| 1. |
- Leonardsson, O, et al.
(författare)
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The surgical approach for hemiarthroplasty does not influence patient-reported outcome : a national survey of 2118 patients with one-year follow-upa
- 2016
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Ingår i: The Bone & Joint Journal. - 2049-4408. ; 98-B:4, s. 7-542
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Hemiarthroplasty of the hip is usually carried out through either a direct lateral or posterior approach. The aim of this prospective observational study was to determine any differences in patient-reported outcomes between the two surgical approaches.PATIENTS AND METHODS: From the Swedish Hip Arthroplasty Register we identified patients of 70 years and above who were recorded as having had a hemiarthroplasty during 2009. Only patients who had been treated with modern prostheses were included. A questionnaire was posted to those who remained alive one year after surgery. A total of 2118 patients (78% of those available) with a mean age of 85 years (70 to 102) returned the questionnaire.RESULTS: Patients who had undergone surgery through a posterior approach reported a higher health-related quality of life (HRQoL, EQ-5D mean 0.52 versus 0.47, p = 0.009), less pain (visual analogue scale mean 17 versus 19, p = 0.02) and greater satisfaction with the result of surgery (visual analogue scale mean 22 versus 24, p = 0.02) than those who had a direct lateral approach. However, after adjusting for age, gender, cognitive impairment and American Society of Anesthesiologists grade, no association was found between surgical approach and HRQoL, residual pain or patient satisfaction.TAKE HOME MESSAGE: The surgical approach for hemiarthroplasty does not seem to affect the patient-perceived HRQoL, residual pain or patient satisfaction one year after surgery on elderly patients. The choice of approach should be based on other factors, such as the risk of dislocation. Cite this article: Bone Joint J 2016;98-B:542-7.
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| 2. |
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| 3. |
- Bülow, E., et al.
(författare)
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Low predictive power of comorbidity indices identified for mortality after acute arthroplasty surgery undertaken for femoral neck fracture
- 2019
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Ingår i: Bone and Joint Journal. - 2049-4394. ; 101B:1, s. 104-112
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Tidskriftsartikel (refereegranskat)abstract
- Aims Our aim was to examine the Elixhauser and Charlson comorbidity indices, based on administrative data available before surgery, and to establish their predictive value for mortality for patients who underwent hip arthroplasty in the management of a femoral neck fracture. Patients and Methods We analyzed data from 42 354 patients from the Swedish Hip Arthroplasty Register between 2005 and 2012. Only the first operated hip was included for patients with bilateral arthroplasty. We obtained comorbidity data by linkage from the Swedish National Patient Register, as well as death dates from the national population register. We used univariable Cox regression models to predict mortality based on the comorbidity indices, as well as multivariable regression with age and gender. Predictive power was evaluated by a concordance index, ranging from 0.5 to 1 (with the higher value being the better predictive power). A concordance index less than 0.7 was considered poor. We used bootstrapping for internal validation of the results. Results The predictive power of mortality was poor for both the Elixhauser and Charlson comorbidity indices (concordance indices less than 0.7). The Charlson Comorbidity Index was superior to Elixhauser, and a model with age and gender was superior to both indices. Conclusion Preoperative comorbidity from administrative data did not predict mortality for patients with a hip fracture treated by arthroplasty. This was true even if association on group level existed.
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| 4. |
- Dale, H., et al.
(författare)
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Increasing risk of revision due to infection after primary total hip arthroplasty: results from the Nordic Arthro- plasty Register Association
- 2023
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Ingår i: Acta orthopaedica. - : Medical Journals Sweden. - 1745-3674 .- 1745-3682. ; 94, s. 307-315
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - The incidence of peripros-thetic joint infection after total hip arthroplasty (THA) may be increasing. We performed time-trend analyses of risk, rates, and timing of revision due to infection after primary THAs in the Nordic countries from the period 2004-2018. Patients and methods - 569,463 primary THAs reported to the Nordic Arthroplasty Register Association from 2004 to 2018 were studied. Absolute risk estimates were calculated by Kaplan-Meier and cumulative incidence function methods, whereas adjusted hazard ratios (aHR) were assessed by Cox regression with the first revision due to infection after primary THA as primary endpoint. In addi-tion, we explored changes in the time span from primary THA to revision due to infection. Results - 5,653 (1.0%) primary THAs were revised due to infection during a median follow-up time of 5.4 (IQR 2.5-8.9) years after surgery. Compared with the period 2004-2008, the aHRs for revision were 1.4 (95% confidence interval [CI] 1.3-1.5) for 2009-2013, and 1.9 (CI 1.7-2.0) for 2014-2018. The absolute 5-year rates of revision due to infection were 0.7% (CI 0.7-0.7), 1.0% (CI 0.9-1.0), and 1.2% (CI 1.2-1.3) for the 3 time periods respectively. We found changes in the time span from primary THA to revi-sion due to infection. Compared with 2004-2008, the aHR for revision within 30 days after THA was 2.5 (CI 2.1-2.9) for 2009-2013, and 3.4 (CI 3.0-3.9) for 2013-2018. The aHR for revision within 31-90 days after THA was 1.5 (CI 1.3-1.9) for 2009-2013, and 2.5 (CI 2.1-3.0) for 2013-2018, compared with 2004-2008.Conclusion - The risk of revision due to infection after primary THA almost doubled, both in absolute cumulative incidence and in relative risk, throughout the period 2004- 2018. This increase was mainly due to an increased risk of revision within 90 days of THA. This may reflect a "true" increase (i.e., frailer patients or more use of uncemented implants) and/or an "apparent" increase (i.e., improved diagnostics, changed revision strategy, or completeness of reporting) in incidence of periprosthetic joint infection. It is not possible to disclose such changes in the present study, and this warrants further research.
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| 5. |
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| 6. |
- Gromov, K., et al.
(författare)
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Varying but reduced use of postoperative mobilization restrictions after primary total hip arthroplasty in Nordic countries: a questionnaire-based study
- 2019
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 90:2, s. 143-147
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose Mobilization has traditionally been restricted following total hip arthroplasty (THA) in an attempt to reduce the risk of dislocation and muscle detachment. However, recent studies have questioned the effect and rationale underlying such restrictions. We investigated the use of postoperative restrictions and possible differences in mobilization protocols following primary THA in Denmark (DK), Finland (FIN), Norway (NO), and Sweden (SWE).Patients and methods All hospitals performing primary THA in the participating countries were identified from the latest national THA registry report. A questionnaire containing questions regarding standard surgical procedure, use of restrictions, and postoperative mobilization protocol was distributed to all hospitals through national representatives for each arthroplasty registry.Results 83% to 94% (n = 167) of the 199 hospitals performing THA in DK, FIN, NO, and SWE returned correctly filled out questionnaires. A posterolateral approach was used by 77% of the hospitals. 92% of the hospitals had a standardized mobilization protocol. 50%, 41%, 19%, and 38% of the hospitals in DK, FIN, NO, and SWE, respectively, did not have any postoperative restrictions. If utilized, restrictions were applied for a median of 6 weeks. Two-thirds of all hospitals have changed their mobilization protocol within the last 5 yearsall but 2 to a less restrictive protocol.Interpretation Use of postoperative restrictions following primary THA differs between the Nordic countries, with 19% to 50% allowing mobilization without any restrictions. There has been a strong tendency towards less restrictive mobilization over the last 5 years.
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| 7. |
- Gustafsson, K., et al.
(författare)
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A Multifaceted Picture Of Patient Perspectives Of Health Care And Self-Management In Hip And Knee Osteoarthritis
- 2023
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Ingår i: Osteoarthritis and Cartilage. - : Elsevier BV. - 1063-4584 .- 1522-9653. ; 31, s. S399-S399
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Expressing a desire for surgery already before participating in first-line osteoarthritis (OA) interventions (patient education and exercise therapy) has in previous research shown to contribute to poorer outcomes from the interventions, yet we lack knowledge about patients’ views of health care and self-management of osteoarthritis (OA). This study aimed to explore and describe patients’ perspective of health care and self-management of OA among those expressing a desire for surgery before participating in first-line OA intervention.Methods: Sixteen patients with hip or knee OA who had expressed a desire to undergo surgery before they participated in a standardized first-line OA intervention program in primary health care in Sweden were included in the study. We used individual semi-structured interviews to collect data, which were then analysed using inductive qualitative content analysis to identify, describe, and categorize patterns detected within the data.Results: The analysis resulted in one main theme “A multifaceted picture of needs, expectations and individual choices”, which illustrates how the informants expressed a broad range of topics in their perspectives on health care and self-management of OA. Five categories, with its subcategories were identified: (1) lacking control and needing support, consisting of the perspectives; limiting activities due to pain, having difficulties in identifying patterns and finding strategies, feeling frustration and stress, seeing OA as an inevitable deterioration and needing help and being insecure (2) standing alone in an unsupportive environment, comprised of the two subcategories; being left alone and not being taken seriously (3) being passive, which included the subcategories; unstructured self-management, getting used to and adapting to the situation, limited retrieval of information and knowledge and passive health care consumer. (4) having expectations which was divided into the following subcategories: wanting quick help, doubts about the health care provided and expectations based on previous function and experiences and (5) taking ownership, which included trying to stay active or actively adapting to the situation and seeking control and answers (Fig.1).Conclusions: The patients’ perspectives of expressing a desire for surgery already before participating in a first-line OA intervention program are multifaceted and based on a broad range of aspects, from a passive approach manifested by lack of control, adapting to the situation, being left alone, often resulting in doubts or mistrust regarding provided health care to actively trying to adapt to the situation and striving to maintain in control. Findings from this study strengthen insights on the importance of individualizing OA interventions and can contribute to optimizing the support that physiotherapists provide to patients in daily clinic practice.
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| 8. |
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| 9. |
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| 10. |
- Hussey, D. K., et al.
(författare)
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Worse health-related quality of life and hip function in female patients with elevated chromium levels A prospective study of 659 patients with a recalled THR metal-on-metal implant
- 2016
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 87:5, s. 485-491
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Blood metal ion levels can be an indicator for detecting implant failure in metal-on-metal (MoM) hip arthroplasties. Little is known about the effect of bilateral MoM implants on metal ion levels and patient-reported outcomes. We compared unilateral patients and bilateral patients with either an ASR hip resurfacing (HR) or an ASR XL total hip replacement (THR) and investigated whether cobalt or chromium was associated with a broad spectrum of patient outcomes. Patients and methods - From a registry of 1,328 patients enrolled in a multicenter prospective follow-up of the ASR Hip System, which was recalled in 2010, we analyzed data from 659 patients (311 HR, 348 THR) who met our inclusion criteria. Cobalt and chromium blood metal ion levels were measured and a 21-item patient-reported outcome measures (PROMs) questionnaire was used mean 6 years after index surgery. Results - Using a minimal threshold of >= 7 ppb, elevated chromium ion levels were found to be associated with worse health related quality of life (HRQoL) (p < 0.05) and hip function (p < 0.05) in women. These associations were not observed in men. Patients with a unilateral ASR HR had lower levels of cobalt ions than bilateral ASR HR patients (p < 0.001) but similar levels of chromium ions (p = 0.09). Unilateral ASR XL THR patients had lower chromium and cobalt ion levels (p < 0.005) than bilateral ASR XL THR patients. Interpretation - Chromium ion levels of > 7 ppb were associated with reduced functional outcomes in female MoM patients.
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| 11. |
- Makela, K. T., et al.
(författare)
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The benefits of collaboration: the Nordic Arthroplasty Register Association
- 2019
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Ingår i: Efort Open Reviews. - : Bioscientifica. - 2058-5241 .- 2396-7544. ; 4:6, s. 391-400
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Tidskriftsartikel (refereegranskat)abstract
- The Nordic Arthroplasty Register Association (NARA) was established in 2007 by arthroplasty register representatives from Sweden, Norway and Denmark with the overall aim to improve the quality of research and thereby enhance the possibility for quality improvement with arthroplasty surgery. Finland joined the NARA collaboration in 2010. NARA minimal hip, knee and shoulder datasets were created with variables that all countries can deliver. They are dynamic datasets, currently with 25 variables for hip arthroplasty, 20 for knee arthroplasty and 20 for shoulder arthroplasty. NARA has published statistical guidelines for the analysis of arthroplasty register data. The association is continuously working on the improvement of statistical methods and the application of new ones. There are 31 published peer-reviewed papers based on the NARA databases and 20 ongoing projects in different phases. Several NARA publications have significantly affected clinical practice. For example, metal-on-metal total hip arthroplasty and resurfacing arthroplasty have been abandoned due to increased revision risk based on i.a. NARA reports. Further, the use of uncemented total hip arthroplasty in elderly patients has decreased significantly, especially in Finland, based on the NARA data. The NARA collaboration has been successful because the countries were able to agree on a common dataset and variable definitions. The collaboration was also successful because the group was able to initiate a number of research projects and provide answers to clinically relevant questions. A number of specific goals, set up in 2007, have been achieved and new one has emerged in the process.
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| 12. |
- Mikkelsen, R. T., et al.
(författare)
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Does choice of bearings influence the survival of cement-less total hip arthroplasty in patients aged 20-55 years? Comparison of 21,594 patients reported to the Nordic Arthroplasty Register Association dataset 2005-2017
- 2023
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Ingår i: Acta Orthopaedica. - 1745-3674. ; 94, s. 266-273
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - The bearings with the best survivorship for young patients with total hip arthroplasty (THA) should be identified. We compared hazard ratios (HR) of revision of primary stemmed cementless THAs with metal-on-metal (MoM), ceramic-on-ceramic (CoC), and ceramic-on-highly-crosslinked-polyethylene (CoXLP) with that of metal-on-highly-crosslinked-polyethylene (MoXLP) bearings in patients aged 20-55 years with primary osteoar-thritis or childhood hip disorders. Patients and methods - From the Nordic Arthroplasty Register Association dataset we included 1,813 MoM, 3,615 CoC, 5,947 CoXLP, and 10,219 MoXLP THA in patients operated on between 2005 and 2017 in a prospective cohort study. We used the Kaplan-Meier estimator for THA sur-vivorship and Cox regression to estimate HR of revision adjusted for confounders (including 95% confidence inter-vals [CI]). MoXLP was used as reference. HRs were calcu-lated during 3 intervals (0-2, 2-7, and 7-13 years) to meet the assumption of proportional hazards. Results - Median follow-up was 5 years for MoXLP, 10 years for MoM, 6 years for CoC, and 4 years for CoXLP. 13-year Kaplan-Meier survival estimates were 95% (CI 94-95) for MoXLP, 82% (CI 80-84) for MoM, 93% (CI 92-95) for CoC, and 93% (CI 92-94) for CoXLP bearings. MoM had higher 2-7 and 7-13 years' adjusted HRs of revi-sion (3.6, CI 2.3-5.7 and 4.1, CI 1.7-10). MoXLP, CoC, and CoXLP had similar HRs in all 3 periods. The 7-13-year adjusted HRs of revision of CoC and CoXLP were statisti-cally non-significantly higher. Conclusion - In young patients, MoXLP for primary cementless THA had higher revision-free survival and lower HR for revision than MoM bearings. Longer follow-up is needed to compare MoXLP, CoC, and CoXLP.
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| 13. |
- Rysinska, A., et al.
(författare)
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Aseptic loosening after total hip arthroplasty and the risk of cardiovascular disease: A nested case-control study
- 2018
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Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 13:11
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Tidskriftsartikel (refereegranskat)abstract
- Background Patients with surgically treated osteoarthritis of the hip have an increased risk of cardiovascular morbidity and mortality many years after the operation compared with controls. Our hypothesis is that this increased risk after total hip arthroplasty (THA) is mediated by development of periprosthetic osteolysis leading to aseptic loosening of the implant. Methods We conducted a nation-wide, nested, case-control study consisting of patients receiving a cemented THA due to osteoarthritis between the years 1992 and 2005. Our study population included a total of 14,430 subjects identified in the Swedish hip arthroplasty register and linked to the Swedish National Patient Register. The case group consisted of patients (n = 2,886) who underwent reoperation of the treated hip due to osteolysis or aseptic loosening at any time within five years after the index surgery. Each case was matched with four controls (n = 11,544) who had not undergone reoperation. The main outcomes were cardiovascular events i.e. myocardial infarction, heart failure and cerebral infarction according to ICD-codes and time to the first cardiovascular event during the exposure period. Outcomes were subgrouped into cardiac and cerebral events. We used regression models to calculate the incidence rates and adjusted our results for confounders. Findings Overall, 5.1% of patients had cardiac events, with slightly more overall cardiovascular events occurring in the control group (8.1% vs. 6.7%, odds ratio 0.8, 95% confidence interval (CI) 0.7 to 1.0). After adjusting for confounders, the case group had an increased relative risk of 1.3 (95% confidence interval (CI) 1.1 to 1.3) for total number of cardiovascular events. Similar effect sizes were observed for time to first event. Interpretation Patients with osteoarthritis who received THA and subsequently underwent a revision operation due to loosening had a higher relative risk of developing cardiovascular events than controls. Thus there is an association which could be explained by a common inflammatory disease pathway that requires further experimental research. Copyright: © 2018 Rysinska et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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| 14. |
- Silman, A. J., et al.
(författare)
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International variation in distribution of ASA class in patients undergoing total hip arthroplasty and its influence on mortality: data from an international consortium of arthroplasty registries
- 2021
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 92:3, s. 304-310
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - A challenge comparing outcomes from total hip arthroplasty between countries is variation in preoperative characteristics, particularly comorbidity. Therefore, we investigated between-country variation in comorbidity in patients based on ASA class distribution, and determined any variation of ASA class to mortality risk between countries. Patients and methods - All arthroplasty registries collecting ASA class and mortality data in patients with elective primary THAs performed 2012-2016 were identified. Survival analyses of the influence of ASA class on 1-year mortality were performed by individual registries, followed by meta-analysis of aggregated data. Results - 6 national registries and 1 US healthcare organization registry with 418,916 THAs were included. There was substantial variation in the proportion of ASA class III/IV, ranging from 14% in the Netherlands to 39% in Finland. Overall, 1-year mortality was 0.93% (95% CI 0.87-1.01) and increased from 0.2% in ASA class I to 8.9% in class IV. The association between ASA class and mortality measured by hazard ratios (HR) was strong in all registries even after adjustment for age and sex, which reduced them by half in all registries. Combined adjusted HRs were 2.0, 6.1, and 22 for ASA class II-IV vs. I, respectively. Associations were moderately heterogeneous across registries. Interpretation - We observed large variation in ASA class distribution between registries, possibly explained by differences in background morbidity and/or international variation in access to surgery. The similar, strong mortality trends by ASA class between countries enhance the relevance of its use as an indicator of comorbidity in international registry studies.
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| 15. |
- Varnum, C., et al.
(författare)
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Impact of hip arthroplasty registers on orthopaedic practice and perspectives for the future
- 2019
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Ingår i: Efort Open Reviews. - : Bioscientifica. - 2058-5241 .- 2396-7544. ; 4:6, s. 368-376
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Tidskriftsartikel (refereegranskat)abstract
- Total hip arthroplasty (THA) registers are established in several countries to collect data aiming to improve the results after THA. Monitoring of adverse outcomes after THA has focused mainly on revision surgery, but patient-reported outcomes have also been investigated. Several surgery-related factors influencing the survival of the THA have been thoroughly investigated and have changed clinical practice. These factors include surgical approach, specific implants, the size of the components, type of fixation and different bone cements. Register data have been used to examine the risk of venous thromboembolism and bleeding after THA. These investigations have resulted in shorter duration of thromboprophylaxis and a reduced frequency of blood transfusion. Registers may provide specific information to surgeons on the outcome of all THAs that they have performed with a detailed analysis of revisions rates and reasons for the revisions. A number of other stakeholders can use register data to provide benchmarks. The National Joint Registry for England, Wales, Northern Ireland and the Isle of Man supplies data to the Orthopaedic Device Evaluation Panel (ODEP), which provides benchmarks at 3, 5, 7, 10, and 13 years graded from A*, A, B and C. Future perspectives: National registers have to play a major role in documenting the quality of THA in order to describe best practice and report implant outliers. The registers have to be used for research and post-market surveillance and register data may be a source for intelligent decision tools.
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