| 1. |
- Kärrholm, Johan, 1951, et al.
(författare)
-
Effects on work resumption of a co-operation project in vocational rehabilitation. Systematic, multi-professional, client-centred and solution-oriented co-operation
- 2006
-
Ingår i: Disabil Rehabil. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 28:7, s. 457-67
-
Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The present aim was to evaluate the effect of systematic multi-professional co-ordinated rehabilitation (the Stockholm Co-operation Project) on the number of days' sick leave during the first and second half-years after the rehabilitation co-ordination period, compared to the year before. Another aim was to evaluate the economic effects at national level. METHOD: A matched-pairs design was used. The study group was based on 64 rehabilitees employed by a public employer in Stockholm, who took part in a systematic multi-professional co-operation project. To obtain pairs, the 64 individuals were individually matched with 64 people who received conventionally organised rehabilitation. Thus, there were 128 subjects altogether. RESULTS: The study group had substantially less sick leave days per month than the comparison group during the second half-year after the rehabilitation co-ordination period. The effect was even greater in a subgroup with more previous sick leave. During the first half-year after the intervention the comparison group had relatively more sick leave. No effect was found for a subgroup with less previous sick leave. The economic benefit of the intervention was estimated to 1,278 euros per month and person based on the whole group, and to 2,405 euros per month and person based on those with more sick leave. CONCLUSIONS: People who undergo co-ordinated rehabilitation have more working days after the intervention period than those with conventional rehabilitation. This way for rehabilitation actors to co-operate gives better outcomes for rehabilitation cases with long previous sick leave, but not for cases with less previous sick leave. It also generates economic gains at several levels.
|
|
| 2. |
- Saari, Tuuli, 1965, et al.
(författare)
-
Changed gait pattern in patients with total knee arthroplasty but minimal influence of tibial insert design: gait analysis during level walking in 39 TKR patients and 18 healthy controls
- 2005
-
Ingår i: Acta Orthop. - : Medical Journals Sweden AB. - 1745-3674. ; 76:2, s. 253-60
-
Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Previous radiostereometric studies have revealed abnormal anterior-posterior translation of the femur in patients operated with AMK (DePuy, Johnson and Johnson, Leeds, UK) total knee arthroplasty (TKA). Based on these observations, we hypothesized that patients with TKA have an abnormal gait pattern, and that there are differences in kinematics depending on the design of the tibial joint area. METHOD: We used a gait analysis system to evaluate the influence of joint area design on the kinematics of the hip and knee during level walking. 39 TKA patients (42 knees) and 18 healthy age-matched controls were studied. Patients with 5 degrees varus/valgus alignment or less were randomized to receive either a relatively flat or a concave tibial insert with retention of the posterior cruciate ligament. Patients who had more than 5 degrees varus-valgus alignment and/or extension defect of 10 degrees or more were randomized to receive the concave or a posterior-stabilized tibial component with resection of the posterior cruciate ligament. RESULTS: Patients with TKA tended to have less hip and knee extension and decreased knee and hip extension moment than controls. They also tended to walk more slowly. TKA altered the gait pattern, but choice of implant design had little influence. INTERPRETATION: In patients with a similar degree of degenerative joint disease and within the limits of the constraints offered by the prostheses under study, the choice of joint area constraint has little influence on the gait pattern.
|
|
| 3. |
- Saari, Tuuli, 1965, et al.
(författare)
-
Influence of polyethylene constraint on tibial component fixation in total knee arthroplasty: follow-up report after 5 years
- 2006
-
Ingår i: J Arthroplasty. - : Elsevier BV. - 0883-5403. ; 21:7, s. 1032-7
-
Tidskriftsartikel (refereegranskat)abstract
- The influence of articulating surface design of AMK total knee prosthesis (DePuy, Johnson & Johnson) on migration and radiographic outcome at 5 years was evaluated. The knees were randomly allocated to receive a flat or a concave insert with retention of the posterior cruciate ligament when preoperative deformity was less severe and either a concave or a posterior-stabilized insert with resection of the posterior cruciate ligament when deformity was more pronounced. In 64 knees, migration was measured with radiostereometry. The posterior-stabilized component displayed more varus-valgus tilting than the concave insert. Other statistically significant differences in migration were not seen. Radiolucent lines were frequently seen without differences between prosthesis groups.
|
|
| 4. |
- Saari, Tuuli, 1965, et al.
(författare)
-
Joint area constraint had no influence on bone loss in proximal tibia 5 years after total knee replacement
- 2007
-
Ingår i: J Orthop Res. - : Wiley. - 0736-0266. ; 25:6, s. 798-803
-
Tidskriftsartikel (refereegranskat)abstract
- After total knee replacement (TKR) the bone mineral density (BMD) decreases in the proximal tibia. Our aim was to evaluate if changes in constraint of the cemented AMK TKR (DePuy, Johnson & Johnson, Leeds, UK) had any effect on postoperative bone remodeling in the proximal tibia. We used dual-energy X-ray absorptiometry in 43-53 knees to record changes in BMD in three regions of interest around the tibial component up to 5 years after operation with the AMK (DePuy) TKR. The knees had been randomly allocated to receive a flat or a concave tibial insert with retention of the posterior cruciate ligament when preoperative deformity was less severe, and either a concave or a posterior-stabilized (PS) insert with resection of the posterior cruciate ligament when deformity was more pronounced. All designs were associated with loss of BMD in the proximal tibia. The mean bone loss varied from 5 to 23% depending on the region of interest. There were no statistically significant differences between the groups, and the alteration of tibial insert constraint did not influence the bone remodeling. However, low precision values may have impaired the detection of differences.
|
|
| 5. |
- Saari, Tuuli, 1965, et al.
(författare)
-
Posterior stabilized component increased femoral bone loss after total knee replacement. 5-year follow-up of 47 knees using dual energy X-ray absorptiometry
- 2006
-
Ingår i: Knee. - 0968-0160. ; 13:6, s. 435-9
-
Tidskriftsartikel (refereegranskat)abstract
- After total knee replacement (TKR) bone mineral density (BMD) commonly decreases behind the anterior flange of the femoral component, which may increase the risk for supracondylar fracture. Our aim was to evaluate if changes in femoral design and joint area constraint had any effect on the postoperative bone remodeling in the distal femur. We used dual-energy X-ray absorptiometry in 47 knees up to 5 years after operation with the AMK (DePuy, Johnson and Johnson Leeds, UK) TKR. The knees had been randomly allocated to receive a flat or a concave tibial insert with retention of the posterior cruciate ligament when preoperative deformity was less severe, and either a concave or a posterior-stabilized (PS) insert with resection of the posterior cruciate ligament when deformity was more pronounced. The most pronounced relative reduction (15-38%) in bone mineral density (BMD) was seen posterior to the anterior flange. There were no significant differences in relative change in BMD between flat and concave inserts. Knees operated with PS inserts had more reduction posterior to the flange than knees with concave inserts in the subgroup with more advanced preoperative deformity (23% and 38% respectively). Use of posterior stabilized insert may increase the risk of supracondylar fracture compared to concave insert in knees with advanced preoperative deformity.
|
|
| 6. |
- Saari, Tuuli, 1965, et al.
(författare)
-
The effect of tibial insert design on rising from a chair; motion analysis after total knee replacement
- 2004
-
Ingår i: Clin Biomech (Bristol, Avon). - : Elsevier BV. - 0268-0033. ; 19:9, s. 951-6
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: There are few previous studies of sit-to-stand movement following total knee arthroplasty. Aim of the study was to test the hypotheses that total knee replacement alters the maximum trunk, hip, knee and ankle flexion-extension movements during chair rising, and that the design of the tibial plateau has small influence on the kinematics. METHODS: A motion analysis system was used to evaluate kinematics of the trunk, hip, knee and ankle when rising from one chair and sitting down on another. Patients with 5 degrees varus/valgus alignment or less received either a flat or a concave tibial insert with retention of the posterior cruciate ligament. Patients who had more malalignment and /or extension defect of 10 degrees or more were randomized to receive the concave or a posterior-stabilized tibial component with resection of the posterior cruciate ligament. The two groups of patients operated with and without resection of the posterior cruciate ligament were analysed separately and compared with a control group. 28 patients (29 knees) and 16 controls were in the final analysis. FINDINGS: Decreased hip and knee extension compared to the controls was seen, but there were no statistically significant differences in kinematics between the designs. INTERPRETATION: Choice of implant design in total knee arthroplasty had no detectable effects on kinematics of hip and knee joints during sit-to-stand movement.
|
|
| 7. |
- Saari, Tuuli, 1965, et al.
(författare)
-
Total knee replacement influences both knee and hip joint kinematics during stair climbing
- 2004
-
Ingår i: Int Orthop. - : Springer Science and Business Media LLC. - 0341-2695. ; 28:2, s. 82-6
-
Tidskriftsartikel (refereegranskat)abstract
- A gait analysis system was used to evaluate the kinematics of the hip and knee during stair ascending and descending after operation with total knee replacement.Patients with 5 degrees varus/valgus alignment or less were selected randomly to receive either a flat or a concave tibial component with retention of the posterior cruciate ligament. Patients who had more than 5 degrees varus/valgus alignment and/or an extension defect of 10 degrees or more were selected randomly to receive the concave or posterior-stabilized tibial component with resection of the posterior cruciate ligament. Twenty patients and 17 controls were studied 1-2 years after the operation. Patients had abnormal kinematics during stair ascending and descend-ing. Both knee extension and flexion were reduced. Hip extension tended to decrease, and decreased hip extension moment was noted.
|
|
| 8. |
- Stenberg, Johan, et al.
(författare)
-
Quantitative proteomics reveals regulatory differences in the chondrocyte secretome from human medial and lateral femoral condyles in osteoarthritic patients
- 2013
-
Ingår i: Proteome Science. - : Springer Science and Business Media LLC. - 1477-5956. ; 11:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Osteoarthritis (OA) is a destructive joint disease and there are no known biomarkers available for an early diagnosis. To identify potential disease biomarkers and gain further insight into the disease mechanisms of OA we applied quantitative proteomics with SILAC technology on the secretomes from chondrocytes of OA knees, designated as high Mankin (HM) scored secretome. A quantitative comparison was made between the secretomes of the medial and lateral femur condyle chondrocytes in the same knee since the medial femur condyle is usually more affected in OA than the lateral condyle, which was confirmed by Mankin scoring. The medial/lateral comparison was also made on the secretomes from chondrocytes taken from one individual with no clinically apparent joint-disease, designated as low Mankin (LM) scored secretome. Results: We identified 825 proteins in the HM secretome and 69 of these showed differential expression when comparing the medial and lateral femoral compartment. The LM scored femoral condyle showed early signs of OA in the medial compartment as assessed by Mankin score. We here report the identification and relative quantification of several proteins of interest for the OA disease mechanism e.g. CYTL1, DMD and STAB1 together with putative early disease markers e.g. TIMP1, PPP2CA and B2M. Conclusions: The present study reveals differences in protein abundance between medial/lateral femur condyles in OA patients. These regulatory differences expand the knowledge regarding OA disease markers and mechanisms.
|
|
| 9. |
- Uvehammer, Johan, 1953, et al.
(författare)
-
Cemented versus hydroxyapatite fixation of the femoral component of the Freeman-Samuelson total knee replacement: A RADIOSTEREOMETRIC ANALYSIS
- 2007
-
Ingår i: J Bone Joint Surg Br. - 0301-620X. ; 89:1, s. 39-44
-
Tidskriftsartikel (refereegranskat)abstract
- We have carried out a radiostereometric study of 50 patients (54 knees) with osteoarthritis of the knee who were randomly allocated to receive a cemented or a hydroxyapatite-coated femoral component for total knee replacement. The patients were also stratified to receive one of three types of articulating surface (standard, rotating platform, Freeman-Samuelson (FS)1000) all based on the Freeman-Samuelson design. The tibial components were cemented in all cases. Radiostereometry was performed post-operatively and at 3, 12 and 24 months. The analysis was restricted to rotation of the femoral component over time. After two years, rotation of the femoral components in the transverse, longitudinal and sagittal planes did not differ between the cemented and the hydroxyapatite-coated implants (p = 0.2 to 0.9). In total knee replacements with a rotating platform, the femoral component tended to tilt more posteriorly than in the other two designs, regardless of the choice of fixation (cemented or hydroxyapatite-coated, p = 0.04). The standard version of the femoral component, whether cemented or hydroxyapatite-coated, rotated more into valgus than was observed with the rotating-platform and FS1000 designs (p = 0.005). The increased constraint provided by the FS1000 component did not appear to have any adverse effect on fixation of the femoral component.
|
|
| 10. |
- Uvehammer, Johan, 1953, et al.
(författare)
-
Influence of joint area design on tibial component migration: comparison among a fixed symmetrical, asymmetrical, and moveable bearing
- 2007
-
Ingår i: J Knee Surg. - 1538-8506. ; 20:1, s. 20-6
-
Tidskriftsartikel (refereegranskat)abstract
- Fifty-four knees (50 patients) were allocated to three different tibial polyethylene inserts (standard/rotating platform/FS1000) in the Freeman-Samuelson (Finsbury Orthopaedics Ltd, Surrey, United Kingdom) total knee arthroplasty. The FS1000 design has a spherical medial and a roller-in-trough configuration laterally. Radiostereometric examinations were done postoperatively and after 3, 12, and 24 months. The median migration of the metal-backing and the Hospital for Special Surgery scores did not differ between the three groups. At 2 years, the median external/ internal displacements for the rotating platforms were 2.8 degrees and 0.2 degrees, respectively (rotating platforms versus standard inserts/rotating platforms versus FS1000: P < .0005). Longitudinal rotations above the detection limits for radiostereometry were observed in some of the fixed implants (standard and FS1000 designs), indicating conditions for backside wear.
|
|
