| 1. |
- Bremander, Ann B, et al.
(author)
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Revision in previously satisfied knee arthroplasty patients is the result of their call on the physician, not on pre-planned follow-up : a retrospective study of 181 patients who underwent revision within 2 years
- 2005
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In: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 76:6, s. 785-90
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Journal article (peer-reviewed)abstract
- BACKGROUND: Degree of satisfaction with a knee arthroplasty is said to be correlated to reduced pain and better function. During a validation of the Swedish Knee Arthroplasty Register in 1997, previously operated patients were asked how satisfied they were with their knee. A subgroup of "satisfied" patients was identified who underwent revision within 2 years of having expressed satisfaction. Our aim was to study the revision diagnosis, to determine whether the problem leading to revision had been discovered as a result of routine follow-up, and also to find out when the symptoms leading to revision had started.METHODS: We retrospectively studied the medical records of 181 patients (181 knees), with a median age of 74 (31-88) years. 68% were women and the median time between primary operation and revision was 8 (3-21) years.RESULTS: Aseptic loosening (74/181) was the most common diagnosis. 2 cases were revised as a result of routine follow-up. 44% of the medical records included reports of pain in the replaced knee prior to answering the satisfaction questionnaire.INTERPRETATION: Few patients were admitted to knee revision surgery due to medical findings discovered during routine follow-up. The term "satisfaction" must be interpreted with care, as it seems to have a more complex meaning for the patients than absence of knee pain.
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| 2. |
- Ranstam, Jonas, et al.
(author)
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Health-care quality registers: outcome-orientated ranking of hospitals is unreliable.
- 2008
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In: Journal of Bone and Joint Surgery: British Volume. - 2044-5377. ; 90:12, s. 1558-1561
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Journal article (peer-reviewed)abstract
- Public disclosure of outcome-orientated ranking of hospitals is becoming increasingly popular and is routinely used by Swedish health-care authorities. Whereas uncertainty about an outcome is usually presented with 95% confidence intervals, ranking's based on the same outcome are typically presented without any concern for bias or statistical precision. In order to study the effect of incomplete registration of re-operation on hospital ranking we performed a simulation study using published data on the two-year risk of re-operation after total hip replacement. This showed that whereas minor registration incompleteness has little effect on the observed risk of revision, it can lead to major errors in the ranking of hospitals. We doubt whether a level of data entry sufficient to generate a correct ranking can be achieved, and recommend that when ranking hospitals, the uncertainties about data quality and random events should be clearly described as an integral part of the results.
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| 3. |
- Robertsson, Otto, et al.
(author)
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Increased long-term mortality in patients less than 55 years old who have undergone knee replacement for osteoarthritis - Results from the Swedish knee arthroplasty register
- 2007
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In: Journal of Bone and Joint Surgery: British Volume. - 2044-5377. ; 89B:5, s. 599-603
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Journal article (peer-reviewed)abstract
- Patients with osteoarthritis undergoing knee replacement have been reported to have an overall reduced mortality compared with that of the general population. This has been attributed to the selection of healthier patients for surgery. However, previous studies have had a maximum follow-up time of ten years. We have used information from the Swedish Knee Arthroplasty Register to study the mortality of a large national series of patients with total knee replacement for up to 28 years after surgery and compared their mortality with that of the normal population. In addition, for a subgroup of patients operated on between 1980 and 2002 we analysed their registered causes of death to determine if they differed from those expected. We found a reduced overall mortality during the first 12 post-operative years after which it increased and became significantly higher than that of the general population. Age-specific analysis indicated an inverse correlation between age and mortality, where the younger the patients were, the higher their mortality. The shift at 12 years was caused by a relative over-representation of younger patients with a longer follow-up. Analysis of specific causes of death showed a higher mortality for cardiovascular, gastrointestinal and urogenital diseases. The observation that early onset of osteoarthritis of the knee which has been treated by total knee replacement is linked to an increased mortality should be a reason for increased general awareness of health problems in these patients.
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| 4. |
- Robertsson, Otto
(author)
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Knee arthroplasty registers.
- 2007
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In: Journal of Bone and Joint Surgery: British Volume. - 2044-5377. ; 89-B:1, s. 1-4
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Research review (peer-reviewed)abstract
- This article considers the establishment, purpose and conduct of knee arthroplasty registers using the Swedish register as an example. The methods of collection of appropriate data, the cost, and the ways in which this information may be used are considered.
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| 5. |
- Robertsson, Otto, et al.
(author)
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The Short-Term Results of 3 Common UKA Implants During Different Periods in Sweden.
- 2008
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In: Journal of Arthroplasty. - : Elsevier BV. - 0883-5403. ; Feb 27, s. 801-807
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Journal article (peer-reviewed)abstract
- We studied 13299 operations of 3 common unicompartmental implants inserted during 1984 to 2004 and compared their cumulative revision rate during different periods, as well as whether minimally invasive surgery (MIS) had been used. In this way, we tried to evaluate how the introduction of implants and approaches affected the short-term results. The oldest implant, the Link, had stable results over time. However, when used with MIS without adequate instruments or training, the results deteriorated. The initial Oxford results were disappointing (phase I and early phase II models). However, with time, the results improved substantially, even when the phase III version using MIS was introduced. For the Miller/Galante, there was significant improvement with time, and MIS was not found to affect the short-term results.
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| 7. |
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| 8. |
- Stefansdottir, Anna, et al.
(author)
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Higher Early Mortality with Simultaneous Rather than Staged Bilateral TKAs Results From the Swedish Knee Arthroplasty Register
- 2008
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In: Clinical Orthopaedics and Related Research. - : Ovid Technologies (Wolters Kluwer Health). - 0009-921X. ; 466:12, s. 3066-3070
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Journal article (peer-reviewed)abstract
- Patients with knee osteoarthritis (OA) often present with symptoms that warrant bilateral TKAs. There are potential benefits to operating on both knees on the same day, but the safety of simultaneous bilateral TKAs has been questioned. To evaluate whether there were any differences in 30-day mortality between patients having simultaneous bilateral TKAs and those having staged bilateral TKAs, we analyzed data from the Swedish Knee Arthroplasty Register and the Swedish Cause of Death Register. We included 48,931 patients with OA having 60,062 primary TKAs during 1985 to 2004; 1139 had surgery on both knees on the same day (simultaneous bilateral) and 3432 had surgery on both knees on two different occasions with less than 1 year between operations (staged bilateral). The 30-day mortality after simultaneous bilateral TKAs was 7.53 (confidence interval, 2.62-21.69) times higher than after the second of staged TKA and 3.77 (confidence interval, 2.04-6.98) times higher than after a primary unilateral TKA. Assuming the total risk for a staged procedure is twice that of a unilateral procedure, the risk of mortality within 30 days is 1.94 (confidence interval, 1.05-3.59) times higher with simultaneous than staged TKA. It is safer to operate on one knee at a time.
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| 9. |
- Stefansdottir, Anna, et al.
(author)
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Inadequate timing of prophylactic antibiotics in orthopedic surgery. We can do better.
- 2009
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In: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 80:6, s. 633-638
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Journal article (peer-reviewed)abstract
- BACKGROUND AND PURPOSE: There are rising concerns about the frequency of infection after arthroplasty surgery. Prophylactic antibiotics are an important part of the preventive measures. As their effect is related to the timing of administration, it is important to follow how the routines with preoperative prophylactic antibiotics are working. METHODS: In 114 consecutive cases treated at our own university clinic in Lund during 2008, the time of administration of preoperative prophylactic antibiotic in relation to the start of surgery was recorded from a computerized operation report. In 291 other cases of primary total knee arthroplasty (TKA), randomly selected from the Swedish Knee Arthroplasty Register (SKAR), the type and dose of prophylactic antibiotic as well as the time of administration in relation to the inflation of a tourniquet and to the start of surgery was recorded from anesthetic records. RESULTS: 45% (95% CI: 36-54) of the patients operated in Lund and 57% (CI: 50-64) of the TKAs randomly selected from the SKAR received the preoperative antibiotic 15-45 min before the start of surgery. 53% (CI: 46-61) received antibiotics 15-45 min before inflation of a tourniquet. INTERPRETATION: The inadequate timing of prophylactic antibiotics indicates that the standards of strict antiseptic and aseptic routines in arthroplasty surgery are falling. The use of a simple checklist to ensure the surgical safety may be one way of reducing infections in arthroplasty surgery.
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| 10. |
- Stefansdottir, Anna, et al.
(author)
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Microbiology of the infected knee arthroplasty: Report from the Swedish Knee Arthroplasty Register on 426 surgically revised cases.
- 2009
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In: Scandinavian Journal of Infectious Diseases. - : Informa UK Limited. - 1651-1980 .- 0036-5548. ; 41:11-12, s. 831-840
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Journal article (peer-reviewed)abstract
- Surgically revised deep infected primary knee arthroplasties reported to the Swedish knee arthroplasty register during the years 1986-2000 were studied with respect to microbiology, antimicrobial susceptibility pattern and changes over time. In early, delayed and late infections, coagulase-negative staphylococci (CoNS) were most prevalent (105/299, 35.1%), and twice as common as Staphylococcus aureus (55/299, 18.4%). In haematogenous infections, S. aureus was the dominating pathogen (67/99, 67.7%), followed by streptococci and Gram-negative bacteria. Methicillin resistance was found in 1/84 tested isolates of S. aureus and 62/100 tested isolates of CoNS. During the study period, methicillin resistance among CoNS increased (p=0.002). Gentamicin resistance was found in 1/28 tested isolates of S. aureus and 19/29 tested CoNS isolates. A relative decrease in infections caused by S. aureus was observed, while enterococci increased. In empiric treatment of infected knee arthroplasty the type of infection should direct the choice of antibiotics. Awareness of the fact that most early infections are caused by CoNS can increase the chances of successful treatment with retained implant. Due to the high rate of gentamicin resistance among CoNS in infected knee arthroplasty, other antibiotics should be used in bone cement at revision.
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