| 1. |
- Khoschnau, Shwan, et al.
(author)
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Type I collagen alpha1 Sp1 polymorphism and the risk of cruciate ligament ruptures or shoulder dislocations
- 2008
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In: American Journal of Sports Medicine. - : SAGE Publications. - 0363-5465 .- 1552-3365. ; 36:12, s. 2432-2436
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Journal article (peer-reviewed)abstract
- BACKGROUND: Cruciate ligament ruptures and shoulder dislocations are often caused by trauma, but predisposing intrinsic factors might also influence the risk. These injuries are more common in those with a previously injured sibling, an observation that might indicate a genetic predisposition. It is well known that polymorphisms in the collagen I gene are associated not only with osteoporosis and osteoporotic fracture risk, but also with osteoarthritis. HYPOTHESIS: Because collagen I is abundant in ligaments and tendons, the authors hypothesized that collagen I alpha1 Sp1 polymorphism also was related to the occurrence of cruciate ligament ruptures and shoulder dislocations. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: A total of 358 patients and 325 randomly selected population-based female controls were included in the study. Of the cases, 233 had a cruciate ligament rupture and 126 had had a shoulder dislocation. Age-adjusted odds ratios (ORs) with 95% confidence intervals (CIs) estimated by unconditional logistic regression were used as measures of association. RESULTS: Compared with the homozygous SS category, the heterozygous participants displayed a similar risk (OR, 1.06; 95% CI, 0.76-1.49), whereas the ss genotype was underrepresented in the injured population compared with the controls (OR, 0.15; 95% CI, 0.03-0.68). This latter estimate was similar for both cruciate ligament ruptures and shoulder dislocations, and was furthermore not modified by general joint laxity. CONCLUSION: The authors found a substantially decreased risk of these injuries associated with collagen type I alpha1 Sp1 polymorphism. The study might encourage other investigators to consider further research in the area of genes and soft tissue injuries.
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| 2. |
- Gordins, Vladislavs, et al.
(author)
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Risk of arthropathy after the Bristow-Latarjet repair : a radiologic and clinical thirty-three to thirty-five years of follow-up of thirty-one shoulders
- 2015
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In: Journal of shoulder and elbow surgery. - : Elsevier BV. - 1058-2746 .- 1532-6500. ; 24:5, s. 691-699
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Journal article (peer-reviewed)abstract
- BACKGROUND: Transfer of the coracoid (Bristow-Latarjet [B-L]) is used to stabilize anterior shoulder instability. We report the long-term results of our first 31 operations with this method.MATERIALS AND METHODS: Thirty-six patients (mean age, 26.7 years) had a B-L repair from 1977 to 1979. Five patients died, and during 2012 to 2013, the remaining 31 shoulders had a follow-up with questionnaire, physical examination, Western Ontario Shoulder Instability Index, Subjective Shoulder Value, Subjective Assessment of Shoulder Function, subjective assessment of loss of motion, and radiologic imaging.RESULTS: One patient required revision surgery because of recurrence and another because of repeat dislocation. Six patients reported subluxations. Eighteen patients (58%) were very satisfied, and 13 (42%) were satisfied. The mean Western Ontario Shoulder Instability Index score (100 possible) was 85, and the median score was 93. According to Samilson-Prieto classification of arthropathy of the shoulder, 39% were classified as normal, 27% as mild, 23% as moderate, and 11% as severe. The classification of arthropathy varied with observers and radiologic views. Age younger than 22 years at the primary dislocation meant less arthropathy at follow-up (P = .045).CONCLUSION: The degree of arthropathy 33 to 35 years after the B-L repair seems to follow the natural history of shoulder dislocation with respect to arthropathic joint degeneration. Postoperative restriction of external rotation does not increase later arthropathy.
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| 3. |
- Hovelius, Lennart, et al.
(author)
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Bristow-Latarjet and Bankart : a comparative study of shoulder stabilization in 185 shoulders during a seventeen-year follow-up
- 2011
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In: Journal of shoulder and elbow surgery. - St. Louis, MO : Mosby Yearbook, Inc.. - 1058-2746 .- 1532-6500. ; 20:7, s. 1095-1101
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Journal article (peer-reviewed)abstract
- Background: In 2 Swedish hospitals, 88 consecutive shoulders underwent Bankart repair (B), and 97 consecutive shoulders underwent Bristow-Latarjet repair (B-L) for traumatic anterior recurrent instability. Materials and methods: Mean age at surgery was 28 years (B-L group) and 27 years (B group). All shoulders had a follow-up by letter or telephone after a mean of 17 years (range, 13-22 years). The patients answered a questionnaire and completed the Western Ontario Shoulder Index (WOSI), Disability of Arm Shoulder and Hand (DASH), and SSV (Simple Shoulder Value) assessments. Results: Recurrance resulted revision surgery in 1 shoulder in the B-L group and in 5 shoulders in the B group (P=.08). Redislocation or subluxation after the index operation occurred in 13 of 97 B-L shoulders and in 25 of 87 of B shoulders (after excluding 1 patient with arthroplasty because of arthropathy, P=.017). Of the 96 Bristow shoulders, 94 patients were very satisfied/satisfied compared with 71 of 80 in the B series (P=.01). Mean WOSI score was 88 for B-L shoulders and 79 for B shoulders (P=.002). B-L shoulders also scored better on the DASH (P=.002) and SSV (P=.007). Patients had 11 degrees loss of subjectively measured outward rotation with the arm at the side after B-L repair compared with 19 degrees after Bankart (P=.012). The original Bankart, with tunnels through the glenoid rim, had less redislocation(s) or subluxation(s) than shoulders done with anchors (P=.048). Conclusions: Results were better after the Bristow-Latarjet repair than after Bankart repairs done with anchors with respect to postoperative stability and subjective evaluation. Shoulders with original Bankart repair also seemed to be more stable than shoulders repaired with anchors. Level of evidence: Level III, Retrospective Case Control Study, Treatment Study. (C) 2011 Journal of Shoulder and Elbow Surgery Board of Trustees.
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| 4. |
- Hovelius, Lennart, et al.
(author)
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Primary anterior dislocation of the shoulder : long-term prognosis at the age of 40 years or younger.
- 2016
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In: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 24:2, s. 330-42
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Journal article (peer-reviewed)abstract
- PURPOSE: We describe the long-term prognosis in 257 first-time anterior shoulder dislocations (255 patients, aged 12-40 years) registered at 27 Swedish emergency units between 1978 and 1979.METHODS: Half the shoulders were immobilised for 3-4 weeks after repositioning. Follow-ups were performed after two (questionnaire), five (questionnaire), 10 (questionnaire and radiology) and 25 (questionnaire and radiology) years in 227 patients (229 shoulders). Twenty-eight patients died during the 25 years of observation.RESULTS: Early movement or immobilisation after the primary dislocation resulted in the same long-term prognosis. Recurrences increased up to 10 years of follow-up, but, after 25 years, 29 % of the shoulders with ≥2 recurrences appeared to have stabilised over time. Arthropathy increased from 9 % moderate to severe and 11 % mild at 10 years, to 34 % moderate to severe and 27 % mild after 25 years. Alcoholics had a poorer prognosis with respect to dislocation arthropathy (P < 0.001). Age <25 years and/or bilateral instability represent a poorer prognosis, where stabilising surgery is necessary in every second shoulder. Fracture of the greater tuberosity means a good prognosis, and we have found no evidence that athletic activity, gender, a Hill-Sachs lesion and minor rim fractures had any prognostic impact. During the 25 years in which these patients were followed, 28/255 died (11 %), representing a mortality rate (SMR) that was more than double that of the general Swedish population (P < 0.001).CONCLUSION: Almost half of all first-time dislocations at the age of <25 years will have stabilising surgery and two-thirds will develop different stages of arthropathy within 25 years.
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| 5. |
- Hovelius, Lennart, et al.
(author)
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The effect of capsular repair, bone block healing, and position on the results of the Bristow-Laterjet procedure (study III) : long-term follow-up in 319 shoulders
- 2012
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In: Journal of shoulder and elbow surgery. - : Elsevier BV. - 1058-2746 .- 1532-6500. ; 21:5, s. 647-660
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Journal article (peer-reviewed)abstract
- Background We evaluated the results of the May modification of the Bristow-Latarjet procedure (“coracoid in standing position”) in 319 shoulders with respect to (1) coracoid healing and position and (2) surgical treatment of the joint capsule.Methods From 1980 until 2004, all shoulders with a Bristow-Latarjet repair were registered at our hospital. This study consists of 3 different cohorts with respect to follow-up. Series 1, 118 shoulders operated on during 1980 through 1985, had 15 years’ radiographic and clinical follow-up. Series 2, 167 shoulders that had surgery during 1986 through 1999, underwent retrospective follow-up by a questionnaire and scores—Western Ontario Shoulder Instability Index; Disabilities of the Arm, Shoulder and Hand; and Subjective Shoulder Value—after 10 to 23 years. Series 3, 34 shoulders treated during 2000 through 2004, with an added modified Bankart repair (“capsulopexy”) in 33 shoulders, were prospectively followed up for 5 to 8 years with the same questionnaire and scores as series 2.Results Of 319 shoulders, 16 (5%) had 1 or more redislocations and 3 of these (1%) had revision surgery because of remaining instability. One or more subluxations were reported in 41 shoulders (13%). The worst scores were found in 16 shoulders with 2 or more subluxations (P < .001). Radiographs showed bony healing in 246 of 297 shoulders (83%), fibrous union in 34 (13%), migration by 0.5 cm or more in 14 (5%), and no visualization in 3 (1%). Five of six shoulders that had the transplant positioned 1 cm or more medial to the glenoid rim had redislocations (83%, P = .001). Shoulders with migrated transplants did not differ from those with bony or fibrous healing with respect to redislocations and subluxations. When just a horizontal capsular shift was added to the transfer, the recurrence rate (redislocations or subluxations) decreased, with 2 of 53 (4%)compared with 37 of 208 (18%) with just anatomic closure of the capsule (P = .005), and the Western Ontario Shoulder Instability Index score improved (92 vs 85.6, P = .048). In total, for 307 of 319 shoulders (96%), patients were satisfied or very satisfied at final follow-up.Conclusion The open Bristow-Latarjet procedure yields good and consistent results, with bony fusion of the coracoid in 83%. A position of the coracoid 1 cm or more medial to the rim meant significantly more recurrences. The rate of recurrences decreased and subjective results improved when a horizontal capsular shift was added to the coracoid transfer.
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| 6. |
- Johansson, Lisa, et al.
(author)
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High incidence of periprosthetic joint infection with propionibacterium acnes after the use of a stemless shoulder prosthesis with metaphyseal screw fixation : a retrospective cohort study of 241 patients propionibacter infections after eclipse TSA
- 2017
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In: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 18
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Journal article (peer-reviewed)abstract
- Background: A stemless shoulder prosthesis with humeral metaphyseal screw fixation was introduced in order to save bone-stock and to facilitate reconstruction of biomechanics (Eclipse (R)). The aim of this study was to analyze whether the risk of infection is different with this implant compared to conventional shoulder prosthesis.Methods: Two hundred and forty-one patients (54.8% females) were operated with a shoulder arthroplasty and followed for median 2.0 (0.1-5.7) years. One hundred and two (42.3%) had received an Eclipse (R) prosthesis, the remaining patients were operated with other implants. There was an overrepresentation of males in the Eclipse (R) group (63.7% males) when compared with the control group (31.7% males).Results: In the Eclipse (R) group 10 (9.8%) patients developed a periprosthetic joint infection, as opposed to 1 (0.7%) in the control group. The most common bacteria was Propionibacterium acnes. Unadjusted infection-free survival after 4 years was 88.8% (CI 82.5-95.7) for Eclipse (R) patients and 95.7% (CI 87.7-100.0) for controls (p = 0.002). After adjustment for age, gender, diagnosis, and type of shoulder prosthesis (total or hemi), the risk ratio for revision due to infection was 4.3 (CI 0.5-39.1) for patients with the Eclipse (R) prosthesis.Conclusions: Deep infections seem to be more common after the use of the metaphyseally fixed Eclipse (R) prosthesis than after conventional shoulder implants, but a predominance of male gender and younger age in the Eclipse group may have biased our findings. Future studies on larger cohorts and in vitro investigations on bacterial adherence and biofilm formation are needed.
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| 7. |
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| 8. |
- Khoschnau, Shwan, et al.
(author)
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Improved healing of ligament to bone with point fixation in rabbits
- 2006
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In: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 77:6, s. 967-972
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Journal article (peer-reviewed)abstract
- Background Secure healing of soft tissue to bone is a prerequisite for many orthopedic operations. This healing can be achieved either by pressing the tissue against the bone (press fixation) or by suturing the soft tissue to the bone (point fixation). Experiments and findings We tested the hypothesis that point fixation of soft tissue to bone results in better mechanical properties than press fixation. 10 skeletally mature New Zealand White rabbits were operated on bilaterally at the knees. The medial collateral ligaments were fixated to the bone just above the original insertion on the tibia. Two types of plates were used for this purpose, one with flat undersurface (left knee) and the other one with a pegged undersurface (right knee). The pegged plate was thought to mimic fixation achieved with suture anchors. After 4 weeks, mechanical testing revealed an almost doubled force at failure, stiffness and energy uptake in the knees operated with the pegged plates. Interpretation Suture anchors or devices with a pegged undersurface are better for soft tissue fixation to bone than devices with a flat surface, such as screws with washers or staples.
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| 9. |
- Khoschnau, Shwan, et al.
(author)
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MRI without contrast is an unreliable method for detection of capsular reaction following shoulder surgery
- 2012
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Other publication (pop. science, debate, etc.)abstract
- Background Subacromial decompression is a common surgical procedure in patients with subacromial outlet impingement. The results are often good, although some patients develop adhesive capsulitis with postoperative pain and stiffness. The main aim of the present study was to analyze the reaction of the joint capsule 3 months after subacromial decompression using MRI without contrast. We also wanted to study if there was a relation between the capsular reaction and the Constant score (CS) or the subjective shoulder value (SSV).MethodsForty-eight patients with a median age of fifty-six years underwent subacromial decompression with or without AC-joint resection. They were investigated with a standard x ray and MRI pre surgery and MRI three months after surgery. The CS and SSV were measured preoperatively and at three months, six months, and two years postoperatively for SSV. Two musculoskeletal radiologists independently evaluated the MRI images and used a scoring system from 0-7. ResultsThe relationship between the baseline CS and the MRI pre-surgery score was significant for both raters. There were a significant difference between the raters’ pre and post-surgery average MRI scores, which simply means that there was a difference found in the average score between baseline and three months. However, the inter-rater reliability was poor. The improvement in the CS from baseline to three and six months postoperation was significant. The subjective shoulder value improved at three, six and 24 months after surgery.ConclusionsMRI is an unreliable method to study capsular reaction in the shoulder joint due to the high subjectivity of the radiologists. Considerable improvements were observed in the CS and the SSV.
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| 10. |
- Khoschnau, Shwan
(author)
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Soft Tissue Aspects of the Shoulder Joint
- 2012
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Doctoral thesis (other academic/artistic)abstract
- The aim of this thesis was to study different aspects of the soft tissues of the shoulder joint. The variation in the quality of the tendons and ligaments can be explained by genetic factors. To test the hypothesis that collagen 1 α1 Sp1 polymorphism is related to the occurrence of cruciate ligament ruptures and shoulder dislocations, a total of 358 patients (233 patients with cruciate ligament ruptures and 126 with shoulder dislocations) were included in the study. We found a decreased risk of these injuries associated with collagen type 1 α1 Sp1 polymorphism. To study the mechanical properties of a better type of fixation of soft tissue to bone, 10 skeletally mature New Zealand white rabbits were operated bilaterally on the knees. The medial collateral ligaments were fixed by two types of plates one with a flat undersurface and the other with a pegged undersurface. After 4 weeks the force at failure, stiffness and energy uptake was almost double in the knees operated with the pegged plates. The prevalence and dysfunction of rotator cuff tears was investigated in 106 subjects who had never sought for their shoulder complaints, using Constant score, ultrasound and plain x-ray. The prevalence of full-thickness cuff tears was 30% (21% of all shoulders). The Constant score was lower in subjects with full-thickness tears. Partial-thickness tears and acromioclavicular joint osteoarthritis had no impact on shoulder complaints or Constant score. The subacromial index was lower for shoulders with full-thickness tears. Forty-eight patients with median age 56 years underwent subacromial decompression with or without acromioclavicular joint resection, investigated with MRI pre- and 3 months postoperatively. The Constant score and subjective shoulder value were measured preoperatively and at 3 and 6 months after surgery and even 2 years for subjective shoulder value. Two raters investigated the MRI. The results showed poor inter-rater reliability for MRI. However, both Constant score and subjective shoulder value improved over time. MRI is not a reliable method to study the capsular reaction after subacromial decompression due to high subjectivity of the radiologists.
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| 11. |
- Lagerström, Christel, et al.
(author)
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Recovery of isometric grip strength after Colles' fracture : a prospective two-year study
- 1999
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In: Scandinavian Journal of Rehabilitation Medicine. - 0036-5505 .- 1940-2228. ; 31:1, s. 55-62
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Journal article (peer-reviewed)abstract
- Grip strength during short and sustained maximal voluntary isometric contractions was measured in 28 females and 5 males with displaced Colles' fracture involving the distal radio-ulnar joint. The patients were randomized into two groups, treated either through immobilization with plaster cast or with external fixation. The recovery of isometric grip strength was followed over a two-year period. A significant difference was registered between women with plaster casts and women with external fixators six weeks after the fracture. Regaining of grip strength occurred up to one year after the fracture. The pattern of recovery was slower for women with primary external fixation. Neither the dominant nor the non-dominant injured side regained short or sustained maximal voluntary isometric contraction. The dominant injured side showed no significant difference between sides but the non-dominant injured side remained significantly weaker. It is thus important to identify hand dominance. Pain during measurements was reduced after two years, but about one-fifth of the patients still perceived pain. The present findings may serve as guidance in physiotherapy for these patients.
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| 12. |
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| 13. |
- Mukka, Sebastian, et al.
(author)
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Radial head arthroplasty for radial head fractures : a clinical and radiological comparison of monopolar and bipolar radial head arthroplasty at a mean follow-up of 6 years
- 2020
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In: European Journal of Trauma and Emergency Surgery. - : Springer. - 1863-9933 .- 1863-9941. ; 46:3, s. 565-572
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Journal article (peer-reviewed)abstract
- Purpose: The purpose of this study was to compare clinical and radiographic outcomes of bipolar and monopolar radial head arthroplasty in treatment of radial head fracture at a mean follow-up of 6 years.Methods: A retrospective multicentre cohort study of 30 patients treated for unreconstructable radial head fractures. Patients were treated either with a cemented bipolar or an uncemented monopolar radial head arthroplasty. All patients included were evaluated with patient-rated outcome questionnaire, physical examination, and radiographic evaluation at a mean of 6 years (range, 2–12 years) postoperatively.Results: There was no statistical difference in QuickDASH between the bipolar or monopolar groups. The majority of patients had no to little pain during rest. Neither flexion nor extension of the injured arm was significantly affected by the type of prosthesis. None of the patients in the bipolar group had any secondary surgery at the time of follow-up. In the monopolar group, four patients required removal of the arthroplasty. Signs of ulnohumeral degenerative changes were seen in the majority of patients in both groups (55% in the monopolar group, 92% in the bipolar group).Conclusion: In this retrospective cohort study comparing a bipolar and a monopolar radial head arthroplasty for treatment of radial head fractures, we found comparable functional outcome but more revision procedures in the monopolar group at a mean follow-up of 6 years.
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| 14. |
- Nestorson, Jens, 1969-, et al.
(author)
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Arthroplasty as primary treatment for distal humeral fractures produces reliable results with regards to revisions and adverse events : a registry-based study
- 2019
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In: Journal of shoulder and elbow surgery. - Philadelphia, PA, United States : Mosby, Inc.. - 1058-2746 .- 1532-6500. ; 28:4, s. E104-E110
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Journal article (peer-reviewed)abstract
- BackgroundPrimary prosthetic replacement has become an accepted method for the treatment of complex distal humeral fractures. The present study investigated implant survival and adverse events related to this procedure based on available Swedish registries and examined the completeness of the Swedish Elbow Arthroplasty register.Materials and methodsPatients treated in Sweden with a primary elbow replacement due to a distal humeral fracture between 1999 and 2014 were identified through 3 different registries: The Swedish Elbow Arthroplasty Register, National Board of Health and Welfare inpatient register, and local registries of all orthopedic departments. Prosthetic survival was examined using Cox regression analysis with Kaplan-Meier plots. Adverse events, defined as medical treatment of the affected elbow besides revision, were analyzed separately. The study included 406 elbows in 405 patients, and no register was complete.ResultsImplant survival at 10 years was 90% (95% confidence interval, 85%-96%), but only 45 patients had an observation time of 10 years or more because 46% of the patients had died, resulting in a mean observation time of 67 (standard deviation, 47) months. An increase in the use of hemiarthroplasties and a proportional decrease of total elbow arthroplasties was detected. There were 18 revisions (4%), and 26 patients (6%) experienced an adverse event, of whom 16 (4%) required surgery. The completeness of the Swedish Elbow Arthroplasty Register regarding primary arthroplasty was 81%.ConclusionPrimary arthroplasty as treatment of distal humeral fractures produces reliable results with regards to revisions and other adverse events.
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| 15. |
- Nordqvist, Anders, et al.
(author)
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Axelns sjukdomar
- 2007
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In: Läkartidningen. - 0023-7205. ; 104:19, s. 6-1492
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Journal article (peer-reviewed)abstract
- The authors were requested to analyse the frequency of shoulder surgery at the different orthopaedic units of Sweden and to propose national indications according to evidence in literature.(nko.se) Three main groups of shoulder disorders were studied: subacromial pain, shoulder instability and pain caused by degenerative glenohumeral pathology. About 6500 shoulders were operatively treated in Sweden 2004. Since 1998 there has been an annual increase of about 10 per cent. Variations in incidences were seen between different parts of the country. The indications and techniques of shoulder surgery have improved during the last years - further knowledge of the disorders, new arthroscopic techniques, modern prosthetic design etc. The morbidity has decreased and ambulatory surgery has been more frequent. The indications and techniques of modern shoulder surgery generally are evidence based according to literature but in some field further prospective, randomized studies are indicated.
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| 16. |
- Rahme, Hans, et al.
(author)
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Cement and press-fit humeral stem fixation provides similar results in rheumatoid patients
- 2006
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In: Clinical Orthopaedics and Related Research. - : Ovid Technologies (Wolters Kluwer Health). - 0009-921X .- 1528-1132. ; :448, s. 28-32
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Journal article (peer-reviewed)abstract
- It is unclear whether humeral stems should be fixed with or without cement. We question whether press-fit fixation would provide similar results to cemented stem fixation. We prospectively randomized 26 shoulders in 24 patients with rheumatoid arthritis (20 women, 4 men) to have either a cemented or press-fit stem. In the press-fit group, stems were matched to the medullary canal, while lavage, pressurizing and distal plugging were used in the cemented group. We followed patients with conventional radiographs and radiostereometric analysis (RSA) at 5 to 7 days, 4 months, 1 year, and 2 years after surgery. One patient died from unrelated causes before the 1-year followup, while the remaining patients were followed according to the protocol. All but two patients were very satisfied or satisfied at 2 years. No stem was radiographically loose. There was no difference in micromotion between groups. The average rotation for all axes was less than 0.25° for both groups and the average translation was less than 0.32 mm for all three axes including subsidence, which was less than 0.1 mm for the uncemented stems. We concluded at 2 years these stems provided similar fixation in rheumatoid shoulders.
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| 17. |
- Rahme, Hans, et al.
(author)
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Loss of external rotation after open Bankart repair : an important prognostic factor for patient satisfaction
- 2010
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In: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 18:3, s. 404-408
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Journal article (peer-reviewed)abstract
- The repair of the capsuloligamentous complex during shoulder stabilisation procedures can be followed by a persistent restricted capacity of external rotation. The prognostic importance of this loss in external rotation for patient satisfaction has not previously been evaluated. We therefore followed 68 consecutive patients operated for recurrent traumatic unidirectional anterior instability of the glenohumeral joint to assess the association between loss of external rotation and patient satisfaction. All patients underwent open Bankart repair. Two independent observers carried out a follow-up (5 years on average) after surgery. At follow-up, recurrent dislocation had developed in four of the 68 patients (6%). The median pre-operative Rowe score was 65 (range 42-87), which can be compared with 92 (range 46-100) at the follow-up. Three patients rated their outcome as poor, 13 as fair, 23 as good and 29 as excellent. There was a five-fold increased risk for a poor or fair outcome among patients with loss of external rotation in 0 degrees of abduction (age- and gender-adjusted odds ratio [OR] 5.3; 95% confidence interval [CI] 1.3-22.0, P = 0.0007). A linear association between the degree of loss in external rotation and patient dissatisfaction was found. The risk of being dissatisfied, independent of recurrent dislocation, occasional pain, positive apprehension test, age and gender, more than doubled (OR 2.6; 95% CI 1.4-4.8, P = 0.002) for every 10 degrees of post-operative loss of external rotation. Loss of external rotation almost explained all of the variation in patient satisfaction with a population attributable risk of 0.85 (95% CI 0.20-0.94). We conclude that open Bankart repair with a modified Rowe procedure is an excellent surgical option regarding stability, but restriction in external rotation reduces the likelihood of a satisfied patient.
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| 18. |
- Rahme, Hans, et al.
(author)
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Stability of cemented in-line pegged glenoid compared with keeled glenoid components in total shoulder arthroplasty
- 2009
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In: Journal of Bone and Joint Surgery. American volume. - 0021-9355 .- 1535-1386. ; 91:8, s. 1965-1972
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Journal article (peer-reviewed)abstract
- BACKGROUND: Considerable interest has been focused on the design of the glenoid component used in total shoulder arthroplasty in order to reduce the risk of loosening. One design-related feature that has attracted attention is whether to use pegged or keeled cemented glenoid components. The main purpose of this study was to compare the fixation of cemented keeled glenoid components with that of cemented in-line pegged glenoid components. METHODS: In a prospective randomized study, we compared the stability of cemented, all-polyethylene, keeled glenoid components and cemented, all-polyethylene, in-line three-pegged glenoid components by radiostereometric analysis. Twenty-seven shoulders in twenty-five patients with osteoarthritis (twenty-two shoulders had primary and five shoulders had secondary osteoarthritis) were included. There were sixteen women and nine men, and the mean age was sixty-four years. Radiostereometric analysis and conventional radiographs were carried out at five days, at four months, and at one and two years postoperatively. RESULTS: The mean Constant and Murley score preoperatively and two years postoperatively was 25 and 70, respectively, for shoulders with the keeled glenoid component and 22 and 70 for the shoulders with a pegged component. No significant difference was detected between groups with regard to the average micromigration of the glenoid components at any of the time points. The average translation was <1 mm, while the median value was <0.3 mm at two years, with no significant difference between the different axes. In five shoulders (three with the keeled component and two with the pegged component), translation at two years was >1 mm. In fourteen shoulders (eight with the keeled and six with the pegged component), the rotation around one or several axes was >2 degrees . We were not able to detect any specific pattern with regard to movement for either type of component nor were we able to detect any difference between the two types of components in the way they migrated, if migration occurred. CONCLUSIONS: Cemented all-polyethylene keeled or in-line three-pegged glenoid components appear to have similar stability during the first two years after surgery. Studies with a longer follow-up period are needed to relate these findings to long-term clinical and radiographic outcomes.
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| 19. |
- Rahme, Hans, et al.
(author)
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Stable fixation of the ulnar component in the Kudo elbow prosthesis : A radiostereometric (RSA) study of 13 prostheses with 2-year follow-up
- 2005
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In: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 76:1, s. 104-108
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Journal article (peer-reviewed)abstract
- Background Concern has been expressed about the large number of radiolucent lines around the ulnar component of the Kudo elbow prosthesis in medium-term follow-up. Patients and methods We studied the metal-backed cemented ulnar component in 13 Kudo elbow prostheses (type 5) using radiostereometric analysis (RSA). All patients had rheumatoid arthritis. There were 2 men and 9 women with a mean age of 55 years. 2 were operated bilaterally. The metal-backed ulnar component was marked with three 0.8 mm tantalum spheres and the proximal ulna with 5 spheres of 0.8 or 1.0 mm diameter. The initial RSA examination was performed during the first week after the operation. Further examinations were done at 4, 12 and 24 months. Conventional radiographs were taken during the first week postoperatively, and at 12 and 24 months. Results Translations (medial/lateral, antero/posterior and proximal/distal) were less than 0.5 mm in all but 1 patient who had a maximal translation of 3.4 mm distally. The mean rotations around all three axes were less than 0.4 degrees. The patient who had a translation of 3.4 mm also had varus angulation exceeding 4 degrees. This patient also had progressive circumferential radiolucent lines on conventional radiographs. The Mayo elbow score increased from 40 (25-65) before surgery to 92 (45-100) at 2 years. Interpretation The fixation of the metal-backed ulnar component of the Kudo elbow prosthesis at 2 years is good.
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| 20. |
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| 21. |
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| 22. |
- Schollin-Borg, Maria, et al.
(author)
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Presentation, outcome, and cause of septic arthritis after anterior cruciate ligament reconstruction : a case control study
- 2003
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In: Arthroscopy. - : Elsevier BV. - 0749-8063 .- 1526-3231. ; 19:9, s. 941-7
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Journal article (peer-reviewed)abstract
- PURPOSE: The objective of this study was to examine clinical presentation and medium-term outcome of patients with septic arthritis of the knee after anterior cruciate ligament (ACL) reconstruction. TYPE OF STUDY: Matched case control study. METHODS: From a consecutive case series of 575 patients who underwent ACL reconstruction from 1996 through 1999, we report on 10 patients (1.7%) with postoperative septic arthritis. These patients were compared with individually matched patients without infection, on average, 3 years after surgery. The examination included physical and radiographic evaluation, functional testing, KT-1000, Lysholm and Tegner scales, and the International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS) form. RESULTS: The predominant clinical presentation among patients with septic arthritis was modest classic signs of local infection. However, all had fever and elevated sedimentation rate or high C-reactive protein. Bacterial cultures showed coagulase-negative Staphylococcus species in 6, Staphylococcus aureus in 1, and Propionibacteriaceae species in 1 patient. The diagnosis was established with a delay of approximately 5 days. All patients underwent arthroscopic debridement and lavage (2 cases) or continuous irrigation (8 cases), as well as antibiotic treatment. One experienced graft rupture caused by the infection. At the end of the follow-up evaluation, the infected patients reported significantly lower activity levels than the control subjects (mean Tegner score, 5.3 v 7.2, P =.03). No statistically significant differences were noted in mean Lysholm, IKDC, or KOOS scores, or in KT-1000 difference. Two infected patients scored lower on the Tegner and Lysholm scales postoperatively than they did preoperatively. When examining the causes of infection, we found contamination by coagulase-negative Staphylococcus on supposedly sterile suture clamps on 3 graft preparation boards. CONCLUSIONS: In cases of suspected septic arthritis after ACL reconstruction, laboratory studies and aspiration followed by culture testing should be performed liberally to avoid the otherwise frequently delayed diagnosis. The inferior postoperative activity level noted in infected patients appeared not to be secondary to graft failure but may be related to arthrofibrosis, cartilage damage, or recurring postinfectious meniscal tears.
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| 23. |
- Solem-Bertoft, Eva, et al.
(author)
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The hand in neck manoeuvre as a tool to analyze pain-generating mechanismsin the subacromial impingement syndrome
- 1994
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In: Scandinavian Journal of Rehabilitation Medicine. - 0036-5505 .- 1940-2228. ; 26:2, s. 59-64
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Journal article (peer-reviewed)abstract
- A scoring system for a standardized composite movement of the shoulder--the Hand in Neck (HIN) manoeuvre--is presented. The EMG activity of the supraspinatus muscle was studied in 5 healthy subjects at different performance levels of this test. It is shown that the supraspinatus muscle is about four times more active during normal performance than at the subnormal levels, which among themselves do not differ. EMG activity was also studied during normal performance of another standardized manoeuvre--the Pour out of a Pot (POP) test. Based on a comparison of the EMG data with clinical data from patients with the subacromial impingement syndrome it is suggested that an abnormal HIN test indicates the presence of a traction responsive pain generator in the supraspinatus tendon. In the same patient group, the combination of a normal HIN test and an abnormal POP test indicates pain generated by compression of subacromial structures.
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| 24. |
- Sörensen, Jens, et al.
(author)
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Long-standing increased bone turnover at the fixation points after anterior cruciate ligament reconstruction : A positron emission tomography (PET) study of 8 patients
- 2006
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In: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 77:6, s. 921-925
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Journal article (peer-reviewed)abstract
- Background: A secure incorporation of the graft in a bone tunnel is a prerequisite for successful anterior cruciate ligament reconstruction. In this cross-sectional pilot study, we studied the healing process with positron emission tomography (PET) scanning. Patients and methods: 8 young patients underwent an anterior cruciate ligament reconstruction with a bonepatellar tendon-bone graft (BTB, n = 4) or a quadruple semitendinosus and gracilis graft (ST/G, n = 4). Regional bone turnover was quantified with an 18F-fluoride PET scan in each patient 1 day, 3 weeks, 7 months, or 22 months after surgery. Results: The highest activity level was found 3 weeks after surgery, but the activity at the femoral fixation points was markedly increased even after 7 months. The bone turnover was almost normalized 22 months after the operation. Interpretation: It would take at least 7 months until an anterior cruciate ligament graft, fixed with an interference screw, is completely incorporated. This finding is important for postoperative rehabilitation. Furthermore, PET is a feasible tool when studying new ways of fixing soft tissue to bone.
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| 25. |
- Ödquist, Magnus, et al.
(author)
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Lower age increases the risk of revision for stemmed and resurfacing shoulder hemi arthroplasty.
- 2018
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In: Acta Orthopaedica. - : Taylor & Francis Group. - 1745-3674 .- 1745-3682. ; 89, s. 3-9
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Journal article (peer-reviewed)abstract
- Background and purpose - The number of patients where shoulder hemiarthroplasty (SHA) is an option is still substantial. Descriptive analyses performed by the Swedish Shoulder Arthroplasty Registry (SSAR) showed that while patients receiving SHA designs, i.e. resurfacing hemi (RH) and stemmed hemi (SH), reported similar shoulder functionality and quality of life, the revision rate for RH (12%) was larger than for SH (6.7%); this difference was studied. Patients and methods - All primary SHA (n = 1,140) for OA reported to SSAR between 1999 and 2009 were analyzed regarding risk factors for revision and PROM outcome, 950 shoulders with primary OA (POA), and 190 secondary OA (SOA). Mean age was 67.4 years (SD 10.8). PROM including WOOS and EQ-5D were collected at 5 years, until December 31, 2014. Results - 76/950 prostheses because of POA and 16/190 prosthesis because of SOA were revised. Age at primary surgery was the main factor that influenced the risk of revision, lower age increased the risk of revision, and was also the explanation for the difference between SH and RH. We also found that SH and RH had similar outcomes measured by PROM, but the POA group had higher scores than the SOA group with a clinically relevant difference of 10% in WOOS. Interpretation - The risk of revision for SH and RH is similar when adjusted for age and does not depend on primary diagnosis or sex. A lower age increases the risk of revision. Patients suffering from POA experience better shoulder functionality than SOA patients irrespective of implant type.
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| 26. |
- Ödquist, Magnus, et al.
(author)
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Lower age increases the risk of revision for stemmed and resurfacing shoulder hemi arthroplasty : A study from the Swedish shoulder arthroplasty register
- 2018
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In: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 89:1, s. 3-9
-
Journal article (peer-reviewed)abstract
- Background and purpose — The number of patients where shoulder hemiarthroplasty (SHA) is an option is still substantial. Descriptive analyses performed by the Swedish Shoulder Arthroplasty Registry (SSAR) showed that while patients receiving SHA designs, i.e. resurfacing hemi (RH) and stemmed hemi (SH), reported similar shoulder functionality and quality of life, the revision rate for RH (12%) was larger than for SH (6.7%); this difference was studied. Patients and methods — All primary SHA (n = 1,140) for OA reported to SSAR between 1999 and 2009 were analyzed regarding risk factors for revision and PROM outcome, 950 shoulders with primary OA (POA), and 190 secondary OA (SOA). Mean age was 67.4 years (SD 10.8). PROM including WOOS and EQ-5D were collected at 5 years, until December 31, 2014. Results — 76/950 prostheses because of POA and 16/190 prosthesis because of SOA were revised. Age at primary surgery was the main factor that influenced the risk of revision, lower age increased the risk of revision, and was also the explanation for the difference between SH and RH. We also found that SH and RH had similar outcomes measured by PROM, but the POA group had higher scores than the SOA group with a clinically relevant difference of 10% in WOOS. Interpretation — The risk of revision for SH and RH is similar when adjusted for age and does not depend on primary diagnosis or sex. A lower age increases the risk of revision. Patients suffering from POA experience better shoulder functionality than SOA patients irrespective of implant type.
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| 27. |
- Östman, Bengt, et al.
(author)
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Tourniquet-induced ischemia and reperfusion in human skeletal muscle
- 2004
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In: Clinical Orthopaedics and Related Research. - 0009-921X .- 1528-1132. ; 418, s. 260-265
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Journal article (peer-reviewed)abstract
- Microdialysis conceivably enables longitudinal and simultaneous investigation of several metabolites by repeated measurements in skeletal muscle. We used and evaluated microdialysis as an in vivo method to characterize the time-course and relative kinetics of pyruvate, glucose, lactate, glycerol, hypoxanthine, uric acid, and urea, in skeletal muscles, exposed to ischemia and reperfusion, in eight patients having arthroscopic-assisted anterior cruciate ligament reconstruction. A dialysis probe was implanted before surgery in the rectus femoris muscle. Dialysate samples were collected at 10-minute intervals at a flow rate of 1 microL/minute until 2 hours after tourniquet deflation. Ninety minutes of ischemia resulted in accumulation of lactate (234% +/- 38%), hypoxanthine (582% +/- 166%), and glycerol (146% +/- 46%), consumption of glucose (54% +/- 9%) and pyruvate (16% +/- 44%), and a slight decrease of urea (78% +/- 11%) compared with baseline (100%). Uric acid was unchanged (95% +/- 12%). Within 90 minutes after tourniquet deflation the concentrations were virtually normalized for all measured metabolites, suggesting that the duration of ischemia was well tolerated by the patients. The results indicate that the use of microdialysis for monitoring energy metabolic events during orthopaedic surgery that requires ischemia and reperfusion is feasible and safe.
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