| 1. |
- Dale, H., et al.
(författare)
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Increasing risk of revision due to infection after primary total hip arthroplasty: results from the Nordic Arthro- plasty Register Association
- 2023
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Ingår i: Acta orthopaedica. - : Medical Journals Sweden. - 1745-3674 .- 1745-3682. ; 94, s. 307-315
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - The incidence of peripros-thetic joint infection after total hip arthroplasty (THA) may be increasing. We performed time-trend analyses of risk, rates, and timing of revision due to infection after primary THAs in the Nordic countries from the period 2004-2018. Patients and methods - 569,463 primary THAs reported to the Nordic Arthroplasty Register Association from 2004 to 2018 were studied. Absolute risk estimates were calculated by Kaplan-Meier and cumulative incidence function methods, whereas adjusted hazard ratios (aHR) were assessed by Cox regression with the first revision due to infection after primary THA as primary endpoint. In addi-tion, we explored changes in the time span from primary THA to revision due to infection. Results - 5,653 (1.0%) primary THAs were revised due to infection during a median follow-up time of 5.4 (IQR 2.5-8.9) years after surgery. Compared with the period 2004-2008, the aHRs for revision were 1.4 (95% confidence interval [CI] 1.3-1.5) for 2009-2013, and 1.9 (CI 1.7-2.0) for 2014-2018. The absolute 5-year rates of revision due to infection were 0.7% (CI 0.7-0.7), 1.0% (CI 0.9-1.0), and 1.2% (CI 1.2-1.3) for the 3 time periods respectively. We found changes in the time span from primary THA to revi-sion due to infection. Compared with 2004-2008, the aHR for revision within 30 days after THA was 2.5 (CI 2.1-2.9) for 2009-2013, and 3.4 (CI 3.0-3.9) for 2013-2018. The aHR for revision within 31-90 days after THA was 1.5 (CI 1.3-1.9) for 2009-2013, and 2.5 (CI 2.1-3.0) for 2013-2018, compared with 2004-2008.Conclusion - The risk of revision due to infection after primary THA almost doubled, both in absolute cumulative incidence and in relative risk, throughout the period 2004- 2018. This increase was mainly due to an increased risk of revision within 90 days of THA. This may reflect a "true" increase (i.e., frailer patients or more use of uncemented implants) and/or an "apparent" increase (i.e., improved diagnostics, changed revision strategy, or completeness of reporting) in incidence of periprosthetic joint infection. It is not possible to disclose such changes in the present study, and this warrants further research.
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| 2. |
- Gustafsson, K., et al.
(författare)
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A Multifaceted Picture Of Patient Perspectives Of Health Care And Self-Management In Hip And Knee Osteoarthritis
- 2023
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Ingår i: Osteoarthritis and Cartilage. - : Elsevier BV. - 1063-4584 .- 1522-9653. ; 31, s. S399-S399
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Expressing a desire for surgery already before participating in first-line osteoarthritis (OA) interventions (patient education and exercise therapy) has in previous research shown to contribute to poorer outcomes from the interventions, yet we lack knowledge about patients’ views of health care and self-management of osteoarthritis (OA). This study aimed to explore and describe patients’ perspective of health care and self-management of OA among those expressing a desire for surgery before participating in first-line OA intervention.Methods: Sixteen patients with hip or knee OA who had expressed a desire to undergo surgery before they participated in a standardized first-line OA intervention program in primary health care in Sweden were included in the study. We used individual semi-structured interviews to collect data, which were then analysed using inductive qualitative content analysis to identify, describe, and categorize patterns detected within the data.Results: The analysis resulted in one main theme “A multifaceted picture of needs, expectations and individual choices”, which illustrates how the informants expressed a broad range of topics in their perspectives on health care and self-management of OA. Five categories, with its subcategories were identified: (1) lacking control and needing support, consisting of the perspectives; limiting activities due to pain, having difficulties in identifying patterns and finding strategies, feeling frustration and stress, seeing OA as an inevitable deterioration and needing help and being insecure (2) standing alone in an unsupportive environment, comprised of the two subcategories; being left alone and not being taken seriously (3) being passive, which included the subcategories; unstructured self-management, getting used to and adapting to the situation, limited retrieval of information and knowledge and passive health care consumer. (4) having expectations which was divided into the following subcategories: wanting quick help, doubts about the health care provided and expectations based on previous function and experiences and (5) taking ownership, which included trying to stay active or actively adapting to the situation and seeking control and answers (Fig.1).Conclusions: The patients’ perspectives of expressing a desire for surgery already before participating in a first-line OA intervention program are multifaceted and based on a broad range of aspects, from a passive approach manifested by lack of control, adapting to the situation, being left alone, often resulting in doubts or mistrust regarding provided health care to actively trying to adapt to the situation and striving to maintain in control. Findings from this study strengthen insights on the importance of individualizing OA interventions and can contribute to optimizing the support that physiotherapists provide to patients in daily clinic practice.
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| 3. |
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| 4. |
- Mikkelsen, R. T., et al.
(författare)
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Does choice of bearings influence the survival of cement-less total hip arthroplasty in patients aged 20-55 years? Comparison of 21,594 patients reported to the Nordic Arthroplasty Register Association dataset 2005-2017
- 2023
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Ingår i: Acta Orthopaedica. - 1745-3674. ; 94, s. 266-273
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - The bearings with the best survivorship for young patients with total hip arthroplasty (THA) should be identified. We compared hazard ratios (HR) of revision of primary stemmed cementless THAs with metal-on-metal (MoM), ceramic-on-ceramic (CoC), and ceramic-on-highly-crosslinked-polyethylene (CoXLP) with that of metal-on-highly-crosslinked-polyethylene (MoXLP) bearings in patients aged 20-55 years with primary osteoar-thritis or childhood hip disorders. Patients and methods - From the Nordic Arthroplasty Register Association dataset we included 1,813 MoM, 3,615 CoC, 5,947 CoXLP, and 10,219 MoXLP THA in patients operated on between 2005 and 2017 in a prospective cohort study. We used the Kaplan-Meier estimator for THA sur-vivorship and Cox regression to estimate HR of revision adjusted for confounders (including 95% confidence inter-vals [CI]). MoXLP was used as reference. HRs were calcu-lated during 3 intervals (0-2, 2-7, and 7-13 years) to meet the assumption of proportional hazards. Results - Median follow-up was 5 years for MoXLP, 10 years for MoM, 6 years for CoC, and 4 years for CoXLP. 13-year Kaplan-Meier survival estimates were 95% (CI 94-95) for MoXLP, 82% (CI 80-84) for MoM, 93% (CI 92-95) for CoC, and 93% (CI 92-94) for CoXLP bearings. MoM had higher 2-7 and 7-13 years' adjusted HRs of revi-sion (3.6, CI 2.3-5.7 and 4.1, CI 1.7-10). MoXLP, CoC, and CoXLP had similar HRs in all 3 periods. The 7-13-year adjusted HRs of revision of CoC and CoXLP were statisti-cally non-significantly higher. Conclusion - In young patients, MoXLP for primary cementless THA had higher revision-free survival and lower HR for revision than MoM bearings. Longer follow-up is needed to compare MoXLP, CoC, and CoXLP.
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| 5. |
- Silman, A. J., et al.
(författare)
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International variation in distribution of ASA class in patients undergoing total hip arthroplasty and its influence on mortality: data from an international consortium of arthroplasty registries
- 2021
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 92:3, s. 304-310
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - A challenge comparing outcomes from total hip arthroplasty between countries is variation in preoperative characteristics, particularly comorbidity. Therefore, we investigated between-country variation in comorbidity in patients based on ASA class distribution, and determined any variation of ASA class to mortality risk between countries. Patients and methods - All arthroplasty registries collecting ASA class and mortality data in patients with elective primary THAs performed 2012-2016 were identified. Survival analyses of the influence of ASA class on 1-year mortality were performed by individual registries, followed by meta-analysis of aggregated data. Results - 6 national registries and 1 US healthcare organization registry with 418,916 THAs were included. There was substantial variation in the proportion of ASA class III/IV, ranging from 14% in the Netherlands to 39% in Finland. Overall, 1-year mortality was 0.93% (95% CI 0.87-1.01) and increased from 0.2% in ASA class I to 8.9% in class IV. The association between ASA class and mortality measured by hazard ratios (HR) was strong in all registries even after adjustment for age and sex, which reduced them by half in all registries. Combined adjusted HRs were 2.0, 6.1, and 22 for ASA class II-IV vs. I, respectively. Associations were moderately heterogeneous across registries. Interpretation - We observed large variation in ASA class distribution between registries, possibly explained by differences in background morbidity and/or international variation in access to surgery. The similar, strong mortality trends by ASA class between countries enhance the relevance of its use as an indicator of comorbidity in international registry studies.
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