| 1. |
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| 2. |
- Bragdon, C. R., et al.
(författare)
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Experimental assessment of precision and accuracy of radio stereometric analysis for the determination of polyethylene wear in a total hip replacement model
- 2002
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Ingår i: Journal of Orthopaedic Research. ; 20:4, s. 688-695
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to develop and testa phantom model based on actual total hip replacement (THR) components to simulate the true penetration of the femoral h cad resulting fro in polyethylene car, This Model was used to Study both the accuracy and the precision of radiostereometric analysis, RSA, in measuring wear. We also used this model to evaluate optimum tantalum bead configuration for this particular cup design when used in a clinical setting. A physical model of a total hip replacement (a phantom) was constructed which Could simulate progressive. three-dimensional (3-D) penetration of the femoral head into the polyethylene component of a THR. Using it coordinate Measuring machine (CMM) the positioning of the femoral head using the phantom was measured to be accurate to within 7 mum The accuracy and precision of an RSA analysis system was determined from five repeat examinations of the phantom using various experimental set-ups of the phantom. The accuracy of the radiostereometric analysis, in this optimal experimental set-up studied was 33 mum for the medial direction, 22 mum for the superior direction, 86 mum for the posterior direction and 55 mum for the resultant 3-D vector length. The corresponding precision at the 95% confidence interval of the test results for repositioning the phantom five times. measured 8.4 mum for the medial direction, 5.5 mum for the superior direction. 16.0 mum for the posterior direction. and 13 5 mum for the resultant 3-D vector length. This in vitro model is proposed as a useful tool for developing a standard for the evaluation of radiostereometric and other radiographic methods used to measure in vivo wear. (C) 2002 Orthopaedic Research Society. Published by Elsevier Science Ltd, All rights reserved.
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| 3. |
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| 4. |
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| 5. |
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| 6. |
- Ioppolo, J. L., et al.
(författare)
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Kinematic joint measurement RSA flouroscopy
- 2004
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Ingår i: Proc. Ann. Meet. Aust. Coll. Phys. Scient. Eng. Med. (WA Branch). ; , s. 7-7
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)
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| 7. |
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| 8. |
- Nelissen, Rob G H H, et al.
(författare)
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RSA and registries: the quest for phased introduction of new implants.
- 2011
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Ingår i: The Journal of bone and joint surgery. American volume. - 1535-1386. ; 93 Suppl 3, s. 62-5
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Tidskriftsartikel (refereegranskat)abstract
- Although the overall survival of knee and hip prostheses at ten years averages 90%, recent problems with several hip and knee prostheses have illustrated that the orthopaedic community, industry, and regulators can still further improve patient safety. Given the early predictive properties of roentgen stereophotogrammetric analysis (RSA) and the meticulous follow-up of national joint registries, these two methods are ideal tools for such a phased clinical introduction. In this paper, we elaborate on the predictive power of RSA within a two-year follow-up after arthroplasty and its relationship to national joint registries. The association between RSA prosthesis-migration data and registry data is evaluated.The five-year rate of revision of RSA-tested total knee replacements was compared with that of non-RSA-tested total knee replacements. Data were extracted from the published results of the national joint registries of Sweden, Australia, and New Zealand.There was a 22% to 35% reduction in the number of revisions of RSA-tested total knee replacements as compared with non-RSA-tested total knee replacements in the national joint registries. Assuming that the total cost of total knee arthroplasty is $37,000 in the United States, a 22% to 35% reduction in the number of revisions (currently close to 55,000 annually) could lead to an estimated annual savings of over $400 million to the health-care system.The phased clinical introduction of new prostheses with two-year RSA results as a qualitative tool could lead to better patient care and could reduce the costs associated with revision total knee arthroplasty. Follow-up in registries is necessary to substantiate these results and to improve post-market surveillance.
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| 9. |
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| 10. |
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| 11. |
- Bragdon, Charles R, 1959, et al.
(författare)
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Comparison of femoral head penetration using RSA and the Martell method
- 2006
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Ingår i: Clin Orthop Relat Res. - 0009-921X. ; 448, s. 52-7
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Tidskriftsartikel (refereegranskat)abstract
- Radiostereometry has high precision and accuracy measuring polyethylene wear in total hip arthroplasty but requires a specialized setup. The Martell method is simpler and can be used on larger populations. The hypothesis that the radiostereometry analysis and the Martell analysis would yield comparable wear data from the same group of patients having total hip arthroplasty was tested. A group of twenty-five total hip arthroplasty patients who had both radiostereometry and standard anterior-posterior pelvic and cross-table lateral radiographs of sufficient quality for analysis were identified. The films were taken at postoperative periods of 6 weeks, 1 year, 2 years, and 5 years. Femoral head penetration was measured by both methods at each time point. The median penetration rates measured by each method decreased over time. Penetration results were affected by method of analysis, time, and dimension, with greater penetration for Martell compared with radiostereometry at each time point, greater penetration with increasing time for each method, and larger three-dimensional magnitude compared with two-dimensional analysis. LEVEL OF EVIDENCE: Case series Level IV. See Guidelines for Authors for a complete description of levels of evidence.
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| 12. |
- Bragdon, Charles R, 1959, et al.
(författare)
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Comparison of two digital radiostereometric analysis methods in the determination of femoral head penetration in a total hip replacement phantom
- 2004
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Ingår i: J Orthop Res. - : Wiley. - 0736-0266. ; 22:3, s. 659-64
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Tidskriftsartikel (refereegranskat)abstract
- Radiostereometric analysis (RSA) has been used extensively to evaluate the magnitude and direction of penetration of the femoral head into the acetabular component of a total hip replacement as a result of polyethylene wear and creep. The accuracy and precision of an RSA study depends on several factors, including the radiographic technique, the analytical software, and the positioning of the tantalum markers. This study had three sequential purposes. First, an in vitro phantom model was used to quantify the accuracy and precision of digital images versus conventional radiography in RSA measurements of penetration of the femoral head into the acetabular shell in a total hip replacement. The Umea RSA software package was used for analysis of both the conventional films, which were digitized at a resolution of 300 DPI, and digital radiographs, which were converted from a DICOM format at a resolution of 218 DPI. Digital radiography was found to be superior. Next, two methods of RSA analysis currently in use for determining femoral head penetration into polyethylene of total joint replacements were compared. Using the phantom model, we compared the Umea RSA system (Biomedical Innovations AB) to the RSA-CMS (RSA Clinical Measurement Solution) and in both cases used the digital radiographs. The Umea RSA system was found to be superior. Finally, two methods of marking the position of the acetabular component with tantalum beads were compared: one in which beads were inserted into previously described towers protruding from the back of the acetabular shell and another in which beads were placed into the peripheral flange of the polyethylene liner using the Umea RSA analysis system of the digital radiographs. The results using the two marker configurations were similar.
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| 13. |
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| 14. |
- Bragdon, Charles R, 1959, et al.
(författare)
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Standing versus supine radiographs in RSA evaluation of femoral head penetration
- 2006
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Ingår i: Clin Orthop Relat Res. - 0009-921X. ; 448, s. 46-51
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Tidskriftsartikel (refereegranskat)abstract
- Evaluation of polyethylene acetabular component wear in total hip arthroplasties commonly is performed using serial radiographs of the hip by measuring the change in the location of the center of the femoral head in relation to the acetabular component. Of the different methods currently used for this purpose, radiostereometric analysis (RSA) is considered the most accurate and precise. In all such radiographic studies, it is assumed the femoral head is seated into the deepest portion of the acetabular component during all radiographic examinations. Although most radiographs used for wear measurements are taken with the patient supine, we questioned whether standing radiographs, with substantial joint load, are better suited for these measurements. We evaluated two groups of patients having total hip arthroplasty who had radiostereometric radiographs taken in supine and standing positions. The average femoral head penetration that occurred between the 6-month and 2-year time interval was measured with radiographs taken in the standing or supine position. We found no difference between the average total femoral head penetration when using supine or standing radiographs.
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| 15. |
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| 16. |
- Donahue, GS, et al.
(författare)
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Risk factors for mid-term revision surgery in patients with articular surface replacement total hip arthroplasty
- 2018
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Ingår i: Hip international : the journal of clinical and experimental research on hip pathology and therapy. - : SAGE Publications. - 1724-6067. ; 28:1, s. 44-49
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Tidskriftsartikel (refereegranskat)abstract
- This study assessed the associations between gender and implant survival, as well as adverse local tissue reaction (ALTR), in patients with articular surface replacement (ASR) XL total hip arthroplasty (THA). Secondly, we sought to report the differences between genders in metal ion levels and patient reported outcome measures (PROMs) in these patients. Methods: 563 unilateral ASR XL THA patients were enrolled in a multicentre follow-up study at a mean of 6.4 years after index surgery. All patients had blood metal ion levels and PROMs obtained annually, and a valid anteroposterior pelvis radiograph. A sub-set of patients from a single centre had annual MRI performed and were analysed for the presence of moderate-to-severe ALTR. Results: 60 hips (11%) were revised during the study period. The only variables found to be associated with revision surgery in patients with unilateral THA were VAS pain (hazard ratio [HR], 1.35; p<0.001) and elevated cobalt metal ion levels (HR, 1.05; p<0.001). No variables assessed were found to be associated with prevalence of ALTR. Chromium concentrations were greater in female patients than males, while cobalt levels were similar between genders. Males reported higher HHS, EQ-5D and UCLA scores than females. Conclusions: Both males and females with metal-on-metal THA implants should be followed with equal vigilance as gender does not appear to be associated with poor outcomes, such as revision surgery and presence of ALTR.
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| 17. |
- Galea, V. P., et al.
(författare)
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Evaluation of in vivo wear of vitamin E-diffused highly crosslinked polyethylene at five years
- 2018
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Ingår i: Bone and Joint Journal. - 2049-4394. ; 100B100-B:12, s. 1592-1599
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Tidskriftsartikel (refereegranskat)abstract
- Aims The primary aim of this study was to compare the wear properties of vitamin E-diffused, highly crosslinked polyethylene (VEPE) and one formulation of moderately crosslinked and mechanically annealed ultra-high molecular weight polyethylene (ModXLPE) in patients five years after primary total hip arthroplasty (THA). The secondary aim was to assess the clinical results of patients treated with VEPE by evaluating patient-reported outcome measures (PROMs), radiological evidence of fixation, and the incidence of mechanical failure. Patients and Methods A total of 208 patients (221 THAs) from four international centres were recruited into a prospective study involving radiostereometric analysis (RSA) and the assessment of clinical outcomes. A total of 193 hips (87%) were reviewed at the five-year follow-up. Of these, 136 (70%) received VEPE (vs ModXLPE) liners and 68 (35%) received ceramic (vs metal) femoral heads. PROMs and radiographs were collected preoperatively and at one, two, and five years postoperatively. In addition, RSA images were collected to measure PE wear postoperatively and at one, two, and five years after surgery. Results We observed similar bedding in one year postoperatively and wear two years postoperatively between the two types of liner. However, there was significantly more penetration of the femoral head in the ModXLPE cohort compared with the VEPE cohort five years postoperatively (p < 0.001). The only variables independently predictive of increased wear were ModXLPE (vs VEPE) liner type (β = 0.22, p = 0.010) and metal (vs ceramic) femoral head (β = 0.21, p = 0.013). There was no association between increased wear and the development of radiolucency (p = 0.866) or PROMs. No patient had evidence of osteolysis. Conclusion Five years postoperatively, patients with VEPE (vs ModXLPE) and ceramic (vs metal) femoral heads had decreased wear. The rates of wear for both liners were very low and have not led to any osteolysis or implant failure due to aseptic loosening. ©2018 The British Editorial Society of Bone & Joint Surgery.
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| 18. |
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| 19. |
- Goude, F, et al.
(författare)
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Effects of competition and bundled payment on the performance of hip replacement surgery in Stockholm, Sweden: results from a quasi-experimental study
- 2022
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 12:7, s. e061077-
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Tidskriftsartikel (refereegranskat)abstract
- To evaluate the effects of competition and a bundled payment model on the performance of hip replacement surgery.DesignA quasi-experimental study where a difference-in-differences analytical framework is applied to analyse routinely collected patient-level data from multiple registers.SettingHospitals providing hip replacement surgery in Sweden.ParticipantsThe study included patients who underwent elective primary total hip replacement due to osteoarthritis from 2005 to 2012. The final study sample consisted of 85 275 hip replacement surgeries, where the exposure group consisted of 14 570 surgeries (n=6380 prereform and n=8190 postreform) and the control group consisted of 70 705 surgeries (n=32 799 prereform and n=37 906 postreform).InterventionA reform involving patient choice, free entry of new providers and a bundled payment model for hip replacement surgery, which came into force in 2009 in Region Stockholm, Sweden.Outcome measuresPerformance is measured as length of stay of the surgical admission, adverse event rate within 90 days following surgery and patient satisfaction 1 year postsurgery.ResultsThe reform successfully improved the adverse event rate (1.6 percentage reduction, p<0.05). Length of stay decreased less in the more competitive market than in the control group (0.7 days lower, p<0.01). These effects were mainly driven by university and central hospitals. No effects of the reform on patient satisfaction were found (no significance).ConclusionsThe study concludes that the incentives of the reform focusing on avoidance of adverse events have a predictable impact. Since the payment for providers is fixed per case, the impact on resource use is limited. Our findings contribute to the general knowledge about the effects of financial incentives and market-oriented reforms.
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| 20. |
- Hagberg, Kerstin, 1957, et al.
(författare)
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A 15-year follow-up of transfemoral amputees with bone-anchored transcutaneous prostheses. Mechanical complications and patient-reported outcomes
- 2020
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Ingår i: Bone & Joint Journal. - 2049-4394. ; 102B:1, s. 55-63
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Tidskriftsartikel (refereegranskat)abstract
- Aims The aim of this study was to describe implant and patient-reported outcome in patients with a unilateral transfemoral amputation (TFA) treated with a bone-anchored, transcutaneous prosthesis. Patients and Methods In this cohort study, all patients with a unilateral TFA treated with the Osseointegrated Prostheses for the Rehabilitation of Amputees (OPRA) implant system in Sahlgrenska University Hospital, Gothenburg, Sweden, between January 1999 and December 2017 were included. The cohort comprised 111 patients (78 male (70%)), with a mean age 45 years (17 to 70). The main reason for amputation was trauma in 75 (68%) and tumours in 23 (21%). Patients answered the Questionnaire for Persons with Transfemoral Amputation (Q-TFA) before treatment and at two, five, seven, ten, and 15 years' follow-up. A prosthetic activity grade was assigned to each patient at each timepoint. All mechanical complications, defined as fracture, bending, or wear to any part of the implant system resulting in removal or change, were recorded. Results The Q-TFA scores at two, five, seven, and ten years showed significantly more prosthetic use, better mobility, fewer problems, and an improved global situation, compared with baseline. The survival rate of the osseointegrated implant part (the fixture) was 89% and 72% after seven and 15 years, respectively. A total of 61 patients (55%) had mechanical complications (mean 3.3 (SD 5.76)), resulting in exchange of the percutaneous implant parts. There was a positive relationship between a higher activity grade and the number of mechanical complications. Conclusion Compared with before treatment, the patient-reported outcome was significantly better and remained so over time. Although osseointegration and the ability to transfer loads over a 15-year period have been demonstrated, a large number of mechanical failures in the external implant parts were found. Since these were related to higher activity, restrictions in activity and improvements to the mechanical properties of the implant system are required.
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| 21. |
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| 22. |
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| 23. |
- Ioppolo, J., et al.
(författare)
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Validation of a low-dose hybrid RSA and fluoroscopy technique : Determination of accuracy, bias and precision
- 2007
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Ingår i: Journal of Biomechanics. ; 40:3, s. 686-692
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Tidskriftsartikel (refereegranskat)abstract
- Analyzing skeletal kinematics with radiostereometric analysis (RSA) following corrective orthopedic surgery allows the quantitative comparison of different implant designs. The purpose of this study was to validate a technique for dynamically estimating the relative position and orientation of skeletal segments using RSA and single plane X-ray fluoroscopy. Two micrometer-based in vitro phantom models of the skeletal segments in the hip and knee joints were used. The spatial positions of tantalum markers that were implanted into each skeletal segment were reconstructed using RSA. The position and orientation of each segment were determined in fluoroscopy images by minimizing the difference between the markers measured and projected in the image plane. Accuracy was determined in terms of bias and precision by analyzing the deviation between the applied displacement protocol and measured pose estimates. Measured translational accuracy was less than 100 mu m parallel to the image plane and less than 700 mu m in the direction orthogonal to the image plane. The measured rotational error was less than 1 degrees. Measured translational and rotational bias was not statistically significant at the 95% level of confidence. The technique allows real-time kinematic skeletal measurements to be performed on human subjects implanted with tantalum markers for quantitatively measuring the motion of normal joints and different implant designs. (c) 2006 Elsevier Ltd. All rights reserved.
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| 24. |
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| 25. |
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| 26. |
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| 27. |
- Nebergall, A. K., et al.
(författare)
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Stable Fixation of a Cementless, Proximally Coated, Double Wedged, Double Tapered Femoral Stem in Total Hip Arthroplasty: A 5-Year Radiostereometric Analysis
- 2016
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Ingår i: Journal of Arthroplasty. - : Elsevier BV. - 0883-5403. ; 31:6, s. 1267-1274
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Tidskriftsartikel (refereegranskat)abstract
- Background: The objective of this 5-year prospective study of 51 hips was to assess migration of a cementless tapered femoral stem using radiostereometric analysis (RSA), plain radiographs (radiolucencies), and patient-reported outcome measures (PROMs). Methods: Forty-seven patients (51 hips) agreed to participate in this prospective RSA study. All patients received a Taperloc stem. Tantalum beads were inserted into the femoral bone surrounding the stem to measure migration using RSA. RSA films, plain radiograph, and PROM follow-up were obtained immediately after surgery, 6 months, 1, 2, 3, and 5 years after surgery. Results: The median (interquartile range) subsidence was 0.03 mm (-0.23 to 0.06) at 5 years, with no significant differences over time. Four outlier stems had >1.5 mm of subsidence by 1 year. No stem showed radiolucencies in more than 3 zones during the 5 years. All PROMs remained favorable at 5 years, suggesting an excellent outcome. There were no stems revised for mechanical loosening; 1 stem was revised for an infection. Conclusion: After initial settling, the cementless tapered femoral stems in our series were stable. The 4 outlier stems with >1.5 mm of subsidence by 1 year remain stable at 5 years. RSA was the most sensitive method of detection for stems at greater risk for potential future failure. This report adds contributions to the positive results associated with this type of fixation. The results at 5 years showed excellent midterm survivorship in this cohort with a cementless tapered femoral component. (C) 2015 Elsevier Inc. All rights reserved.
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| 28. |
- Nebergall, A. K., et al.
(författare)
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Thirteen- Year Evaluation of Highly Cross-Linked Polyethylene Articulating With Either 28-mm or 36-mm Femoral Heads Using Radiostereometric Analysis and Computerized Tomography
- 2016
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Ingår i: Journal of Arthroplasty. - : Elsevier BV. - 0883-5403. ; 31:9
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Tidskriftsartikel (refereegranskat)abstract
- Background: The objective of this 13-year prospective evaluation of highly cross-linked ultra high molecular weight polyethylene (HXLPE) was to (1) assess the long-term wear of HXLPE articulating with 2 femoral head sizes using radiostereometric analysis (RSA) and to (2) determine if osteolysis is a concern with this material through the use of plain radiographs and computerized tomography (CT). Methods: All patients received a Longevity HXLPE liner with tantalum beads and either a 28-mm or 36-mm femoral head. Twelve patients (6 in each head size group) agreed to return for 13-year RSA, plain radiograph, and CT follow-up. The 1-year and 13-year plain radiographs as well as the CT scans were analyzed for the presence of osteolysis. Results: The 13-year mean +/- standard error steady-state wear was 0.05 +/- 0.02 mm with no significant increase over time or between the 2 head size groups. Two patients' CT scans showed radiolucent regions in the acetabulum of 4.51 cm(3) and 11.25 cm(3), respectively. In one patient, this area corresponded to a partially healed degenerative cyst treated with autograft during surgery. The second patient had an acetabular protrusio treated with autograft, and the CT scan revealed areas of remodeling of this graft. One patient's 13-year plain radiographs showed evidence of cup loosening and linear radiolucencies in zones 2 and 3. Conclusion: There was no evidence of significant wear over time using RSA. The CT scans did not show evidence of osteolysis due to wear particles. These results suggest that this material has reduced wear compared to conventional polyethylene, irrespective of head size.
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| 29. |
- Ostendorf, M, et al.
(författare)
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The epidemiology of total hip replacement in the Netherlands and Sweden - Present status and future needs
- 2002
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Ingår i: Acta Orthopaedica Scandinavica. - : Medical Journals Sweden AB. - 0001-6470. ; 73:3, s. 282-286
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Tidskriftsartikel (refereegranskat)abstract
- By combining data from the Discharge registers and the census bureaus in The Netherlands and Sweden, we calculated the age-specific incidences of primary total hip replacement (THR), studied the demographic profile of the population receiving THR and predicted demands. In the period 1986-1997, the number of THRs increased by 20% in Sweden to 10,000 operations (1131100,000 inhabitants) and by 68% to 17,400 operations (112/100,000 inhabitants) in The Netherlands. Of this increase 3% and 15% could be explained by changes in the age-profile and size of the population, respectively. Although the overall incidence of THR was similar in both countries in 1997, we found that, after correction for differences in population structure, the incidence of THR was 20% higher in The Netherlands. In Sweden, relatively more men were operated on than in The Netherlands. We also found that in Sweden, but not in the Netherlands, relatively more older people were operated on in 1997 than in 1987. Assuming no further change in the age- and sex-specific arthroplasty rates, the predicted annual number of total hip replacements by the year 2020 will increase by at least one fourth in Sweden and almost one half in The Netherlands.
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| 30. |
- Paxton, Elizabeth W., et al.
(författare)
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Meta-analysis of individual registry results enhances international registry collaboration
- 2018
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 89:4, s. 369-373
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Although common in medical research, meta-analysis has not been widely adopted in registry collaborations. A meta-analytic approach in which each registry conducts a standardized analysis on its own data followed by a meta-analysis to calculate a weighted average of the estimates allows collaboration without sharing patient-level data. The value of meta-analysis as an alternative to individual patient data analysis is illustrated in this study by comparing the risk of revision of porous tantalum cups versus other uncemented cups in primary total hip arthroplasties from Sweden, Australia, and a US registry (2003-2015). Patients and methods - For both individual patient data analysis and meta-analysis approaches a Cox proportional hazard model was fit for time to revision, comparing porous tantalum (n = 23,201) with other uncemented cups (n = 128,321). Covariates included age, sex, diagnosis, head size, and stem fixation. In the meta-analysis approach, treatment effect size (i.e., Cox model hazard ratio) was calculated within each registry and a weighted average for the individual registries' estimates was calculated. Results - Patient-level data analysis and meta-analytic approaches yielded the same results with the porous tantalum cups having a higher risk of revision than other uncemented cups (HR (95% CI) 1.6 (1.4-1.7) and HR (95 % CI) 1.5 (1.4-1.7), respectively). Adding the US cohort to the meta-analysis led to greater generalizability, increased precision of the treatment effect, and similar findings (HR (95% CI) 1.6 (1.4-1.7)) with increased risk of porous tantalum cups. Interpretation - The meta-analytic technique is a viable option to address privacy, security, and data ownership concerns allowing more expansive registry collaboration, greater generalizability, and increased precision of treatment effects.
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| 31. |
- Rojanasopondist, P., et al.
(författare)
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What Preoperative Factors are Associated With Not Achieving a Minimum Clinically Important Difference After THA? Findings from an International Multicenter Study
- 2019
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Ingår i: Clinical orthopaedics and related research. - 1528-1132. ; 477:6, s. 1301-1312
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Despite innovations in THA, there remains a subgroup of patients who experience only modest pain relief and/or functional improvement after the procedure. Although several studies have previously sought to identify factors before surgery that were associated with achieving or not achieving a meaningful improvement after THA, there is no consensus on which factors are most associated; many studies have relied on single-center or single-country multicenter studies for their cohorts. QUESTIONS/PURPOSES: We sought to identify (1) the proportion of patients who do not achieve a minimum clinically important difference (MCID) in pain and function 1 year after THA, and (2) the preoperative factors that were associated with not achieving MCIDs in pain and function 1 year after THA. METHODS: This retrospective study analyzed data gathered from a prospective international, multicenter study examining the long-term clinical outcomes of two different polyethylene liners and two different acetabular shells. A total of 814 patients from 12 centers across four countries were enrolled in the study, with the final cohort consisting of 594 patients (73%) who all had complete preoperative and 1-year PROMs as well as a valid preoperative radiograph used to measure minimum joint space width. The outcomes in this study were achieving evidence-derived MCIDs in (1) pain, defined as a reduction of two points on an 11-point (0 = very little, 10 = worst imaginable) numerical rating scale (NRS) for hip-related pain or reporting a 1 year NRS-pain score of 0, and (2) function, defined as an increase equal to or greater than 8.3 on the SF-36 Physical Function subscore (range: 0 to 100; 0 = maximum disability, 100 = no disability) or reporting a 1-year SF-36 Physical Function subscore within the 95th percentile of scores in our cohort. All demographic variables, such as age, sex, country; surgical factors, including body mass index (BMI), surgical approach, acetabular liner type, and preoperative PROMs, were included as covariates in a binary logistic regression model. We used a backwards stepwise elimination algorithm to reach the simplest, best-fit model. RESULTS: In the final analysis cohort of 594 patients, 54 patients (9%) did not achieve the MCID in pain and 146 (25%) patients did not achieve the MCID in physical function after THA. After controlling for potential confounding variables such as age, BMI, and preoperative PROMs, we found that higher joint space width (odds ratio (OR) = 2.19; 95% confidence interval (CI) = 1.49-3.22; p < 0.001), lower preoperative SF-36 Mental Component Summary (MCS) (OR = 0.95; 95% CI = 0.93-0.98; p = 0.001), and female sex (OR = 2.04; 95% CI = 1.08-3.82; p = 0.027) were associated with failing to achieve a MCID in pain. It is important to note that the effect size of having a higher preoperative SF-36 MCS is small, with a 1- or 10-point increase in SF-36 MCS decreasing the odds of a patient not achieving the pain MCID by 5% or 63%, respectively.In a separate multivariable model, after controlling for potential confounding variables such as age, BMI, and preoperative PROMs, we found that higher joint space width (OR = 1.54; 95% CI = 1.18-2.02; p = 0.002), higher preoperative Harris hip score (HHS) (OR = 1.01; 95% CI = 1.00-1.03; p = 0.019) and undergoing surgery in Scandinavia (OR = 1.73; 95% CI = 1.17-2.55; p = 0.006) were associated with failing to achieve a MCID in physical function. It is important to note that the effect size of having a higher preoperative HHS is very small, with a 1- or t10-point increase in HHS increasing the odds of not achieving the physical function MCID by only 1% or 15%, respectively. CONCLUSIONS: These findings suggest that surgeons should counsel patients with high joint space width, female patients, and patients undergoing surgery in Scandinavia that they may be much less likely to experience meaningful pain relief or functional improvement after THA, and in light of that, determine whether indeed surgery should be postponed or avoided in those patients. Lower SF-36 MCS score and higher HHS before surgery were also found to be associated with not achieving MCIDs in pain and physical function, respectively, after surgery, but both had relatively small effect sizes. Future prospective studies may consider exploring the relationship between less pain relief or functional improvement and the risk factors identified in this study, such as high joint space width, to validate our findings and determine if the variables we identified are truly predictive of worse postoperative outcomes. Future retrospective studies of regional or national registry data should use the analysis methods presented within this study to both identify the portion of the THA patients who do not achieve a MCID in pain or physical function after surgery and confirm if the preoperative risk factors for poor improvement identified within our international, multicenter cohort are also found in a larger patient population with more diverse implants and comorbidities. LEVEL OF EVIDENCE: Level III, therapeutic study.
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| 32. |
- Svensson, Karin, 1990, et al.
(författare)
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Reflecting on and managing the emotional impact of prosthetic joint infections on orthopaedic surgeons-a qualitative study
- 2020
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Ingår i: Bone & Joint Journal. - 2049-4394. ; 102B:6, s. 736-743
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Tidskriftsartikel (refereegranskat)abstract
- Aims To investigate the experience and emotional impact of prosthetic joint infection (PJI) on orthopaedic surgeons and identify holistic strategies to improve the management of PJI and protect surgeons' wellbeing. Methods In total, 18 prosthetic joint surgeons in Sweden were recruited using a purposive sampling strategy. Content analysis was performed on transcripts of individual in-person interviews conducted between December 2017 and February 2018. Results PJI had a negative emotional impact on Swedish surgeons. Many felt guilt, stress, and a sense of failure, and several aspects of PJI management were associated with psychosocial challenges. Peer support was reported as the most important coping strategy as was collaborating with infectious disease specialists. Conclusion Our study affirms that there is a negative emotional impact of PJI on surgeons which can be minimized by improved peer support and working in multidisciplinary teams. Based on the surgeons' experiences we have identified desired improvements that may facilitate the management of PJI. These may also be applicable within other surgical specialties dealing with postoperative infections, but need to be evaluated for their efficacy.
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- Vingard, E, et al.
(författare)
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Osteoarthrosis of the hip in women and its relationship to physical load from sports activities
- 1998
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Ingår i: The American journal of sports medicine. - : SAGE Publications. - 0363-5465 .- 1552-3365. ; 26:1, s. 78-82
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Tidskriftsartikel (refereegranskat)abstract
- In a case-control study, the relationship between sporting activities and osteoarthrosis of the hip in women was investigated. The study base comprised Swedish women 50 to 70 years of age between 1991 and 1994. Case subjects (N 230) had had total hip replacements because of primary osteoarthrosis of the hip, and control subjects (N 273) were randomly selected women without hip problems from the study base. All women were interviewed about sports activities to the age of 50, health status, smoking habits, occupational history, and work in the home. Three exposure classes were defined based on total hours of sports activities aggregated to the age of 50. The relative risks of developing osteoarthrosis of the hip leading to total hip replacement was 2.3 (confidence interval, 1.5 to 3.7) for those with high sports exposure and 1.5 (0.9 to 2.5) for those with medium sports exposure compared with those with low exposure. The relative risks were adjusted for age, occupational physical load, body mass index, hormone therapy, and smoking. Physical load from sporting activities seems to be a moderate risk factor for women for the development of severe osteoarthrosis of the hip. Participation in sports was low, and therefore individual risk estimates for different sports activities were not possible to obtain.
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