| 1. |
- Axenhus, Michael, et al.
(författare)
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Comparative outcomes of uncemented and cemented stem revision in managing periprosthetic femoral fractures : a retrospective cohort study
- 2024
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Ingår i: Journal of Orthopaedics and Traumatology. - : Springer Nature. - 1590-9921 .- 1590-9999. ; 25:1
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Periprosthetic femoral fractures (PFFs) following hip arthroplasty, especially Vancouver B2 and B3 fractures, present a challenge due to the association with a loose femoral stem, necessitating either open reduction and internal fixation or stem revision. This study aims to compare outcomes between uncemented and cemented stem revisions in managing Vancouver B2 and B3 fractures, considering factors such as hip-related complications, reoperations, and clinical outcome.Methods: A retrospective cohort study was conducted at Danderyd Hospital, Sweden, from 2008 to 2022, encompassing operatively treated Vancouver B2 and B3 fractures. Patients were categorized into uncemented and cemented stem revision groups, with data collected on complications, revision surgeries, fracture healing times, and clinical outcomes.Results: A total of 241 patients were identified. Significant differences were observed between the two groups in patient demographics, with the cemented group comprising older patients and more females. Follow up ranged from 1 to 15 years. Average follow up time was 3.9 years for the cemented group and 5.5 years for the uncemented group. The cemented stems demonstrated lower rates of dislocation (8.9% versus 22.5%, P = 0.004) and stem loosening (0.6% versus 9.3%, P = 0.004) than the uncemented method. Moreover, the cemented group exhibited shorter fracture healing times (11.4 weeks versus 16.7 weeks, P = 0.034). There was no difference in clinical outcome between groups. Mortality was higher in the cemented group.Conclusions: This retrospective study indicates that cemented stem revision for Vancouver B2–3 fractures is correlated with lower dislocation and stem loosening rates, necessitating fewer reoperations and shorter fracture healing times compared with the uncemented approach. The cemented group had a notably higher mortality rate, urging caution in its clinical interpretation. Level of evidence III
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| 2. |
- Axenhus, Michael, et al.
(författare)
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Long-term follow-up of bone density changes in total hip arthroplasty : comparative analysis from a randomized controlled trial of a porous titanium construct shell vs. a porous coated shell.
- 2024
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Ingår i: International Orthopaedics. - : Springer Nature. - 0341-2695 .- 1432-5195.
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Periacetabular bone loss poses a considerable challenge in the longevity and stability of acetabular implants used in total hip arthroplasty (THA). Innovations in implant design, specifically the introduction of three-dimensional (3D) porous titanium constructs, might reduce bone resorption. The purpose of this study was to build upon our previous randomized controlled trial, which found no change in periacetabular bone loss between a 3D porous none-hydroxyapatite coated titanium cup and a standard porous hydroxyapatite coated cup over a two year follow-up period by extending the follow-up duration to ten years post-surgery.METHODS: This was a single-centre, long-term follow-up study conducted over a ten year period in patients who had previously participated in a randomized controlled trial comparing a 3D porous titanium construct shell (PTC group) with a standard porous hydroxyapatite coated titanium shell (PC-group). The primary outcome measured was the change in bone mineral density (BMD) within four specific periacetabular zones, alongside overall bone loss, which was assessed through BMD in the lumbar spine at two, six and ten years postoperatively. Secondary outcomes included clinical outcome measures.RESULTS: In total, 18 in the PTC and 20 in the PC group were analysed for the primary endpoint up to ten years. The mean bone mineral density in zones 1-4 was 3.7% higher in the PTC group than in the PC group at six years postoperatively and 12.0% higher at ten years. Clinical outcomes, and the frequency of adverse events did not differ between the groups.CONCLUSIONS: The PTC group displayed superior long-term bone preservation compared to the PC group while maintaining similar clinical outcomes up to ten years postoperatively. Although with a small sample size, our findings suggest that porous titanium cups have the potential to minimize BMD loss around the cup which could contribute to improving THA outcomes and implant durability.
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| 3. |
- Hommel, Ami, et al.
(författare)
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Exploring the incidence and nature of nursing-sensitive orthopaedic adverse events : A multicenter cohort study using Global Trigger Tool
- 2020
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Ingår i: International Journal of Nursing Studies. - : Elsevier. - 0020-7489 .- 1873-491X. ; 102, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- Background: For decades, patient safety has been recognized as a critical global healthcare issue. However, there is a gap of knowledge of all types of adverse events sensitive to nursing care within hospitals in general and within orthopaedic care specifically. Objectives: The aim of this study is to explore the incidence and nature of nursing-sensitive adverse events following elective or acute hip arthroplasty at a national level. Design: A retrospective multicenter cohort study. Outcome variables: Nursing-sensitive adverse events, preventability, severity and length of stay. Methods: All patients, 18 years or older, who had undergone an elective (degenerative joint disease) or acute (fractures) hemi or total hip arthroplasty surgery at 24 hospitals were eligible for inclusion. Retrospective reviews of weighted samples of 1998 randomly selected patient records were carried out using the Swedish version of the Global Trigger Tool. The patients were followed for readmissions up to 90 days postoperatively throughout the whole country regardless of index hospital. Results: A total of 1150 nursing-sensitive adverse events were identified in 728 (36.4%) of patient records, and 943 (82.0%) of the adverse events were judged preventable in the study cohort. The adjusted cumulative incidence regarding nursing-sensitive adverse events for the study population was 18.8%. The most common nursing-sensitive adverse event types were different kinds of healthcare-associated infections (40.9%) and pressure ulcers (16.5%). Significantly higher proportions of nursing-sensitive adverse events were found among female patients compared to male, p < 0.001, and patients with acute admissions compared to elective patients, p < 0.001. Almost half (48.5%) of the adverse events were temporary and of a less severe nature. On the other hand, 592 adverse events were estimated to have contributed to 3351 extra hospital days. Conclusions: This study shows the magnitude of nursing-sensitive adverse events. We found that nursing-sensitive adverse events were common, in most cases deemed preventable and were associated with different kinds of adverse events and levels of severity in orthopaedic care. Registered nurses play a vital role within the interdisciplinary team as they are the largest group of healthcare professionals, work 24/7 and spend much time at the bedside with patients. Therefore, nursing leadership at all hospital levels must assume responsibility for patient safety and authorize bedside registered nurses to deliver high-quality and sustainable care to patients. (C) 2019 The Authors. Published by Elsevier Ltd.
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| 4. |
- Kelly-Pettersson, Paula, et al.
(författare)
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The influence of depression on patient-reported outcomes for hip-fracture patients 1 year after surgery : a prospective cohort study.
- 2020
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Ingår i: Aging Clinical and Experimental Research. - : Springer Science and Business Media LLC. - 1594-0667 .- 1720-8319. ; 32:2, s. 247-255
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Depression is common in elderly hip-fracture patients and together with cognitive impairment is associated with increased risk of mortality.AIM: We aimed to examine the influence depression has on patient-reported outcome up to 1 year after acute hip fracture.METHODS: 162 hip-fracture patients participated in the prospective observational cohort study and were followed up at baseline, and 3 and 12 months using patient-reported outcome scores. Patients with cognitive impairment were excluded. Depression was defined as a score ≥ 8 on the depression subscale of the Hospital Anxiety Depression Scale (HADS D), having a diagnosis of depression or being treated with anti-depressant medication. Hip function was assessed using Harris Hip Score (HHS), EQ-5D was used to assess health status and Quality of life, and the Pain Numerical Rating Scale (PRNS) was used to assess pain levels. A linear regression model adjusted for group, age, sex, and ASA class was used to identify risk factors for functional outcome 12 months after fracture.RESULTS: 35 patients were included in the depression group versus 127 in the control group. No statistical differences were found in the demographic data (age, sex, ASA class, fracture type, operation method, living situation, activities of daily living ADL and clinical pathway) between the groups. In the regression model, we found no correlation between depression and the patient-reported outcome.CONCLUSION: In young elderly hip fracture patients without cognitive dysfunction, depression may not be of major importance for the rehabilitation of hip function in the short term.
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| 5. |
- Magnéli, Martin
(författare)
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Adverse events following surgery of the hip
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: An adverse event (AE) is when a patient is harmed in healthcare. There are many different definitions of AEs and internationally, many different definitions are used. It may seem obvious that the healthcare should not harm the patients, but nevertheless, over one million patients die each year because of AE following surgical care, globally. This thesis is dedicated to study AEs following acute and elective hip surgery. It consists of four different papers from two studies: The fast-track study and the VARA (Validation of Register Data After Hip Arthroplasty)-study. The overall aim of this thesis was to compare two fast-track systems for hip fracture patients, to validate an instrument for measuring AEs following hip arthroplasty surgery, to study AE claims and to create a new model for measuring AEs following hip arthroplasty surgery. Paper I, the fast-track study. The aim of this paper was study if the implementation of a new fast-track system for hip fracture patients could reduce the time from arrival at the hospital to the commencement of surgery. We included 415 consecutive hip fracture patients participating in two parallel fast- track systems in this prospective cohort study. Main outcomes were time to surgery and the proportion of patients that underwent surgery within 24 hours, secondary outcomes were number of AEs and mortality. The patients in the improved fast-track group had in mean three hours shorter time to surgery and there were a 13-percentage difference in the proportion of patients operated within 24 hours. The VARA-study papers II to IV Paper II. The aim of this paper was to validate a Swedish instrument for measuring AEs following hip arthroplasty surgery and to calculate the incidence of AEs. In this Swedish multicentre study we included 2,000 acute and elective hip arthroplasty patients and performed retrospective record review (RRR) on all medical records, on all admissions and unplanned out-patient visits within 90 days after surgery. The results were used for validation of the AE measure instrument. The instrument is based on diagnosis codes in the patient register. We also calculated the adjusted cumulative incidence of AEs. The 30-day sensitivity was 6% and specificity 95% for the AE measure instrument. The adjusted cumulative 30-day incidence was 28% for all patients, and 51% and 17% for the acute and the elective patients, respectively. Paper III. The aim of this paper was to study the proportion of patients with an AE from paper II that also had an accepted claim from the mutual insurance company of the county councils (Löf). The patients in the VARA-study were matched against Löf’s records and the proportion of patients with a major preventable AE that had an accepted claim was calculated. The proportion was 7%. 94% of the claims were approved and received compensation. The proportion of accepted claims was higher for the elective patients compared with the acute patients. Paper IV. The aim for this paper develop a new model to predict AEs following hip arthroplasty surgery. The dataset from the VARA-study was used to train and evaluate different statistical models for predicting AEs. Different machine learning models including neural networks were used. The best performing model was a logistic regression model including the variables age, length of stay for the primary admission, number of readmissions and accident and emergency department (A&E) visits. It was compared with the AE measure instrument from paper II, a model based on diagnosis codes. The new model had two to three times better sensitivity and the same specificity as the diagnosis code-based model. Conclusions: Paper I. An improved fast-track system that bypasses the A&E could reduce the time to hip fracture surgery by 3 hours and the proportion of patients who underwent surgery within 24 hours. The fast-track system could be performed in a safe way but did not affect mortality or the number of AEs. Paper II. The cumulative incidence of AEs following hip arthroplasty surgery was high, and the instrument based on administrative data with diagnosis codes could not measure this incidence with any convincing accuracy. Furthermore, the incidence of AEs was much higher for the acute patients than the elective patients, and only approximately half of the identified AEs had a correct diagnosis code. Paper III. The proportion of accepted claims for AEs following hip arthroplasty is very low in Sweden, even for obvious and serious AEs such as periprosthetic joint infection. The proportion of accepted claims is higher for elective than acute patients. Whether the healthcare system fails to inform patients about their rights to file a claim for compensation or the patients are informed but choose not to file a claim is unknown. Paper IV. A prediction model for AEs following hip arthroplasty surgery based on administrative data without diagnosis codes is more accurate than a model based on diagnosis codes. In addition to the accuracy variables such as LOS, readmissions, gender and age are robust and objective and, therefore, not prone to bias in a manner similar to diagnosis codes.
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| 6. |
- Magnéli, Martin, et al.
(författare)
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Only 8% of major preventable adverse events after hip arthroplasty are filed as claims : a Swedish multi-center cohort study on 1,998 patients
- 2020
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 91:1, s. 20-25
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose — Hip arthroplasty is one of the most performed surgeries in Sweden, and the rate of adverse events (AEs) is fairly high. All patients in publicly financed healthcare in Sweden are insured by the Mutual Insurance Company of Swedish County Councils (Löf). We assessed the proportion of patients that sustained a major preventable AE and filed an AE claim to Löf. Patients and methods — We performed retrospective record review using the Global Trigger Tool to identify AEs in a Swedish multi-center cohort consisting of 1,998 patients with a total or hemi hip arthroplasty. We compared the major preventable AEs with all patient-reported claims to Löf from the same cohort and calculated the proportion of filed claims. Results — We found 1,066 major preventable AEs in 744 patients. Löf received 62 claims for these AEs, resulting in a claim proportion of 8%. 58 of the 62 claims were accepted by Löf and received compensation. The claim proportion was 13% for the elective patients and 0.3% for the acute patients. The most common AE for filing a claim was periprosthetic joint infection; of the 150 infections found 37 were claimed. Interpretation — The proportion of filed claims for major preventable AEs is very low, even for obvious and serious AEs such as periprosthetic joint infection.
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| 7. |
- Magnéli, Martin, et al.
(författare)
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Validation of adverse events after hip arthroplasty : a Swedish multi-centre cohort study.
- 2019
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 9:3
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Preventing adverse events (AEs) after orthopaedic surgery is a field with great room for improvement. A Swedish instrument for measuring AEs after hip arthroplasty based on administrative data from the national patient register is used by both the Swedish Hip Arthroplasty Register and the Swedish Association of Local Authorities and Regions. It has never been validated and its accuracy is unknown. The aim of this study was to validate the instrument's ability to detect AEs, and to calculate the incidence of AEs following primary hip arthroplasties.DESIGN: Retrospective cohort study using retrospective record review with Global Trigger Tool methodology in combination with register data.SETTING: 24 different hospitals in four major regions of Sweden.PARTICIPANTS: 2000 patients with either total or hemi-hip arthroplasty were recruited from the SHAR. We included both acute and elective patients.PRIMARY AND SECONDARY OUTCOME MEASURES: The sensitivity and specificity of the instrument. Adjusted cumulative incidence and incidence rate.RESULTS: The sensitivity for all identified AEs was 5.7% (95% CI: 4.9% to 6.7%) for 30 days and 14.8% (95% CI: 8.2 to 24.3) for 90 days, and the specificity was 95.2% (95% CI: 93.5% to 96.6%) for 30 days and 92.1% (95% CI: 89.9% to 93.8%) for 90 days. The adjusted cumulative incidence for all AEs was 28.4% (95% CI: 25.0% to 32.3%) for 30 days and 29.5% (95% CI: 26.0% to 33.8%) for 90 days. The incidence rate was 0.43 AEs per person-month (95% CI: 0.39 to 0.47).CONCLUSIONS: The AE incidence was high, and most AEs occurred within the first 30 days. The instrument sensitivity for AEs was very low for both 30 and 90 days, but the specificity was high for both 30 and 90 days. The studied instrument is insufficient for valid measurements of AEs after hip arthroplasty.
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| 8. |
- Rosenberg, Guillermo Sanchez, et al.
(författare)
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ChatGPT-4 generates orthopedic discharge documents faster than humans maintaining comparable quality : a pilot study of 6 cases
- 2024
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden. - 1745-3674 .- 1745-3682. ; 95, s. 152-156
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Large language models like ChatGPT-4 have emerged. They hold the potential to reduce the administrative burden by generating everyday clinical documents, thus allowing the physician to spend more time with the patient. We aimed to assess both the quality and efficiency of discharge documents generated by ChatGPT-4 in comparison with those produced by physicians.Patients and methods - To emulate real -world situations, the health records of 6 fictional orthopedic cases were created. Discharge documents for each case were generated by a junior attending orthopedic surgeon and an advanced orthopedic resident. ChatGPT-4 was then prompted to generate the discharge documents using the same health record information. The quality assessment was performed by an expert panel (n = 15) blinded to the source of the documents. As secondary outcome, the time required to generate the documents was compared, logging the duration of the creation of the discharge documents by the physician and by ChatGPT-4.Results - Overall, both ChatGPT-4 and physiciangenerated notes were comparable in quality. Notably, ChatGPT-4 generated discharge documents 10 times faster than the traditional method. 4 events of hallucinations were found in the ChatGPT-4-generated content, compared with 6 events in the human/physician produced notes.Conclusion - ChatGPT-4 creates orthopedic discharge notes faster than physicians, with comparable quality. This shows it has great potential for making these documents more efficient in orthopedic care. ChatGPT-4 has the potential to significantly reduce the administrative burden on healthcare professionals.
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