↓ Direkt till sidans innehåll
↓ Direkt till sidans sekundära innehåll (sidomenyn)

Träfflista för sökning "WFRF:(Mohaddes Maziar 1974) "

Sökning: WFRF:(Mohaddes Maziar 1974)

Resultat 1-50 av 73

Sortera/gruppera träfflistan

Sortering: Träffar per sida:

Numrering	Referens	Omslagsbild	Hitta
1.	Angelomenos, Vasileios, et al. (författare) Precision of low-dose CT-based micromotion analysis technique for the assessment of early acetabular cup migration compared with gold standard RSA: a prospective study of 30 patients up to 1 year 2022 Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 93, s. 459-465 Tidskriftsartikel (refereegranskat)abstract Background and purpose - Computed tomography micromotion analysis (CTMA) can be used to determine implant micro-movements using low-dose CT scans. By using CTMA, a non-invasive measurement of joint implant movement is enabled. We evaluated the precision of CTMA in measuring early cup migration. Standard marker-based radiostereometric analysis (RSA) was used as reference. We hypothesised that CTMA can be used as an alternative to RSA in assessing implant micromotions. Patients and methods - We included 30 patients undergoing total hip arthroplasty (THA). Acetabular cup migration at 1 year was measured with RSA and CTMA. To determine the precision of both methods, 20 double examinations (postoperatively) with repositioning of the patients were performed. The precision was calculated from zero by assuming that there was no motion of the prosthesis between the 2 examinations. Results - The precision of RSA ranged from 0.06 to 0.15 mm for translations and 0.21 degrees to 0.63 degrees for rotations. Corresponding values for CTMA were 0.06 to 0.13 mm and 0.23 degrees to 0.35 degrees. A good level of agreement was found between the methods regarding cup migration and rotation at 1 year. Interpretation - The precision of CTMA in measuring acetabular cup migration and rotation is comparable to marker-based RSA. CTMA could possibly thus be used as an alternative method to detect early implant migration.
2.	Aslani, H., et al. (författare) Iranian Joint Registry (Iranian National Hip and Knee Arthroplasty Registry) 2016 Ingår i: Archives of Bone and Joint Surgery-Abjs. - 2345-4644. ; 4:2, s. 192-196 Tidskriftsartikel (refereegranskat)abstract Periodic evaluation and monitoring the health and economic outcome of joint replacement surgery is a common and popular process under the territory of joint registries in many countries. In this article we introduce the methodology used for the foundation of the National Iranian Joint Registry ( IJR) with a joint collaboration of the Social Security Organization (SSO) and academic research departments considering the requirements of the Iran's Ministry of Health and Education.
3.	Bergh, Camilla, et al. (författare) Increased risk of revision in patients with non-traumatic femoral head necrosis. 2014 Ingår i: Acta orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 85:1, s. 11-17 Tidskriftsartikel (refereegranskat)abstract Background and purpose Previous studies of patients who have undergone total hip arthroplasty (THA) due to femoral head necrosis (FHN) have shown an increased risk of revision compared to cases with primary osteoarthritis (POA), but recent studies have suggested that this procedure is not associated with poor outcome. We compared the risk of revision after operation with THA due to FHN or POA in the Nordic Arthroplasty Register Association (NARA) database including Denmark, Finland, Norway, and Sweden. Patients and methods 427,806 THAs performed between 1995 and 2011 were included. The relative risk of revision for any reason, for aseptic loosening, dislocation, deep infection, and periprosthetic fracture was studied before and after adjustment for covariates using Cox regression models. Results 416,217 hips with POA (mean age 69 (SD 10), 59% females) and 11,589 with FHN (mean age 65 (SD 16), 58% females) were registered. The mean follow-up was 6.3 (SD 4.3) years. After 2 years of observation, 1.7% in the POA group and 3.0% in the FHN group had been revised. The corresponding proportions after 16 years of observation were 4.2% and 6.1%, respectively. The 16-year survival in the 2 groups was 86% (95% CI: 86-86) and 77% (CI: 74-80). After adjusting for covariates, the relative risk (RR) of revision for any reason was higher in patients with FHN for both periods studied (up to 2 years: RR = 1.44, 95% CI: 1.34-1.54; p < 0.001; and 2-16 years: RR = 1.25, 1.14-1.38; p < 0.001). Interpretation Patients with FHN had an overall increased risk of revision. This increased risk persisted over the entire period of observation and covered more or less all of the 4 most common reasons for revision.
4.	Brynjólfsson, Siggeir Fannar, et al. (författare) Long-lived plasma cells in human bone marrow can be either CD191(+) or CD19(-) 2017 Ingår i: Blood Advances. - : American Society of Hematology. - 2473-9529 .- 2473-9537. ; 1:13, s. 835-838 Tidskriftsartikel (refereegranskat)abstract Long-lived plasma cells secreting vaccinia-specific antibodies are detected in human bone marrow >35 years after the eradication of smallpox. Long-lived plasma cells secreting vaccinia-specific antibodies are still able to express the B-lymphocyte antigen CD19.
5.	Bunyoz, K. I., et al. (författare) No difference in whole-blood metal ions between 32-mm and 36-to 44-mm femoral heads in metal-on-polyethylene total hip arthroplasty: a 2-year report from a randomised control trial 2023 Ingår i: HIP International. - : SAGE Publications. - 1120-7000 .- 1724-6067. ; 33:2, s. 184-192 Tidskriftsartikel (refereegranskat)abstract Aim: To investigate the effect of femoral head size on blood metal-ion levels caused by taper corrosion in metal-on-polyethylene total hip arthroplasty, comparing 36- to 44-mm heads with 32-mm heads. Methods: In a randomised, controlled, single-blinded trial, 96 patients were allocated to receive either a 32-mm metal head or the largest possible metal head (36-44 mm) that could be accommodated in the thinnest available vitamin E, cross-linked polyethylene insert. Blood metal ion levels were collected at 1- and 2-year follow-ups. Results: At 1-year, metal-ion levels did not differ between the groups. The median (interquartile range) blood-ion levels for the 32-mm versus the 36- to 44-mm group were 0.11 mu g/L (0.08-0.15) versus 0.12 mu g/L (0.08-0.22), p = 0.546, for cobalt, 0.50 mu g/L (0.50-0.59) versus 0.50 mu g/L (0.50-1.20), p = 0.059, for chromium and 1.58 mu g/L (1.38-2.05) versus 1.48 mu g/L (1.14-1.87), p = 0.385, for titanium. At 2 years, there was no difference either and the corresponding values were 0.15 mu g/L (0.12-0.24) versus 0.18 mu g/L (0.12-0.28), p = 0.682 for cobalt, 0.50 mu g/L (0.50-0.50) versus 0.50 mu g/L (0.50-0.57), p = 0.554, for chromium and 1.54 mu g/L (1.16-1.87) versus 1.42 mu g/L (1.01-1.72), p = 0.207 for titanium. Conclusions: The use of the largest possible metal head (36-44 mm) compared to a 32-mm head in metal-on-polyethylene bearings does not appear to elevate blood metal-ion levels up to 2 years postoperatively. As taper corrosion is probably time-dependent, longer-term reports are needed to evaluate the association between large metal heads and blood metal ion levels. Trial registration: ClinicalTrials.gov (reg. ID NCT0231 6704)
6.	Bunyoz, Kristine, et al. (författare) The size of the femoral head does not influence metal ion levels after metal-onpolyethylene total hip arthroplasty: a five-year report from a randomized controlled trial 2024 Ingår i: BONE & JOINT JOURNAL. - 2049-4394. ; 106B:3, s. 31-37 Tidskriftsartikel (refereegranskat)abstract Aims In metal-on- polyethylene (MoP) total hip arthroplasty (THA), large metal femoral heads have been used to increase stability and reduce the risk of dislocation. The increased size of the femoral head can, however, lead to increased taper corrosion, with the release of metal ions and adverse reactions. The aim of this study was to investigate the relationship between the size of the femoral head and the levels of metal ions in the blood in these patients. Methods A total of 96 patients were enrolled at two centres and randomized to undergo MoP THA using either a 32 mm metal head or a femoral head of between 36 mm and 44 mm in size, being the largest possible to fit the thinnest available polyethylene insert. The levels of metal ions and patient-reported outcome measures (Oxford Hip Score, University of California, Los Angeles Activity Scale) were recorded at two and five years postoperatively. Results At five years, the median levels of chromium, cobalt, and titanium were 0.5 mu g/l (interquartile range (IQR) 0.50 to 0.62), 0.24 mu g/l (IQR 0.18 to 0.30), and 1.16 mu g/l (IQR 1.0 to 1.68) for the 32 mm group, and 0.5 mu g/l (IQR 0.5 to 0.54), 0.23 mu g/l (IQR 0.17 to 0.39), and 1.30 mu g/l (IQR 1 to 2.05) for the 36 mm to 44 mm group, with no significant difference between the groups (p = 0.825, p = 1.000, p = 0.558). There were increased levels of metal ions at two years postoperatively in seven patients in the 32 mm group, compared with four in the 36 mm to 44 mm group, and at five years postoperatively in six patients in the 32 mm group, compared with seven in the 36 mm to 44 mm group. There was no significant difference in either the OHS (p = 0.665) or UCLA (p = 0.831) scores between patients with or without an increased level of metal ions. Conclusion In patients who underwent MoP THA, we found no differences in the levels of metal ions five years postoperatively between those with a femoral head of 32 mm and those with a femoral head of between 36 mm and 44 mm, and no corrosion-related revisions. As taper corrosion can start after five years, there remains a need for longer-term studies investigating the relationship between the size of the femoral head size and corrosion in patients undergoing MoP THA.
7.	Chamat, J., et al. (författare) Avascular necrosis in a patient diagnosed with coxartrosis : Patient med diagnosen koxartros visade sig ha avaskulär nekros. Mindre vanlig orsak till ledsmärta med hög morbiditet 2019 Ingår i: Lakartidningen. - 1652-7518. ; 116 Tidskriftsartikel (refereegranskat)abstract Coxartrosis is a common cause of hip pain among the elderly population. Avascular necrosis (AVN), also known as osteonecrosis, is a disease that most commonly affects the femoral head as a result of decreased blood supply to the bone. The etiology and pathogenesis is still unclear, but there are various traumatic and atraumatic factors that have been suggested as risk factors for AVN. However, almost half of the patients present none of these risk factors. Compared to coxartrosis, AVN typically occurs in a younger population. Initially it can be difficult to differ between these conditions. Plain film radiographic findings are absent in early stages of AVN, but magnetic resonance imaging (MRI) can provide early diagnosis. Thereby, MRI is the golden standard of noninvasive diagnostic evaluation. We present a patient with bilateral AVN that initially was diagnosed with coxartrosis.
8.	Cnudde, Peter, 1970, et al. (författare) Association between patient survival following reoperation after total hip replacement and the reason for reoperation: an analysis of 9,926 patients in the Swedish Hip Arthroplasty Register 2019 Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 90:3, s. 226-230 Tidskriftsartikel (refereegranskat)abstract Background and purpose The association between long-term patient survival and elective primary total hip replacement (THR) has been described extensively. The long-term survival following reoperation of THR is less well understood. We investigated the relative survival of patients undergoing reoperation following elective THR and explored an association between the indication for the reoperation and relative survival.Patients and methods In this observational cohort study we selected the patients who received an elective primary THR and subsequent reoperations during 1999-2017 as recorded in the Swedish Hip Arthroplasty Register. The selected cohort was followed until the end of the study period, censoring or death. The indications for 1st- and eventual 2nd-time reoperations were analyzed and the relative survival ratio of the observed survival and the expected survival was determined.Results There were 9,926 1st-time reoperations and of these 2,558 underwent further reoperations. At 5 years after the latest reoperation, relative survival following 1st-time reoperations was 0.94% (95% CI 0.93-0.96) and 0.90% (CI 0.87-0.92) following 2nd-time reoperations. At 5 years patients with a 1st-time reoperation for aseptic loosening had higher survival than expected; however, reoperations performed for periprosthetic fracture, dislocation, and infection had lower survival.Interpretation The relative survival following 1st- and 2nd-time reoperations in elective THR patients differs by reason for reoperation. The impact of reoperation on life expectancy is more obvious for infection/dislocation and periprosthetic fracture.
9.	Cnudde, Peter, 1970, et al. (författare) Cement-in-cement revision of the femoral stem: analysis of 1179 first-time revisions in the Swedish Hip Arthroplasty Register. 2017 Ingår i: The bone & joint journal. - 2049-4408. ; 99-B:4 Supple B, s. 27-32 Tidskriftsartikel (refereegranskat)abstract Compared with primary total hip arthroplasty (THA), revision surgery can be challenging. The cement-in-cement femoral revision technique involves removing a femoral component from a well-fixed femoral cement mantle and cementing a new stem into the original mantle. This technique is widely used and when carried out for the correct indications, is fast, relatively inexpensive and carries a reduced short-term risk for the patient compared with the alternative of removing well-fixed cement. We report the outcomes of this procedure when two commonly used femoral stems are used.We identified 1179 cement-in-cement stem revisions involving an Exeter or a Lubinus stem reported to the Swedish Hip Arthroplasty Register (SHAR) between January 1999 and December 2015. Kaplan-Meier survival analysis was performed.Survivorship is reported up to six years and was better in the Exeter group (91% standard deviation (sd) 2.8% versus 85% sd 5.0%) (p = 0.02). There was, however, no significant difference in the survival of the stem and risk of re-revision for any reason (p = 0.58) and for aseptic loosening (p = 0.97), between revisions in which the Exeter stem (94% sd 2.2%; 98% sd 1.6%) was used compared with those in which the Lubinus stem (95% sd 3.2%; 98% sd2.2%) was used. The database did not allow identification of whether a further revision was indicated for loosening of the acetabular or femoral component or both.The cement-in-cement technique for revision of the femoral component gave promising results using both designs of stem, six years post-operatively. Cite this article: Bone Joint J 2017;99-B(4 Supple B):27-32.
10.	Cnudde, Peter, 1970, et al. (författare) Is Preoperative Patient-Reported Health Status Associated with Mortality after Total Hip Replacement? 2017 Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1660-4601. ; 14:8 Tidskriftsartikel (refereegranskat)abstract The influence of comorbidities and worse physical status on mortality following total hip replacement (THR) leads to the idea that patient-reported health status may also be a predictor of mortality. The aim of this study was to investigate the relationship between patient-reported health status before THR and the risk of dying up to 5 years post-operatively. For these analyses, we used register data on 42,862 THR patients with primary hip osteoarthritis operated between 2008 and 2012. The relative survival ratio was calculated by dividing the observed survival in the patient group by age-and sex-adjusted expected survival of the general population. Pre-operative responses to the five EQ-5D-3L (EuroQol Group) dimensions along with age, sex, education status, year of surgery, and hospital type were used as independent variables. Results shown that, as a group, THR patients had a better survival than the general population. Broken down by the five EQ-5D-3L dimensions we observed differentiated survival patters. For all dimensions, those reporting extreme problems had higher mortality than those reporting moderate or no problems. In conclusion, worse health status according to the EQ-5-3L before THR is associated with higher mortality up to five years after surgery. EQ-5D-3L responses may be useful in a multifactorial individualized risk assessment before THR.
11.	Diarbakerli, E., et al. (författare) Learning from the past to plan for the future: A scoping review of musculoskeletal clinical research in Sweden 2010-2020 2022 Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 127:1 Tidskriftsartikel (refereegranskat)abstract Background: The aims of this study are to 1) determine the scope of musculoskeletal (MSK)-related clinical research in Sweden; 2) collate the amount of first-tier funding received; 3) discuss strategies and infrastructure supporting future MSK clinical trials in Sweden. Methods: A systematic scoping review protocol was applied in PubMed, Scopus, and SweCRIS databases. The articles were examined, and data were extracted in multiple stages by three blinded authors. Results: The search strategy resulted in 3,025 publications from 479 Swedish-affiliated authors. Primary health care was the basis for 14% of the publications, 84% from secondary health care, and 2% from occupational health care with a similar proportional distribution of first-tier research grant financing. Approximately one in six publications were randomized controlled trials (RCTs), while the majority were of observational cohort design. The majority of publications in primary and occupational health care were related to pain disorders (51 and 67%, respectively), especially diagnosis, prognosis, and healthcare organizational-related interventions (34%) and rehabilitation (15%) with similar proportional distribution of first-tier research grant financing. In secondary health care, rheumatic inflammatory disorder-related publications were most prevalent (30%), most frequently concerning diagnosis, prognosis, and healthcare organizational-related interventions (20%), attracting approximately half of all first-tier funding. Publications related to degenerative joint disorders (25%), fractures (16%), and joint, tendon, and muscle injuries (13%) frequently concerned surgical and other orthopedic-related interventions (16, 6, and 8%, respectively). Pain disorder-related publications (10%) as well as bone health and osteoporosis-related publications (4%) most frequently concerned diagnosis, prognosis, and healthcare organizational-related interventions (5 and 3%, respectively). Conclusions: Swedish-affiliated MSK disorder research 2010-2020 was predominantly observational cohort rather than RCT based. There was skewed first-tier funding allocation considering prevalence/incidence and burden of disease. Use of infrastructure supporting register-based RCTs, placebo-controlled RCTs, and hybrid effectiveness-implementation studies on prevention and clinical intervention is important strategies for the future in all healthcare sectors.
12.	Diarbakerli, Elias, et al. (författare) Swedish musculoskeletal researchers view on a collaborative network and future research priorities in Swedish healthcare 2024 Ingår i: Musculoskeletal Care. - : John Wiley & Sons. - 1478-2189 .- 1557-0681. ; 22:1 Tidskriftsartikel (refereegranskat)abstract Background: Musculoskeletal disorders (MSK) are a global burden causing significant suffering and economic impact. Systematic identification and targeting of research questions of highest interest for stakeholders can aid in improving MSK disorder knowledge and management.Objective: To obtain Swedish MSK researchers' opinions and views on a collaborative Swedish MSK network (SweMSK) and identify future research areas of importance for Swedish MSK research.Methods: A web-based survey was conducted July to September 2021 to collect data from 354 Swedish MSK researchers. The survey focused on the need, objectives, and structure of a SweMSK network and identified prioritised areas for future MSK research.Results: The study included 141 respondents, of which 82 were associate professors or professors. The majority (68%) supported the creation of a new musculoskeletal network. The most supported element was increased collaboration regarding nationwide and multicenter studies. Respondents recommended the creation of a homepage and the establishment of national work groups with different specific interests as the primary elements of a new network.Conclusion: The results demonstrated a need and desire for increased national research collaboration and the creation of a new musculoskeletal network. The high academic experience and active research participation of the respondents suggest the need for MSK disorder knowledge and management improvement in Sweden. Therefore, the SweMSK network may help facilitate effective collaboration and research efforts that can contribute to the advancement of MSK disorder management and care. This study may provide valuable insights for policymakers, clinicians, and researchers to improve MSK disorder care and management in Sweden.
13.	Eneqvist, Ted, 1982, et al. (författare) Can patient-reported outcomes predict re-operations after total hip replacement? 2018 Ingår i: International Orthopaedics. - : Springer Science and Business Media LLC. - 0341-2695 .- 1432-5195. ; 42:2, s. 273-279 Tidskriftsartikel (refereegranskat)abstract © 2018 The Author(s) Purpose: We investigated if patient-reported outcomes (PROMs) one year after total hip replacement (THR) can predict the risk of re-operation using data from the Swedish Hip Arthroplasty Register. Methods: A total of 75,899 patients with THR due to osteoarthritis operated in 2002–2014 were included. We used Kaplan-Meier and Cox regression to investigate the relationship between one-year post-operative PROMs and risk of re-operation (all types of further hip surgery). The predictive power of the model and post-operative PROMs were evaluated by concordance index (C). Results: Kaplan-Meier estimates for not being re-operated at eight years was 95.5% (95%CI; 95.3–95.8). Cox regression analyses showed that all PROMs, except for EQ-VAS, were associated with re-operation. The full model had a concordance index of 0.68. Satisfaction (C = 0.65) and pain (C = 0.65) in isolation had the highest predictive power. Conclusions: Worse PROMs predicted higher risk of re-operation. Therefore, we believe PROMs may be helpful in identifying patients at risk for re-operation and timely address their problems.
14.	Goude, F., et al. (författare) The effects of competition and bundled payment on patient reported outcome measures after hip replacement surgery 2021 Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 21 Tidskriftsartikel (refereegranskat)abstract BackgroundCompetition-promoting reforms and economic incentives are increasingly being introduced worldwide to improve the performance of healthcare delivery. This study considers such a reform which was initiated in 2009 for elective hip replacement surgery in Stockholm, Sweden. The reform involved patient choice of provider, free establishment of new providers and a bundled payment model. The study aimed to examine its effects on hip replacement surgery quality as captured by patient reported outcome measures (PROMs) of health gain (as indicated by the EQ-5D index and a visual analogue scale (VAS)), pain reduction (VAS) and patient satisfaction (VAS) one and six years after the surgery.MethodsUsing patient-level data collected from multiple national registers, we applied a quasi-experimental research design. Data were collected for elective primary total hip replacements that were carried out between 2008 and 2012, and contain information on patient demography, the surgery and PROMs at baseline and at one- and six-years follow-up. In total, 36,627 observations were included in the analysis. First, entropy balancing was applied in order to reduce differences in observable characteristics between treatment groups. Second, difference-in-difference analyses were conducted to eliminate unobserved time-invariant differences between treatment groups and to estimate the causal treatment effects.ResultsThe entropy balancing was successful in creating balance in all covariates between treatment groups. No significant effects of the reform were found on any of the included PROMs at one- and six-years follow-up. The sensitivity analyses showed that the results were robust.ConclusionsCompetition and bundled payment had no effects on the quality of hip replacement surgery as captured by post-surgery PROMs of health gain, pain reduction and patient satisfaction. The study provides important insights to the limited knowledge on the effects of competition and economic incentives on PROMs.
15.	Gustavsson, Linnéa, 1992, et al. (författare) No major difference in perceived quality of care in patients with hip or knee osteoarthritis assessed in a physical therapy-led triage compared with standard care: a randomized controlled trial 2023 Ingår i: BMC Musculoskeletal Disorders. - 1471-2474. ; 24:1 Tidskriftsartikel (refereegranskat)abstract BackgroundPhysical therapy-led orthopedic triage is a care model used to optimize pathways for patients with hip or knee osteoarthritis. However, scientific evidence of the effectiveness of this model of care is still limited and only a few studies report patients' perception of it. The aim of this study was to compare patients' perceived quality of care after physical therapy-led triage with standard practice in a secondary care setting for patients with primary hip or knee osteoarthritis.MethodsIn this randomized study, patients with hip or knee osteoarthritis referred for an orthopedic consultation received either physical therapy-led triage (n = 344) or a standard care assessment by an orthopedic surgeon (n = 294). To evaluate the patients' perceived quality of care, a short version of the Quality from the Patient's Perspective (QPP) questionnaire was sent to the patients within a week after their assessment. The primary outcome was the statement "I received the best examination and treatment" on QPP.ResultsA total of 348 patients (70%, physical therapy-led triage: n = 249, standard care: n = 199) answered the questionnaire. No significant difference was found in the primary outcome between the groups (p = 0.6). Participants in the triage group perceived themselves to have received significantly better information about how to take care of their osteoarthritis (p = 0.017) compared with the standard care group. The standard care group reported that they participated in the decision-making process to a greater extent (p = 0.005), that their expectations were met to a greater degree (p = 0.013), and that their care depended more on their need for care rather than the caregivers' routines (0.007).ConclusionBoth groups report high perceived quality of care. Significant differences were found in four of 14 questions, one in favor of the physical therapist and three in favor of the standard care group. The findings of this study are in line with previous research and support the use of this care model for patients with hip or knee OA in secondary care. However, due to the dropout size, the results should be interpreted with caution.
16.	Halvorsen, V., et al. (författare) Outcome of 881 total hip arthroplasties in 747 patients 21 years or younger: data from the Nordic Arthroplasty Register Association (NARA) 1995-2016 2019 Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 90:4, s. 331-337 Tidskriftsartikel (refereegranskat)abstract Background and purpose - The literature is scarce on the outcome of the youngest patients with total hip arthroplasties (THAs). We analyzed register data, revision risk, and related factors in patients 21 years or younger with THAs in the Nordic Arthroplasty Register Association (NARA). Patients and methods - We included all THA patients 21 years or younger reported during 1995 through 2016 to the Danish, Finnish, Norwegian, and Swedish hip arthroplasty registers and merged these into the NARA dataset. Primary outcome was any implant revision. Results - We identified 881 THAs in 747 patients. Mean age at primary surgery was 18 years (9-21). The indications for THA were pediatric hip diseases (33%), systemic inflammatory disease (23%), osteoarthritis (4%), avascular necrosis (12%), hip fracture sequelae (7%), and other diagnoses (21%). Unadjusted 10-year survival for all THAs was 86%. Comparison between indications showed no differences in survival. Uncemented implants were used most frequently. Survival for uncemented and cemented implants was the same adjusted for sex, indication, head size, and time period for primary surgery. Aseptic loosening was the main cause of revision. Interpretation - Both cemented and uncemented fixations seem to be a viable option in this age group, but with a lower implant survival than in older patient groups.
17.	Hermodsson, Jakob, et al. (författare) Active or semi-active robotic arm-assisted versus manual knee arthroplasty: benefits and risks : Regional activity-based HTA 2022:126 2022 Rapport (övrigt vetenskapligt/konstnärligt)
18.	Itayem, Raed, 1967, et al. (författare) Influence of implant variations on survival of the Lubinus SP II stem: evaluation of 76,530 hips in the Swedish Arthroplasty Register, 2000-2018. 2022 Ingår i: Acta orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 93, s. 37-42 Tidskriftsartikel (refereegranskat)abstract Background and purpose - Almost all prosthetic implant brands include several variations. Most studies on implant performance investigate an implant system without sub-analysis of implant attributes. We studied the influence of design variations during the last 2 decades on implant survival of the most frequently used cemented femoral stem, the Lubinus SPII, reported to the Swedish Arthroplasty Register (SHAR). Patients and methods - Between 2000 and 2018, 100,032 cemented Lubinus SP II stems had been reported to SHAR. Patients with primary osteoarthritis operated on with stem length 150 mm together with a cemented cup from the same manufacturer (n = 76,530) were included in this analysis. Primary study outcome was non-infectious stem revision. Cox regression with adjustment for age, sex, surgical approach, and year of surgery was used. Hazard rates (HR) are presented with 95% confidence intervals (CI). Results - Average follow-up was 7.6 years (SD 4.2). At 18 years the overall stem survival was 99.1 (CI 98.9-99.3). Increased revision rate was observed for stems with extra offset, when a long or an extra-long head length had been used. Smaller stem sizes, in particular the smallest stem size (01), substantially increased the rate of mechanical failure as reflected by an almost 10 times increased rate of revision compared with the standard size (2). Interpretation - In this study with larger sample size and longer follow-up than previously presented from the same register, we observed more pronounced effects of previously documented design variations. Based on our results, surgeons using the Lubinus SPII stems are advised to consider an alternative solution if a Lubinus stem size 01, Lubinus extra offset, or an extra-long head seems to be the most suitable choice at the preoperative planning.
19.	Itayem, Raed, 1967, et al. (författare) What is the Role of Stem Size and Offset in the Risk of Nonseptic Revision of the Exeter & REG; 150-mm Stem? A Study From the Swedish Arthroplasty Register 2023 Ingår i: Clinical Orthopaedics and Related Research. - 0009-921X. ; 481:9, s. 1689-1699 Tidskriftsartikel (refereegranskat)abstract BackgroundThe Exeter & REG; stem is used worldwide, often in older patients, and it is the second most commonly used cemented stem design in Sweden. Previous studies have shown that for cemented stems with a composite beam, the smallest sizes result in an increased risk of revision for mechanical failure. However, little is known about whether the survivorship of the polished Exeter stem, which generally has been shown to be good, might be associated with design parameters such as stem dimensions or offset at extreme implant sizes.Question/purposeAre differences in (1) stem size or (2) offset of the standard Exeter V40 150-mm stem associated with differences in the risk of stem revision for aseptic loosening?MethodsBetween 2001 and 2020, 47,161 Exeter stems were reported to the Swedish Arthroplasty Register, with very high coverage and completeness documented during the period studied. In this cohort, we included patients with primary osteoarthritis who underwent surgery with a standard Exeter stem length of 150 mm and V40 cone with any type of cemented cups that had had at least 1000 reported insertions. This selection resulted in a study cohort representing 79% (37,619 of 47,161) of the total number of Exeter stems in the registry during that time. The primary study outcome was stem revision for aseptic indications such as loosening, periprosthetic fracture, dislocation, and implant fracture. A Cox regression was performed, with adjustment for age, gender, surgical approach, year of surgery, use of highly crosslinked polyethylene cups, and femoral head size and length dictated by the shape of the head trunnion. Adjusted hazard ratios are presented with 95% confidence intervals. Two separate analyses were performed. The first analysis excluded stems with the highest offsets (50 mm and 56 mm, which were not available for stem size 0). The second analysis excluded stem size 0 to include all offsets. Because stem survival was not proportional over time, we divided the analyses into two insertion periods, 0 to 8 years and beyond 8 years.ResultsStem size 0 (compared to size 1) was associated with an increased risk of revision up to 8 years when all stem sizes were included (first analysis 0 to 8 years, HR 1.7 [95% CI 1.2 to 2.3]; p = 0.002). Forty-four percent (63 of 144) of revisions of size 0 stems were for periprosthetic fracture. There was no consistent association between stem size and risk of aseptic stem revision when size 0 was excluded in the second analysis beyond 8 years. The most common offset (44 mm) was associated with an increased risk of revision (compared with 37.5 mm) up to 8 years when all sizes were included (first analysis, HR 1.6 [95% CI 1.1 to 2.1]; p = 0.01). In the second analysis (beyond 8 years, all offsets included), offset of 44 mm was compared with offset of 37.5 mm; compared with the first period, this offset was associated with a reduced risk (HR 0.6 [95% CI 0.4 to 0.9]; p = 0.005).ConclusionWe found overall high survival of the Exeter stem, with generally little or no influence of stem variations on the risk of aseptic revision. However, stem size 0 was associated with an increased risk of revision mainly for periprosthetic fractures. If the femoral anatomy offers a choice between sizes 0 and 1 in patients with poor bone quality who are at risk of periprosthetic fracture, our data speak in favor of choosing the larger stem if the surgeon believes it is safe to insert the larger size, or, if available, another stem design that has a documented lower risk of this complication. For patients with good cortical bone quality but very narrow canals, a cementless stem may also be a good alternative.
20.	Jolbäck, Per, et al. (författare) A small number of surgeons outside the control-limit: an observational study based on 9,482 cases and 208 surgeons performing primary total hip arthroplasties in western Sweden 2020 Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 91:5, s. 581-586 Tidskriftsartikel (refereegranskat)abstract Background and purpose - Feedback programs relating to surgeon levels have been introduced in some orthopedic quality registers around the globe. The aim of an established surgeon feedback program is to help surgeons understand their practice and enable an analysis of their own results. There is no surgeon feedback program in Sweden in the orthopedic quality registers and there is a fear that a feedback system might pinpoint surgeons as poor performers, partly due to patient case mix. As a step prior to the introduction of a future possible feedback program in Sweden, we assessed the variation in the occurrence of adverse events (AE) within 90 days and reoperations within 2 years between surgeons in western Sweden and explored the number of surgeons outside the control-limit following primary total hip arthroplasties (THAs). Patients and methods - Patient data, surgical data, and information on the surgeons, relating to surgeries performed in 2011-2016, were retrieved from 9 publicly funded hospitals in western Sweden. Data from medical hospital records, the Swedish Hip Arthroplasty Register (SHAR) and a regional patient register located in western Sweden were linked to a database. Funnel plots with control-limits based on upper 95% and 99.8% confidence intervals (CI) were used to illustrate the variation between surgeons in terms of the outcome and to explore the number of surgeons outside the control-limit. Both observed and standardized proportions are explored. The definition of surgeons outside the control-limit in the study is a surgeon above the upper 95% CI. Results - The study comprised 9,482 primary THAs due to osteoarthritis performed by 208 surgeons, where 91% of the included primary THAs were performed by orthopedic specialists and 9% by trainees. The mean overall annual volume for all surgeons was 27. The observed overall mean rate for AEs within 90 days for all surgeons was 6.2% (5.8-6.7) and for reoperations within 2 years 1.8% (1.7-2.2). The proportion of surgeons outside the 95% CI was low for both AEs (0-5%) and reoperations within 2 years (0-1%) in 2011-2016. The corresponding numbers were even lower for AEs (0-3%) but similar for reoperations (0-1%) after standardization for differences in case mix. In a sub-analysis when the number of surgeries performed was restricted to more than 10 primary THAs annually to being evaluated, almost half or more of all the surgeons were excluded from the annual analysis. The result of this restriction was that all surgeons outside the control-limit disappeared after standardization for both AEs and reoperations for all the years investigated. Considering the complete period of 6 years, less than 1% (1 high-volume surgeon for AEs and 2 high-volume surgeons for reoperations) after risk adjustments were outside the 95% CI, and no surgeons were outside the 99.8% CI. Interpretation - In a Swedish setting, the variation in surgeon performance, as measured by AEs within 90 days and reoperations within 2 years following primary THA, was small and 3% or less of the surgeons were outside the 95% CI for the investigated years after adjustments for case mix. The risk for an individual surgeon to be regarded as having poor performance when creating surgeon-specific feedback in the SHAR is very low when volume and patient risk factors are considered.
21.	Jolbäck, Per, et al. (författare) Does surgeon experience affect patient-reported outcomes 1 year after primary total hip arthroplasty? 2018 Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 0300-8827 .- 1745-3674 .- 1745-3682. ; 89:3, s. 265-271 Tidskriftsartikel (refereegranskat)abstract Background and purpose - Several studies have reported on the influence of various factors on patient-reported outcomes (PROs) after total hip arthroplasty (THA), but very few have focused on the experience of the surgeon. We investigated any association between surgeons' experience and PROs 1 year after primary THA. Patients and methods - Patient characteristics and surgical data at 10 hospitals in western Sweden were linked with PROs (EQ-5D-3L, Satisfaction Visual Analogue Scale (VAS), Pain VAS). These data were retrieved from the Swedish Hip Arthroplasty Register (SHAR). The surgeon's level of experience was divided into 4 subgroups related to experience: < 8 years, 8-15 years, and >15 years of clinical practice after specialist certificate. If no specialist certificate was obtained the surgery was classified as a trainee surgery. Surgeons with >15 years' experience as an orthopedic specialist were used as reference group in the analyses. Results - 8,158 primary THAs due to osteoarthritis were identified. We identified the surgeons' level of experience in 8,116 THAs. Data from SHAR on pre- and postoperative PROs and satisfaction at 1 year were available for 6,713 THAs. We observed a statistically significant difference among the 4 groups of surgeons regarding mean patient age, ASA classification, Charnley classification, diagnosis, and fixation technique. At 1-year follow-up, there were no statistically significant differences in Pain VAS, EQ-5D index, or EQ VAS among the subgroups of orthopedic specialists. Patients operated on by orthopedic trainees reported less satisfaction with the result of the surgery compared with the reference group. Interpretation - These findings indicate that patients can expect similar health improvements, pain reduction, and satisfaction 1 year after a primary THA operation irrespective of years in practice after specialty certification as an orthopedic surgeon.
22.	Jolbäck, Per, et al. (författare) High annual surgeon volume reduces the risk of adverse events following primary total hip arthroplasty: a registry-based study of 12,100 cases in Western Sweden 2019 Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 90:2, s. 153-158 Tidskriftsartikel (refereegranskat)abstract Background and purpose — Most earlier publications investigating whether annual surgeon volume is associated with lower levels of adverse events (AE), reoperations, and mortality are based on patient cohorts from North America. There is also a lack of adjustment for important confounders in these studies. Therefore, we investigated whether higher annual surgeon volume is associated with a lower risk of adverse events and mortality within 90 days following primary total hip arthroplasty (THA). Patients and methods — We collected information on primary total hip arthroplasties (THA) performed between 2007 and 2016 from 10 hospitals in Western Sweden. These data were linked with the Swedish Hip Arthroplasty Register and a regional patient register. We used logistic regression (simple and multiple) adjusted for age, sex, comorbidities, BMI, fiation technique, diagnosis, surgical approach, time in practice as orthopedic specialist and annual volume. Annual surgeon volume was calculated as the number of primary THAs the operating surgeon had performed 365 days prior to the index THA. Results — 12,100 primary THAs, performed due to both primary and secondary osteoarthritis by 268 different surgeons, were identified. The median annual surgeon volume was 23 primary THAs (range 0–82) 365 days prior to the THA of interest and the mean risk of AE within 90 days was 7%. If the annual volume increased by 10 primary THAs in the simple logistic regression the risk of AE decreased by 10% and in the adjusted multiple regression the corresponding number was 8%. The mortality rate in the study was low (0.2%) and we could not find any association between 90-day mortality and annual surgeon volume. Interpretation — High annual surgical activity is associated with a reduced risk of adverse events within 90 days. Based on these findings healthcare providers should consider planning for increased surgeon volume. © 2019, © 2019 The Author(s). Published by Taylor & Francis on behalf of the Nordic Orthopedic Federation.
23.	Jolbäck, Per, et al. (författare) Patient-surgeon sex discordance impacts adverse events but does not affect patient-reported satisfaction after primary total hip arthroplasty: a regional register-based cohort study. 2022 Ingår i: Acta orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 93, s. 922-29 Tidskriftsartikel (refereegranskat)abstract The sex of the surgeon has been proposed to be associated with a disparity in clinical outcomes after different surgical procedures. We investigated the association between surgeon-patient sex discordance and adverse events (AEs) and surgical AEs (SAEs) within 90 days after primary total hip arthroplasty (THA). We also investigated patient-reported satisfaction with surgical outcomes 1 year after the surgery.We conducted a register-based cohort study including primary THAs performed due to osteoarthritis between 2008 and 2016 at 10 publicly managed hospitals in western Sweden. Hospital data was linked to the Swedish Arthroplasty Register and a regional patient register. Logistic regression models investigated discordant sex of patients and surgeons on AEs/SAEs and patient-reported satisfaction with the surgical outcome.11,993 primary THAs were included in the study. The proportion of AEs for the concordant group was 7.3% and for the discordant group 6.1%. For SAEs, the proportion was 5.0% for the concordant group and 4.3% for the discordant group. After adjustment the discordant group still had a lower likelihood of an AE or SAE than the concordant group: adjusted odds ratio (aOR) for AE (0.82, 95%CI 0.71-0.95) and for SAE (0.86, CI 0.72-0.99). No association was detected between patient-reported satisfaction and sex discordance.Sex discordance between surgeons and patients is linked to a decreased risk of an AE but not a lower level of patient-reported satisfaction with the surgical outcome.
24.	Kasina, P., et al. (författare) Postoperative Thromboprophylaxis With New Oral Anticoagulants is Superior to LMWH in Hip Arthroplasty Surgery: Findings from the Swedish Registry 2019 Ingår i: Clinical orthopaedics and related research. - 1528-1132. ; 477:6, s. 1335-1343 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Although the use of thromboprophylaxis is well established, there is no consensus on the preferred thromboprophylaxis regimen after THA; large, population-based studies offer an opportunity to examine this problem in a robust way that can complement results from randomized trials. QUESTIONS/PURPOSES: Using data from a large national registry, we asked: (1) Is there any difference between low-molecular weight heparin (LMWH) and new oral anticoagulants in preventing symptomatic deep vein thrombosis (DVT) and pulmonary embolism (PE), after THA? (2) Are there any differences in safety parameters, such as bleeding, reoperations and mortality, between LMWH and new oral anticoagulants? METHODS: Between 2008 and 2012, 78,066 THAs were performed in Sweden. This study evaluated 32,663 (42%) of them, selected through the merger of several national registries. These patients underwent unilateral THA due to primary osteoarthritis. They had not experienced any venous thromboembolic events 5 years before the index operation and were not prescribed potent antithrombotic agents, of any type, in the 6 months before the index operation. Additionally, their postoperative thromboprophylaxis was confirmed in a national registry by purchase of prescribed medications. We divided the cohort into two groups: those patients who received new oral anticoagulants (5752, 18%) and those who received LMWH (26,881, 82%) as postoperative thromboprophylaxis. Our primary endpoints were the frequencies of symptomatic DVT and symptomatic PE within 3 months of surgery. Our secondary comparison was a between-group comparison of bleeding (by way of diagnostic coding), reoperation, and mortality within 3 months of surgery. Odds ratios (OR) are presented with 95% confidence intervals (CIs) as pooled results for the two groups after adjustment for duration of thromboprophylaxis (short or extended for at least 28 days), year of the index operation, Elixhauser comorbidity index, sex, age and previous treatment with platelet aggregation inhibitors. RESULTS: The risk of symptomatic DVT was lower in the group that received new oral anticoagulants than the group that received LMWH (0.3% versus 0.6%, OR, 0.47; 95% CI, 0.27-0.76; p = 0.026). The risk of symptomatic PE was lower in the group that received new oral anticoagulants than the group that received LMWH (0.1% versus 0.4%, OR, 0.36; 95% CI, 0.16-0.69; p = 0.005). There was no difference in the risk of bleeding (by way of diagnostic coding) (OR, 1.03; 95% CI, 0.82-1.28; p = 0.688), reoperation (OR, 1.02; 95% CI, 0.71-1.44; p = 0.860) or mortality (OR, 0.83; 95% CI, 0.31-1.88; p = 0.883) between groups. CONCLUSIONS: New oral anticoagulants were associated with a lower risk of symptomatic DVT and symptomatic PE in this large, registry study, and we observed no differences in the risk of bleeding, reoperation, or death between the groups. Although we were able to control for a number of potential confounding variables, we cannot ascertain the indications that drove the prescription decisions in this setting, and there were important between-group differences in terms of duration of thromboprophylaxis (new oral anticoagulants generally were used for a longer period of time after surgery). Future studies, preferably large randomized trials with pragmatic inclusion criteria, to analyze symptomatic DVT, symptomatic PE and death are needed to confirm or refute our findings. LEVEL OF EVIDENCE: Level III, therapeutic study.
25.	Klein, Lisbeth, et al. (författare) Similar clinical results and early subsidence between the Collum Femoris Preserving and the Corail stem: a randomized radiostereometric study of 77 hips with 2 years’ follow-up 2019 Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 90:3, s. 202-208 Tidskriftsartikel (refereegranskat)abstract Background and purpose — Femoral neck preserving hip replacement has been suggested to improve clinical results and facilitate late revision. We compared the 2-year outcome and radiostereometric pattern of femoral head migration between the Collum Femoris Preserving (CFP) stem and the Corail stem. Patients and methods — 83 patients were randomized to either a CFP stem or a Corail stem. All patients received the same cup. At 2 years clinical outcomes were assessed using validated scoring systems and plain radiographs. 2-year migration was determined using radiostereometric analysis. Results — At 2 years the clinical outcomes (Oxford Hip Score, Harris Hip Score, SF-36, EQ5D-VAS, satisfaction VAS, and pain VAS) were similar between the 2 groups. The radiographic measurements showed that the femoral neck was resected around 1 cm more proximally with use of CFP stems (p < 0.001). The proximal–distal and medial–lateral migration of the femoral head center was similar. The Corail stem showed increased posterior displacement after 1 year, but no difference was found between the absolute translations in the anterior–posterior direction (p = 0.2). 2 CFP stems were revised due to loosening within the first 2 years. None of the Corail stems was revised. Interpretation — In the 2-year perspective clinical outcomes suggested no obvious advantages with use of the CFP stem. The magnitude of the early stem migration was similar, but the pattern of migration differed. The early revisions in the CFP are a cause of concern. © 2019, © 2019 The Author(s). Published by Taylor & Francis on behalf of the Nordic Orthopedic Federation.
26.	Klerken, Tina, et al. (författare) High early migration of the revised acetabular component is a predictor of late cup loosening: 312 cup revisions followed with radiostereometric analysis for 2-20 years. 2015 Ingår i: Hip international : the journal of clinical and experimental research on hip pathology and therapy. - : SAGE Publications. - 1724-6067. ; 25:5, s. 471-476 Tidskriftsartikel (refereegranskat)abstract Radiostereometric analysis (RSA) is an accurate and precise measurement tool of migration and rotation of implants. We investigated if early migration measured with RSA can be used to predict the risk of later aseptic loosening in acetabular revision surgery.
27.	Kärrholm, Johan, 1951, et al. (författare) Swedish Hip Arthroplasty Register. Annual Report 2015. 2016 Rapport (övrigt vetenskapligt/konstnärligt)
28.	Kärrholm, Johan, 1951, et al. (författare) Swedish Hip Arthroplasty Register Annual Report 2016 2017 Rapport (övrigt vetenskapligt/konstnärligt)
29.	Kärrholm, Johan, 1951, et al. (författare) Swedish Hip Arthroplasty Register Annual Report 2017 2018 Rapport (övrigt vetenskapligt/konstnärligt)
30.	Kärrholm, Johan, 1951, et al. (författare) Swedish Hip Arthroplasty Register Annual Report 2018 2018 Rapport (övrigt vetenskapligt/konstnärligt)
31.	Lind, Dennis, et al. (författare) Long-term risk of reoperation after modular hemiarthroplasty 2023 Ingår i: BMC MUSCULOSKELETAL DISORDERS. - 1471-2474. ; 24:1 Tidskriftsartikel (refereegranskat)abstract BackgroundIt is unclear whether unipolar (UHA) or bipolar (BHA) hemiarthroplasty should be the preferred treatment of femoral neck fracture (FNF).AimWe investigated the reoperation rate at 13 years post-fracture after BHA and UHA as treatment of FNF, including a subgroup analysis of individuals who survived 5 years or more, and described the reasons for reoperation after BHA and UHA respectively.MethodsIn an observational cohort study on prospectively collected national register data, 16,216 BHA and 22,186 UHA were available for matching. A propensity score for treatment with bipolar HA was estimated using logistic regression. Matching was done using the 1:1 nearest neighbor matching without replacement. Of the 16,216 BHA patients, 12,280 were matched to a UHA control. A subgroup analysis based on the matched sample excluded individuals who died within 5 years and comprised 3,637 individuals with BHA and 3,537 with UHA. Kaplan-Meier survival analysis was used.ResultsIn the Kaplan-Meier analysis, 92% of the BHA group was free from reoperation at 13 years (95% CI 0.91-0.93), compared to 92% in the UHA group (CI 0.89-0.94). BHA was associated with more reoperations until 3 years. Reoperation due to infection was most common after BHA, n = 212 (1.7%) compared to n = 141 (1.1%) after UHA. Dislocation led to reoperation in 192 of the BHA cases (1.6%) and in 157 of the UHA cases (1.3%). Acetabular erosion/pain occurred in 0.1% and 0.4%. Amongst those surviving >= 5 years, 93% of the BHA group was free from reoperation (CI 0.92-0.94) at 13 years, 92% after UHA (CI 0.90-0.94). BHA had more reoperations during the 1st year only. The causes for reoperations showed similar rates except for acetabular erosion/pain. Here the BHA group had 2 cases (0.1%), the UHA had 39 (1.1%).ConclusionWith a modular hemiarthroplasty relatively few patients need a reoperation. During the first years, there is a higher reoperation rate after BHA compared to UHA. Thereafter, no differences are seen. In patients who survive >= 5 years after the fracture there are more reoperations due to acetabular erosion after UHA, but crude numbers are extremely low, and the total reoperation rate is not affected.
32.	Lindman, Ida, et al. (författare) Prior hip arthroscopy does not affect 1-year patient-reported outcomes following total hip arthroplasty: a register-based matched case-control study of 675 patients 2021 Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 92:4, s. 408-412 Tidskriftsartikel (refereegranskat)abstract Background and purpose - Femoroacetabular impingement syndrome (FAIS) is a common cause of hip pain and may contribute to the development of osteoarthritis. We investigated whether a prior hip arthroscopy affects the patient-reported outcomes (PROMs) of a later total hip arthroplasty (THA). Patients and methods - Patients undergoing hip arthroscopy between 2011 and 2018 were identified from a hip arthroscopy register and linked to the Swedish Hip Arthroplasty Register (SHAR). A propensity-score matched control group without a prior hip arthroscopy, based on demographic data and preoperative score from the EuroQoL visual analogue scale (EQ VAS) and hip pain score, was identified from SHAR. The group with a hip arthroscopy (treated group) consisted of 135 patients and the matched control group comprised 540 patients. The included PROMs were EQ-5D and EQ VAS of the EuroQoL group, and a questionnaire regarding hip pain and another addressing satisfaction. Rate of reoperation was collected from the SHAR. The follow-up period was 1 year. Results - The mean interval from arthroscopy to THA was 27 months (SD 19). The EQ-5D was 0.81 and 0.82, and EQ VAS was 78 and 79 in the treated group and the matched control group respectively. There were no differences in hip pain, and reported satisfaction was similar with 87% in the treated group and 86% in the matched control group. Interpretation - These results offer reassurance that a prior hip arthroscopy for FAIS does not appear to affect the short-term patient-reported outcomes of a future THA and indicate that patients undergoing an intervention are not at risk of inferior results due to their prior hip arthroscopy.
33.	Lovera, Davide, et al. (författare) Cost-effectiveness of implant movement analysis in aseptic loosening after hip replacement: a health-economic model. 2023 Ingår i: Cost effectiveness and resource allocation : C/E. - 1478-7547. ; 21:1 Tidskriftsartikel (refereegranskat)abstract To investigate the cost-effectiveness of using Implant Movement Analysis (IMA) to follow up suspected aseptic loosening when the diagnosis after an initial X-ray is not conclusive, compared with a diagnostic pathway with X-ray follow-up.A health-economic model in the form of a decision tree was developed using quality-adjusted life years (QALY) from the literature, cost-per-patient data from a university hospital and the probabilities of different events from expert physicians' opinions. The base case incremental cost-effectiveness ratio (ICER) was compared with established willingness-to-pay thresholds and sensitivity analyses were performed to account for assumptions and uncertainty.The base case ICER indicated that the IMA pathway was cost effective (SEK 99,681, compared with the SEK 500,000 threshold). In the sensitivity analysis, the IMA pathway remained cost effective during most changes in parameters. ICERs above the threshold value occurred in cases where a larger or smaller proportion of people receive immediate surgery.A diagnostic pathway using IMA after an inconclusive X-ray for suspected aseptic loosening was cost effective compared with a pathway with X-ray follow-up.
34.	Mohaddes, Maziar, 1974 (författare) Acetabular Revisions. Risk Factors and Prediction of Re-revision. 2015 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Hip replacement is a successful intervention when treating patients with hip osteoarthritis. Approximately 10% of all patients undergoing primary hip replacement surgery require further surgical interventions (revisions) during their lifetime. Acetabular component (cup) failure is the most common reason for a revision. Cemented fixation in acetabular revision surgery was a common method until the mid-1980s. Low survival rates reported for cemented revision cups and encouraging results. There are, however, no studies comparing the results of revision surgery based on the method of fixation for the acetabular component. In 2006, a highly porous trabecular metal (TM) tantalum cup was introduced in the Swedish market and, in 2013, this cup was the most commonly used acetabular revision component in Sweden. The primary aim of this thesis was to compare cemented and uncemented fixation in acetabular revisions using radiostereometric analysis (RSA). Further, a comparative analysis of the TM cup and other cup designs frequently used in acetabular revisions was performed. Data from the SHAR, on 18,593 first-time revisions, were used in the first study to analyse differences relating to the risk of re-revision between cemented and uncemented cups. The overall risk of acetabular component failure did not differ between the two modes of fixation. In this analysis, cemented revision cups were re-revised more often due to aseptic loosening but less often due to dislocation. In Paper II, TM cups were compared with the other two cups most frequently used in first-time revisions recorded in the SHAR. The short-term re-revision rate of the TM design did not differ from that of the other two designs. The third paper addressed the influence of proximal migration on the risk of aseptic loosening. An analysis of 312 acetabular revisions followed with RSA for two to 20 years showed that proximal migration measured with RSA can be used a predictor of aseptic loosening of the acetabular component. In the fourth paper, 45 patients (47 hips) undergoing surgery with cemented or uncemented fixation were followed prospectively for 17 years. Radiostereometry was used to monitor the migration and rotation of acetabular components. Cups installed using cemented fixation showed a higher rate of early migration. In a randomised prospective study (Paper V), the RSA migration pattern of the TM cup was compared with that of a cemented cup in hips with large bone defects. The TM design showed less proximal migration compared with the cemented design, indicating a lower risk of aseptic loosening when the TM cup is used in hips with large bone defects. To summarise, there was no difference in the overall risk of re-revision based on the method of fixation, according to data from the SHAR. Proximal migration measured with RSA is a predictor of late aseptic loosening in acetabular revisions. The TM cup shows promising short-term results in the SHAR. The low early proximal migration of the TM design suggests that it has the potential to reduce the risk of late aseptic loosening in revision surgery, but this remains to be demonstrated in clinical studies with longer follow-up.
35.	Mohaddes, Maziar, 1974, et al. (författare) High proximal migration in cemented acetabular revisions operated with bone impaction grafting; 47 revision cups followed with RSA for 17 years. 2017 Ingår i: Hip international : the journal of clinical and experimental research on hip pathology and therapy. - : SAGE Publications. - 1724-6067. ; 27:3, s. 251-258 Tidskriftsartikel (refereegranskat)abstract Bone impaction grafting is a biologically and mechanically appealing option in acetabular revision surgery, allowing restitution of the bone stock and restoration of the biomechanics. We analysed differences in proximal migration of the revision acetabular components when bone impaction grafting is used together with a cemented or an uncemented cup.43 patients (47 hips), revised due to acetabular loosening and judged to have less than 50% host bone-implant contact were included. The hips were randomised to either an uncemented (n = 20) or a cemented (n = 27) revision cup. Radiostereometry and radiography was performed postoperatively, at 3 and 6 months, 1, 2, 3, 5, 7, 10 and 13 and 17 years postoperatively. Clinical follow-up was performed at 1, 2 and 5 years postoperatively and thereafter at the same interval as in the radiographic follow-up.There were no differences in the base line demographic data between the 2 groups. At the last follow-up (17 years) 14 hips (10 cemented, 4 uncemented) had been re-revised due to loosening. 3 additional cups (1 uncemented and 2 cemented) were radiographically loose. There was a higher early proximal migration in the cemented cups.Cups operated on with cement showed a higher early migration measured with RSA and also a higher number of late revisions. The reason for this is not known, but factors such as inclusion of cases with severe bone defects, use of smaller bone chips and issues related to the impaction technique might have had various degrees of influence.
36.	Mohaddes, Maziar, 1974, et al. (författare) Implant survival and patient-reported outcome following total hip arthroplasty in patients 30 years or younger: a matched cohort study of 1,008 patients in the Swedish Hip Arthroplasty Register 2019 Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 90:3, s. 249-252 Tidskriftsartikel (refereegranskat)abstract Background and purpose The outcome of total hip arthroplasty (THA) in younger patients is suggested to be inferior compared with the general THA population. There is a lack of studies with long-term follow up for very young patients. We report on implant survival and patient-reported outcome in patients aged 30 years or younger.Patients and methods Data on THAs performed in Sweden between the years 2000 and 2016 were included. There were 504 patients 30 years or younger with complete demographic and surgical data (study group). A matched comparison group older than 30 years was identified. Implant survival was analyzed using the Kaplan-Meier method. Patient-reported outcome was analyzed in a subgroup of patients.Results The 10-year and 15-year implant survivorship for the study group was 90% and 78%, respectively. The corresponding figures for the patients older than 30 years were 94% and 89%. The median preoperative EQ-5D index was lower in the study group; the improvement in EQ-5D index was similar between the study and the comparison groups. The preoperative EQ-VAS was lower and the improvement in EQ-VAS at 1 year was larger in the study group.Interpretation The promising 10-year implant survival and 1-year improvement in patient-reported outcome suggests that THA is a feasible option in the patients 30 years or younger.
37.	Mohaddes, Maziar, 1974, et al. (författare) Method of Fixation Does Not Influence the Overall Risk of Rerevision in First-time Cup Revisions 2013 Ingår i: Clinical orthopaedics and related research. - : Ovid Technologies (Wolters Kluwer Health). - 1528-1132 .- 0009-921X. ; 471:12, s. 3922-3931 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: During the last two decades, uncemented fixation has been increasingly preferred worldwide during cup revision surgery. In Sweden, the number of uncemented cup revisions has been increasing during the last decade. However, it is unclear whether the risk of rerevision differs between cemented and uncemented cups. QUESTION/PURPOSES: We determined (1) the risk of rerevision after cemented and uncemented fixation; (2) the influence of concomitant stem revision on the risk of rerevision of the cup; (3) the difference in risk of rerevision of an uncemented cup revision compared with liner revision only; and (4) whether the surgical incision influenced the risk of rerevision. METHODS: Between 1979 and 2010, 19,342 first-time cup revisions were reported to the Swedish Hip Arthroplasty Register. From these, 749 were excluded (hip resurfacing, cases with tumor diagnoses, and missing data) leaving 18,593 (73% cemented) for further analysis. We used a Cox regression model adjusted for age, sex, primary diagnosis, method of fixation, concomitant stem revision, and cemented/uncemented fixation to assess risk of rerevision. RESULTS: The relative risk for rerevision for any reason did not differ between cemented and uncemented fixation (relative risk [RR], 0.94). If the stem was not revised at index revision, the risk of further cup revision increased twofold (RR, 1.91). Liner revisions were associated with a 70% increased risk for rerevision of the cup as a result of any reason and especially because of dislocation (RR, 2.94). The surgical incision did not influence the overall risk for rerevision (direct lateral/posterolateral: RR, 1.02) or the risk of rerevision resulting from dislocation (RR, 0.91). CONCLUSIONS: We found no difference in the overall risk of rerevision between cemented and uncemented fixation. Liner exchange had a higher risk for rerevision when compared with cases being rerevised with a new uncemented cup. LEVEL OF EVIDENCE: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
38.	Mohaddes, Maziar, 1974, et al. (författare) No increased risk of early revision during the implementation phase of new cup designs: Analysis of 52,903 hip arthroplasties reported to the Swedish Hip Arthroplasty Register 2016 Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 87, s. 31-36 Tidskriftsartikel (refereegranskat)abstract Background and purpose In Sweden, less than 5% of patients who undergo total hip arthroplasty (THA) have revision. Younger patients have an increased risk of revision. New prosthetic designs are being introduced in order to improve outcomes further. We investigated whether the introductory phase of new cup designs would increase the revision rate.Patients and methods All THAs and first-time cup revisions performed from 1993 through 2011 were identified in the Swedish Hip Arthroplasty Register. The 15 types of cups used in more than 500 operations and inserted in more than 50 cases in each hospital (n = 52,903) were selected. All cups were given an order number, based on the order in which the cup had been inserted at each hospital. The influence of order number on the risk of revision was analyzed in a regression model, which was adjusted for potentially confounding demographic and surgical data. Revision within 2 years for all reasons (n = 940) was used as primary endpoint. Changes in the risk of revision based on the order number were analyzed using a spline.Results The order number of the cup had no influence on the risk of early revision (p 0.7). Categorizing the order number using cutoff values obtained from the splines did not result in any statistically significant changes in risk of revision (p 0.2).Interpretation We did not find any increased risk of early revision during the implementation phase of new cup designs. This finding is unexpected, and partly conflicts with data from other registries. The structured and stepwise introduction of new prosthesis designs, facilitated by the annual feedback from the Swedish Hip Arthroplasty Register, may partly explain this discrepancy.
39.	Mohaddes, Maziar, 1974, et al. (författare) Short-term survival of the trabecular metal cup is similar to that of standard cups used in acetabular revision surgery. 2015 Ingår i: Acta orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 86:1, s. 26-31 Tidskriftsartikel (refereegranskat)abstract Background and purpose - The use of trabecular metal (TM) cups in revision surgery has increased worldwide during the last decade. Since the introduction of the TM cup in Sweden in 2006, this design has gradually replaced other uncemented designs used in Sweden. According to data from the Swedish Hip Arthroplasty Register (SHAR) in 2012, one-third of all uncemented first-time cup revisions were performed using a TM cup. We compared the risk of reoperation and re-revision for TM cups and the 2 other most frequently used cup designs in acetabular revisions reported to the SHAR. The hypothesis was that the performance of TM cups is as good as that of established designs in the short term. Patients and methods - The study population consisted of 2,384 patients who underwent 2,460 revisions during the period 2006 through 2012. The most commonly used cup designs were the press-fit porous-coated cup (n = 870), the trabecular metal cup (n = 805), and the cemented all-polyethylene cup (n = 785). 54% of the patients were female, and the median age at index revision was 72 (19-95) years. Reoperation was defined as a second surgical intervention, and re-revision-meaning exchange or removal of the cup-was used as endpoint. The mean follow-up time was 3.3 (0-7) years. Results - There were 215 reoperations, 132 of which were re-revisions. The unadjusted and adjusted risk of reoperation or re-revision was not significantly different for the TM cup and the other 2 cup designs. Interpretation - Our data support continued use of TM cups in acetabular revisions. Further follow-up is necessary to determine whether trabecular metal cups can reduce the re-revision rate in the long term, compared to the less costly porous press-fit and cemented designs.
40.	Mohaddes, Maziar, 1974, et al. (författare) Use of dual-mobility cup in revision hip arthroplasty reduces the risk for further dislocation: analysis of seven hundred and ninety one first-time revisions performed due to dislocation, reported to the Swedish Hip Arthroplasty Register. 2017 Ingår i: International orthopaedics. - : Springer Science and Business Media LLC. - 1432-5195 .- 0341-2695. ; 41:3, s. 583-588 Tidskriftsartikel (refereegranskat)abstract Dislocation after total hip arthroplasty (THA) is a common reason for revision. The last decade fostered a significant increase in the use of dual-mobility cups (DMCs). Here we report our study on the short-term survival rate of a cemented DMC reported to the Swedish Hip Arthroplasty Register (SHAR) compared with other cemented designs used in first-time revision due to dislocation.During 2005-2015, 984 first-time revisions for dislocation were reported to SHAR. In 436 of these cases a cemented dual articular cup was used. During the same time period, 355 revisions performed with a standard cemented cup (femoral head size 28-36mm) were reported to the SHAR. Patients receiving a DMC were slightly older (75years, p=0.005). Re-revision for all reasons was used as primary endpoint. We also anlaysed risk for re-revision of the acetabular component and re-revision due to dislocation. Kaplan-Meier implant survival and a Cox regression analyses adjusted for age and gender were performed.Implant survival at 4years for all reasons (91%±3.7% vs 86%±4.1%, p=0.02), and especially for re-operation because of dislocation, favours the DMC group (96%±3.0% vs 92%±3.3%, p=0.001).Our findings indicate that use of a cemented DMC reduces the short- to mid-term risk of a second revision in first-time revisions compared with classic cup designs. Longer follow-up is needed to establish any long-term clinical advantages when DMCs are used in revisions performed due to dislocation.
41.	Möller Rydberg, Emilia, et al. (författare) Knowledge support for ankle fractures in the Swedish Fracture Register - a qualitative study of physicians' experiences 2022 Ingår i: Bmc Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 22:1 Tidskriftsartikel (refereegranskat)abstract Background The aim of this study is to investigate the experiences of physicians presented with a knowledge support system while registering data on ankle fractures in the Swedish Fracture Register. The present study aims to answer the following research questions: center dot "How is receiving knowledge support while registering a fracture in the Swedish Fracture Register experienced by the physicians using it?". center dot "Can a feeling of increased usability of a quality register be achieved by providing the user with real-time feedback?". Methods A total of 20 physicians using the Swedish Fracture Register were recruited using a purposive sampling strategy. Qualitative content analysis was performed on individual semi-structured interviews performed in May and June 2020. Results The present study demonstrates that the knowledge support system in the Swedish Fracture Register was perceived by the physicians as strengthening the evidence base and improving the quality of ankle fracture treatment. The knowledge support system was evaluated as a good tool for validating clinical decisions and managing the information that needs to be processed to make informed decisions. Conclusions The present study affirms that being provided with knowledge support is appreciated by physicians, increase value for work and enhance the initiative to register. The physicians experienced that the knowledge support provided an appreciated validation of the clinical decisions taken and a feeling of improved care. When incorporating knowledge support into an NQR, consideration must be given to physicians' fears of becoming overly reliant on a template and losing control of the clinical base.
42.	Pallot, J., et al. (författare) Is Parkinson's disease associated with worse outcomes following hip replacement for treatment of acute hip fracture? 2021 Ingår i: Acta Orthopaedica Belgica. - 0001-6462. ; 86:S 3, s. 94-101 Tidskriftsartikel (refereegranskat)abstract The prevalence of Parkinson's disease (PD) is increasing. Targeted research evaluating clinical outcomes following hip arthroplasty (HR) for acute hip fractures in this high-risk group of patients is lacking. This study evaluates whether PD is associated with worse outcomes with regards to revision rate and mortality in patients who sustain hip fractures treated with total or hemiarthroplasty. Between 2005 and 2012, 1,204 patients with PD who underwent HR surgery following acute hip fracture were identified in the Swedish Hip Arthroplasty Register (SHAR). A control group was generated, with 1 :1 exact matching for potentially confounding variables. Risks of revision and mortality were compared at predetermined intervals over a six-year study period, using Kaplan-Meier and Log-rank testing. No significant differences were detected in revision rates between PD and control groups at 30 days (p=0.71), 90 days (p=0.85), one-year (p=0.51) and sixyears (p=0.40). Increased mortality was observed in the PD group at all time periods assessed. Log-rank testing identified these differences to be significantly higher at 90 days (p<0.01) and on completion of the six-year study period (p<0.001). Differences in mortality rates observed at interim periods of 30 days (p=0.06) and one year (p=0.07) were not shown to be of statistical significance. Patients with PD had increased risk for mortality following total or hemiarthroplasty after a hip fracture, however we were unable to identify an increased risk of revision. As increased incidence of hip fracture sustained by PD patients is predicted, multidisciplinary care must be prioritised to improve outcomes.
43.	Paxton, Elizabeth W., et al. (författare) Meta-analysis of individual registry results enhances international registry collaboration 2018 Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 89:4, s. 369-373 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.
44.	Perlbach, Rico, et al. (författare) Good implant survival after acetabular revision with extensive impaction bone grafting and uncemented components 2020 Ingår i: The bone & joint journal. - : BRITISH EDITORIAL SOC BONE JOINT SURGERY. - 2049-4408 .- 2049-4394. ; 102-B:2, s. 198-204 Tidskriftsartikel (refereegranskat)abstract AIMS: This single-centre observational study aimed to describe the results of extensive bone impaction grafting of the whole acetabular cavity in combination with an uncemented component in acetabular revisions performed in a standardized manner since 1993. METHODS: Between 1993 and 2013, 370 patients with a median age of 72 years (interquartile range (IQR) 63 to 79 years) underwent acetabular revision surgery. Of these, 229 were more than ten years following surgery and 137 were more than 15 years. All revisions were performed with extensive use of morcellized allograft firmly impacted into the entire acetabular cavity, followed by insertion of an uncemented component with supplementary screw fixation. All types of reoperation were captured using review of radiographs and medical charts, combined with data from the local surgical register and the Swedish Hip Arthroplasty Register. RESULTS: Among patients with possible follow-up of ten and 15 years, 152 and 72 patients remained alive without revision of the acetabular component. The number of deaths was 61 and 50, respectively. Of those who died, six patients in each group had a reoperation performed before death. The number of patients with a reoperation was 22 for those with ten-year follow-up and 21 for those with 15 years of follow-up. The Kaplan-Meier implant survival rate for aseptic loosening among all 370 patients in the cohort was 96.3% (95% confidence interval (CI) 94.1 to 98.5) after ten years and 92.8% (95% CI 89.2 to 96.6) after 15 years. CONCLUSION: Extensive bone impaction grafting combined with uncemented revision components appears to be a reliable method with favourable long-term survival. This technique offers the advantage of bone stock restoration and disputes the long-standing perception that uncemented components require > 50% of host bone contact for successful implant survival. Cite this article: Bone Joint J 2020;102-B(2):198-204.
45.	Persson, A., et al. (författare) EPOS trial: The effect of air filtration through a plasma chamber on the incidence of surgical site infection in orthopaedic surgery: A study protocol of a randomised, double-blind, placebo-controlled trial 2022 Ingår i: Bmj Open. - : BMJ. - 2044-6055. ; 12:2 Tidskriftsartikel (refereegranskat)abstract Introduction There is controversy regarding the importance of air-transmitted infections for surgical site infections (SSIs) after orthopaedic surgery. Research has been hindered by both the inability in blinding the exposure, and by the need for recruiting large enough cohorts. The aim of this study is to investigate whether using a new form of air purifier using plasma air purification (PAP) in operating rooms (ORs) lowers the SSI rate or not. Methods and analysis Multicentre, double-blind, cluster-randomised, placebo-controlled trial conducted at seven hospitals in 2017-2022. All patients that undergo orthopaedic surgery for minimum 30 min are included. Intervention group: patients operated in OR with PAP devices turned on. Control group: patients operated in OR with PAP devices turned off. Randomisation: each OR will be randomised in periods of 4 weeks, 6 weeks or 8 weeks to either have the devices on or off. Primary outcome: any SSI postoperatively defined as a composite endpoint of any of the following: use of isoxazolylpenicillin, clindamycin or rifampicin for 2 days or more, International Classification of Diseases codes or Nordic Medico-Statistical Committee codes indicating postoperative infection. In a second step, we will perform a chart review on those patients with positive indicators of SSI to further validate the outcome. Secondary outcomes are described in the Methods section. Power: we assume an SSI rate of 2%, an SSI reduction rate of 25% and we need approximately 45 000 patients to attain a power of 80% at a significance level of 0.05. Ethics and dissemination The study is approved by the Swedish Ethical Review Authority. The interim analysis results from the study will be presented only to the researchers involved unless the study thereafter is interrupted for whatever reason. Publication in a medical journal will be presented after inclusion of the last patient. Trial registration number NCT02695368. © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.
46.	Persson, A., et al. (författare) Increased mortality after total hip prosthetic joint infection is mainly caused by the comorbidities rather than the infection itself 2023 Ingår i: Acta Orthopaedica. - 1745-3674 .- 1745-3682. ; 94, s. 484-489 Tidskriftsartikel (refereegranskat)abstract Background and purpose - Periprosthetic joint infection (PJI) is a feared complication of arthroplasty surgery. There is controversy as to whether PJI also correlates with increased mortality. Our aim was to investigate in a nation-wide cohort if PJI is an independent risk factor for dying. Patients and methods - We performed a retrospective cohort study based on data from the Swedish Hip Arthro-plasty Register (SHAR). All patients with a revision THA performed between 1998 and 2017 were included. The out-come is mortality; exposure is PJI according to SHAR. The control group was study participants who underwent aseptic revision. Confounders were age, sex, diagnosis, and comorbidity according to the Elixhauser index. The outcome was analyzed with a Cox proportional hazards model. Results - 4,943 PJI revisions and 12,529 non-infected revisions were included in the analysis. The median follow-up time was 4.1 years. In the PJI group, 1,972 patients died and in the control group, 4,512. The incidence rate ratio was 1.19 (95% confidence interval [CI] 1.13-1.25), the crude hazard ratio (HR) 1.19 (CI 1.13-1.25), and the adjusted HR 1.05 (CI 0.99-1.12) for the exposed versus the unexposed group. The strongest confounder was comorbidity. Conclusion - The increased mortality risk after revision due to PJI is mainly caused by the comorbidity of the patient, rather than by the infection itself.
47.	Rampal, S., et al. (författare) A review of the efficacy of intraarticular hip injection for patients with hip osteoarthritis: To inject or not to inject in hip osteoarthritis? 2022 Ingår i: Joint Diseases and Related Surgery. - : Joint Diseases and Related Surgery. - 2687-4784 .- 2687-4792. ; 33:1, s. 255-262 Tidskriftsartikel (refereegranskat)abstract Hip injection (HI) for osteoarthritis (OA) are in vogue nowadays. Corticosteroids (CSs) and hyaluronic acid (HA) gel are the two most common agents injected into the hip. Off late, platelet-rich plasma (PRP), mesenchymal stem cell (MSC), bone marrow aspirate concentrate (BMAC), local anesthetic (LA) agents, non-steroidal anti-inflammatory drugs (NSAIDs) and their different combinations have also been injected in hips to provide desired pain relief. However, there is a group of clinicians who vary of these injections. A search of the literature was performed on PubMed, Cochrane Library, and DOAJ using the keywords "hip osteoarthritis injection". Data were analyzed and compiled. Intraarticular CSs are effective in providing the desired pain relief in OA hip, but repeated injections should be avoided and the interval between HI and hip arthroplasty must be kept for more than three months. Methylprednisolone or triamcinolone are combined with 1% lidocaine or 0.5% bupivacaine. Chondrotoxic effects of LA is a concern. Although national guidelines do not favor the use of HA for hip OA, numerous publications have favored its usage for a moderate grade of OA. The PRP, MSC, and BMAC are treatment options with great potential; however, currently, the evidence is conflicting on their role in hip OA. There is always a risk of septic arthritis, particularly when aseptic precautions are not followed, and clinicians must vary of this complication.
48.	Ray, G. S., et al. (författare) Changes in health-related quality of life are associated with patient satisfaction following total hip replacement: an analysis of 69,083 patients in the Swedish Hip Arthroplasty Register 2020 Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 91:1, s. 48-52 Tidskriftsartikel (refereegranskat)abstract Background and purpose - Total hip replacement (THR) aims mainly to improve quality of life via restoration of hip function and provision of pain relief. This study sought to assess whether improvements in quality of life between the preoperative and 1-year postoperative period were associated with patient satisfaction Patients and methods - Data were extracted for 69,083 THR operations with complete data reported to the Swedish Hip Arthroplasty Register (SHAR) between 2008 and 2015. Health-related quality of life and patient satisfaction were captured using the Euro-Qol-5D (EQ-5D) and visual analogue scale (VAS), respectively. Multivariable analysis was performed to assess associations between the changes in pre- and postoperative EQ5D and patient satisfaction. Results - In patients reporting severe or moderate problems with mobility preoperatively, improvement to no problems was associated with numerically higher patient satisfaction (coefficient -18 [95% CI -22 to -14] and -18 [-18 to -17]). Improvement in the self-care dimension from severe or moderate problems to no problems was associated with numerically higher patient satisfaction (-15 [-16 to -14] and -13 [-15 to -11]). Improvement from severe problems with the ability to perform usual activities to no problems was associated with numerically higher patient satisfaction (-18 [-19 to -17]). This association was also found for improvement in pain/discomfort and anxiety/depression (-16 [-17 to -15] and -15 [-16 to -14]). Interpretation - Our results indicate that satisfaction with the operated hip is a valid patient-reported outcome reflecting the changes in different EQ-5D dimensions and should be included in the follow-up of patients after THR surgery.
49.	Rilby, Karin, et al. (författare) No difference in outcome or migration but greater loss of bone mineral density with the Collum Femoris Preserving stem compared with the Corail stem: a randomized controlled trial with five-year follow-up 2022 Ingår i: Bone & Joint Journal. - 2049-4394. ; 104B:5, s. 581-588 Tidskriftsartikel (refereegranskat)abstract Aims The aim of this study was to compare the mid-term patient-reported outcome, bone remodelling, and migration of a short stem (Collum Femoris Preserving; CFP) with a conventional uncemented stem (Corail). Methods Of 81 patients who were initially enrolled, 71 were available at five years' follow-up. The outcomes at two years have previously been reported. The primary outcome measure was the clinical result assessed using the Oxford Hip Score (OHS). Secondary outcomes were the migration of the stem, measured using radiostereometric analysis (RSA), change of bone mineral density (BMD) around the stem, the development of radiolucent lines, and additional patient-reported outcome measures (PROMs). Results There were no statistically significant differences between the groups regarding PROMs (median OHS (CFP 45 (interquartile range (IQR) 35 to 48); Corail 45 (IQR 40 to 48); p = 0.568). RSA showed stable stems in both groups, with little or no further subsidence between two and five years. Resorption of the femoral neck was evident in nine patients in the CFP group and in none of the 15 Corail stems with a collar that could be studied. Dual X-ray absorbiometry showed a significantly higher loss of BMD in the proximal Gruen zones in the CFP group (mean changes in BMD: Gruen zone 1, CFP -9.5 (95% confidence interval (CI) -14.8 to -4.2), Corail 1.0 (95% CI 3.4 to 5.4); Gruen zone 7, CFP -23.0 (95% CI -29.4 to -16.6), Corail -7.2 (95% CI -15.9 to 1.4). Two CFP stems were revised before two years' follow-up due to loosening, and one Corail stem was revised after two years due to chronic infection. Conclusion The CFP stem has a similar clinical outcome and subsidence pattern when compared with the Corail stem. More pronounced proximal stress-shielding was seen with the CFP stem, suggesting diaphyseal fixation, and questioning its femoral neck-sparing properties in the long term.
50.	Rilby, Karin, et al. (författare) Similar outcome with a new anteverted or a straight standard stem: a randomized study of 72 total hip arthroplasties evaluated with clinical variables, radiostereometry, and DXA up to 2 years 2022 Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 93, s. 59-67 Tidskriftsartikel (refereegranskat)abstract Background and purpose - The anatomical uncemented stem, SP-CL (Static Physiologicus - CementLess), designed to facilitate insertion and to avoid stress concentration at solitary contact points, has been on the market since 2014 but is not well documented. We studied its clinical performance, migration, and associated bone remodeling in a randomized controlled trial, with the Corail stem as control. Patients and methods - 79 patients (80 hips) were primarily recruited and 71 patients (72 hips, 36 SP-CL, 36 Corail) attended the last follow-up at 2 years. The Oxford Hip Score (OHS) was the primary outcome. In addition, we assessed stem migration, changes in bone mineral density, and development of radiolucencies by RSA, DXA, and conventional radiography. Results - At 2 years Oxford Hip Score was similar between the SP-CL and Corail stem. At 2 years the SP-CL stems showed a median distal migration of 0.23 mm (-0.1 to 5.2) and the Corail stems of 0.11 mm (-0.4 to 4.4). The SP-CL stems showed slightly more loss of bone mineral density in Gruen region 7 (p = 0.003). Interpretation - We found no difference in clinical results between the SP-CL and the well-documented Corail stem. The same stem stability was reached between 1 and 2 years postoperatively for both stems. As a next step we think that the SP-CL stem should be studied in a multi-center setting, before being accepted for general use.

Skapa referenser, mejla, bekava och länka

Länka till träfflistan

Resultat 1-50 av 73

Avgränsa träffmängd

Typ av publikation: tidskriftsartikel (61); rapport (10); doktorsavhandling (1); forskningsöversikt (1)

Typ av innehåll: refereegranskat (62); övrigt vetenskapligt/konstnärligt (11)

Författare/redaktör: Mohaddes, Maziar, 19 ... (73); Kärrholm, Johan, 195 ... (38); Rolfson, Ola, 1973 (36); Nemes, Szilard, 1977 (11); Rogmark, Cecilia (10); Malchau, Henrik, 195 ... (10); visa fler...; Bülow, Erik (9); Cnudde, Peter, 1970 (8); Tsikandylakis, Georg ... (8); Lindahl, Hans, 1950 (5); Jolbäck, Per (5); Odin, D. (5); Naucler, E. (4); Garellick, Göran, 19 ... (4); W-Dahl, Annette (4); Eskelinen, A. (3); Mukka, Sebastian (3); Gerdhem, Paul (2); Vinblad, Johanna (2); Thoreson, Olof, 1981 (2); Overgaard, S. (2); Pedersen, A. B. (2); Englund, Martin (2); Öberg, Birgitta (2); Persson, A. (2); Erichsen Andersson, ... (2); Shareghi, Bita (2); Björklund, Martin, 1 ... (2); Pedersen, Alma B. (2); Carlsen, Hanne Krage (2); Troelsen, Anders (2); Svensson, Karin, 199 ... (2); Dahlberg, Leif E (2); Bergh, Camilla (2); Overgaard, Søren (2); Mäkelä, Keijo T (2); Svensson Malchau, Ka ... (2); Hailer, Nils P. (2); Malchau, H (2); Eisler, T (2); Hailer, Nils (2); Gromov, K. (2); Troelsen, A. (2); Gromov, Kirill (2); Gordon, M (2); Sköldenberg, O (2); Tyson, Yosef (2); Timperley, J. (2); Wall, Alexander (2); Carling, Malin (2); visa färre...

Lärosäte: Göteborgs universitet (73); Uppsala universitet (8); Karolinska Institutet (7); Umeå universitet (5); Linköpings universitet (4); Lunds universitet (3); visa fler...; Högskolan i Gävle (2); Jönköping University (1); RISE (1); visa färre...

Språk: Engelska (70); Svenska (3)

Forskningsämne (UKÄ/SCB): Medicin och hälsovetenskap (73)

År

Kungliga biblioteket hanterar dina personuppgifter i enlighet med EU:s dataskyddsförordning (2018), GDPR. Läs mer om hur det funkar här.
Så här hanterar KB dina uppgifter vid användning av denna tjänst.

LIBRIS.kb.se

Stäng

Kopiera och spara länken för att återkomma till aktuell vy