| 1. |
- Adolfsson, Lars, 1955-
(författare)
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Post-traumatic stiff elbow
- 2018
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Ingår i: EFORT open reviews. - : British Editorial Society of Bone & Joint Surgery. - 2058-5241 .- 2396-7544. ; 3:5, s. 210-216
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Forskningsöversikt (refereegranskat)abstract
- Post-traumatic and post-operative stiffness of the elbow joint is relatively common and may in pronounced cases markedly interfere with normal upper extremity function.Soft-tissue contractures and heterotopic bone formation are two major causes of limited movement.Extensive recent research has elucidated many of the pathways contributing to these conditions, but the exact mechanisms are still unknown.In the early phase of soft-tissue contractures conservative treatment may be valuable, but in longstanding cases operative treatment is often necessary.Several different options are available depending on the severity of the condition and the underlying offending structures. Surgical treatment may allow significant gains in movement but rarely complete restoration, and complications are not uncommon.The following presentation reviews the recent literature on pathomechanisms and treatment alternatives. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170062.
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| 2. |
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| 3. |
- Andersson, Jonny K, 1972, et al.
(författare)
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Misdiagnosed and maltreated scaphoid fractures – costly both for society and patients : A review of filed claims to the Swedish National Patient Insurance Company 2011–2018
- 2022
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Ingår i: EFORT Open Reviews. - 2396-7544. ; 7:2, s. 129-136
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Tidskriftsartikel (refereegranskat)abstract
- • Misdiagnosed and maltreated scaphoid fractures filed to the Swedish National Patient Insurance Company (LÖF) 2011–2018 were analyzed in terms of complications and costs for society. All filed claims are database-registered (altogether 200 000 claims since 2000). This database was assessed in June 2019 through injury ICD10-SWE-diagnoses. Demographics, complications, complaints, corrective surgeries and costs were analyzed. The numbers of claims for scaphoid fractures were reviewed and compared with all claims. • There was a statistically significant trend towards decreasing numbers of notified scaphoid fracture cases during this time. This is not the case compared with the total annually notified injuries to LÖF during the same time, where we instead can see statistically significant increased numbers. • Median age for the 128 patients was 24 years. Men represented 76%. Seventy-eight of the 128 (61%) claims were judged as avoidable, compared with 42% in terms of all notified injuries. Pseudoarthrosis dominated as complication (n = 71). Total numbers of complications were 117, and 47 of the 78 patients had medical invalidity as a consequence. Up to six secondary corrective surgeries per patient were required. Complications and disabilities were more severe if patients needed more than one surgery. The total costs were calculated to €1 226 193. • Level of Evidence: LoE III, Therapeutic
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| 4. |
- Andersson, Jonny K, 1972
(författare)
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Treatment of scapholunate ligament injury: current concepts
- 2017
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Ingår i: Efort Open Reviews. - : Bioscientifica. - 2058-5241 .- 2396-7544. ; 2:9, s. 382-393
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Tidskriftsartikel (refereegranskat)abstract
- Injuries to the scapholunate joint are the most common cause of carpal instability. An isolated injury to the scapholunate ligament may progress to abnormal joint mechanics and degenerative cartilage changes. Treatment for scapholunate instability is aimed at arresting the degenerative process by restoring ligament continuity and normalising carpal kinematics. Early arthroscopic diagnosis of scapholunate injury is mandatory for establishing the prognosis of the injury, as a proper ligament repair is recommended within four to six weeks after trauma. In this review, anatomy, diagnosis and treatment of scapholunate ligament injury and carpal instability are discussed. Recommendations for treatment based on the stage and classification of injury and the degree of instability and arthritic changes are proposed.
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| 5. |
- Arias, C, et al.
(författare)
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Diversity in orthopaedics and traumatology: a global perspective
- 2020
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Ingår i: EFORT open reviews. - : Bioscientifica. - 2058-5241 .- 2396-7544. ; 5:10, s. 743-752
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Tidskriftsartikel (refereegranskat)abstract
- Europe represents true diversity, with cultural, linguistic and geopolitical variation spanning a large geographical area. Politics for many of its 750 million inhabitants revolves around the European Union (EU) and its 27 member states. The overarching goal of the EU is to promote peace and the values of the union (inclusion, tolerance, justice, solidarity and non-discrimination).1,2 EFORT was created to connect orthopaedic associations across Europe, fostering relationships between member countries that celebrated diversity and facilitated the exchange of knowledge. Whilst the global landscape changes and politics attempts to interfere in how we live our lives, it is important to remember that a strong organization is a diverse one that evolves over time. Various initiatives exist across the global landscape to support diversity in terms of culture; gender; black, Asian and minority ethnic (BAME) groups; disability groups; lesbian, gay, bisexual, transgender and queer (or questioning) and others (LGBTQ+); and the ‘ageing’ surgeon. This article explores the creation of some of these initiatives and how they have been supported by different orthopaedic organizations. Cite this article: EFORT Open Rev 2020;5:743-752. DOI: 10.1302/2058-5241.5.200022
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| 6. |
- Arner, M
(författare)
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Developing a national quality registry for hand surgery: challenges and opportunities
- 2016
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Ingår i: EFORT open reviews. - : Bioscientifica. - 2058-5241 .- 2396-7544. ; 1:4, s. 100-106
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Tidskriftsartikel (refereegranskat)abstract
- The Scandinavian National Healthcare Quality Registries (NQRs) have brought about considerable improvements since their introduction in the 1970s. One such registry – HAKIR (‘hand surgery’) – was established in 2010 and was likely the first NQR for hand surgery. Patient-reported outcome and reoperations due to post-operative complications are registered in HAKIR, as well as hand function in selected groups of surgical procedures. Creating simple logistics for collecting data and careful planning are important factors when establishing a new NQR. Continuous surveillance of data validity and coverage are crucial for success. With perseverance, large databases for clinical research can be created, along with the establishment of national multi-professional collaboration in healthcare improvement work.Cite this article: Arner, M. Developing a national quality registry for hand surgery: challenges and opportunities. EFORT Open Rev 2016;1:100-106. DOI: 10.1302/2058-5241.1.000045.
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| 7. |
- Biscevic, Mirza, et al.
(författare)
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Intraoperative neuromonitoring in spine deformity surgery: modalities, advantages, limitations, medicolegal issues - surgeons' views.
- 2020
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Ingår i: EFORT open reviews. - : Bioscientifica. - 2058-5241 .- 2396-7544. ; 5:1, s. 9-16
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Tidskriftsartikel (refereegranskat)abstract
- In spine deformity surgery, iatrogenic neurologic injuries might occur due to the mechanical force applied to the spinal cord from implants, instruments, and bony structures, or due to ischemic changes from vessel ligation during exposure and cord distraction/compression during corrective manoeuvres.Prompt reaction within the reversible phase (reducing of compressive/distractive forces) usually restores functionality of the spinal cord, but if those forces continue to persist, a permanent neurological deficit might be expected.With monitoring of sensory pathways (dorsal column-medial lemniscus) by somatosensory-evoked potentials (SSEPs), such events are detected with a sensitivity of up to 92%, and a specificity of up to 100%.The monitoring of motor pathways by transcranial electric motor-evoked potentials (TceMEPs) has a sensitivity and a specificity of up to 100%, but it requires avoidance of halogenated anaesthetics and neuromuscular blockades.Different modalities of intraoperative neuromonitoring (IONM: SSEP, TceMEP, or combined) can be performed by the neurophysiologist, the technician or the surgeon. Combined SSEP/TceMEP performed by the neurophysiologist in the operating room is the preferable method of IONM, but it might be impractical or unaffordable in many institutions. Still, many spine deformity surgeries worldwide are performed without any type of IONM. Medicolegal aspects of IONM are different worldwide and in many cases some vagueness remains.The type of IONM that a spinal surgeon employs should be reliable, affordable, practical, and recognized by the medicolegal guidelines. Cite this article: EFORT Open Rev 2020;5:9-16. DOI: 10.1302/2058-5241.5.180032.
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| 8. |
- Cheng, Tian, et al.
(författare)
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Idiopathic scoliosis : a systematic review and meta-analysis of heritability
- 2022
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Ingår i: EFORT OPEN REVIEWS. - : Bioscientifica. - 2396-7544 .- 2058-5241. ; 7:6, s. 414-421
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Forskningsöversikt (refereegranskat)abstract
- PurposeIdiopathic scoliosis is the most common spinal deformity and affects 1–3% of children and adolescents. Idiopathic scoliosis may run in families and the purpose of this systematic review was to describe the degree of heritability.MethodsWe searched Medline, Web of Science and EMBASE for family and twin studies reporting heritability estimates for idiopathic scoliosis, or studies from which heritability estimates could be calculated. Reference lists were screened for additional papers. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The protocol was registered at PROSPERO (registration number: CRD42022307329).ResultsThe literature search identified 1134 reports. After full-text screening, nine eligible reports were included for data extraction. Seven were twin studies containing between 5 and 526 pairs, and two were family studies with 1149 and 2732 individuals, respectively. Quality was ‘good’ in four studies and ‘fair’ in five studies. In general, studies with radiograph-confirmed diagnosis reported higher heritability estimates than studies with self-reported diagnosis. Population-based twin studies reported lower heritability estimates than clinic-based twin studies. Family-based studies reported higher heritability estimates than twin studies. Pairwise concordance for scoliosis ranged from 0.11 to 1.00 in monozygotic twins and from 0 to 1.0 in dizygotic twins. A meta-analysis of three studies resulted in a narrow sense heritability estimate of 0.57 (95% CI: 0.29–0.86).ConclusionTwin and family studies indicate a hereditary component in idiopathic scoliosis, but study heterogeneity is large, and the degree of the heritability is uncertain. Nevertheless, known genetic variants associated with idiopathic scoliosis can still only explain a minor part of heritability.
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| 9. |
- Clementson, Martin, et al.
(författare)
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Acute scaphoid fractures : Guidelines for diagnosis and treatment
- 2020
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Ingår i: EFORT Open Reviews. - : Bioscientifica. - 2396-7544 .- 2058-5241. ; 5:2, s. 96-103
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Tidskriftsartikel (refereegranskat)abstract
- In cases of suspected scaphoid fracture where the initial radiographs are negative, a supplementary MRI, or alternatively CT, should be carried out within three to five days. Fracture classification, assessment of dislocation as well as evaluation of fracture healing is best done on CT with reconstructions in the coronal and sagittal planes, following the longitudinal axis of the scaphoid. After adequate conservative management, union is achieved at six weeks for approximately 90% of nondisplaced or minimally displaced (≤ 0.5 mm) scaphoid waist fractures. Scaphoid waist fractures with moderate displacement (0.5-1.5 mm) can be treated conservatively, but require prolonged cast immobilization for approximately eight to ten weeks. Internal fixation is recommended for all scaphoid waist fractures with dislocation ≥ 1.5 mm. Distal scaphoid fractures can be treated conservatively. The majority heal uneventfully after four to six weeks of immobilization, depending on fracture type. In general, proximal scaphoid fractures should be treated with internal fixation.
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| 10. |
- Dahlin, Lars B., et al.
(författare)
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Nerve injuries of the upper extremity and hand
- 2017
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Ingår i: EFORT OPEN REVIEWS. - : BRITISH EDITORIAL SOC BONE & JOINT SURGERY. - 2058-5241 .- 2396-7544. ; 2:5, s. 158-170
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Tidskriftsartikel (refereegranskat)abstract
- A nerve injury has a profound impact on the patient's daily life due to the impaired sensory and motor function, impaired dexterity, sensitivity to cold as well as eventual pain problems. To perform an appropriate treatment of nerve injuries, a correct diagnosis must be made, where the injury is properly classified, leading to an optimal surgical approach and technique, where timing of surgery is also important for the outcome. Knowledge about the nerve regeneration process, where delicate processes occur in neurons, non-neuronal cells (i. e. Schwann cells) and other cells in the peripheral as well as the central nervous systems, is crucial for the treating surgeon. The surgical decision to perform nerve repair and/or reconstruction depends on the type of injury, the condition of the wound as well as the vascularity of the wound. To reconnect injured nerve ends, various techniques can be used, which include both epineurial and fascicular nerve repair, and if a nerve defect is caused by the injury, a nerve reconstruction procedure has to be performed, including bridging the defect using nerve-grafts or nerve transfer techniques. The patients must be evaluated properly and regularly after the surgical procedure and appropriate rehabilitation programmes are useful to improve the final outcome.
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| 11. |
- Hobusch, G. M., et al.
(författare)
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Advanced techniques in amputation surgery and prosthetic technology in the lower extremity
- 2020
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Ingår i: EFORT Open Reviews. - : Bioscientifica. - 2396-7544 .- 2058-5241. ; 5:10, s. 724-741
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Tidskriftsartikel (refereegranskat)abstract
- Bone-anchored implants give patients with unmanage-able stump problems hope for drastic improvements in function and quality of life and are therefore increasingly considered a viable solution for lower-limb amputees and their orthopaedic surgeons, despite high infection rates. Regarding diversity and increasing numbers of implants worldwide, efforts are to be supported to arrange an international bone-anchored implant register to transparently overview pros and cons. Due to few, but high-quality, articles about the beneficial effects of targeted muscle innervation (TMR) and regenerative peripheral nerve interface (RPNI), these surgical techniques ought to be directly transferred into clinical protocols, observations and routines. Bionics of the lower extremity is an emerging cutting-edge technology. The main goal lies in the reduction of recognition and classification errors in changes of ambulant modes. Agonist-antagonist myoneuronal interfaces may be a most promising start in controlling of actively powered ankle joints. As advanced amputation surgical techniques are becoming part of clinical routine, the development of financing strategies besides medical strategies ought to be boosted, leading to cutting-edge technology at an affordable price. Microprocessor-controlled components are broadly available, and amputees do see benefits. Devices from different manufacturers differ in gait kinematics with huge inter individual varieties between amputees that cannot be explained by age. Active microprocessor-controlled knees/ ankles (A-MPK/As) might succeed in uneven ground walking. Patients ought to be supported to receive appropriate prosthetic components to reach their everyday goals in a desirable way. Increased funding of research in the field of prosthetic technology could enhance more high-quality research in order to generate a high level of evidence and to identify individuals who can profit most from microprocessor controlled prosthetic components.
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| 12. |
- Laedermann, Alexandre, et al.
(författare)
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Shoulder apprehension : a multifactorial approach
- 2018
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Ingår i: EFORT OPEN REVIEWS. - : BRITISH EDITORIAL SOC BONE & JOINT SURGERY. - 2058-5241 .- 2396-7544. ; 3:10, s. 550-557
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Forskningsöversikt (refereegranskat)abstract
- Shoulder apprehension is related to changes in functional cerebral networks induced by dislocations, peripheral neuromuscular lesions and persistent mechanical glenohumeral instability consisting of micro-motion. All the damage to the osseous and soft-tissue stabilizers of the shoulder, as well as neurologic impairment persisting even after stabilization, must be properly identified in order to offer the best possible treatment to the patient. There is growing evidence supporting the use of a global multimodal approach, involving, on the one hand, shoulder 'reafferentation', including proprioception, mirror therapy and even cognitive behavioural approaches, and, on the other hand, surgical stabilization techniques and traditional physical therapy in order to minimize persistent micro-motion, which may help brain healing. This combined management could improve return to sport and avoid dislocation arthropathy in the long term.
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| 13. |
- Makela, K. T., et al.
(författare)
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The benefits of collaboration: the Nordic Arthroplasty Register Association
- 2019
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Ingår i: Efort Open Reviews. - : Bioscientifica. - 2058-5241 .- 2396-7544. ; 4:6, s. 391-400
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Tidskriftsartikel (refereegranskat)abstract
- The Nordic Arthroplasty Register Association (NARA) was established in 2007 by arthroplasty register representatives from Sweden, Norway and Denmark with the overall aim to improve the quality of research and thereby enhance the possibility for quality improvement with arthroplasty surgery. Finland joined the NARA collaboration in 2010. NARA minimal hip, knee and shoulder datasets were created with variables that all countries can deliver. They are dynamic datasets, currently with 25 variables for hip arthroplasty, 20 for knee arthroplasty and 20 for shoulder arthroplasty. NARA has published statistical guidelines for the analysis of arthroplasty register data. The association is continuously working on the improvement of statistical methods and the application of new ones. There are 31 published peer-reviewed papers based on the NARA databases and 20 ongoing projects in different phases. Several NARA publications have significantly affected clinical practice. For example, metal-on-metal total hip arthroplasty and resurfacing arthroplasty have been abandoned due to increased revision risk based on i.a. NARA reports. Further, the use of uncemented total hip arthroplasty in elderly patients has decreased significantly, especially in Finland, based on the NARA data. The NARA collaboration has been successful because the countries were able to agree on a common dataset and variable definitions. The collaboration was also successful because the group was able to initiate a number of research projects and provide answers to clinically relevant questions. A number of specific goals, set up in 2007, have been achieved and new one has emerged in the process.
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| 14. |
- Mjöberg, Bengt
(författare)
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Is early migration enough to explain late clinical loosening of hip prostheses?
- 2020
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Ingår i: EFORT Open Reviews. - : Bioscientifica. - 2396-7544 .- 2058-5241. ; 5:2, s. 113-117
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Forskningsöversikt (refereegranskat)abstract
- Prosthetic loosening has been debated for decades, both in terms of the timing and nature of the triggering events. Multiple radiostereometric studies of hip prostheses have now shown that early migration poses a risk of future clinical failure, but is this enough to explain late clinical loosening? To answer this question, the progression of loosening from initiation to radiographic detection is described; and the need for explanations other than early prosthetic loosening is analysed, such as stress-shielding, particle disease, and metal sensitivity. Much evidence indicates that prosthetic loosening has already been initiated during or shortly after the surgery, and that the subsequent progression of loosening is affected by biomechanical factors, fluid pressure fluctuations and inflammatory responses to necrotic cells and cell fragments, i.e. the concept of late loosening appears to be a misinterpretation of late-detected loosening. Clinical implications: atraumatic surgery and initial prosthetic stability are crucial in ensuring low risk of prosthetic loosening.
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| 15. |
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| 16. |
- Pijls, B. G., et al.
(författare)
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MoM total hip replacements in Europe: a NORE report
- 2019
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Ingår i: Efort Open Reviews. - : Bioscientifica. - 2058-5241 .- 2396-7544. ; 4:6, s. 423-429
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this paper is to determine the prevalence of metal-on-metal (MoM) total hip replacement (THR) in European registries, to assess the incidence of revision surgery and to describe the national follow-up guidelines for patients with MoM THR including resurfacings. Eleven registries of the Network of Orthopaedic Registries of Europe (NORE) participated totalling 54 434 resurfacings and 58 498 large stemmed MoM THRs. The resurfacings and stemmed large head MoM had higher pooled revision rates at five years than the standard total hip arthroplasties (THA): 6.0%, 95% confidence interval (CI) 5.3 to 6.8 for resurfacings; 6.9%, 95% CI 4.4 to 9.4 for stemmed large head MoM; and 3.0%, 95% CI 2.5 to 3.6 for conventional THA. The resurfacings and stemmed large head MoM had higher pooled revision rates at ten years than the standard THAs: 12.1%, 95% CI 11.0 to 13.3 for resurfacings; 15.5%, 95% CI 9.0 to 22 for stemmed large head MoM; and 5.1%, 95% CI 3.8 to 6.4 for conventional THA. Although every national registry reports slightly different protocols for follow-up, these mostly consist of annual assessments of cobalt and chromium levels in blood and MRI (MARS) imaging.
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| 17. |
- Ström, Peter
(författare)
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Glenoid fractures of the shoulder
- 2020
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Ingår i: EFORT OPEN REVIEWS. - : BRITISH EDITORIAL SOC BONE & JOINT SURGERY. - 2396-7544 .- 2058-5241. ; 5:10, s. 620-623
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Tidskriftsartikel (refereegranskat)abstract
- Glenoid fractures of the shoulder are uncommon. Any scapular fracture involving the glenoid should be scrutinized carefully for a surgical treatment option. Classification is helpful in deciding the surgical tactic.Cite this article: EFORT Open Rev 2020;5:620-623. DOI: 10.1302/2058-5241.5.190057
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| 18. |
- Tsikandylakis, Georgios, et al.
(författare)
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Global diversity in bearings in primary THA.
- 2020
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Ingår i: EFORT open reviews. - : Bioscientifica. - 2058-5241 .- 2396-7544. ; 5:10, s. 763-775
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Tidskriftsartikel (refereegranskat)abstract
- Choice of articulating materials, head size and the design of the articulation will become decisive for the long-term performance of a total hip arthroplasty (THA) and especially in terms of risk for dislocation and wear-related problems. Here we account for common alternatives based on available studies and the evidence that can be derived from them.Metal or ceramic femoral heads articulating against a liner or cup made of highly cross-linked polyethylene and ceramic-on-ceramic articulations have about similar risk for complications leading to revision, whereas the performance of metal-on-metal articulations, especially with use of big heads, is inferior. The clinical significance of problems related to ceramic-on-ceramic articulations such as squeaking remains unclear. With use of current technology ceramic fractures are rare.Large femoral heads have the potential to increase the range of hip movement before impingement occurs and are therefore expected to reduce dislocation rates. On the other hand, issues related to bearing wear, corrosion at the taper-trunnion junction and groin pain may arise with larger heads and jeopardize the longevity of THA. Based on current knowledge, 32-mm heads seem to be optimal for metal-on-polyethylene bearings. Patients with ceramic-on-ceramic bearings may benefit from even larger heads such as 36 or 40 mm, but so far there are no long-term reports that confirm the safety of bearings larger than 36 mm.Assessment of lipped liners is difficult because randomized studies are lacking, but retrospective clinical studies and registry data seem to indicate that this liner modification will reduce the rate of dislocation or revision due to dislocation without clear evidence of clinically obvious problems due to neck-liner impingement.The majority of studies support the view that constrained liners and dual mobility cups (DMC) will reduce the risk of revision due to dislocation both in primary and revision THA, the latter gaining increasing popularity in some countries. Both these devices suffer from implant-specific problems, which seem to be more common for the constrained liner designs. The majority of studies of these implants suffer from various methodological problems, not least selection bias, which calls for randomized studies preferably in a multi-centre setting to obtain sufficient power. In the 2020s, the orthopaedic profession should place more effort on such studies, as has already been achieved within other medical specialties, to improve the level of evidence in the choice of articulation when performing one of the most common in-hospital surgical procedures in Europe. Cite this article: EFORT Open Rev 2020;5:763-775. DOI: 10.1302/2058-5241.5.200002.
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| 19. |
- Tsikandylakis, Georgios, et al.
(författare)
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Head size in primary total hip arthroplasty
- 2018
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Ingår i: Efort Open Reviews. - : Bioscientifica. - 2058-5241 .- 2396-7544. ; 3:5, s. 225-231
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Tidskriftsartikel (refereegranskat)abstract
- The use of larger femoral head size in total hip arthroplasty (THA) has increased during the past decade; 32 mm and 36 mm are the most commonly used femoral head sizes, as reported by several arthroplasty registries. The use of large femoral heads seems to be a trade-off between increased stability and decreased THA survivorship. We reviewed the literature, mainly focussing on the past 5 years, identifying benefits and complications associated with the trend of using larger femoral heads in THA. We found that there is no benefit in hip range of movement or hip function when head sizes > 36 mm are used. The risk of revision due to dislocation is lower for 36 mm or larger bearings compared with 28 mm or smaller and probably even with 32 mm. Volumetric wear and frictional torque are increased in bearings bigger than 32 mm compared with 32 mm or smaller in metal-on-cross-linked polyethylene (MoXLPE) THA, but not in ceramic-on-XLPE (CoXLPE). Long-term THA survivorship is improved for 32 mm MoXLPE bearings compared with both larger and smaller ones. We recommend a 32 mm femoral head if MoXLPE bearings are used. In hips operated on with larger bearings the use of ceramic heads on XLPE appears to be safer.
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| 20. |
- Varnum, C., et al.
(författare)
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Impact of hip arthroplasty registers on orthopaedic practice and perspectives for the future
- 2019
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Ingår i: Efort Open Reviews. - : Bioscientifica. - 2058-5241 .- 2396-7544. ; 4:6, s. 368-376
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Tidskriftsartikel (refereegranskat)abstract
- Total hip arthroplasty (THA) registers are established in several countries to collect data aiming to improve the results after THA. Monitoring of adverse outcomes after THA has focused mainly on revision surgery, but patient-reported outcomes have also been investigated. Several surgery-related factors influencing the survival of the THA have been thoroughly investigated and have changed clinical practice. These factors include surgical approach, specific implants, the size of the components, type of fixation and different bone cements. Register data have been used to examine the risk of venous thromboembolism and bleeding after THA. These investigations have resulted in shorter duration of thromboprophylaxis and a reduced frequency of blood transfusion. Registers may provide specific information to surgeons on the outcome of all THAs that they have performed with a detailed analysis of revisions rates and reasons for the revisions. A number of other stakeholders can use register data to provide benchmarks. The National Joint Registry for England, Wales, Northern Ireland and the Isle of Man supplies data to the Orthopaedic Device Evaluation Panel (ODEP), which provides benchmarks at 3, 5, 7, 10, and 13 years graded from A*, A, B and C. Future perspectives: National registers have to play a major role in documenting the quality of THA in order to describe best practice and report implant outliers. The registers have to be used for research and post-market surveillance and register data may be a source for intelligent decision tools.
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| 21. |
- Wilson, I., et al.
(författare)
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Orthopaedic registries with patient-reported outcome measures
- 2019
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Ingår i: Efort Open Reviews. - : Bioscientifica. - 2058-5241 .- 2396-7544. ; 4:6, s. 357-367
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Tidskriftsartikel (refereegranskat)abstract
- Total joint arthroplasty is performed to decreased pain, restore function and productivity and improve quality of life. One-year implant survivorship following surgery is nearly 100%; however, self-reported satisfaction is 80% after total knee arthroplasty and 90% after total hip arthroplasty. Patient-reported outcomes (PROs) are produced by patients reporting on their own health status directly without interpretation from a surgeon or other medical professional; a PRO measure (PROM) is a tool, often a questionnaire, that measures different aspects of patient-related outcomes. Generic PROs are related to a patient's general health and quality of life, whereas a specific PRO is focused on a particular disease, symptom or anatomical region. While revision surgery is the traditional endpoint of registries, it is blunt and likely insufficient as a measure of success; PROMs address this shortcoming by expanding beyond survival and measuring outcomes that are relevant to patients - relief of pain, restoration of function and improvement in quality of life. PROMs are increasing in use in many national and regional orthopaedic arthroplasty registries. PROMs data can provide important information on value-based care, support quality assurance and improvement initiatives, help refine surgical indications and may improve shared decision-making and surgical timing. There are several practical considerations that need to be considered when implementing PROMs collection, as the undertaking itself may be expensive, a burden to the patient, as well as being time and labour intensive.
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| 22. |
- Wronka, K. S., et al.
(författare)
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Extended trochanteric osteotomy: Improving the access and reducing the risk in revision THA
- 2020
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Ingår i: EFORT Open Reviews. - : Bioscientifica. - 2396-7544 .- 2058-5241. ; 5:2, s. 104-112
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Tidskriftsartikel (refereegranskat)abstract
- This review article presents a comprehensive literature review regarding extended trochanteric osteotomy (ETO). The history, rationale, biomechanical considerations as well as indications are discussed. The outcomes and complications as reported in the literature are presented, discussed and compared with our own practice. Based on the available evidence, we present our preferred technique for performing ETO, its fixation, as well as postoperative rehabilitation. The ETO aids implant removal and enhanced access. Reported union rate of ETO is high. The complications related to ETO are much less frequent than in cases when accidental intra-operative femoral fracture occurred that required fixation. Based on the literature and our own experience we recommend ETO as a useful adjunct in the arsenal of the revision hip specialist. © 2020 The author(s).
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