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- Al-Bayati, Mohanad, et al.
(författare)
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Good subjective outcome and low risk of revision surgery with a novel customized metal implant for focal femoral chondral lesions at a follow-up after a minimum of 5 years
- 2022
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Ingår i: Archives of Orthopaedic and Trauma Surgery. - : Springer. - 0936-8051 .- 1434-3916. ; 142:10, s. 2887-2892
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: Patients with focal cartilage lesions experience functional impairment. Results for biological treatments in the middle-aged patient is poor. Previous studies with focal prosthetic inlay resurfacing have shown a higher risk of conversion to total knee replacement at mid-term follow-up. A novel customized implant (Episealer, Episurf, Stockholm, Sweden) has been proposed to improve implant positioning and survival. The primary objective was to assess subjective-, objective function and implant survival at a minimum of five years after surgery.Materials and methods: The inclusion criteria were patients aged 30–65 years with symptomatic focal chondral defects in the medial femoral condyle, International Cartilage Research Society grade 3 or 4 and failed conservative or surgical treatment. Minimum follow-up of 5 years. Clinical and radiologic assessments were made. Patient-reported outcome measurements at the latest follow-up were compared with the baseline data for the Knee injury and Osteoarthritis Outcome Score (KOOS), the EuroQoL (EQ-5D), the Tegner Activity Scale and a Visual Analog Scale of pain (VAS 0–10).Results: Ten patients with the mean follow-up period of 75 months (60–86 months, SD 10) were included. Signs of osteoarthritis were seen in one patient (Ahlbäck 1). No cases with revision to knee replacement. VAS for pain and KOOS showed improvements that reached significance for VAS (p ≤ 0.001) and the KOOS subscores Pain (p = 0.01), ADL (p = 0.003), Sport and Recreation (p = 0.024) and Quality of Life (p = 0.003).Conclusion: A good subjective outcome, a low risk of progression to degenerative changes and the need for subsequent surgery were seen at the mid-term follow-up with this customized focal knee-resurfacing implant.Level of evidence: Prospective case series, level 4.
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- Belfrage, Ola, et al.
(författare)
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Preserved periprosthetic bone stock at 5 years post-operatively with uncemented short hip stem in both collared and collarless version
- 2022
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Ingår i: Archives of Orthopaedic and Trauma Surgery. - : Springer Science and Business Media LLC. - 0936-8051 .- 1434-3916. ; 142:11, s. 3489-3496
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Previous bone density studies have generally shown bone resorption around both cemented and uncemented total hip arthroplasty (THA) stems. This is presumed to be due to stress shielding. Short stems have been introduced partly to preserve bone in the proximal femur by a more physiological loading of the bone. The purpose of this study was to evaluate bone remodeling around a short, fully hydroxyapatite-coated titanium stem that comes in a collared and collarless version. Patients and methods: A prospective cohort of 50 patients included in a study evaluating the Furlong Evolution stem has been followed for 5 years. Examination was done with dual energy X-ray absorptiometry (DXA) postoperatively, at 1, 2 and 5 years. Clinical outcome was followed with radiography and both general and hip specific outcome measures. Results: The two versions of the stem behaved similarly regarding bone remodeling. After an initial decrease up to 1 year, bone mineral density (BMD) increased in all Gruen zones up to 2 years and at 5 years bone stock was still preserved compared with postoperatively (net BMD + 1.2% (95% CI − 0.4 to 2.8)). Increase in BMD occurred mainly in the greater trochanter and distally around the stem with a decrease in the calcar area. Both versions showed excellent clinical outcome up to 5 years. Conclusion: This short stem seems to preserve proximal bone stock up to 5 years, exhibiting similar behaviour both with and without a collar. Trial registration number and date of registration: ClinicalTrials.gov, (identifier: NCT01894854). July 10, 2013.
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| 6. |
- Borg, Tomas, 1963-, et al.
(författare)
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Outcome 5 years after surgical treatment of acetabular fractures : a prospective clinical and radiographic follow-up of 101 patients
- 2015
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Ingår i: Archives of Orthopaedic and Trauma Surgery. - : Springer. - 0936-8051 .- 1434-3916. ; 135:2, s. 227-233
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: The aim of this study was to evaluate functional outcome after surgically treated acetabular fracture using radiography and patient-reported outcome measures, and to determine predictors of hip joint failure 5 years post-surgery.PATIENTS AND METHODS: All patients with acetabular fractures treated with open reduction and internal fixation (ORIF) at our unit are prospectively entered into a local register. 101 acetabular fractures in 112 patients treated from 2004 to 2007 were eligible for analysis 5 years after surgery. Radiographs and questionnaires regarding physical function (Short Form[SF]-36) and pelvic discomfort index (PDI, 100 % = worst outcome) were obtained. The primary outcome measure was "joint failure" defined as either secondary total hip arthroplasty (THA) or a Girdlestone situation. Univariable analysis was used to compare patients with joint failure to those without, and binary logistic regression analysis was performed to identify risk factors of joint failure.RESULTS: 77 % of 101 followed patients had a preserved hip joint 5 years after surgery, and failure of the hip joint most often occurred within the first 2 years after injury. Patients with preserved hip joints had higher scores in the SF-36 physical function domain (median 75 vs. 48; p = 0.004) and better PDI (28 vs. 43 %, p = 0.03). Femoral head impaction was associated with an increased risk of joint failure [relative risk (RR) = 15.2, 95 % CI 3-95; p = 0.002], as was an age of ≥60 years at the time of injury (RR = 4.2, CI 1.3-15; p = 0.02).CONCLUSIONS: Patients with failed hip joints after surgery for acetabular fracture have inferior global and disease-specific functional outcomes, even after secondary arthroplasty surgery. We suggest that patients with predictors of joint failure could benefit from other treatment strategies than ORIF, and primary insertion of THA may be an alternative treatment strategy for this subgroup.
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| 10. |
- Grøgaard, B, et al.
(författare)
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The polymorphonuclear leukocyte : has it a role in fracture healing?
- 1990
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Ingår i: Archives of Orthopaedic and Trauma Surgery. - 0936-8051 .- 1434-3916. ; 109:5, s. 268-71
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the present study was to assess whether the presence of polymorphonuclear leukocytes in the first stage of fracture repair was of any importance. In anesthetized male Wistar rats, a transverse osteotomy was performed at midshaft in one femur and immediately stabilized by an intramedullary Kirschner nail. The animals were allowed unprotected weight bearing immediately. Nine animals were made neutropenic before operation by injection of a specific rat polymorphonuclear leukocyte antiserum (antineutrophil serum, ANS) raised in sheep. The number of circulating polymorphonuclear leukocytes were kept below 20% of their normal value for 72 h postoperatively by intraperitoneal injections of ANS every 12 h. Control animals were injected with the same amount of normal sheep serum (NSS). All animals received cefuroxime (100 mg/kg day) concomitantly with the ANS injections. Six weeks after operation the animals were killed, the amount of callus formation was measured, and the bones were radiologically examined. The nails were then removed and both the healing fractures and the nonoperated femurs mechanically tested for bending. There were no differences in the amount of callus measured or in radiological healing. However, there was a significantly higher bending moment in femurs from animals treated with ANS than in those given NSS (P less than 0.02). No differences were observed in rigidity or total energy absorption.
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