Pub Date : 2015-08-01DOI: 10.3109/17453674.2015.1056702
Trude Basso
{"title":"Internal fixation of fragility fractures of the femoral neck.","authors":"Trude Basso","doi":"10.3109/17453674.2015.1056702","DOIUrl":"https://doi.org/10.3109/17453674.2015.1056702","url":null,"abstract":"","PeriodicalId":87168,"journal":{"name":"Acta orthopaedica. Supplementum","volume":"86 361","pages":"1-36"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3109/17453674.2015.1056702","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33235133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-06-01DOI: 10.3109/17453674.2015.1041354
Vincent Busch
{"title":"The young osteoarthritic hip: Clinical outcome of total hip arthroplasty and a cost-effectiveness analysis.","authors":"Vincent Busch","doi":"10.3109/17453674.2015.1041354","DOIUrl":"https://doi.org/10.3109/17453674.2015.1041354","url":null,"abstract":"","PeriodicalId":87168,"journal":{"name":"Acta orthopaedica. Supplementum","volume":"86 360","pages":"1-21"},"PeriodicalIF":0.0,"publicationDate":"2015-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3109/17453674.2015.1041354","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33119659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-04-01DOI: 10.3109/17453674.2015.1022707
Thomas Johan Kibsgård
Background Different techniques have been used to quantify the movement of sacroiliac (SI) joints. These include radiostereometric analysis (RSA), but the accuracy and precision of this method have not been properly evaluated and it is unclear how many markers are required and where they should be placed to achieve proper accuracy and precision. Purpose The purpose of this study was to test accuracy and precision of RSA, applied to the SI joint, in a phantom model and in patients. Methods We used a plastic phantom attached to a micrometer to obtain a true value of the movement of the SI joint and compared this value with the measured value obtained by RSA; the difference represented the accuracy. The precision of the system was measured by double examination in the phantom and in six patients, and was expressed by a limit of significance (LOS). We analyzed different marker distributions to find optimal marker placement and number of markers needed. Results The accuracy was high and we identified no systematic errors. The precision of the phantom was high with a LOS less than 0.25 and 0.16 mm for all directions, and in patients, the precision was less than 0.71 for rotations and 0.47 mm translations. No markers were needed in the pubic symphysis to obtain good precision. Conclusions The accuracy and precision are high when RSA is used to measure movement in the SI joint and support the use of RSA in research of SI joint motion.
{"title":"Radiostereometric analysis of sacroiliac joint movement and outcomes of pelvic joint fusion.","authors":"Thomas Johan Kibsgård","doi":"10.3109/17453674.2015.1022707","DOIUrl":"https://doi.org/10.3109/17453674.2015.1022707","url":null,"abstract":"Background Different techniques have been used to quantify the movement of sacroiliac (SI) joints. These include radiostereometric analysis (RSA), but the accuracy and precision of this method have not been properly evaluated and it is unclear how many markers are required and where they should be placed to achieve proper accuracy and precision. Purpose The purpose of this study was to test accuracy and precision of RSA, applied to the SI joint, in a phantom model and in patients. Methods We used a plastic phantom attached to a micrometer to obtain a true value of the movement of the SI joint and compared this value with the measured value obtained by RSA; the difference represented the accuracy. The precision of the system was measured by double examination in the phantom and in six patients, and was expressed by a limit of significance (LOS). We analyzed different marker distributions to find optimal marker placement and number of markers needed. Results The accuracy was high and we identified no systematic errors. The precision of the phantom was high with a LOS less than 0.25 and 0.16 mm for all directions, and in patients, the precision was less than 0.71 for rotations and 0.47 mm translations. No markers were needed in the pubic symphysis to obtain good precision. Conclusions The accuracy and precision are high when RSA is used to measure movement in the SI joint and support the use of RSA in research of SI joint motion.","PeriodicalId":87168,"journal":{"name":"Acta orthopaedica. Supplementum","volume":"86 359","pages":"1-43"},"PeriodicalIF":0.0,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3109/17453674.2015.1022707","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33093334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-12-01DOI: 10.3109/17453674.2014.976807
Freyr Gauti Sigmundsson
Lumbar spinal stenosis (LSS) is a degenerative disorder of the spine that predominantly affects the elderly. LSS is the most common spinal disorder leading to surgery in Sweden. Recent randomized controlled studies have showed better outcome with surgery compared to conservative treatment. However, after surgery, health related quality of life (HRQoL) and function continue to be inferior to that of the background population. Many patients experience residual leg or back pain and 60-70% of patients are satisfied with the outcome. Knowledge on what characterizes the different subtypes of spinal stenosis and to which extent the stenosis type influences pain, function and HRQoL is lacking. Little is also known about the relationship between degree of stenosis and outcome. In earlier studies, patients with predominant back pain (back pain ≥ leg pain) reported inferior outcomes, but the role of spinal fusion in patients with predominant back or leg pain has not been investigated. For this thesis two clinical databases were used. A Department of Orthopedics in Lund database which included radiological data (MRI) and patient related outcome measures for 140 patients and the Swedish Spine Register which contains data on more than 15,000 patients operated for three different forms of LSS; lateral recess stenosis (LRS), central spinal stenosis (CSS) and LSS with degenerative spondylolisthesis (DS). In Study I, we showed spinal measurements, including central dural sac area, multilevel stenosis, and DS to have a limited correlation to pain, function and HRQoL. In Study II, we showed preoperative duration of symptoms exceeding two years and poor preoperative function to predict poor outcome of surgery. Back pain was often experienced by patients scheduled for spinal stenosis surgery and HRQoL and function was low irrespective of whether back or leg pain was predominant in LRS, CSS and DS (Study III). In Study IV, predominant back pain (PB) was associated with inferior outcome of surgery for CSS. In Study IV, patients with PB operated with fusion had a marginally better outcome than patients decompressed only. However, this advantage diminished when we adjusted for confounders. At the two year follow-up no significant benefit for fusion was observed. In Study V, DS patients with fusion and PB benefited from fusion compared with patients with decompression only as the fused patients improved more in terms of leg and back pain as well as function at the one year follow-up. Patients with predominant leg pain appeared to have better outcome in terms of back pain with fusion but significant baseline differences in back pain between the treatment groups precluded firm conclusions regarding this benefit. In conclusion, decompression supplemented with fusion may lead to improved outcome in highly selected patients with CSS and predominant back pain. Further studies are needed to identify this subgroup. Adding fusion leads to superior one year outcome in DS patients wi
{"title":"Determinants of outcome in lumbar spinal stenosis surgery.","authors":"Freyr Gauti Sigmundsson","doi":"10.3109/17453674.2014.976807","DOIUrl":"https://doi.org/10.3109/17453674.2014.976807","url":null,"abstract":"Lumbar spinal stenosis (LSS) is a degenerative disorder of the spine that predominantly affects the elderly. LSS is the most common spinal disorder leading to surgery in Sweden. Recent randomized controlled studies have showed better outcome with surgery compared to conservative treatment. However, after surgery, health related quality of life (HRQoL) and function continue to be inferior to that of the background population. Many patients experience residual leg or back pain and 60-70% of patients are satisfied with the outcome. Knowledge on what characterizes the different subtypes of spinal stenosis and to which extent the stenosis type influences pain, function and HRQoL is lacking. Little is also known about the relationship between degree of stenosis and outcome. In earlier studies, patients with predominant back pain (back pain ≥ leg pain) reported inferior outcomes, but the role of spinal fusion in patients with predominant back or leg pain has not been investigated. For this thesis two clinical databases were used. A Department of Orthopedics in Lund database which included radiological data (MRI) and patient related outcome measures for 140 patients and the Swedish Spine Register which contains data on more than 15,000 patients operated for three different forms of LSS; lateral recess stenosis (LRS), central spinal stenosis (CSS) and LSS with degenerative spondylolisthesis (DS). In Study I, we showed spinal measurements, including central dural sac area, multilevel stenosis, and DS to have a limited correlation to pain, function and HRQoL. In Study II, we showed preoperative duration of symptoms exceeding two years and poor preoperative function to predict poor outcome of surgery. Back pain was often experienced by patients scheduled for spinal stenosis surgery and HRQoL and function was low irrespective of whether back or leg pain was predominant in LRS, CSS and DS (Study III). In Study IV, predominant back pain (PB) was associated with inferior outcome of surgery for CSS. In Study IV, patients with PB operated with fusion had a marginally better outcome than patients decompressed only. However, this advantage diminished when we adjusted for confounders. At the two year follow-up no significant benefit for fusion was observed. In Study V, DS patients with fusion and PB benefited from fusion compared with patients with decompression only as the fused patients improved more in terms of leg and back pain as well as function at the one year follow-up. Patients with predominant leg pain appeared to have better outcome in terms of back pain with fusion but significant baseline differences in back pain between the treatment groups precluded firm conclusions regarding this benefit. In conclusion, decompression supplemented with fusion may lead to improved outcome in highly selected patients with CSS and predominant back pain. Further studies are needed to identify this subgroup. Adding fusion leads to superior one year outcome in DS patients wi","PeriodicalId":87168,"journal":{"name":"Acta orthopaedica. Supplementum","volume":"85 357","pages":"1-45"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3109/17453674.2014.976807","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32893957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-08-01DOI: 10.3109/17453674.2014.937924
Sven Young
This thesis is based on three published papers about complications after intramedullary (IM) nailing of fractures of the long bones in lowand middle-income countries (LMICs). The first two studies were register studies using data from the SIGN online surgical database (SOSD). The third study was a prospective study of patients treated for femoral fractures at Kamuzu Central Hospital in Malawi. The SOSD is, to my knowledge, currently the largest database in the world containing data on orthopaedic trauma surgery in LMICs. It was established to ease communication between SIGN Fracture Care International (SIGN) and surgeons using their IM nail. SIGN provides hospitals in LMICs with IM nails free of charge for the treatment of fractures in poor people. Being operated with an IM nail for a fracture of the thigh bone (femur) will have a patient out of bed in a few days, and this has been the obvious treatment of choice in high-income countries for more than half a century now. In many LMICs, however, femoral fractures are still treated with the patient in bed on traction for one and a half to three months. There are still many myths about the risks of doing surgery in LMICs. We wished to document the results and complications of IM nailing in LMICs so that better informed decisions can be made when planning surgical services in these countries. Lack of sufficient follow-up is a challenge in research in LMICs. We also wished to see how this influences results. We found that returning for follow-up in LIC can be difficult and very expensive for many patients. The motivation for returning for follow-up is therefore very low if a patient does not have any complaints. Insisting on very high follow-up rates in clinical research from low-income countries is unrealistic and can exclude important information from the literature. It does, however, seem as if people in low income countries mostly do return for follow-up if they have a complaint after surgery even if total follow up rates are low. This implies that results based only on the patients that returned for follow-up in LIC will be negatively biased. This should be kept in mind when interpreting results in research from LIC.
{"title":"Orthopaedic trauma surgery in low-income countries.","authors":"Sven Young","doi":"10.3109/17453674.2014.937924","DOIUrl":"https://doi.org/10.3109/17453674.2014.937924","url":null,"abstract":"This thesis is based on three published papers about complications after intramedullary (IM) nailing of fractures of the long bones in lowand middle-income countries (LMICs). The first two studies were register studies using data from the SIGN online surgical database (SOSD). The third study was a prospective study of patients treated for femoral fractures at Kamuzu Central Hospital in Malawi. The SOSD is, to my knowledge, currently the largest database in the world containing data on orthopaedic trauma surgery in LMICs. It was established to ease communication between SIGN Fracture Care International (SIGN) and surgeons using their IM nail. SIGN provides hospitals in LMICs with IM nails free of charge for the treatment of fractures in poor people. Being operated with an IM nail for a fracture of the thigh bone (femur) will have a patient out of bed in a few days, and this has been the obvious treatment of choice in high-income countries for more than half a century now. In many LMICs, however, femoral fractures are still treated with the patient in bed on traction for one and a half to three months. There are still many myths about the risks of doing surgery in LMICs. We wished to document the results and complications of IM nailing in LMICs so that better informed decisions can be made when planning surgical services in these countries. Lack of sufficient follow-up is a challenge in research in LMICs. We also wished to see how this influences results. We found that returning for follow-up in LIC can be difficult and very expensive for many patients. The motivation for returning for follow-up is therefore very low if a patient does not have any complaints. Insisting on very high follow-up rates in clinical research from low-income countries is unrealistic and can exclude important information from the literature. It does, however, seem as if people in low income countries mostly do return for follow-up if they have a complaint after surgery even if total follow up rates are low. This implies that results based only on the patients that returned for follow-up in LIC will be negatively biased. This should be kept in mind when interpreting results in research from LIC.","PeriodicalId":87168,"journal":{"name":"Acta orthopaedica. Supplementum","volume":"85 356","pages":"1-35"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3109/17453674.2014.937924","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32529517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-06-01DOI: 10.3109/17453674.2014.922007
Jeppe V Rasmussen
This thesis includes four studies focusing on the functional outcome, shoulder-specific quality of life and risk of revision following shoulder replacement in patients with glenohumeral osteoarthritis without symptomatic rotator cuff pathology. The Danish version of WOOS, translated according to international standardized guidelines, had substantial psychometric properties comparable to the original version. It is recommendable to use WOOS in the evaluation of patients with glenohumeral osteoarthritis treated with shoulder replacement. Data from DSR showed that the shoulder specific quality of life following total shoulder arthroplasty was superior to that of hemiarthroplasty (resurfacing hemiarthroplasty and stemmed hemiarthroplasty). The difference between stemmed hemiarthroplasty and resurfacing hemiarthroplasty was small and did not exceed the minimal clinically important difference. The revision rate following resurfacing hemiarthroplasty was surprisingly high compared with previous reports but there were no statistical significant differences in revision rate between arthroplasty designs. The shoulder specific quality of life and revision rate in patients under the age of 55 was worrying. The use of resurfacing hemiarthroplasty has relied on the results from case series only. The efficacy in the treatment of glenohumeral osteoarthritis has been promising but the CMS found in the randomized clinical trial indicate that the functional outcome may be inferior to that of stemmed hemiarthroplasty and less favourable than previously reported. However, the limited number of patients may have influenced the results and a larger definitive RCT is needed.Shoulder replacement is relevant and effective in the treatment of glenohumeral osteoarthritis; however, resurfacing hemiarthroplasty was associated with a poorer outcome and a higher risk of revision than previously assumed especially in patients under the age of 55. Based on data from this thesis, and based on existing knowledge, it seems like total shoulder arthroplasty should be preferred in the treatment of glenohumeral osteoarthritis. Shoulder replacement is rarely indicated in younger patients where other treatment options (e.g., physiotherapy; intraarticular injections of hyaluronate; and joint preserving surgery) should be considered until the efficacy of shoulder replacement has been more thoroughly documented.
{"title":"Outcome and risk of revision following shoulder replacement in patients with glenohumeral osteoarthritis.","authors":"Jeppe V Rasmussen","doi":"10.3109/17453674.2014.922007","DOIUrl":"https://doi.org/10.3109/17453674.2014.922007","url":null,"abstract":"<p><p>This thesis includes four studies focusing on the functional outcome, shoulder-specific quality of life and risk of revision following shoulder replacement in patients with glenohumeral osteoarthritis without symptomatic rotator cuff pathology. The Danish version of WOOS, translated according to international standardized guidelines, had substantial psychometric properties comparable to the original version. It is recommendable to use WOOS in the evaluation of patients with glenohumeral osteoarthritis treated with shoulder replacement. Data from DSR showed that the shoulder specific quality of life following total shoulder arthroplasty was superior to that of hemiarthroplasty (resurfacing hemiarthroplasty and stemmed hemiarthroplasty). The difference between stemmed hemiarthroplasty and resurfacing hemiarthroplasty was small and did not exceed the minimal clinically important difference. The revision rate following resurfacing hemiarthroplasty was surprisingly high compared with previous reports but there were no statistical significant differences in revision rate between arthroplasty designs. The shoulder specific quality of life and revision rate in patients under the age of 55 was worrying. The use of resurfacing hemiarthroplasty has relied on the results from case series only. The efficacy in the treatment of glenohumeral osteoarthritis has been promising but the CMS found in the randomized clinical trial indicate that the functional outcome may be inferior to that of stemmed hemiarthroplasty and less favourable than previously reported. However, the limited number of patients may have influenced the results and a larger definitive RCT is needed.Shoulder replacement is relevant and effective in the treatment of glenohumeral osteoarthritis; however, resurfacing hemiarthroplasty was associated with a poorer outcome and a higher risk of revision than previously assumed especially in patients under the age of 55. Based on data from this thesis, and based on existing knowledge, it seems like total shoulder arthroplasty should be preferred in the treatment of glenohumeral osteoarthritis. Shoulder replacement is rarely indicated in younger patients where other treatment options (e.g., physiotherapy; intraarticular injections of hyaluronate; and joint preserving surgery) should be considered until the efficacy of shoulder replacement has been more thoroughly documented.</p>","PeriodicalId":87168,"journal":{"name":"Acta orthopaedica. Supplementum","volume":"85 355","pages":"1-23"},"PeriodicalIF":0.0,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3109/17453674.2014.922007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32423979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-04-01DOI: 10.3109/17453674.2014.900597
Ole Reigstad
{"title":"Wrist arthroplasty: bone fixation, clinical development and mid to long term results.","authors":"Ole Reigstad","doi":"10.3109/17453674.2014.900597","DOIUrl":"https://doi.org/10.3109/17453674.2014.900597","url":null,"abstract":"","PeriodicalId":87168,"journal":{"name":"Acta orthopaedica. Supplementum","volume":"85 354","pages":"1-53"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3109/17453674.2014.900597","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32194402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-02-01DOI: 10.3109/17453674.2013.869716
Jan Hendrik Duedal Rölfing
{"title":"The effect of erythropoietin on bone.","authors":"Jan Hendrik Duedal Rölfing","doi":"10.3109/17453674.2013.869716","DOIUrl":"https://doi.org/10.3109/17453674.2013.869716","url":null,"abstract":"","PeriodicalId":87168,"journal":{"name":"Acta orthopaedica. Supplementum","volume":"85 353","pages":"1-27"},"PeriodicalIF":0.0,"publicationDate":"2014-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3109/17453674.2013.869716","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32078649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-12-01DOI: 10.3109/17453674.2013.850008
Jörg Schilcher
“The beginning of knowledge is the discovery of something we do not understand.” – Frank Herbert
{"title":"Epidemiology, radiology and histology of atypical femoral fractures.","authors":"Jörg Schilcher","doi":"10.3109/17453674.2013.850008","DOIUrl":"https://doi.org/10.3109/17453674.2013.850008","url":null,"abstract":"“The beginning of knowledge is the discovery of something we do not understand.” – Frank Herbert","PeriodicalId":87168,"journal":{"name":"Acta orthopaedica. Supplementum","volume":"84 352","pages":"1-26"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3109/17453674.2013.850008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31926129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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