| 1. |
- Holmberg, Anna, et al.
(författare)
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75% success rate after open debridement, exchange of tibial insert, and antibiotics in knee prosthetic joint infections.
- 2015
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 86:4, s. 457-462
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Prosthetic joint infection (PJI) is a leading cause of early revision after total knee arthroplasty (TKA). Open debridement with exchange of tibial insert allows treatment of infection with retention of fixed components. We investigated the success rate of this procedure in the treatment of knee PJIs in a nationwide material, and determined whether the results were affected by microbiology, antibiotic treatment, or timing of debridement. Patients and methods - 145 primary TKAs revised for the first time, due to infection, with debridement and exchange of the tibial insert were identified in the Swedish Knee Arthroplasty Register (SKAR). Staphylococcus aureus was the most common pathogen (37%) followed by coagulase-negative staphylococci (CNS) (23%). Failure was defined as death before the end of antibiotic treatment, revision of major components due to infection, life-long antibiotic treatment, or chronic infection. Results - The overall healing rate was 75%. The type of infecting pathogen did not statistically significantly affect outcome. Staphylococcal infections treated without a combination of antibiotics including rifampin had a higher failure rate than those treated with rifampin (RR = 4, 95% CI: 2-10). In the 16 cases with more than 3 weeks of symptoms before treatment, the healing rate was 62%, as compared to 77% in the other cases (p = 0.2). The few patients with a revision model of prosthesis at primary operation had a high failure rate (5 of 8). Interpretation - Good results can be achieved by open debridement with exchange of tibial insert. It is important to use an antibiotic combination including rifampin in staphylococcal infections.
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| 2. |
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| 3. |
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| 4. |
- Atroshi, I, et al.
(författare)
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Quality of life after hip revision with impaction bone grafting on a par with that 4 years after primary cemented arthroplasty
- 2004
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Ingår i: Acta Orthopaedica Scandinavica. - : Medical Journals Sweden AB. - 0001-6470. ; 75:6, s. 677-683
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Tidskriftsartikel (refereegranskat)abstract
- Background There have been few studies evaluating patient-reported quality of life outcomes after hip revision with impaction bone grafting. Patients and methods The inclusion criteria were aseptic loosening after primary arthroplasty performed for osteoarthrosis, and first-time revision with impacted morselized allograft bone and cemented Exeter stem. During a 4-year period, 35 patients were eligible and all were included. The Nottingham Health Profile (NHP) was completed by the patients and the Charnley hip scores recorded by the examining surgeon preoperatively, after 6 months and yearly up to 4 years (28 patients) postoperatively. For comparison, 35 osteoarthrotic patients completed the NHP 4 years after cemented Exeter primary arthroplasty. Results At 4 years, the NHP scores for the revision patients did not differ significantly from those recorded in the primary arthroplasty group. Among the revision patients, mixed model analysis showed improvement in NHP pain (p < 0.001) and physical mobility scores (p = 0.002). The effect size at 4 years was large for pain (1.2) and moderate for physical mobility (0.6). The major improvement was recorded at 6 months, with no further substantial change observed. The correlations between the NHP and Charnley scores were weak or moderate (r, -0.15 to -0.67). Interpretation Hip revision with impaction bone grafting leads to substantially improved quality of life, similar to that 4 years after primary arthroplasty.
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| 5. |
- Borgas, Ylva, et al.
(författare)
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Anti-rheumatic treatment and prosthetic joint infection : An observational study in 494 elective hip and knee arthroplasties
- 2020
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Surgical site infections are more frequent among patients with rheumatic disease. To what extent this is related to immunosuppressive antirheumatic drugs is unclear, as is the value of discontinuing medication perioperatively. The aim of study was to assess the rate of surgical site infections after knee and hip replacement in patients with inflammatory joint disease, with an emphasis on periprosthetic joint infection, and to investigate the influence of treatment with disease-modifying antirheumatic drugs (DMARDs) in this regard. Methods: Data were collected from 494 primary elective hip (51.4%) and knee arthroplasties, along with demographic and medication data. The primary outcome was surgical site infection during the first year after surgery. Results: In 78% (n = 385) of the cases the patient used 1 to 3 disease-modifying antirheumatic drugs perioperatively. Thirty-two percent (n = 157) of patients used a TNF-alpha inhibitor. The rate of surgical site infection was 3.8% (n = 19). The rate of periprosthetic joint infection was 1.4% (n = 7), all of which occurred after knee arthroplasty. Periprosthetic joint infection occurred in only 1 patient medicating perioperatively with a TNF-alpha inhibitor. Conclusion: Surgical site infections were not associated with ongoing medication with disease-modifying antirheumatic drugs. Due to the low event rate this should be interpreted with caution, but our center will maintain its routine of continuing treatment with TNF-alpha inhibitors perioperatively.
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| 6. |
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| 7. |
- Ghanem, Elie, et al.
(författare)
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Wound management
- 2014
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Ingår i: Journal of Orthopaedic Research. - : Wiley. - 0736-0266. ; 32:SUPPL.1, s. 108-119
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Tidskriftsartikel (refereegranskat)
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| 8. |
- Ghanem, Elie, et al.
(författare)
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Wound management
- 2014
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Ingår i: Journal of Arthroplasty. - : Elsevier BV. - 0883-5403. ; 29:2 suppl., s. 84-92
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Tidskriftsartikel (refereegranskat)
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| 9. |
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| 10. |
- Jansson, Anna, et al.
(författare)
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Increased body fat content in horses alters metabolic and physiological exercise response, decreases performance, and increases locomotion asymmetry
- 2021
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Ingår i: Physiological Reports. - : Wiley. - 2051-817X. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- This study examined the effect of altered body weight (BW) and body fat content on exercise performance and recovery. Nine horses were divided into two groups, and changes in BW and fat content were induced by feeding a high (HA) or restricted (RA) energy allowance for 36 days in a cross-over design. In the last week of each treatment, BW and body condition score (BCS) were recorded, body fat percentage was estimated using ultrasound, and a standardized incremental treadmill exercise test (SET) and competition-like field test were performed (scored by judges blinded to treatments). Blood samples were collected, and heart rate (HR), rectal temperature (RT), and respiratory rate (RR) were also recorded. Objective locomotion analyses were performed before and after the field test. Body weight, body fat percentage, and BCS were higher (5-8%) in HA than in RA horses (p < 0.05). In SET, HA horses showed higher HR, plasma lactate concentration, RR, and RT than RA horses (p < 0.05), and lower VLa4, hematocrit (Hct), plasma glucose, and plasma NEFA concentrations (p < 0.05). Hct was also lower in HA horses in the field test, while RA horses showed higher scores (p < 0.05). After both tests, resting plasma lactate concentrations were reached faster in RA than in HA horses (p < 0.05). Objective locomotion asymmetry was higher in HA than in RA (p < 0.05). These results clearly show that increased BW and body fat content in horses lower physiological fitness in terms of VLa4, plasma lactate removal, Hct levels, plasma glucose availability and reduce true performance evaluated by blinded judges.
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| 11. |
- Jansson, Anna, et al.
(författare)
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Plasma insulin concentration increases linearly with body condition in Icelandic horses
- 2016
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Ingår i: Acta Veterinaria Scandinavica. - : Springer Science and Business Media LLC. - 0044-605X .- 1751-0147. ; 58
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Tidskriftsartikel (refereegranskat)abstract
- Background: This study investigated the variation in plasma insulin concentration (PIC) in a group of Icelandic horses in training, considered to be healthy and examined possible relationships between PIC and gender, age, body size, body condition score and management factors such as feed allowance and subjective level of fitness.Results: Plasma insulin concentration ranged from 0.2 to 13.9 mU/l, body condition score from 2.3 to 4.0 and concentrate allowance from 0 to 4 kg. There was a significant effect of concentrate allowance (P = 0.0007) and body condition score (P = 0.004) on PIC. For every 1 kg increase in the concentrate allowance, log-PIC increased by 0.26 mU/l. For every 1 unit increase in body condition score, log-PIC increased by 0.45 mU/l. There was no effect of hay allowance, level of fitness, transport time, body size and age on insulin concentration.Conclusion: Owners of Icelandic horses should be aware that increased body condition elevates PIC, and thereby potentially the risk of laminitis. However, in the group of horses studied, the concentrations were within the range considered normal.
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| 12. |
- Jonsson, Eythor Orn, et al.
(författare)
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Sjúkratilfelli. Sýking í gervilið í hné eftir endurteknar liðástungur
- 2016
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Ingår i: Laeknabladid. - : Laeknabladid/The Icelandic Medical Journal. - 0023-7213. ; 102:9, s. 6-393
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Forskningsöversikt (refereegranskat)abstract
- UNLABELLED: An 80-year old male presented with an infected knee replacement following repeated joint aspirations. They were carried out due to recurrent hemarthrosis resulting from an initially missed quadriceps tendon injury. The infection was eradicated first after arthrodesis. This case highlights that prosthetic joints are sensitive to infection, which once established can be difficult to eradicate. Careful consideration is necessary before aspirating prosthetic joints. Diagnosing quadriceps tendon injuries can be difficult and they must be included in the differential diagnosis of traumatic hemarthrosis. We review the initials steps in the diagnosis and management of periprosthetic joint infections.KEY WORDS: periprosthetic joint infection, total knee replacement, quadriceps tendon rupture, hemarthrosis, joint aspiration. Correspondence: Eythor Orn Jonsson, eythororn@gmail.com.
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| 13. |
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| 14. |
- Jonsson, Stefan, et al.
(författare)
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Identification of sequence variants influencing immunoglobulin levels
- 2017
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Ingår i: Nature Genetics. - : Springer Science and Business Media LLC. - 1546-1718 .- 1061-4036. ; 49:8, s. 1182-1191
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Tidskriftsartikel (refereegranskat)abstract
- Immunoglobulins are the effector molecules of the adaptive humoral immune system. In a genome-wide association study of 19,219 individuals, we found 38 new variants and replicated 5 known variants associating with IgA, IgG or IgM levels or with composite immunoglobulin traits, accounted for by 32 loci. Variants at these loci also affect the risk of autoimmune diseases and blood malignancies and influence blood cell development. Notable associations include a rare variant at RUNX3 decreasing IgA levels by shifting isoform proportions (rs188468174[C>T]: P = 8.3 × 10(-55), β = -0.90 s.d.), a rare in-frame deletion in FCGR2B abolishing IgG binding to the encoded receptor (p.Asn106del: P = 4.2 × 10(-8), β = 1.03 s.d.), four IGH locus variants influencing class switching, and ten new associations with the HLA region. Our results provide new insight into the regulation of humoral immunity.
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| 15. |
- Lazarinis, Stergios, et al.
(författare)
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Consensus document on prosthetic joint infections
- 2013
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 84:6, s. 507-508
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 16. |
- Lidgren, Lars, et al.
(författare)
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Infection of prosthetic joints.
- 2003
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Ingår i: Best Practice & Research: Clinical Rheumatology. - 1532-1770. ; 17:2, s. 209-218
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Tidskriftsartikel (refereegranskat)
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| 17. |
- Middleton, Anna, et al.
(författare)
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Global Public Perceptions of Genomic Data Sharing : What Shapes the Willingness to Donate DNA and Health Data?
- 2020
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Ingår i: American Journal of Human Genetics. - : Elsevier BV. - 0002-9297 .- 1537-6605. ; 107:4, s. 743-752
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Tidskriftsartikel (refereegranskat)abstract
- Analyzing genomic data across populations is central to understanding the role of genetic factors in health and disease. Successful data sharing relies on public support, which requires attention to whether people around the world are willing to donate their data that are then subsequently shared with others for research. However, studies of such public perceptions are geographically limited and do not enable comparison. This paper presents results from a very large public survey on attitudes toward genomic data sharing. Data from 36,268 individuals across 22 countries (gathered in 15 languages) are presented. In general, publics across the world do not appear to be aware of, nor familiar with, the concepts of DNA, genetics, and genomics. Willingness to donate one's DNA and health data for research is relatively low, and trust in the process of data's being shared with multiple users (e.g., doctors, researchers, governments) is also low. Participants were most willing to donate DNA or health information for research when the recipient was specified as a medical doctor and least willing to donate when the recipient was a for-profit researcher. Those who were familiar with genetics and who were trusting of the users asking for data were more likely to be willing to donate. However, less than half of participants trusted more than one potential user of data, although this varied across countries. Genetic information was not uniformly seen as different from other forms of health information, but there was an association between seeing genetic information as special in some way compared to other health data and increased willingness to donate. The global perspective provided by our "Your DNA, Your Say" study is valuable for informing the development of international policy and practice for sharing genomic data. It highlights that the research community not only needs to be worthy of trust by the public, but also urgent steps need to be taken to authentically communicate why genomic research is necessary and how data donation, and subsequent sharing, is integral to this.
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| 18. |
- Milne, Richard, et al.
(författare)
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Demonstrating trustworthiness when collecting and sharing genomic data : public views across 22 countries
- 2021
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Ingår i: Genome Medicine. - : Springer Science and Business Media LLC. - 1756-994X. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPublic trust is central to the collection of genomic and health data and the sustainability of genomic research. To merit trust, those involved in collecting and sharing data need to demonstrate they are trustworthy. However, it is unclear what measures are most likely to demonstrate this.MethodsWe analyse the ‘Your DNA, Your Say’ online survey of public perspectives on genomic data sharing including responses from 36,268 individuals across 22 low-, middle- and high-income countries, gathered in 15 languages. We examine how participants perceived the relative value of measures to demonstrate the trustworthiness of those using donated DNA and/or medical information. We examine between-country variation and present a consolidated ranking of measures.ResultsProviding transparent information about who will benefit from data access was the most important measure to increase trust, endorsed by more than 50% of participants across 20 of 22 countries. It was followed by the option to withdraw data and transparency about who is using data and why. Variation was found for the importance of measures, notably information about sanctions for misuse of data—endorsed by 5% in India but almost 60% in Japan. A clustering analysis suggests alignment between some countries in the assessment of specific measures, such as the UK and Canada, Spain and Mexico and Portugal and Brazil. China and Russia are less closely aligned with other countries in terms of the value of the measures presented.ConclusionsOur findings highlight the importance of transparency about data use and about the goals and potential benefits associated with data sharing, including to whom such benefits accrue. They show that members of the public value knowing what benefits accrue from the use of data. The study highlights the importance of locally sensitive measures to increase trust as genomic data sharing continues globally.
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| 19. |
- Milne, Richard, et al.
(författare)
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Return of genomic results does not motivate intent to participate in research for all: Perspectives across 22 countries
- 2022
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Ingår i: Genetics in Medicine. - : Elsevier BV. - 1098-3600 .- 1530-0366. ; 24:5, s. 1120-1129
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of this study was to determine how attitudes toward the return of genomic research results vary internationally. Methods: We analyzed the “Your DNA, Your Say” online survey of public perspectives on genomic data sharing including responses from 36,268 individuals across 22 low-, middle-, and high-income countries, and these were gathered in 15 languages. We analyzed how participants responded when asked whether return of results (RoR) would motivate their decision to donate DNA or health data. We examined variation across the study countries and compared the responses of participants from other countries with those from the United States, which has been the subject of the majority of research on return of genomic results to date. Results: There was substantial variation in the extent to which respondents reported being influenced by RoR. However, only respondents from Russia were more influenced than those from the United States, and respondents from 20 countries had lower odds of being partially or wholly influenced than those from the United States. Conclusion: There is substantial international variation in the extent to which the RoR may motivate people's intent to donate DNA or health data. The United States may not be a clear indicator of global attitudes. Participants’ preferences for return of genomic results globally should be considered.
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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. |
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| 22. |
- 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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| 23. |
- Robertsson, Otto, et al.
(författare)
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Higher risk of revision for infection using systemic clindamycin prophylaxis than with cloxacillin : A report from the Swedish Knee Arthroplasty Register on 78,000 primary total knee arthroplasties for osteoarthritis
- 2017
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 88:5, s. 562-567
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose — Clindamycin has not been compared with other antibiotics for prophylaxis in arthroplasty. Since 2009, the Swedish Knee Arthroplasty Register (SKAR) has been collecting information on the prophylactic antibiotic regime used at every individual operation. In Sweden, when there is allergy to penicillin, clindamycin has been the recommended alternative. We examined whether there were differences in the rate of revision due to infection depending on which antibiotic was used as systemic prophylaxis. Patients and methods — Patients who had a total knee arthroplasty (TKA) performed due to osteoarthritis (OA) during the years 2009–2015 were included in the study. Information on which antibiotic was used was available for 80,018 operations (55,530 patients). Survival statistics were used to calculate the rate of revision due to infection until the end of 2015, comparing the group of patients who received cloxacillin with those who received clindamycin as systemic prophylaxis. Results — Cloxacillin was used in 90% of the cases, clindamycin in 7%, and cephalosporins in 2%. The risk of being revised due to infection was higher when clindamycin was used than when cloxacillin was used (RR =1.5, 95% CI: 1.2–2.0; p = 0.001). There was no significant difference in the revision rate for other causes (p = 0.2). Interpretation — We advise that patients reporting allergic reaction to penicillin should have their allergic history explored. In the absence of a clear history of type-I allergic reaction (e.g. urticaria, anaphylaxis, or bronchospasm), we suggest the use of a third-generation cephalosporin instead of clindamycin as perioperative prophylaxis when undergoing a TKR. No recommendation can be given regarding patients with type-1 allergy.
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| 24. |
- Robertsson, Otto, et al.
(författare)
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Increased long-term mortality in patients less than 55 years old who have undergone knee replacement for osteoarthritis - Results from the Swedish knee arthroplasty register
- 2007
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Ingår i: Journal of Bone and Joint Surgery: British Volume. - 2044-5377. ; 89B:5, s. 599-603
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Tidskriftsartikel (refereegranskat)abstract
- Patients with osteoarthritis undergoing knee replacement have been reported to have an overall reduced mortality compared with that of the general population. This has been attributed to the selection of healthier patients for surgery. However, previous studies have had a maximum follow-up time of ten years. We have used information from the Swedish Knee Arthroplasty Register to study the mortality of a large national series of patients with total knee replacement for up to 28 years after surgery and compared their mortality with that of the normal population. In addition, for a subgroup of patients operated on between 1980 and 2002 we analysed their registered causes of death to determine if they differed from those expected. We found a reduced overall mortality during the first 12 post-operative years after which it increased and became significantly higher than that of the general population. Age-specific analysis indicated an inverse correlation between age and mortality, where the younger the patients were, the higher their mortality. The shift at 12 years was caused by a relative over-representation of younger patients with a longer follow-up. Analysis of specific causes of death showed a higher mortality for cardiovascular, gastrointestinal and urogenital diseases. The observation that early onset of osteoarthritis of the knee which has been treated by total knee replacement is linked to an increased mortality should be a reason for increased general awareness of health problems in these patients.
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| 25. |
- Stefansdottir, Anna, et al.
(författare)
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Bacterial colonization and resistance patterns in 133 patients undergoing a primary hip- or knee replacement in Southern Sweden.
- 2013
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 84:1, s. 87-91
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose Prosthetic joint infections can be caused by bacteria derived from the patient's skin. The aim of the study was: (1) to determine which bacteria colonize the nose and groin in patients planned for primary hip or knee arthroplasty, (2) to determine the antimicrobial resistance patterns, and (3) to monitor changes in bacterial colonization and resistance patterns connected to surgery. Patients and methods 2 weeks before scheduled primary hip or knee arthroplasty, culture samples were taken from the anterior nares and from the groin of 133 consecutive patients. At surgery, cloxacillin was given prophylactically and cement with gentamicin was used. 2 weeks after surgery, another set of samples were taken from 120 of these patients. Bacterial findings and resistance patterns were analyzed. Results Preoperatively, 95% of the patients had coagulase-negative staphylococci (CNS) in the groin and 77% in the nose. The proportion of patients with a methicillin-resistant CNS in the groin increased from 20% preoperatively to 50% postoperatively (p < 0.001), and the proportion of patients with a gentamicin-resistant CNS in the groin increased from 5% to 45% (p < 0.001). 28% of the patients had Staphylococcus aureus in the nose preoperatively, and 7% in the groin. Methicillin-resistant Staphylococcus aureus (MRSA) was found in the nose of 1 patient. Interpretation In southern Sweden, beta-lactams were effective against 99% of the Staphylococcus aureus strains and 80% of the CNS strains colonizing the patients undergoing primary hip or knee arthroplasty. Gentamicin protects against most CNS strains in cemented primary joint replacements.
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| 26. |
- Stefansdottir, Anna, et al.
(författare)
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Epidemiology of childhood injuries in Reykjavik 1974-1991
- 1997
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 15:1, s. 30-34
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To determine and analyse the incidence of childhood injuries in Reykjavik 1974-1991. DESIGN: Descriptive, retrospective study. SETTING: Reykjavik City district with a mean number of 88700 inhabitants, of which 23.4% were children under 15 years of age. SUBJECTS: All children 0-14 years old who came to the emergency department at Reykjavik City Hospital because of an injury. MAIN OUTCOME MEASURES: Number of injured children per 1000 children per year. RESULTS: 111726 cases were studied. The total incidence of injuries increased from 275 per 1000 children per year in 1974-76 to 327 in 1980-82, but it then decreased to 275 in 1989-91. The injury incidence for 0-4 years old decreased from 353 in 1980-82 to 259 in 1989-91. The injury incidence for children 5-9 years old was 249 in 1989-91. The injury incidence for children 10-14 years old increased from 235 in 1974-76 to 336 in 1980-82, and in 1989-91 it was 321. The incidence of hospital admissions was 7.6 per 1000 children per year, or 2.6%. The child accident mortality rate in Reykjavik from 1987-1991 was 6.5 per 100000 children per year. CONCLUSION: Childhood injuries in Reykjavik are far too many, and a major effort is needed to reduce their number.
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| 27. |
- Stefansdottir, Anna, et al.
(författare)
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Higher Early Mortality with Simultaneous Rather than Staged Bilateral TKAs Results From the Swedish Knee Arthroplasty Register
- 2008
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Ingår i: Clinical Orthopaedics and Related Research. - : Ovid Technologies (Wolters Kluwer Health). - 0009-921X. ; 466:12, s. 3066-3070
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Tidskriftsartikel (refereegranskat)abstract
- Patients with knee osteoarthritis (OA) often present with symptoms that warrant bilateral TKAs. There are potential benefits to operating on both knees on the same day, but the safety of simultaneous bilateral TKAs has been questioned. To evaluate whether there were any differences in 30-day mortality between patients having simultaneous bilateral TKAs and those having staged bilateral TKAs, we analyzed data from the Swedish Knee Arthroplasty Register and the Swedish Cause of Death Register. We included 48,931 patients with OA having 60,062 primary TKAs during 1985 to 2004; 1139 had surgery on both knees on the same day (simultaneous bilateral) and 3432 had surgery on both knees on two different occasions with less than 1 year between operations (staged bilateral). The 30-day mortality after simultaneous bilateral TKAs was 7.53 (confidence interval, 2.62-21.69) times higher than after the second of staged TKA and 3.77 (confidence interval, 2.04-6.98) times higher than after a primary unilateral TKA. Assuming the total risk for a staged procedure is twice that of a unilateral procedure, the risk of mortality within 30 days is 1.94 (confidence interval, 1.05-3.59) times higher with simultaneous than staged TKA. It is safer to operate on one knee at a time.
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| 28. |
- Stefansdottir, Anna, et al.
(författare)
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Inadequate timing of prophylactic antibiotics in orthopedic surgery. We can do better.
- 2009
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 80:6, s. 633-638
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: There are rising concerns about the frequency of infection after arthroplasty surgery. Prophylactic antibiotics are an important part of the preventive measures. As their effect is related to the timing of administration, it is important to follow how the routines with preoperative prophylactic antibiotics are working. METHODS: In 114 consecutive cases treated at our own university clinic in Lund during 2008, the time of administration of preoperative prophylactic antibiotic in relation to the start of surgery was recorded from a computerized operation report. In 291 other cases of primary total knee arthroplasty (TKA), randomly selected from the Swedish Knee Arthroplasty Register (SKAR), the type and dose of prophylactic antibiotic as well as the time of administration in relation to the inflation of a tourniquet and to the start of surgery was recorded from anesthetic records. RESULTS: 45% (95% CI: 36-54) of the patients operated in Lund and 57% (CI: 50-64) of the TKAs randomly selected from the SKAR received the preoperative antibiotic 15-45 min before the start of surgery. 53% (CI: 46-61) received antibiotics 15-45 min before inflation of a tourniquet. INTERPRETATION: The inadequate timing of prophylactic antibiotics indicates that the standards of strict antiseptic and aseptic routines in arthroplasty surgery are falling. The use of a simple checklist to ensure the surgical safety may be one way of reducing infections in arthroplasty surgery.
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| 29. |
- Stefansdottir, Anna, et al.
(författare)
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Microbiology of the infected knee arthroplasty: Report from the Swedish Knee Arthroplasty Register on 426 surgically revised cases.
- 2009
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Ingår i: Scandinavian Journal of Infectious Diseases. - : Informa UK Limited. - 1651-1980 .- 0036-5548. ; 41:11-12, s. 831-840
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Tidskriftsartikel (refereegranskat)abstract
- Surgically revised deep infected primary knee arthroplasties reported to the Swedish knee arthroplasty register during the years 1986-2000 were studied with respect to microbiology, antimicrobial susceptibility pattern and changes over time. In early, delayed and late infections, coagulase-negative staphylococci (CoNS) were most prevalent (105/299, 35.1%), and twice as common as Staphylococcus aureus (55/299, 18.4%). In haematogenous infections, S. aureus was the dominating pathogen (67/99, 67.7%), followed by streptococci and Gram-negative bacteria. Methicillin resistance was found in 1/84 tested isolates of S. aureus and 62/100 tested isolates of CoNS. During the study period, methicillin resistance among CoNS increased (p=0.002). Gentamicin resistance was found in 1/28 tested isolates of S. aureus and 19/29 tested CoNS isolates. A relative decrease in infections caused by S. aureus was observed, while enterococci increased. In empiric treatment of infected knee arthroplasty the type of infection should direct the choice of antibiotics. Awareness of the fact that most early infections are caused by CoNS can increase the chances of successful treatment with retained implant. Due to the high rate of gentamicin resistance among CoNS in infected knee arthroplasty, other antibiotics should be used in bone cement at revision.
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| 30. |
- 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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| 31. |
- Stefansdottir, Anna
(författare)
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The infected knee arthroplasty
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The Swedish Knee Arthroplasty Register (SKAR) was used to identify 478 cases that underwent a first-time revision with exchange or removal of the prosthesis due to infection during the years 1986–2000. 30% of the infections were diagnosed within 3 months from primary operation and two-thirds were diagnosed within 2 years. These cases frequently had a history of wound complication after the primary arthroplasty. Acute haematogenous infection accounted for 22% and was more common in rheumatoid than in osteoarthritic patients. The most common pathogen in cases infected within 2 years from the primary arthroplasty was coagulase-negative staphylococcus (CNS) and in acute haematogenous infections it was Staphylococcus aureus. Only 1 case of methicillin resistant S. aureus (MRSA) was found, while resistance to methicillin was common in CNS and increased during the study period. Two-stage revision arthroplasty was performed in 60% and one-stage in 9%. Almost 30% were treated with poorer functional alternatives, i.e. arthrodesis, extraction of the implant, or above-the-knee amputation. After a two-stage revision arthroplasty, only half of those with failure to eradicate infection were re-revised, the cumulative re-revision rate at 2 years being 9.4% and the cumulative rate of failure to eradicate infection being 17.8%. The only factor that predicted failure to eradicate infection after a one- and two-stage revision arthroplasty was a history of wound complication after the primary operation. In a separate study the timing of administration of the first dose of perioperative antibiotic prophylaxis was studied and was found to be suboptimal in 55% of the 114 cases studied at Lund University Hospital, and in 47% of 198 cases randomly selected from the SKAR. Awareness of the fact that most infections arise early, are associated with wound complications, and often caused by CNS should encourage use of judicious postoperative care to allow early diagnosis and adequate treatment. To improve the results of revision surgery it is recommended that the treatment is centralised to units where specialists in orthopaedics and infectious diseases are working in a team.
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| 32. |
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| 33. |
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| 34. |
- Stefánsdóttir, Gudrún, et al.
(författare)
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A comparison of a portable blood lactate analyser and laboratory plasma analysis of blood samples from exercised horses.
- 2012
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Ingår i: Comparative Exercise Physiology. - 1755-2540 .- 1755-2559. ; 8, s. 227-231
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Tidskriftsartikel (refereegranskat)abstract
- Quick, simple methods for blood lactate analysis could be helpful in evaluating xercise response in the field, but methods validated for analysis of blood collected after high intensity exercise in horses are scarce. The aim of the present study was to compare the results obtained using a commercial, portable blood lactate analyser with those from laboratory plasma analysis of blood samples from horses performing intensive exercise. Venous blood samples were collected from 220 horses within 5 min of performing exercise at a mean peak heart rate of 222 ±9 beats/min. The samples were kept chilled and analysed using portable analyser within 10 min of collection. Samples were also centrifuged and the plasma frozen (-20 °C) until analysed using an enzymatic and spectrophotometric laboratory lactate analysis. There was a significant (P<0.05) correlation (R=0.94) between the methods at portable analyser values <12.0 mmol/l, but at higher values there was no correlation. There was a significant effect of method (P<0.0001) and portable analyser values were 21% lower than plasma lactate concentrations in the range 2.0-12.0 mmol/l. It is concluded that the portable analysis correlated well to a laboratory plasma analysis at portable analyser values <12.0 mmol/l and that the portable analyser appears to be a safe method for lactate analysis during training conditions, when very high lactate concentrations are not expected. However, users should be aware that the results underestimate the corresponding plasma values by approximately 20%.
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| 35. |
- Stefánsdóttir, Gudrún, et al.
(författare)
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A comparison of the physiological response to tolt and trot in the Icelandic horse.
- 2015
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Ingår i: Journal of Animal Science. - : Oxford University Press (OUP). - 0021-8812 .- 1525-3163. ; 93, s. 3862-3870
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Tidskriftsartikel (refereegranskat)abstract
- This study compared the effect of ridden tolt and trot at 3 speeds on physiological responses in trained adult (15.3 +/- 1.6 yr) Icelandic horses. The experiment had a crossover design with 8 horses, 2 treatments (incremental exercise test in tolt and trot), and 2 riders. Each horse performed 2 tests per day (1 gait with 2 riders, minimum 4.5 h between) on 2 separate days, with 1 d of rest in between. The exercise test consisted of three 642-m phases at 3.0 m/s (Speed(3)), 4.0 m/s (Speed(4)), and 5.0 m/s (Speed(5)) and was performed outdoors on a 300-m oval gravel riding track in northern Iceland in May 2012. Heart rate (HR) was measured during warm-up, the exercise test, and after 5, 15, and 30 min of recovery. Blood samples were taken at rest, after warm-up, after each phase of the exercise test, and after 5, 15, and 30 min of recovery. Respiratory rate was counted for at least 15 s at rest, at the end of the exercise test, and at the end of the 30-min recovery, and rectal temperature was measured on these occasions. There were no differences in HR between tolt and trot at any time point (P > 0.05). At Speed3, hematocrit and plasma lactate concentration were greater (P < 0.05) in tolt (40% +/- 1%, 1.1 +/- 0.06 mmol/L) than in trot (39% +/- 1%; 0.9 +/- 0.06 mmol/L). There was a prolonged recovery of hematocrit and respiratory rate, a slower decrease in rectal temperature, and a tendency of a prolonged recovery of plasma lactate concentration (P = 0.0675) after tolt. In conclusion, there were only minor differences in physiological responses to tolt and trot in this selected group of experienced adult Icelandic horses and the biological and practical significance of the slightly elevated physiological responses to tolt and the slower recovery remains to be determined.
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| 36. |
- Stefánsdóttir, Gudrún, et al.
(författare)
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Physiological response to a breed evaluation field test in Icelandic horses
- 2014
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Ingår i: Animal. - 1751-7311 .- 1751-732X. ; 8, s. 431-439
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Tidskriftsartikel (refereegranskat)abstract
- This study examined the response in terms of heart rate (HR), respiratory rate (RR), haematocrit (Htc), rectal temperature (RT), and some plasma variables in Icelandic horses of different sexes and ages performing the riding assessment in a breed evaluation field test (BEFT). The study was conducted in Iceland on 266 horses (180 mares and 86 stallions, divided into four age groups; 4, 5, 6 and > 7 years old). RT and RR were recorded and blood samples were taken before the warm-up and after the riding assessment. Horse HR, velocity and distance were recorded during the warm-up, the riding assessment and a 5-min recovery period. The distance covered in the BEFT was 2.9 +/- 0.4 km (range: 1.8 to 3.8 km, n=248), the duration was 9:37 +/- 1:22 min:s (range: 5:07 to 15:32 min:s, n=260) and the average speed was 17.8 +/- 1.4 km/h (range: 13.2 to 21.3 km/h, n=248). Average HR was 184 +/- 13 b.p.m. (range: 138 to 210 b.p.m., n=102) and peak HR 224 +/- 9 b.p.m. (range: 195 to 238 b.p.m., n=102), and 36% of the BEFT was performed at HR > 200 b.p.m. Post-exercise plasma lactate concentration (Lac) was 18.0 +/- 6.5 mmol/l (range: 2.1 to 34.4 mmol/l, n=266), and there was an increase in total plasma protein, plasma creatine kinase and aspartate amino transferase concentration, as well as RR, RT and Htc. Stallions covered a longer total distance (in the warm-up and BEFT) (P<0.05), at a faster speed during BEFT (P<0.001) than mares and had higher Htc and lower HR and post-exercise Lac values. There were few effects of age, but the 4- and 5-year-old horses had lower Htc than older horses and 4-year-old horses had higher post-exercise RR than older horses, although they were ridden for a shorter distance, shorter duration and at lower peak velocity (P<0.1). The results showed that the riding assessment in the BEFT is a high-intensity exercise. The results also showed that aerobic fitness was higher in stallions and that age had a limited effect on the physiological response. It is suggested that these results should be used as a guide for the development of training programmes and fitness tests in Icelandic horses that would improve both performance and welfare of the horse.
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| 37. |
- Stefánsdóttir, Gudrún, et al.
(författare)
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Physiological response to an experimental 100 m flying pace race in Icelandic horses and effect of rider
- 2017
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Ingår i: Comparative Exercise Physiology. - 1755-2540 .- 1755-2559. ; 13, s. 205-215
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Tidskriftsartikel (refereegranskat)abstract
- This study evaluated the physiological response to an experimental 100 m flying pace race (EPR) in Icelandic horses with pace-competition experience, and whether there was an effect of rider. A cross-over design with nine horses and two riders was used. The EPR was performed twice (once with each rider) with four days of rest in-between. The EPR consisted of two runs (I and II), of which at least 100 m was in pace at full speed according to international competition rules. Plasma lactate concentration increased and was greater after pace run II than I (18.5 +/- 1.3 vs 11.9 +/- 0.7 mmol/l; P< 0.001). Heart rate was higher during pace run I than II (207 +/- 3 vs 205 +/- 3; P=0.02). Heart rate and Lact had not recovered 30 min post exercise but Hct was back to resting level after 30 min recovery. Speed did not differ between riders and pace runs (pooled mean +/- standard deviation of pace runs: 10.4 +/- 0.7 m/s, range 9.2-12.1 m/s) but HR and Lact were higher from warm-up and until 30 min recovery with rider 1 than 2 (P< 0.001). There was a negative correlation between post EPR Lact with rider 1 and previous best record (r(2)=0.72, P=0.032). To conclude, a 100 m flying pace race in the Icelandic horse is a high-intensity exercise and anaerobic metabolism is crucial for performance. The rider had an effect on the physiological response but it is unclear if it was due to body weight, riding style or both. The practical relevance of the differences observed between riders remains to be proven but our results indicate that they may have limited impact on single day competitions since the speed was the same with the two riders.
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| 38. |
- Stefánsdóttir, Gudrún, et al.
(författare)
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The effect of rider weight and additional weight in Icelandic horses in tölt: part I. Physiological responses
- 2017
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Ingår i: Animal. - 1751-7311 .- 1751-732X. ; 11, s. 1558-1566
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Tidskriftsartikel (refereegranskat)abstract
- This study examined the effect of increasing BW ratio (BWR) between rider and horse, in the BWR range common for Icelandic horses (20% to 35%), on heart rate (HR), plasma lactate concentration (Lac), BWR at Lac 4 mmol/l (W-4), breathing frequency (BF), rectal temperature (RT) and hematocrit (Hct) in Icelandic horses. In total, eight experienced school-horses were used in an incremental exercise test performed outdoors on an oval riding track and one rider rode all horses. The exercise test consisted of five phases (each 642 m) in tolt, a four-beat symmetrical gait, at a speed of 5.4 +/- 0.1 m/s (mean +/- SD), where BWR between rider (including saddle) and horse started at 20% (BWR20), was increased to 25% (BWR25), 30% (BWR30), and 35% (BWR35) and finally decreased to 20% (BWR20b). Between phases, the horses were stopped (similar to 5.5 min) to add lead weights to specially adjusted saddle bags and a vest on the rider. Heart rate was measured during warm-up, the exercise test and after 5, 15 and 30 min of recovery and blood samples were taken and BF recorded at rest, and at end of each of these aforementioned occasions. Rectal temperature was measured at rest, at end of the exercise test and after a 30-min recovery period. Body size and body condition score (BCS) were registered and a clinical examination performed on the day before the test and for 2 days after. Heart rate and BF increased linearly (P < 0.05) and Lac exponentially (P < 0.05) with increasing BWR. The W-4 was 22.7 +/- 4.3% (individual range 17.0% to 27.5%). There was a positive correlation between back BCS and W-4 (r = 0.75; P = 0.032), but no other correlations between body measurements and W-4 were found. Hematocrit was not affected by BWR (P>0.05), but negative correlations (P < 0.05) existed between body size measurements and Hct. While HR, Hct and BF recovered to values at rest within 30 min, Lac and RT did not. All horses had no clinical remarks on palpation and at walk 1 and 2 days after the test. In conclusion, increasing BWR from 20% to 35% resulted in increased HR, Lac, RT and BF responses in the test group of experienced adult Icelandic riding horses. The horses mainly worked aerobically until BWR reached 22.7%, but considerable individual differences (17.0% to 27.5%) existed that were not linked to horse size, but to back BCS.
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| 39. |
- Stefánsdóttir, Gudrún, et al.
(författare)
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The effect of rider weight and additional weight in Icelandic horses in tölt: part II. Stride parameters responses
- 2017
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Ingår i: Animal. - 1751-7311 .- 1751-732X. ; 11, s. 1567-1572
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Tidskriftsartikel (refereegranskat)abstract
- This study investigated the effects of rider weight in the BW ratio (BWR) range common for Icelandic horses (20% to 35%), on stride parameters in tolt in Icelandic horses. The kinematics of eight experienced Icelandic school horses were measured during an incremental exercise test using a high-speed camera (300 frames/s). Each horse performed five phases (642 m each) in tolt at a BWR between rider (including saddle) and horse starting at 20% (BWR20) and increasing to 25% (BWR25), 30% (BWR30), 35% (BWR35) and finally 20% (BWR20b) was repeated. One professional rider rode all horses and weight (lead) was added to saddle and rider as needed. For each phase, eight strides at speed of 5.5 m/s were analyzed for stride duration, stride frequency, stride length, duty factor (DF), lateral advanced placement, lateral advanced liftoff, unipedal support (UPS), bipedal support (BPS) and height of front leg action. Stride length became shorter (Y = 2.73-0.004x; P < 0.01) and more frequent (Y = 2.56+0.002x; P < 0.001) with added weight. Duty factor and BPS increased with increased BWR (P < 0.001), whereas UPS decreased (P < 0.001). Lateral advanced timing of limb placement and liftoff and height of front leg action were not affected by BWR (P > 0.05). In conclusion, increased BWR decreased stride length and increased DF proportionally to the same extent in all limbs, whereas BPS increased at the expense of decreased UPS. These changes can be expected to decrease tolt quality when subjectively evaluated according to the breeding goals for the Icelandic horse. However, beat, symmetry and height of front leg lifting were not affected by BWR.
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| 40. |
- Stefansdottir, Halla Steinunn, et al.
(creator_code:cre_t)
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H e (a) r
- 2018
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Konstnärligt arbete (övrigt vetenskapligt/konstnärligt)abstract
- Album with Nordic Affect (Halla Steinunn Stefánsdóttir, violin, Guðrún Hrund Harðardóttir, viola, Hanna Loftsdóttir, cello, Guðrún Óskarsdóttir, harpsichord). Works by Hildur Guðnadóttir, Halla Steinunn Stefánsdóttir, María Huld Markan Sigfúsdóttir, Mirjam Tally and Anna Thorvaldsóttir. Recording, mixing and mastering: Daniel Shores. Producer: Dan Merceruio. Recording technician: Allison Noah. Editing engineers: Dan Merceruio and Daniel Shores. Recording and mixing of He(a)r on the album: Halla Steinunn Stefánsdóttir at Inter Arts Center Studios. Performers Carina Ehrenholm, Angela Rawlings, Halla Steinunn Stefánsdóttir and Liv Kaastrup Vesterskov. Final mix and mastering: Daniel Shores. Photography on cover: Minna Kurjenluoma. David Oldfield on p. 5 in booklet. Graphic design: Caleb NeiExecutive producer: Collin J. Rae. Blu-ray authoring: Stefan Bock, MSM-Studio.
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| 41. |
- Stefansdottir, Halla Steinunn
(creator_code:cre_t)
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Performance of An Urban Archive as an English Garden at SPOR festival
- 2019
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Konstnärligt arbete (övrigt vetenskapligt/konstnärligt)abstract
- Premiere of An Urban Archive as an English Garden by Davíð Brynjar Franzson at the SPOR festival, Aarhus, Denmark. The work includes field recordings by Halla Steinunn Stefánsdóttir. The festival and choice of location was curated by Anna Berit Asp Christensen and Anne Marqvardsen.
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| 42. |
- Thompson, Olof, et al.
(författare)
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A population-based study on the treatment and outcome of enterococcal prosthetic joint infections. : A consecutive series of 55 cases.
- 2019
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Ingår i: Journal of Bone and Joint Infection. - : Copernicus GmbH. - 2206-3552. ; 4:6, s. 285-291
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Tidskriftsartikel (refereegranskat)abstract
- AIM Enterococci cause 2-11% of all prosthetic joint infections (PJI) and are generally considered difficult to treat. However, study-results are not consistent. In this study we present a population-based case series of 55 cases with enterococcal PJI, investigating treatment and outcome, as well as describing the affected patient population regarding demography and co-morbidities. METHODS We identified all enterococcal PJIs in the Region of Skåne, Sweden, during a five-year period (2011-2015) and reviewed the patients' medical records. RESULTS Fifty-five enterococcal PJIs were found. Enterococcus faecalis was the most frequently isolated species (84%), and poly-microbial infections were common (64%). Treatment with intention to cure was given to 43 (78%) cases. Debridement with retention of the implant and antibiotics (DAIR) was the most common surgical treatment strategy (71%), with a cure-rate of 72%. Overall cure-rate was 67%, and in cases where cure was intended, this was achieved in 80%. CONCLUSIONS When cure is aimed for, the prognosis for enterococcal PJI is not so poor, and DAIR treatment can provide adequate results in many cases.
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| 43. |
- Thompson, Olof, et al.
(författare)
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Increased short- and long-term mortality amongst patients with early periprosthetic knee joint infection
- 2022
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) is a severe complication in terms of disability, morbidity, and cost. We performed a study to investigate whether early PJI (within 90 days of primary TKA) is associated with increased mortality. Secondary aims were to compare mortality rates over time and between surgical treatment methods. Methods: Patients with suspected PJI were identified by linkage of the Swedish Knee Arthroplasty Register (SKAR) and the Swedish Prescribed Drug Register (SPDR) in 2007–2008 and 2012–2013. Medical records of patients receiving more than 4 weeks of continuous antibiotic therapy were subsequently reviewed to verify the PJI diagnosis. Information on mortality was obtained through the SKAR which is updated daily from the tax agency and patients with PJI were compared to patients without PJI. Results: Four hundred sixty-six patients were diagnosed with PJI within 90 days and compared to 40,362 patients without PJI. Mortality rates were significantly higher for PJI patients in both short- and long term: 2.6% vs. 0.8% at 1 year, 4.9% vs. 1.9% at 2 years, 15.7% vs. 7.1% at 5 years, and 38% vs. 21.4% at 10 years. The difference in mortality rate remained after adjusting for sex, age, diagnosis, and time period for surgery with Hazard Ratio 1.8 (95% CI:1.6–2.1). Mortality rates did not differ between time periods, and we found no correlation to surgical treatment. Conclusion: Patients with early PJI after primary TKA have an increased mortality rate compared to TKA patients without PJI. Improvements in surgical treatment strategy has not resulted in better survival. Long term difference in mortality rates indicates that PJI is not the sole reason for mortality suggesting a general frailty in PJI patients.
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| 44. |
- W-Dahl, Annette, et al.
(författare)
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Timing of preoperative antibiotics for knee arthroplasties : Improving the routines in Sweden
- 2011
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Ingår i: Patient Safety in Surgery. - : Springer Science and Business Media LLC. - 1754-9493. ; 5:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: A slight increase in revisions for infected joint arthroplasties has been observed in the Nordic countries since 2000 for which the reasons are unclear. However, in 2007 a Swedish study of the timing for prophylactic antibiotics in a random sample of knee arthroplasties found that only 57% of the patients had received the antibiotic during the optimal time interval 45-15 minutes before surgery. The purpose of the report was to evaluate the effect of measures taken to improve the timing of prophylactic antibiotics.Findings: Reporting this finding to surgeons at national meetings during 2008 the Swedish Knee Arthroplasty Register (SKAR) introduced a new report form from January 2009 including the time for administration of preoperative antibiotics. Furthermore, the WHO's surgical checklist was introduced during 2009 and a national project was started to reduce infections in arthroplasty surgery (PRISS). The effect of these measures was found to be positive showing that in 2009, 69% of the 12,707 primary knee arthroplasties were reported to have received the prophylaxis within the 45-15 min time interval and 79% of the first 7,000 knee arthroplasties in 2010. A survey concerning the use of the WHO checklist at Swedish hospitals showed that 73 of 75 clinics had introduced a surgical checklist.Conclusions: By registration and bringing back information to surgeons on the state of infection prophylaxis in combination with the introduction of the WHO checklist and the preventive work done by the PRISS project, the timing of preoperative prophylactic antibiotics in knee arthroplasty surgery was clearly improved.
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