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| 2. |
- Olivecrona, H, et al.
(författare)
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Stability of acetabular axis after total hip arthroplasty, repeatability using CT and a semiautomated program for volume fusion
- 2003
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Ingår i: Acta radiologica (Stockholm, Sweden : 1987). - : SAGE Publications. - 0284-1851 .- 1600-0455. ; 44:6, s. 653-661
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To validate a CT method for detecting changes in acetabular cup orientation after THA Material and Methods: 26 CT examinations were obtained from a pelvic model with an uncemented acetabular cup. The model position was altered between acquisitions, but the cup axis angle vis-à-visthe pelvis was maintained. Data sets were combined into 37 pairs, each containing a unique positioning error. The pelvi in different examinations were fused, creating transformed volumes. Landmarks corresponding to the cup before and after fusion were placed interactively by two independent examiners. The orientation of the acetabular axis was calculated for each volume and compared across volumes. Results: Before fusion the mean angle error between the acetabular axes was 4.17° (SD ± 1.95°). After fusion the mean angle error was 0.36° (SD ± 0.17). The 95% repeatability limits were below 0.7°. There was no significant interobserver difference. Analysis of the cup landmarking pattern by condition numbers and individual landmark errors showed stability. Conclusion: Non-invasive fusion of CT volumes and a stable landmarking pattern for the acetabular cup outperforms routine plain radiography in detecting changes in the orientation of the acetabular axis over time. The method delivers both visual and numerical output and could be used in clinical practice.
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| 5. |
- Akermark, C, et al.
(författare)
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A prospective randomized controlled trial of plantar versus dorsal incisions for operative treatment of primary Morton's neuroma
- 2013
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Ingår i: Foot & ankle international. - : SAGE Publications. - 1071-1007 .- 1944-7876. ; 34:9, s. 1198-1204
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Tidskriftsartikel (refereegranskat)abstract
- There are a great number of studies on the outcome of surgery for Morton’s neuroma. However, there is a lack of controlled trials to determine the outcome in general and for the 2 most used surgical approaches. This prospective and randomized trial studied the outcome and adverse events of resected primary Morton’s neuromas, comparing plantar and dorsal incisions. Methods: Seventy-six patients were randomized to treatment with either a plantar or a dorsal incision by 2 senior surgeons. Questionnaires were evaluated and physical examinations performed at baseline and at 3 and 12 months postoperatively by the treating surgeon and at a mean of 34 months (range, 28-42 months) by an independent surgeon. The follow-up rate was 93%. Results: Histological examination of specimens verified resection of nerves in all cases except 1, which was in the dorsal group (artery). The main outcome variable, pain at daily activities, was significantly reduced by 96% (plantar) and 97% (dorsal) and restrictions in daily activities were reduced by 77% (plantar) and 67% (dorsal) at the final follow-up. Scar tenderness was noted by 3% (plantar) and 0% (dorsal) at the final evaluation. Clinically good results with surgery were noted in 87% (plantar) and 83% (dorsal) of cases. There were 5 complications in the plantar group and 6 in the dorsal group, with a difference in type of complications. Conclusions: This study demonstrated 87% (plantar) and 83% (dorsal) clinically good outcomes and no significant differences between the procedures in regard to pain, restrictions in daily activities, and scar tenderness. However, there was a difference between the groups in the type of complications. Level of Evidence: Level I, prospective randomized trial.
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| 11. |
- Carlsson, Lars, 1952, et al.
(författare)
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Bone conserving hip replacement.
- 2004
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Ingår i: 3rd Annual SICOT/SIROT Conference 2004.
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Konferensbidrag (refereegranskat)
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| 12. |
- Carlsson, Lars, 1952, et al.
(författare)
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Stepwise introduction of a bone-conserving osseointegrated hip arthroplasty using RSA and a randomized study: II. Clinical proof of concept--40 patients followed for 2 years
- 2006
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 77:4, s. 559-566
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: We have developed a bone-conserving commercially pure titanium hip replacement system using osseointegration principles: a metaphyseal loading proximal femoral component affixing into the retained neck and metaphysis only, leaving the femoral canal untouched. The acetabular cup closely fits a dual-geometry cavity, avoiding stress protection at the dome. PATIENTS AND METHODS: After extensive laboratory and clinical pilot trial investigations, the surface-engineered implants were submitted to a prospective randomized controlled clinical trial involving 40 patients (40 hips), in which they were compared to the cemented Spectron femoral component and cementless Trilogy cup as control implant. The following clinical measures were used to monitor progress at regular intervals for the first 2 postoperative years: radiostereometric analysis (RSA), Harris Hip Score, pain score, WOMAC, and SF-36. RESULTS: After 2 years of follow-up, no statistically significant differences were seen between the groups concerning rotation or translation along the cardinal axes. The patients receiving the Gothenburg osseointegrated titanium (GOT) system had significantly higher Harris Hip Score at 6 months, suggesting more rapid recovery. WOMAC, SF-36 and pain analysis were similar for the first 2 postoperative years. INTERPRETATION: Our RSA data suggest that osseointegration was achieved for all patients receiving the GOT hip system. This bone-conserving prosthesis may provide a good alternative, especially for young and active patients.
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| 20. |
- Hyldahl, H., et al.
(författare)
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All-polyethylene vs. metal-backed tibial component in total knee arthroplasty-a randomized RSA study comparing early fixation of horizontally and completely cemented tibial components: part 1. Horizontally cemented components: AP better fixated than MB
- 2005
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Ingår i: Acta Orthop. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 76:6, s. 769-77
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Controversy still exists as to whether to mount the tibial bearing on a metal baseplate or not. Furthermore, the tibial component can be either horizontally or completely cemented. We evaluated metal backing versus all-polyethylene using horizontal cementing technique. PATIENTS AND METHODS: We randomized 40 patients with knee arthrosis (40 knees) to 2 groups: cemented total knee arthroplasty (AGC, Biomet) using either all-polyethylene (AP) or metal-backed (MB) tibial components (n = 20 for each group). All tibial implants had a total thickness of 8 mm. We used proximal cement-ing, including only the horizontal part of the tibia with avoidance of the stem-bone interface. RESULTS: The positioning of the implants, as judged by the HKA angle, showed an average neutral alignment in both groups. Preoperatively and after 2 years, there was no statistically significant difference between the HSS scores in both groups (p = 0.6 and 0.4). After 2 years, the metal-backed components had rotated more around the longitudinal axis, median 0.5 degrees vs. 0.2 degrees (internal or external rotation, p = 0.002), and showed increased maximum total point motion, median 1.0 vs. 0.4 mm (maximum migration or MTPM, p = 0.003). INTERPRETATION: Our study indicates that better fixation can be obtained with the all-polyethylene design if proximally cemented thin components are used.
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| 21. |
- Hyldahl, H., et al.
(författare)
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All-polyethylene vs. metal-backed tibial component in total knee arthroplasty-a randomized RSA study comparing early fixation of horizontally and completely cemented tibial components: part 2. Completely cemented components: MB not superior to AP components
- 2005
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Ingår i: Acta Orthop. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 76:6, s. 778-84
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Uncertainty exists as to whether metal backing (MB) of the tibial component is better than an all-polyethylene component (AP). This is valid for both horizontally and completely cemented components. We evaluated completely cemented MB vs. AP (Part 2). PATIENTS AND METHODS: In a randomized study, 39 patients (40 knees) with knee arthrosis were operated with cemented low-conforming total knee arthroplasty (AGC, Biomet) with a tibial component of uniform thickness (8 mm), cemented both beneath the tibial tray and around the stem. 20 patients had an all-polyethylene (AP) tibial component and 20 patients had an identical but metal-backed (MB) tibial component. We used clinical examination and radiostereometric analysis (RSA) to evaluate the hypothesis that MB improves component fixation. Fixation was evaluated using RSA up to 2 years after surgery. Clinical assessment was performed preoperatively and after 2 years using the Hospital for Special Surgeons (HSS) score. RESULTS: We found no differences in micromotion, and no differences in clinical scores could be detected between the groups at any time point. INTERPRETATION: Our findings indicate that there was equal initial fixation of the AP and MB stemmed monobloc components when they were cemented beneath the tibial plateau and around the stem.
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| 22. |
- Jacobson, E, et al.
(författare)
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Knee arthroscopy with the use of local anesthesia--an increased risk for repeat arthroscopy? A prospective, randomized study with a six-month follow-up
- 2002
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Ingår i: The American journal of sports medicine. - : SAGE Publications. - 0363-5465 .- 1552-3365. ; 30:1, s. 61-65
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Tidskriftsartikel (refereegranskat)abstract
- Although there have been many reports of good results when local anesthesia is used with knee arthroscopy, it is not used as a standard anesthetic. Concerns about local anesthesia include the fear of prolonged surgery, which could result in inadequate anesthesia, thus causing the patient unnecessary discomfort. The purpose of this study was to evaluate the risk of repeat arthroscopy and the patient satisfaction rate up to 6 months after knee arthroscopy under local anesthesia. In this prospective, randomized study, 400 patients scheduled for elective knee arthroscopy were allocated to one of three groups: local anesthesia (200 patients), spinal anesthesia (100 patients), or general anesthesia (100 patients). All enrolled patients were asked to complete a questionnaire 6 months after surgery and all of their medical records were reviewed. No repeat arthroscopies occurred in the spinal and general anesthesia groups and only three occurred in the local anesthesia group, a nonsignificant difference. In only one of these three cases was the clinical course altered by the repeat arthroscopy. There was no difference in the satisfaction rate between the three anesthesia groups. We conclude that the choice of anesthesia does not influence the frequency of repeat arthroscopy, satisfaction with the procedure, or recovery at 6 months after knee arthroscopy.
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| 25. |
- Mikhail, W. E., et al.
(författare)
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Complex cemented revision using polished stem and morselized allograft. Minimum 5-years' follow-up
- 1999
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Ingår i: Archives of Orthopaedic and Trauma Surgery. - New York, USA : Springer-Verlag New York. - 0936-8051 .- 1434-3916. ; 119:5-6, s. 288-291
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate the results of complex hip revision using a cemented, collarless and polished femoral stem design (CPT, Zimmer, Warsaw, In.) within a tightly impacted morselized allograft. We have now been using the impaction grafting technique in combination with the CPT stem (Zimmer) for 10 years in complex cases of severe bone loss. In this study we have elected to report only those patients who have been revised at least once before revision using the impaction grafting technique. All the patients in the study group have a minimum follow-up of 5 years after the impaction grafting revision. In total, 43 consecutive hips in 40 patients, 22 men and 18 women, with a follow-up time of between 5 and 7 years are included in the study. The complications related to the revised hip consist of three early dislocations managed by closed reduction. Two patients suffered from periprosthetic fracture, both managed with plate osteosynthesis. Two cementless sockets were revised due to aseptic socket loosening. The Endoklinik rating of preoperative bone loss for the revised hips was 2 in 13 hips, 3 in 23 hips, and 4 in 7 hips. During the first year 29 stems subsided 2-4 mm within the cement mantle. In 8 cases, a subsidence of 5-9 mm was measured. The subsidence was nonprogressive, and no subsidence occurred after the 1st year. The Charnley, D'Aubigne, Postel scoring (maximum 6 points) for pain improved from 2.2 points preoperatively to 4.4 postoperatively, function from 2.3 to 4.3, and movement from 2.3 to 4.1. In conclusion, the concept of impaction grafting in THR revision in our study has so far proven to be successful with good clinical results at 5 years despite the relatively high early subsidence of the femoral component.
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| 26. |
- Mikhail, W. E., et al.
(författare)
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Femoral bone regeneration subsequent to impaction grafting during hip revision : histologic analysis of a human biopsy specimen
- 1999
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Ingår i: The Journal of Arthroplasty. - Philadelphia, USA : Elsevier. - 0883-5403 .- 1532-8406. ; 14:7, s. 849-953
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Tidskriftsartikel (refereegranskat)abstract
- Cemented revision with impaction grafting shows encouraging early clinical results; postoperative biopsy specimens taken from the proximal femur in humans have demonstrated viable trabecular and cortical bone. Human radiographic studies also illustrate density changes within the proximal femur, consistent with remodeling of bone-graft. In an animal experiment, bone incorporation was shown in the proximal femur, but graft lysis was reported around the distal portion of the implant. We report on a patient who sustained a traumatic femoral fracture at the level of the tip of the femoral component 27 months after revision with impaction grafting and a collarless polished taper stem. At the time of open reduction and internal fixation of the fracture, we obtained circumferential biopsy specimens from the fracture site. Three distinct zones could be identified histologically: i) an inner zone consisting of bone-cement, fibrous tissue, and partially necrotic trabeculae with evidence of bone remodeling; ii) a middle zone consisting of viable trabecular bone and probable neocortex formation with fewer particles of bone-cement; and iii) an outer zone with viable cortex. Fibrous tissue was present around some of the incorporating bone-graft fragments, but no continuous fibrous membrane was present. Cement particles were identified, but no polyethylene debris was found by light microscopy. Biopsy specimens from the distal aspect of the prosthesis may not reflect changes seen proximally, but based on the available tissue, this case illustrated histological evidence of bone-graft remodeling after impaction grafting. These results are consistent with our expectations based on radiographic findings and clinical results.
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| 27. |
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| 28. |
- Moström, EB, et al.
(författare)
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Long-term follow-up of nonoperatively and operatively treated acute primary patellar dislocation in skeletally immature patients
- 2014
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Ingår i: TheScientificWorldJournal. - : Hindawi Limited. - 1537-744X. ; 2014, s. 473281-
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Tidskriftsartikel (refereegranskat)abstract
- Purpose. The present study reports a long-term follow-up of acute primary patellar dislocation in patients with open physes. The purpose of the study was to evaluate knee function and recurrence rates after surgical and nonsurgical treatment of patellar dislocation.Methods. A total of 51 patients, including 29 girls and 22 boys, who were 9–14 years of age at the time of injury, were retrospectively evaluated. The minimum follow-up time was 5 years. Thigh muscle torque, range of motion, the squat test, the knee injury and osteoarthritis outcome score (KOOS), the Kujala score, and the recurrence rate were registered. Radiological predisposing factors at the time of injury were determined.Results. Quality of life and sports/recreation were the most affected subscales, according to KOOS, and a reduced Kujala score was also observed in all treatment groups. The surgically treated patients had a significantly lower recurrence rate. Those patients also exhibited reduced muscle performance, with a hamstring to quadriceps ratio (H/Q) of 1.03. The recurrence rate was not correlated with knee function.Conclusions. Patellar dislocation in children influences subjective knee function in the long term. Surgery appears to reduce the recurrence rate, but subjective knee function was not restored.
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| 29. |
- Moström, EB, et al.
(författare)
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T2 mapping and post-contrast T1 (dGEMRIC) of the patellar cartilage: 12-year follow-up after patellar stabilizing surgery in childhood
- 2017
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Ingår i: Acta radiologica open. - : SAGE Publications. - 2058-4601. ; 6:10, s. 2058460117738808-
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Tidskriftsartikel (refereegranskat)abstract
- Cartilage degeneration has been reported after recurrent patellar dislocation. However, effects of surgical stabilization in childhood have not yet been described.PurposeTo examine the cartilage quality in very young adults operated with a patellar stabilizing procedure due to recurrent patellar dislocation in childhood, and evaluate if cartilage quality correlates with clinical parameters and patient-reported outcomes.Material and MethodsSeventeen patients were investigated ≥ 5 years (mean = 11.6 years) after patellar stabilizing surgery in childhood. Pre-contrast T2 relaxation times were analyzed in four superficial and four deep patellar cartilage regions of both knees. Two hours after 0.2 mM/kg Gd-DTPA2i.v., post-contrast T1 (T1(Gd)) was analyzed in the same regions. Patient-reported outcomes (KOOS, Kujala, and Tegner scores) and recurrence rates were evaluated.ResultsComparing operated to healthy side, neither T2 nor dGEMRIC differed between the operated and the reference knee regarding the superficial half of the cartilage. In the deep half of the cartilage, T1(Gd) was shorter in the central part of the cartilage, whereas T2 was longer medially ( P < 0.05). A low score in the KOOS subscales Symptom and Sports & Recreation, was correlated to the degenerative changes detected by T1(Gd) (r = 0.5, P = 0.041).ConclusionIn general, our findings demonstrate good cartilage quality 12 years after patellar stabilizing surgery during childhood. The subtle changes in T2 and T1(Gd) in the deep cartilage layer may be a result of altered biomechanics, although very early degenerative changes cannot be excluded. The short T1(Gd) centrally may reflect lower glycosaminoglycan content, whereas the increase in T2 medially indicates increased cartilage hydration.
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| 32. |
- Sandgren, B., et al.
(författare)
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Assessment of wear and periacetabular osteolysis using dual energy computed tomography on a pig cadaver to identify the lowest acceptable radiation dose
- 2016
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Ingår i: Bone & Joint Research. - : BRITISH EDITORIAL SOC BONE JOINT SURGERY. - 2046-3758. ; 5:7, s. 307-313
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Computed tomography (CT) plays an important role in evaluating wear and periacetabular osteolysis (PAO) in total hip replacements. One concern with CT is the high radiation exposure since standard pelvic CT provides approximately 3.5 millisieverts (mSv) of radiation exposure, whereas a planar radiographic examination with three projections totals approximately 0.5 mSv. The objective of this study was to evaluate the lowest acceptable radiation dose for dual-energy CT (DECT) images when measuring wear and periacetabular osteolysis in uncemented metal components. Materials and Methods A porcine pelvis with bilateral uncemented hip prostheses and with known linear wear and acetabular bone defects was examined in a third-generation multidetector DECT scanner. The examinations were performed with four different radiation levels both with and without iterative reconstruction techniques. From the high and low peak kilo voltage acquisitions, polychrmoatic images were created together with virtual monochromatic images of energies 100 kiloelectron volts (keV) and 150 keV. Results We could assess wear and PAO while substantially lowering the effective radiation dose to 0.7 mSv for a total pelvic view with an accuracy of around 0.5 mm for linear wear and 2 mm to 3 mm for PAO. Conclusion CT for detection of prosthetic wear and PAO could be used with clinically acceptable accuracy at a radiation exposure level equal to plain radiographic exposures.
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| 33. |
- Sandgren, B, et al.
(författare)
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Risk factors for periacetabular osteolysis and wear in asymptomatic patients with uncemented total hip arthroplasties
- 2014
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Ingår i: TheScientificWorldJournal. - : Hindawi Limited. - 1537-744X. ; 2014, s. 905818-
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Tidskriftsartikel (refereegranskat)abstract
- Osteolysis is a silent disease leading to aseptic loosening. This has not been studied in a cohort of asymptomatic patients. The aim of this study was to detect factors that might be associated with the development of periacetabular osteolysis and wear around an uncemented cup. We assessed 206 patients with an uncemented cup, measuring wear and periacetabular osteolysis using computed tomography with a median follow-up of 10 years after surgery (range 7–14 years). EQ5D, pain from the hip, and satisfaction were assessed. The association between periacetabular osteolysis and wear, age, gender, activity, BMI, cup type, cup age, positioning of the cup, and surface coating was investigated with a proportional odds model. Wear and male gender were associated with an increased risk for periacetabular osteolysis. There was no association with periacetabular osteolysis for time from operation, patient age, UCLA Activity Score, liner thickness at time of operation, BMI, cup positioning, and type of implant. A thin liner at time of operation is correlated to increased wear. Linear wear rate was 0.18 mm/year and 46 of 206 patients had large periacetabular osteolysis. Asymptomatic patients with these implants should be followed up on a regular basis with a sensitive method such as CT in order to detect complications early.
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| 34. |
- Soop, M., et al.
(författare)
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Preoperative oral carbohydrate treatment attenuates endogenous glucose release 3 days after surgery
- 2004
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Ingår i: Clin Nutr. - Edinburgh, United Kingdom : Elsevier BV. - 0261-5614 .- 1532-1983. ; 23:4, s. 733-41
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND & AIMS: Postoperative metabolism is characterised by insulin resistance and a negative whole-body nitrogen balance. Preoperative carbohydrate treatment reduces insulin resistance in the first day after surgery. We hypothesised that preoperative oral carbohydrate treatment attenuates insulin resistance and improves whole-body nitrogen balance 3 days after surgery. METHODS: Fourteen patients undergoing total hip replacement were double-blindly randomised to preoperative oral carbohydrate treatment (12.5%, 800 + 400 ml, n = 8) or placebo (n = 6). Glucose kinetics (6,6-D2-glucose), substrate utilisation (indirect calorimetry) and insulin sensitivity (hyperinsulinaemic-euglycaemic clamp) were measured preoperatively and on the third day after surgery. Nitrogen losses were monitored for 3 days after surgery. Values are mean (SEM). Analysis of variance (ANOVA) statistics were used. RESULTS: Endogenous glucose release during insulin infusion increased after surgery in the placebo group. Preoperative carbohydrate treatment, as compared to placebo, significantly attenuated postoperative endogenous glucose release (0.69 (0.07) vs. 1.21 (0.13)mg kg(-1) x min(-1), P < 0.01), while whole-body glucose disposal and nitrogen balance were similar between groups. CONCLUSIONS: While insulin resistance in the first day after surgery has previously been characterised by reduced glucose disposal, enhanced endogenous glucose release was the main component of postoperative insulin resistance on the third postoperative day. Preoperative carbohydrate treatment attenuated endogenous glucose release on the third postoperative day.
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| 37. |
- Weidenhielm, L
(författare)
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Collarless, polished, tapered stem failure
- 2000
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Ingår i: JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME. - : Ovid Technologies (Wolters Kluwer Health). - 0021-9355. ; 82A:10, s. 1513-1513
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 44. |
- Wretenberg, Per, 1963-, et al.
(författare)
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Rising from a chair by a spring-loaded flap seat : a biomechanical analysis
- 1993
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Ingår i: Scandinavian Journal of Rehabilitation Medicine. - Oslo, Norway : Scandinavian University Press. - 0036-5505 .- 1940-2228. ; 25:4, s. 153-159
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Tidskriftsartikel (refereegranskat)abstract
- Nine healthy male subjects and 8 patients with unilateral knee osteoarthrosis were studied while rising from a chair with and without the aid of a spring-loaded flap seat. The seat force started at 216 N and decreased with increasing seat angle. Ground reaction forces and motion were recorded using a force plate and video. EMG of the left vastus lateralis muscle was recorded. The effort when rising was estimated by the Borg scale. The use of the flap seat reduced the mean peak knee moment for the healthy subjects from 73 to 41 Nm and for the patients from 55 to 33 Nm. The decreases were significant at a p < 0.001 level. The patients also reduced their hip moment significantly from 50 to 35 Nm (p < 0.005). The muscle activity in the vastus lateralis was also significantly lower when the flap seat was used (p < 0.005). When the theoretically maximal friction force between seat and subject was added, the effective seat force decreased more slowly, and the relation between its horizontal and vertical force components was more advantageous. The patients estimated greater effort reduction than the healthy subjects comparing the ordinary chair and the flap seat.Conclusion: a spring-loaded flap seat can reduce knee and hip load and can thus be useful for people with knee osteoarthrosis.
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