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Sökning: WFRF:(Wretenberg Per)

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1.
  • Benoit, Daniel L, et al. (författare)
  • Effect of skin movement artifact on knee kinematics during gait and cutting motions measured in vivo
  • 2006
  • Ingår i: Gait & Posture. - : Elsevier. - 0966-6362 .- 1879-2219. ; 24:2, s. 152-164
  • Tidskriftsartikel (refereegranskat)abstract
    • Eight healthy male subjects had intra-cortical bone-pins inserted into the proximal tibia and distal femur. Three reflective markers were attached to each bone-pin and four reflective markers were mounted on the skin of the tibia and thigh, respectively. Roentgen-stereophotogrammetric analysis (RSA) was used to determine the anatomical reference frame of the tibia and femur. Knee joint motion was recorded during walking and cutting using infrared cameras sampling at 120Hz. The kinematics derived from the bone-pin markers were compared with that of the skin-markers. Average rotational errors of up to 4.4 degrees and 13.1 degrees and translational errors of up to 13.0 and 16.1mm were noted for the walk and cut, respectively. Although skin-marker derived kinematics could provide repeatable results this was not representative of the motion of the underlying bones. A standard error of measurement is proposed for the reporting of 3D knee joint kinematics.
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2.
  • Benoit, Daniel L, et al. (författare)
  • In vivo knee kinematics during gait reveals new rotation profiles and smaller translations
  • 2007
  • Ingår i: Clinical Orthopaedics and Related Research. - : Lippincott Williams & Wilkins. - 0009-921X .- 1528-1132. ; 454, s. 81-88
  • Tidskriftsartikel (refereegranskat)abstract
    • In order to identify abnormal or pathological motions associated with clinically relevant questions such as injury mechanisms or factors leading to joint degeneration, it is essential to determine the range of normal tibiofemoral motion of the healthy knee. In this study we measured in vivo 3D tibiofemoral motion of the knee during gait and characterized the nonsagittal plane rotations and translations in a group of six healthy young adults. The subjects were instrumented with markers placed on intracortical pins inserted into the tibia and femur as well as marker clusters placed on the skin of the thigh and shank. The secondary rotations and translation excursions of the knee were much smaller than those derived from skin markers and previously described in the literature. Also, for a given knee flexion angle, multiple combinations of transverse and frontal plane knee translation or rotation positions were found. This represents normal knee joint motions and ensemble averaging of gait data may mask this important subject-specific information.
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3.
  • Lundqvist, Eva, 1985- (författare)
  • Distal radius fractures AO type C : A clinical and radiographic investigation
  • 2022
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The function of the hand is of substantial importance, and injuries have an impact on daily life. Distal radius fracture (DRF) is the most common fracture among adults. The annual incidence is 26 per 10,000 inhabitants, and the incidence is increasing because of an aging population. There has been a shift from conservative and other operative treatments, toward volar plate fixation to restore the anatomy and improve results. Operative treatment is often considered for displaced and unstable fractures. The optimal choice of treatment and fixation is still debated. The aim of this thesis was to study results after internal fixation of DRF AO type C.Study I (retrospective study, n=74) assessed outcomes after combined plating (CP) of DRFs AO type C, with 1-year follow-up. CP restored the anatomy and achieved a good functional outcome. The radiographic outcome did not correspond to the clinical or functional outcome.Study II (prospective study, n=97) assessed the prevalence of post-traumatic arthritis (PA) following CP of DRFs AO type C. CP yielded a good clinical outcome 7 years postoperatively and the prevalence of PA was low (29%). The presence of PA did not correlate with fracture group, radio-graphic, clinical, or functional outcome. Study III (randomized controlled trial, n=147) assessed the radiographic and clinical outcome following surgical treatment of DRFs AO type C, comparing volar plating (VP) with CP. Fixation with VP yieldedthe same radiographic and functional results as CP, but with a lower frequency of complications in the VP group.Study IV (prospective pilot study, n=10) assessed fragment migration with CTMA (CT-based micromotion analysis) after osteosynthesis with VP after DRF AO type C. The CTMA technique indicated that variable angle volar locking plate fixation can yield and maintain a stable reduction of the fracture fragments. CT volume registration could be a valuable tool in the detailed assessment of fracture fragment migration following VP fixation of DRFs. 
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4.
  • Lundqvist, Eva, 1985-, et al. (författare)
  • Posttraumatic Arthritis After Combined Plating of Distal Radius Fractures AO Type C : A 7-Year Follow-up of 97 Cases
  • 2022
  • Ingår i: Hand (New York, N.Y.). - : Sage Publications. - 1558-9447 .- 1558-9455. ; :Sup. 1, s. 50S-59S
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Volar locking plate fixation is the most common method of operative fixation of distal radius fractures (DRFs). For more complex cases, combined plating is an option for stabilizing intra-articular fragments. The prevalence of posttraumatic arthritis (PA) after an intra-articular DRF, and its relation to patient-reported outcome measures (PROMs), remains unclear. The purpose of this study was to study the prevalence of PA and its correlation to clinical outcome measures.METHODS: We evaluated 97 consecutive patients with intra-articular DRF, operated with combined plating, 7 years postoperatively. The primary outcome measure was the prevalence of radiographic PA. Secondary outcome measures included visual analog scale (VAS) pain score, hand grip strength, wrist range of motion (ROM), Patient-Rated Wrist Evaluation (PRWE) score, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score. Radiographic examination was performed between 1 and 7 years postoperatively.RESULTS: The prevalence of PA was 29% at the 7-year follow-up. No correlation was found between PA and ROM, hand grip strength, PRWE, QuickDASH, VAS pain scores, or radiographic reduction. Median wrist ROM and grip strength were significantly inferior compared with the uninjured side. Hardware removal was performed in 51.5% of cases. There were 2 cases of tendon ruptures.CONCLUSIONS: Combined plating can yield a good clinical outcome 7 years postoperatively and a low prevalence of PA. The presence of PA did not correlate to clinical outcome measures or to the accuracy of anatomical reduction 1 year postoperatively. The frequency of tendon ruptures was acceptable, but the high frequency of hardware removal is a concern.
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5.
  • Lundqvist, Eva, 1985-, et al. (författare)
  • Volar Locking Plate Compared With Combined Plating of AO Type C Distal Radius Fractures : A Randomized Controlled Study of 150 Cases
  • 2022
  • Ingår i: Journal of Hand Surgery-American Volume. - : Elsevier. - 0363-5023 .- 1531-6564. ; 47:9, s. 813-822
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: The optimal way to stabilize intra-articular distal radius fractures is unclear despite recent advances in surgical management. Volar plating is the most common treatment but may not be sufficient for more complex intra-articular AO type C fractures. The purpose of this randomized controlled study was to evaluate the radiographic and clinical outcomes following surgical treatment of AO type C distal radius fractures, comparing volar with combined plating.METHODS: In this study, 150 patients were randomized to volar locking plate (n = 75) or combined plating (n = 75) following a distal radius fracture AO type C. The 1-year follow-up included radiographic outcome (Batra score), visual analog scale pain score, hand grip strength, wrist range of motion, Patient-Rated Wrist Evaluation score, and Quick Disabilities of the Arm, Shoulder, and Hand score.RESULTS: Overall, 147 patients (median age 61 years) completed the 1-year follow-up (73 patients with volar plate and 74 with combined plating). No difference was found in radiographic outcome between the treatment groups. The volar plate group had significantly better Patient-Rated Wrist Evaluation scores, Quick Disabilities of the Arm, Shoulder, and Hand scores, hand grip strength, visual analog scale scores during activity, and flexion, extension, ulnar and radial deviation than the combined plate group. Hardware removal was performed in 10% in the volar plate group and in 31% in the combined plate group. There was no postoperative infection in the volar plate group but 3 cases in the combined plate group.CONCLUSIONS: In patients with complex AO type C intra-articular fractures, volar and combined plating yielded the same radiographic result. The differences in Patient-Rated Wrist Evaluation and Quick Disabilities of the Arm, Shoulder, and Hand scores between the groups did not reach the thresholds for minimal clinically important differences, suggesting similar clinical outcome. The combined plating group had a considerably higher frequency of hardware removal and postoperative infections.TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.
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6.
  • Per-Henrik, Ågren, et al. (författare)
  • Factors affecting long-term treatment results of displaced intraarticular calcaneal fractures: a post hoc analysis of a prospective, randomized, controlled multicenter trial
  • 2014
  • Ingår i: Journal of Orthopaedic Trauma. - : Lippincott Williams & Wilkins. - 0890-5339 .- 1531-2291. ; 28:10, s. 564-568
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: To study the factors affecting long-term treatment results of displaced intraarticular calcaneal fractures (DIACFs). Design: A post hoc analysis. Settings: Tertiary care teaching hospitals. Patients: Eight to twelve years of results from a randomized controlled multicenter trial of operative versus nonoperative treatment (n = 56) were divided into 2 groups: the superior 50% results (n = 28) and the inferior 50% results (n = 28), regardless of the treatment given. The determinant of this division was a visual analog score for pain and function. Interventions: The operative treatment consists of open reduction and internal fixation, whereas the nonoperative treatment consists of nonweight bearing and early range of motion exercise. Main Outcome Measurements: A visual analog score for pain and function, the short-form 36 (SF-36) general health outcome questionnaire, the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scale, and Olerud-Molander score. We compared age, sex, fracture type (Sanders classification), treatment given, Böhler angle, residual articular surface step-off at healing, type of occupation, and injury insurance between the 2 groups. Results: Patients of the superior group had higher physical SF-36, AOFAS, and Olerud-Molander score than in the inferior group. Operative treatment, better Böhler angle and articular surface restoration, light labor/retirement, and absence of injury insurance were more common in the superior group. Age, sex, pretreatment Böhler angle, and fracture type were comparable in the superior and inferior groups. Conclusions: The decision making for definitive treatment of intraarticular calcaneal fractures is multifactorial with a spectrum of results and trends such as patient demographic features that should be considered in choosing the best treatment option.
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7.
  • Reiser, Daniel, 1972-, et al. (författare)
  • Clinical, Radiographic, and Patient-Perceived Outcome After Radial Hemi-Wrist Arthroplasty With a New Implant : 20 Cases With 5-Year Follow-up
  • 2024
  • Ingår i: Hand (New York, N.Y.). - : Sage Publications. - 1558-9447 .- 1558-9455. ; 19:5, s. 742-750
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Distal component loosening is a common mode of failure in total wrist arthroplasty (TWA). A radial hemi-wrist arthroplasty (RHWA) has the potential to avoid problems related to the distal component in TWA. The aim of this study is to investigate clinical outcomes following surgical treatment with a new RHWA design.METHODS: In this pilot study of 20 consecutive RHWAs, patients were assessed preoperatively and postoperatively for range of motion, grip strength, Visual Analog Scale (VAS) pain scores, and functional scoring using Patient-Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder, and Hand (DASH), and Canadian Occupational Performance Measure. Radiographs were analyzed at 12 months and 5 years (mean, 5.1 years) postoperatively.RESULTS: A total of 46 secondary surgeries were undertaken in 16 wrists, including 7 revisions. Another 6 patients are waiting for revision to radiocarpal arthrodesis. In non-revised patients, the DASH and PRWE scores improved, and wrist range of motion remained largely unchanged except for wrist flexion, which decreased. The VAS pain score during activity was reduced, and hand grip strength remained largely unchanged.CONCLUSIONS: The new implant resulted in improved functional scoring and improved VAS pain scores in non-revised patients, but many cases needed secondary surgery due to persistent pain. The high revision rate is a major concern, and further use of the implant in its current form cannot be recommended.
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8.
  • Reiser, Daniel, et al. (författare)
  • Total Wrist Arthroplasty With a New Design, 20 Cases With 8-Year Follow-Up
  • 2023
  • Ingår i: Journal of Hand Surgery-American Volume. - : Elsevier. - 0363-5023 .- 1531-6564.
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: Total wrist arthroplasty (TWA) is an established motion-preserving alternative to arthrodesis in the treatment of wrist arthritis, but post-TWA complications requiring additional surgery remain an issue. A new TWA design has been proposed. The purpose of this study was to report the outcome of a cohort study of 20 patients who underwent surgery using the new TWA design.METHODS: Patients were assessed before surgery and at 1, 2, and 8 years after surgery for visual analog scale (VAS) pain scores, wrist range of motion, hand grip strength, and patient-reported outcome measures (PROMs). Radiographic examination was conducted for evidence of prosthetic loosening. Reasons for revision were analyzed.RESULTS: In total, 24 reoperations were performed, including 12 revisions in 6 patients. Patient-reported outcome measures improved significantly at the 2-year follow-up compared with preoperative values. Hand grip strength, wrist extension, and VAS pain scores improved significantly at the 2-year follow-up. No radiographic loosening of the components was observed, but backing out of the carpal screws was noted in 16 of the 20 cases.CONCLUSIONS: The new TWA resulted in improved VAS pain scores, PROMs, wrist extension, and hand grip strength. The high frequency of reoperation is a concern, and modification of the implant is needed.TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
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9.
  • Sayed-Noor, Arkan S., et al. (författare)
  • Interobserver reliability and intraobserver reproducibility of three radiological classification systems for intra-articular calcaneal fractures
  • 2011
  • Ingår i: Foot & ankle international. - Seattle, USA : American Orthopaedic Foot & Ankle Society. - 1071-1007 .- 1944-7876. ; 32:9, s. 861-866
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The management of intra-articular calcaneal fractures is difficult. One aspect for successful management is the use of a reliable and reproducible fracture classification system (FCS). The purpose of this study was to evaluate the interobserver reliability and intraobserver reproducibility of Letournel, Sanders, and Zwipp classification systems on CT scan and the Bohler's angle measurement on plain X-ray. Furthermore, we studied if the addition of a CT scan to the plain X-ray influenced the evaluation of fracture extension to the calcaneocuboid joint.Methods: The CT scan and plain X-ray images of 51 intra-articular calcaneal fractures were evaluated two times by three observers (two radiologists and one orthopedic surgeon) within a 5-month interval. The interobserver reliability was measured using the Fleiss kappa while the intraobserver reproducibility was measured using the Cohen's kappa.Results: The mean kappa values for the interobserver reliability and intraobserver reproducibility of the Sanders classification were 0.25 and 0.39, respectively, of Zwipp classification were 0.24 and 0.16, respectively, while those of the Letournel classification were 0.50 and 0.42, respectively. For the Böhler's angle, the mean kappa values for the interobserver reliability and intraobserver reproducibility were 0.34 and 0.32, respectively. The addition of CT scan images to plain X-ray found a higher incidence of calcaneocuboid joint involvement.Conclusion: Clinicians should be aware of the limitation regarding the interobserver reliability and intraobserver reproducibility of the Letournel, Sanders and Zwipp classification systems for calcaneal fractures. Future studies should attempt to improve the present classification systems.
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10.
  • Svedmark, Per, et al. (författare)
  • Broken wings : common with the Hardinger plug
  • 2002
  • Ingår i: Acta Orthopaedica Scandinavica. - Oslo, Norway : Taylor & Francis. - 0001-6470. ; 73:4, s. 407-408
  • Tidskriftsartikel (refereegranskat)abstract
    • We used the Hardinger occluder plug in 51 consecutive total hip arthroplasties. In 34 hips, 1 or more of the 12 polyethylene wings fractured and could be washed out from the canal. As many as 7 wings were loose in 2 arthroplasties. Although numerous wings were broken, no failure occurred in occlusion. The placement of loose wings in the femoral canal was studied by cementing a Charnley prosthesis in a saw-bone prepared with loose wings. The model was cut into slices. We found that the plastic wings could come into contact with both the bone and prosthesis.
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11.
  • Weiss, Rüdiger J., et al. (författare)
  • Gait pattern in rheumatoid arthritis
  • 2008
  • Ingår i: Gait & Posture. - Clare, Ireland : Elsevier. - 0966-6362 .- 1879-2219. ; 28:2, s. 229-234
  • Tidskriftsartikel (refereegranskat)abstract
    • The purpose of this study was to analyse kinematic and kinetic gait changes in rheumatoid arthritis (RA) patients in comparison to healthy controls and to examine whether levels of functional disability (Health Assessment Questionnaire (HAQ)-scores) were associated with gait parameters. Using a three-dimensional motion analysis system, kinematic and kinetic gait parameters were measured in 50 RA patients and 37 healthy controls. There was a significant reduction in joint motions, joint moments and work in the RA cohort compared with healthy controls. The following joint motions were decreased: hip flexion-extension range (Delta6 degrees ), hip abduction (Delta4 degrees ), knee flexion-extension range (Delta8 degrees ) and ankle plantarflexion (Delta10 degrees ). The following joint moments were reduced: hip extensor (Delta0.30Nm/kg) and flexor (Delta0.20Nm/kg), knee extensor (Delta0.11Nm/kg) and flexor (Delta0.13Nm/kg), and ankle plantarflexor (Delta0.44Nm/kg). Work was lower in hip positive work (Delta0.07J/kg), knee negative work (Delta0.08J/kg) and ankle positive work (Delta0.15J/kg). Correlations were fair although significant between HAQ and hip flexion-extension range, hip abduction, knee flexion-extension range, hip abductor moment, stride length, step length and single support (r=-0.30 to -0.38, p<0.05). Our findings suggest that RA patients have overall less joint movement and specifically restricted joint moments and work across the large joints of the lower limbs during walking than healthy controls. There were only fair associations between levels of functional disability and gait parameters. The findings of this study help to improve the understanding how RA affects gait changes in the lower limbs.
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12.
  • Ågren, Per-Henrik, et al. (författare)
  • Post-traumatic in situ fusion after calcaneal fractures : a retrospective study with 7-28 years follow-up
  • 2015
  • Ingår i: Foot and Ankle Surgery. - Amsterdam, Netherlands : Elsevier. - 1268-7731 .- 1460-9584. ; 21:1, s. 56-59
  • Tidskriftsartikel (refereegranskat)abstract
    • Background In situ fusion as salvage operation after calcaneal fractures has been used. In this retrospective investigation, a group of in situ fused patients is analyzed with long-term follow-up.Methods: Twenty-nine patients with in situ single or multiple fusions performed between 1970 and 1990 were included. In 1998 these patients were examined with plain radiographs and computerized tomography (CT) scan of the affected foot. Also, a visual analogue score (VAS) for calcaneal fractures, short form health survey (SF-36), Olerud Molander score and American Orthopaedic Foot and Ankle society (AOFAS) hindfoot score were evaluated.Results: The plain radiographs and CT scan showed severe remaining deformities in these patients. The outcome parameters were generally poor and correlated to the degree of remaining deformity.Conclusions: Simple in situ fusion, without consideration of the deformity at hand, after a calcaneal fracture is not an adequate treatment and generally associated with poor outcome.
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13.
  • Affas, Fatin, et al. (författare)
  • Pain control after total knee arthroplasty : a randomized trial comparing local infiltration anesthesia and continuous femoral block
  • 2011
  • Ingår i: Acta Orthopaedica. - New York : Taylor & Francis. - 1745-3674 .- 1745-3682. ; 82:4, s. 441-447
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND AND PURPOSE: Pain after total knee arthroplasty (TKA) is usually severe, and epidural analgesia or femoral nerve block has been considered to be an effective pain treatment. Recently, local infiltration analgesia (LIA) has become increasingly popular but the outcome of this method regarding the analgesic effect has not been fully evaluated. We compared local infiltration analgesia and femoral block with regard to analgesia and morphine demand during the first 24 h after TKA.METHODS: 40 patients undergoing TKA under spinal anesthesia were randomized to receive femoral nerve block (group F) or peri- and intraarticular infiltration analgesia (group LIA) with a mixture containing ropivacaine, ketorolac, and epinephrine. All patients had access to intravenous patient-controlled analgesia (PCA) with morphine postoperatively. Pain intensity at rest and upon movement was assessed on a numeric rating scale (0-10) on an hourly basis over 24 h if the patients were awake.RESULTS: The average pain at rest was marginally lower with LIA (1.6) than with femoral block (2.2). Total morphine consumption per kg was similar between the 2 groups. Ancillary analysis revealed that 1 of 20 patients in the LIA group reported a pain intensity of > 7 upon movement, as compared to 7 out of 19 in the femoral block group (p = 0.04).INTERPRETATION: Both LIA and femoral block provide good analgesia after TKA. LIA may be considered to be superior to femoral block since it is cheaper and easier to perform.
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14.
  • Ahl, Rebecka, 1987-, et al. (författare)
  • A nationwide observational cohort study of the relationship between beta-blockade and survival after hip fracture surgery
  • 2022
  • Ingår i: European Journal of Trauma and Emergency Surgery. - : Urban und Vogel Medien und Medizin Verlagsgesellsc. - 1863-9933 .- 1863-9941. ; 48:2, s. 743-751
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: Despite advances in the care of hip fractures, this area of surgery is associated with high postoperative mortality. Downregulating circulating catecholamines, released as a response to traumatic injury and surgical trauma, is believed to reduce the risk of death in noncardiac surgical patients. This effect has not been studied in hip fractures. This study aims to assess whether survival benefits are gained by reducing the effects of the hyper-adrenergic state with beta-blocker therapy in patients undergoing emergency hip fracture surgery.METHODS: This is a retrospective nationwide observational cohort study. All adults [Formula: see text] 18 years were identified from the prospectively collected national quality register for hip fractures in Sweden during a 10-year period. Pathological fractures were excluded. The cohort was subdivided into beta-blocker users and non-users. Poisson regression with robust standard errors and adjustments for confounders was used to evaluate 30-day mortality.RESULTS: 134,915 patients were included of whom 38.9% had ongoing beta-blocker therapy at the time of surgery. Beta-blocker users were significantly older and less fit for surgery. Crude 30-day all-cause mortality was significantly increased in non-users (10.0% versus 3.7%, p < 0.001). Beta-blocker therapy resulted in a 72% relative risk reduction in 30-day all-cause mortality (incidence rate ratio 0.28, 95% CI 0.26-0.29, p < 0.001) and was independently associated with a reduction in deaths of cardiovascular, respiratory, and cerebrovascular origin and deaths due to sepsis or multiorgan failure.CONCLUSIONS: Beta-blockers are associated with significant survival benefits when undergoing emergency hip fracture surgery. Outlined results strongly encourage an interventional design to validate the observed relationship.
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15.
  • Al-Khalili, L, et al. (författare)
  • Human skeletal muscle cell differentiation is associated with changes in myogenic markers and enhanced insulin-mediated MAPK and PKB phosphorylation
  • 2004
  • Ingår i: Acta Physiologica Scandinavica. - : Wiley-Blackwell. - 0001-6772 .- 1365-201X. ; 180:4, s. 395-403
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM: We hypothesized that myogenic differentiation of HSMC would yield a more insulin responsive phenotype.METHODS: We assessed expression of several proteins involved in insulin action or myogenesis during differentiation of primary human skeletal muscle cultures (HSMC).RESULTS: Differentiation increased creatine kinase activity and expression of desmin and myocyte enhancer factor (MEF)2C. No change in expression was observed for big mitogen-activated protein kinase (BMK1/ERK5), MEF2A, insulin receptor (IR), hexokinase II, and IR substrates 1 and 2, while expression of glycogen synthase, extracellular signal-regulated kinase 1 and 2 (ERK1/2 MAP kinase) and the insulin responsive aminopeptidase increased after differentiation. In contrast to protein kinase B (PKB)a, expression of (PKB)b increased, with differentiation. Both basal and insulin-stimulated PI 3-kinase activity increased with differentiation. Insulin-mediated phosphorylation of PKB and ERK1/2 MAP kinase increased after differentiation.CONCLUSION: Components of the insulin-signalling machinery are expressed in myoblast and myotube HSMC; however, insulin responsiveness to PKB and ERK MAP kinase phosphorylation increases with differentiation.
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16.
  • Andjelkov, Nenad, et al. (författare)
  • Neuralgic and Nociceptive Pain in the Knee as a Cause of the Treatment Failure after Cartilage Repair Surgery : Two Case Reports
  • 2018
  • Ingår i: Journal of Pain & Relief. - : Omics Publishing Group. - 2167-0846. ; 7:4
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Cartilage injuries are one of the most frequent causes of knee pain. Other causes such as meniscus tears, synovial plica, synovitis, partial and total ligament ruptures are rather easy to identify by standard diagnostic methods and diagnostic arthroscopy. In this study we are describing two other clinical states, which could be the cause of the knee pain and should be addressed before a decision for operative treatment of cartilage injury has been made by a surgeon.Materials and Methods: Two patients with isolated focal defects due to previous trauma to the knee were diagnosed both using magnetic resonance imaging preoperatively and intraoperatively during arthroscopy. These were operated arthroscopically with standard procedure for micro fracture. Both patients had treatment failure without a sign of significant improvement after six and twelve months.Results: Second look arthroscopy was performed in both cases due to the treatment failure and close to normal cartilage was found in the patella in first case and both in trochlea and medial femoral condyle in other case. No other cause of pain could be identified both with second look arthroscopy and magnetic resonance imaging done 6-12 months postoperatively. The patients were diagnosed with neuralgic pain in one case, and nociceptive pain in other case.Conclusion: These states are rare, but have to be addressed by the surgeon before making the decision about the operative treatment. By doing so, one could avoid eventual treatment failure and exposition of the patient to an unnecessary risk of complications during the surgery.
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17.
  • Andjelkov, N., et al. (författare)
  • The enhancement of cartilage regeneration by use of a chitosan-based scaffold in a 3D model of microfracture in vitro : a pilot evaluation
  • 2021
  • Ingår i: Journal of experimental orthopaedics. - : Springer. - 2197-1153. ; 8:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: Even though various types of scaffolds have been used lately as a complement to microfracture, the exact mechanism of reported cartilage repair improvement when using scaffolds is still unclear. In this study, an effort has been made to identify the specific effects that scaffolds may have on the cells of reparation when using this technique.Methods: A 3‑D model in vitro, representing microfracture and containing both chondrocytes and bone marrow‑derived cells in different experimental conditions was made, and the cells were cultured for eight weeks. Subse‑quently, the constructs containing our 3‑D model were removed from the cell culture medium, fixed in paraffin and analyzed with immunohistochemistry.Results: Bone marrow – derived cells migrated to the upper compartment of the construct through a perforated nylon membrane containing both enzymatically digested‑ and non‑digested particulated cartilage. The histological sections were stained with hematoxylin, eosin, S‑100, SOX‑9, Gomori, and procollagen type I and II. When minced cartilage wasn’t pretreated with collagenase, exclusively bone‑derived cells have created new extracellular matrix as showed by the histological analysis.Conclusions: In this model of microfracture, bone‑derived cells but not chondrocytes have shown to have an active role in new cartilage formation without predigestion with collagenase. Moreover, it seems that the addition of a chitosan‑based scaffold may lead to the improvement of a new cartilage matrix synthesis and integration. This effect hasn’t been seen without the use of scaffold or when a fibrin‑ or a collagen‑based scaffold have been used.
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18.
  • Arborelius, U P, et al. (författare)
  • The effects of armrests and high seat heights on lower-limb joint load and muscular activity during sitting and rising
  • 1992
  • Ingår i: Ergonomics. - : Taylor & Francis. - 0014-0139 .- 1366-5847. ; 35:11, s. 1377-1391
  • Tidskriftsartikel (refereegranskat)abstract
    • The loading moment of force on the hip, knee, and ankle joints of nine healthy men rising from four different types of stools were compared, together with the levels of myoelectrical activity (EMG) in four leg muscles. Two types of stool (stand stools) had higher seats than a normal chair. The other two were of ordinary seat height, but one also had armrests. The bodyweight carried by the different stools when sitting was also measured, and the subject estimated the effort required for each trial. The mean maximum knee moment was over 60% lower when rising from the high stool than from 'ordinary' seat height. The difference between the high and low stand stool was also significant (p less than 0.001). Using the high stool or help of the arms reduced the mean maximum hip moment by about 50%. The mean maximum ankle moment was only marginally influenced by the different stools. Knee moment was influenced more by seat height than was hip moment. Vastus lateralis activity was significantly higher when subjects rose from 'ordinary' height than when rising from either stand stool (p less than 0.001). The rectus femoris muscle was little activated and the semitendinosus muscle was activated earlier when rising from higher seat heights. All subjects estimated the effort of rising from the higher stand stool to be lower than from the lower stand stool or from 'ordinary' height without arm rests. It was concluded that stand stools are good alternatives for workers who change frequently between sitting and standing work.
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19.
  • Bitar, C., et al. (författare)
  • 11-Year outcomes in patients with metal-on-metal ASR hip arthroplasty
  • 2022
  • Ingår i: Journal of Orthopaedics. - : Elsevier BV. - 0972-978X .- 2589-9082. ; 32, s. 98-103
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: We analysed the long-term revision rate, clinical outcomes and metal ion concentrations in blood over time in patients who had undergone metal-on metal Articular Surface Replacement (ASR) hip arthroplasty. Methods: A total of 38 patients (43 hips) were included: 24 patients (28 hips) underwent large-head total hip arthroplasty (XL THA), and 14 patients (15 hips) underwent hip resurfacing arthroplasty (HRA). The median follow-up time was 11 (range 7-12) years. Results: None of 15 HRA implants were revised. Nine of 28 XL THA implants (32%) in 8 patients were revised. The Co ion levels significantly increased in the XL THA group (p=0.009) over a median time period of 84 (25-97) months. Conclusion: The levels of Co ions in blood were higher in the patients who had undergone XL THA and increased significantly over time.
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20.
  • Bitar, C., et al. (författare)
  • Living with a recalled implant: a qualitative study of patients' experiences with ASR hip resurfacing arthroplasty
  • 2021
  • Ingår i: Patient Safety in Surgery. - : Springer Science and Business Media LLC. - 1754-9493. ; 15:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundTotal hip arthroplasty is the traditional treatment for osteoarthritis in the hip joint. Hip resurfacing arthroplasty, with metal on metal bearing, is a modern concept initially developed mainly for young active people. The metal-on-metal hip arthroplasty implant, Articular Surface Replacement (ASR), was implanted in approximately 93,000 patients before it was recalled in 2010 due to a high complication rate. This study aimed to evaluate patients' own experiences living with an implant that they knew had a high complication rate and had been recalled from the market.MethodsA total of 14 patients, still living with the implant, of a cohort of 34 patients were available for follow-up. Qualitative semi-structured interviews were conducted with 14 patients where a majority actively sought for metal-on-metal hip resurfacing arthroplasty (HRA), and subsequently underwent HRA with an ASR prosthesis between 11/21/2006 and 09/28/2009. The responses were analyzed using content analysis described by Graneheim and Lundman to compress text and identify categories and subcategories.ResultsThe results showed that most patients had already decided that they wanted a metal-on-metal HRA implant before meeting the surgeon. They expressed that the implant made it possible to live an active life. A majority did not think about the fact that they had a hip implant, because they lacked subjective pain. Most of the patients were positive about the annual exams at the hospital and wanted them to continue. None of them felt that their trust towards the healthcare system had changed after the implant recall. They expressed a belief that they would need new surgery sooner than they first thought.ConclusionsDespite all the attention when the ASR prosthesis was recalled, patients with ASR-HRA did not report themselves negatively affected by the recall in this group of patients where a majority had actively sought for an HRA procedure. The healthcare system has an obligation to continue the annual exams, even if the implant provider does not continue reimbursement.
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21.
  • Broström, E W, et al. (författare)
  • Change in Gait Deviation Index after anti-tumour necrosis factor-α treatment in individuals with rheumatoid arthritis : a pilot study
  • 2013
  • Ingår i: Scandinavian Journal of Rheumatology. - : Informa Healthcare. - 0300-9742 .- 1502-7732. ; 42:5, s. 356-361
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: Anti-tumour necrosis factor-alpha (TNF-α) inhibitors provide fast, effective resolution of rheumatoid arthritis (RA) inflammation. In this study we aimed to quantify the impact of TNF-α treatment on gait dynamics.METHOD: The sample comprised 16 subjects [11 female, median age 56 (range 48-66) years, median disease duration 9.5 (range 4.6-20.6) years] with RA who met the American College of Rheumatology (ACR) criteria, had lower extremity involvement, did not use walking aids, and had started TNF-α treatment within 1 week of baseline gait analysis. Gait analysis focused on three-dimensional (3D) lower extremity joint kinematics, kinetics, time and distance parameters. The Gait Deviation Index (GDI) and GDI-Kinetic were calculated. Data on gait, disease activity, and physical disability were collected at baseline and at 3.5 months.RESULTS: Following treatment with TNF-α, statistically significant improvements were found in disease activity [using the 28-joint Disease Activity Score based on C-reactive protein (DAS28-CRP); median difference (m(d)) = 2.3, p < 0.01], physical disability [Health Assessment Questionnaire (HAQ) m(d) = 0.4, p < 0.01], and pain during walking [visual analogue scale (VAS) m(d) = 11.0, p < 0.05]. Reductions in gait deviations were noted (GDI m(d) = 3.7, p = 0.04; GDI-Kinetic m(d) = 4.1, p = 0.05) along with reductions in dimensionless time and distance parameters. A moderate to good negative correlation existed between baseline GDI and GDI change scores (r(s) = -0.7, p < 0.01).CONCLUSIONS: Treatment with TNF-α improved gait dynamics in adults with RA. Significant gait deviations were, however, still present after treatment. In this study, GDI and GDI-Kinetic scores appeared to be useful outcome measures to quantify changes in gait deviations after this intervention.
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22.
  • Brüggemann, Anders (författare)
  • Hip Revision Surgery : Identification of Genetic Markers and Evaluation of Novel Treatment Strategies
  • 2020
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Total hip arthroplasty (THA) is, despite its overall good outcome, for some patients followed by hip revision surgery. This seems in parts to be because of genetic susceptibility to revision surgery. The most common reason for revision surgery is aseptic loosening followed by periprosthetic joint infection and dislocation. Cups made of porous tantalum (TM cups) were thought to be favorable in revision surgery to address aseptic loosening, but they seem to confer an increased risk of dislocation. The effectiveness and biocompatibility in vivo of TM cups have not been researched. Dual mobility cups (DMCs) with two articulating surfaces are proposed to prevent dislocation to a higher degree than standard polyethylene liners.Our hypotheses were that TM cups are superior to their historical treatment alternative in terms of re-revision rates; that the combination of DMC cemented into TM cups would decrease the risk for dislocation after revision surgery; that tantalum ion liberation is marginal after the use of TM cups; and that certain risk genes are associated with an increased risk for revision surgery after total joint arthroplasty.Studies I&II were register-based cohort studies comparing the implant survival of TM cups and conventional acetabular reinforcement rings (study I), and the combination of TM cups/DMC with TM cups/standard polyethylene liners (study II). We found that TM cups perform equally well as reinforcement rings, but that the two implants differ in their failure mechanisms. Cementing a DMC into TM cups adequately addressed the issue of recurrent dislocation. In study III we investigated whether tantalum ion liberation does occur after implantation of a TM cups and how this affects patients’ immunological response by comparison of three groups: primary non-tantalum THA, primary tantalum THA and revision tantalum THA. We found the highest concentration of tantalum ions in the revision cases, yet tantalum ions were not associated with an immunological response, and we found no signs of alteration in the investigated lymphocyte subsets. Study IV aimed to identify possible risk genes for revision surgery after total hip or knee replacement by a genome wide association study. We found six significant risk genes for the endpoint revision surgery for any reason, and three for the endpoint revision due to aseptic loosening. We found a variety of suggestive risk genes within the region coding for the ABO-system.In conclusion, the novel treatment options TM cups and DMC show good results in hip revision surgery, but longer follow-up is warranted. The use of porous tantalum seems not to be associated with the immunological activation that can be observed in metallosis. The risk for revision surgery is associated with certain risk genes.
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23.
  • Burkard, Theresa, et al. (författare)
  • The associations between bariatric surgery and hip or knee arthroplasty, and hip or knee osteoarthritis : Propensity score-matched cohort studies
  • 2022
  • Ingår i: Osteoarthritis and cartilage open. - : Elsevier. - 2665-9131 .- 2665-9131. ; 4:2
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To investigate the associations between bariatric surgery and hip or knee arthroplasty, and secondary care hip or knee osteoarthritis (OA).METHODS: We performed cohort studies using data from Swedish nationwide healthcare registries. Patients aged 18-79 years who underwent bariatric surgery between 2006 and 2019 were matched on their propensity score (PS) to up to 2 obese patients ("unexposed episodes") in risk-set sampling. After a 1-year run-in period, episodes were followed in an "as-treated" approach. Using Cox proportional hazard regression, we calculated hazard ratios (HR) with 95% confidence intervals (CIs) of hip or knee arthroplasty overall and in subgroups of age, sex, joint location, arthroplasty type, bariatric surgery type, and by duration of follow-up if proportional hazard assumptions were violated. In a secondary cohort, we assessed the outcome incident secondary care hip or knee osteoarthritis (OA).RESULTS: Among 39'392 bariatric surgery episodes when compared to 61'085 ​PS-matched unexposed episodes (47'594 unique patients), the risk of hip or knee arthroplasty was strongest increased within the first three years of follow-up (HR 1.79, 95% CI 1.56-2.07), decreased thereafter, but remained elevated throughout follow-up. In a secondary cohort of 37'929 exposed when compared to 58'600 ​PS-matched unexposed episodes, the risk of hip or knee osteoarthritis was decreased (HR 0.84, 95% CI 0.79-0.90).CONCLUSION: Bariatric surgery is associated with increased risks of hip or knee arthroplasty, but also with decreased risks of secondary care OA. This contradiction supports the hypothesis that bariatric surgery may act as an enabler for hip or knee arthroplasty.
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24.
  • Edvinsson, Marie, et al. (författare)
  • No evidence of Chlamydia pneumoniae in the synovia of patients with osteoarthritis
  • 2019
  • Ingår i: Journal of international medical research. - : Sage Publications. - 0300-0605 .- 1473-2300. ; 47:2, s. 635-640
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: Osteoarthritis (OA) is a common cause of disability affecting millions of people of all ages worldwide. The pathogenesis involves an inflammatory component, but the cause of the inflammation remains incompletely understood. The intracellular bacteria Chlamydia trachomatis and C. pneumoniae have been demonstrated in patients with reactive arthritis. Both of these microorganisms can cause chronic and persistent infections, with C. trachomatis being the most common cause of reactive arthritis. This study was performed to investigate the presence of C. pneumoniae in a large number of patients with primary OA.METHODS: The study included 75 patients who underwent total knee arthroplasty. During surgery, a synovial biopsy was performed and synovial fluid drawn. Real-time polymerase chain reaction (PCR) of C. pneumoniae was run on all patients, and real-time PCR of bacterial 16S rDNA was conducted on 30 of the 75 patients to screen for the presence of other bacteria.RESULTS: Real-time PCR showed no evidence of the presence of C. pneumoniae in the patients' specimens, nor were other bacteria detected.CONCLUSIONS: Although an inflammatory component is part of the pathogenesis of OA, we found no evidence indicating that C. pneumoniae is a stimulator of that inflammation.
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25.
  • Eldh, Ann Catrine, 1965-, et al. (författare)
  • Onset PrevenTIon of urinary retention in Orthopaedic Nursing and rehabilitation, OPTION-a study protocol for a randomised trial by a multi-professional facilitator team and their first-line managers' implementation strategy
  • 2021
  • Ingår i: Implementation Science. - : BioMed Central. - 1748-5908. ; 16:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: The Onset PrevenTIon of urinary retention in Orthopaedic Nursing and rehabilitation, OPTION, project aims to progress knowledge translation vis-à-vis evidence-based bladder monitoring in orthopaedic care, to decrease the risk of urinary retention, and voiding complications. Urinary retention is common whilst in hospital for hip surgery. If not properly identified and managed, there is a high risk of complications, some lifelong and life threatening. Although evidence-based guidelines are available, the implementation is lagging.METHODS: Twenty orthopaedic sites are cluster randomised into intervention and control sites, respectively. The intervention sites assemble local facilitator teams among nursing and rehabilitation staff, including first-line managers. The teams receive a 12-month support programme, including face-to-face events and on-demand components to map and bridge barriers to guideline implementation, addressing leadership behaviours and de-implementation of unproductive routines. All sites have access to the guidelines via a public healthcare resource, but the control sites have no implementation support.Baseline data collection includes structured assessments of urinary retention procedures via patient records, comprising incidence and severity of voiding issues and complications, plus interviews with managers and staff, and surveys to all hip surgery patients with interviews across all sites. Further assessments of context include the Alberta Context Tool used with staff, the 4Ps tool for preference-based patient participation used with patients, and data on economic aspects of urinary bladder care.During the implementation intervention, all events are recorded, and the facilitators keep diaries. Post intervention, the equivalent data collections will be repeated twice, and further data will include experiences of the intervention and guideline implementation.Data will be analysed with statistical analyses, including comparisons before and after, and between intervention and control sites. The qualitative data are subjected to content analysis, and mixed methods are applied to inform both clinical outcomes and the process evaluation, corresponding to a hybrid design addressing effectiveness, experiences, and outcomes.DISCUSSION: The OPTION trial has a potential to account for barriers and enablers for guideline implementation in the orthopaedic context in general and hip surgery care in particular. Further, it may progress the understanding of implementation leadership by dyads of facilitators and first-line managers.TRIAL REGISTRATION: The study was registered as NCT04700969 with the U.S. National Institutes of Health Clinical Trials Registry on 8 January 2021, that is, prior to the baseline data collection.
  •  
26.
  • Ericson, A, et al. (författare)
  • Variation in the position and orientation of the elbow flexion axis
  • 2003
  • Ingår i: Journal of Bone and Joint Surgery. - : British Editorial Society of Bone and Joint Surgery. - 0301-620X .- 2044-5377. ; 85B:4, s. 538-544
  • Tidskriftsartikel (refereegranskat)abstract
    • We analysed the axis of movement in the normal elbow during flexion in vivo using radiostereometric analysis (RSA). The results show an intraindividual variation in the inclination of the axis ranging from 2.1 degrees to 14.3 degrees in the frontal and from 1.6 degrees to 9.8 degrees in the horizontal plane analysed at 30 degrees increments. The inclination of the mean axis of rotation varied within a range of 12.7 degrees in the frontal and 4.6 degrees in the horizontal plane. In both planes, the mean axes were located close to a line joining the centres of the trochlea and capitellum. The intra- and interindividual variations of the axes of flexion of the elbow were greater than previously reported. These factors should be considered in the development of elbow prostheses.
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27.
  • Esbjörnsson, A-C, et al. (författare)
  • Quantifying gait deviations in individuals with rheumatoid arthritis using the Gait Deviation Index
  • 2014
  • Ingår i: Scandinavian Journal of Rheumatology. - : Informa Healthcare. - 0300-9742 .- 1502-7732. ; 43:2, s. 124-131
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: In this study we evaluated the usability of the Gait Deviation Index (GDI), an index that summarizes the amount of deviation in movement from a standard norm, in adults with rheumatoid arthritis (RA). The aims of the study were to evaluate the ability of the GDI to identify gait deviations, assess inter-trial repeatability, and examine the relationship between the GDI and walking speed, physical disability, and pain.METHOD: Sixty-three adults with RA and 59 adults with typical gait patterns were included in this retrospective case-control study. Following a three-dimensional gait analysis (3DGA), representative gait cycles were selected and GDI scores calculated. To evaluate the effect of walking speed, GDI scores were calculated using both a free-speed and a speed-matched reference set. Physical disability was assessed using the Health Assessment Questionnaire (HAQ) and subjects rated their pain during walking.RESULTS: Adults with RA had significantly increased gait deviations compared to healthy individuals, as shown by lower GDI scores [87.9 (SD = 8.7) vs. 99.4 (SD = 8.3), p < 0.001]. This difference was also seen when adjusting for walking speed [91.7 (SD = 9.0) vs. 99.9 (SD = 8.6), p < 0.001]. It was estimated that a change of ≥ 5 GDI units was required to account for natural variation in gait. There was no evident relationship between GDI and low/high RA-related physical disability and pain.CONCLUSIONS: The GDI seems to useful for identifying and summarizing gait deviations in individuals with RA. Thus, we consider that the GDI provides an overall measure of gait deviation that may reflect lower extremity pathology and may help clinicians to understand the impact of RA on gait dynamics.
  •  
28.
  • Feng, Y., et al. (författare)
  • Effects of arm support on shoulder and arm muscle activity during sedentary work
  • 1997
  • Ingår i: Ergonomics. - London, United Kingdom : Taylor & Francis. - 0014-0139 .- 1366-5847. ; 40:8, s. 834-848
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this study was to evaluate different arm supports by comparing the activity of shoulder and arm muscles during various work tasks, with and without the lower arm supported. Twelve female subjects, aged between 23 and 37 years, were asked to perform three types of tasks: typing, simulated assembly work (in two different positions), and pipetting. The supports used were: fixed arm support (FIX), horizontal movable arm support (HOR), and spring-loaded arm support (SLA). During the experiments, the electromyograms (EMG) of four muscles were simultaneously recorded: m. deltoideus anterior and lateralis, m. trapezius pars descendens and m. extensor carpi radialis brevis. Normalization was made against maximum isometric contraction. The mean values of the normalized EMG levels showed a reduced EMG level of the shoulder muscles when using arm supports in all the tasks, and for all muscles but the wrist extensor, compared to the EMG levels without arm supports. The horizontal movable support was more effective in reducing the EMG levels of the shoulder muscles than other arm supports, in tasks at table height. Thus, it is possible to reduce muscle activity of the shoulder region by using arm supports. Further research is needed to make biomechanical calculations to compare the EMG level of these muscles using suspension and the effects of inclination of work task.
  •  
29.
  • Feng, Y., et al. (författare)
  • Effects of arm suspension in simulated assembly line work : muscular activity and posture angles
  • 1999
  • Ingår i: Applied Ergonomics. - Oxon, United Kingdom : Elsevier. - 0003-6870 .- 1872-9126. ; 30:3, s. 247-253
  • Tidskriftsartikel (refereegranskat)abstract
    • The electromyogram and posture angles of the shoulder and arm were recorded during sitting manipulative work in three positions, with and without the forearm suspended by a balancer. A Selspot system was used to record movements. The results from 12 female subjects (mean age 29 yr) showed that the activity in deltoideus anterior decreased significantly by using a balancer. Lower mean values were also noted for deltoideus lateralis and the trapezius muscles. The neck inclination increased with higher work area position, but was independent of the use of a balancer.
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30.
  • Forssten, Maximilian Peter, 1996-, et al. (författare)
  • A nationwide analysis on the interaction between frailty and beta-blocker therapy in hip fracture patients
  • 2023
  • Ingår i: European Journal of Trauma and Emergency Surgery. - : Urban und Vogel Medien und Medizin Verlagsgesellsc. - 1863-9933 .- 1863-9941. ; 49:3, s. 1485-1497
  • Tidskriftsartikel (refereegranskat)abstract
    • INTRODUCTION: Hip fracture patients, who are often frail, continue to be a challenge for healthcare systems with a high postoperative mortality rate. While beta-blocker therapy (BBt) has shown a strong association with reduced postoperative mortality, its effect in frail patients has yet to be determined. This study's aim is to investigate how frailty, measured using the Orthopedic Hip Frailty Score (OFS), modifies the effect of preadmission beta-blocker therapy on mortality in hip fracture patients.METHODS: This retrospective register-based study included all adult patients in Sweden who suffered a traumatic hip fracture and subsequently underwent surgery between 2008 and 2017. Treatment effect was evaluated using the absolute risk reduction (ARR) in 30-day postoperative mortality when comparing patients with (BBt+) and without (BBt-) ongoing BBt. Inverse probability of treatment weighting (IPTW) was used to reduce potential confounding when examining the treatment effect. Patients were stratified based on their OFS (0, 1, 2, 3, 4 and 5) and the treatment effect was also assessed within each stratum.RESULTS: A total of 127,305 patients were included, of whom 39% had BBt. When IPTW was performed, there were no residual differences in observed baseline characteristics between the BBt+ and BBt- groups, across all strata. This analysis found that there was a stepwise increase in the ARRs for each additional point on the OFS. Non-frail BBt+ patients (OFS 0) exhibited an ARR of 2.2% [95% confidence interval (CI) 2.0-2.4%, p < 0.001], while the most frail BBt+ patients (OFS 5) had an ARR of 24% [95% CI 18-30%, p < 0.001], compared to BBt- patients within the same stratum.CONCLUSION: Beta-blocker therapy is associated with a reduced risk of 30-day postoperative mortality in frail hip fracture patients, with a greater effect being observed with higher Orthopedic Hip Frailty Scores.
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31.
  • Forssten, Maximilian Peter, 1996-, et al. (författare)
  • Postoperative mortality in hip fracture patients stratified by the Revised Cardiac Risk Index : a Swedish nationwide retrospective cohort study
  • 2021
  • Ingår i: Trauma surgery & acute care open. - : BMJ Publishing Group Ltd. - 2397-5776. ; 6:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: The Revised Cardiac Risk Index (RCRI) is a tool that can be used to evaluate the 30-day risk of postoperative myocardial infarction, cardiac arrest and mortality. This study aims to confirm its association with postoperative mortality in patients who underwent hip fracture surgery.Methods: All adults who underwent primary emergency hip fracture surgery in Sweden between January 1, 2008 and December 31, 2017 were included in this study. The database was retrieved by cross-referencing the Swedish National Quality Register for hip fractures with the Swedish National Board of Health and Welfare registers. The outcomes of interest were the association between the RCRI score and mortality at 30 days, 90 days and 1 year postoperatively.Results: 134 915 cases were included in the current study. There was a statistically significant linear trend in postoperative mortality with increasing RCRI scores at 30 days, 90 days and 1 year. An RCRI score ≥4 was associated with a 3.1 times greater risk of 30-day postoperative mortality (adjusted incidence rate ratio (IRR) 3.13, p<0.001), a 2.5 times greater risk of 90-day postoperative mortality (adjusted IRR 2.54, p<0.001) and a 2.8 times greater risk of 1-year postoperative mortality (adjusted HR 2.81, p<0.001) compared with that observed with an RCRI score of 0.Conclusion: An increasing RCRI score is strongly associated with an elevated risk 30-day, 90-day and 1-year postoperative mortality after primary hip fracture surgery. The objective and easily retrievable nature of the variables included in the RCRI calculation makes it an appealing choice for risk stratification in the clinical setting.Levels of evidence: Level III.
  •  
32.
  • Forssten, Maximilian Peter, 1996-, et al. (författare)
  • The association between the Revised Cardiac Risk Index and short-term mortality after hip fracture surgery
  • 2022
  • Ingår i: European Journal of Trauma and Emergency Surgery. - : Urban und Vogel Medien und Medizin Verlagsgesellschaft. - 1863-9933 .- 1863-9941. ; 48:3, s. 1885-1892
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: The post-operative mortality after hip fracture surgery is high and has remained largely unchanged during the last decades. The Revised Cardiac Risk Index (RCRI) is a tool used to evaluate the 30-day risk of, among other outcomes, post-operative mortality. The aim of this study is to determine the association between the RCRI score and post-operative mortality in patients undergoing hip fracture surgery.METHODS: Data was obtained from the national hip fracture register which was cross-referenced with patients' electronic hospital records. All adults who underwent primary emergency hip fracture surgery in Orebro County, Sweden, between January 1, 2013 and December 31, 2017, were included. Patients were divided into two cohorts: low RCRI (score = 0-1) and high RCRI (score ≥ 2). A Poisson regression model was employed to investigate the association between a high RCRI score and 30- and 90-day post-operative mortality.RESULTS: A total of 2443 patients, of whom 446 (18%) had a high RCRI score, were included in the current study. When adjusting for age, sex, comorbidities and type of surgery, the incidence of 30-day mortality increased by 46% in the high RCRI cohort (adj. IRR 1.46, 95% CI, 1.10-1.94, p = 0.010). Similar results were observed for 90-day mortality (adj. IRR 1.50, 95% CI, 1.21-1.84, p < 0.001).CONCLUSION: The RCRI is applicable to patients that undergo surgery for traumatic hip fractures. A high RCRI score is associated with an increased incidence of both 30- and 90-day post-operative mortality. Future studies to evaluate these findings are needed.
  •  
33.
  • Forssten, Maximilian Peter, 1996-, et al. (författare)
  • The consequences of out-of-hours hip fracture surgery : insights from a retrospective nationwide study
  • 2022
  • Ingår i: European Journal of Trauma and Emergency Surgery. - : Springer. - 1863-9933 .- 1863-9941. ; 48:2, s. 709-719
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: The study aimed to investigate the association between out-of-hours surgery and postoperative mortality in hip fracture patients. Furthermore, internal fixation and arthroplasty were compared to determine if a difference could be observed in patients operated with these techniques at different times during the day.METHODS: All patients above 18 of age years in Sweden who underwent hip fracture surgery between 2008 and 2017 were eligible for inclusion. Pathological fractures, non-operatively managed fractures, or cases whose time of surgery was missing were excluded. The cohort was subdivided into on-hour (08:00-17:00) and out-of-hours surgery (17:00-08:00). Poisson regression with adjustments for confounders was used to evaluate the association between out-of-hours surgery and both 30-day and 90-day postoperative mortality.RESULTS: Out-of-hours surgery was associated with a 5% increase in the risk of both 30-day [adj. IRR (95% CI) 1.05 (1.00-1.10), p = 0.040] and 90-day [adj. IRR (95% CI) 1.05 (1.01-1.09), p = 0.005] mortality after hip fracture surgery compared to on-hour surgery. There was no statistically significant association between out-of-hours surgery and postoperative mortality among patients who received an internal fixation. Arthroplasties performed out-of-hours were associated with a 13% increase in 30-day postoperative mortality [adj. IRR (95% CI) 1.13 (1.04-1.23), p = 0.005] and an 8% increase in 90-day postoperative mortality [adj. IRR (95% CI) 1.08 (1.01-1.15), p = 0.022] compared to on-hour surgery.CONCLUSION: Out-of-hours surgical intervention is associated with an increase in both 30- and 90-day postoperative mortality among hip fracture patients who received an arthroplasty, but not among patients who underwent internal fixation.
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34.
  • Forssten, Maximilian Peter, 1996-, et al. (författare)
  • The mortality burden of frailty in hip fracture patients : a nationwide retrospective study of cause-specific mortality
  • 2023
  • Ingår i: European Journal of Trauma and Emergency Surgery. - : Springer. - 1863-9933 .- 1863-9941. ; 49:3, s. 1467-1475
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: Frailty is a condition characterized by a reduced ability to adapt to external stressors because of a reduced physiologic reserve, which contributes to the high risk of postoperative mortality in hip fracture patients. This study aims to investigate how frailty is associated with the specific causes of mortality in hip fracture patients.Methods: All adult patients in Sweden who suffered a traumatic hip fracture and underwent surgery between 2008 and 2017 were eligible for inclusion. The Orthopedic Hip Frailty Score (OFS) was used to classify patients as non-frail (OFS 0), pre-frail (OFS 1), and frail (OFS & GE; 2). The association between the degree of frailty and both all-cause and cause-specific mortality was determined using Poisson regression models with robust standard errors and presented using incidence rate ratios (IRRs) with corresponding 95% confidence intervals (CIs), adjusted for potential sources of confounding.Results: After applying the inclusion and exclusion criteria, 127,305 patients remained for further analysis. 23.9% of patients were non-frail, 27.7% were pre-frail, and 48.3% were frail. Frail patients exhibited a 4 times as high risk of all-cause mortality 30 days [adj. IRR (95% CI): 3.80 (3.36-4.30), p < 0.001] and 90 days postoperatively [adj. IRR (95% CI): 3.88 (3.56-4.23), p < 0.001] as non-frail patients. Of the primary causes of 30-day mortality, frailty was associated with a tripling in the risk of cardiovascular [adj. IRR (95% CI): 3.24 (2.64-3.99), p < 0.001] and respiratory mortality [adj. IRR (95% CI): 2.60 (1.96-3.45), p < 0.001] as well as a five-fold increase in the risk of multiorgan failure [adj. IRR (95% CI): 4.99 (3.95-6.32), p < 0.001].Conclusion: Frailty is associated with a significantly increased risk of all-cause and cause-specific mortality at 30 and 90 days postoperatively. Across both timepoints, cardiovascular and respiratory events along with multiorgan failure were the most prevalent causes of mortality.
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35.
  • Grondal, L, et al. (författare)
  • Arthrodesis versus Mayo resection : the management of the first metatarsophalangeal joint in reconstruction of the rheumatoid forefoot
  • 2006
  • Ingår i: Journal of Bone and Joint Surgery. - : British Editorial Society of Bone and Joint Surger. - 0301-620X .- 2044-5377. ; 88B:7, s. 914-919
  • Tidskriftsartikel (refereegranskat)abstract
    • In a prospective randomised study 31 patients were allocated to either arthrodesis or Mayo resection of the first metatarsophalangeal joint as part of a total reconstruction of the rheumatoid forefoot. Of these, 29 were re-examined after a mean of 72 months (57 to 80), the Foot Function Index was scored and any deformity measured. Load distribution was analysed using a Fscan mat in 14 cases, and time and distance were measured in 12 of these patients using a 3D Motion system. We found excellent patient satisfaction and a significant, lasting reduction of the Foot Function Index, with no statistically significant differences between the groups. There were no significant differences in recurrence of the deformity, the need for special shoes, gait velocity, step length, plantar moment, mean pressure or the position of the centre of force under the forefoot. The cadence was higher and the stance phase shorter in the fusion group.These results suggest that a Mayo resection may be an equally good option for managing the first metatarsophalangeal joint in reconstruction of the rheumatoid forefoot.
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36.
  • Grondal, Lollo, et al. (författare)
  • The foot : still the most important reason for walking incapacity in rheumatoid arthritis - Distribution of symptomatic joints in 1,000 RA patients
  • 2008
  • Ingår i: Acta Orthopaedica. - New York, USA : Informa Healthcare. - 1745-3674 .- 1745-3682. ; 79:2, s. 257-261
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and purpose: Our knowledge of frequency of foot involvement in rheumatoid arthritis (RA) is still often based on a study from Finland in 1956. Great changes in the treatment of RA may have led to a different situation. We investigated the distribution of joint involvement in RA patients today, with special attention given to the feet and subjective walking ability.Methods: 1,000 RA patients answered a questionnaire concerning joints affected, joint surgery, foot problems, and subjectively experienced reasons for walking incapacity.Results: In 45% of the patients, the forefoot was involved at the start of the disease. In 17%, the hindfoot/ankle was involved at the start. Only hand symptoms were commoner. 80% of patients reported current foot problems, 86% in the forefoot and 52% in the hindfoot/ankle. Difficulty in walking due to the feet was reported by 71%. For 41% of patients, the foot was the most important part of the lower extremity causing reduced walking capacity, and for 32% it was the only part.Interpretation: After the hand, the foot was the most frequently symptomatic joint complex at the start of the disease, but also during active medical treatment. The foot caused walking disability in three-quarters of the cases and-4 times as often as the knee or the hip-it was the only joint to subjectively impair gait.
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37.
  • Ighani Arani, Perna, 1989-, et al. (författare)
  • Bariatric surgery prior to total knee arthroplasty is not associated with lower risk of revision : a register-based study of 441 patients
  • 2021
  • Ingår i: Acta Orthopaedica. - : Taylor & Francis. - 1745-3674 .- 1745-3682. ; 92:1, s. 97-101
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and purpose: Obesity is a considerable medical challenge in society. We investigated the risk of revision for any reasons and for infection in patients having total knee arthroplasty (TKA) for osteoarthritis (OA) within 2 years after bariatric surgery (BS) and compared them with TKAs without BS.Patients and methods: We used the Scandinavian Obesity Surgery Registry (SOReg) and the Swedish Knee Arthroplasty Register (SKAR) to identify patients operated on in 2009-2019 with BS who had had primary TKA for OA within 2 years after the BS (BS group) and compared them with TKAs without prior BS (noBS group). We determined adjusted hazard ratio (HR) for the BS group and noBS group using Cox proportional hazard regression for revision due to any reasons and for infection. Adjustments were made for sex, age groups, and BMI categories preoperatively.Results: 441 patients were included in the BS group. The risk of revision for infection was higher for the BS group with HR 2.2 (95% CI 1.1-4.7) adjusting for BMI before the TKA, while the risk of revision for any reasons was not statistically significant different for the BS group with HR 1.3 (CI 0.9-2.1). Corresponding figures when adjusting for BMI before the BS were HR 0.9 (CI 0.4-2) and HR 1.2 (CI 0.7-2).Interpretation: Our findings did not indicate that BS prior to TKA was associated with lower risk of revision.
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38.
  • Ighani Arani, Perna, 1989-, et al. (författare)
  • Information and BMI limits for patients with obesity eligible for knee arthroplasty : the Swedish surgeons' perspective from a nationwide cross-sectional study
  • 2022
  • Ingår i: Journal of Orthopaedic Surgery and Research. - : BioMed Central (BMC). - 1749-799X. ; 17:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: In the past decades, the incidence of obesity has increased worldwide. This disease is often accompanied with several comorbidities and therefore, surgeons and anesthesiologists should be prepared to provide optimal management for these patients. The aim of this descriptive cross-sectional study was to map the criteria and routines that are used by Swedish knee arthroplasty surgeons today when considering patients with obesity for knee arthroplasty.METHODS: A survey including 21 items was created and sent to all the Swedish centers performing knee arthroplasty. The survey included questions about the surgeons' experience, hospital routines of preoperative information given and the surgeons' individual assessment of patients with obesity that candidates for knee arthroplasty. Descriptive statistics were used to present the data.RESULTS: A total of 203 (64%) knee surgeons responded to the questionnaire. Almost 90% of the surgeons claimed to inform their patients with obesity that obesity has been associated with an increased risk of complications after knee arthroplasty. Seventy-nine percent reported that they had an upper BMI limit to perform knee arthroplasty, a larger proportion of the private centers had a BMI limit compared to public centers. The majority of the centers had an upper BMI limit of 35.CONCLUSION: The majority of the knee arthroplasty surgeons in Sweden inform their patients with obesity regarding risks associated with knee arthroplasty. Most centers that perform knee arthroplasties in Sweden have an upper BMI limit.
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39.
  • Ighani Arani, Perna, 1989-, et al. (författare)
  • Pain, Function, and Satisfaction After Total Knee Arthroplasty, with or Without Bariatric Surgery
  • 2022
  • Ingår i: Obesity Surgery. - : Springer. - 0960-8923 .- 1708-0428. ; 32:4, s. 1164-1169
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: The impact of obesity on patient-reported outcome (PRO) after total knee arthroplasty (TKA) surgery has demonstrated varying results. We evaluated knee pain, Activity in Daily Life function (ADL), and satisfaction after TKA surgery in patients with and without prior bariatric surgery (BS).METHODS: Scandinavian Obesity Surgery Registry (SOReg) and the Swedish Knee Arthroplasty Register (SKAR) were used to identify patients operated on with primary TKA for osteoarthritis (OA) between 2009 and 2019 that had a BS within 2 years before the TKA (BS group). These patients were compared to patients with TKA without prior BS (no BS group). The patients filled in the Knee injury and Osteoarthritis Outcome Score (KOOS) preoperatively and one year postoperatively as well as satisfaction with the surgery one year postoperatively. Multiple linear regression analysis was used to evaluate 1-year postoperative KOOS pain and ADL function between the 2 groups. Adjustments were made for sex, age, and preoperative KOOS pain and ADL function respectively.RESULTS: Forty-four patients were included in the BS group and 3,525 patients in the no BS group. We found no statistically or clinically significant difference in one-year postoperative KOOS pain and ADL function between the BS group and the no BS group. The majority of the patients in both groups were classified as satisfied or very satisfied one year postoperatively to the TKA.CONCLUSIONS: Our results indicate that patients without BS prior to the TKA gain similar 1-year outcome in pain, ADL function and satisfaction as patients with prior BS.
  •  
40.
  • Ighani Arani, Perna, 1989-, et al. (författare)
  • Total knee arthroplasty and bariatric surgery : change in BMI and risk of revision depending on sequence of surgery
  • 2023
  • Ingår i: BMC Surgery. - : BioMed Central (BMC). - 1471-2482. ; 23:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Patients with obesity have a higher risk of complications after total knee arthroplasty (TKA). We investigated the change in weight 1 and 2 years post-Bariatric Surgery (BS) in patients that had undergone both TKA and BS as well as the risk of revision after TKA based on if BS was performed before or after the TKA.METHODS: Patients who had undergone BS within 2 years before or after TKA were identified from the Scandinavian Obesity Surgery Register (SOReg) and the Swedish Knee Arthroplasty Register (SKAR) between 2007 and 2019 and 2009 and 2020, respectively. The cohort was divided into two groups; patients who underwent TKA before BS (TKA-BS) and patients who underwent BS before TKA (BS-TKA). Multilinear regression analysis and a Cox proportional hazards model were used to analyze weight change after BS and the risk of revision after TKA.RESULTS: Of the 584 patients included in the study, 119 patients underwent TKA before BS and 465 underwent BS before TKA. No association was detected between the sequence of surgery and total weight loss 1 and 2 years post-BS, - 0.1 (95% confidence interval (CI), - 1.7 to 1.5) and - 1.2 (95% CI, - 5.2 to 2.9), or the risk of revision after TKA [hazard ratio 1.54 (95% CI 0.5-4.5)].CONCLUSION: The sequence of surgery in patients undergoing both BS and TKA does not appear to be associated with weight loss after BS or the risk of revision after TKA.
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41.
  • Ighani Arani, Perna, 1989- (författare)
  • Total Knee Arthroplasty and Bariatric Surgery : Patients, Outcomes and Surgeons
  • 2023
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Osteoarthritis (OA) is the most common disorder of the joint, affecting over 500million people globally, and is one of the most demanding disabilities worldwide.One of the most prominent risk factors for developing OA is obesity. Clinically, the most common site of OA is the knee. Obesity has been associated with worseoutcomes after Total Knee Arthroplasty (TKA) and patients with obesity have beenshown to have an increased risk of revision after TKA. Obesity is further associatedwith several comorbidities as well as psychological problems, including depression and low self-esteem. Treatment of obesity using lifestyle modifications often results in insufficient weight loss. The most effective method of achieving weight loss in patients with obesity and counteracting morbid obesity with its relatedcomorbidities is Bariatric Surgery (BS). Consequently, BS before TKA may reduce the risk of revision after TKA. Thus, this thesis evaluates risk of revision, pain,Activity in Daily Life function (ADL), and weight change after TKA in patients with prior BS compared to patients without prior BS. Additionally, the thesis aims toidentify the criteria and practices used by Swedish centers and knee arthroplasty surgeons when performing knee arthroplasty in patients who have obesity. Data were extracted from the Swedish Knee Arthroplasty Registry and Scandinavian Obesity Registry to identify patients with BS and TKA in Papers I–III. In Paper IV, a survey was created and sent to all the Swedish centers performing knee arthroplasty.No benefit in risk of revision for all reasons or in outcome regarding pain and ADL after TKA were found in patients with prior BS compared to patients without prior BS. This was also seen when comparing to patients with BS following TKA for riskof revision for all reasons. However, when adjusting for Body Mass Index (BMI) prior to TKA, the risk of revision due to suspected or verified infection was higher in patients with BS prior to TKA than in patients without BS. Additionally, no statistically significant difference in 1-year or 2-years postoperative weight change depending on the sequence of surgery was found. Paper IV indicated that most knee arthroplasty surgeons in Sweden inform their patients with obesity regarding risksof knee arthroplasty. Furthermore, most centers that perform knee arthroplasties inSweden have an upper BMI limit. 
  •  
42.
  • Ivarsson, Mikael, 1962-, et al. (författare)
  • Mussel Adhesive Protein as a Promising Alternative to Fibrin for Scaffold Fixation during Cartilage Repair Surgery
  • 2021
  • Ingår i: Cartilage. - : Sage Publications. - 1947-6035 .- 1947-6043. ; 13:Suppl. 2, s. 663S-671S
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: Fibrin has been used as a standard material for scaffold fixation during cartilage repair surgery. Most of the commercially available fibrin preparations need an additional method for scaffold fixation, most often with sutures, thus damaging the surrounding healthy cartilage. There is therefore a need to find alternatives to this method. In our study, we have investigated the potential possibility to use mussel adhesive protein as such an alternative.METHODS: In this study, hydrophobic plastic was coated with the mussel adhesive protein Mefp-1 as well as with other cell adhesives (poly-lysine, fibronectin, and collagen). Human keratinocytes and chondrocytes were seeded on these substrates at 37°C in culture medium, followed by analysis of attachment and proliferation by crystal violet staining and metabolic labelling. Performance of Mefp-1 and fibrin as tissue glues were estimated by tensional force resistance measurement of moist porcine dermis (as a correlate to scaffold) glued to dermis, cartilage, or bone at 37°C.RESULTS: Mefp-1 supported maximal cell attachment at a coating density of approximately 1 µg/cm2. This was at least as good as the other adhesives tested. In addition, it supported cell proliferation at least as good as regular tissue culture plastic over a 7-day period. Measurement of tensional force resistance showed that Mefp-1 performed equally well as fibrin when porcine dermis was glued to cartilage and bone at the same concentration. Separation of the moist tissues after 15-minute incubation required a force of approximately 1 N/cm2 for both compounds.CONCLUSIONS: Mefp-1 show properties that qualify it as a compound that potentially could replace fibrin as a tissue glue for scaffold fixation. Given the possibilities to modify this protein by bioengineering, it is likely that the properties can be further improved.
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43.
  • Jackwert, Kim, et al. (författare)
  • Agreement between Clinical Frailty Scale-scores based on information from patient interviews and Clinical Frailty Scale-scores based on information from medical records : a cross sectional study
  • 2024
  • Ingår i: BMC Geriatrics. - : BioMed Central (BMC). - 1471-2318. ; 24:1
  • Tidskriftsartikel (refereegranskat)abstract
    • INTRODUCTION: Frailty is an age-related condition with increased risk for adverse health outcomes. Assessing frailty according to the Clinical Frailty Scale (CFS) based on data from medical records is useful for previously unassessed patients, but the validity of such scores in exclusively geriatric populations and in patients with dementia is relatively unknown.METHODS: Patients admitted for the first time to one of two geriatric wards at Örebro University hospital between January 1st - December 31st, 2021, were included in this study if they had been appointed a CFS-score by anamnestic interview (CFSI) at admission. CFS scores based on medical records (CFSR) were appointed by a single medical student, who was blinded to the CFSI score. Score-agreement was evaluated with quadratic weighted Cohen's kappa (κ).RESULTS: In total, 145 patients between the age of 55-101 were included in the study. The CFSR and CFSI scores agreed perfectly in 102 cases (0.7, 95% CI 0.65-0.77). There was no significant difference regarding age, sex, comorbidity, or number of patients diagnosed with dementia between the patients with complete agreement and the patients whose scores did not agree. Agreement between the scores was substantial, κ = 0.66, 95% CI 0.53-0.80.CONCLUSIONS: CFS scores based on information from medical records can be generated with substantial agreement to CFS scores based on in-person anamnestic interviews. A dementia diagnosis does not influence the agreement between the scores. Therefore, these scores are a useful tool for assessing frailty in geriatric patients who previously lack a frailty assessment, both in clinical practice and future research. The results support previous findings, but larger studies are warranted.
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44.
  • Jakobsson, Hugo, 1990-, et al. (författare)
  • Pulp-to-palm distance after plate fixation of a distal radius fracture corresponds to functional outcome
  • 2023
  • Ingår i: Archives of physiotherapy. - : BioMed Central (BMC). - 2057-0082. ; 13:1
  • Tidskriftsartikel (refereegranskat)abstract
    • INTRODUCTION: Several factors can influence the outcome after a distal radius fracture (DRF). The aim of this study was to assess whether postoperative pulp-to-palm (PTP) distance correlated with functional outcomes after plate fixation of DRF. MATERIALS &METHODS: This is a secondary analysis of a randomized controlled trial aimed to investigate the effects of plate fixation in patients with type-C fractures. Subjects (N = 135) were divided into 2 groups based on PTP distance (equal to or higher than 0 cm) at 4 weeks postoperatively. Outcome measures were collected prospectively at 3, 6 and 12 months and included Patient-Rated Wrist Evaluation (PRWE), Quick Disabilities of the Arm Shoulder and Hand (QuickDASH) scores, wrist range of motion (ROM), Visual Analog Scale (VAS) pain scores, and hand grip strength.RESULTS: Overall, at 3 and 6 months patients with PTP > 0 cm had significantly worse outcomes (PRWE, QuickDASH, wrist ROM) than those with PTP =0 cm. At 12 months, QuickDASH and wrist ROM were still significantly worse. In the volar-plating subgroup, patients with PTP > 0 cm had significantly worse wrist ROM and grip strength at 3 months, but no significant differences were found in subsequent follow-ups. In the combined-plating group, patients with PTP > 0 cm had significantly worse QuickDASH, wrist ROM and grip strength at 3 months. At 6 and 12 months, wrist ROM was still significantly worse.CONCLUSIONS: Measurement of PTP distance appears to be useful to identify patients likely to have worse outcome after plating of a DRF. This could be a tool to improve the allocation of hand rehabilitation resources.
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45.
  • Joelson, Anders, 1970-, et al. (författare)
  • Adjacent segment disk degeneration three decades after fusion without attempted reduction for high-grade isthmic spondylolisthesis
  • 2020
  • Ingår i: Spine Deformity. - : Springer Science and Business Media LLC. - 2212-134X .- 2212-1358. ; 8, s. 743-750
  • Tidskriftsartikel (refereegranskat)abstract
    • Study design: Observational study. Objectives: To evaluate adjacent segment disk degeneration (ASD) after fusion without attempted reduction at a young age for high-grade isthmic spondylolisthesis. Summary of background data: The clinical relevance of ASD remains unclear. Previous studies have shown that spinal fusion is associated with increased ASD but without influence on clinical outcome. Since high-grade spondylolisthesis is a severe kyphotic deformity, one could hypothesize that fusion without attempted reduction in young patients leads to accelerated adjacent segment disk degeneration in adult life. Methods: Anterior and posterior disk heights were evaluated on supine radiographs of the spine 8years and 29years after fusion without attempted reduction for high-grade spondylolisthesis and also on standing radiographs 8years and 33years after surgery. Pelvic parameters were evaluated on standing radiographs obtained 33years after surgery. Health-related quality of life was evaluated with the Scoliosis Research Society (SRS)-22r questionnaire. Results: One segment above fusion the anterior disk height significantly decreased on standing radiographs. Two segments above the fusion, the anterior disk height significantly decreased on supine as well as on standing radiographs. The largest reduction was found two segments above the fusion where the disk height was reduced from 33 to 28% of anterior vertebral height between the measurements at mean 8years and mean 33years after surgery. There were no statistically significant decreases in posterior disk heights in any measurement. The disk height showed a moderate negative correlation to PT. There was no correlation between disk height reduction and SRS-22r outcome. Conclusions: In our long-term follow-up of fusion without attempted reduction for high-grade spondylolisthesis in young patients, we found only a minor but statistically significant reduction in adjacent segment disk height which had no apparent impact on clinical outcome. Level of evidence: Level IV. © 2020, Scoliosis Research Society.
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46.
  • Joelson, Anders, 1970-, et al. (författare)
  • Clinical appearance and reliability in visual assessment after in situ fusion for high-grade isthmic spondylolisthesis
  • 2021
  • Ingår i: Spine Deformity. - : Springer Science and Business Media LLC. - 2212-134X .- 2212-1358. ; 9, s. 155-160
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: The current literature on clinical appearance after surgery for high-grade spondylolisthesis is inconclusive. The few long-term comparative studies on surgical reduction versus in situ fusion report contradictory findings concerning appearance-related issues. The purpose of the current study was to evaluate and quantify clinical appearance three decades after in situ fusion for high-grade isthmic spondylolisthesis. Methods: The Scoliosis Research Society (SRS)-22r questionnaire, digital photographs and standing lateral radiographs were used to evaluate clinical appearance for 22 patients three decades after in situ fusion for high-grade spondylolisthesis. The appearance was assessed by two spine surgeons, by the patient themselves, and by quantification of cosmesis relevant radiographic variables including pelvic parameters and sagittal balance. Results: The surgeon inter- and intraobserver reliability of the photographic evaluation of the trunk deformity was at most moderate (Cohen’s kappa 0.5). Correlation analysis revealed at most medium correlation between radiographic outcome and self-rated (SRS-22r) self-image (Spearman’s rank correlation coefficient 0.3). The agreement between patient and surgeon-rated trunk appearance was poor (Cohen’s kappa 0.2). Conclusions: Photographic evaluation of the trunk deformity in high-grade spondylolisthesis is unreliable. There were only weak correlations between patient self-assessed trunk appearance and radiographic parameters. The results reflect the pronounced subjectivity of cosmesis, and that the trunk deformity in high-grade spondylolisthesis is not easily observed. Level of evidence: IV. © 2020, Scoliosis Research Society.
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47.
  • Joelson, Anders, 1970- (författare)
  • High-grade spondylolisthesis in young patients : Long-term results of in situ fusion
  • 2020
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The purpose of this long-term follow-up of 38 of 40 consecutive patients was to evaluate the results of uninstrumented in situ fusion for high-grade isthmic spondylolisthesis three decades after surgery. The mean age at surgery was 14 (range 9-24) years. The first of four studies evaluated clinical outcome, function, work status, and health-related quality of life (HRQoL) after in situ fusion in relation to age-matched Swedish population data. The second study evaluated effects on sagittal balance after in situ fusion. The third study evaluated adjacent segment disk degeneration after in situ fusion. The fourth study evaluated self-imageand HRQoL after in situ fusion in relation to healthy controls.The main findings were that (1) young patients fused in situ for highgrade isthmic spondylolisthesis have long-term HRQoL similar to the general Swedish population and controls matched for age and gender, (2) signs of non-compensated sagittal imbalance were observed only ina few individuals whereas compensated sagittal balance was the norm, (3) there was no correlation between any radiographic sagittal balance parameter and HRQoL outcome, (4) there was only a minor reduction inadjacent segment disk height which had no impact on HRQoL outcome, and (5) the only patient reported outcome measure indicating a detrimental effect at long-term follow-up was self-assessed trunk appearance which was slightly negatively affected.
  •  
48.
  • Joelson, Anders, et al. (författare)
  • Sagittal Balance and Health-Related Quality of Life Three Decades After in Situ Arthrodesis for High-Grade Isthmic Spondylolisthesis
  • 2018
  • Ingår i: Journal of Bone and Joint Surgery-American Volume. - : Ovid Technologies (Wolters Kluwer Health). - 0021-9355 .- 1535-1386. ; 100:16, s. 1357-1365
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: This case series of consecutive patients evaluated sagittal balance and health-related quality of life (HRQoL) 3 decades after in situ arthrodesis for high-grade isthmic spondylolisthesis. Methods: Global sagittal balance, pelvic parameters, and compensatory mechanisms were evaluated on standing lateral radiographs of the spine and pelvis for 28 of 39 consecutive patients, 28 to 41 years after in situ arthrodesis for high-grade L5 to S1 spondylolisthesis. The mean age at surgery was 14 years (range, 9 to 24 years), and the mean age at the time of follow-up was 48 years (range, 39 to 59 years). A subset of the radiographic parameters was compared with the corresponding data from an 8-year follow-up examination of the same patients. HRQoL was evaluated with the Scoliosis Research Society (SRS)-22r questionnaire. Results: We found that 3 of the 28 patients had a global sagittal imbalance (T1 spinopelvic inclination of > 0 degrees). Signs of compensatory mechanisms, such as reduced thoracic kyphosis and pelvic retroversion, were frequent. There was a significant decrease in sacral slope compared with 8-year follow-up data (p = 0.01). The median SRS-22r subscore was on the same level as Swedish normative data. We found no association between radiographic parameters and SRS-22r outcome. Conclusions: Three decades after in situ arthrodesis for high-grade spondylolisthesis, radiographic signs of non-compensated sagittal imbalance were observed in only a few individuals. The patients had normal SRS-22r scores. There was no association between any radiographic parameter and SRS-22r outcome. The findings are relevant in the controversial discussion on whether to perform a reduction procedure to treat high-grade spondylolisthesis.
  •  
49.
  • Joelson, Anders, 1970-, et al. (författare)
  • Sagittal Balance and Health-Related Quality of Life Three Decades After in Situ Arthrodesis for High-Grade Isthmic Spondylolisthesis
  • 2018
  • Ingår i: Journal of Bone and Joint Surgery. American volume. - : Stanford University Press. - 0021-9355 .- 1535-1386. ; 100:16, s. 1357-1365
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: This case series of consecutive patients evaluated sagittal balance and health-related quality of life (HRQoL) 3 decades after in situ arthrodesis for high-grade isthmic spondylolisthesis.METHODS: Global sagittal balance, pelvic parameters, and compensatory mechanisms were evaluated on standing lateral radiographs of the spine and pelvis for 28 of 39 consecutive patients, 28 to 41 years after in situ arthrodesis for high-grade L5 to S1 spondylolisthesis. The mean age at surgery was 14 years (range, 9 to 24 years), and the mean age at the time of follow-up was 48 years (range, 39 to 59 years). A subset of the radiographic parameters was compared with the corresponding data from an 8-year follow-up examination of the same patients. HRQoL was evaluated with the Scoliosis Research Society (SRS)-22r questionnaire.RESULTS: We found that 3 of the 28 patients had a global sagittal imbalance (T1 spinopelvic inclination of >0°). Signs of compensatory mechanisms, such as reduced thoracic kyphosis and pelvic retroversion, were frequent. There was a significant decrease in sacral slope compared with 8-year follow-up data (p = 0.01). The median SRS-22r subscore was on the same level as Swedish normative data. We found no association between radiographic parameters and SRS-22r outcome.CONCLUSIONS: Three decades after in situ arthrodesis for high-grade spondylolisthesis, radiographic signs of noncompensated sagittal imbalance were observed in only a few individuals. The patients had normal SRS-22r scores. There was no association between any radiographic parameter and SRS-22r outcome. The findings are relevant in the controversial discussion on whether to perform a reduction procedure to treat high-grade spondylolisthesis.LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
  •  
50.
  • Joelson, Anders, 1970-, et al. (författare)
  • Self-Image and Health-Related Quality of Life Three Decades After Fusion In Situ for High-Grade Isthmic Spondylolisthesis
  • 2019
  • Ingår i: Spine deformity. - : Elsevier. - 2212-134X .- 2212-1358. ; 7:2, s. 293-297
  • Tidskriftsartikel (refereegranskat)abstract
    • STUDY DESIGN: Observational study.OBJECTIVES: To evaluate self-image after in situ fusion for high-grade isthmic spondylolisthesis.SUMMARY OF BACKGROUND DATA: Certain clinical findings such as short trunk or waistline skin folds are often seen in high-grade spondylolisthesis. Since treatment with spinal fusion in situ does not address appearance, self-image and also health-related quality of life might be negatively affected in the short-term as well as the long-term perspective. This observational study evaluated health-related quality of life outcome including self-image three decades after in situ fusion for high-grade isthmic spondylolisthesis in relation to healthy controls.METHODS: Thirty-eight of 39 consecutive patients, fused in situ for high-grade isthmic spondylolisthesis at a young age, completed the Scoliosis Research Society (SRS)-22r questionnaire 28-41 years after surgery. The results were compared with the results of an age- and gender-matched control group.RESULTS: We found that the SRS-22r self-image domain scores were statistically significantly lower in patients than in controls whereas the pain and mental health scores were similar in patients and controls. Also, the SRS-22r function domain scores were statistically significantly lower in patients but the difference in means was small. We found no correlation between severity of slip and SRS-22r outcome.CONCLUSIONS: In situ fusion for high-grade isthmic spondylolisthesis is a safe treatment option in the long term from a function and pain perspective, but the results of our study suggest that self-image is negatively affected long into adult life.LEVEL OF EVIDENCE: Level IV.
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