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- Anderson, Mattias, et al.
(författare)
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Limited angular remodelling after in-situ fixation for slipped capital femoral epiphysis
- 2024
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Ingår i: BMC Musculoskeletal Disorders. - : BMC. - 1471-2474. ; 25:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundIn Sweden, most children with slipped capital femoral epiphysis (SCFE) are operated on with a single smooth pin or a short-threaded screw, allowing further growth of the femoral neck. Using the Swedish Pediatric Orthopaedic Quality registry, SPOQ, we investigated whether angular remodelling occurs adjacent to the proximal femoral epiphysis after fixation of SCFE using implants, allowing continued growth of the femoral neck.MethodsDuring 2008-2010 a total national population of 155 children were reported to the SPOQ registry. Following our strict inclusion criteria, radiographs of 51 hips were further assessed. The lateral Head Shaft Angle (HSA), the Notzli 3-point alpha-angle, the anatomic alpha-angle, and the Anterior Offset Ratio (AOR) on the first postoperative radiographs and at follow-up were measured to describe the occurrence of remodelling. Slip severity was categorised as mild, moderate or severe according to postoperative HSA.ResultsMean and SD values for the change in HSA were 3,7 degrees (5,0 degrees), for 3-point alpha-angle 6,8 degrees (8,9 degrees), and anatomic alpha-angle 13,0 degrees (16,3 degrees). The overall increase in AOR was 0,038 (0.069). There were no significant differences between the slip severity groups.ConclusionsWe found limited angular remodelling after in situ fixation with smooth pins or short threaded screws for SCFE. The angular remodelling and the reduction of the CAM deformity was less than previously described after fixation of SCFE with similar implants. Results about the same magnitude with non-growth sparing techniques suggest that factors other than longitudinal growth of the femoral neck are important for angular remodelling.
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| 2. |
- Risto, Anton, et al.
(författare)
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Long-term Follow-up, Patient Satisfaction, and Quality of Life for Patients With Kocks Continent Ileostomy
- 2021
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Ingår i: Diseases of the Colon & Rectum. - : LIPPINCOTT WILLIAMS & WILKINS. - 0012-3706 .- 1530-0358. ; 64:4, s. 420-428
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Continent ileostomy is a solution for patients after proctocolectomy. OBJECTIVE: The aim of this study was to assess the long-term complications and failure rate alongside patient satisfaction, function, and quality of life for patients with a continent ileostomy. DESIGN: This was a retrospective, descriptive cross-sectional study. SETTINGS: All patients were operated in 1 center between 1980 and 2016. PATIENTS: A total of 85 patients received a de novo continent ileostomy in our institution. Sixty-nine patients (80%) had ulcerative colitis, 12 (14%) had Crohns disease, 2 had indeterminate colitis, and 1 each had familial adenomatous polyposis and anal atresia. MAIN OUTCOME MEASURES: Medical charts were reviewed for reoperations and pouchitis. The 36-Item Short Form, Short Health Scale, and a local continent ileostomy questionnaire were used to assess quality of life, function, and satisfaction. RESULTS: After a median follow-up of 24 years, 67 patients (79%) underwent a total of 237 reoperations, of which 15 were conversions to end ileostomies, that is, failures. Fifty patients (59%) underwent repeat laparotomies, excluding loop ileostomy closures. Nipple detachment was the most common cause for repeat laparotomy, and fistulation was the most common cause for pouch removal. IPAA before continent ileostomy was associated with an increased risk for failure. Crohns disease was not associated with an increased risk for reoperation or failure. Forty-three patients (84%) reported that they were satisfied. Seventy patients were available for questionnaires, and 50 patients (71%) answered. There was no difference in the 36-Item Short Form between the continent ileostomy population and an age-matched control population. LIMITATIONS: The retrospective, single-center design of the study alongside <100% response rate are to be considered limitations. CONCLUSIONS: Despite large numbers of complications, patients are generally satisfied with their continent ileostomies, and their quality of life is comparable to the general population. See Video Abstract at http://links.lww.com/DCR/B444.
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| 3. |
- Risto, Anton, 1984-
(författare)
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Reconstruction after Colectomy for Inflammatory Bowel Disease
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- After colectomy there are four options available. The least complicated and most common is to leave the end ileostomy and not go for any reconstructive surgery. Then there is the ileal pouch anal anastomosis (IPAA) in which the rectum is removed, but the anal canal and a small rectal “cuff” is preserved. The pouch is created from the distal ileum and anastomosed to the rectal cuff. In the ileorectal anastomosis (IRA) the rectum is spared, and the distal ileum is anastomosed to the top of the rectum. In the continent ileostomy (CI), also referred to as the Kock pouch, the fecal flow is let out through the abdominal wall, but a pouch and a nipple valve mechanism is created making the stoma continent which needs to be manually emptied. This thesis aims to investigate function, quality of life, satisfaction, complications, and aspects associated with the chance of having reconstructive surgery after colectomy for inflammatory bowel disease (IBD), i.e. ulcerative colitis (UC) or Crohn’s disease (CD).The first two papers focus on the continent ileostomy, the most uncommon of the options after colectomy. In Paper 1 all patients who have received a CI at our center were identified and medical charts were reviewed for complications and CI patency. Function and quality of life were evaluated with the 36-item short form survey (SF-36), short health scale (SHS) and a local CI specific questionnaire for function and satisfaction. In Paper II, the Swedish national patient register (NPR) was used to identify all patients with an IBD diagnosis who had received a CI and data on diagnosis, demographics, reoperations, and excisions were obtained from the register. Paper III describes an ongoing prospective non-randomized, multi-center, open-label, controlled trial between IRA and IPAA in UC patients subjected to colectomy. The primary endpoint is satisfaction but Quality of Life (QoL), sexual function, bowel function and complications are also evaluated. In Paper IV, we investigated if the chance of getting reconstructed after colectomy was dependent on the IPAA volumes at the colectomy hospital using data from the national patient register. The hospitals were arranged in to four categories based on the average annual number of IPAA procedures: (0, 1-3, 4-7, >7 procedures per year). In Paper I we found that 59 % of CI patients needed repeat laparotomy after a median follow up of 24 years and nipple detachment was the most common cause of repeat laparotomy. Fifteen patients (18 %) had their CIs converted to end ileostomies and the most common cause for this was fistulas. Eighty-four per cent of CI patients reported satisfaction with their reconstruction. The national study in Paper II identified 727 IBD patients with CI and the median follow-up time was 27 years. During follow-up, 1484 reoperations were performed on 536 patients (74 %). Twenty-six per cent of the patients did not have any reoperations, 24 % had one reoperation, 20 % had two reoperations and the remaining 30 % had between three and 15 reoperations each. The CIs were identified to have been removed in 77 (11 %) patients. In Paper III we have so far included 47 patients in the intervention arms out of which 35 (74 %) have chosen IRA and 12 patients (26 %) have chosen IPAA. Another 44 (40 % of the whole group) patients have so far received an IPAA but were deemed non-eligible for both IRA and IPAA and were hence not eligible for the intervention arms. So far 18 patients (17 % of the whole group) have chosen an ileostomy. In Paper IV we first identified 4112 UC patients subjected to colectomy between 1997 and 2020. Out of these 4112 patients, 1932 (47 %) went through some kind of reconstruction, 964 (50 %) IRA, 927 (48 %) IPAA and 41 (2 %) CI. The proportion having restorative surgery was larger for patients subjected to colectomy at a high IPAA volume center (62 % vs 38 %) and the chance of getting an IPAA increased with each IPAA volume category (Hazard ratios (HR) were: 1; 1.49 95 % CI (1.25-1.78) ; 1.79 95 % CI (1.49-2.15) and 2.11 95 % CI (1.70-2.62) respectively)The IPAA volumes did not affect the chance of receiving an IRA or the risk of failure of reconstruction.
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| 4. |
- Risto, Olof, et al.
(författare)
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Outcome after osteochondroplasty and relative neck lengthening for patients with healed Legg-Calve-Perthes disease: a retrospective cohort study of patients with hip-deformities treated with osteochondroplasty and relative neck lengthening
- 2021
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Ingår i: HIP International. - : Sage Publications. - 1120-7000 .- 1724-6067. ; 31:3, s. 417-423
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Our main objectives were to evaluate the effect of surgery using self-assessed health scores. Secondary objectives were to correlate outcome with grade of deformity (Stulberg classification I-V) or age at surgery and whether additional periacetabular osteotomy (PAO) is beneficial for patients with concurrent acetabular dysplasia. Methods: This was a retrospective cohort and in part a cross sectional study using a planned clinical and radiological follow-up of patients. All patients with healed Legg-Calve-Perthes disease (LCPD) treated with osteochondroplasty and relative neck lengthening using surgical hip dislocation, with or without periacetabular osteotomy (PAO) were included. A total of 39 patients were identified and invited to participate (29 males and 10 females) of which 32 accepted. Radiographic assessment and Stulberg classification were obtained. The Nonarthritic Hip Score (NAHS), modified Harris Hip Score (mHHS) and the VAS scale of EQ-5D-5L were used. Results: The majority of the patients experienced improvement (74%, n = 27) and 21 patients (78%, n = 27) found the surgery worthwhile. Preoperative Stulberg II and III patients (83% improvement) showed better results than Stulberg IV and V patients (56% improvement) (n = 27, p = 0.121). There was significantly better patient-satisfaction for those younger than 29 years of age (amp;lt;= 18 years old (92%), 19-28 years old (89%), amp;gt; 29 years old (67%), x(2)(2) = 8512, n = 27, p = 0.022) and a negative correlation for age at onset of LCPD and mHHS (r = -0.420, p = 0.046, n = 23). Patients with concurrent acetabular dysplasia (n = 19), 82% (9 of 11) improved after additional PAO compared to 63% (5 of 8) who were not operated on with PAO. Conclusion: This procedure is worthwhile in selected cases except for severe deformity (Stulberg IV and V) and patients amp;gt;28 years of age.
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