| 1. |
- Ali, Abdulemir, et al.
(författare)
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Dissatisfied patients after total knee arthroplasty
- 2014
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 85:3, s. 229-233
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - In 2003, an enquiry by the Swedish Knee Arthroplasty Register (SKAR) 2-7 years after total knee arthroplasty (TKA) revealed patients who were dissatisfied with the outcome of their surgery but who had not been revised. 6 years later, we examined the dissatisfied patients in one Swedish county and a matched group of very satisfied patients. Patients and methods - 118 TKAs in 114 patients, all of whom had had their surgery between 1996 and 2001, were examined in 2009-2010. 55 patients (with 58 TKAs) had stated in 2003 that they were dissatisfied with their knees and 59 (with 60 TKAs) had stated that they were very satisfied with their knees. The patients were examined clinically and radiographically, and performed functional tests consisting of the 6-minute walk and chair-stand test. All the patients filled out a visual analog scale (VAS, 0-100 mm) regarding knee pain and also the Hospital and Anxiety and Depression scale (HAD). Results - Mean VAS score for knee pain differed by 30 mm in favor of the very satisfied group (p < 0.001). 23 of the 55 patients in the dissatisfied group and 6 of 59 patients in the very satisfied group suffered from anxiety and/or depression (p = 0.001). Mean range of motion was 11 degrees better in the very satisfied group (p < 0.001). The groups were similar with regard to clinical examination, physical performance testing, and radiography. Interpretation - The patients who reported poor response after TKA continued to be unhappy after 8-13 years, as demonstrated by VAS pain and HAD, despite the absence of a discernible objective reason for revision.
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| 2. |
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| 3. |
- Badawy, Mona, et al.
(författare)
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Hospital volume and the risk of revision in Oxford unicompartmental knee arthroplasty in the Nordic countries -an observational study of 14,496 cases
- 2017
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: High procedure volume and dedication to unicompartmental knee arthroplasty (UKA) has been suggested to improve revision rates. This study aimed to quantify the annual hospital volume effect on revision risk in Oxfordu? nicompartmental knee arthroplasty in the Nordic countries. Methods: 14,496 cases of cemented medial Oxford III UKA were identified in 126 hospitals in the four countries included in the Nordic Arthroplasty Register Association (NARA) database from 2000 to 2012. Hospitals were divided by quartiles into 4 annual procedure volume groups (≤11, 12-23, 24-43 and ≥44). The outcome was revision risk after 2 and 10 years calculated using Kaplan Meier method. Multivariate Cox regression analysis was used to assess the Hazard Ratio (HR) of any revision due to specific reasons with 95% confidence intervals (CI). Results: The implant survival was 80% at 10 years in the volume group ≤11 procedures per year compared to 83% in other volume groups. The HR adjusted for age category, sex, year of surgery and nation was 0.87 (95% CI: 0.76-0.99, p = 0.036) for the group 12-23 procedures per year, 0.78 (95% CI: 0.68-0.91, p = 0.002) for the group 24-43 procedures per year and 0.82 (95% CI: 0.70-0.94, p = 0.006) for the group ≥44 procedures per year compared to the low volume group. Log-rank test was p = 0.003. The risk of revision for unexplained pain was 40-50% higher in the low compared with other volume groups. Conclusion: Low volume hospitals performing ≤11 Oxford III UKAs per year were associated with an increased risk of revision compared to higher volume hospitals, and unexplained pain as revision cause was more common in low volume hospitals.
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| 4. |
- Bremander, Ann B, et al.
(författare)
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Revision in previously satisfied knee arthroplasty patients is the result of their call on the physician, not on pre-planned follow-up : a retrospective study of 181 patients who underwent revision within 2 years
- 2005
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 76:6, s. 785-90
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Degree of satisfaction with a knee arthroplasty is said to be correlated to reduced pain and better function. During a validation of the Swedish Knee Arthroplasty Register in 1997, previously operated patients were asked how satisfied they were with their knee. A subgroup of "satisfied" patients was identified who underwent revision within 2 years of having expressed satisfaction. Our aim was to study the revision diagnosis, to determine whether the problem leading to revision had been discovered as a result of routine follow-up, and also to find out when the symptoms leading to revision had started.METHODS: We retrospectively studied the medical records of 181 patients (181 knees), with a median age of 74 (31-88) years. 68% were women and the median time between primary operation and revision was 8 (3-21) years.RESULTS: Aseptic loosening (74/181) was the most common diagnosis. 2 cases were revised as a result of routine follow-up. 44% of the medical records included reports of pain in the replaced knee prior to answering the satisfaction questionnaire.INTERPRETATION: Few patients were admitted to knee revision surgery due to medical findings discovered during routine follow-up. The term "satisfaction" must be interpreted with care, as it seems to have a more complex meaning for the patients than absence of knee pain.
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| 5. |
- Carr, Andrew J., et al.
(författare)
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Knee replacement
- 2012
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Ingår i: The Lancet. - 1474-547X. ; 379:9823, s. 1331-1340
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Tidskriftsartikel (refereegranskat)abstract
- Knee-replacement surgery is frequently done and highly successful. It relieves pain and improves knee function in people with advanced arthritis of the joint. The most common indication for the procedure is osteoarthritis. We review the epidemiology of and risk factors for knee replacement. Because replacement is increasingly considered for patients younger than 55 years, improved decision making about whether a patient should undergo the procedure is needed. We discuss assessment of surgery outcomes based on data for revision surgery from national joint-replacement registries and on patient-reported outcome measures. Widespread surveillance of existing implants is urgently needed alongside the carefully monitored introduction of new implant designs. Developments for the future are improved delivery of care and training for surgeons and clinical teams. In an increasingly ageing society, the demand for knee-replacement surgery will probably rise further, and we predict future trends. We also emphasise the need for new strategies to treat early-stage osteoarthritis, which will ultimately reduce the demand for joint-replacement surgery.
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| 6. |
- Cebatorius, Algimantas, et al.
(författare)
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Choice of approach, but not femoral head size, affects revision rate due to dislocations in THA after femoral neck fracture: results from the Lithuanian Arthroplasty Register
- 2015
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Ingår i: International Orthopaedics. - : Springer Science and Business Media LLC. - 1432-5195 .- 0341-2695. ; 39:6, s. 1073-1076
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Hip dislocation after arthroplasty for femoral neck fractures (FNF) remains a serious complication. The aim of our study was to investigate FNF patients treated with THA, with a special focus of comparing the effect of surgical approach and femoral head size on the risk of revision for dislocation. Methods Data were derived from the Lithuanian Arthroplasty Register, and we calculated the cumulative revision rates after surgery. For survival analysis, we used revision due to dislocation as an end-point. Cox proportional hazards models were used to analyse the influence of various covariates (age, gender, femoral head size, surgical approach). Results A total of 8,813 primary THAs were registered from 1 January 2011 to 31 December 2013, of which 1,412 were due to FNF: 899 involved 28-mm femoral heads and the remaining 513 received 32-mm heads. The posterior approach was used in 1,156 cases and the anterolateral approach in 256.. At the end of the follow-up period, 74 hips had been revised for recurrent dislocation. Cox regression adjusting for age, gender and head size showed that the posterior approach had 2.3-times [95% confidence interval (CI): 1.0-5.0, p = 0.04] greater risk of revision for dislocation Conclusions We conclude that in order to reduce the early dislocation rate in FNF patients treated with THA, it is more effective to use the anterolateral approach than it is to select a femoral head size of 32 mm instead of 28 mm.
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| 7. |
- Comfort, Thomas, et al.
(författare)
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International comparative evaluation of fixed-bearing non-posterior-stabilized and posterior-stabilized total knee replacements.
- 2014
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Ingår i: Journal of Bone and Joint Surgery. American Volume. - 1535-1386. ; 96A, s. 65-72
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Tidskriftsartikel (refereegranskat)abstract
- Differences in survivorship of non-posterior-stabilized compared with posterior-stabilized knee designs carry substantial economic consequences, especially with limited health-care resources. However, these comparisons have often been made between relatively small groups of patients, often with short-term follow-up, with only small differences demonstrated between the groups. The goal of this study is to compare the outcomes of non-posterior-stabilized and posterior-stabilized total knee arthroplasties with use of a unique collaboration of multiple established knee arthroplasty registries.
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| 8. |
- Dunbar, M J, et al.
(författare)
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Appropriate questionnaires for knee arthroplasty. Results of a survey of 3600 patients from The Swedish Knee Arthroplasty Registry
- 2001
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Ingår i: Journal of Bone and Joint Surgery: British Volume. - 2044-5377. ; 83:3, s. 339-344
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Tidskriftsartikel (refereegranskat)abstract
- The Swedish Knee Arthroplasty Registry (SKAR) has recorded knee arthroplasties prospectively in Sweden since 1975. The only outcome measure available to date has been revision status. While questionnaires on health outcome may function as more comprehensive endpoints, it is unclear which are the most appropriate. We tested various outcome questionnaires in order to determine which is the best for patients who have had knee arthroplasty as applied in a cross-sectional, discriminative, postal survey. Four general health questionnaires (NHP, SF-12, SF-36 and SIP) and three disease/site-specific questionnaires (Lequesne, Oxford-12, and WOMAC) were tested on 3600 patients randomly selected from the SKAR. Differences were found between questionnaires in response rate, time required for completion, the need for assistance, the efficiency of completion, the validity of the content and the reliability. The mean overall ranks for each questionnaire were generated. The SF-12 ranked the best for the general health, and the Oxford-12 for the disease/site-specific questionnaires. These two questionnaires could therefore be recommended as the most appropriate for use with a large knee arthroplasty database in a cross-sectional population.
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| 9. |
- Dunbar, Michael J, et al.
(författare)
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Translation and validation of the Oxford-12 item knee score for use in Sweden
- 2000
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Ingår i: Acta Orthopaedica Scandinavica. - : Medical Journals Sweden AB. - 0001-6470. ; 71:3, s. 268-274
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Tidskriftsartikel (refereegranskat)abstract
- The Oxford-12 Item Knee Score is a recently developed and validated patient-completed outcome measure designed specifically for use with knee arthroplasty in the United Kingdom. We have translated this questionnaire into Swedish and tested the validity and reliability of the translated version in a cross-sectional study by a postal survey to 1,200 randomly selected patients from the Swedish Knee Arthroplasty Register. Swedish versions of the WOMAC, Nottingham Health Profile, SF-36, SF-12, and the Sickness Impact Profile were employed in the validation process. We also tested feasibility and patient-burden parameters. The translated version appeared to be linguistically and culturally equivalent to the original version with good validity and reliability. Indirect measures of responsiveness indicated that it is at least as responsive to relevant knee arthroplasty patient states as the previously validated Swedish version of the WOMAC. Application of the translated questionnaire to this population is feasible with minimal imposed patient-burden. The Swedish translation of the Oxford-12 Item Knee Score is a valid and reliable tool for outcome studies on knee arthroplasty patients.
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| 10. |
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| 11. |
- Espinosa, P., et al.
(författare)
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Sequence of 305,996 total hip and knee arthroplasties in patients undergoing operations on more than 1 joint
- 2019
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682.
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Patient-specific data on multiple total arthroplasties (TA) of the lower limbs due to osteoarthritis (OA) are limited. We investigated the sequence of surgical procedures and risk factors for additional surgery in such patients. Patients and methods - 305,996 patients operated with a TA of the hip and/or knee due to OA were extracted from the Swedish National Hip (SHAR) and the Swedish Knee Arthroplasty Register (SKAR). 177,834 total hip arthroplasty (THA, 56% women, mean age 69 years) and 128,162 total knee arthroplasty (TKA, 60% women, mean age 69 years) procedures constituted the index operations. The mean, median, and maximum follow-up was 8, 6, and 23 years. Multivariable Cox regression analysis was used and Kaplan-Meier survival curves were constructed. Results - Right-sided primary TA (34%) was most frequent. Subsequent surgery was most frequent after primary left-sided TKA (33%). The time interval to a second TA procedure was 3.1 (SD 3.2) years after TKA and 4.0 (SD 3.9) years after THA. After the index TA the probability of no subsequent surgery amounted to 64% (SD 0.3) for THA and 58% (SD 0.4) for TKA over 20 years. Lower age, female sex, left side, and TKA at index operation were associated with a higher probability for subsequent TA. Interpretation - Delineation of factors that influence risk and the size of the risk for subsequent TA in 1 of the 3 major remaining joints is of value for clinicians and healthcare providers in the decision-making process for future resource allocation.
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| 12. |
- Franklin, Jonas, et al.
(författare)
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Natural history of radiographic hip osteoarthritis: A retrospective cohort study with 11-28 years of followup.
- 2011
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Ingår i: Arthritis Care and Research. - : Wiley. - 2151-4658 .- 2151-464X. ; 63:5, s. 689-695
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Tidskriftsartikel (refereegranskat)abstract
- Abstract OBJECTIVE: To evaluate the association between radiographic hip osteoarthritis (OA) and future total hip replacement (THR) due to OA or hip fracture. METHODS: We studied a cohort of individuals who had colon radiography from 1980-1997. Minimal joint space (MJS) was measured and each hip was graded for radiographic OA according to the Kellgren/Lawrence scale. Subjects were followed until the end of 2008. A Cox proportional hazards model, adjusted for age and sex, was used to evaluate factors associated with THR and hip fracture. RESULTS: A total of 2,953 hips were studied (57% women). The cumulative incidence of THR was 2.5% and the cumulative incidence of hip fracture was 2.6%. For hips with radiographic hip OA (MJS of 2.5 mm or less), the cumulative incidence of THR was 16.9% and the hazard ratio (HR) for THR was 13.2 (95% confidence interval [95% CI] 8.1-21). Using Kellgren/Lawrence grading, the HR for THR was 12.9 (95% CI 7.9-21) for hips with radiographic OA compared to those without. The HR for all types of hip fracture for hips with radiographic OA (MJS of 2.5 mm or less) was 0.47 (95% CI 0.15-1.5), for intracapsular fractures was 0.29 (95% CI 0.04-2.1), and for extracapsular fractures was 0.67 (95% CI 0.16-2.8). CONCLUSION: The risk of THR due to OA is substantially increased in patients with radiographic hip OA, regardless of symptoms, and increases with decreasing MJS. However, 11-28 years after having had radiographic hip OA, more than 4 of 5 of those having radiographic signs of hip OA had not had a THR for OA.
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| 13. |
- Franklin, Jonas, et al.
(författare)
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Revision and complication rates in 654 Exeter total hip replacements, with a maximum follow-up of 20 years.
- 2003
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 4:1, s. 1-5
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Tidskriftsartikel (refereegranskat)abstract
- Background: Iceland's geographical isolation with a stable and small population gives a rare opportunity for follow-up studies of medical interventions. Total hip replacements (THR) have been done at FSA Central Hospital in Akureyri, Iceland since 1982 with the Exeter hip implant being in use from the beginning. Methods: Hospital records for all patients operated on with THR between 1982 and the end of 1999 were reviewed and the patients were followed until the end of 2001. Information was gathered regarding the indication for primary surgery, the reason for revision if needed, as well as that of any complications. Survival statistics were used to calculate the cumulative revision rate. Results: The mean age at primary THR was 68.4 years for males and 68.8 years for females. 654 primary THRs were done; of which 571 (87 %) were due to osteoarthritis. 37 of the primary arthroplasties had been revised before the end of year 2001. Conclusion: We have in this unique 2-20 year study of 654 THRs with no loss to follow-up for the patients, found revision rates that conform with the large Swedish THR registry. Complication rates in general are in agreement with that reported for other comparable patient groups, while infection rates appear lower.
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| 14. |
- Graves, Stephen, et al.
(författare)
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International comparative evaluation of knee replacement with fixed or mobile-bearing posterior-stabilized prostheses.
- 2014
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Ingår i: Journal of Bone and Joint Surgery. American Volume. - 1535-1386. ; 96A, s. 59-64
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Tidskriftsartikel (refereegranskat)abstract
- Posterior-stabilized total knee prostheses were introduced to address instability secondary to loss of posterior cruciate ligament function, and they have either fixed or mobile bearings. Mobile bearings were developed to improve the function and longevity of total knee prostheses. In this study, the International Consortium of Orthopaedic Registries used a distributed health data network to study a large cohort of posterior-stabilized prostheses to determine if the outcome of a posterior-stabilized total knee prosthesis differs depending on whether it has a fixed or mobile-bearing design.
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| 15. |
- Gudnason, Asgeir, et al.
(författare)
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All-Polyethylene Versus Metal-Backed Tibial Components-An Analysis of 27,733 Cruciate-Retaining Total Knee Replacements from the Swedish Knee Arthroplasty Register.
- 2014
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Ingår i: Journal of Bone and Joint Surgery. American Volume. - 1535-1386 .- 0021-9355. ; 96A:12, s. 994-999
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Tidskriftsartikel (refereegranskat)abstract
- Currently, the use of metal-backed tibial components is more common than the use of all-polyethylene components in total knee arthroplasty. However, the available literature indicates that all-polyethylene tibial components are not inferior to the metal-backed design. We hypothesized that there would be no difference in the ten-year survival rate between all-polyethylene and metal-backed tibial components of a specific design in a large nationwide cohort.METHODS: In the Swedish Knee Arthroplasty Register, we identified 27,733 cruciate-retaining total knee replacements using the press-fit condylar prosthesis with either metal-backed or all-polyethylene tibial components inserted from 1999 to 2011. Unadjusted survival functions were calculated with the end points of revision for any reason, revision due to infection, and revision due to reasons other than infection, and the differences between the groups were investigated with the log-rank test. Cox proportional hazard models were fitted to analyze the influence of various covariates on the adjusted relative risk of revision.RESULTS: The median duration of follow-up was 4.5 years (range, zero to 12.9 years). Of all total knee replacements, 16,896 (60.9%) were in women and 10,837 (39.1%) were in men. Metal-backed components were used in 16,011 total knee arthroplasties (57.7%) and all-polyethylene in 11,722 total knee arthroplasties (42.3%). With revision for any reason as the end point, the all-polyethylene tibial component had slightly superior, unadjusted ten-year survival compared with the metal-backed component: 97.2% (95% confidence interval [CI], 96.7% to 97.7%) compared with 96.6% (95% CI, 96.2% to 96.9%; p = 0.002). Cox multiple regression analysis adjusting for age group, sex, and patellar resurfacing showed that all-polyethylene components had a reduced risk of revision for any reason (relative risk = 0.75; 95% CI, 0.64 to 0.89) and a reduced risk of revision due to infection (relative risk = 0.63; 95% CI, 0.46 to 0.86). Patellar resurfacing and male sex increased the risk of revision due to infection (relative risk = 2.22 [95% CI, 1.37 to 3.62] and 2.21 [95% CI, 1.66 to 2.94], respectively).CONCLUSIONS: These all-polyethylene tibial components were at least as good as or superior to metal-backed tibial components with respect to implant survivorship at ten years in cruciate-retaining total knee replacements. We concluded that these less expensive all-polyethylene tibial components can be safely and effectively used in total knee arthroplasty.LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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| 16. |
- Harrysson, OLA, et al.
(författare)
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Higher cumulative revision rate of knee arthroplasties in younger patients with osteoarthritis
- 2004
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Ingår i: Clinical Orthopaedics and Related Research. - : Ovid Technologies (Wolters Kluwer Health). - 0009-921X. ; :421, s. 162-168
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Tidskriftsartikel (refereegranskat)abstract
- This study was designed to test the hypothesis that younger patients treated for osteoarthritis and similar conditions using total knee arthroplasty and unicompartmental knee arthroplasty have a lower implant survival rate when compared with older patients. Previous studies have been done on a small number of patients and only included the younger patients. In many cases patients treated for rheumatoid arthritis have been included in the studies and exceptional survival rates have been reported. The current study compared the cumulative revision rate of the components in 33,251 patients older than 60 years and 2606 patients younger than 60 years treated with total knee arthroplasty or unicompartmental knee arthroplasty for osteoarthritis or similar conditions. Cox regression was used to compare the risk for revision between the two age groups and between gender and the effect of year of operation. The results showed a higher cumulative revision rate for the group of younger patients in all statistical analyses and the risk ratio for revision was significantly lower for the group of older patients. The risk for revision decreased for both groups when considering the year of surgery. This is probably attributable to better implant components and surgical techniques.
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| 17. |
- Hekmat, Korosh, et al.
(författare)
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Decrease in the incidence of total hip arthroplasties in patients with rheumatoid arthritis - results from a well defined population in south Sweden
- 2011
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Ingår i: Arthritis research & therapy. - : Springer Science and Business Media LLC. - 1478-6362 .- 1478-6354. ; 13:2
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: INTRODUCTION: One aim of modern pharmacologic treatment in rheumatoid arthritis (RA) is to prevent joint destruction and reduce the need for surgery. Our purpose was to investigate secular trends in the incidence of primary total hip and knee arthroplasties in a well defined sample of patients with RA. METHODS: Prevalent cases with RA in 1997 and incident cases from 1997 to 2007 in a community based register in Malmö, south Sweden, were included. Based on a structured review of the medical records, patients were classified according to the 1987 ACR criteria for RA. This cohort was linked to the Swedish Hip Arthroplasty Register (through December 2006) and the Swedish Knee Arthroplasty Register (through October 2007). Patients with a registered total hip or knee arthroplasty before 1997 or before RA diagnosis were excluded. Incidence rates for the period of introduction of TNF inhibitors (1998 to 2001) were compared to the period when biologics were part of the established treatment for severe RA (2002 to 2006/2007). RESULTS: In the cohort (n = 2,164; 71% women) a primary hip arthroplasty was registered for 115 patients and a primary knee arthroplasty for 82 patients. The incidence of primary total hip arthroplasties decreased from the period 1998 to 2001 (12.6/1,000 person-years (pyr)) to 2002 to 2006 (6.6/1,000 pyr) (rate ratio (RR) 0.52; 95% confidence interval (CI) 0.35 to 0.76). There was a trend towards an increase of primary knee arthroplasties (incidence 4.8/1,000 pyr vs. 6.8/1,000 pyr; RR 1.43; 95% CI 0.89 to 2.31). CONCLUSIONS: Our investigation shows a significant decrease in the incidence of total hip arthroplasties in patients with RA after 2001. Possible explanations include a positive effect on joint damage from more aggressive pharmacological treatment.
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| 18. |
- Holmberg, Anna, et al.
(författare)
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75% success rate after open debridement, exchange of tibial insert, and antibiotics in knee prosthetic joint infections.
- 2015
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 86:4, s. 457-462
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Prosthetic joint infection (PJI) is a leading cause of early revision after total knee arthroplasty (TKA). Open debridement with exchange of tibial insert allows treatment of infection with retention of fixed components. We investigated the success rate of this procedure in the treatment of knee PJIs in a nationwide material, and determined whether the results were affected by microbiology, antibiotic treatment, or timing of debridement. Patients and methods - 145 primary TKAs revised for the first time, due to infection, with debridement and exchange of the tibial insert were identified in the Swedish Knee Arthroplasty Register (SKAR). Staphylococcus aureus was the most common pathogen (37%) followed by coagulase-negative staphylococci (CNS) (23%). Failure was defined as death before the end of antibiotic treatment, revision of major components due to infection, life-long antibiotic treatment, or chronic infection. Results - The overall healing rate was 75%. The type of infecting pathogen did not statistically significantly affect outcome. Staphylococcal infections treated without a combination of antibiotics including rifampin had a higher failure rate than those treated with rifampin (RR = 4, 95% CI: 2-10). In the 16 cases with more than 3 weeks of symptoms before treatment, the healing rate was 62%, as compared to 77% in the other cases (p = 0.2). The few patients with a revision model of prosthesis at primary operation had a high failure rate (5 of 8). Interpretation - Good results can be achieved by open debridement with exchange of tibial insert. It is important to use an antibiotic combination including rifampin in staphylococcal infections.
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| 19. |
- Ighani Arani, Perna, 1989-, et al.
(författare)
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Bariatric surgery prior to total knee arthroplasty is not associated with lower risk of revision : a register-based study of 441 patients
- 2021
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Ingår i: Acta Orthopaedica. - : Taylor & Francis. - 1745-3674 .- 1745-3682. ; 92:1, s. 97-101
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: Obesity is a considerable medical challenge in society. We investigated the risk of revision for any reasons and for infection in patients having total knee arthroplasty (TKA) for osteoarthritis (OA) within 2 years after bariatric surgery (BS) and compared them with TKAs without BS.Patients and methods: We used the Scandinavian Obesity Surgery Registry (SOReg) and the Swedish Knee Arthroplasty Register (SKAR) to identify patients operated on in 2009-2019 with BS who had had primary TKA for OA within 2 years after the BS (BS group) and compared them with TKAs without prior BS (noBS group). We determined adjusted hazard ratio (HR) for the BS group and noBS group using Cox proportional hazard regression for revision due to any reasons and for infection. Adjustments were made for sex, age groups, and BMI categories preoperatively.Results: 441 patients were included in the BS group. The risk of revision for infection was higher for the BS group with HR 2.2 (95% CI 1.1-4.7) adjusting for BMI before the TKA, while the risk of revision for any reasons was not statistically significant different for the BS group with HR 1.3 (CI 0.9-2.1). Corresponding figures when adjusting for BMI before the BS were HR 0.9 (CI 0.4-2) and HR 1.2 (CI 0.7-2).Interpretation: Our findings did not indicate that BS prior to TKA was associated with lower risk of revision.
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| 20. |
- Irmola, Tero, et al.
(författare)
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Association between fixation type and revision risk in total knee arthroplasty patients aged 65 years and older : a cohort study of 265,877 patients from the Nordic Arthroplasty Register Association 2000–2016
- 2021
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 92:1, s. 91-96
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose — The population of the Nordic countries is aging and the number of elderly patients undergoing total knee arthroplasty (TKA) is also expected to increase. Reliable fixation methods are essential to avoid revisions. We compared the survival of different TKA fixation concepts with cemented fixation as the gold standard. Patients and methods — We used data from the Nordic Arthroplasty Register Association (NARA) database of 265,877 unconstrained TKAs performed for patients aged ≥ 65 years with primary knee osteoarthritis between 2000 and 2016. Kaplan–Meier (KM) survival analysis with 95% confidence intervals (CI) and the Cox multiple-regression model were used to compare the revision risk of the fixation methods. Results — Cemented fixation was used in 243,166 cases, uncemented in 8,000, hybrid (uncemented femur with cemented tibia) in 14,248, and inverse hybrid (cemented femur with uncemented tibia) fixation in 463 cases. The 10-year KM survivorship (95% CI) of cemented TKAs was 96% (96 − 97), uncemented 94% (94 − 95), hybrid 96% (96 − 96), and inverse hybrid 96% (94 − 99), respectively. Uncemented TKA was associated with increased risk of revision compared with the cemented TKA; the adjusted hazard ratio was 1.3 (95% CI 1.1 − 1.4). Interpretation — Cemented, hybrid, and inverse hybrid TKAs showed 10-year survival rates exceeding 95%. Uncemented fixation was associated with an increased risk of revision in comparison with cemented fixation. As both hybrid and inverse hybrid fixation were used in only a limited number of TKAs, indicating possibility of selection bias in their favor, cemented TKA still remains the gold standard, as it works reliably in the hands of many.
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| 21. |
- Irmola, Tero, et al.
(författare)
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Impact of the Nordic Arthroplasty Register Association (NARA) collaboration on demographics, methods and revision rates in knee arthroplasty : a register-based study from NARA 2000–2017
- 2022
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 93, s. 866-873
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose — We have previously observed differences in treatment and outcome of knee arthroplasties in the Nordic countries. To evaluate the impact of Nordic collaboration in the last 15 years we aimed to compare patient demographics, methods, and revision rates in primary knee arthroplasties among the 4 Nordic countries. Patients and methods — We included 535,051 primary knee arthroplasties reported 2000–2017 from the Nordic Arthroplasty Register Association (NARA) database. Kaplan–Meier analysis (KM) and restricted mean survival time (RMST) analysis were used to evaluate the cumulative revision rate (CRR) and RMST estimates with 95% confidence intervals (CI) and to compare countries in relation to risk of revision for any reason. Results — After 2010, the increase in incidence of knee arthroplasty plateaued in Sweden and Denmark but contin-ued to increase in Finland and Norway. In 2017 the incidence was highest in Finland with 226 per 105 person-years, while it was less than 150 per 105 in the 3 other Nordic coun-tries. In total knee arthroplasties performed for osteoarthri-tis (OA), overall CRR at 15 years for revision due to any reason was higher in Denmark (CRR 9.6%, 95% CI 9.2−10), Norway (CRR 9.1%, CI 8.7−9.5), and Finland (CRR 7.0%, CI 6.8−7.3) compared with Sweden (CRR 6.6%, CI 6.4−6.8). There were differences among the countries in use of implant brand and type, fixation, patellar component, and use of unicompartmental knee arthroplasty. Interpretation — We evinced a slowing growth of incidence of knee arthroplasties in the Nordic countries after 2010 with Finland having the highest incidence. We also noted substantial differences among the 4 Nordic countries, with Sweden having a lower risk of revision than the other countries. No impact of NARA could be demonstrated and CRR did not improve over time.
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| 22. |
- Juréus, Jan, et al.
(författare)
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The natural course of spontaneous osteonecrosis of the knee (SPONK) A 1-to 27-year follow-up of 40 patients
- 2013
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 84:4, s. 410-414
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose Spontaneous osteonecrosis of the knee (SPONK) is a painful lesion in the elderly, frequently leading to osteoarthritis and subsequent knee surgery. We evaluated the natural course and long-term consequences of SPONK in terms of need for major knee surgery. Methods Between 1982 and 1988, 40 consecutive patients were diagnosed with SPONK. The short-term outcome has been reported previously (1991). After 1-7 years, 10 patients had a good radiographic outcome and 30 were considered failures, developing osteoarthritis. In 2012, all 40 of the patients were matched with the Swedish Knee Arthroplasty Register (SKAR) and their medical records were reviewed to evaluate the long-term need for major knee surgery. Results At the 2012 review, 33 of the 40 patients had died. The mean follow-up time from diagnosis to surgery, death, or end of study was 9 (1-27) years. 17 of 40 patients had had major knee surgery with either arthroplasty (15) or osteotomy (2). All operated patients but 1 were in the radiographic failure group and had developed osteoarthritis in the study from 1991. 6 of 7 patients with large lesions (> 40% of the AP radiographic view of the condyle) at the time of the diagnosis were operated. None of the 10 patients with a lesion of less than 20% were ever operated. Interpretation It appears that the size of the osteonecrotic lesion can be used to predict the outcome. Patients showing early signs of osteoarthritis or with a large osteonecrosis have a high risk of later major knee surgery.
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| 23. |
- Kesteris, U, et al.
(författare)
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Cumulative revision rate with the Scan Hip Classic I total hip prosthesis. 1,660 cases followed for 2-12 years
- 1998
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Ingår i: Acta Orthopaedica Scandinavica. - : Medical Journals Sweden AB. - 0001-6470. ; 69:2, s. 133-137
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Tidskriftsartikel (refereegranskat)abstract
- We analyzed the cumulative revision rate in 1,474 patients (1,660 hips) operated on with a cemented Scan Hip Classic I prosthesis from November 1983 to January 1994 at Lund University Hospital. The revision rate was analyzed for 3 diagnoses--arthrosis, rheumatoid arthritis and complication after a hip fracture--and for 2 head diameters--22 and 32 mm. Until January 1996, 36 hips were revised: 31 because of aseptic loosening, 3 because of dislocation and 2 because of infection. The overall revision rate was 5.6% after 10 years and was similar in arthrosis, rheumatoid arthritis and fracture cases. Due to revisions because of dislocation in the 22 mm group, the total revision rate was lower in the 32 mm group (p = 0.03).
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| 24. |
- Kesteris, Uldis, et al.
(författare)
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Polyethylene wear and synovitis in total hip arthroplasty: a sonographic study of 48 hips
- 1999
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Ingår i: Journal of Arthroplasty. - 0883-5403. ; 14:2, s. 138-143
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Tidskriftsartikel (refereegranskat)abstract
- Forty-six patients (48 hips), operated on with cemented total hip arthroplasty (THA) because of arthrosis, were examined radiographically and sonographically at 10-year follow-up. Polyethylene wear of acetabular cups was measured on conventional non-weight-bearing pelvic radiographs, and the volume of polyethylene debris was calculated. Radiographic signs of loosening were identified. The capsular distance (ie, thickness of the synovium or synovial contents) was measured sonographically. We found a significant correlation between increased volumetric wear and increased capsular distance. Hips with radiographically loose acetabular components had significantly greater volumetric wear and capsular distance than those without signs of acetabular loosening. This relationship was not observed in hips with radiographically loose femoral components. In cemented THA, the volume of polyethylene wear debris and the thickness of the synovium and the synovial contents are related. In the event of radiographic loosening of the acetabular component, they are both increased.
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| 25. |
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