| 1. |
- Atroshi, Isam, et al.
(författare)
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Carpal tunnel syndrome and keyboard use at work - A population-based study
- 2007
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Ingår i: Arthritis and Rheumatism. - : Wiley. - 1529-0131 .- 0004-3591. ; 56:11, s. 3620-3625
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To investigate the relationship between carpal tunnel syndrome (CTS) and keyboard use at work in a general population. Methods. A health status questionnaire was mailed to 2,465 persons of working age (25-65 years) who were randomly selected from the general population of a representative region of Sweden. The questionnaire required the subjects to provide information about the presence and severity of pain, numbness and tingling in each body region, employment history, and work activities, including average time spent using a keyboard during a usual working day. Those reporting recurrent hand numbness or tingling in the median nerve distribution were asked to undergo a physical examination and nerve conduction testing. The prevalence of CTS, defined as symptoms plus abnormal results on nerve conduction tests, was compared between groups of subjects that differed in their intensity of keyboard use, adjusting for age, sex, body mass index, and smoking status. Results. Eighty-two percent responded to the questionnaire, and 80% of all symptomatic persons attended the examinations. Persons who had reported intensive keyboard use on the questionnaire were significantly less likely to be diagnosed as having CTS than were those who had reported little keyboard use, with a prevalence that increased from 2.6% in the highest keyboard use group (>= 4 hours/day), to 2.9% in the moderate use group (1 to <4 hours/day), 4.9% in the low use group (<1 hour/day), and 5.2% in the no keyboard use at work group (P for trend = 0.032). Using >= 1 hour/day to designate high keyboard use and <1 hour/ day to designate low keyboard use, the prevalence ratio of CTS in the groups with high to low keyboard use was 0.55 (95% confidence interval 0.32, 0.96). Conclusion. Intensive keyboard use appears to be associated with a lower risk of CTS.
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| 2. |
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| 3. |
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| 4. |
- Atroshi, Isam, et al.
(författare)
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Open compared with 2-portal endoscopic carpal tunnel release: a 5-year follow-up of a randomized controlled trial.
- 2009
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Ingår i: The Journal of Hand Surgery. - : Elsevier BV. - 1531-6564 .- 0363-5023. ; 34:2, s. 266-272
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The purpose of this investigation was to extend the previously reported short-term randomized trial of open and endoscopic carpal tunnel release in patients with carpal tunnel syndrome (CTS) to compare outcomes 5 years after surgery. METHODS: In a single-center randomized controlled trial, 128 patients (25 to 60 years) with clinically diagnosed and electrophysiologically confirmed idiopathic CTS were randomized immediately before surgery to open or 2-portal endoscopic release. The outcome measures included the validated CTS questionnaire's symptom severity and functional status scales (scored from 1 to 5) completed at baseline and 1 year postoperatively. At the extended follow-up of the trial 5 years after surgery, 2 patients had died and the other 126 participants (63 patients in each group) completed the CTS questionnaire. RESULTS: At the 5-year follow-up no difference between the groups was found in the CTS symptom severity score. The mean (SD) score in the open group was 1.42 (0.7) and in the endoscopic group was 1.45 (0.7), and the mean difference in score change from baseline was 0.03 (95% confidence interval, -0.21 to 0.27). Between 1 year and 5 years postoperatively, the CTS symptom severity score had deteriorated by at least 0.4 point in 9 patients in the open group and in 10 patients in the endoscopic group. The mean (SD) CTS functional status score was 1.29 (0.5) in the open group and 1.30 (0.5) in the endoscopic group. At 5 years, 11 patients in the open group and 10 patients in the endoscopic group reported persistent pain in the scar or proximal palm. Three patients in each group had repeat surgery on the operated hand because of persistent or recurrent symptoms. CONCLUSIONS: The improvements in symptoms of CTS and hand-related disability 5 years after open and 2-portal endoscopic carpal tunnel release were equivalent. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.
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| 5. |
- Atroshi, Isam, et al.
(författare)
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Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: randomised controlled trial.
- 2006
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Ingår i: BMJ. - 0959-8138. ; 332(7556):1473, s. 1473-1476
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To compare endoscopic and open carpal tunnel release surgery among employed patients with carpal tunnel syndrome. Design and setting Randomised controlled trial at a single orthopaedic department. Participants 128 employed patients aged 25-60 years with clinically diagnosed and electrophysiologically confirmed idiopathic carpal tunnel syndrome. Main outcome measures The primary outcome was severity of postoperative pain in the scar or proximal palm and the degree to which pain or tenderness limits activities, each rated on a 4 point scale, transformed into a combined score of 0 (none) to 100 (severe pain or tenderness causing severe activity limitation). The secondary outcomes were length of postoperative work absence, severity of symptoms of carpal tunnel syndrome and functional status scores, SF-12 quality of life score, and hand sensation and strength (blinded examiner); follow-up at three and six weeks and three and 12 months. Results 63 patients were allocated to endoscopic surgery and 65 patients to open surgery, with no withdrawals or dropouts. Pain hi the scar or proximal palm was less prevalent or severe after endoscopic surgery than after open surgery but die differences were generally small. At three months, pain in the scar or palm was reported by 33 patients (52%) in the endoscopic group and 53 patients (82%) in the open group (number needed to treat 3.4,95% confidence interval 2.3 to 7.7) and the mean score difference for severity of pain in scar or palm and limitation of activity was 13.3 (5.3 to 21.3). No differences between the groups were found in the other outcomes. The median length of work absence after surgery was 28 days in both groups. Quality of life measures improved substantially. Conclusions In carpal tunnel syndrome, endoscopic surgery was associated with less postoperative pain than open surgery, but the small size of the benefit and similarity in other outcomes make its cost effectiveness uncertain.
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| 6. |
- Atroshi, Isam, et al.
(författare)
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Patient satisfaction and return to work after endoscopic carpal tunnel surgery
- 1998
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Ingår i: The Journal of Hand Surgery. - 1531-6564. ; 23:1, s. 58-65
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Tidskriftsartikel (refereegranskat)abstract
- One hundred twenty-eight patients with idiopathic carpal tunnel syndrome were evaluated before surgery and 3 and 6 months after unilateral endoscopic carpal tunnel release. The variables analyzed included patient demographics, symptoms and signs, activities of daily living (ADL), sensibility and strength measurements, preoperative distal motor latency of the median nerve, operating surgeon, postoperative palmar pain and tenderness, return to work, and patient satisfaction with the results of surgery. Multivariate statistical analyses were performed, with patient satisfaction at 6 months after surgery and the time until return to work after surgery as the dependent variables. On stepwise logistic regression analysis of all preoperative variables, significant predictors of patient dissatisfaction at 6 months after surgery were higher age, heavy vibration exposure, worse ADL score, and better distal motor latency. Analysis of all preoperative and 3-month postoperative variables showed heavy vibration exposure, better distal motor latency, and worse 3-month postoperative ADL score to have the strongest independent correlation with patient dissatisfaction at 6 months. No significant independent association was found between any of the preoperative variables studied and the length of time until return to work after surgery.
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| 7. |
- Atroshi, Isam, et al.
(författare)
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Prevalence of carpal tunnel syndrome in a general population
- 1999
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Ingår i: JAMA: The Journal of the American Medical Association. - : American Medical Association (AMA). - 1538-3598. ; 282:2, s. 153-158
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Tidskriftsartikel (refereegranskat)abstract
- CONTEXT: Carpal tunnel syndrome (CTS) is a cause of pain, numbness, and tingling in the hands and is an important cause of work disability. Although high prevalence rates of CTS in certain occupations have been reported, little is known about its prevalence in the general population. OBJECTIVE: To estimate the prevalence of CTS in a general population. DESIGN: General health mail survey sent in February 1997, inquiring about symptoms of pain, numbness, and tingling in any part of the body, followed 2 months later by clinical examination and nerve conduction testing of responders reporting symptoms in the median nerve distribution in the hands, as well as of a sample of those not reporting these symptoms (controls). SETTING: A region in southern Sweden with a population of 170000. PARTICIPANTS: A sex- and age-stratified sample of 3000 subjects (age range, 25-74 years) was randomly selected from the general population register and sent the survey, with a response rate of 83% (n = 2466; 46% men). Of the symptomatic responders, 81% underwent clinical examination. MAIN OUTCOME MEASURES: Population prevalence rates, calculated as the number of symptomatic responders diagnosed on examination as having clinically certain CTS and/or electrophysiological median neuropathy divided by the total number of responders. RESULTS: Of the 2466 responders, 354 reported pain, numbness, and/or tingling in the median nerve distribution in the hands (prevalence, 14.4%; 95% confidence interval [CI], 13.0%-15.8%). On clinical examination, 94 symptomatic subjects were diagnosed as having clinically certain CTS (prevalence, 3.8%; 95% CI, 3.1%-4.6%). Nerve conduction testing showed median neuropathy at the carpal tunnel in 120 symptomatic subjects (prevalence, 4.9%; 95% CI, 4.1%-5.8%). Sixty-six symptomatic subjects had clinically and electrophysiologically confirmed CTS (prevalence, 2.7%; 95% CI, 2.1%-3.4%). Of 125 control subjects clinically examined, electrophysiological median neuropathy was found in 23 (18.4%; 95% CI, 12.0%-26.3%). CONCLUSION: Symptoms of pain, numbness, and tingling in the hands are common in the general population. Based on our data, 1 in 5 symptomatic subjects would be expected to have CTS based on clinical examination and electrophysiologic testing.
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| 8. |
- Atroshi, Isam, et al.
(författare)
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Prevalensen för kliniskt säkerställt karpaltunnelsyndrom 4 procent
- 2000
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Ingår i: Läkartidningen. - 0023-7205. ; 97:14, s. 1668-1670
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Tidskriftsartikel (refereegranskat)abstract
- This article summarizes the results of a large-scale population-based study conducted to determine the prevalence of carpal tunnel syndrome in the Swedish general population. The study utilized a health questionnaires as well as clinical and electrophysiological examinations. Population prevalence rates of carpal tunnel syndrome, based on clinical diagnosis and electrophysiological criteria, were calculated. Obesity and specific work-related hand activities were shown to be risk factors for carpal tunnel syndrome.
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| 9. |
- Atroshi, Isam, et al.
(författare)
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Primary care patients with musculoskeletal pain : value of health-status and sense-of-coherence measures in predicting long-term work disability
- 2002
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Ingår i: Scandinavian Journal of Rheumatology. - 0300-9742 .- 1502-7732. ; 31:4, s. 239-244
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate long-term sick leave among primary care patients with musculoskeletal disorders and the predictive value of health-status and sense-of-coherence measures. METHODS: Patients aged 17 to 64 years who, during seven weeks, attended one of six primary care centers because of non-traumatic musculoskeletal pain and who completed the SF-36 health questionnaire and the sense of coherence (SOC) scale at baseline and after one year. RESULTS: Of 189 patients, 36 (19%) were sicklisted for at least three months before and/or after their visit; the most common diagnoses were non-specific soft-tissue or multiple joint, low back, and shoulder pain. The long-term sicklisted patients had significantly worse baseline SF-36 and SOC scores than the non-sicklisted patients; moderate improvement in the SF-36 bodily pain but no improvement in the physical functioning scores occurred. The duration of sick leave at baseline and the SF-36 bodily pain score were significant predictors of continuos one-year work disability. CONCLUSION: Long-term sick leave was common among primary care patients with musculoskeletal pain. The physical functioning and return-to-work outcomes after one year were poor. The SF-36 bodily pain scale might be helpful in identifying at risk patients.
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| 10. |
- Atroshi, Isam, et al.
(författare)
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Primary care patients with musculoskeletal pain. Value of health-status and sense-of-coherence measures in predicting long-term work disability
- 2002
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Ingår i: Scandinavian Journal of Rheumatology. - : Informa UK Limited. - 1502-7732 .- 0300-9742. ; 31:4, s. 239-244
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate long-term sick leave among primary care patients with musculoskeletal disorders and the predictive value of health-status and sense-of-coherence measures. METHODS: Patients aged 17 to 64 years who, during seven weeks, attended one of six primary care centers because of non-traumatic musculoskeletal pain and who completed the SF-36 health questionnaire and the sense of coherence (SOC) scale at baseline and after one year. RESULTS: Of 189 patients, 36 (19%) were sicklisted for at least three months before and/or after their visit; the most common diagnoses were non-specific soft-tissue or multiple joint, low back, and shoulder pain. The long-term sicklisted patients had significantly worse baseline SF-36 and SOC scores than the non-sicklisted patients; moderate improvement in the SF-36 bodily pain but no improvement in the physical functioning scores occurred. The duration of sick leave at baseline and the SF-36 bodily pain score were significant predictors of continuos one-year work disability. CONCLUSION: Long-term sick leave was common among primary care patients with musculoskeletal pain. The physical functioning and return-to-work outcomes after one year were poor. The SF-36 bodily pain scale might be helpful in identifying at risk patients.
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| 11. |
- Atroshi, Isam, et al.
(författare)
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Radial tunnel release. Unpredictable outcome in 37 consecutive cases with a 1-5 year follow-up
- 1995
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Ingår i: Acta Orthopaedica Scandinavica. - : Medical Journals Sweden AB. - 0001-6470. ; 66:3, s. 255-257
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Tidskriftsartikel (refereegranskat)abstract
- 37 consecutive patients with radial tunnel syndrome treated by decompression of the posterior interosseous nerve and application of a free fat transplant were retrospectively evaluated 3.5 (1-5) years post-operatively by an independent observer. Substantial pain relief was reported by 13 patients and 15 patients were satisfied with the outcome. 16 of 35 patients returned to their preoperative employment. There were complications in 12 cases, including two radial nerve pareses. Preoperative and operative findings did not correlate to the outcome. Judging from this study, the symptoms and signs used as diagnostic criteria for radial tunnel syndrome may be unreliable and the results of posterior interosseous nerve decompression unpredictable.
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| 12. |
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| 13. |
- Atroshi, Isam, et al.
(författare)
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Severe carpal tunnel syndrome potentially needing surgical treatment in a general population.
- 2003
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Ingår i: The Journal of Hand Surgery. - 1531-6564. ; 28:4, s. 639-644
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To estimate the prevalence of severe carpal tunnel syndrome (CTS) that potentially needs surgical treatment in a general population. Methods: A health-status questionnaire was mailed to a random general population sample of 3,000 subjects (ages, 25-74 y). The responders who reported numbness and/or tingling in the median nerve distribution in the hands were asked to attend a clinical evaluation at which they completed the validated CTS questionnaire and underwent physical examination and nerve conduction tests. The CTS questionnaire measures the severity of symptoms and disability on a scale from 1 (none) to 5 (most severe). The potential need for surgery was defined as CTS symptom severity score of 3.2 or greater or functional status score of 2.5 or greater (corresponding to median preoperative scores for surgical patients in previous reports). Results: The response rate for the survey was 83%. Of the responders who reported numbness and/or tingling in the median nerve distribution in the hands 81% attended the clinical evaluation. Of the 94 subjects diagnosed with clinically certain CTS, 19 (20%; 12 with electrophysiologically proven median neuropathy) had previously undiagnosed CTS that potentially needed surgical treatment, yielding a population prevalence of 7 per 1,000 (95% confidence interval, 4-11 per 1,000). Conclusions: In a general population there was a 0.7% prevalence of undiagnosed CTS with a severity similar to-that-of patients undergoing surgery. The degree to which variable numbers of this group are drawn into a medical system could account for variations in the rate of surgery performed.
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| 14. |
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| 15. |
- Atroshi, I, et al.
(författare)
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The SF-6D health utility index in carpal tunnel syndrome.
- 2007
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Ingår i: Journal of Hand Surgery (British Volume). - : SAGE Publications. - 0266-7681 .- 1753-1934 .- 2043-6289. ; 32:2, s. 198-202
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Tidskriftsartikel (refereegranskat)abstract
- Cost effectiveness is an important factor to consider when choosing between various hand surgical interventions. Health utility measures can be used to determine cost effectiveness. The SF-6D is a health utility index derived from 11 items of the SF-36 quality of life questionnaire; values range from 0.296 to 1.0 (“perfect” health). We evaluated the validity of the SF-6D in patients with carpal tunnel syndrome (CTS) who completed the SF-36 and the CTS symptom severity and functional status questionnaire before and 3 months after carpal tunnel release. Complete responses to the SF-6D items were available for 100 patients at baseline and 95 patients at baseline and follow-up. The mean SF-6D health utility index was 0.69 (SD 0.13) before surgery and 0.77 (SD 0.13) after surgery (moderate effect size). The SF-6D could discriminate between patient groups differing in self-rated global health and in whether, or not, they had a minimal clinically important improvement in CTS symptom severity after surgery. The SF-6D appears to be a valid measure of health utilities in patients with CTS and can be used in cost effectiveness studies.
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| 16. |
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| 17. |
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| 18. |
- Iderberg, Hanna, et al.
(författare)
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Predicting clinical outcome and length of sick leave after surgery for lumbar spinal stenosis in Sweden : a multi-register evaluation
- 2019
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Ingår i: European spine journal. - : Springer Science and Business Media LLC. - 0940-6719 .- 1432-0932. ; 28:6, s. 1423-1432
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Lumbar spinal stenosis (LSS) can be surgically treated, with variable outcome. Studies have linked socioeconomic factors to outcome, but no nation-wide studies have been performed. This register-based study, including all patients surgically treated for LSS during 2008-2012 in Sweden, aimed to determine predictive factors for the outcome of surgery.Methods: Clinical and socioeconomic factors with impact on outcome in LSS surgery were identified in several high-coverage registers, e.g., the national quality registry for spine surgery (Swespine, FU-rate 70-90%). Multivariate regression analyses were conducted to assess their effect on outcome. Two patient-reported outcome measures, Global Assessment of leg pain (GA) and the Oswestry Disability Index (ODI), as well as length of sick leave after surgery were analyzed.Results: Clinical and socioeconomic factors significantly affected health outcome (both GA and ODI). Some predictors of a good outcome (ODI) were: being born in the EU, reporting no back pain at baseline, a high disposable income and a high educational level. Some factors predicting a worse outcome were previous surgery, having had back pain more than 2years, having comorbidities, being a smoker, being on social welfare and being unemployed.Conclusions: The study highlights the relevance of adding socioeconomic factors to clinical factors for analysis of patient-reported outcomes, although the causal pathway of most predictors' impact is unknown. These findings should be further investigated in the perspective of treatment selection for individual LSS patients. The study also presents a foundation of case mix algorithms for predicting outcome of surgery for LSS.
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| 19. |
- Ornstein, Ewald, et al.
(författare)
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Early complications after one hundred and forty-four consecutive hip revisions with impacted morselized allograft bone and cement
- 2002
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Ingår i: Journal of Bone and Joint Surgery. American Volume. - 1535-1386. ; 84-A:8, s. 1323-1328
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The use of impacted morselized allograft bone and cement in hip revision arthroplasty has been popular, but studies that specifically address intraoperative and postoperative complications have been scarce. METHODS: All complications that occurred during, and within the first year after, 144 consecutive hip revision arthroplasties (108 stems and 130 sockets) performed with impacted morselized allograft bone and cement were recorded. Clinical and radiographic follow-up evaluation was performed at three months and at one year after surgery for all patients except eight (seven who had died of causes unrelated to the hip surgery and one who had sustained a stroke). Of these eight patients, seven had a six-week and/or three-month follow-up evaluation. RESULTS: Thirty-nine femoral fractures occurred in thirty-seven hips; twenty-nine of the fractures occurred during surgery and ten, within five months after surgery. Of the intraoperative femoral fractures, twelve were proximal, nine were diaphyseal, and eight involved the greater trochanter. Of the postoperative femoral fractures, one was proximal and nine were diaphyseal. Other intraoperative complications were the creation of a femoral cortical window in seven hips and incidental perforation of the femoral cortex in fourteen. Multivariate analysis showed the risk factors for femoral fracture during or after revision to be concomitant disease, greater deficiency of the femoral bone stock, and an intraoperative femoral window or perforation. Other complications included dislocation of the femoral head in nine hips, deep infection in one hip, persistence of preoperative deep infection in one hip, and superficial wound infection requiring wound debridement in two hips. CONCLUSIONS: We found the complication rate to be high after hip revision arthroplasty performed with impacted morselized allograft bone and cement. The most serious complication was postoperative diaphyseal femoral fracture.
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| 20. |
- Ornstein, Ewald, et al.
(författare)
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Five-year follow-up of socket movements and loosening after revision with impacted morselized allograft bone and cement - A radiostereometric and radiographic analysis
- 2006
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Ingår i: Journal of Arthroplasty. - : Elsevier BV. - 0883-5403. ; 21:7, s. 975-984
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Tidskriftsartikel (refereegranskat)abstract
- In 1999, we reported on the 2-year results of a series of 21 first-time socket revisions using impacted morselized allograft bone. Seven still migrated between 1.5 and 2 years. Seventeen remained for the current 5-year follow-up. No socket had been rerevised. Five sockets showed signs of radiographic loosening. These 5 cases also exhibited radiographic signs of allograft resorption as well as high rates of socket migration and rotation as measured by radiostereometric analysis. Of the 6 remaining sockets that had migrated between 1.5 and 2 years, 3 stabilized and 3 were among those with signs of radiographic loosening. Fifteen patients (15 hips) revealed pain reduction at the 5-year follow-up. Three had slight pain on walking that disappeared immediately at rest (pain score 4). All the others revealed either no pain (pain score 6) or slight pain that disappeared with activity (pain score 5). No pattern of early socket migration according to radiostereometric analysis could be identified, predicting later socket migration or loosening. The rate of cases with signs of radiographic loosening (29%, 5/17) was comparable to that reported by the Nijmegen group but the follow-up was shorter in the current study. The rate of cases with signs of radiographic loosening was comparable to both conventionally cemented socket revisions and cementless revisions. The future will show if further sockets loosen and if the loose sockets up to date will end up in rerevisions.
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| 21. |
- Ornstein, Ewald, et al.
(författare)
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Hip revision using the Exeter stem, impacted morselized allograft bone and cement: A consecutive 5-year radiostereometric and radiographic study in 15 hips
- 2004
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Ingår i: Acta Orthopaedica Scandinavica. - : Medical Journals Sweden AB. - 0001-6470. ; 75:5, s. 533-543
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Tidskriftsartikel (refereegranskat)abstract
- Background: Impaction grafting in hip revision surgery is widely used but studies with mid- and long-term follow-up are scarce. Patients, methods and results A 5-year radiostereometric (RSA) follow-up of 15 hip revisions with the Exeter stem, morselized impacted allograft bone and cement revealed that 3 stems had not migrated between 2 and 5 years after revision, 11 stems had migrated to a minor degree in at least 1 direction, and 1 stem was loose according to RSA but without any radiographic signs of loosening or pain. The pain score was comparable to primary arthroplasties. Interpretation From a 5-year perspective, first-time hip revisions for aseptic loosening with impacted morselized allograft bone and cement appear to yield good clinical results, although stem migration continues to a minor degree 2 years after revision.
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| 22. |
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| 23. |
- Ornstein, Ewald
(författare)
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Hip revisions with impacted morselized allograft bone and cement. Patient outcome, prosthetic fixation and risks.
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- 144 consecutive hip revisions performed with morselized allograft bone and cement were followed up to 5 years after surgery. In 49 hips patient outcome was evaluated with the Nottingham Health Profile (NHP) questionnaire and Charnley hip scores in 47 hips prosthetic fixation was evaluated with radiostereometry (RSA)and in all 144 hips risks and complications were recorded using a prspective protocol. Patient outcome regarding pain, physical mobility and sleep at 4 years after revision was comparable to that of primary hip replacements. The correlations between NHP and Charnley pain and physical mobility scores were weak to moderate. RSA index examination should be done as early as possible after surgery. The Exeter stem subsides within the cement mantle and in revisions additional subsidence of the stem-cementbeam occurs relative to the femur. All stems and most sockets migrated, mostly early after revision, without correlation to the grade of bone stock deficiency; one third of the prosthetic components still migrated between 1.5 and 2 years postoperatively. 1 of 15 stems had aseptic loosening according to RSA while the other had migrated only marginally between the 2-year and 5-year follow-up examinations. 5 of 17 sockets had signs of radiographic loosening (radiolucent line >2mm; these sockets were also among those showing the most pronounced migration and rotation at the 5-year follow-up. Neither for the stems nor for the sockets did early migration pattern predict future prosthetic movements. In a pilot study free weight bearing was practised and the migration of the stem and socket was similar to that shown among patients who practised restricted weight bearing for 3 months after revision. Concomitant disease, large bone stock deficiency, intraoperative femoral cortical window or perforation increased the risk for femoral fracture but all 9 hips but could be managed without lasting morbidity.
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| 24. |
- Ornstein, Ewald, et al.
(författare)
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Migration of the acetabular component after revision with impacted morselized allografts: a radiostereometric 2-year follow-up analysis of 21 cases
- 1999
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Ingår i: Acta Orthopaedica Scandinavica. - : Medical Journals Sweden AB. - 0001-6470. ; 70:4, s. 338-342
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Tidskriftsartikel (refereegranskat)abstract
- In a consecutive series of hip revisions due to mechanical loosening, using impacted morselized allografts and cement, we followed 21 acetabular components by radiostereometric analysis (RSA) during 2 years. All but 1 acetabular component migrated in the proximal direction (median 2.1 (0.5-6.4) mm). 6 components migrated in the medial direction (median 0.8 (0.4-1.2) mm) and 6 in the lateral (median 0.8 (0.4-2.0) mm). 14 components migrated in the posterior direction (median 0.8 (0.3-2.3) mm) and 1 in the anterior 0.6 mm. The migration rate gradually decreased in all directions, but 7 acetabular components still migrated in at least 1 direction (median 0.3-0.6 mm) between 1.5 and 2 years postoperatively.
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| 25. |
- Ornstein, Ewald, et al.
(författare)
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Results of hip revision using the Exeter stem, impacted allograft bone, and cement
- 2001
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Ingår i: Clinical Orthopaedics and Related Research. - 0009-921X. ; :389, s. 126-133
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Tidskriftsartikel (refereegranskat)abstract
- The Exeter stem and impacted, morselized allograft bone and cement were used in the revisions of 18 consecutive femoral components (17 patients). The primary arthroplasty had been done because of osteoarthritis. All of the femoral components were revised for the first time because of aseptic loosening. The migration pattern of the Exeter stem after revision was studied using roentgen stereophotogrammetric analysis. At 2 years after surgery, all 18 femoral stems had migrated in the distal direction (average, 2.5 mm). In addition, seven of the stems had migrated in the medial direction (average, 1.3 mm), and two stems had migrated in the lateral direction (0.5 mm and 1 mm, respectively). Sixteen of the femoral stems also had migrated in the posterior direction (average, 2.9 mm), but none migrated in the anterior direction. The migration rate decreased gradually with time during the followup. Six femoral stems continued to migrate between 1.5 and 2 years after surgery. In patients with major femoral bone deficiency at the time of hip revision, the use of impacted morselized allograft bone and cement yielded an initial fixation similar to that obtained in conventionally cemented revisions. Pain had improved in all patients at the 2-year followup.
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| 26. |
- Stefansdottir, Anna, et al.
(författare)
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Movement pattern of the Exeter femoral stem: A radiostereometric analysis of 22 primary hip arthroplasties followed for 5 years
- 2004
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Ingår i: Acta Orthopaedica Scandinavica. - : Medical Journals Sweden AB. - 0001-6470. ; 75:4, s. 408-414
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Tidskriftsartikel (refereegranskat)abstract
- Background The design of the Exeter stem may facilitate distal migration, but radiostereometric analysis (RSA) studies have been limited to 2 years of follow-up. Patients and methods We followed migration of the Exeter femoral stems in 22 primary hip arthroplasties for 5 years with RSA. Results All stems migrated distally and the median migration at 2 years was 1.34 mm, while at 5 years it was 1.77 mm. 7 stems migrated above accuracy between 3 and 5 years. (RSA) evaluation of the cement mantle could be performed in 14 cases, and in 5 slight migration was found. Most of the stems rotated towards retroversion and the median rotation at 2 years was 1.2°, while at 5 years it was 1.6°. We found 1 patient with impending clinical failure but no deviation in the RSA migration pattern, and 1 patient with unstable migration pattern but no clinical symptoms. Interpretation We found a greater distal migration of the Exeter stem for longer periods of time than seen with other types of cemented implants.
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| 27. |
- Strom, Oskar, et al.
(författare)
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Long-term cost and effect on quality of life of osteoporosis-related fractures in Sweden
- 2008
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 79:2, s. 269-280
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose Few economic or quality-of-life studies have investigated the long-term consequences of fragility fractures. This prospective observational data collection study assessed the cost and quality of life related to hip, vertebral, and wrist fracture 13-18 months after the fracture, based on 684 patients surviving 18 months after fracture. Patients and methods Data regarding resource use and quality of life related to fractures was collected using questionnaires at 7 research centers in Sweden. Information was collected using patient records, register sources, and by asking the patient. Quality of life was estimated using the EQ-5D questionnaire. Direct and indirect costs were estimated from a societal standpoint. Results The mean fracture-related cost 13-18 months after a hip, vertebral, or wrist fracture were estimated to be (sic)2,422, (sic)3,628, and (sic)316, respectively. Between 12 and 18 months after hip, vertebral, and wrist fracture, utility increased by 0.03, 0.05, and 0.02, respectively. Compared to prefracture levels, the mean loss in quality of life between 13 and 18 months after fracture was estimated to be 0.05, 0.11, and 0.005 for hip, vertebral, and wrist fracture. Interpretation The sample of vertebral fracture patients was fairly small and included a high proportion of fractures leading to hospitalization, but the results indicate higher long-term costs and greater loss in quality of life related to vertebral fracture than previously believed.
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| 28. |
- Sundberg, Martin, et al.
(författare)
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Bone mineral density in adolescents. Higher values in a rural area--a population-based study of 246 subjects in southern Sweden
- 1997
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Ingår i: Acta Orthopaedica Scandinavica. - : Medical Journals Sweden AB. - 0001-6470. ; 68:5, s. 456-460
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Tidskriftsartikel (refereegranskat)abstract
- We performed, in a cross-sectional study, dual energy X-ray absorptiometry (DXA) among 15-16-year-old boys (n 58) and girls (n 44) living in an urban area and among boys (n 82) and girls (n 66) of the same age from a rural area. We measured bone mineral density (BMD) of the total body, the lumbar spine and the hip. In the rural population, we found significantly higher BMD levels in the lumbar spine (14% for the boys and 12% for the girls) and the total body (6.9% for the boys and 3.4% for the girls). We detected no significant differences in the hip BMD. Adolescents in rural areas seem to develop a higher peak bone mass and thereby presumably have a lower risk of developing fragility fractures.
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| 29. |
- Sundberg, Martin, et al.
(författare)
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Comparison of quantitative ultrasound measurements in calcaneus with DXA and SXA at other skeletal sites: a population-based study on 280 children aged 11-16 years
- 1998
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Ingår i: Osteoporosis International. - : Springer Science and Business Media LLC. - 1433-2965 .- 0937-941X. ; 8:5, s. 410-417
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Tidskriftsartikel (refereegranskat)abstract
- We performed ultrasound measurements (QUS) of the calcaneus in a population-based setting on 280 healthy children, aged 11-16 years, from a small urban area in southern Sweden. The results are compared with dual-energy X-ray absorptiometry (DXA) measurements in the total body, the lumbar spine and the hip, as well as single-energy X-ray absorptiometry (SXA) of the forearm. Normative data and correlations between the three different techniques were determined. We found significant correlations between QUS and age (r = 0.34-0.54), height (r = 0.13-0.56) and weight (r = 0.30-0.60), and between QUS and bone mineral density (BMD) measurements (r = 0.44-0.70). Boys increased all their bone mineral variables with age, whereas girls showed a decreasing trend from age 15 years. QUS had a significantly higher increase in standardized value with age than Ward's triangle BMD, but a significantly lower increase in standardized value with age than distal radius (cortical site) BMD. At other BMD sites we did not find any significant differences compared with QUS regarding changes with age. The measurements obtained by QUS, DXA and SXA, respectively, were divided into, quartiles. Of all subjects in the lowest quartile for QUS measurements, only 34-50% were also in the lowest quartiles for DXA and SXA measurements. In conclusion, QUS measurements of the calcaneus in children show similar results as for adult regarding the correlation with DXA and SXA; they also have a significant correlation with anthropometric data. QUS did not identify the same individuals with low bone mass as the X-ray techniques.
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| 30. |
- Sundberg, Martin, et al.
(författare)
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Peripubertal moderate exercise increases bone mass in boys but not in girls: a population-based intervention study
- 2001
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Ingår i: Osteoporosis International. - : Springer Science and Business Media LLC. - 1433-2965 .- 0937-941X. ; 12:3, s. 230-238
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Tidskriftsartikel (refereegranskat)abstract
- On the basis of cross-sectional studies in elite athletes and longitudinal studies, physical activity in growing children has been suggested to enhance bone mineral acquisition and prevent osteoporosis later in life. The level of exercise in most of these studies is not applicable in a population on a day-to-day basis. The aim of this study was to determine whether moderate increased exercise within the school curriculum from age 12 to 16 years would have anabolic bone effects. In a population-based setting of 40 boys and 40 girls the school curriculum was enhanced to physical education 4 times per week for 3-4 years. Controls were 82 boys and 66 girls who had had physical education twice a week over a corresponding period. Both cases and controls were measured at age 16 years. Bone mineral content (BMC), areal bone mineral density (aBMD), bone size (femoral neck width) and volumetric BMD (vBMD) were measured in total body, spine and femoral neck (FN) by dual-energy X-ray absorptiometry. Data are presented as mean +/- SD. BMC (8 +/- 15%, p = 0.04), aBMD (9 +/- 13%, p = 0.002) and vBMD (9 +/- 15%, p = 0.001) were all higher in FN in the male intervention group compared with controls. FN bone size was no higher in the intervention group than in the controls. In girls, no differences were found when comparing the intervention group with controls. The results remained after adjusting for confounding factors such as weight, height, milk intake and activity after school. In summary, we report that increased bone mass can be achieved in a population-based cohort of boys (but not in girls) by moderate increased physical activity within the school curriculum from age 12 to 16 years. We speculate that the same results can be seen in girls if intervention starts at an earlier age. We conclude that increasing the physical education content of the Swedish school curriculum may improve bone mass in at least peripubertal boys.
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| 31. |
- Zampelis, Vasileios, et al.
(författare)
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A simple visual analog scale for pain is as responsive as the WOMAC, the SF-36, and the EQ-5D in measuring outcomes of revision hip arthroplasty
- 2014
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 85:2, s. 128-132
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Little is known about the comparative performance of patient-reported outcome measures in revision hip arthroplasty. We compared the performance of the WOMAC, the SF-36, the EQ-5D, and a pain-related visual analog scale (VAS) in revision hip arthroplasty. Methods - 45 patients with aseptic prosthetic loosening following primary hip arthroplasty completed the WOMAC, the SF-36, the EQ-5D, and a VAS for pain-at baseline and 2 years after revision. Responsiveness of the measures was compared with the effect size (with >= 0.8 being considered large). Agreement between scales measuring the same type of outcome (pain or physical function) was assessed with the Bland-Altman method. Results - The mean preoperative scores for the pain and physical function scales of WOMAC and SF-36, EQ-5D index, and VAS for pain improved statistically significantly 2 years after revision. The effect size for the WOMAC pain was 1.7, that for SF-36 pain was 1.4, that for WOMAC physical function was 1.6, that for SF-36 physical function was 0.8, and that for EQ-5D index was 1.2. The VAS for pain had an effect size of 2.1, which was larger than that for SF-36 pain and for the EQ-5D index (p <= 0.03) but not for WOMAC pain (p = 0.2). The limits of agreement between WOMAC pain, SF-36 pain, and the VAS scale measuring pain- and between the WOMAC and SF-36 scales measuring physical function-were wide. Internal-consistency reliability was high for the WOMAC and SF-36 scales but low for the EQ-5D. Interpretation - In patients with first-time revision hip arthroplasty done for aseptic loosening, the WOMAC, SF-36, and EQ-5D showed high responsiveness in measuring patient-reported outcomes and the simple VAS for pain performed equally well.
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