8, Leiden, 2333 CL, the Netherlands; Leiden University Medical Center, Department of Internal Medicine, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands; Leiden Academic Centre for Drug Research, PO box 9500, Leiden, 2300 RA, the Netherlands
| | - I M C Kamerling
- Centre for Human Drug Research, Zernikedreef 8, Leiden, 2333 CL, the Netherlands; Leiden University Medical Center, Department of Infectious Diseases, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands.
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7
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Rietbergen T, Marang-van de Mheen PJ, de Graaf J, Diercks RL, Janssen RPA, van der Linden-van der Zwaag HMJ, van den Akker-van Marle ME, Steyerberg EW, Nelissen RGHH, van Bodegom-Vos L, Hofstee DJ, van Geenen RCI, Koenraadt KLM, Onderwater JPAH, Kleinlugtenbelt YV, Gosens T, Klos TVS, Rijk PC, Dijkstra B, Zeegers AVCM, Hoogeslag RAG, Veld MHAHI, Polak AA, Pereira NRP, Vervest TMJS, van der Veen HC, Lopuhaä N. A tailored intervention does not reduce low value MRI's and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:4134-4143. [PMID: 35391552 PMCID: PMC9668785 DOI: 10.1007/s00167-022-06949-w] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the effectiveness of a tailored intervention to reduce low value MRIs and arthroscopies among patients ≥ 50 years with degenerative knee disease in 13 Dutch orthopaedic centers (intervention group) compared with all other Dutch orthopaedic centers (control group). METHODS All patients with degenerative knee disease ≥ 50 years admitted to Dutch orthopaedic centers from January 2016 to December 2018 were included. The tailored intervention included participation of clinical champions, education on the Dutch Choosing Wisely recommendation for MRI's and arthroscopies in degenerative knee disease, training of orthopaedic surgeons to manage patient expectations, performance feedback, and provision of a patient brochure. A difference-in-difference analysis was used to compare the time trend before (admitted January 2016-June 2017) and after introduction of the intervention (July 2017-December 2018) between intervention and control hospitals. Primary outcome was the monthly percentage of patients receiving a MRI or knee arthroscopy, weighted by type of hospital. RESULTS 136,446 patients were included, of whom 32,163 were treated in the intervention hospitals. The weighted percentage of patients receiving a MRI on average declined by 0.15% per month (β = - 0.15, P < 0.001) and by 0.19% per month for arthroscopy (β = - 0.19, P < 0.001). However, these changes over time did not differ between intervention and control hospitals, neither for MRI (β = - 0.74, P = 0.228) nor arthroscopy (β = 0.13, P = 0.688). CONCLUSIONS The extent to which patients ≥ 50 years with degenerative knee disease received a MRI or arthroscopy declined significantly over time, but could not be attributed to the tailored intervention. This secular downward time trend may reflect anoverall focus of reducing low value care in The Netherlands. LEVEL OF EVIDENCE III.
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Affiliation(s)
- T. Rietbergen
- grid.10419.3d0000000089452978Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - P. J. Marang-van de Mheen
- grid.10419.3d0000000089452978Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - J. de Graaf
- grid.10419.3d0000000089452978Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - R. L. Diercks
- grid.4494.d0000 0000 9558 4598Department of Orthopaedics, University Medical Center Groningen, Groningen, The Netherlands
| | - R. P. A. Janssen
- grid.414711.60000 0004 0477 4812Department of Orthopaedic Surgery and Trauma, Maxima Medical Center, Eindhoven, The Netherlands ,grid.6852.90000 0004 0398 8763Orthopaedic Biomechanics, Department Of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands ,grid.448801.10000 0001 0669 4689Chair Value-Based Health Care, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | | | - M. E. van den Akker-van Marle
- grid.10419.3d0000000089452978Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - E. W. Steyerberg
- grid.10419.3d0000000089452978Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - R. G. H. H. Nelissen
- grid.10419.3d0000000089452978Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - L. van Bodegom-Vos
- grid.10419.3d0000000089452978Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC Leiden, The Netherlands
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Rietbergen T, Marang-van de Mheen PJ, Diercks RL, Janssen RPA, van der Linden-van der Zwaag HMJ, Nelissen RGHH, Steyerberg EW, van Bodegom-Vos L. Performing a knee arthroscopy among patients with degenerative knee disease: one-third is potentially low value care. Knee Surg Sports Traumatol Arthrosc 2022; 30:1568-1574. [PMID: 34146116 PMCID: PMC9033717 DOI: 10.1007/s00167-021-06615-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 05/17/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to assess in which proportion of patients with degenerative knee disease aged 50+ in whom a knee arthroscopy is performed, no valid surgical indication is reported in medical records, and to explore possible explanatory factors. METHODS A retrospective study was conducted using administrative data from January to December 2016 in 13 orthopedic centers in the Netherlands. Medical records were selected from a random sample of 538 patients aged 50+ with degenerative knee disease in whom arthroscopy was performed, and reviewed on reported indications for the performed knee arthroscopy. Valid surgical indications were predefined based on clinical national guidelines and expert opinion (e.g., truly locked knee). A knee arthroscopy without a reported valid indication was considered potentially low value care. Multivariate logistic regression analysis was performed to assess whether age, diagnosis ("Arthrosis" versus "Meniscal lesion"), and type of care trajectory (initial or follow-up) were associated with performing a potentially low value knee arthroscopy. RESULTS Of 26,991 patients with degenerative knee disease, 2556 (9.5%) underwent an arthroscopy in one of the participating orthopedic centers. Of 538 patients in whom an arthroscopy was performed, 65.1% had a valid indication reported in the medical record and 34.9% without a reported valid indication. From the patients without a valid indication, a joint patient-provider decision or patient request was reported as the main reason. Neither age [OR 1.013 (95% CI 0.984-1.043)], diagnosis [OR 0.998 (95% CI 0.886-1.124)] or type of care trajectory [OR 0.989 (95% CI 0.948-1.032)] were significantly associated with performing a potentially low value knee arthroscopy. CONCLUSIONS In a random sample of knee arthroscopies performed in 13 orthopedic centers in 2016, 65% had valid indications reported in the medical records but 35% were performed without a reported valid indication and, therefore, potentially low value care. Patient and/or surgeons preference may play a large role in the decision to perform an arthroscopy without a valid indication. Therefore, interventions should be developed to increase adherence to clinical guidelines by surgeons that target invalid indications for a knee arthroscopy to improve care. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- T Rietbergen
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC, Leiden, the Netherlands
| | - P J Marang-van de Mheen
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC, Leiden, the Netherlands
| | - R L Diercks
- Department of Orthopaedics, University Medical Center Groningen, Groningen, the Netherlands
| | - R P A Janssen
- Department of Orthopaedics, Máxima Medical Center, Eindhoven, the Netherlands
| | | | - R G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - E W Steyerberg
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC, Leiden, the Netherlands
| | - L van Bodegom-Vos
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.
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9
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Fraser AG, Nelissen RGHH, Kjærsgaard-Andersen P, Szymański P, Melvin T, Piscoi P. Improved clinical investigation and evaluation of high-risk medical devices: the rationale and objectives of CORE-MD (Coordinating Research and Evidence for Medical Devices). Eur Heart J Qual Care Clin Outcomes 2021; 8:249-258. [PMID: 34448829 PMCID: PMC9071523 DOI: 10.1093/ehjqcco/qcab059] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022]
Abstract
In the European Union (EU) the delivery of health services is a national responsibility but there are concerted actions between member states to protect public health. Approval of pharmaceutical products is the responsibility of the European Medicines Agency, while authorising the placing on the market of medical devices is decentralised to independent 'conformity asssessment' organisations called notified bodies. The first legal basis for an EU system of evaluating medical devices and approving their market access was the medical device directives, from the 1990s. Uncertainties about clinical evidence requirements, among other reasons, led to the EU Medical Device Regulation (2017/745) that has applied since May 2021. It provides general principles for clinical investigations but few methodological details ‒ which challenges responsible authorities to set appropriate balances between regulation and innovation, pre- and post-market studies, and clinical trials and real-world evidence. Scientific experts should advise on methods and standards for assessing and approving new high-risk devices, and safety, efficacy, and transparency of evidence should be paramount. The European Commission recently awarded a Horizon 2020 grant to a consortium led by the European Society of Cardiology and the European Federation of National Associations of Orthopaedics and Traumatology, that will review methodologies of clinical investigations, advise on study designs, and develop recommendations for aggregating clinical data from registries and other real-world sources. The CORE‒MD project (Coordination of Research and Evidence for Medical Devices) will run until March 2024; here we describe how it may contribute to the development of regulatory science in Europe.
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Affiliation(s)
- A G Fraser
- Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK
| | - R G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - P Kjærsgaard-Andersen
- Department of Orthopaedics, Vejle Hospital, South Danish University, DK-7100 Vejle, Denmark
| | - P Szymański
- Centre of Postgraduate Medical Education, MSWiA Central Clinical Hospital, ul. Woloska 137, 02-507 Warsaw, Poland
| | - T Melvin
- Healthcare Products Regulatory Authority, Earlsfort Terrace, Dublin 2, Ireland
| | - P Piscoi
- Health Technology Unit B6, Directorate General for Health (DG SANTE), European Commission, Brussels, Belgium
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10
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Houtman E, Coutinho de Almeida R, Tuerlings M, Suchiman HED, Broekhuis D, Nelissen RGHH, Ramos YFM, van Meurs JBJ, Meulenbelt I. Characterization of dynamic changes in Matrix Gla Protein (MGP) gene expression as function of genetic risk alleles, osteoarthritis relevant stimuli, and the vitamin K inhibitor warfarin. Osteoarthritis Cartilage 2021; 29:1193-1202. [PMID: 33984465 DOI: 10.1016/j.joca.2021.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/25/2020] [Revised: 04/28/2021] [Accepted: 05/05/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We here aimed to characterize changes of Matrix Gla Protein (MGP) expression in relation to its recently identified OA risk allele rs1800801-T in OA cartilage, subchondral bone and human ex vivo osteochondral explants subjected to OA related stimuli. Given that MGP function depends on vitamin K bioavailability, we studied the effect of frequently prescribed vitamin K antagonist warfarin. METHODS Differential (allelic) mRNA expression of MGP was analyzed using RNA-sequencing data of human OA cartilage and subchondral bone. Human osteochondral explants were used to study exposures to interleukin one beta (IL-1β; inflammation), triiodothyronine (T3; Hypertrophy), warfarin, or 65% mechanical stress (65%MS) as function of rs1800801 genotypes. RESULTS We confirmed that the MGP risk allele rs1800801-T was associated with lower expression and that MGP was significantly upregulated in lesioned as compared to preserved OA tissues, mainly in risk allele carriers, in both cartilage and subchondral bone. Moreover, MGP expression was downregulated in response to OA like triggers in cartilage and subchondral bone and this effect might be reduced in carriers of the rs1800801-T risk allele. Finally, warfarin treatment in cartilage increased COL10A1 and reduced SOX9 and MMP3 expression and in subchondral bone reduced COL1A1 and POSTN expression. DISCUSSION & CONCLUSIONS Our data highlights that the genetic risk allele lowers MGP expression and upon OA relevant triggers may hamper adequate dynamic changes in MGP expression, mainly in cartilage. The determined direct negative effect of warfarin on human explant cultures functionally underscores the previously found association between vitamin K deficiency and OA.
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Affiliation(s)
- E Houtman
- Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - R Coutinho de Almeida
- Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - M Tuerlings
- Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - H E D Suchiman
- Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - D Broekhuis
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - R G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Y F M Ramos
- Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - J B J van Meurs
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - I Meulenbelt
- Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
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11
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Leichtenberg CS, van Tol FR, Gademan MGJ, Krom T, Tilbury C, Horemans HLD, Bussmann JBJ, Verdegaal SHM, Marijnissen WJCM, Nelissen RGHH, Vliet Vlieland TPM. Are pain, functional limitations and quality of life associated with objectively measured physical activity in patients with end-stage osteoarthritis of the hip or knee? Knee 2021; 29:78-85. [PMID: 33582594 DOI: 10.1016/j.knee.2020.12.019] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/31/2020] [Accepted: 12/21/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Physical activity is promoted in patients with hip or knee osteoarthritis (OA), yet little is known about its relationship with symptoms, functional limitations and Quality of Life (QoL). We investigated if OA-associated pain, functional limitations and QoL are associated with objectively measured physical activity in patients with end-stage hip/knee OA. METHODS Cross-sectional study including patients scheduled for primary total hip/knee arthroplasty. Patients wore an accelerometer (Activ8) with physical activity assessed over waking hours, and expressed as number of activity daily counts (ADC) per hour, %time spent on physical activity i.e. walking, cycling or running (%PA), and %time spent sedentary (%SB). Pain, functional limitations and joint-specific and general QoL were assessed with the Hip disability/Knee Injury and Osteoarthritis Outcome Score (HOOS/KOOS) and the Short Form (SF)-12. Multivariate linear regression models with the three to Z-scores transformed parameters of physical activity as dependent variables and adjusted for confounding, were conducted. RESULTS 49 hip and 48 knee OA patients were included. In hip and knee OA patients the mean number of ADC, %PA and %SB were 18.79 ± 7.25 and 21.19 ± 6.16, 14 ± 6.4 and 15 ± 5.0, and 66 ± 10.5 and 68 ± 8.7, respectively. In hip OA, better joint-specific and general QoL were associated with more ADC, (β 0.028; 95%CI:0.007-0.048, β0.041; 95%CI:0.010-0.071). Also, better general QoL was associated with the %PA (β 0.040, 95%CI:0.007-0.073). No other associations were found. CONCLUSION Whereas QoL was associated with physical activity in hip OA, pain and functional limitations were not related to objectively measured physical activity in patients with end-stage hip or knee OA.
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Affiliation(s)
- C S Leichtenberg
- Leiden University Medical Center, Department of Orthopaedics, Leiden, the Netherlands
| | - F R van Tol
- Leiden University Medical Center, Department of Orthopaedics, Leiden, the Netherlands
| | - M G J Gademan
- Leiden University Medical Center, Department of Orthopaedics, Leiden, the Netherlands; Leiden University Medical Center, Department of Clinical Epidemiology, Leiden, the Netherlands.
| | - T Krom
- Leiden University Medical Center, Department of Orthopaedics, Leiden, the Netherlands
| | - C Tilbury
- Leiden University Medical Center, Department of Orthopaedics, Leiden, the Netherlands
| | - H L D Horemans
- Erasmus MC University Medical Center, Department of Rehabilitation Medicine, Rotterdam, the Netherlands
| | - J B J Bussmann
- Erasmus MC University Medical Center, Department of Rehabilitation Medicine, Rotterdam, the Netherlands
| | - S H M Verdegaal
- Alrijne Hospital, Department of Orthopaedics, Leiderdorp, the Netherlands
| | - W J C M Marijnissen
- Albert Schweitzer Hospital, Department of Orthopaedics, Dordrecht, the Netherlands
| | - R G H H Nelissen
- Leiden University Medical Center, Department of Orthopaedics, Leiden, the Netherlands
| | - T P M Vliet Vlieland
- Leiden University Medical Center, Department of Orthopaedics, Leiden, the Netherlands; Sophia Rehabilitation Center, The Hague, the Netherlands; Rijnlands Rehabilitation Center, Leiden, the Netherlands
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12
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Rassir R, Nolte PA, van der Lugt JCT, Nelissen RGHH, Sierevelt IN, Verra WC. No differences in cost-effectiveness and short-term functional outcomes between cemented and uncemented total knee arthroplasty. BMC Musculoskelet Disord 2020; 21:448. [PMID: 32646453 PMCID: PMC7350734 DOI: 10.1186/s12891-020-03477-x] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/05/2020] [Indexed: 11/23/2022] Open
Abstract
Background There is an ongoing debate regarding optimal fixation of total knee arthroplasty (TKA), however cost has not been addressed as profoundly. Therefore, the current study primarily aimed to compare costs and cost-effectiveness 1 year after cemented or uncemented TKA. A secondary objective was to compare short-term functional outcomes between both groups. Methods A posthoc prospective observational multicenter cohort study of 60 cemented and 50 uncemented Low Contact Stress (LCS) knee systems. Outcome was evaluated using the EuroQol5D-3 L (EQ5D) index, in order to calculate quality adjusted life years (QALYs). Total costs were calculated considering direct costs within the hospital setting (inpatient cost) as well as direct and indirect costs outside the hospital. Cost-effectiveness (total costs per QALY), Oxford Knee Score (OKS) and Numeric Rating Scale (NRS) were compared between cemented and uncemented cases at 1 year after surgery. HealthBASKET project, a micro-costing approach, represents the Dutch costs and situation and was used to calculate hospital stay. (In) direct costs outside the healthcare (medical cost and productivity cost) were determined using two validated questionnaires. Results Median costs per QALY were similar between cemented and uncemented TKA patients (€16,269 and €17,727 respectively; p = 0.50). Median OKS (44 and 42; p = 0.79), EQ5D (0.88 and 0.90; p = 0.82) and NRS for pain (1.0 and 1.0; p = 0.48) and satisfaction (9.0 and 9.0; p = 0.15) were also comparable between both groups. Conclusion For this type of knee implant (LCS), inpatient hospital costs and costs after hospitalization were comparable between groups.
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Affiliation(s)
- R Rassir
- Department of Orthopaedic Surgery, Spaarne Hospital, Spaarnepoort 1, 2134, TM, Hoofddorp, the Netherlands.
| | - P A Nolte
- Department of Orthopaedic Surgery, Spaarne Hospital, Spaarnepoort 1, 2134, TM, Hoofddorp, the Netherlands
| | - J C T van der Lugt
- Department of Orthopaedic Surgery, Haga Hospital, The Hague, the Netherlands
| | - R G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - I N Sierevelt
- Spaarne Academy, Department of Epidemiology, Spaarne Hospital, Hoofddorp, the Netherlands
| | - W C Verra
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands.,Department of Orthopaedic Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
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13
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Latijnhouwers DAJM, Martini CH, Nelissen RGHH, Van der Linden HMJ, Vliet Vlieland TPM, Gademan MGJ. FRI0412 DOES SEVERE ACUTE POSTOPERATIVE PAIN RESULT IN MORE LONG-TERM PAIN AFTER TOTAL HIP OR KNEE ARTHROPLASTY (THA OR TKA) FOR OSTEOARTHRITIS? Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.493] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Chronic pain is a frequently reported unfavourable outcome of total hip and knee arthroplasties (THA/TKA) (7-23% and 10-34%, respectively) in osteoarthritis (OA) patients (1), which is difficult to treat as underlying mechanisms are not fully understood. Acute postoperative pain has been identified as risk factor for development of long-term pain in other surgical procedures, such as mastectomy and thoracotomy (2). However, the effect of acute postoperative pain on development of long-term pain in THA and TKA patients is unknown.Objectives:To investigate if acute pain following THA/TKA in OA patients is associated with long-term pain and if acute pain affects the course of pain up to 1-year postoperatively.Methods:From a longitudinal multicenter study, OA patients scheduled for primary THA or TKA were included. Acute pain scores, using Numeric Rating Scale (NRS), were routinely collected as part of standard care (≤72 hours after surgery). In case of ≥2 NRS scores the two highest scores were averaged (n=160), else the single score was taken. Pain was dichotomized into severe (NRS≥5) and mild (NRS<5). Pain was assessed preoperatively, at 3 (only THA), 6 and 12 months postoperatively using HOOS/KOOS subscale pain. Separate mixed-effect models for THA and TKA patients were used, with dichotomized acute pain as fixed-effect and long-term pain as outcome, while adjusting for confounders (age, sex, BMI, preoperative pain, mental component scale of the SF12 (MCS-12), and duration of the surgery and hospitalization). We included an interaction between time of measurement and acute postoperative pain to analyse whether effect modification was present. Missing values in preoperative pain and MCS-12 were imputed using multiple imputation methods.Results:81 THA and 87 TKA patients were included, of whom 32.1% and 56.3% reported severe acute pain. The results did not show an associated between severe acute pain and long term pain (THA: β=2.0, 95%-CI:-10.9-7.0; TKA: β=3.8, 95%-CI:-10.6-2.9). Furthermore, It seems that there is no effect present of difference in severity of acute pain and the course of pain over time (THA 6-months: β=6.4, 95%-CI:1.9-10.9 and 12-months: β=0.2, 95%-CI:-4.4-4.8; TKA 12-months: β=3.2, 95%-CI:-0.5-6.8).Conclusion:We did not find an association between acute pain and the development of long-term pain nor that severity of acute pain affects the course of postoperative pain in THA and TKA patients. The fact that THA and TKA patients often experience chronic preoperative pain might be a possible explanation for this finding. Nonetheless, future studies including additional measures of acute pain and pain sensitization in patients with chronic preoperative pain are necessary to draw stronger conclusions.References:[1]Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ open. 2012;2(1):e000435.[2]Katz J, Seltzer Ze. Transition from acute to chronic postsurgical pain: risk factors and protective factors. Expert review of neurotherapeutics. 2009;9(5):723-44.Acknowledgments:We would like to thank the study group that consists of: B.L. Kaptein, Leiden University Medical Center, Leiden; S.B.W Vehmeijer, Reinier de Graaf Hospital, Delft; R. Onstenk, Groene Hart Hospital, Gouda; S.H.M. Verdegaal, Alrijne Hospital, Leiderdorp; H.H. Kaptijn, LangeLand Hospital, Zoetermeer; W.C.M. Marijnissen, Albert Schweitzer Hospital, Dordrecht; P.J. Damen, Waterland Hospital, Hoorn; the NetherlandsDisclosure of Interests:None declared
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14
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Rietbergen T, Diercks RL, Anker-van der Wel I, van den Akker-van Marle ME, Lopuhaä N, Janssen RPA, van der Linden-van der Zwaag HMJ, Nelissen RGHH, Marang-van de Mheen PJ, van Bodegom-Vos L. Preferences and beliefs of Dutch orthopaedic surgeons and patients reduce the implementation of "Choosing Wisely" recommendations in degenerative knee disease. Knee Surg Sports Traumatol Arthrosc 2020; 28:3101-3117. [PMID: 31555844 PMCID: PMC7511282 DOI: 10.1007/s00167-019-05708-8] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 09/11/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to assess which factors were associated with the implementation of "Choosing Wisely" recommendations to refrain from routine MRI and arthroscopy use in degenerative knee disease. METHODS Cross-sectional surveys were sent to 123 patients (response rate 95%) and 413 orthopaedic surgeons (response rate 62%) fulfilling the inclusion criteria. Univariate and multivariate logistic regression analyses were used to identify factors associated with implementation of "Choosing Wisely" recommendations. RESULTS Factors reducing implementation of the MRI recommendation among patients included explanation of added value by an orthopaedic surgeon [OR 0.18 (95% CI 0.07-0.47)] and patient preference for MRI [OR 0.27 (95% CI 0.08-0.92)]. Factors reducing implementation among orthopaedic surgeons were higher valuation of own MRI experience than existing evidence [OR 0.41 (95% CI 0.19-0.88)] and higher estimated patients' knowledge to participate in shared decision-making [OR 0.38 (95% CI 0.17-0.88)]. Factors reducing implementation of the arthroscopy recommendation among patients were orthopaedic surgeons' preferences for an arthroscopy [OR 0.03 (95% CI 0.00-0.22)] and positive experiences with arthroscopy of friends/family [OR 0.03 (95% CI 0.00-0.39)]. Factors reducing implementation among orthopaedic surgeons were higher valuation of own arthroscopy experience than existing evidence [OR 0.17 (95% CI 0.07-0.46)] and belief in the added value [OR 0.28 (95% CI 0.10-0.81)]. CONCLUSIONS Implementation of "Choosing Wisely" recommendations in degenerative knee disease can be improved by strategies to change clinician beliefs about the added value of MRIs and arthroscopies, and by patient-directed strategies addressing patient preferences and underlying beliefs for added value of MRI and arthroscopies resulting from experiences of people in their environment. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- T Rietbergen
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - R L Diercks
- Department of Orthopaedics, University Medical Center Groningen, Groningen, The Netherlands
| | - I Anker-van der Wel
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - M E van den Akker-van Marle
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - N Lopuhaä
- ReumaNederland, Amsterdam, The Netherlands
| | - R P A Janssen
- Department of Orthopaedics, Máxima Medical Center, Eindhoven, The Netherlands
| | | | - R G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - P J Marang-van de Mheen
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - L van Bodegom-Vos
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
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15
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Sarac C, Hogendoorn S, Nelissen RGHH. A New Surgical Technique for Internal Shoulder Contractures Secondary to Obstetric Brachial Plexus Injury: An Anterior Coracohumeral Ligament Release. J Brachial Plex Peripher Nerve Inj 2019; 14:e35-e38. [PMID: 31413723 PMCID: PMC6692147 DOI: 10.1055/s-0039-1693746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 05/20/2019] [Indexed: 11/16/2022] Open
Abstract
Background
Obstetric brachial plexus injuries result from traction injury during delivery; 30% of these children sustain persisting functional limitations related to an external rotation deficit of the shoulder. The aim of this study was to compare the intraoperative gain in external rotation after a posterior subscapular release and an anterior coracohumeral ligament release.
Methods
This is a prospective study on 102 children with an internal rotation contracture of the shoulder who received either a posterior subscapular release (posterior skin incision along the medial border of the scapula of 3–5 cm) or an anterior (5-mm skin incision) coracohumeral ligament release between 1996 and 2010. After general anesthesia, internal and external rotations in both adduction and abduction were measured before and after the surgical release.
Results
After a posterior subscapular release, the intraoperative external rotation improved with a mean of 64 degrees (95% confidence interval [CI]: 54–74;
p
< 0.001) in adduction and with a mean of 41 degrees (95% CI: 32–49;
p
< 0.001) in abduction. After an anterior coracohumeral ligament release, external rotation increased with a mean of 61 degrees (95% CI: 56–66;
p
< 0.001) in adduction and a mean of 42 degrees in abduction (95%CI: 39–45,
p
< 0.001). Differences between these two groups were not statistically different.
Conclusion
The anterior release technique shows comparable results with the posterior subscapular release. And since it is performed through a smaller incision of 5 mm, this is our preferred method to increase passive external rotation.
Level of evidence
II.
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Affiliation(s)
- C Sarac
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - S Hogendoorn
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - R G H H Nelissen
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
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16
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Scheper H, Derogee R, Mahdad R, van der Wal RJP, Nelissen RGHH, Visser LG, de Boer MGJ. A mobile app for postoperative wound care after arthroplasty: Ease of use and perceived usefulness. Int J Med Inform 2019; 129:75-80. [PMID: 31445292 DOI: 10.1016/j.ijmedinf.2019.05.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [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: 07/19/2018] [Revised: 11/19/2018] [Accepted: 05/11/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Early postoperative discharge after joint arthroplasty may lead to decreased wound monitoring. A mobile woundcare app with an integrated algorithm to detect complications may lead to improved monitoring and earlier treatment of complications. In this study, the ease of use and perceived usefulness of such a mobile app was investigated. OBJECTIVE Primary objective was to investigate the ease of use and perceived usefulness of using a woundcare app. Secondary objectives were the number of alerts created, the amount of days the app was actually used and patient-reported wound infection. METHODS Patients that received a joint arthroplasty were enrolled in a prospective cohort study. During 30 postoperative days, patients scored their surgical wound by daily answering of questions in the app. An inbuilt algorithm advised patients to contact their treating physician if needed. On day 15 and day 30, additional questionnaires in the app investigated ease of use and perceived usefulness. RESULTS Sixty-nine patients were included. Median age was 68 years. Forty-one patients (59.4%) used the app until day 30. Mean grade for ease of use (on a Likert-scale of 1-5) were 4.2 on day 15 and 4.2 on day 30; grades for perceived usefulness were 4.1 on day 15 and 4.0 on day 30. Out of 1317 days of app use, an alert was sent to patients on 29 days (2.2%). Concordance between patient-reported outcome and physician-reported outcome was 80%. CONCLUSIONS Introduction of a woundcare app with an alert communication on possible wound problems resulted in a high perceived usefulness and ease of use. Future studies will focus on validation of the algorithm and the association between postoperative wound leakage and the incidence of prosthetic joint infection.
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Affiliation(s)
- H Scheper
- Department of Infectious Diseases, Leiden University Medical Centre, Albinusdreef 2, 2333ZA, the Netherlands.
| | - R Derogee
- Department of Infectious Diseases, Leiden University Medical Centre, Albinusdreef 2, 2333ZA, the Netherlands
| | - R Mahdad
- Department of Orthopaedic Surgery, Alrijne Hospital, Leiderdorp, the Netherlands
| | - R J P van der Wal
- Department of Orthopaedics, Leiden University Medical Centre, Albinusdreef 2, 2333ZA, the Netherlands
| | - R G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Centre, Albinusdreef 2, 2333ZA, the Netherlands
| | - L G Visser
- Department of Infectious Diseases, Leiden University Medical Centre, Albinusdreef 2, 2333ZA, the Netherlands
| | - M G J de Boer
- Department of Infectious Diseases, Leiden University Medical Centre, Albinusdreef 2, 2333ZA, the Netherlands
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Abstract
Objectives Prosthetic joint infection (PJI) is a devastating complication following total joint arthroplasty. Non-contact induction heating of metal implants is a new and emerging treatment for PJI. However, there may be concerns for potential tissue necrosis. It is thought that segmental induction heating can be used to control the thermal dose and to limit collateral thermal injury to the bone and surrounding tissues. The purpose of this study was to determine the thermal dose, for commonly used metal implants in orthopaedic surgery, at various distances from the heating centre (HC). Methods Commonly used metal orthopaedic implants (hip stem, intramedullary nail, and locking compression plate (LCP)) were heated segmentally using an induction heater. The thermal dose was expressed in cumulative equivalent minutes at 43°C (CEM43) and measured with a thermal camera at several different distances from the HC. A value of 16 CEM43 was used as the threshold for thermal damage in bone. Results Despite high thermal doses at the HC (7161 CEM43 to 66 640 CEM43), the thermal dose at various distances from the HC was lower than 16 CEM43 for the hip stem and nail. For the fracture plate without corresponding metal screws, doses higher than 16 CEM43 were measured up to 5 mm from the HC. Conclusion Segmental induction heating concentrates the thermal dose at the targeted metal implant areas and minimizes collateral thermal injury by using the non-heated metal as a heat sink. Implant type and geometry are important factors to consider, as they influence dissipation of heat and associated collateral thermal injury. Cite this article: B. G. Pijls, I. M. J. G. Sanders, E. J. Kuijper, R. G. H. H. Nelissen. Segmental induction heating of orthopaedic metal implants. Bone Joint Res 2018;7:609–619. DOI: 10.1302/2046-3758.711.BJR-2018-0080.R1.
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Affiliation(s)
- B G Pijls
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - I M J G Sanders
- Department of Medical Microbiology, Section Experimental Bacteriology, Leiden University Medical Center, Leiden, The Netherlands
| | - E J Kuijper
- Department of Medical Microbiology, Section Experimental Bacteriology, Leiden University Medical Center, Leiden, The Netherlands
| | - R G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
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Kolk A, Henseler JF, Overes FJ, Nagels J, Nelissen RGHH. Teres major tendon transfer in the treatment of irreparable posterosuperior rotator cuff tears: long-term improvement of shoulder function and pain reduction at eight to 12 years’ follow-up. Bone Joint J 2018; 100-B:309-317. [PMID: 29589499 DOI: 10.1302/0301-620x.100b3.bjj-2017-0920.r1] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Since long-term outcome of teres major tendon transfer surgery for irreparable posterosuperior rotator cuff (RC) tears is largely unknown, the primary aim of this study was to evaluate the long-term outcome of the teres major transfer. We also aimed to report on the results of a cohort of patients with a similar indication for surgery that underwent a latissimus dorsi tendon transfer. Patients and Methods Patients and Methods In this prospective cohort study, we reported on the long-term results of 20 consecutive patients with a teres major tendon transfer for irreparable massive posterosuperior RC tears. Additionally, we reported on the results of the latissimus dorsi tendon transfer (n = 19). The mean age was 60 years (47 to 77). Outcomes included the Constant score (CS), and pain at rest and during movement using the Visual Analogue Scale (VAS). Results At a mean of ten years (8 to 12) following teres major transfer, the CS was still 23 points (95% confidence interval (CI) 14.6 to 30.9, p < 0.001) higher than preoperatively. VAS for pain at rest (21 mm, 95% CI 4.0 to 38.9, p = 0.016) and movement (31 mm, 95% CI 16.0 to 45.1, p < 0.001) were lower than preoperatively. We also found an increase in CS (32 points, 95% CI 23.4 to 40.2, p < 0.001) and reduction of pain (26 mm, 95% CI 9.9 to 41.8, p = 0.001) six years after latissimus dorsi transfer. Conclusion Teres major tendon transfer is a treatment option to gain shoulder function and reduce pain in patients with an irreparable posterosuperior RC tear at a mean follow-up of ten years. The teres major tendon might be a valuable alternative to the commonly performed latissimus dorsi tendon transfer in the treatment of irreparable posterosuperior RC tears. Cite this article: Bone Joint J 2018;100-B:309-17.
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Affiliation(s)
- A Kolk
- Department of Orthopaedics, Leiden University Medical Center, Postzone J-11-R, PO box 9600, 2300 RC Leiden, The Netherlands
| | - J F Henseler
- Department of Orthopaedics, Leiden University Medical Center, Postzone J-11-R, PO box 9600, 2300 RC Leiden, The Netherlands
| | - F J Overes
- Department of Orthopaedics, Leiden University Medical Center, Postzone J-11-R, PO box 9600, 2300 RC Leiden, The Netherlands
| | - J Nagels
- Department of Orthopaedics, Leiden University Medical Center, Postzone J-11-R, PO box 9600, 2300 RC Leiden, The Netherlands
| | - R G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Postzone J-11-R, PO box 9600, 2300 RC Leiden, The Netherlands
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Rietveld ABMB, Hagemans FMT, Haitjema S, Vissers T, Nelissen RGHH. Results of Treatment of Posterior Ankle Impingement Syndrome and Flexor Hallucis Longus Tendinopathy in Dancers: A Systematic Review. J Dance Med Sci 2018; 22:19-32. [DOI: 10.12678/1089-313x.22.1.19] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- A. B. M. Boni Rietveld
- Medical Center for Dancers and Musicians, MC Haaglanden, Medical Centre for Dancers and Musicians (MCDM), The Hague Medical Centre, Postbox 432, 2501 CK The Hague, The Netherlands;,
| | - F. M. T. Hagemans
- Medical Center for Dancers and Musicians, MC Haaglanden, The Hague, The Netherlands
| | - S. Haitjema
- Medical Center for Dancers and Musicians, MC Haaglanden, The Hague, The Netherlands
| | - T. Vissers
- Landsteiner Institute, MC Haaglanden, The Hague, The Netherlands
| | - R. G. H. H. Nelissen
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Pijls BG, Sanders IMJG, Kuijper EJ, Nelissen RGHH. Non-contact electromagnetic induction heating for eradicating bacteria and yeasts on biomaterials and possible relevance to orthopaedic implant infections: In vitro findings. Bone Joint Res 2017; 6:323-330. [PMID: 28522446 PMCID: PMC5457641 DOI: 10.1302/2046-3758.65.bjr-2016-0308.r1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 11/14/2016] [Accepted: 03/13/2017] [Indexed: 11/13/2022] Open
Abstract
Objectives Infection of implants is a major problem in elective and trauma surgery. Heating is an effective way to reduce the bacterial load in food preparation, and studies on hyperthermia treatment for cancer have shown that it is possible to heat metal objects with pulsed electromagnetic fields selectively (PEMF), also known as induction heating. We therefore set out to answer the following research question: is non-contact induction heating of metallic implants effective in reducing bacterial load in vitro? Methods Titanium alloy cylinders (Ti6Al4V) were exposed to PEMF from an induction heater with maximum 2000 watts at 27 kHz after being contaminated with five different types of micro-organisms: Staphylococcus epidermidis; Staphylococcus aureus; Pseudomonas aeruginosa; spore-forming Bacillus cereus; and yeast Candida albicans. The cylinders were exposed to incremental target temperatures (35°C, 45°C, 50°C, 55°C, 60°C, 65°C, 70°C) for up to 3.5 minutes. Results There was an average linear heating rate of 0.39°C per second up to the target temperature, and thereafter the target temperature was maintained until the end of the experiment. At 60°C and higher (duration 3.5 minutes), there was a 6-log reduction or higher for every micro-organism tested. At 60°C, we found that the shortest duration of effective induction heating was 1.5 minutes. This resulted in a 5-log reduction or higher for every micro-organism tested. Conclusion Non-contact induction heating of a titanium disk is effective in reducing bacterial load in vitro. These promising results can be further explored as a new treatment modality for infections of metal orthopaedic implants. Cite this article: B. G. Pijls, I. M. J. G. Sanders, E. J. Kuijper, R. G. H. H. Nelissen. Non-contact electromagnetic induction heating for eradicating bacteria and yeasts on biomaterials and possible relevance to orthopaedic implant infections: In vitro findings. Bone Joint Res 2017;6:323–330. DOI: 10.1302/2046-3758.65.BJR-2016-0308.R1.
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Affiliation(s)
- B G Pijls
- Leiden University Medical Centre, Albinusdreef 2, P.O. Box 9600, Postzone J-11-S, 2300 RC Leiden, The Netherlands
| | - I M J G Sanders
- Leiden University Medical Centre, Albinusdreef 2, P.O. Box 9600, Postzone J-11-S, 2300 RC Leiden, The Netherlands
| | - E J Kuijper
- Leiden University Medical Centre, Albinusdreef 2, P.O. Box 9600, Postzone J-11-S, 2300 RC Leiden, The Netherlands
| | - R G H H Nelissen
- Leiden University Medical Centre, Albinusdreef 2, P.O. Box 9600, Postzone J-11-S, 2300 RC Leiden, The Netherlands
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21
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Metsaars WP, Biegstraaten M, Nelissen RGHH. Biceps Rerouting after Forearm Osteotomy: An Effective Treatment Strategy for Severe Supination Deformity in Obstetric Plexus Palsy. J Hand Microsurg 2017; 9:1-5. [PMID: 28442854 DOI: 10.1055/s-0037-1598088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 05/10/2016] [Accepted: 12/20/2016] [Indexed: 10/20/2022] Open
Abstract
Study Design Retrospective cohort study. Objective Supination deformity in obstetric brachial plexus injury can have debilitating consequences for the functionality of the hand. Surgical treatment by a forearm osteotomy has a recurrence rate of 20 to 42%. As a complement to forearm osteotomy, a biceps rerouting may improve outcome. Methods Children with residual brachial plexus injury, who had a forearm osteotomy for a supination contracture and had a postoperative decrease of pronation to 50 degrees or less, were indicated for a biceps rerouting. Shoulder, elbow and hand function, biceps strength, Mallet score, and Raimondi score were assessed with a minimum follow-up of 2 years. Results Five patients (median age: 8 years; range: 4-10) underwent biceps rerouting between 2008 and 2012. Median follow-up time was 6.8 years (range: 3.2-7.0 years). Passive pronation increased in all cases (median 0 degree at baseline to 80 degrees at final follow-up). Active pronation also increased. Active median wrist extension was -30 degrees at baseline and 45 degrees at follow-up. Biceps strength and grip strength improved in two cases. No recurrences were present. Conclusion The sequentially planned surgical treatment of forearm osteotomy and biceps rerouting should be considered in the treatment of severe supination deformity, as it is effective in improving pronation of the forearm and hand function, without recurrence at follow-up. Level of Evidence/Type of Study Level III, case series, therapeutic study.
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Affiliation(s)
- W P Metsaars
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - M Biegstraaten
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - R G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
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22
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Pijls BG, Meessen JMTA, Schoones JW, Fiocco M, van der Heide HJL, Sedrakyan A, Nelissen RGHH. [Increased mortality in metal-on-metal versus non-metal-on-metal primary total hip arthroplasty at 10 years and longer follow-up: a systematic review and meta-analysis]. Ned Tijdschr Geneeskd 2017; 161:D1162. [PMID: 28832291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To determine the mortality and the morbidity in patients with metal-on-metal articulations (MOM THA) when compared to patients with non-metal-on-metal articulations (non-MOM THA) after primary total hip arthroplasty. DESIGN Systematic review, meta-analyses and meta-regression (registration: PROSPERO 2014:CRD42014007417). METHOD Search of PubMed, MEDLINE, EMBASE, Web of Science, Cochrane, CINAHL, AcademicSearchPremier, ScienceDirect, Wiley and clinical trial registers. We included randomised controlled trials and observational studies of primary total hip arthroplasty comparing MOM THA with non-MOM THA. We used meta-regression to identify and evaluate potential modifying variables such as follow-up duration. RESULTS Forty-seven studies were included, comprising over 4,000 THA in randomised trials and over 500,000 THA in observational studies. For mortality, random effects analysis revealed a higher pooled risk difference (RD) of 0.7% (95%-CI: 0.0-2.3%; I-square 42%); the heterogeneity was explained by differences in follow-up. When restricted to studies with long term follow-up (i.e. 10 years or more), the RD for mortality was 8,5% (95%-CI: 5,8-11,2). Further subgroup analyses and meta-regression random effects models revealed no evidence for other modifying variables (study level covariates, e.g. resurfacing vs. non-resurfacing MOM) than follow-up duration. CONCLUSION Meta-analysis suggests there may be an increased long-term risk of mortality associated with MOM THA compared to patients with non-MOM THA.
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Affiliation(s)
- B G Pijls
- * Dit onderzoek werd eerder gepubliceerd in PLoS One (2016;11: e0156051) met als titel 'Increased mortality in metal-on-metal versus non-metal-on-metal primary total hip arthroplasty at 10 years and longer follow-up: a systematic review and meta-analysis'. Afgedrukt met toestemming
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van Vendeloo SN, Brand PLP, Burger BJ, Nelissen RGHH, Bulstra SK, Verheyen CCPM. [Registration of assessments in orthopaedic residents' portfolios is falling short]. Ned Tijdschr Geneeskd 2017; 160:D630. [PMID: 28074720] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To evaluate of the number of registered competency assessments in the portfolios of orthopaedic residents in the Netherlands, for whom a competency-based training programme is mandatory. DESIGN National cohort study. METHOD We collected data regarding the registered assessments of all orthopaedic residents who finished their training between 2012-2015. We determined the number of registered assessments of 'standard orthopaedic treatments' (evaluating residents' competency in 70 different orthopaedic treatments), objective structured clinical skills evaluations (OSCEs), critically appraised topics (CATs), and 360 degree feedback appraisals. We compared the number of registered assessments in the portfolios with the minimum requirements laid down by the training curriculum. RESULTS A total of 196 residents finished their training between 2012 and 2015. These residents finished their training with a mean (i.e., percentage of minimally required number of assessments) of 17.0 (34%) 'standard orthopaedic treatments' (level 4 or 5), 13.6 (34%) OSCEs, 2.6 (33%) CATs and 0.2 (4%) 360 degree feedback. CONCLUSION On average, only one-third of the minimally required number of assessments were registered in the portfolios of orthopaedic residents (OSCEs and standard orthopaedic treatments level 4 or 5). These revelations show that action is needed to improve the way in which the progress of residents is monitored. These findings are going to have an effect on the new curriculum which must be more practical and less complex. Additionally, external quality control will focus more on residents at the end of their training and on the training region involved. This information may serve as a framework for postgraduate training programmes in other scientific associations which also find themselves in the same process of modernisation.
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Meessen JMTA, Peter WF, Wolterbeek R, Cannegieter SC, Tilbury C, Bénard MR, van der Linden HMJ, Onstenk R, Tordoir R, Vehmeijer SB, Verdegaal SHM, Vermeulen HM, Nelissen RGHH, Vliet Vlieland TPM. Patients who underwent total hip or knee arthroplasty are more physically active than the general Dutch population. Rheumatol Int 2016; 37:219-227. [PMID: 27853860 PMCID: PMC5258787 DOI: 10.1007/s00296-016-3598-9] [Citation(s) in RCA: 12] [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: 08/08/2016] [Accepted: 11/04/2016] [Indexed: 01/22/2023]
Abstract
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) bring relief of pain and functional disability to patients with end-stage osteoarthritis, and however, the literature on their impact on patients' level of physical activity (PA) is scarce. Cross-sectional study in patients who underwent THA/TKA surgery in the preceding 6-22 months and a random sample of persons aged >40 years from the Dutch general population, participating in a national survey. PA in minutes per week (min/week) and adherence to the Dutch recommendation for PA (NNGB yes/no) were measured by the short questionnaire to assess health-enhancing PA. Multivariable linear (total min/week) and logistic regression analyses (meeting recommendations PA), adjusting for confounders, were performed for THA and TKA separately. In total, 258 THA [62.3% female, aged 69.4 (9.1)] and 221 TKA [65.7% female, aged 69.5 (8.9)] patients and 4373 persons from the Dutch general population [51.4% female, aged 58.9 (11.6)] were included. The presence of THA was associated after adjusting for age, sex, BMI education and musculoskeletal comorbidities, with more total min/week spent on PA (THA 13.8% increase, 95% CI 1.6-27.6%), whilst both TJA groups were associated with adhering to NNGB (THA: OR 1.79, 95% CI 1.26-2.56; TKA: OR 1.73, 95% CI 1.20-2.51). As this study used questionnaires to compare the PA of THA/TKA patients to the general population, some recall and selection bias might have been induced. After surgery, overall, TJA patients are more likely to adhere NNGB than a representative sample of persons >40 years from the Dutch general population.
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Affiliation(s)
- J M T A Meessen
- Department of Orthopaedics, Leiden University Medical Center, J11R, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - W F Peter
- Department of Orthopaedics, Leiden University Medical Center, J11R, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - R Wolterbeek
- Department of Medical Statistics, LUMC, Leiden, The Netherlands
| | - S C Cannegieter
- Department of Clinical Epidemiology, LUMC, Leiden, The Netherlands
| | - C Tilbury
- Department of Orthopaedics, Leiden University Medical Center, J11R, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - M R Bénard
- Department of Orthopaedics, Reinier de Graaf Groep, Delft, The Netherlands
| | - H M J van der Linden
- Department of Orthopaedics, Leiden University Medical Center, J11R, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - R Onstenk
- Department of Orthopaedics, Groene Hart Ziekenhuis, Gouda, The Netherlands
| | - R Tordoir
- Department of Orthopaedics, Rijnland Ziekenhuis, Leiderdorp, The Netherlands
| | - S B Vehmeijer
- Department of Orthopaedics, Groene Hart Ziekenhuis, Gouda, The Netherlands
| | - S H M Verdegaal
- Department of Orthopaedics, Rijnland Ziekenhuis, Leiderdorp, The Netherlands
| | - H M Vermeulen
- Department of Physiology, LUMC, Leiden, The Netherlands
| | - R G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, J11R, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - T P M Vliet Vlieland
- Department of Orthopaedics, Leiden University Medical Center, J11R, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.,Rijnlands Rehabilitation Centre, Leiden, The Netherlands.,Sophia Rehabilitation, The Hague, The Netherlands
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van der Voort P, Valstar ER, Kaptein BL, Fiocco M, van der Heide HJL, Nelissen RGHH. Comparison of femoral component migration between Refobacin bone cement R and Palacos R + G in cemented total hip arthroplasty: A randomised controlled roentgen stereophotogrammetric analysis and clinical study. Bone Joint J 2016; 98-B:1333-1341. [PMID: 27694586 DOI: 10.1302/0301-620x.98b10.37116] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 05/12/2016] [Indexed: 11/05/2022]
Abstract
AIMS The widely used and well-proven Palacos R (a.k.a. Refobacin Palacos R) bone cement is no longer commercially available and was superseded by Refobacin bone cement R and Palacos R + G in 2005. However, the performance of these newly introduced bone cements have not been tested in a phased evidence-based manner, including roentgen stereophotogrammetric analysis (RSA). PATIENTS AND METHODS In this blinded, randomised, clinical RSA study, the migration of the Stanmore femoral component was compared between Refobacin bone cement R and Palacos R + G in 62 consecutive total hip arthroplasties. The primary outcome measure was femoral component migration measured using RSA and secondary outcomes were Harris hip score (HHS), Hip disability and Osteoarthritis Outcome Score (HOOS), EuroQol 5D (EQ-5D) and Short Form 36 (SF-36). RESULTS Femoral component migration was comparable between Refobacin bone cement R and Palacos R + G during the two-year follow-up period with an estimated mean difference of 0.06 mm of subsidence (p = 0.56) and 0.08° of retroversion (p = 0.82). Five hips (three Refobacin bone cement R and two Palacos R + G) showed non-stabilising, continuous migration; the femoral cement mantle in these hips, was mean 0.7 mm thicker (p = 0.02) and there were more radiolucencies at the bone-cement interface (p = 0.004) in comparison to hips showing stabilising migration. Post-operative HHS was comparable throughout the follow-up period (p = 0.62). HOOS, EQ5D, and SF-36 scores were also comparable (p-values > 0.05) at the two-year follow-up point. CONCLUSION Refobacin bone cement R and Palacos R + G show comparable component migration and clinical outcome during the first two post-operative years. Hips showing continuous migration are at risk for early failure. However, this seems to be unrelated to cement type, but rather to cementing technique. Cite this article: Bone Joint J 2016;98-B:1333-41.
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Affiliation(s)
- P van der Voort
- Leiden University Medical Center, Albinusdreef 2, J11-R-70, Leiden, 2333 ZA, The Netherlands
| | - E R Valstar
- Leiden University Medical Center, Albinusdreef 2, J11-R-70, Leiden, 2333 ZA, The Netherlands
| | - B L Kaptein
- Leiden University Medical Center, Albinusdreef 2, J11-R-70, Leiden, 2333 ZA, The Netherlands
| | - M Fiocco
- Leiden University Medical Center, Albinusdreef 2, J11-R-70, Leiden, 2333 ZA, The Netherlands
| | - H J L van der Heide
- Leiden University Medical Center, Albinusdreef 2, J11-R-70, Leiden, 2333 ZA, The Netherlands
| | - R G H H Nelissen
- Leiden University Medical Center, Albinusdreef 2, J11-R-70, Leiden, 2333 ZA, The Netherlands
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Abstract
PURPOSE The objective of this study was to evaluate the effectiveness of serial casting of elbow flexion contractures in neonatal brachial plexus palsy. METHODS A prospective consecutive cohort study was performed with a median follow-up of 5 years. Forty-one patients with elbow flexion contractures ≥ 30° were treated with serial casting until the contracture was ≤ 10°, for a maximum of 8 weeks. Range of motion, number of recurrences and patient satisfaction were recorded and analyzed using Wilcoxon signed-rank and Cox regression tests. RESULTS Passive extension increased from a median of -40° (IQR -50 to -30) to -15° (IQR -10 to -20, p < 0.001). Twenty patients showed 37 recurrences. The baseline severity of passive elbow extension had a hazard ratio of 0.93 (95% CI 0.89 to 0.96, p < 0.001) for first recurrence. Median patient satisfaction was moderate. Four patients showed loss of flexion mobility and in two patients serial casting had to be prematurely replaced by night splinting due to complaints. CONCLUSION Serial casting improved elbow flexion contractures, although recurrences were frequent. The severity of elbow flexion contracture is a predictor of recurrence. We recommend more research on muscle degeneration and determinants involved in elbow flexion contractures to improve treatment strategies and prevent side-effects.
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Affiliation(s)
- B J Duijnisveld
- Departments of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - D Steenbeek
- Department of Rehabilitation, Leiden University Medical Center, Leiden, The Netherlands
| | - R G H H Nelissen
- Departments of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
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Pijls BG, Ritchie ED, van den Bremer J, Brink PRG, Nelissen RGHH. Management of fractures of the distal radius 4 years after the introduction of national guidelines. J Hand Surg Eur Vol 2016; 41:777-9. [PMID: 26896450 DOI: 10.1177/1753193416632142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- B G Pijls
- Department Orthopaedics, Leiden University Medical Center (LUMC)
| | - E D Ritchie
- Department General Surgery, Rijnland Hospital
| | | | - P R G Brink
- Department Traumatology, Maastricht University Medical Center (MUMC)
| | - R G H H Nelissen
- Department Orthopaedics, Leiden University Medical Center (LUMC)
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van IJsseldijk EA, Valstar ER, Stoel BC, Nelissen RGHH, Baka N, Van't Klooster R, Kaptein BL. Three dimensional measurement of minimum joint space width in the knee from stereo radiographs using statistical shape models. Bone Joint Res 2016; 5:320-7. [PMID: 27491660 PMCID: PMC5005472 DOI: 10.1302/2046-3758.58.2000626] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 05/05/2016] [Indexed: 11/16/2022] Open
Abstract
Objectives An important measure for the diagnosis and monitoring of knee osteoarthritis is the minimum joint space width (mJSW). This requires accurate alignment of the x-ray beam with the tibial plateau, which may not be accomplished in practice. We investigate the feasibility of a new mJSW measurement method from stereo radiographs using 3D statistical shape models (SSM) and evaluate its sensitivity to changes in the mJSW and its robustness to variations in patient positioning and bone geometry. Materials and Methods A validation study was performed using five cadaver specimens. The actual mJSW was varied and images were acquired with variation in the cadaver positioning. For comparison purposes, the mJSW was also assessed from plain radiographs. To study the influence of SSM model accuracy, the 3D mJSW measurement was repeated with models from the actual bones, obtained from CT scans. Results The SSM-based measurement method was more robust (consistent output for a wide range of input data/consistent output under varying measurement circumstances) than the conventional 2D method, showing that the 3D reconstruction indeed reduces the influence of patient positioning. However, the SSM-based method showed comparable sensitivity to changes in the mJSW with respect to the conventional method. The CT-based measurement was more accurate than the SSM-based measurement (smallest detectable differences 0.55 mm versus 0. 82 mm, respectively). Conclusion The proposed measurement method is not a substitute for the conventional 2D measurement due to limitations in the SSM model accuracy. However, further improvement of the model accuracy and optimisation technique can be obtained. Combined with the promising options for applications using quantitative information on bone morphology, SSM based 3D reconstructions of natural knees are attractive for further development. Cite this article: E. A. van IJsseldijk, E. R. Valstar, B. C. Stoel, R. G. H. H. Nelissen, N. Baka, R. van’t Klooster, B. L. Kaptein. Three dimensional measurement of minimum joint space width in the knee from stereo radiographs using statistical shape models. Bone Joint Res 2016;320–327. DOI: 10.1302/2046-3758.58.2000626.
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Affiliation(s)
- E A van IJsseldijk
- Department of Orthopaedics, Leiden University Medical Center, Biomechanics and Imaging Group, PO 9600, 2300 RC, Leiden, The Netherlands
| | - E R Valstar
- Department of Orthopaedics, Leiden University Medical Center, Biomechanics and Imaging Group, PO 9600, 2300 RC, Leiden, The Netherlands
| | - B C Stoel
- Department of Radiology, Leiden University Medical Center, Division of Image Processing, PO 9600, 2300 RC, Leiden, The Netherlands
| | - R G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Biomechanics and Imaging Group, PO 9600, 2300 RC, Leiden, The Netherlands
| | - N Baka
- Department of Orthopaedics, Leiden University Medical Center, Biomechanics and Imaging Group, PO 9600, 2300 RC, Leiden, The Netherlands
| | - R Van't Klooster
- Department of Radiology, Leiden University Medical Center, Division of Image Processing, PO 9600, 2300 RC, Leiden, The Netherlands
| | - B L Kaptein
- Department of Orthopaedics, Leiden University Medical Center, Biomechanics and Imaging Group, PO 9600, 2300 RC, Leiden, The Netherlands
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Bomer N, den Hollander W, Suchiman H, Houtman E, Slieker RC, Heijmans BT, Slagboom PE, Nelissen RGHH, Ramos YFM, Meulenbelt I. Neo-cartilage engineered from primary chondrocytes is epigenetically similar to autologous cartilage, in contrast to using mesenchymal stem cells. Osteoarthritis Cartilage 2016; 24:1423-30. [PMID: 26995110 DOI: 10.1016/j.joca.2016.03.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 12/22/2015] [Revised: 02/16/2016] [Accepted: 03/10/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare the epigenetic landscape of 3D cell models of human primary articular chondrocytes (hPACs) and human bone-marrow derived mesenchymal stem cells (hBMSCs) and their respective autologous articular cartilage. DESIGN Using Illumina Infinium HumanMethylation450 BeadChip arrays, the DNA methylation landscape of the different cell sources and autologous cartilage was determined. Pathway enrichment was analyzed using DAVID. RESULTS Principal Component Analysis (PCA) of methylation data revealed separate clustering of hBMSC samples. Between hBMSCs and autologous cartilage 86,881 cytosine-phosphate-guanine dinucleotides (CpGs) (20.2%), comprising 3,034 differentially methylated regions (DMRs; Δβ > 0.1; with the same direction of effect), were significantly differentially methylated. In contrast, between hPACs and autologous cartilage only 5,706 CpGs (1.33%) were differentially methylated. Of interest was the finding of the transcriptionally active, hyper-methylation of a Cartilage Intermediate Layer Protein (CILP) annotated DMR (Δβ = 0.16) in PAC-cartilage, corresponding to a profound decrease in CILP expression after in vitro culturing of hPACs as compared to autologous cartilage. CONCLUSIONS In vitro engineered neo-cartilage tissue from primary chondrocytes, hPACs, exhibits a DNA methylation landscape that is almost identical (99% similarity) to autologous cartilage, in contrast to neo-cartilage engineered from bone marrow-derived mesenchymal stem cells (MSCs). Although hBMSCs are widely used for cartilage engineering purposes the effects of these vast differences on cartilage regeneration and long term consequences of implantation, are not known. The use of hBMSCs or hPACs for future cartilage tissue regeneration purposes should therefore be investigated in more depth in future endeavors to better understand the consequences of the differential methylome on neo-cartilage.
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Affiliation(s)
- N Bomer
- Dept. of Molecular Epidemiology, LUMC, Leiden, The Netherlands; IDEAL, LUMC, Leiden, The Netherlands
| | - W den Hollander
- Dept. of Molecular Epidemiology, LUMC, Leiden, The Netherlands
| | - H Suchiman
- Dept. of Molecular Epidemiology, LUMC, Leiden, The Netherlands
| | - E Houtman
- Dept. of Molecular Epidemiology, LUMC, Leiden, The Netherlands
| | - R C Slieker
- Dept. of Molecular Epidemiology, LUMC, Leiden, The Netherlands; IDEAL, LUMC, Leiden, The Netherlands
| | - B T Heijmans
- Dept. of Molecular Epidemiology, LUMC, Leiden, The Netherlands; IDEAL, LUMC, Leiden, The Netherlands
| | - P E Slagboom
- Dept. of Molecular Epidemiology, LUMC, Leiden, The Netherlands; IDEAL, LUMC, Leiden, The Netherlands
| | | | - Y F M Ramos
- Dept. of Molecular Epidemiology, LUMC, Leiden, The Netherlands
| | - I Meulenbelt
- Dept. of Molecular Epidemiology, LUMC, Leiden, The Netherlands.
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Voorn VMA, Hout A, So‐Osman C, Vliet Vlieland TPM, Nelissen RGHH, Akker‐van Marle ME, Dahan A, Marang‐van de Mheen PJ, Bodegom‐Vos L. Erythropoietin to reduce allogeneic red blood cell transfusion in patients undergoing total hip or knee arthroplasty. Vox Sang 2016; 111:219-225. [DOI: 10.1111/vox.12412] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 03/14/2016] [Accepted: 03/30/2016] [Indexed: 01/28/2023]
Affiliation(s)
- V. M. A. Voorn
- Department of Medical Decision Making Leiden University Medical Center Leiden The Netherlands
| | - A. Hout
- Department of Medical Decision Making Leiden University Medical Center Leiden The Netherlands
| | - C. So‐Osman
- Department of Transfusion Medicine and Centre for Clinical Transfusion Research Sanquin Blood Supply Foundation Leiden The Netherlands
- Department of Internal Medicine Groene Hart Hospital Gouda The Netherlands
| | | | - R. G. H. H. Nelissen
- Department of Orthopaedics Leiden University Medical Center Leiden The Netherlands
| | - M. E. Akker‐van Marle
- Department of Medical Decision Making Leiden University Medical Center Leiden The Netherlands
| | - A. Dahan
- Department of Anaesthesiology Leiden University Medical Center Leiden The Netherlands
| | | | - L. Bodegom‐Vos
- Department of Medical Decision Making Leiden University Medical Center Leiden The Netherlands
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Pijls BG, Meessen JMTA, Schoones JW, Fiocco M, van der Heide HJL, Sedrakyan A, Nelissen RGHH. Increased Mortality in Metal-on-Metal versus Non-Metal-on-Metal Primary Total Hip Arthroplasty at 10 Years and Longer Follow-Up: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0156051. [PMID: 27295038 PMCID: PMC4905643 DOI: 10.1371/journal.pone.0156051] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 05/09/2016] [Indexed: 11/19/2022] Open
Abstract
IMPORTANCE There are concerns about increased mortality in patients with metal-on-metal bearings in total hip arthroplasty (THA). OBJECTIVE To determine the mortality and the morbidity in patients with metal-on-metal articulations (MOM THA) compared to patients with non-metal-on-metal articulations (non-MOM THA) after primary total hip arthroplasty. DATA SOURCES Search of PubMed, MEDLINE, EMBASE, Web of Science, Cochrane, CINAHL, AcademicSearchPremier, ScienceDirect, Wiley and clinical trial registers through March 2015, augmented by a hand search of references from the included articles. No language restrictions were applied. STUDY SELECTION Two reviewers screened and identified randomised controlled trials and observational studies of primary total hip arthroplasty comparing MOM THA with non-MOM THA. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted study data and assessed risk of bias. Risk differences (RD) were calculated with random effect models. Meta-regression was used to explore modifying factors. MAIN OUTCOMES AND MEASURES Difference in mortality and difference in morbidity expressed as revisions and medical complications between patients with MOM THA and non-MOM THA. RESULTS Forty-seven studies were included, comprising 4,000 THA in randomised trials and over 500,000 THA in observational studies. For mortality, random effects analysis revealed a higher pooled RD of 0.7%, 95%, confidence interval (CI) [0.0%, 2.3%], I-square 42%; the heterogeneity was explained by differences in follow-up. When restricted to studies with long term follow-up (i.e. 10 years or more), the RD for mortality was 8.5%, 95%, CI [5.8%, 11.2%]; number needed to treat was 12. Further subgroup analyses and meta-regression random effects models revealed no evidence for other moderator variables (study level covariates, e.g. resurfacing vs. non-resurfacing MOM) than follow-up duration. The quality of the evidence presented in this meta-analysis was characterized as moderate according to the CLEAR-NPT (for non-pharmacological trials) and Cochrane risk of bias Table. CONCLUSIONS AND RELEVANCE Meta-analysis suggests there may be an increased long-term risk of mortality and revision surgery for patients with MOM THA compared to patients with non-MOM THA. REGISTRATION PROSPERO 2014:CRD42014007417.
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Affiliation(s)
- B G Pijls
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - J M T A Meessen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - J W Schoones
- Walaeus Library, Leiden University Medical Centre, Leiden, The Netherlands
| | - M Fiocco
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
- Mathematical Institute, Leiden University, Leiden, The Netherlands
| | - H J L van der Heide
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - A Sedrakyan
- FDA Medical Device Epidemiology (MDEpiNet) Science and Infrastructure Center, U.S. Food and Drug Administration, Silver Spring, MD, United States of America
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, United States of America
| | - R G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
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Affiliation(s)
- B G Pijls
- Department of Orthopaedics, Leiden University Medical Center, The Netherlands
| | - R G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, The Netherlands
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Swart NM, van Oudenaarde K, Reijnierse M, Nelissen RGHH, Verhaar JAN, Bierma-Zeinstra SMA, Luijsterburg PAJ. Effectiveness of exercise therapy for meniscal lesions in adults: A systematic review and meta-analysis. J Sci Med Sport 2016; 19:990-998. [PMID: 27129638 DOI: 10.1016/j.jsams.2016.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 03/16/2016] [Accepted: 04/12/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study evaluated the effectiveness of exercise therapy in patients with meniscal lesions. DESIGN Systematic review and meta-analysis. METHODS Nine databases were searched up to July 2015, including EMBASE and Medline OvidSP. Randomized and controlled clinical trials in adults with traumatic or degenerative meniscal lesions were considered for inclusion. Interventions had to consist of exercise therapy in non-surgical patients or after meniscectomy, and had to be compared with meniscectomy, no exercise therapy, or to a different type of exercise therapy. Primary outcomes were pain and function on short term (≤3 months) and long term (>3 months). Two researchers independently selected the studies, assessed the risk of bias, and extracted data. RESULTS Of the 1415 identified articles 14 articles describing 12 studies were included; all had some concerns about the risk of bias. There was no significant difference between exercise therapy and meniscectomy for pain (MD 0.27 [-4.30,4.83]) and function (SMD -0.32 [-0.68,0.03]). After meniscectomy, there was conflicting evidence for the effectiveness of exercise therapy when compared to no exercise therapy for pain and function. There was no significant difference between various types of exercise therapy for pain (MD 19.30 [-6.60,45.20]) and function (SMD 0.01 [-0.27,0.28]). CONCLUSIONS Exercise therapy and meniscectomy yielded comparable results on pain and function. Exercise therapy compared to no exercise therapy after meniscectomy showed conflicting evidence at short term, but was more effective on function at long term. The preferable type/frequency/intensity of exercise therapy remains unclear. The strength of the evidence was low to very low.
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Affiliation(s)
- N M Swart
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - K van Oudenaarde
- Department of Radiology, Leiden University Medical Center, The Netherlands
| | - M Reijnierse
- Department of Radiology, Leiden University Medical Center, The Netherlands
| | - R G H H Nelissen
- Department of Orthopedics, Leiden University Medical Center, The Netherlands
| | - J A N Verhaar
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands; Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - P A J Luijsterburg
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands
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de Lange-Brokaar BJE, Kloppenburg M, Andersen SN, Dorjée AL, Yusuf E, Herb-van Toorn L, Kroon HM, Zuurmond AM, Stojanovic-Susulic V, Bloem JL, Nelissen RGHH, Toes REM, Ioan-Facsinay A. Characterization of synovial mast cells in knee osteoarthritis: association with clinical parameters. Osteoarthritis Cartilage 2016; 24:664-71. [PMID: 26671522 DOI: 10.1016/j.joca.2015.11.011] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [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: 06/02/2015] [Revised: 10/29/2015] [Accepted: 11/17/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the presence of mast cells in the osteoarthritic (OA) synovium and their association with clinical parameters in comparison with rheumatoid arthritis (RA) samples. METHOD Synovial tissues of 56 symptomatic OA and 49 RA patients were obtained. Two to three paraffin slides were used to quantify inflammation using haematoxylin and eosin (H&E) staining (synovitis score 0-9), and numbers of mast cells (per 10 high-power fields) using double immunofluorescence for CD117 and tryptase. Average scores per patient were used for analysis. Knee radiographs of OA patients were scored according to the Kellgren and Lawrence (KL) system and pain was determined in OA patients at baseline by visual analogue scale (VAS). RESULTS Median (range) of mast cells was significantly higher in OA samples 45 (1-168) compared to RA samples 4 (1-47) (P-value < 0.001), despite a lower median (range) synovitis score in OA (2.5 (0-6.0)) compared to 4.6 (0-8.0) in RA samples. The synovitis score was significantly correlated with the number of mast cells (in OA Spearman's rho (P-value) 0.3 (0.023) and RA 0.5 (P-value < 0.001)). Interestingly, we observed a trend towards an association between the number of mast cells and an increased KL-grade (P-value 0.05) in OA patients, independently of synovitis. No associations were found with self-reported pain. CONCLUSION Prevalence of mast cells in OA synovial tissue is relatively high and associates with structural damage in OA patients, suggesting a role of mast cells in this disease.
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Affiliation(s)
| | - M Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
| | - S N Andersen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - A L Dorjée
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - E Yusuf
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - L Herb-van Toorn
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - H M Kroon
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
| | | | | | - J L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
| | - R G H H Nelissen
- Department Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.
| | - R E M Toes
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - A Ioan-Facsinay
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
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de Witte PB, van Adrichem RA, Selten JW, Nagels J, Reijnierse M, Nelissen RGHH. [Persistent shoulder symptoms in calcific tendinitis: clinical and radiological predictors]. Ned Tijdschr Geneeskd 2016; 160:D521. [PMID: 27900924] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE We assessed the most important demographics and radiological characteristics at the time of diagnosis of rotator cuff calcific tendinitis (RCCT), and their associations with long-term clinical outcome. DESIGN Observational study. METHOD Baseline characteristics and treatment were evaluated in 342 patients in whom RCCT had been diagnosed. Interobserver agreement of the radiological investigations was analysed. Patients were sent a general questionnaire and 2 shoulder questionnaires, the "Western Ontario rotator cuff" (WORC) and the "Disabilities of the arm, shoulder and hand" (DASH) for evaluation of long-term clinical outcome. Associations between baseline characteristics and long-term outcomes were analysed using logistic regression. RESULTS Mean age at diagnosis was 49.0 years (SD = 10.0), and 60% were female. The dominant arm was affected in 66%, and 21% had bilateral RCCT. Calcifications were on average 18.7 mm in size (SD = 10.1, ICC = 0.84 (p < 0.001)) and located 10.1 mm (SD = 11.8) medially to the acromion (ICC = 0.77 (p < 0.001)). 32% of the calcifications had a Gärtner type I classification (κ: 0.47 (p<0.001)). After a mean follow-up of 14 years (SD =7.1), median WORC score was 72.5 (range: 3.0-100.0) and median DASH score 17.0 (range: 0.0-82.0). Female gender, dominant arm involvement, bilateral disease, longer duration of symptoms at presentation, and presence of multiple calcifications were associated with inferior long-term outcomes. CONCLUSION RCCT is not self-limiting. Radiological variations have no significant predictive value. We identified specific prognostic factors for inferior long-term outcome; more intensive follow-up and treatment should be considered in patients with these characteristics.
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Affiliation(s)
- P B de Witte
- *Dit onderzoek werd eerder gepubliceerd in European Radiology (2016;26:3401-11) met als titel 'Radiological and clinical predictors of long-term outcome in rotator cuff calcific tendinitis'. Afgedrukt met toestemming
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Verra WC, Witteveen KQ, Maier AB, Gademan MGJ, van der Linden HMJ, Nelissen RGHH. The reason why orthopaedic surgeons perform total knee replacement: results of a randomised study using case vignettes. Knee Surg Sports Traumatol Arthrosc 2016; 24:2697-703. [PMID: 26759152 PMCID: PMC4969334 DOI: 10.1007/s00167-015-3961-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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] [Received: 06/27/2015] [Accepted: 12/23/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE End-stage knee osteoarthritis (OA) results in total knee arthroplasty (TKA) surgery. The decision to perform TKA is not well defined, resulting in variation of indications among orthopaedic surgeons. Non-operative treatment measures are often not extensively used. Aim of this study was to investigate factors influencing the decision to perform TKA by Dutch orthopaedic surgeons. METHODS Three case vignettes, each case divided into two versions, being identical except for information on age (younger and older age), pain (mild and severe pain) or radiological OA (low and high grade) were developed. A questionnaire including these three case vignettes was sent to 599 Dutch orthopaedic surgeons, who were randomised to either one of the two versions. The orthopaedic surgeons were asked whether TKA would be the next step in treatment. Furthermore, from a list of patient factors they were asked how strong these factors would influence the decision to perform TKA. RESULTS 54 % of the orthopaedic surgeons completed the questionnaire (n = 326). Orthopaedic surgeons indicated to perform TKA significantly more often at higher age (73.3 vs. 45.5 %, p < 0.001). In the presence of mild pain, orthopaedic surgeons were slightly more reluctant to perform a TKA compared to severe pain (57.0 vs. 64.0 %, n.s.). Mild radiological OA made surgeons more reluctant to perform TKA compared to severe OA (9.7 vs. 96.9 %, p < 0.001). CONCLUSION Old age and severe radiological OA are variables which are considered to be important in the decision to perform a TKA. Pain symptoms of moderate or severe pain are unequivocal when considering a TKA. LEVEL OF EVIDENCE Economic/decision analysis, Level III.
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Affiliation(s)
- W C Verra
- Department of Orthopaedic Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
| | - K Q Witteveen
- Department of Orthopaedic Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - A B Maier
- Section of Gerontology and Geriatrics, Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - M G J Gademan
- Department of Orthopaedic Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - H M J van der Linden
- Department of Orthopaedic Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - R G H H Nelissen
- Department of Orthopaedic Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
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Tilbury C, Leichtenberg CS, Tordoir RL, Holtslag MJ, Verdegaal SHM, Kroon HM, Nelissen RGHH, Vliet Vlieland TPM. Return to work after total hip and knee arthroplasty: results from a clinical study. Rheumatol Int 2015; 35:2059-67. [PMID: 26119221 PMCID: PMC4651988 DOI: 10.1007/s00296-015-3311-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 01/29/2015] [Accepted: 06/04/2015] [Indexed: 12/19/2022]
Abstract
The aim of this study was to measure return to work and duration until return to work in patients undergoing total hip or knee arthroplasty (THA or TKA). This prospective study included patients under 65 years of age, undergoing THA or TKA, who provided information on their work status preoperatively (paid work yes/no and working hours) and 1 year thereafter (paid work yes/no, working hours and time until return to work). Seventy-one THA and 64 TKA patients had a paid job preoperatively. The employment rates 1 year postoperatively were 64/71 (90 %) after THA and 53/64 (83 %) after TKA. Of those who returned to work, 9/64 (14 %) of THA patients and 10/53 (19 %) of TKA patients worked less hours than preoperatively [mean decrease of 16 (SD 11.5) and 14 (SD 13.0) hours, respectively]. The mean time to return to work was 12.5 (SD 7.6) and 12.9 (SD 8.0) weeks in THA and TKA, respectively. The majority of working patients who underwent THA or TKA returned to work, after approximately 12 weeks. A considerable proportion of the patients returning to work worked less hours than preoperatively. More research into patients who do not return or decrease their working hours is needed.
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Affiliation(s)
- C Tilbury
- Department of Orthopaedics J11, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - C S Leichtenberg
- Department of Orthopaedics J11, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - R L Tordoir
- Department of Orthopaedics, Alrijne Hospital, Leiderdorp, The Netherlands
| | - M J Holtslag
- Department of Orthopaedics J11, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - S H M Verdegaal
- Department of Orthopaedics, Alrijne Hospital, Leiderdorp, The Netherlands
| | - H M Kroon
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - R G H H Nelissen
- Department of Orthopaedics J11, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - T P M Vliet Vlieland
- Department of Orthopaedics J11, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
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Marks M, Vliet Vlieland TPM, Audigé L, Herren DB, Nelissen RGHH, van den Hout WB. Healthcare costs and loss of productivity in patients with trapeziometacarpal osteoarthritis. J Hand Surg Eur Vol 2015; 40:927-34. [PMID: 25646143 DOI: 10.1177/1753193414568293] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 12/04/2014] [Indexed: 02/03/2023]
Abstract
The objective of this study was to analyse healthcare and productivity costs in patients with trapeziometacarpal osteoarthritis. We included 161 patients who received surgery or steroid injection and calculated their healthcare costs in Euro (€) over 1 year. Patients filled out the Work Productivity and Activity Impairment Questionnaire to assess loss of productivity at baseline, and after 3, and 12 months. In the surgical group, loss of productivity among employed patients first increased and then decreased (50%, 64%, and 25% at 0, 3, and 12 months). Productivity was more stable over time in the injection group (52%, 38%, and 48%). In the surgical group, estimated total annual healthcare and productivity costs were €5770 and €5548, respectively. In the injection group, healthcare and productivity costs were €348 and €3503. These findings highlight the need for assessing productivity costs to get a comprehensive view of the costs associated with a treatment.Level of Evidence III.
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Affiliation(s)
- M Marks
- Department of Research and Development, Schulthess Clinic, Zurich, Switzerland Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - T P M Vliet Vlieland
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - L Audigé
- Department of Research and Development, Schulthess Clinic, Zurich, Switzerland
| | - D B Herren
- Department of Hand Surgery, Schulthess Clinic, Zurich, Switzerland
| | - R G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - W B van den Hout
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
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van Adrichem RA, Nelissen RGHH, Schipper IB, Rosendaal FR, Cannegieter SC. Risk of venous thrombosis after arthroscopy of the knee: results from a large population-based case-control study. J Thromb Haemost 2015; 13:1441-8. [PMID: 25940206 DOI: 10.1111/jth.12996] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 04/10/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND From the currently available evidence, the risk of venous thrombosis after knee arthroscopy remains unclear. OBJECTIVES To estimate the risk of venous thrombosis after arthroscopy of the knee, and to identify high-risk groups. PATIENTS AND METHODS We used data from a large population-based case-control study (the Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis [MEGA] study) on the etiology of venous thrombosis (4416 cases; 6150 controls). Odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for age, sex, body mass index, rheumatic disease, and regular exercise, were calculated. RESULTS One hundred and three patients and 24 controls had a knee arthroscopy in the year before the index date, resulting in a six-fold increased risk (OR 5.9, 95% CI 3.7-9.3). Ligament reconstructions led to a higher risk (OR 17.2, 95% CI 2.2-136) than meniscal surgery, diagnostic arthroscopy, or chondroplasty (OR 5.4, 95% CI 3.4-8.7). An additionally increased risk was found for combinations with genetic and acquired risk factors: with oral contraceptives (OR 46.6, 95% CI 6.1-353); and with factor V Leiden, factor II G20210A mutation, or non-O blood type (OR 15.3, 95% CI 8.1-28.5). The risk of venous thrombosis was particularly high in the first 3 months after knee arthroscopy, with an 18-fold increased risk (OR 16.2, 95% CI 7.8-33.7). CONCLUSIONS We observed a strongly increased risk of venous thrombosis after knee arthroscopy, especially in the first months after the procedure. The risk was particularly high in the presence of other acquired or genetic risk factors, making knee arthroscopy a high-risk intervention in certain individuals.
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Affiliation(s)
- R A van Adrichem
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - R G H H Nelissen
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - I B Schipper
- Department of Trauma Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - F R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - S C Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
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de Lange-Brokaar BJE, Ioan-Facsinay A, Yusuf E, Visser AW, Kroon HM, van Osch GJVM, Zuurmond AM, Stojanovic-Susulic V, Bloem JL, Nelissen RGHH, Huizinga TW, Kloppenburg M. Association of pain in knee osteoarthritis with distinct patterns of synovitis. Arthritis Rheumatol 2015; 67:733-40. [PMID: 25418977 DOI: 10.1002/art.38965] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 11/13/2014] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To determine possible patterns of synovitis on contrast-enhanced magnetic resonance imaging (CE-MRI) and its relation to pain and severity in patients with radiographic knee osteoarthritis (OA). METHODS In total, 86 patients (mean age 62 years, 66% women, median body mass index 29 kg/m(2) ) with symptomatic knee OA (Kellgren/Lawrence radiographic score 3) were included. T1-weighted, gadolinium-chelate-enhanced MRI with fat suppression was used to semiquantitatively score the extent of synovitis at 11 knee sites (total score range 0-22). Self-reported pain was assessed with 3 standardized questionnaires. Principal components analysis (PCA) was used to investigate patterns (the location and severity) of synovitis. Subsequently, these patterns were assessed for associations with pain measures and radiographic severity in adjusted logistic regression models. RESULTS Synovitis was observed in 86 patients and was found to be generally mild on CE-MRI (median total synovitis score 7, range 0-16). The median pain scores were 53 (range 0-96) on the visual analog scale for pain, 51.4 (range 2.8-97.2) on the Knee Injury and Osteoarthritis Outcome Score (KOOS) for pain, 35 (range 0-75) on the Intermittent and Constant Osteoarthritis Pain (ICOAP) score for constant pain, and 40.6 (range 0-87.5) on the ICOAP score for intermittent pain. PCA resulted in extraction of 3 components, explaining 53.4% of the variance. Component 1 was characterized by synovitis at 7 sites (mainly medial parapatellar involvement) and was associated with scores on the KOOS pain subscale and the ICOAP constant pain subscale. Component 2 was characterized by synovitis at 4 sites (mainly the site adjacent to the anterior cruciate ligament), but was not associated with pain measures or with radiographic severity. Component 3, characterized by synovitis at 3 sites (mainly at the loose body site), was associated with radiographic severity. CONCLUSION Different patterns of synovitis in knee OA were observed. The pattern that included several patellar sites was associated with pain, whereas other patterns showed no association, suggesting that pain perception in patients with knee OA is a localized response.
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Abstract
The aim of this study was to quantify the stability of fracture-implant complex in fractures after fixation. A total of 15 patients with an undisplaced fracture of the femoral neck, treated with either a dynamic hip screw or three cannulated hip screws, and 16 patients with an AO31-A2 trochanteric fracture treated with a dynamic hip screw or a Gamma Nail, were included. Radiostereometric analysis was used at six weeks, four months and 12 months post-operatively to evaluate shortening and rotation. Migration could be assessed in ten patients with a fracture of the femoral neck and seven with a trochanteric fracture. By four months post-operatively, a mean shortening of 5.4 mm (-0.04 to 16.1) had occurred in the fracture of the femoral neck group and 5.0 mm (-0.13 to 12.9) in the trochanteric fracture group. A wide range of rotation occurred in both types of fracture. Right-sided trochanteric fractures seem more rotationally stable than left-sided fractures. This prospective study shows that migration at the fracture site occurs continuously during the first four post-operative months, after which stabilisation occurs. This information may allow the early recognition of patients at risk of failure of fixation. Cite this article: Bone Joint J 2015;97-B:391–7.
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Affiliation(s)
- D. van Embden
- Leiden University Medical Center, Albinusdreef
2, 2333 ZA, Leiden, The, Netherlands
| | | | - L. A. Koster
- Leiden University Medical Center, Albinusdreef
2, 2333 ZA, Leiden, The, Netherlands
| | - B. L. Kaptein
- Leiden University Medical Center, Albinusdreef
2, 2333 ZA, Leiden, The, Netherlands
| | - R. G. H. H. Nelissen
- Leiden University Medical Center, Albinusdreef
2, 2333 ZA, Leiden, The, Netherlands
| | - I. B. Schipper
- Leiden University Medical Center, Albinusdreef
2, 2333 ZA, Leiden, The, Netherlands
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van der Zwaal P, Pijls BG, Thomassen BJW, Lindenburg R, Nelissen RGHH, van de Sande MAJ. The natural history of the rheumatoid shoulder: a prospective long-term follow-up study. Bone Joint J 2015; 96-B:1520-4. [PMID: 25371467 DOI: 10.1302/0301-620x.96b11.34133] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The purpose of this study was to evaluate the natural history of rheumatoid disease of the shoulder over an eight-year period. Our hypothesis was that progression of the disease is associated with a decrease in function with time. A total of 22 patients (44 shoulders; 17 women, 5 men, (mean age 63)) with rheumatoid arthritis were followed for eight years. All shoulders were assessed using the Constant score, anteroposterior radiographs (Larsen score, Upward-Migration-Index (UMI)) and ultrasound (US). At final follow-up, the Short Form-36, disabilities of the arm, shoulder and hand (DASH) Score, erythrocyte sedimentation rate and use of anti-rheumatic medication were determined. The mean Constant score was 72 points (50 to 88) at baseline and 69 points (25 to 100) at final follow-up. Radiological evaluation showed progressive destruction of the peri-articular structures with time. This progression of joint and rotator cuff destruction was significantly associated with the Constant score. However, at baseline only the extent of rotator cuff disease and the UMI could predict the Constant score at final follow-up. A plain anteroposterior radiograph of the shoulder is sufficient to assess any progression of rheumatoid disease and to predict functional outcome in the long term by using the UMI as an indicator of rotator cuff degeneration.
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Affiliation(s)
- P van der Zwaal
- Department of Orthopedic Surgery and Trauma, MC Haaglanden, Lijnbaan32, 2501 CK, The Hague, The Netherlands
| | - B G Pijls
- Department of Orthopaedics, LUMC, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - B J W Thomassen
- Department of Orthopedic Surgery and Trauma, MC Haaglanden, Lijnbaan32, 2501 CK, The Hague, The Netherlands
| | - R Lindenburg
- MSK Sonography Fysus Communications, Emmapark 12, 2641 EL Pijnacker, The Netherlands
| | - R G H H Nelissen
- Department of Orthopaedics, LUMC, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - M A J van de Sande
- Department of Orthopaedics, LUMC, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
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Berendes TD, Pilot P, Nagels J, Vochteloo AJH, Nelissen RGHH. Survey on the management of acute first-time anterior shoulder dislocation amongst Dutch public hospitals. Arch Orthop Trauma Surg 2015; 135:447-54. [PMID: 25697813 PMCID: PMC4365281 DOI: 10.1007/s00402-015-2156-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 07/18/2014] [Indexed: 10/31/2022]
Abstract
INTRODUCTION The primary aim of this study was to record how orthopaedic surgeons are currently managing acute first-time anterior shoulder dislocation (AFASD) 8 years after introduction of the Dutch national guideline: "acute primary shoulder dislocation, diagnostics and treatment" in 2005. The second aim was to evaluate how these surgeons treat recurrent instability after AFASD. MATERIALS AND METHODS An online questionnaire regarding the management of AFASD and recurrent shoulder instability was held amongst orthopaedic surgeons of all 98 Dutch hospitals. RESULTS The overall response rate was 60%. Of the respondents, 75% had a local protocol for managing AFASD, of which 28% had made changes in their treatment protocol after the introduction of the national guideline. The current survey showed wide variety in the overall treatment policies for AFASD. Twenty-seven percent of the orthopaedic surgeons were currently unaware of the national guideline. The variability in treatment for AFASD was present throughout the whole treatment from which policy at the emergency department; when to operate for recurrent instability; type of surgical technique for stabilization and type of fixation of the labrum. As for the treatment of recurrent instability, the same variability was seen: 36% of the surgeons perform only arthroscopic procedures, 7% only open and 57% perform both open and arthroscopic procedures. CONCLUSIONS Despite the introduction of the national guideline for the initial management of AFASD in 2005, still great variety among orthopaedic surgeons in the Netherlands was present. As for the surgical stabilization technique, the vast majority of the respondents are performing an arthroscopic shoulder stabilization procedure at the expense of the more traditional open procedure as a first treatment option for post-traumatic shoulder instability.
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Affiliation(s)
- T. D. Berendes
- Department of Orthopaedics, Meander Medical Centre, Maatweg 3, Postbox 1502, 3800 BM Amersfoort, The Netherlands ,Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
| | - P. Pilot
- Department of Orthopaedics, Reinier de Graaf Hospital, Delft, The Netherlands
| | - J. Nagels
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - R. G. H. H. Nelissen
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
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van IJsseldijk EA, Harman MK, Luetzner J, Valstar ER, Stoel BC, Nelissen RGHH, Kaptein BL. Validation of a model-based measurement of the minimum insert thickness of knee prostheses: a retrieval study. Bone Joint Res 2014; 3:289-96. [PMID: 25278502 PMCID: PMC4220171 DOI: 10.1302/2046-3758.310.2000304] [Citation(s) in RCA: 5] [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] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Wear of polyethylene inserts plays an important role in failure of total knee replacement and can be monitored in vivo by measuring the minimum joint space width in anteroposterior radiographs. The objective of this retrospective cross-sectional study was to compare the accuracy and precision of a new model-based method with the conventional method by analysing the difference between the minimum joint space width measurements and the actual thickness of retrieved polyethylene tibial inserts. METHOD Before revision, the minimum joint space width values and their locations on the insert were measured in 15 fully weight-bearing radiographs. These measurements were compared with the actual minimum thickness values and locations of the retrieved tibial inserts after revision. RESULTS The mean error in the model-based minimum joint space width measurement was significantly smaller than the conventional method for medial condyles (0.50 vs 0.94 mm, p < 0.01) and for lateral condyles (0.06 vs 0.34 mm, p = 0.02). The precision (standard deviation of the error) of the methods was similar (0.84 vs 0.79 mm medially and both 0.46 mm laterally). The distance between the true minimum joint space width locations and the locations from the model-based measurements was less than 10 mm in the medial direction in 12 cases and less in the lateral direction in 13 cases. CONCLUSION The model-based minimum joint space width measurement method is more accurate than the conventional measurement with the same precision. Cite this article: Bone Joint Res 2014;3:289-96.
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Affiliation(s)
- E A van IJsseldijk
- Leiden University Medical Center, Department of Orthopaedics, Biomechanics and Imaging Group, PO 9600, 2300 RC, Leiden, The Netherlands
| | - M K Harman
- Clemson University, Department of Bioengineering, 301 Rhodes Engineering Research Center, Clemson, 29634, USA
| | - J Luetzner
- University Hospital Carl Gustav Carus, Department of Orthopaedic and Trauma Surgery, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - E R Valstar
- Leiden University Medical Center, Department of Orthopaedics, Biomechanics and Imaging Group, PO 9600, 2300 RC, Leiden, The Netherlands
| | - B C Stoel
- Leiden University Medical Center, Department of Radiology, Div. of Image Processing, PO 9600, 2300 RC, Leiden, The Netherlands
| | - R G H H Nelissen
- Leiden University Medical Center, Department of Orthopaedics, Biomechanics and Imaging Group, PO 9600, 2300 RC, Leiden, The Netherlands
| | - B L Kaptein
- Leiden University Medical Center, Department of Orthopaedics, Biomechanics and Imaging Group, PO 9600, 2300 RC, Leiden, The Netherlands
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de Lange-Brokaar BJE, Ioan-Facsinay A, Yusuf E, Visser AW, Kroon HM, Andersen SN, Herb-van Toorn L, van Osch GJVM, Zuurmond AM, Stojanovic-Susulic V, Bloem JL, Nelissen RGHH, Huizinga TWJ, Kloppenburg M. Degree of synovitis on MRI by comprehensive whole knee semi-quantitative scoring method correlates with histologic and macroscopic features of synovial tissue inflammation in knee osteoarthritis. Osteoarthritis Cartilage 2014; 22:1606-13. [PMID: 24365722 DOI: 10.1016/j.joca.2013.12.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 11/25/2013] [Accepted: 12/10/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the association between synovitis on contrast enhanced (CE) MRI with microscopic and macroscopic features of synovial tissue inflammation. METHOD Forty-one patients (mean age 60 years, 61% women) with symptomatic radiographic knee OA were studied: twenty underwent arthroscopy (macroscopic features were scored (0-4), synovial biopsies obtained), twenty-one underwent arthroplasty (synovial tissues were collected). After haematoxylin and eosin staining, the lining cell layer, synovial stroma and inflammatory infiltrate of synovial tissues were scored (0-3). T1-weighted CE-MRI's (3 T) were used to semi-quantitatively score synovitis at 11 sites (0-22) according to Guermazi et al. Spearman's rank correlations were calculated. RESULTS The mean (SD) MRI synovitis score was 8.0 (3.7) and the total histology grade was 2.5 (1.6). Median (range) scores of macroscopic features were 2 (1-3) for neovascularization, 1 (0-3) for hyperplasia, 2 (0-4) for villi and 2 (0-3) for fibrin deposits. The MRI synovitis score was significantly correlated with total histology grade [r = 0.6], as well as with lining cell layer [r = 0.4], stroma [r = 0.3] and inflammatory infiltrate [r = 0.5] grades. Moreover, MRI synovitis score was also significantly correlated with macroscopic neovascularization [r = 0.6], hyperplasia [r = 0.6] and villi [r = 0.6], but not with fibrin [r = 0.3]. CONCLUSION Synovitis severity on CE-MRI assessed by a new whole knee scoring system by Guermazi et al. is a valid, non-invasive method to determine synovitis as it is significantly correlated with both macroscopic and microscopic features of synovitis in knee OA patients.
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Affiliation(s)
| | - A Ioan-Facsinay
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - E Yusuf
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - A W Visser
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - H M Kroon
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
| | - S N Andersen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - L Herb-van Toorn
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - G J V M van Osch
- Department of Orthopaedics and Otorhinolarynogology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | | | | | - J L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
| | - R G H H Nelissen
- Department Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.
| | - T W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - M Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
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Nieuwenhuijse MJ, Nelissen RGHH, Schoones JW, Sedrakyan A. Appraisal of evidence base for introduction of new implants in hip and knee replacement: a systematic review of five widely used device technologies. BMJ 2014; 349:g5133. [PMID: 25208953 PMCID: PMC4159610 DOI: 10.1136/bmj.g5133] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To determine the evidence of effectiveness and safety for introduction of five recent and ostensibly high value implantable devices in major joint replacement to illustrate the need for change and inform guidance on evidence based introduction of new implants into healthcare. DESIGN Systematic review of clinical trials, comparative observational studies, and registries for comparative effectiveness and safety of five implantable device innovations. DATA SOURCES PubMed (Medline), Embase, Web of Science, Cochrane, CINAHL, reference lists of articles, annual reports of major registries, summaries of safety and effectiveness for pre-market application and mandated post-market studies at the US Food and Drug Administration. STUDY SELECTION The five selected innovations comprised three in total hip replacement (ceramic-on-ceramic bearings, modular femoral necks, and uncemented monoblock cups) and two in total knee replacement (high flexion knee replacement and gender specific knee replacement). All clinical studies of primary total hip or knee replacement for symptomatic osteoarthritis in adults that compared at least one of the clinical outcomes of interest (patient centred outcomes or complications, or both) in the new implant group and control implant group were considered. Data searching, abstraction, and analysis were independently performed and confirmed by at least two authors. Quantitative data syntheses were performed when feasible. RESULTS After assessment of 10,557 search hits, 118 studies (94 unique study cohorts) met the inclusion criteria and reported data related to 15,384 implants in 13,164 patients. Comparative evidence per device innovation varied from four low to moderate quality retrospective studies (modular femoral necks) to 56 studies of varying quality including seven high quality (randomised) studies (high flexion knee replacement). None of the five device innovations was found to improve functional or patient reported outcomes. National registries reported two to 12 year follow-up for revision occurrence related to more than 200,000 of these implants. Reported comparative data with well established alternative devices (over 1,200,000 implants) did not show improved device survival. Moreover, we found higher revision occurrence associated with modular femoral necks (hazard ratio 1.9) and ceramic-on-ceramic bearings (hazard ratio 1.0-1.6) in hip replacement and with high flexion knee implants (hazard ratio 1.0-1.8). CONCLUSION We did not find convincing high quality evidence supporting the use of five substantial, well known, and already implemented device innovations in orthopaedics. Moreover, existing devices may be safer to use in total hip or knee replacement. Improved regulation and professional society oversight are necessary to prevent patients from being further exposed to these and future innovations introduced without proper evidence of improved clinical efficacy and safety.
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Affiliation(s)
- Marc J Nieuwenhuijse
- Patient Centered Comparative Effectiveness Program and US Food and Drug Administration Medical Device Epidemiology Science and Infrastructure Center, Department of Public Health, Weill Cornell Medical College, New York, NY 10065, USA Department of Orthopaedics, Leiden University Medical Center, 2300 RC Leiden, Netherlands Office of Surveillance and Biometrics, Center for Devices and Radiological Health, FDA, Silver Spring, MD 20993, USA
| | - R G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, 2300 RC Leiden, Netherlands
| | - J W Schoones
- Walaeus Library, Leiden University Medical Center, 2300 RC Leiden, Netherlands
| | - A Sedrakyan
- Patient Centered Comparative Effectiveness Program and US Food and Drug Administration Medical Device Epidemiology Science and Infrastructure Center, Department of Public Health, Weill Cornell Medical College, New York, NY 10065, USA Office of Surveillance and Biometrics, Center for Devices and Radiological Health, FDA, Silver Spring, MD 20993, USA
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van Adrichem RA, Debeij J, Nelissen RGHH, Schipper IB, Rosendaal FR, Cannegieter SC. Below-knee cast immobilization and the risk of venous thrombosis: results from a large population-based case-control study. J Thromb Haemost 2014; 12:1461-9. [PMID: 25040873 DOI: 10.1111/jth.12655] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 06/29/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND From the available evidence, the risk of venous thrombosis in patients with below-knee cast immobilization remains unclear. OBJECTIVES To estimate the risk of venous thrombosis after below-knee cast immobilization and to identify high-risk groups. PATIENTS AND METHODS We used data from a large population-based case-control study (MEGA study) on the etiology of venous thrombosis (4418 cases; 6149 controls). Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, and adjusted for age, sex, body mass index, and regular exercise. Absolute risks were estimated from the ORs. RESULTS One hundred and thirty-four patients and 23 controls had below-knee plaster cast immobilization in the year before the index date, resulting in an eight-fold increased risk (OR 8.3 [95% CI 5.3-12.9]). Traumatic indications led to a higher risk than non-traumatic indications: OR 12.7 (95% CI 6.6-24.6) vs. OR 7.6 (95% CI 0.9-66.4). An additionally increased risk was found for combinations with genetic or acquired risk factors: oral contraceptives (OR 18.2 [95% CI 6.2-53.4]); obesity (OR 17.2 [95% CI 5.4-55.2]); factor V Leiden, factor II 20210A mutation, and/or non-O blood group (OR 23.0 [95% CI 11.5-46.0]); all for a period of 1 year. Ninety per cent of the events occurred in the first 3 months after cast application. This led to a 56-fold increased risk (OR 56.3 [95% CI 17.9-177.3]) in this period. CONCLUSIONS Below-knee cast immobilization strongly increases the risk of venous thrombosis. We found distinct differences in intrinsic risk between individuals with respect to indication for cast immobilization and the presence of genetic or acquired risk factors.
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Affiliation(s)
- R A van Adrichem
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Schaasberg W, van der Steenhoven TJ, van de Velde SK, Nelissen RGHH, Valstar ER. Feasibility of osteosynthesis of fractured cadaveric hips following preventive elastomer femoroplasty. Clin Biomech (Bristol, Avon) 2014; 29:742-6. [PMID: 25001328 DOI: 10.1016/j.clinbiomech.2014.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 12/26/2013] [Revised: 06/10/2014] [Accepted: 06/10/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND In vitro cadaveric studies showed that elastomer femoroplasty prevents displacement of fracture parts after proximal hip fracture allowing for conservative treatment. In the event that secondary displacement does occur, the purpose of this present study was to determine the feasibility of performing osteosynthesis of a fractured hip after preventive treatment with elastomer femoroplasty. METHODS Ten pairs of human cadaveric femurs were fractured in a simulated fall configuration. From each pair, one femur was randomly selected for elastomer femoroplasty prior to fracture generation and the contralateral femur was used as control. Following hip fracture generation, osteosynthesis was performed in all femurs. The operative time per case, technical difficulties during the procedure, and postoperative energy-to-failure load were recorded. RESULTS The mean (SD) time to perform osteosynthesis was 20 (6) minutes in the control-group and 19 (5) minutes in the elastomer femoroplasty-group (P=0.69). During osteosynthesis of the fractured hip in the elastomer femoroplasty-group, no difficulties including the need for additional instruments to remove elastomer from the proximal femur were recorded. Postoperative energy-to-failure load was similar in the control-group and the elastomer femoroplasty-group. CONCLUSION Fixation with routine osteosynthesis of displaced cadaveric hip fractures is not hindered by the presence of previously injected elastomer.
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Affiliation(s)
- W Schaasberg
- Leiden University Medical Center, Department of Orthopaedics, Leiden, The Netherlands.
| | | | - S K van de Velde
- Leiden University Medical Center, Department of Orthopaedics, Leiden, The Netherlands
| | - R G H H Nelissen
- Leiden University Medical Center, Department of Orthopaedics, Leiden, The Netherlands
| | - E R Valstar
- Leiden University Medical Center, Biomechanics and Imaging Group, Department of Orthopaedics, Leiden, The Netherlands; Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, TU Delft, The Netherlands
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Thomassen BJW, den Hollander PHC, Kaptijn HH, Nelissen RGHH, Pilot P. Autologous wound drains have no effect on allogeneic blood transfusions in primary total hip and knee replacement: a three-arm randomised trial. Bone Joint J 2014; 96-B:765-71. [PMID: 24891576 DOI: 10.1302/0301-620x.96b6.33021] [Citation(s) in RCA: 15] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We hypothesised there was no clinical value in using an autologous blood transfusion (ABT) drain in either primary total hip (THR) or total knee replacement (TKR) in terms of limiting allogeneic blood transfusions when a modern restrictive blood management regime was followed. A total of 575 patients (65.2% men), with a mean age of 68.9 years (36 to 94) were randomised in this three-arm study to no drainage (group A), or to wound drainage with an ABT drain for either six hours (group B) or 24 hours (group C). The primary outcome was the number of patients receiving allogeneic blood transfusion. Secondary outcomes were post-operative haemoglobin (Hb) levels, length of hospital stay and adverse events. This study identified only 41 transfused patients, with no significant difference in distribution between the three groups (p = 0.857). The mean pre-operative haemoglobin (Hb) value in the transfused group was 12.8 g/dL (9.8 to 15.5) versus 14.3 g/dL (10.6 to 18.0) in the non-transfused group (p < 0.001, 95% confidence interval: 1.08 to 1.86). Post-operatively, the median of re-transfused shed blood in patients with a THR was 280 mL (Interquartile range (IQR) 150 to 400) and in TKR patients 500 mL (IQR 350 to 650) (p < 0.001). ABT drains had no effect on the proportion of transfused patients in primary THR and TKR. The secondary outcomes were also comparable between groups.
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Affiliation(s)
- B J W Thomassen
- Medical Center Haaglanden, Department of Orthopaedic Surgery , Lijnbaan 32, 2501 CK Den Haag, The Netherlands
| | - P H C den Hollander
- Medical Center Haaglanden, Department of Orthopaedic Surgery , Lijnbaan 32, 2501 CK Den Haag, The Netherlands
| | - H H Kaptijn
- The Lange Land Hospital, Department of Orthopaedic Surgery, Toneellaan 1, 2725 NA Zoetermeer, The Netherlands
| | - R G H H Nelissen
- Leiden University Medical Centre, Department of Orthopaedic Surgery, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - P Pilot
- Reinier de Graaf Groep, Department of Orthopaedic Surgery, Reinier de Graafweg 3-11, 2625: AD Delft, The Netherlands
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Hogendoorn S, Duijnisveld BJ, van Duinen SG, Stoel BC, van Dijk JG, Fibbe WE, Nelissen RGHH. Local injection of autologous bone marrow cells to regenerate muscle in patients with traumatic brachial plexus injury: a pilot study. Bone Joint Res 2014; 3:38-47. [PMID: 24565688 PMCID: PMC3942869 DOI: 10.1302/2046-3758.32.2000229] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives Traumatic brachial plexus injury causes severe functional impairment
of the arm. Elbow flexion is often affected. Nerve surgery or tendon
transfers provide the only means to obtain improved elbow flexion.
Unfortunately, the functionality of the arm often remains insufficient.
Stem cell therapy could potentially improve muscle strength and
avoid muscle-tendon transfer. This pilot study assesses the safety
and regenerative potential of autologous bone marrow-derived mononuclear
cell injection in partially denervated biceps. Methods Nine brachial plexus patients with insufficient elbow flexion
(i.e., partial denervation) received intramuscular escalating doses
of autologous bone marrow-derived mononuclear cells, combined with
tendon transfers. Effect parameters included biceps biopsies, motor
unit analysis on needle electromyography and computerised muscle tomography,
before and after cell therapy. Results No adverse effects in vital signs, bone marrow aspiration sites,
injection sites, or surgical wound were seen. After cell therapy
there was a 52% decrease in muscle fibrosis (p = 0.01), an 80% increase
in myofibre diameter (p = 0.007), a 50% increase in satellite cells
(p = 0.045) and an 83% increase in capillary-to-myofibre ratio (p
< 0.001) was shown. CT analysis demonstrated a 48% decrease in
mean muscle density (p = 0.009). Motor unit analysis showed a mean
increase of 36% in motor unit amplitude (p = 0.045), 22% increase
in duration (p = 0.005) and 29% increase in number of phases (p
= 0.002). Conclusions Mononuclear cell injection in partly denervated muscle of brachial
plexus patients is safe. The results suggest enhanced muscle reinnervation
and regeneration. Cite this article: Bone Joint Res 2014;3:38–47.
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Affiliation(s)
- S Hogendoorn
- Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
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