| 1. |
- Aagaard, Knut, et al.
(författare)
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High incidence of acute full-thickness rotator cuff tears. A population-based prospective study in a Swedish Community.
- 2015
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 86:5, s. 558-562
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Epidemiological studies of full-thickness rotator cuff tears (FTRCTs) have mainly investigated degenerative lesions. We estimated the population-based incidence of acute FTRCT using a new diagnostic model. Patients and methods - During the period November 2010 through October 2012, we prospectively studied all patients aged 18-75 years with acute onset of pain after shoulder trauma, with limited active abduction, and with normal conventional radiographs. 259 consecutive patients met these inclusion criteria. The patients had a median age of 51 (18-75) years. 65% were males. The patients were divided into 3 groups according to the clinical findings: group I, suspected FTRCT; group II, other specific diagnoses; and group III, sprain. Semi-acute MRI was performed in all patients in group I and in patients in group III who did not recover functionally. Results - We identified 60 patients with FTRCTs. The estimated annual incidence of MRI-verified acute FTRCT was 16 (95% CI: 11-23) per 105 inhabitants for the population aged 18-75 years and 25 (CI: 18-36) per 105 inhabitants for the population aged 40-75 years. The prevalence of acute FTRCT in the study group was 60/259 (23%, CI: 18-28). The tears were usually large and affected more than 1 tendon in 36 of these 60 patients. The subscapularis was involved in 38 of the 60 patients. Interpretation - Acute FTRCTs are common shoulder injuries, especially in men. They are usually large and often involve the subscapularis tendon.
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| 2. |
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| 3. |
- Ali, Abdulemir, et al.
(författare)
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Doubtful effect of continuous intraarticular analgesia after total knee arthroplasty.
- 2015
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 86:3, s. 373-377
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Local infiltration analgesia (LIA) is well established for effective postoperative pain relief in total knee arthroplasty (TKA). To prolong the effect of LIA, infusion pumps with local intraarticular analgesia can be used. We evaluated the effect of such an infusion pump for the first 48 h postoperatively regarding pain, knee function, length of stay (LOS) in hospital, and complications. Patients and methods - 200 patients received peroperative LIA and a continuous intraarticular elastomeric infusion pump set at 2 mL/h. The patients were randomized either to ropivacaine (7.5 mg/mL) or to NaCl (9 mg/mL) in the pump. Visual analog scale (VAS) pain (0-100 mm), analgesic consumption, side effects of medicine, range of motion (ROM), leg-raising ability, LOS, and complications during the first 3 months were recorded. Results - On the first postoperative day, the ropivacaine group had lower VAS pain (33 vs. 40 at 12 noon and 36 vs. 43 at 8 p.m.; p = 0.02 and 0.03, respectively), but after that all recorded variables were similar between the groups. During the first 3 months, the ropivacaine group had a greater number of superficial and deep surgical wound infections (11 patients vs. 2 patients, p = 0.02). There were no other statistically significant differences between the groups. Interpretation - Continuous intraarticular analgesia (CIAA) with ropivacaine after TKA has no relevant clinical effect on VAS pain and does not affect LOS, analgesic consumption, ROM, or leg-raising ability. There may, however, be a higher risk of wound-healing complications including deep infections.
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| 4. |
- Ali, Abdulemir, et al.
(författare)
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Similar patient-reported outcomes and performance after total knee arthroplasty with or without patellar resurfacing : A randomized study of 74 patients with 6 years of follow-up
- 2016
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Ingår i: Acta Orthopaedica. - : Informa UK Limited. - 1745-3674 .- 1745-3682. ; 87:3, s. 274-279
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose — Knee pain after total knee arthroplasty (TKA) is not uncommon. Patellar retention in TKA is one cause of postoperative knee pain, and may lead to secondary addition of a patellar component. Patellar resurfacing in TKA is controversial. Its use ranges from 2% to 90% worldwide. In this randomized study, we compared the outcome after patellar resurfacing and after no resurfacing. Patients and methods — We performed a prospective, randomized study of 74 patients with primary osteoarthritis who underwent a Triathlon CR TKA. The patients were randomized to either patellar resurfacing or no resurfacing. They filled out the VAS pain score and KOOS questionnaires preoperatively, and VAS pain, KOOS, and patient satisfaction 3, 12, and 72 months postoperatively. Physical performance tests were performed preoperatively and 3 months postoperatively. Results — We found similar scores for VAS pain, patient satisfaction, and KOOS 5 subscales at 3, 12, and 72 months postoperatively in the 2 groups. Physical performance tests 3 months postoperatively were also similar in the 2 groups. No secondary resurfacing was performed in the group with no resurfacing during the first 72 months Interpretation — Patellar resurfacing in primary Triathlon CR TKA is of no advantage regarding pain, physical performance, KOOS 5 subscales, or patient satisfaction compared to no resurfacing. None of the patients were reoperated with secondary addition of a patellar component within 6 years. According to these results, routine patellar resurfacing in primary Triathlon TKA appears to be unnecessary.
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| 5. |
- Andersen, Mikkel Rathsach, et al.
(författare)
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Monoblock versus modular polyethylene insert in uncemented total knee arthroplasty : A randomized RSA study with 2-year follow-up of 53 patients
- 2016
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 87:6, s. 607-614
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose — Backside wear of the polyethylene insert in total knee arthroplasty (TKA) can produce clinically significant levels of polyethylene debris, which can lead to loosening of the tibial component. Loosening due to polyethylene debris could theoretically be reduced in tibial components of monoblock polyethylene design, as there is no backside wear. We investigated the effect of 2 different tibial component designs, monoblock and modular polyethylene, on migration of the tibial component in uncemented TKA. Patients and methods — In this randomized study, 53 patients (mean age 61 years), 32 in the monoblock group and 33 in the modular group, were followed for 2 years. Radiostereometric analysis (RSA) was done postoperatively after weight bearing and after 3, 6, 12, and 24 months. The primary endpoint of the study was comparison of the tibial component migration (expressed as maximum total point motion (MTPM)) of the 2 different implant designs. Results — We did not find any statistically significant difference in MTPM between the groups at 3 months (p = 0.2) or at 6 months (p = 0.1), but at 12 and 24 months of follow-up there was a significant difference in MTPM of 0.36 mm (p = 0.02) and 0.42 mm (p = 0.02) between groups, with the highest amount of migration (1.0 mm) in the modular group. The difference in continuous migration (MTPM from 12 and 24 months) between the groups was 0.096 mm (p = 0.5), and when comparing MTPM from 3–24 months, the difference between the groups was 0.23 mm (p = 0.07). Interpretation — In both study groups, we found the early migration pattern expected, with a relatively high initial amount of migration from operation to 3 months of follow-up, followed by stabilization of the implant with little migration thereafter. However, the modular implants had a statistically significantly higher degree of migration compared to the monoblock. We believe that the greater stiffness of the modular implants was the main reason for the difference in migration, but an initial creep in the polyethylene metal-back locking mechanism of the modular group could also be a possible explanation for the observed difference in migration between the 2 study groups.
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| 7. |
- Atroshi, Isam, et al.
(författare)
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Collagenase treatment of Dupuytrens contracture using a modified injection method
- 2015
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Ingår i: Acta Orthopaedica. - : Informa Healthcare: Creative Commons Attribution Non-Commercial / Informa Healthcare. - 1745-3674 .- 1745-3682. ; 86:3, s. 310-315
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Treatment of Dupuytrens contracture (DC) with collagenase Clostridium histolyticum (CCH) consists of injection followed by finger manipulation. We used a modified method, injecting a higher dose than recommended on the label into several parts of the cord, which allows treatment of multiple joint contractures in 1 session and may increase efficacy. We studied the occurrence of skin tears and short-term outcome with this procedure. Patients and methods - We studied 164 consecutive hands with DC, palpable cord, and extension deficit of greater than= 20 degrees in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joint (mean patient age 70 years, 82% men). A hand surgeon injected all the content of 1 CCH vial (approximately 0.80 mg) into multiple spots in the cord and performed finger extension under local anesthesia after 1 or 2 days. A nurse recorded skin tears on a diagram and conducted a standard telephone follow-up within 4 weeks. A hand therapist measured joint contracture before injection and at a median of 23 (IQR: 7-34) days after finger extension. Results - A skin tear occurred in 66 hands (40%). The largest diameter of the tear was less than= 5 mm in 30 hands and greater than 10 mm in 14 hands. Hands with skin tear had greater mean pretreatment MCP extension deficit than those without tear: 59 degrees (SD 26) as opposed to 32 degrees (SD 23). Skin tear occurred in 21 of 24 hands with MCP contracture of greater than= 75 degrees. All tears healed with open-wound treatment. No infections occurred. Mean improvement in total (MCP + PIP) extension deficit was 55 degrees (SD 28). Interpretation - Skin tears occurred in 40% of hands treated with collagenase injections, but only a fifth of them were larger than 1 cm. Tears were more likely in hands with severe MCP joint contracture. All tears healed without complications. Short-term contracture reduction was good.
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| 8. |
- Axelsson, Paul, et al.
(författare)
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Can implant removal restore mobility after fracture of the thoracolumbar segment? : A radiostereometric study
- 2016
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 87:5, s. 511-515
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose — Randomized trials have found that treating spinal burst fractures with reduction and posterior fixation is adequate without the use of bone grafting for definitive fusion. Restitution of intervertebral mobility of such an unfused segment after fracture healing may unload the adjacent parts of the spine and reduce the risk of degeneration of these segments. We used radiostereometry (RSA) to study whether late implant removal would restore the intervertebral mobility of a thoracolumbar segment treated with posterior instrumentation but no bone grafting for unstable spinal fracture. Patients and methods — We identified 7 patients with implant-related back pain at least 1.5 years after a thoracolumbar fracture (Th12 or L1) treated with reduction and posterior instrumentation. The implants were removed and tantalum indicators for RSA were inserted. 3 months later, each patient was examined with RSA. The intervertebral translations and rotations of the thoracolumbar segment, induced by change in position from flexion to extension, were measured. Progressive deformity was registered by conventional radiography and the overall clinical outcome was assessed by the patients. Results — According to RSA, all 7 patients regained some mobility of the fractured thoracolumbar segment. In 1 patient who was primarily treated for a flexion-distraction type of injury, conventional radiography revealed a progressive kyphotic deformity 3 months after implant removal and the clinical outcome was poor. According to the patients, 1 had a fair clinical outcome and 5 had good outcome. Interpretation — Late implant removal may restore segmental mobility after posterior fracture fixation of the thoracolumbar segment if bone grafting has not been used. The clinical consequences, positive or negative, of the residual mobility demonstrated in our small number of patients should be evaluated in studies based on extended patient series and with different fracture types.
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| 9. |
- Ban, Ilija, et al.
(författare)
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Overtreatment of displaced midshaft clavicle fractures : A survey of hospitals in Sweden, Denmark, and Finland
- 2016
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 87:6, s. 541-545
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose The best treatment for displaced clavicle fractures has been debated for decades. Operative treatment has become more common. However, several randomized trials comparing non-operative and operative treatment have not shown any compelling evidence in favor of surgery. We identified the preferred treatment of displaced midshaft clavicle fractures at public hospitals in 3 countries in Scandinavia.Patients and methods A purpose-made multiple-choice questionnaire in English was sent to all public hospitals in Denmark, Sweden, and Finland. This was addressed to the orthopedic surgeon responsible for treatment of clavicle fractures, and completed questionnaires were obtained from 85 of 118 hospitals.Results In the 3 countries, 69 of the 85 hospitals that responded would treat displaced clavicle fractures operatively. Clear criteria for treatment allocation were used at 58 of the hospitals, with the remaining 27 using individual assessment in collaboration with the patient. Precontoured locking plates were mostly used, placed either superiorly (64/85) or anteriorly (10/85).Interpretation Displaced midshaft clavicle fractures are mainly treated operatively in Sweden, Denmark, and Finland. This treatment is not supported by compelling evidence.
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| 10. |
- Bartels, Stefan, et al.
(författare)
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High failure rate after internal fixation and beneficial outcome after arthroplasty in treatment of displaced femoral neck fractures in patients between 55 and 70 years : An observational study of 2,713 patients reported to the Norwegian Hip Fracture Register
- 2018
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 89:1, s. 53-58
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose — The treatment of patients between 55 and 70 years with displaced intracapsular femoral neck fracture remains controversial. We compared internal fixation (IF), bipolar hemiarthroplasty (HA) and total hip arthroplasty (THA) in terms of mortality, reoperations and patient-reported outcome by using data from the Norwegian Hip Fracture Register. Patients and methods — We included 2,713 patients treated between 2005 and 2012. 1,111 patients were treated with IF, 1,030 with HA and 572 patients with THA. Major reoperations (defined as re-osteosynthesis, secondary arthroplasty, exchange, or removal of prosthesis components and Girdlestone procedure), patient-reported outcome measures (satisfaction, pain, and health-related quality of life (EQ5D) after 4 and 12 months), 1-year mortality, and change in treatment methods over the study period were investigated. Results — Major reoperations occurred in 27% after IF, 3.8% after HA and 2.8% after THA. 549 patients (20% of total study population) answered both questionnaires. Compared with IF, patients treated with THA were more satisfied after 4 and 12 months, reported less pain after 4 months and 12 months, had a higher EQ5D-index score after 4 months and 12 months, and EQ-VAS score after 4 months. Compared with IF, patients treated with HA were more satisfied and reported less pain after 4 months. EQ5D-index and EQ-VAS were similar. Patients treated with HA had higher 1-year mortality and had more comorbidities than both the THA and IF group. All these differences were statistically and clinically significant. Interpretation — This study showed high reoperation rate after IF and better patient-reported outcome after both THA and HA with medium follow-up. Patients selected for HA represented a frailer group than patients treated with THA or IF.
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