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| 3. |
- Digas, Georgios, 1963, et al.
(author)
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The Otto Aufranc Award. Highly cross-linked polyethylene in total hip arthroplasty: randomized evaluation of penetration rate in cemented and uncemented sockets using radiostereometric analysis
- 2004
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In: Clin Orthop Relat Res. - 0009-921X. ; :429, s. 6-16
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Journal article (peer-reviewed)abstract
- The annual wear rate in polyethylene articulations should be 0.1 mm or less to avoid future osteolysis. Highly cross-linked polyethylene shows an 80 to 90% wear reduction in hip simulator testing, but the clinical documentation of this new polyethylene is still inadequate. We evaluated the highly cross-linked polyethylene in two prospective randomized clinical studies. Thirty-two patients (12 men, 20 women; 64 hips) with a median age of 48 years (range, 29-70 years) with bilateral primary or secondary arthrosis of the hip had hybrid total hip arthroplasty with liners made of highly cross-linked polyethylene on one side and conventional polyethylene on the other. Twenty-seven patients in this study have passed 2 years followup. A further group, comprised of 60 patients (61 hips) with a median age of 55 years (range, 35-70 years), was randomized to receive either highly cross-linked polyethylene or conventional cemented all-polyethylene of the same design. Forty-nine of these 60 patients have been observed for 3 years. In both studies all patients received Spectron stems with 28-mm Co-Cr heads. Radiostereometric examinations with the patient supine or standing were done at regular intervals. Wear was measured in the supine position from the first postoperative week, whereas standing examinations were initiated 3 months after the operation. The penetration rate almost was identical in the study and control groups at 6 months after the operation. Thereafter, the penetration rate leveled out in the two groups with highly cross-linked polyethylene. At 2 years the highly cross-linked polyethylene liner showed 62% lower proximal penetration and 31% lower total (three-dimensional) penetration when the patients were examined in supine position. The highly crosslinked all-polyethylene cemented cups showed lower proximal penetration in both positions. The better wear performance of highly cross-linked polyethylene could increase the implant longevity. Longer followup is needed to evaluate if this new material is associated with less occurrence of osteolysis.
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- Havelin, L. I., et al.
(author)
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The Nordic Arthroplasty Register Association
- 2009
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In: Acta Orthopaedica. - 1745-3682. ; 80:4, s. 1-9
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Journal article (peer-reviewed)abstract
- Background and purpose The possibility of comparing results and of pooling the data has been limited for the Nordic arthroplasty registries, because of different registration systems and questionnaires. We have established a common Nordic database, in order to compare demographics and the results of total hip replacement surgery between countries. In addition, we plan to study results in patient groups in which the numbers are too small to be studied in the individual countries. Material and methods Primary total hip replacements (THRs) from 1995-2006 were selected for the study. Denmark, Sweden, and Norway contributed data. A common code set was made and Cox multiple regression, with adjustment for age, sex, and diagnosis was used to calculate prosthesis survival with any revision as endpoint. Results 280,201 operations were included (69,242 from Denmark, 140,821 from Sweden, and 70,138 from Norway). Females accounted for 60% of the patients in Denmark and Sweden, and 70% in Norway. Childhood disease was the cause of 3.1%, 1.8%, and 8.7% of the operations in Denmark, Sweden, and Norway, respectively. Resurfacing of hips accounted for 0.5% or less in all countries. The posterior approach was used in 91% of cases in Denmark, 60% in Sweden, and 24% in Norway. Cemented THRs were used in 46% of patients in Denmark, in 89% of patients in Sweden, and in 79% of patients in Norway. Of the 280,201 primary THRs, 9,596 (3.4%) had been revised. 10-year survival was 92% (95% CI: 91.6-92.4) in Denmark, 94% (95% CI: 93.6-94.1) in Sweden, and 93% (95% CI: 92.3-93.0) in Norway. In Denmark, 34% of the revisions were due to dislocation, as compared to 23% in Sweden and Norway. Replacement of only cup or liner constituted 44% of the revisions in Denmark, 29% in Sweden, and 33% in Norway. Interpretation This unique common Nordic collaboration has shown differences between the countries concerning demographics, prosthesis fixation, and survival. The large number of patients in this database significantly widens our horizons for future research.
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| 8. |
- Johanson, Per-Erik, et al.
(author)
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Highly Crosslinked Polyethylene Does Not Reduce Aseptic Loosening in Cemented THA 10-year Findings of a Randomized Study.
- 2012
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In: Clinical orthopaedics and related research. - : Ovid Technologies (Wolters Kluwer Health). - 1528-1132 .- 0009-921X. ; 470:11, s. 3083-93
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Journal article (peer-reviewed)abstract
- Polyethylene (PE) wear particles are believed to cause aseptic loosening and thereby impair function in hip arthroplasty. Highly crosslinked polyethylene (XLPE) has low short- and medium-term wear rates. However, the long-term wear characteristics are unknown and it is unclear whether reduced wear particle burden improves function and survival of cemented hip arthroplasty.
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| 12. |
- Lindahl, Hans, 1950, et al.
(author)
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Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register
- 2005
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In: J Arthroplasty. - : Elsevier BV. - 0883-5403. ; 20:7, s. 857-65
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Journal article (peer-reviewed)abstract
- Postoperative femoral periprosthetic fracture is an uncommon complication of total hip arthroplasty surgery, but several centers worldwide have recently reported an increase in total numbers of such fractures. This severe complication is costly for society and results in high morbidity. Our analysis of 1049 periprosthetic fractures occurring in Sweden between 1979 and 2000 and recorded in the Swedish National Hip Arthroplasty Register focuses on patient- and implant-related factors, fracture classification, and fracture frequency. These were our 3 major findings: (1) a majority of the patients who sustained a late periprosthetic femoral fracture had a loose stem. (2) Implant-related factors are significantly associated with occurrence of a periprosthetic fracture. (3) Since the 1980s in Sweden, treatment results for periprosthetic fractures have been poor, with low long-term survivorship and a high frequency of complications. We have initiated further studies of this important problem.
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| 13. |
- Lindahl, Hans, 1950, et al.
(author)
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Three hundred and twenty-one periprosthetic femoral fractures
- 2006
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In: J Bone Joint Surg Am. - 0021-9355. ; 88:6, s. 1215-22
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Journal article (peer-reviewed)abstract
- BACKGROUND: The purpose of this study was to determine the demographics, incidence, and results of treatment of periprosthetic fractures in a nationwide observational study. METHODS: In the years 1999 and 2000, 321 periprosthetic fractures were reported to the Swedish National Hip Arthroplasty Register. All of the associated hospital records were collected. At the time of follow-up, the Harris hip score, a health-related quality-of-life measure (the EuroQol-5D [EQ-5D] index), and patient satisfaction were used as outcome measurements. A radiologist performed the radiographic evaluation. RESULTS: Ninety-one patients, with a mean age of 73.8 years, sustained a fracture after one or several revision procedures, and 230 patients, with a mean age of 77.9 years, sustained a fracture after a primary total hip replacement. Minor trauma, including a fall to the floor, and a spontaneous fracture were the main etiologies for the injuries. A high number of patients had a loose stem at the time of the fracture (66% in the primary replacement group and 51% in the revision group). Eighty-eight percent of the fractures were classified as Vancouver type B; however, there was difficulty with preoperative categorization of the fractures radiographically. There was a high failure rate resulting in a low short to mid-term prosthetic survival rate. The sixty-six-month survival rate for the entire fracture group, with reoperation as the end point, was 74.8% +/- 5.0%. One factor associated with fracture risk was implant design. CONCLUSIONS: On the basis of these findings, we believe that high-risk patients should have routine radiographic follow-up. Such a routine could identify a loose implant and make intervention possible before a fracture occurred. Furthermore, we recommend an exploration of the joint to test the stability of the implant in patients with a Vancouver type-B fracture in which the stability of the stem is uncertain.
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| 14. |
- Lohmander, Stefan, et al.
(author)
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Standardized incidence rates of total hip replacement for primary hip osteoarthritis in the 5 Nordic countries: similarities and differences
- 2006
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In: Acta Orthop. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 77:5, s. 733-40
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Journal article (peer-reviewed)abstract
- BACKGROUND: The national hip registers of the Nordic countries provide an opportunity to compare age- and sex-standardized annual incidence of primary total hip replacement (THR) and types of implants used for primary hip osteoarthritis (OA) in Denmark, Finland, Iceland, Norway and Sweden. METHODS: The data on THR were from the national total hip replacement registries, and population data were from the national statistics agencies. Annual incidence density per 100,000 was calculated for each 5-year age group and it was age-standardized using the WHO European standard population. RESULTS: Crude country-specific annual incidence (all ages) for 1996-2000 varied between 73 and 90. WHO age-standardized annual incidence (all ages) varied between 61 (Finland) and 84 (Iceland). For the ages 50-89, comprising 94-98% of all THRs for OA, annual incidence varied between 217 (Finland) and 309 (Iceland). For Norway, the sex incidence ratio (women/men) was 2, and for the other countries it was between 1.1 and 1.3. The use of uncemented and hybrid replacements was considerably higher in Finland and Denmark than in the other countries. INTERPRETATION: We found overall similarity in THR incidence between the 5 Nordic countries, but substantial differences between women and men, and in the use of different types of implant. Population-based, age-standardized and disease-specific information on THR incidence is required in order to properly explore the causes of differences in provision and practice of THR in different countries, regions and groups, and it will aid in projecting future needs.
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| 15. |
- Malchau, Henrik, 1951, et al.
(author)
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Presidential guest address: the Swedish Hip Registry: increasing the sensitivity by patient outcome data
- 2005
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In: Clin Orthop Relat Res. - 0009-921X. ; 441, s. 19-29
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Journal article (peer-reviewed)abstract
- The Swedish Hip Register was initiated in 1979. The mission of the register is to improve the outcome of THA. The hypothesis is that feedback of data stimulates participating clinics to reflect and improve. In addition to revision surgery, patient-based outcome measures and radiographic results are included to improve sensitivity. All patients who have a total hip arthroplasty answer a questionnaire preoperatively and again after 1, 6, and 10 years postoperatively. The questionnaire includes the Charnley classification, EQ-5D and visual analog scales concerning pain and overall satisfaction and is used by 31 of 81 units. Average costs for the procedure ($11,000) are obtained from a national database. The mean gain in the EQ-5D index after 1 year for 3900 patients was 0.37, giving a low cost of $3000 per quality adjusted life year. Patient satisfaction and pain amelioration generally was high. The national average 7-year survival (revision as endpoint), has improved from 93.5% (+/- 0.15) to 95.8 (+/- 0.15) between the two periods 1979 to 1991 and 1992 to 2003. National implant registers define the epidemiology of primary and revision surgery. In conjunction with individual subjective patient data and radiography they contribute to development of evidence-based THA surgery.
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| 17. |
- Mohaddes, Maziar, 1974, et al.
(author)
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High proximal migration in cemented acetabular revisions operated with bone impaction grafting; 47 revision cups followed with RSA for 17 years.
- 2017
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In: Hip international : the journal of clinical and experimental research on hip pathology and therapy. - : SAGE Publications. - 1724-6067. ; 27:3, s. 251-258
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Journal article (peer-reviewed)abstract
- Bone impaction grafting is a biologically and mechanically appealing option in acetabular revision surgery, allowing restitution of the bone stock and restoration of the biomechanics. We analysed differences in proximal migration of the revision acetabular components when bone impaction grafting is used together with a cemented or an uncemented cup.43 patients (47 hips), revised due to acetabular loosening and judged to have less than 50% host bone-implant contact were included. The hips were randomised to either an uncemented (n = 20) or a cemented (n = 27) revision cup. Radiostereometry and radiography was performed postoperatively, at 3 and 6 months, 1, 2, 3, 5, 7, 10 and 13 and 17 years postoperatively. Clinical follow-up was performed at 1, 2 and 5 years postoperatively and thereafter at the same interval as in the radiographic follow-up.There were no differences in the base line demographic data between the 2 groups. At the last follow-up (17 years) 14 hips (10 cemented, 4 uncemented) had been re-revised due to loosening. 3 additional cups (1 uncemented and 2 cemented) were radiographically loose. There was a higher early proximal migration in the cemented cups.Cups operated on with cement showed a higher early migration measured with RSA and also a higher number of late revisions. The reason for this is not known, but factors such as inclusion of cases with severe bone defects, use of smaller bone chips and issues related to the impaction technique might have had various degrees of influence.
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| 19. |
- Rolfson, Ola, 1973, et al.
(author)
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One-stage bilateral total hip replacement is cost-saving
- 2014
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In: Orthopedic & Muscular System: Current Research. - : OMICS Publishing Group. - 2161-0533. ; 12:3 (4)
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Journal article (peer-reviewed)abstract
- Many patients suffer from bilateral hip disease. For these patients two-stage bilateral total hip replacement (THR) is more common than a one-stage procedure because of fear of complications associated with one-stage surgery. However, many studies are in favour of one-stage bilateral THR in healthy and young patients. We investigated costs, complications and patient-reported outcome related to one-stage bilateral THR. Unilateral THR was used as a reference. Thirty-two patients with one-stage bilateral THR were prospectively followed for six years (bilateral group). A matched reference population of 32 patients with unilateral THR was assembled (unilateral group). Medical records, individual data from the Swedish Hip Arthroplasty Register, the Swedish Social Insurance Administration and local data on cost per patient were used for the analyses. For non-retired patients, the duration and costs for sick leave during the first postoperative year were similar in both groups. The rate of complications and their severity were similar in both groups. Using cost data from this study in a theoretical model, comparing one- and two-staged procedures showed a 24% reduction in hospital and sick-leave costs in favour of the one-stage procedure. Our results indicate that the one-stage procedure is cost-saving compared to two-stage procedures for patients with indication for bilateral THR
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| 20. |
- Zügner, Roland, 1958, et al.
(author)
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Stable Fixation but Unpredictable Bone Remodelling Around the Lord Stem: Minimum 23-Year Follow-Up of 66 Total Hip Arthroplasties.
- 2013
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In: The Journal of arthroplasty. - : Elsevier BV. - 1532-8406 .- 0883-5403. ; 28:4, s. 644-649
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Journal article (peer-reviewed)abstract
- Early designs of uncemented hip implants turned out to be failures mainly because the prerequisites for durable implant fixation were unknown. One exception was the chrome-cobalt stem of the Madreporic Lord prosthesis. We prospectively studied this prosthetic design in 107 hips that underwent surgery in 1979-1986. At the last follow-up, five stems and 54 cups had been revised, corresponding to stem and cup survival rates of 92%±3% and 45%±5% at 26years. In all, 66 hips with remaining Lord stems were available for clinical follow-up 26years (24-29) after the index operation. The mean total Harris hip and pain scores were 81 (SD 14) and 41 (SD 5).
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