| 1. |
- Bergkvist, Magnus, et al.
(författare)
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Debridement, antibiotics and implant retention in early periprosthetic joint infection
- 2016
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Ingår i: HIP International. - : SAGE Publications. - 1120-7000 .- 1724-6067. ; 26:2, s. 138-143
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Periprosthetic joint infection (PJI) is a devastating complication in hip arthroplasty surgery. Debridement, antibiotics (AB) and implant retention (DAIR) is recommended in early PJI in association with stable implants. The aim of this study was to evaluate the success rate of DAIR in early PJI (<4 weeks) and to identify factors predicting the outcome. Methods: This cohort study included a consecutive series of 35 patients (median age 74 years, 25 women, 26 primary arthroplasties) treated with DAIR for an early PJI in a regional hospital. Results: 28 patients (80%) had their infection eradicated. DAIR-only eradicated the PJI in 22 (63%) patients with a median follow-up of 50 (24-84) months. In 17 (49%) patients, oral AB had been given prior to intraoperative cultures, which delayed first debridement with average 6 days and delayed hospital stay. Primary surgery for a hip fracture increased the risk of DAIR-failure. Surgical experience did not affect the outcome. 17% (n = 6) of the patients sustained a secondary infection during their hospital stay; the majority was beta-lactam resistant coagulase negative Staphylococcus aureus. Conclusions: The success rate of DAIR was inferior to pervious controls from experienced revision centers. Hip fracture patients should be informed about the increased risk of DAIR treatment failure. In order not to delay surgery, empirically based oral AB should not be administered prior to deep cultures.
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| 2. |
- Boström, Elisabeth Almer, 1983, et al.
(författare)
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Resistin and insulin/insulin-like growth factor signaling in rheumatoid arthritis.
- 2011
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Ingår i: Arthritis and rheumatism. - : Wiley. - 1529-0131 .- 0004-3591. ; 63:10, s. 2894-904
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Tidskriftsartikel (refereegranskat)abstract
- Human resistin has proinflammatory properties that activate NF-κB-dependent pathways, whereas its murine counterpart is associated with insulin resistance. The aim of this study was to examine potential cross-talk between resistin and insulin/insulin-like growth factor (IGF) signaling in rheumatoid arthritis (RA).
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| 3. |
- Brodén, Cyrus, et al.
(författare)
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High risk of early periprosthetic fractures after primary hip arthroplasty in elderly patients using a cemented, tapered, polished stem : an observational, prospective cohort study on 1,403 hips with 47 fractures after mean follow-up time of 4 years
- 2015
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 86:2, s. 169-174
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Postoperative periprosthetic femoral fracture (PPF) after hip arthroplasty is associated with considerable morbidity and mortality. We assessed the incidence and characteristics of periprosthetic fractures in a consecutive cohort of elderly patients treated with a cemented, collarless, polished and tapered femoral stem (CPT). Patients and methods - In this single-center prospective cohort study, we included 1,403 hips in 1,357 patients (mean age 82 (range 52-102) years, 72% women) with primary osteoarthritis (OA) or a femoral neck fracture (FNF) as indication for surgery (367 hips and 1,036 hips, respectively). 64% of patients were ASA class 3 or 4. Hip-related complications and need for repeat surgery were assessed at a mean follow-up time of 4 (1-7) years. A Cox regression analysis was used to evaluate risk factors associated with PPF. Results - 47 hips (3.3%) sustained a periprosthetic fracture at median 7 (2-79) months postoperatively; 41 were comminute Vancouver B2 or complex C-type fractures. The fracture rate was 3.8% for FNF patients and 2.2% for OA patients (hazard ratio (HR) = 4; 95% CI: 1.3-12). Patients > 80 years of age also had a higher risk of fracture (HR = 2; 95% CI: 1.1-4.5). Interpretation - We found a high incidence of early PPF associated with the CPT stem in this old and frail patient group. A possible explanation may be that the polished tapered stem acts as a wedge, splitting the femur after a direct hip contusion. Our results should be confirmed in larger, registry-based studies, but we advise caution when using this stem for this particular patient group.
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| 4. |
- Eisler, Thomas
(författare)
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On loosening and revision in total hip arthroplasty
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Periprosthetic bone resorbtion (osteolysis) and aseptic loosening constitute the major long-term complication in total hip arthroplasty. It has been suggested that osteolysis is the result of the action of osteoclasts generated by prosthetic wear-debris-triggered macrophages. In an electron-microscopic study of biopsies retrieved from periprosthetic osteolytic lesions, however, we were unable to show more osteoclasts than what would be expected in normal adult bone. Macrophages and other phagocytic cells seem to resorb the inflammatory interface membrane, but not bone. Septic loosening is the second most important total hip arthroplasty complication, and it has been hypothesized that the current incidence of low-virulent infections is underestimated because of problems of differential diagnosis. This may entail inadequate handling of the patient in revision surgery. In a histological study of ultrasound-guided biopsies of the pseudocapsule, we found that infection eluded histological detection, and that it was difficult to differentiate between inflammation caused by a low-virulent microorganism and inflammation caused by particulate wear debris. Revision total hip arthroplasty often yields poorer clinical results and durability than primary surgery does. Technically demanding surgery in deranged bone is the main reason. In an epidemiological study of revisions using the Swedish National Hip Arthroplasty Register, with re-revision as end-point, we found that early revisions in particular had an increased risk of re-revision; but that the risk was lower for first revisions performed in university/regional hospitals than for those performed in the central and rural hospitals. For early revisions, both cup and stem, cemented fixation afforded poorer results than uncemented. Femoral impaction bone grafting did not yield better results than conventional recementation. In a radiographic study of re-cemented revisions using modem cementing techniques without bone grafting, we found early radiographic loosening of both components. The reasons were probably inferior surgical technique and that cancellous bone loss offered poor prerequisites for cemented fixation. Revision surgery in large acetabular defects is particularly difficult, and the results can be discouraging. We studied clinical and radiographic results of a stemmed acetabular reconstruction device inserted for severe acetabular bone loss, at five orthopaedic centers in Sweden. Early radiographic loosening necessitated subsequent revision in a majority of the patients. In addition, we studied expectations and outcomes in revision patients. Post-operative dissatisfaction may originate from excessive pre-operative expectations regarding the functional result. Expectations often originated from sources other than the surgeon responsible, and patients were generally not aware of the fundamental differences between primary surgery and revision. Osteolysis and aseptic loosening are a multifactorial syndrome in which the roles of osteoclast-mediated bone resorbtion and infection are unclear. Poor prognosis after early revisions highlights the importance of high-quality index procedures. Uncemented fixation can be considered for early revisions, even though, as with many newer methods such as bone grafting, our present lack of information on long-term outcome prompts extra care. Pre-operative information to revision patients should be improved.
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| 5. |
- Ekwall, Anna-Karin H, et al.
(författare)
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The tumour-associated glycoprotein podoplanin is expressed in fibroblast-like synoviocytes of the hyperplastic synovial lining layer in rheumatoid arthritis.
- 2011
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Ingår i: Arthritis research & therapy. - : Springer Science and Business Media LLC. - 1478-6362. ; 13:2
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: INTRODUCTION: Activated fibroblast-like synoviocytes (FLSs) in rheumatoid arthritis (RA) share many characteristics with tumour cells and are key mediators of synovial tissue transformation and joint destruction. The glycoprotein podoplanin is upregulated in the invasive front of several human cancers and has been associated with epithelial-mesenchymal transition, increased cell migration and tissue invasion. The aim of this study was to investigate whether podoplanin is expressed in areas of synovial transformation in RA and especially in promigratory RA-FLS. METHODS: Podoplanin expression in human synovial tissue from 18 RA patients and nine osteoarthritis (OA) patients was assessed by immunohistochemistry and confirmed by Western blot analysis. The expression was related to markers of synoviocytes and myofibroblasts detected by using confocal immunofluoresence microscopy. Expression of podoplanin, with or without the addition of proinflammatory cytokines and growth factors, in primary human FLS was evaluated by using flow cytometry. RESULTS: Podoplanin was highly expressed in cadherin-11-positive cells throughout the synovial lining layer in RA. The expression was most pronounced in areas with lining layer hyperplasia and high matrix metalloproteinase 9 expression, where it coincided with upregulation of α-smooth muscle actin (α-sma). The synovium in OA was predominantly podoplanin-negative. Podoplanin was expressed in 50% of cultured primary FLSs, and the expression was increased by interleukin 1β, tumour necrosis factor α and transforming growth factor β receptor 1. CONCLUSIONS: Here we show that podoplanin is highly expressed in FLSs of the invading synovial tissue in RA. The concomitant upregulation of α-sma and podoplanin in a subpopulation of FLSs indicates a myofibroblast phenotype. Proinflammatory mediators increased the podoplanin expression in cultured RA-FLS. We conclude that podoplanin might be involved in the synovial tissue transformation and increased migratory potential of activated FLSs in RA.
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| 6. |
- Flowers, Sarah A., et al.
(författare)
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Decrease of core 2 O-glycans on synovial lubricin in osteoarthritis reduces galectin-3 mediated crosslinking
- 2020
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Ingår i: Journal of Biological Chemistry. - 0021-9258 .- 1083-351X. ; 295:47, s. 16023-16036
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Tidskriftsartikel (refereegranskat)abstract
- The synovial fluid glycoprotein lubricin (also known as proteoglycan 4) is a mucin-type O-linked glycosylated biological lubricant implicated to be involved in osteoarthritis (OA) development. Lubricin's ability to reduce friction is related to its glycosylation consisting of sialylated and unsialylated Tn-antigens and core 1 and core 2 structures. The glycans on lubricin have also been suggested to be involved in crosslinking and stabilization of the lubricating superficial layer of cartilage by mediating interaction between lubricin and galectin-3. However, with the spectrum of glycans being found on lubricin, the glycan candidates involved in this interaction were unknown. Here, we confirm that the core 2 O-linked glycans mediate this lubricin-galectin-3 interaction, shown by surface plasmon resonance data indicating that recombinant lubricin (rhPRG4) devoid of core 2 structures did not bind to recombinant galectin-3. Conversely, transfection of Chinese hamster ovary cells with the core 2 GlcNAc transferase acting on a mucin-type O-glycoprotein displayed increased galectin-3 binding. Both the level of galectin-3 and the galectin-3 interactions with synovial lubricin were found to be decreased in late-stage OA patients, coinciding with an increase in unsialylated core 1 O-glycans (T-antigens) and Tn-antigens. These data suggest a defect in crosslinking of surface-active molecules in OA and provide novel insights into OA molecular pathology.
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| 7. |
- Gordon, Max, et al.
(författare)
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Increased Long-Term Cardiovascular Risk After Total Hip Arthroplasty: A Nationwide Cohort Study.
- 2016
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Ingår i: Medicine. - 1536-5964 .- 0025-7974. ; 95:6
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Tidskriftsartikel (refereegranskat)abstract
- Total hip arthroplasty is a common and important treatment for osteoarthritis patients. Long-term cardiovascular effects elicited by osteoarthritis or the implant itself remain unknown. The purpose of the present study was to determine if there is an increased risk of late cardiovascular mortality and morbidity after total hip arthroplasty surgery.A nationwide matched cohort study with data on 91,527 osteoarthritis patients operated on, obtained from the Swedish Hip Arthroplasty Register. A control cohort (n=270,688) from the general Swedish population was matched 1:3 to each case by sex, age, and residence. Mean follow-up time was 10 years (range, 7-21).The exposure was presence of a hip replacement for more than 5 years. The primary outcome was cardiovascular mortality after 5 years. Secondary outcomes were total mortality and re-admissions due to cardiovascular events.During the first 5 to 9 years, the arthroplasty cohort had a lower cardiovascular mortality risk compared with the control cohort. However, the risk in the arthroplasty cohort increased over time and was higher than in controls after 8.8 years (95% confidence interval [CI] 7.0-10.5). Between 9 and 13 years postoperatively, the hazard ratio was 1.11 (95% CI 1.05-1.17). Arthroplasty patients were also more frequently admitted to hospital for cardiovascular reasons compared with controls, with a rate ratio of 1.08 (95% CI 1.06-1.11).Patients with surgically treated osteoarthritis of the hip have an increased risk of cardiovascular morbidity and mortality many years after the operation when compared with controls.
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| 8. |
- Huang, Shan, et al.
(författare)
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Truncated lubricin glycans in osteoarthritis stimulate the synoviocyte secretion of VEGFA, IL-8, and MIP-1α : Interplay between O-linked glycosylation and inflammatory cytokines
- 2022
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Ingår i: Frontiers in Molecular Biosciences. - : Frontiers Media SA. - 2296-889X. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- The primary aim of the study was to identify inflammatory markers relevant for osteoarthritis (OA)-related systemic (plasma) and local (synovial fluid, SF) inflammation. From this, we looked for inflammatory markers that coincided with the increased amount of O-linked Tn antigen (GalNAcα1-Ser/Thr) glycan on SF lubricin. Inflammatory markers in plasma and SF in OA patients and controls were measured using a 44-multiplex immunoassay. We found consistently 29 markers detected in both plasma and SF. The difference in their concentration and the low correlation when comparing SF and plasma suggests an independent inflammatory environment in the two biofluids. Only plasma MCP-4 and TARC increased in our patient cohort compared to control plasma. To address the second task, we concluded that plasma markers were irrelevant for a direct connection with SF glycosylation. Hence, we correlated the SF-inflammatory marker concentrations with the level of altered glycosylation of SF-lubricin. We found that the level of SF-IL-8 and SF-MIP-1α and SF-VEGFA in OA patients displayed a positive correlation with the altered lubricin glycosylation. Furthermore, when exposing fibroblast-like synoviocytes from both controls and OA patients to glycovariants of recombinant lubricin, the secretion of IL-8 and MIP-1α and VEGFA were elevated using lubricin with Tn antigens, while lubricin with sialylated and nonsialylated T antigens had less or no measurable effect. These data suggest that truncated glycans of lubricin, as found in OA, promote synovial proinflammatory cytokine production and exacerbate local synovial inflammation.
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| 9. |
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| 10. |
- Krupic, Ferid, et al.
(författare)
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Influence of ethnicity and socioeconomic factors on outcome after total hip replacement.
- 2013
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Ingår i: Scandinavian journal of caring sciences. - : Wiley. - 1471-6712 .- 0283-9318. ; 27:1, s. 139-146
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Tidskriftsartikel (refereegranskat)abstract
- Scand J Caring Sci; 2012 Influence of ethnicity and socioeconomic factors on outcome after total hip replacement Background: Previous studies have documented ethnic differences in the utilization of total hip arthroplasty. Less is known if this operation is performed at the same stage of symptoms and has equal effects in patients with different ethnicity. Aim: We investigated whether patients born outside Sweden report equal effects of operation with the insertion of a total hip replacement in terms of EQ-5D, pain and overall satisfaction as those born in Sweden. Method: Preoperative and 1-year postoperative data from Swedish Hip Arthroplasty Register, (1216 patients,1216 hips) with primary osteoarthritis of the hip operated between years 2002 and 2006, were analysed. All patients completed the EQ-5D form, filled in a VAS about pain preoperatively and at 1year postoperatively, when a VAS about overall satisfaction was added. Findings: Before the operation and after adjustment for confounders, patients born abroad reported more problems (dichotomized into no or moderate/severe problems), with self-care (p=0.01) and anxiety/depression (p=0.02) in the EQ-5D form than those born in Sweden. They also had more pain (VAS, p=0.04). One year after the operation and after statistical adjustments, patients born outside Sweden reported lower scores for self-care (p=0.008) and usual activities (p=0.001) in the EQ-5D form. They still reported more pain (VAS, p=0.02), but no significant difference concerning degree of satisfaction (p=0.3). Conclusions: Our finding of more preoperative disability and pain (VAS) before the operation in patients born abroad might depend on cultural differences, communication problems and differences in indications. Even if the effect of the total hip replacement was good, patients born abroad scored less for some of the items at 1year. We think that this patient group could benefit from improved pre- and postoperative information and other measures to facilitate and improve their rehabilitation.
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