Session 10: Foot/Ankle and Shoulder/Elbow
Torsdag 27. oktober
13:00 – 14:30
Lokale: Reykjavik
Chairmen: Marianne Vestermark / Brian Elmengaard
Andreas Qvist, Michael Toft Væsel, Carsten Moss, Thomas Jakobsen, Steen Lund Jensen
Orthopedic surgery, Randers Regional Hospital; Orthopedic surgery, Viborg Regional Hospital; Orthopedic surgery, Randers Regional Hospital; Orthopedic surgery, Aalborg University Hospital; Orthopedic surgery, Aalborg University Hospital
Background: Surgical treatment of displaced midshaft fractures of the clavicle reduces the risk of non-union, but provides no long-term benefits in functional outcome scores. Treating all displaced fractures operatively with the purpose of reducing non-union rates would lead to many unnecessary treatments (NNT=7).
Purpose / Aim of Study: To identify early predictors for non-union in displaced midshaft clavicular fractures and to develop a predictor model for non-union.
Materials and Methods: We examined prospectively collected data on 64 non-operatively treated patients aged 18-60 years from a multicentre randomized controlled trial. Odds ratios (OR) for various predictors were calculated using logistic regression. For selected predictors we used receiver operating characteristic (ROC) curve analysis to identify cut-off values for a predictor model.
Findings / Results: We identified 12 (19 %) patients with symptomatic non-union. Failure to reduce pain VAS (pVAS) from week two to week four (OR 20.25, 95% CI 2.56 to 160.78, for no reduction in pain) and pVAS score at week four (OR 2.28, 95% CI 1.4 to 3.6, for each point increase) were predictors of non-union. ROC curve analysis identified a reduction in pVAS at 50 per cent as the cut-off value to predict non-union. The area under the ROC curve was 0.84 (95% CI 0.70 to 0.93). The predictor model identifies 22 (34 %) patients at high risk of developing non-union. In the high risk group 11 (50%) patients developed non-union whereas only one patient (3 %) in the low risk group developed non-union (p<0.0001).
Conclusions: It is possible to identify patients at high risk of non- union using changes in pVAS score from week two to week four combined with pVAS score at week four following a displaced midshaft fracture of the clavicle. This finding could lead to a new treatment algorithm for midshaft clavicular fractures.
Orthopedic surgery, Randers Regional Hospital; Orthopedic surgery, Viborg Regional Hospital; Orthopedic surgery, Randers Regional Hospital; Orthopedic surgery, Aalborg University Hospital; Orthopedic surgery, Aalborg University Hospital
Background: Surgical treatment of displaced midshaft fractures of the clavicle reduces the risk of non-union, but provides no long-term benefits in functional outcome scores. Treating all displaced fractures operatively with the purpose of reducing non-union rates would lead to many unnecessary treatments (NNT=7).
Purpose / Aim of Study: To identify early predictors for non-union in displaced midshaft clavicular fractures and to develop a predictor model for non-union.
Materials and Methods: We examined prospectively collected data on 64 non-operatively treated patients aged 18-60 years from a multicentre randomized controlled trial. Odds ratios (OR) for various predictors were calculated using logistic regression. For selected predictors we used receiver operating characteristic (ROC) curve analysis to identify cut-off values for a predictor model.
Findings / Results: We identified 12 (19 %) patients with symptomatic non-union. Failure to reduce pain VAS (pVAS) from week two to week four (OR 20.25, 95% CI 2.56 to 160.78, for no reduction in pain) and pVAS score at week four (OR 2.28, 95% CI 1.4 to 3.6, for each point increase) were predictors of non-union. ROC curve analysis identified a reduction in pVAS at 50 per cent as the cut-off value to predict non-union. The area under the ROC curve was 0.84 (95% CI 0.70 to 0.93). The predictor model identifies 22 (34 %) patients at high risk of developing non-union. In the high risk group 11 (50%) patients developed non-union whereas only one patient (3 %) in the low risk group developed non-union (p<0.0001).
Conclusions: It is possible to identify patients at high risk of non- union using changes in pVAS score from week two to week four combined with pVAS score at week four following a displaced midshaft fracture of the clavicle. This finding could lead to a new treatment algorithm for midshaft clavicular fractures.
Jeppe Vejlgaard Rasmussen, Steen Lund Jensen, Stig Brorson
Orthopaedic Surgery, Herlev Hospital; Orthopaedic Surgery, Aalborg Hospital; Orthopaedic Surgery, Herlev Hospital
Background: The functional outcome following total shoulder arthroplasty is superior to that of hemiarthroplasty, but surgeons may hesitate to use a glenoid component because of the risk of loosening
Purpose / Aim of Study: The aim of this study was to compare 10-year survival rates for common types of primary shoulder arthroplasty used for osteoarthritis and to evaluate age as risk factor for revision.
Materials and Methods: This study is based on a dataset from the Nordic Arthroplasty Registry Association. Data from 2004-13 was prospectively collected by the national registries in Denmark, Norway and Sweden and merged into a common dataset in 2014. The dataset was defined as a set of variables containing only data that all registries could deliver. Revision was defined as removal or exchange of any component or the addition of a glenoid component.
Findings / Results: 6,871 arthroplasties were used for osteoarthritis. The estimated survival rates at 10 year after resurfacing hemiarthroplasty (n=1,923), stemmed hemiarthroplasty (n=1,587), anatomical total shoulder arthroplasty (n=2,340) were 0.82, 0.92 and 0.96 respectively (p<0.001, Log rank test). Glenoid loosening as a cause of revision in anatomical total shoulder arthroplasty was rare (0.5%). The risk of revision for patients younger than 55 years was 3.8 (2.8-5.3 95% CI), p<0.001 compared to patients older than 75 years, and 1.6 (1.2-2.1 95% CI), p=0.001 compared to patients between 55 and 75 years (gender, year of surgery and arthroplasty design were included in the cox regression model).
Conclusions: We found the lowest revision rate for total shoulder arthroplasty with low risk of glenoid loosening. The results support the choice of anatomical total shoulder arthroplasty as our preferred treatment of osteoarthritis. Young patients have, independently of the arthroplasty type, a high risk of revision.
Orthopaedic Surgery, Herlev Hospital; Orthopaedic Surgery, Aalborg Hospital; Orthopaedic Surgery, Herlev Hospital
Background: The functional outcome following total shoulder arthroplasty is superior to that of hemiarthroplasty, but surgeons may hesitate to use a glenoid component because of the risk of loosening
Purpose / Aim of Study: The aim of this study was to compare 10-year survival rates for common types of primary shoulder arthroplasty used for osteoarthritis and to evaluate age as risk factor for revision.
Materials and Methods: This study is based on a dataset from the Nordic Arthroplasty Registry Association. Data from 2004-13 was prospectively collected by the national registries in Denmark, Norway and Sweden and merged into a common dataset in 2014. The dataset was defined as a set of variables containing only data that all registries could deliver. Revision was defined as removal or exchange of any component or the addition of a glenoid component.
Findings / Results: 6,871 arthroplasties were used for osteoarthritis. The estimated survival rates at 10 year after resurfacing hemiarthroplasty (n=1,923), stemmed hemiarthroplasty (n=1,587), anatomical total shoulder arthroplasty (n=2,340) were 0.82, 0.92 and 0.96 respectively (p<0.001, Log rank test). Glenoid loosening as a cause of revision in anatomical total shoulder arthroplasty was rare (0.5%). The risk of revision for patients younger than 55 years was 3.8 (2.8-5.3 95% CI), p<0.001 compared to patients older than 75 years, and 1.6 (1.2-2.1 95% CI), p=0.001 compared to patients between 55 and 75 years (gender, year of surgery and arthroplasty design were included in the cox regression model).
Conclusions: We found the lowest revision rate for total shoulder arthroplasty with low risk of glenoid loosening. The results support the choice of anatomical total shoulder arthroplasty as our preferred treatment of osteoarthritis. Young patients have, independently of the arthroplasty type, a high risk of revision.
Kajsa Lindberg, Britt Sundekilde Møller, Klaus Kirketerp-Møller, Morten Tange Kristensen
Rehabilitation Centre Vanløse, Copenhagen Municipality, Denmark; Nurse Clinic Vanløse, Copenhagen Municipality, Denmark; Copenhagen Wound Healing Center , Bispebjerg University Hospital, Copenhagen, Denmark ; Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Departments of Physiotherapy and Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Denmark
Background: The common recommendation is that off-loading is necessary for healing of diabetic foot ulcers, and thereby avoiding a potential amputation. However, this is commonly associated with an inactive lifestyle. Thus, the management challenge is to combine off-loading with an active lifestyle that includes regular exercise.
Purpose / Aim of Study: To investigate if an exercise program for people with diabetes, severe polyneuropathy and foot ulcer is safe, feasible and preliminary effective.
Materials and Methods: Five men at a mean (SD) age of 68.2 (7.1) years with diabetic foot ulcers and severe polyneuropathy, participated in a 10 week municipality- based aerobic, resistance and ankle mobility exercise program, designed with a minimum of weight bearing. Safety and feasibility was evaluated by change of the foot ulcer area, adverse events, adherence to the program, and patient satisfaction.
Findings / Results: Only minor adverse events occurred, and foot ulcers were reduced for all participants, from a median of 1.9 (IQR, 1.1-7.3) to 0.0 (0.0-3.0) cm2. All participants completed the program with a session attendance from 85- 95%, and with a satisfaction rate ¡Ý 9 on a 10 point Numeric Rating Scale. The distance on stationary bike was improved from a mean of 3.30 (1.1) to 5.36 (0.5) kilometers, while training loads for muscle groups were progressed, and especially for the lower limbs. Knee-extension strength improved with 23%, while perceived limitations in activities of daily living were reduced from a median of 4 (IQR, 2-5) to 7 (5-8) points.
Conclusions: An exercise program for people with diabetes, severe polyneuropathy and foot ulcers did not compromise the healing of ulcers. Program adherence and patient satisfaction was extremely high, performances improved, and perceived limitations were reduced. We suggest the program be further evaluated.
Rehabilitation Centre Vanløse, Copenhagen Municipality, Denmark; Nurse Clinic Vanløse, Copenhagen Municipality, Denmark; Copenhagen Wound Healing Center , Bispebjerg University Hospital, Copenhagen, Denmark ; Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Departments of Physiotherapy and Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Denmark
Background: The common recommendation is that off-loading is necessary for healing of diabetic foot ulcers, and thereby avoiding a potential amputation. However, this is commonly associated with an inactive lifestyle. Thus, the management challenge is to combine off-loading with an active lifestyle that includes regular exercise.
Purpose / Aim of Study: To investigate if an exercise program for people with diabetes, severe polyneuropathy and foot ulcer is safe, feasible and preliminary effective.
Materials and Methods: Five men at a mean (SD) age of 68.2 (7.1) years with diabetic foot ulcers and severe polyneuropathy, participated in a 10 week municipality- based aerobic, resistance and ankle mobility exercise program, designed with a minimum of weight bearing. Safety and feasibility was evaluated by change of the foot ulcer area, adverse events, adherence to the program, and patient satisfaction.
Findings / Results: Only minor adverse events occurred, and foot ulcers were reduced for all participants, from a median of 1.9 (IQR, 1.1-7.3) to 0.0 (0.0-3.0) cm2. All participants completed the program with a session attendance from 85- 95%, and with a satisfaction rate ¡Ý 9 on a 10 point Numeric Rating Scale. The distance on stationary bike was improved from a mean of 3.30 (1.1) to 5.36 (0.5) kilometers, while training loads for muscle groups were progressed, and especially for the lower limbs. Knee-extension strength improved with 23%, while perceived limitations in activities of daily living were reduced from a median of 4 (IQR, 2-5) to 7 (5-8) points.
Conclusions: An exercise program for people with diabetes, severe polyneuropathy and foot ulcers did not compromise the healing of ulcers. Program adherence and patient satisfaction was extremely high, performances improved, and perceived limitations were reduced. We suggest the program be further evaluated.
Maria Swennergren Hansen, Kristoffer Weisskirchner Barfod, Morten Tange Kristensen
Department of Physiotherapy, Copenhagen University Hospital Hvidovre; Department of Orthopedic Surgery, Clinical Orthopaedic Research Hvidovre; Department of Physiotherapy and Orthopedic Surgery, Copenhagen University Hospital Hvidovre
Background: A prolonged Achilles Tendon (AT) following AT rupture is associated with strength deficits and reduced function. The first three months after injury have been identified as the time when the main changes of the AT length occur. Therefore a valid, reliable, and easily applicable clinical measure of the length of the AT that can be used during this time period after rupture is needed.
Purpose / Aim of Study: To examine the reliability of a new ruler based measurement, the Achilles Tendon Length Measure (ATLM) in comparison with the goniometer-based Achilles Tendon Resting Angle (ATRA).
Materials and Methods: The development of ATLM originates from the well-known Matles test. The ATLM use identical positioning of the patient and feet, but aim to provide an objective assessment by measuring the exact distance between the feet and the examination couch with a ruler. As well as ATRA, the resting position of the feet is measured during ATLM as an indirect measure of the length of the AT. ATLM and ATRA measurements were performed by two independent physiotherapists eight weeks after AT rupture on 28 patients treated non- operatively. The data assessors were inter- and intra-rater blinded to outcome data.
Findings / Results: The mean (SD) injured ATLM was 56.5 (2.3) cm, ICC2.1 0.91(CI [0.72-0.97]), SEM 0.7cm (SEM% 1.2), MDC 1.9cm (MDC% 3.4). Corresponding data for the injured ATRA was mean 64.4° (3.9°), ICC2.1 0.84 (CI [0.68-0-92]), SEM 1.5° (SEM% 2.4), MDC 4.3° (MDC% 6.6).
Conclusions: Both ATLM and ATRA showed excellent inter-rater reliability with low measurement error. Both measurements seem easy to use in clinical practice and potentially providing an indirect measure of the length of the AT after rupture.
Department of Physiotherapy, Copenhagen University Hospital Hvidovre; Department of Orthopedic Surgery, Clinical Orthopaedic Research Hvidovre; Department of Physiotherapy and Orthopedic Surgery, Copenhagen University Hospital Hvidovre
Background: A prolonged Achilles Tendon (AT) following AT rupture is associated with strength deficits and reduced function. The first three months after injury have been identified as the time when the main changes of the AT length occur. Therefore a valid, reliable, and easily applicable clinical measure of the length of the AT that can be used during this time period after rupture is needed.
Purpose / Aim of Study: To examine the reliability of a new ruler based measurement, the Achilles Tendon Length Measure (ATLM) in comparison with the goniometer-based Achilles Tendon Resting Angle (ATRA).
Materials and Methods: The development of ATLM originates from the well-known Matles test. The ATLM use identical positioning of the patient and feet, but aim to provide an objective assessment by measuring the exact distance between the feet and the examination couch with a ruler. As well as ATRA, the resting position of the feet is measured during ATLM as an indirect measure of the length of the AT. ATLM and ATRA measurements were performed by two independent physiotherapists eight weeks after AT rupture on 28 patients treated non- operatively. The data assessors were inter- and intra-rater blinded to outcome data.
Findings / Results: The mean (SD) injured ATLM was 56.5 (2.3) cm, ICC2.1 0.91(CI [0.72-0.97]), SEM 0.7cm (SEM% 1.2), MDC 1.9cm (MDC% 3.4). Corresponding data for the injured ATRA was mean 64.4° (3.9°), ICC2.1 0.84 (CI [0.68-0-92]), SEM 1.5° (SEM% 2.4), MDC 4.3° (MDC% 6.6).
Conclusions: Both ATLM and ATRA showed excellent inter-rater reliability with low measurement error. Both measurements seem easy to use in clinical practice and potentially providing an indirect measure of the length of the AT after rupture.
Jeannette Ø Penny, Merete Speedtsberg, Thomas Kallemose, Jesper Bencke
Dept of orthopeadics, University Hospital Hvidovre; Motion analysis lab, University Hospital Hvidovre; Clinical Orthopaedic Research Hvidovre, University Hospital Hvidovre; Motion analysis lab, University Hospital Hvidovre
Background: Stilettos increases forefoot pressures and pain.
Purpose / Aim of Study: Can an off-the-rack “orthopedic” stiletto alter pressure and comfort scores in the forefoot and arch? Does anatomy have an influence?
Materials and Methods: 22 women, aged 21 to 61, shoe-size 38 (36 to 41) had standardized X-rays and a clinical examination Three conditions tested: 8 cm “orthopaedic” stiletto (OS) with built-in latex metatarsal lift and arch support; same-height standard stiletto (SS) without inlays and a sneaker(SN) . 10 steps analyzed. Peak Pressure (kPa) and Pressure-time integral (kPa/s) measured by Novel Pedar-X pressure insoles. Each shoe-type worn 3 days. Mundermanns comfort VAS recorded daily. P<0.05=*, p>0.01=**, p<0.001=***
Findings / Results: Compared to SS the peak pressure under the 2+3 metatarsals was reduced to 82% in the OS and 60% in the SN***. Under the first metatarsal it was reduced to 73% and 40%, respectively***.Under the arch it was similar for SN and OS and 30% lower for the SS*. Under the heel the OS was 27-28% lower than SS and SN***. Similar reductions were seen in the pressure-time integrals, but with smaller difference between OS and SS**.and larger reductions in the SN to 49% under 2+3 metatarsals***. For forefoot, arch and heel, the comfort was rated highest for the SN*** and lowest for the SS**. No statistical difference between OS and SS in the arch. For each mm the second metatarsal was longer than the first, the pressure time integral rose 3 kPa/s)** under the MT2+3* The VAS score dropped (less comfortable) 0.3 mm for each kPa/s increase.
Conclusions: A mass produced “orthopaedic” stiletto can alter foot pressures, approaching those achieved in a sneaker and increase comfort for the user. An increase in pressure-time integral under 2+3 metatarsals increases the discomfort and the pressure is increased in index-minus feet.
Dept of orthopeadics, University Hospital Hvidovre; Motion analysis lab, University Hospital Hvidovre; Clinical Orthopaedic Research Hvidovre, University Hospital Hvidovre; Motion analysis lab, University Hospital Hvidovre
Background: Stilettos increases forefoot pressures and pain.
Purpose / Aim of Study: Can an off-the-rack “orthopedic” stiletto alter pressure and comfort scores in the forefoot and arch? Does anatomy have an influence?
Materials and Methods: 22 women, aged 21 to 61, shoe-size 38 (36 to 41) had standardized X-rays and a clinical examination Three conditions tested: 8 cm “orthopaedic” stiletto (OS) with built-in latex metatarsal lift and arch support; same-height standard stiletto (SS) without inlays and a sneaker(SN) . 10 steps analyzed. Peak Pressure (kPa) and Pressure-time integral (kPa/s) measured by Novel Pedar-X pressure insoles. Each shoe-type worn 3 days. Mundermanns comfort VAS recorded daily. P<0.05=*, p>0.01=**, p<0.001=***
Findings / Results: Compared to SS the peak pressure under the 2+3 metatarsals was reduced to 82% in the OS and 60% in the SN***. Under the first metatarsal it was reduced to 73% and 40%, respectively***.Under the arch it was similar for SN and OS and 30% lower for the SS*. Under the heel the OS was 27-28% lower than SS and SN***. Similar reductions were seen in the pressure-time integrals, but with smaller difference between OS and SS**.and larger reductions in the SN to 49% under 2+3 metatarsals***. For forefoot, arch and heel, the comfort was rated highest for the SN*** and lowest for the SS**. No statistical difference between OS and SS in the arch. For each mm the second metatarsal was longer than the first, the pressure time integral rose 3 kPa/s)** under the MT2+3* The VAS score dropped (less comfortable) 0.3 mm for each kPa/s increase.
Conclusions: A mass produced “orthopaedic” stiletto can alter foot pressures, approaching those achieved in a sneaker and increase comfort for the user. An increase in pressure-time integral under 2+3 metatarsals increases the discomfort and the pressure is increased in index-minus feet.
Linda Christie Andrea, Poul Frost, Kate Smidt, John Gelicneck, Torben Bæk Hansen, Søren Rasmussen Deutch , Susanne Wiulff Svendsen
Arbejdsmedicinsk Klinik, Hospitalsenheden Vest - Herning; Arbejdsmedicinsk Klinik, Aarhus Universitetshospital; Ortopædkirurgisk Afdeling, Regionshospitalet Viborg; Radiologisk Afdeling, Aarhus Universitetshospital; Ortopædkirurgisk Afdeling, Hospitalsenheden Vest - Holstebro; Ortopædkirurgisk Afdeling, Regionshospitalet Randers; Arbejdsmedicinsk Klinik, Hospitalsenheden Vest - Herning
Background: Danish patients suspected of impingement syndrome generally have radiographs of their shoulder, before their first consultation with a surgeon.
Purpose / Aim of Study: We aimed to describe the prevalence of radiographic findings of rotator cuff- calcifications, osteoarthritis of the acromioclavicular joint, acromial spurs, and a hooked acromion (Bigliani type 3), on standard radiographs. We hypothesized that these findings are associated with shoulder disability in terms of a low Oxford Shoulder Score (OSS)
Materials and Methods: We conducted a cross-sectional study of all 1039 patients aged 18-63 years, who were suspected of impingement syndrome based on the referral letter and who responded a questionnaire, which included OSS, when seen at one of six orthopaedic departments in Central Denmark Region during 2011. Radiographs at time of referral were examined by one of two resident doctors, who were blinded to symptoms and clinical findings. Data was analyzed with logistic regression, with mutual adjustment for each radiographic finding and for sex and age.
Findings / Results: Radiographs were available for 853 patients (82.1%) Mean OSS was 28. The prevalence of radiographic findings was: 25.3% for calcifications, 17. 5% for a hooked acromion, 11.9% for osteoarthritis of the acromioclavicular joint, and 15.1% for spurs. Spurs were associated with a low OSS (OSS<24) with an adjusted OR of 1.7 (95% CI 1.1-2.6). No association was seen between any of the other radiographic findings and a low OSS.
Conclusions: One fourth of all patients referred for orthopaedic evaluation on suspicion of impingement syndrome had rotator cuff calcifications on radiographs. The calcifications have no significant association with OSS. Spurs were the only radiographic findings associated with a low OSS.
Arbejdsmedicinsk Klinik, Hospitalsenheden Vest - Herning; Arbejdsmedicinsk Klinik, Aarhus Universitetshospital; Ortopædkirurgisk Afdeling, Regionshospitalet Viborg; Radiologisk Afdeling, Aarhus Universitetshospital; Ortopædkirurgisk Afdeling, Hospitalsenheden Vest - Holstebro; Ortopædkirurgisk Afdeling, Regionshospitalet Randers; Arbejdsmedicinsk Klinik, Hospitalsenheden Vest - Herning
Background: Danish patients suspected of impingement syndrome generally have radiographs of their shoulder, before their first consultation with a surgeon.
Purpose / Aim of Study: We aimed to describe the prevalence of radiographic findings of rotator cuff- calcifications, osteoarthritis of the acromioclavicular joint, acromial spurs, and a hooked acromion (Bigliani type 3), on standard radiographs. We hypothesized that these findings are associated with shoulder disability in terms of a low Oxford Shoulder Score (OSS)
Materials and Methods: We conducted a cross-sectional study of all 1039 patients aged 18-63 years, who were suspected of impingement syndrome based on the referral letter and who responded a questionnaire, which included OSS, when seen at one of six orthopaedic departments in Central Denmark Region during 2011. Radiographs at time of referral were examined by one of two resident doctors, who were blinded to symptoms and clinical findings. Data was analyzed with logistic regression, with mutual adjustment for each radiographic finding and for sex and age.
Findings / Results: Radiographs were available for 853 patients (82.1%) Mean OSS was 28. The prevalence of radiographic findings was: 25.3% for calcifications, 17. 5% for a hooked acromion, 11.9% for osteoarthritis of the acromioclavicular joint, and 15.1% for spurs. Spurs were associated with a low OSS (OSS<24) with an adjusted OR of 1.7 (95% CI 1.1-2.6). No association was seen between any of the other radiographic findings and a low OSS.
Conclusions: One fourth of all patients referred for orthopaedic evaluation on suspicion of impingement syndrome had rotator cuff calcifications on radiographs. The calcifications have no significant association with OSS. Spurs were the only radiographic findings associated with a low OSS.
Ellen Hamborg-Petersen, Manfred Thomas
Ortopædkirurgisk Afdeling, Odense Universitets Hospital; Fuss- und Sprunggelenkschirurgie , Hessingpark- Clinic
Background: Treatment of symptomatic osteochondral lesions(OCL) of the talus is challenging. Different treatment modalities exist. Little is known about long term outcome after Osteochondral Autograft transfer system (OATS)
Purpose / Aim of Study: Retrospective long term follow up after OATS in the talus
Materials and Methods: Twentynine patients (30 feet) were operated with OATS in the talus at the Hessingpark-Clinic 2004-2009. 15 patients (16 feet) were available for follow up and clinical control. All patients had been followed regularly with MRI and AOFAS score pre- and post operatively. 10 patients were available for a new MRI. Health related quality of life (HRQL) was assessed by using the SF-36 questionnaire for all patients.
Findings / Results: Clinical and radiological follow up time 7,95 ( 5,9-11,6) and 7,69 (5,9-11,2) years. Average patient age 47,2 years (18,6-69,3). OATS donor site: Femur condyle 13, anterior Talus 3. Fourteen medial, 2 lateral OCL lesions. OCL lesion size: average 132 (49-242) mm2. Average AOFAS score preoperatively 62, 1 year postoperatively 71,0 and 8 years post operatively 86,3. Magnetic resonance of cartilage repair tissue (Mocart) score 3 mths post op 82,3 and 8 years post op 52,3. The physical component summary score (PCS) of SF-36 showed no significant difference compared to Danish norm population using one sample T-test, same age. (87,33 and 87,69) No correlation between cystic lesions in the OATS and AOFAS scores. No radiological breakdown of OATS. No reoperations. One patient had pesistent knee pain after OATS.
Conclusions: Long term clinical evaluation of OATS in the talus indicates a high patient satisfaction and a radiologically good long term integration and quality of the Osteochondral cylinders. No correlation between AOFAS score and Mocart score. Knee pain can be a persistent problem for patients after OATS.
Ortopædkirurgisk Afdeling, Odense Universitets Hospital; Fuss- und Sprunggelenkschirurgie , Hessingpark- Clinic
Background: Treatment of symptomatic osteochondral lesions(OCL) of the talus is challenging. Different treatment modalities exist. Little is known about long term outcome after Osteochondral Autograft transfer system (OATS)
Purpose / Aim of Study: Retrospective long term follow up after OATS in the talus
Materials and Methods: Twentynine patients (30 feet) were operated with OATS in the talus at the Hessingpark-Clinic 2004-2009. 15 patients (16 feet) were available for follow up and clinical control. All patients had been followed regularly with MRI and AOFAS score pre- and post operatively. 10 patients were available for a new MRI. Health related quality of life (HRQL) was assessed by using the SF-36 questionnaire for all patients.
Findings / Results: Clinical and radiological follow up time 7,95 ( 5,9-11,6) and 7,69 (5,9-11,2) years. Average patient age 47,2 years (18,6-69,3). OATS donor site: Femur condyle 13, anterior Talus 3. Fourteen medial, 2 lateral OCL lesions. OCL lesion size: average 132 (49-242) mm2. Average AOFAS score preoperatively 62, 1 year postoperatively 71,0 and 8 years post operatively 86,3. Magnetic resonance of cartilage repair tissue (Mocart) score 3 mths post op 82,3 and 8 years post op 52,3. The physical component summary score (PCS) of SF-36 showed no significant difference compared to Danish norm population using one sample T-test, same age. (87,33 and 87,69) No correlation between cystic lesions in the OATS and AOFAS scores. No radiological breakdown of OATS. No reoperations. One patient had pesistent knee pain after OATS.
Conclusions: Long term clinical evaluation of OATS in the talus indicates a high patient satisfaction and a radiologically good long term integration and quality of the Osteochondral cylinders. No correlation between AOFAS score and Mocart score. Knee pain can be a persistent problem for patients after OATS.
Nina Monrad, Ann Ganestam, Thomas Kallemose, KW Barfod
Department of Orthopedics, Copenhagen University Hospital Hvidovre; Department of Orthopedics, Copenhagen University Hospital Hvidovre; Department of Orthopedics, Copenhagen University Hospital Hvidovre; Department of Orthopedics, Copenhagen University Hospital Hvidovre
Background: Degenerative shoulder lesions are common and difficult to treat.
Purpose / Aim of Study: The purpose of the study was to investigate treatment of degenerative shoulder lesions in Denmark from 1996 to 2013 with focus on incidence of surgical procedures, treatment efficacy and the risk of developing frozen shoulder.
Materials and Methods: The National Patient Registry was retrospectively searched to find the number of degenerative shoulder lesions in Denmark during the period 1996– 2013. Regional population data were retrieved from the services of Statistics Denmark. Risk estimates were analyzed by logistic regression models .
Findings / Results: During the 18-year period, 244.519 individual contacts with a DM 75 diagnosis were registered. Of those 28% received surgical treatment due to their shoulder condition. The probability of being operated given you had degenerative shoulder disease was 25% in 1996, rose to 32% in 2008 and dropped to 16% in 2013. Odds ratio for being operated in 2013 compared to 2008 was 0.41, p < 0.001. Patients aged 31-70 had twofold odds of surgery compared to patients aged 18-30 or above 70, p<0,001. The risk of continued shoulder problems 2 years from time of diagnosis did not change significantly over the 18-year study period; the highest risk was 14% for people aged 31-50 and the lowest risk was 7% for people >70. The risk of developing frozen shoulder after a shoulder operation was 3.8% in 1996 and 1.7% in 2013.
Conclusions: The prognosis of having ongoing shoulder pain 2 years after diagnosis did not change over the study period indicating that treatment hasn’t improved over the past 18 years. The probability of being operated given you had degenerative shoulder disease peaked in 2008 after which the probability was halved. This coincides with high quality trials questioning the effect of subacromial decompression.
Department of Orthopedics, Copenhagen University Hospital Hvidovre; Department of Orthopedics, Copenhagen University Hospital Hvidovre; Department of Orthopedics, Copenhagen University Hospital Hvidovre; Department of Orthopedics, Copenhagen University Hospital Hvidovre
Background: Degenerative shoulder lesions are common and difficult to treat.
Purpose / Aim of Study: The purpose of the study was to investigate treatment of degenerative shoulder lesions in Denmark from 1996 to 2013 with focus on incidence of surgical procedures, treatment efficacy and the risk of developing frozen shoulder.
Materials and Methods: The National Patient Registry was retrospectively searched to find the number of degenerative shoulder lesions in Denmark during the period 1996– 2013. Regional population data were retrieved from the services of Statistics Denmark. Risk estimates were analyzed by logistic regression models .
Findings / Results: During the 18-year period, 244.519 individual contacts with a DM 75 diagnosis were registered. Of those 28% received surgical treatment due to their shoulder condition. The probability of being operated given you had degenerative shoulder disease was 25% in 1996, rose to 32% in 2008 and dropped to 16% in 2013. Odds ratio for being operated in 2013 compared to 2008 was 0.41, p < 0.001. Patients aged 31-70 had twofold odds of surgery compared to patients aged 18-30 or above 70, p<0,001. The risk of continued shoulder problems 2 years from time of diagnosis did not change significantly over the 18-year study period; the highest risk was 14% for people aged 31-50 and the lowest risk was 7% for people >70. The risk of developing frozen shoulder after a shoulder operation was 3.8% in 1996 and 1.7% in 2013.
Conclusions: The prognosis of having ongoing shoulder pain 2 years after diagnosis did not change over the study period indicating that treatment hasn’t improved over the past 18 years. The probability of being operated given you had degenerative shoulder disease peaked in 2008 after which the probability was halved. This coincides with high quality trials questioning the effect of subacromial decompression.
Sanja Somodi, Jeannette Østergaard Penny, Kim Hegnet Andersen, Lars Bo Ebskov, Peter Bro Rasmusen, Omar Muharemovic
Dep. of Radiology, Hvidovre Hospital; Dep. of Orthopaedics, Hvidovre Hospital; Dep. of Orthopaedics, Hvidovre Hospital; Dep. of Orthopaedics, Hvidovre Hospital; Dep. of Orthopaedics, Hvidovre Hospital; Dep. of Radiology,
Background: A mobile bearing ankle prosthesis used at Hvidovre Hospital 2010-2013, was abandoned due to failures and findings of bone loss at revision.
Purpose / Aim of Study: The aim of this study was to a) Determine our true revision rate, b) Investigate prevalence, size and location of periprosthetic bone cysts through X-ray and CT and c) Relate these findings patient reported outcome measurements (PROMs).
Materials and Methods: 51 primary surgeries were performed, prior to this study 8 had been revised. Out of 43 un-revised patients, 36 were enrolled and underwent evaluation with metal artefact reduction CT-scans and conventional X-ray. They filled out 3 PROMs; SEFAS, SF-12, EQ-5D. Cyst volume larger than 0.1 ml was measured using VITREA volume tools for CT-scans and calculation of spherical volume for X- rays; using AP- and lateral projections. PROMs association to osteolytic volume was analyzed by linear- and logistic regression.
Findings / Results: Finding large osteolytic lesions caused 4 additional patients to undergo revision and 7 are being monitored due to high risk of failure. Of the original 51 implants 14 have been revised, primarily because of osteolytic lesions and non-union (8 true revisions/implant exchange or bone transplant), periprosthetic fractures (3 cases, of which 2 were non-traumatic fractures) and 3 cases due to exostosis. The 3- and 5 year revision rate was 14% and 16% for revision and 17% and 27% overall. Cystic lesions were found in 81% of participants. Total cystic volume was not significantly related to PROM-scores (P 0.16-0.5).
Conclusions: The implant investigated performs below standard, compared to public registries* that report overall 5 year revision rates at 5 - 6.5% in comparable implants. Cysts were common, large and not related to PROMs. *Swedish National Foot Registry Ann. Report 2013. New Zealand 15 Year Report 2014.
Dep. of Radiology, Hvidovre Hospital; Dep. of Orthopaedics, Hvidovre Hospital; Dep. of Orthopaedics, Hvidovre Hospital; Dep. of Orthopaedics, Hvidovre Hospital; Dep. of Orthopaedics, Hvidovre Hospital; Dep. of Radiology,
Background: A mobile bearing ankle prosthesis used at Hvidovre Hospital 2010-2013, was abandoned due to failures and findings of bone loss at revision.
Purpose / Aim of Study: The aim of this study was to a) Determine our true revision rate, b) Investigate prevalence, size and location of periprosthetic bone cysts through X-ray and CT and c) Relate these findings patient reported outcome measurements (PROMs).
Materials and Methods: 51 primary surgeries were performed, prior to this study 8 had been revised. Out of 43 un-revised patients, 36 were enrolled and underwent evaluation with metal artefact reduction CT-scans and conventional X-ray. They filled out 3 PROMs; SEFAS, SF-12, EQ-5D. Cyst volume larger than 0.1 ml was measured using VITREA volume tools for CT-scans and calculation of spherical volume for X- rays; using AP- and lateral projections. PROMs association to osteolytic volume was analyzed by linear- and logistic regression.
Findings / Results: Finding large osteolytic lesions caused 4 additional patients to undergo revision and 7 are being monitored due to high risk of failure. Of the original 51 implants 14 have been revised, primarily because of osteolytic lesions and non-union (8 true revisions/implant exchange or bone transplant), periprosthetic fractures (3 cases, of which 2 were non-traumatic fractures) and 3 cases due to exostosis. The 3- and 5 year revision rate was 14% and 16% for revision and 17% and 27% overall. Cystic lesions were found in 81% of participants. Total cystic volume was not significantly related to PROM-scores (P 0.16-0.5).
Conclusions: The implant investigated performs below standard, compared to public registries* that report overall 5 year revision rates at 5 - 6.5% in comparable implants. Cysts were common, large and not related to PROMs. *Swedish National Foot Registry Ann. Report 2013. New Zealand 15 Year Report 2014.
Arnar Oskar Bjarnison, Thomas Juul Sørensen, Thomas Kallemose, Kristoffer W. Barfod
Department of Orthopedics, Zealand University Hospital; Department of Orthopedics, Zealand University Hospital; Department of Orthopaedic surgery, Clinical Orthopaedic Research Hvidovre, Copenhagen University Hospital Hvidovre ; Department of Orthopedics, Zealand University Hospital
Background: In 2013 Moor et al introduced the concept of the critical shoulder angle (CSA) and suggested that an abnormal CSA was a leading factor in development of Rotator Cuff Tear (RCT) and Osteoarthritis of the shoulder (OA).
Purpose / Aim of Study: The purpose of the study was to test inter- and intra- rater reliability of the CSA in a population suffering from RCT or OA.
Materials and Methods: The study was performed as a retrospective reliability study. 97 patients with RCT and 87 patients with OA constituted the study population. The CSA was measured as described by Moor et al in 2013 by two independent raters and repeated by rater 1 after 4 weeks. Data were evaluated using the Inter/intra Correlation Coefficient (ICC), calculated by mixed effect models, and the Minimal Detectable Change (MDC).
Findings / Results: Intra-rater reliability showed a non-significant systematic difference in CSA of 0.05° for RCT and 0.08 ° for OA between test days (p=0.71 and 0.52). For RCT the ICC value was 0.92, MDC 0.4°; for OA the ICC was 0.95, MDC 0.4 and 0.3. Inter-rater reliability showed a systematic difference between raters of 0.8° for RCT and 0.7° for OA (p<0.001 for both). For RCT the ICC value was 0.95, MDC 0.3°; for OA the ICC was 0.93, MDC 0.4.
Conclusions: The CSA measurement showed excellent reliability for use between raters and at repeated measurements by the same rater. Differences of more than 0.4° can be detected which is sufficient to distinguish between a normal and an abnormal CSA.
Department of Orthopedics, Zealand University Hospital; Department of Orthopedics, Zealand University Hospital; Department of Orthopaedic surgery, Clinical Orthopaedic Research Hvidovre, Copenhagen University Hospital Hvidovre ; Department of Orthopedics, Zealand University Hospital
Background: In 2013 Moor et al introduced the concept of the critical shoulder angle (CSA) and suggested that an abnormal CSA was a leading factor in development of Rotator Cuff Tear (RCT) and Osteoarthritis of the shoulder (OA).
Purpose / Aim of Study: The purpose of the study was to test inter- and intra- rater reliability of the CSA in a population suffering from RCT or OA.
Materials and Methods: The study was performed as a retrospective reliability study. 97 patients with RCT and 87 patients with OA constituted the study population. The CSA was measured as described by Moor et al in 2013 by two independent raters and repeated by rater 1 after 4 weeks. Data were evaluated using the Inter/intra Correlation Coefficient (ICC), calculated by mixed effect models, and the Minimal Detectable Change (MDC).
Findings / Results: Intra-rater reliability showed a non-significant systematic difference in CSA of 0.05° for RCT and 0.08 ° for OA between test days (p=0.71 and 0.52). For RCT the ICC value was 0.92, MDC 0.4°; for OA the ICC was 0.95, MDC 0.4 and 0.3. Inter-rater reliability showed a systematic difference between raters of 0.8° for RCT and 0.7° for OA (p<0.001 for both). For RCT the ICC value was 0.95, MDC 0.3°; for OA the ICC was 0.93, MDC 0.4.
Conclusions: The CSA measurement showed excellent reliability for use between raters and at repeated measurements by the same rater. Differences of more than 0.4° can be detected which is sufficient to distinguish between a normal and an abnormal CSA.
Halschou-Jensen Peter Max, Bouchelouche Pierre , Sauer Jannie, Fabrin Jesper
Orthopaedic surgery, Zealand University Hospital, Køge; Clinical Biochemistry, Zealand University Hospital, Køge; Orthopaedic surgery, Zealand University Hospital, Køge; Orthopaedic surgery, Zealand University Hospital, Køge
Background: There are about 300.000 diabetics in Denmark. Foot ulcers is a major complication to diabetes and the risk of developing a foot ulcer is as high as 25%. There is no standardized methods for measuring the size of these wounds although several medical devises are used. However, none of these produced results good enough to be useful. With a precise and reproducible device, it will be possible to detect a progress in wound healing within a short period of time. We used a special handheld digital 3D camera and software to measure the wound size as part of a large double blinded randomised controlled study. Our hypothesis is that oral vitamin D supplementation may improve healing in patients with chronic diabetic foot ulcers. We know that about 50% of the general population has vitamin D insufficiency (<50 nmol/l) and that vitamin D insufficiency is more common in diabetics and even more in diabetics with a chronic foot ulcer.
Purpose / Aim of Study: The aim of this study was to evaluate the precision (intra- and interrater variability) and usability of a hand- held wound measurement device.
Materials and Methods: The study was an observational study where four independent raters, three nurses and one doctor, assessed the dimensions of 5 wounds, 5 times. Giving 100 measurements. All the wounds were located on the foot or ankle region and classified as chronic diabetic wounds.
Findings / Results: The mean area of the five wounds were respectably 3.43 cm2, 1.28 cm2, 12.35 cm2, 5.10 cm2 and 12.65 cm2. Variances and coefficients of variation (CV) within raters (intrarater) and between raters (interrater) over the five wounds for surface area was 2.28% and 4.33%.
Conclusions: The device was found to have low intra- and interrater variation. The photographic record and measurements can be collected in approximately two minutes and in a non-contact fashion.
Orthopaedic surgery, Zealand University Hospital, Køge; Clinical Biochemistry, Zealand University Hospital, Køge; Orthopaedic surgery, Zealand University Hospital, Køge; Orthopaedic surgery, Zealand University Hospital, Køge
Background: There are about 300.000 diabetics in Denmark. Foot ulcers is a major complication to diabetes and the risk of developing a foot ulcer is as high as 25%. There is no standardized methods for measuring the size of these wounds although several medical devises are used. However, none of these produced results good enough to be useful. With a precise and reproducible device, it will be possible to detect a progress in wound healing within a short period of time. We used a special handheld digital 3D camera and software to measure the wound size as part of a large double blinded randomised controlled study. Our hypothesis is that oral vitamin D supplementation may improve healing in patients with chronic diabetic foot ulcers. We know that about 50% of the general population has vitamin D insufficiency (<50 nmol/l) and that vitamin D insufficiency is more common in diabetics and even more in diabetics with a chronic foot ulcer.
Purpose / Aim of Study: The aim of this study was to evaluate the precision (intra- and interrater variability) and usability of a hand- held wound measurement device.
Materials and Methods: The study was an observational study where four independent raters, three nurses and one doctor, assessed the dimensions of 5 wounds, 5 times. Giving 100 measurements. All the wounds were located on the foot or ankle region and classified as chronic diabetic wounds.
Findings / Results: The mean area of the five wounds were respectably 3.43 cm2, 1.28 cm2, 12.35 cm2, 5.10 cm2 and 12.65 cm2. Variances and coefficients of variation (CV) within raters (intrarater) and between raters (interrater) over the five wounds for surface area was 2.28% and 4.33%.
Conclusions: The device was found to have low intra- and interrater variation. The photographic record and measurements can be collected in approximately two minutes and in a non-contact fashion.