Session 17: Hip II
Fredag 28. oktober
13:00-14:30
Lokale: Stockholm / Copenhagen
Chairmen: Nanna Sillesen / Kjeld Søballe
Andreas EB Hermann, Anders Holsgaard-Larsen, Bo Zerahn, Steen Mejdahl, Søren Overgaard
Department of Orthopedic Surgery, Herlev University Hospital; Orthopedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital; Department of Clinical Physiology and Nuclear Medicine, Herlev University Hospital; Department of Orthopedic Surgery, Herlev University Hospital; Orthopedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital
Background: Progressive explosive-type resistance training (RT) improves physical function and muscle strength in hip OA patients prior to THA. The potential postoperative effect following THA of preoperative RT has not previously been reported
Purpose / Aim of Study: To investigate the postoperative effect of preoperative RT in hip OA patients scheduled for THA on i) self-reported outcomes and ii) muscle strength and physical function
Materials and Methods: Eighty patients (age 70.4 ± 7.6 years, 70% females (n=52)) diagnosed with hip OA and scheduled for primary THA were randomized into two groups: 1) The intervention group (IG) received RT (4 exercises of 3 series each (~80% of 1 repetition max)) twice a week for 10 weeks prior to surgery 2) The control group (CG) received care as usual. Primary endpoint was Hip Osteoarthritis Outcome Score (HOOS) ADL (12 months), Secondary; other HOOS subscales, muscle strength and function (gait speed, stair-climb, sit-to- stand). Between group changes at follow-up (3 and 12 months) were analyzed using mixed model analysis.
Findings / Results: For all HOOS subscales (including ADL), functional tests (except stair climb; p<0.017) and muscle strength no between group differences were observed at 12 months At 3 months statistical significant between-group difference in HOOS Sport/Rec was observed, where IG scored 10.5 points 95%CI [1.4;19.6] higher compared to CG. Furthermore, IG had higher muscle strength (knee extension; p<0.001) and better function (p<0.02) compared to CG
Conclusions: Preoperative RT does not affect one year postoperative ADL function. Between group differences in secondary outcomes at 3 month indicate that preoperative RT may accelerate postoperative recovery of strenuous activities during early rehabilitation. More strength requiring functions as stair climbing may benefit of RT in the longer term
Department of Orthopedic Surgery, Herlev University Hospital; Orthopedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital; Department of Clinical Physiology and Nuclear Medicine, Herlev University Hospital; Department of Orthopedic Surgery, Herlev University Hospital; Orthopedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital
Background: Progressive explosive-type resistance training (RT) improves physical function and muscle strength in hip OA patients prior to THA. The potential postoperative effect following THA of preoperative RT has not previously been reported
Purpose / Aim of Study: To investigate the postoperative effect of preoperative RT in hip OA patients scheduled for THA on i) self-reported outcomes and ii) muscle strength and physical function
Materials and Methods: Eighty patients (age 70.4 ± 7.6 years, 70% females (n=52)) diagnosed with hip OA and scheduled for primary THA were randomized into two groups: 1) The intervention group (IG) received RT (4 exercises of 3 series each (~80% of 1 repetition max)) twice a week for 10 weeks prior to surgery 2) The control group (CG) received care as usual. Primary endpoint was Hip Osteoarthritis Outcome Score (HOOS) ADL (12 months), Secondary; other HOOS subscales, muscle strength and function (gait speed, stair-climb, sit-to- stand). Between group changes at follow-up (3 and 12 months) were analyzed using mixed model analysis.
Findings / Results: For all HOOS subscales (including ADL), functional tests (except stair climb; p<0.017) and muscle strength no between group differences were observed at 12 months At 3 months statistical significant between-group difference in HOOS Sport/Rec was observed, where IG scored 10.5 points 95%CI [1.4;19.6] higher compared to CG. Furthermore, IG had higher muscle strength (knee extension; p<0.001) and better function (p<0.02) compared to CG
Conclusions: Preoperative RT does not affect one year postoperative ADL function. Between group differences in secondary outcomes at 3 month indicate that preoperative RT may accelerate postoperative recovery of strenuous activities during early rehabilitation. More strength requiring functions as stair climbing may benefit of RT in the longer term
Kirill Gromov, Roshan Latifi, Bjørn Glise Madsen, Henrik Husted, Thomas Kallemose, Anders Troelsen
Department of Orthopaedic Surgery, Hvidovre Hospital; Department of Orthopaedic Surgery, Hvidovre Hospital; Department of Orthopaedic Surgery, Hvidovre Hospital; Department of Orthopaedic Surgery, Hvidovre Hospital; Department of Orthopaedic Surgery, Hvidovre Hospital; Department of Orthopaedic Surgery, Hvidovre Hospital
Background: Multiple patient- as well as surgery-related parameters have been identified as contributing to the risk of dislocation following primary THA, however the role of component positioning is still controversial
Purpose / Aim of Study: In this study, we investigated if surgery-related factors are independent risk factors for dislocation following primary THA performed through a posterolateral approach
Materials and Methods: We identified 1326 consecutive hips receiving primary uncemented THA. All patients were operated using a standardized posterolateral approach. Patient demographics, including age, gender, ASA score and BMI were recorded. Surgery related factors including femoral head size, off-set restoration, leg length restoration and cup positioning were also recorded. All dislocations were identified. Logistical regression analysis was used to identify independent risk factors for dislocation
Findings / Results: Mean follow-up was 701, range (1-1674) days. 59 (4.5%) dislocations were identified. Hips with dislocations were significantly older (75.5 vs 67.9 years, p <0.001), had higher ASA score (p=0.03), significantly less anteverted acetabular components (14.1 vs 17.3, p=0.007). Increasing age (OR 1.06; 95%CI(1.02-1.10)), BMI < 25 (OR 2.65; 95%CI(1.26-5.57), BMI >30 (OR 2.47; 95%CI(1.07- 5.71)) and post operative shortening of the leg >5 mm (OR 2.54; 95%CI(1.02-6.33) were independent risk factors for dislocation
Conclusions: Placement of the acetabular component outside target zone defined as 30º-45° abduction and 5º-25° anteversion does not lead to increased risk for early dislocation following a primary THA performed with a posterolateral approach, however hips with dislocations tend to be less anteverted. Failing to restore or increase leg length lead also leads to increased risk for dislocations
Department of Orthopaedic Surgery, Hvidovre Hospital; Department of Orthopaedic Surgery, Hvidovre Hospital; Department of Orthopaedic Surgery, Hvidovre Hospital; Department of Orthopaedic Surgery, Hvidovre Hospital; Department of Orthopaedic Surgery, Hvidovre Hospital; Department of Orthopaedic Surgery, Hvidovre Hospital
Background: Multiple patient- as well as surgery-related parameters have been identified as contributing to the risk of dislocation following primary THA, however the role of component positioning is still controversial
Purpose / Aim of Study: In this study, we investigated if surgery-related factors are independent risk factors for dislocation following primary THA performed through a posterolateral approach
Materials and Methods: We identified 1326 consecutive hips receiving primary uncemented THA. All patients were operated using a standardized posterolateral approach. Patient demographics, including age, gender, ASA score and BMI were recorded. Surgery related factors including femoral head size, off-set restoration, leg length restoration and cup positioning were also recorded. All dislocations were identified. Logistical regression analysis was used to identify independent risk factors for dislocation
Findings / Results: Mean follow-up was 701, range (1-1674) days. 59 (4.5%) dislocations were identified. Hips with dislocations were significantly older (75.5 vs 67.9 years, p <0.001), had higher ASA score (p=0.03), significantly less anteverted acetabular components (14.1 vs 17.3, p=0.007). Increasing age (OR 1.06; 95%CI(1.02-1.10)), BMI < 25 (OR 2.65; 95%CI(1.26-5.57), BMI >30 (OR 2.47; 95%CI(1.07- 5.71)) and post operative shortening of the leg >5 mm (OR 2.54; 95%CI(1.02-6.33) were independent risk factors for dislocation
Conclusions: Placement of the acetabular component outside target zone defined as 30º-45° abduction and 5º-25° anteversion does not lead to increased risk for early dislocation following a primary THA performed with a posterolateral approach, however hips with dislocations tend to be less anteverted. Failing to restore or increase leg length lead also leads to increased risk for dislocations
Christian Hofbauer, Charlotte Troldborg, Christoffer C Jørgensen, Claus Varnum
Ortopædkirurgisk afdeling, Sygehus Lillebælt, Vejle; Medicinsk afdeling, Sygehus Lillebælt, Kolding; Section for Surgical Pathophysiology , Rigshospitalet; Ortopædkirurgisk afdeling, Sygehus Lillebælt, Vejle
Background: Background: Since 2002 patients having a total hip arthroplasty(THA) at Vejle Hospital have followed a fast- track concept. From 2009 to 2013 patients were informed of an expected length of stay (LOS) between 2 and 4 days. The information was given by all staff members involved in the patient treatment and care (surgeons, physiotherapists and nurses). In addition, the patients received the same information in a leaflet
Purpose / Aim of Study: Objectives: We aimed to investigate if a change in the preoperative information about expected LOS from 2-4 days to 1 day could reduce LOS without decreasing patient safety
Materials and Methods: Methods: A prospective comparative study on patients undergoing elective, primary unilateral THR was carried out.122 patients were consecutively included in the control group from April to August 2014. 122 patients were consecutively included in the intervention group from October to December 2014. All patients received the same standardized fast-track treatment and care. Both groups received identical information except the information related to the expected LOS: Expected LOS between 2-4 days (control group) and 1 day (intervention group). Patients in both groups stayed at hospital until they met the discharge criteria
Findings / Results: Results: Median LOS in the control and intervention groups was 2 (interquartile range (IQR), 1-3) and 1 (IQR 1-2) days (p<0.001). Within the first 90 days after THA, 7 (5.7%) patients from the control group and 10 (8.2%) patients from the intervention group were readmitted due to potentially surgery-related factors (p=0.45). No patient died within the first 90 days after surgery
Conclusions: Discussion: Our study shows that by changing the information regarding expected LOS, it is possible to reduce LOS without compromising patient safety within the first 90 days after primary THA
Ortopædkirurgisk afdeling, Sygehus Lillebælt, Vejle; Medicinsk afdeling, Sygehus Lillebælt, Kolding; Section for Surgical Pathophysiology , Rigshospitalet; Ortopædkirurgisk afdeling, Sygehus Lillebælt, Vejle
Background: Background: Since 2002 patients having a total hip arthroplasty(THA) at Vejle Hospital have followed a fast- track concept. From 2009 to 2013 patients were informed of an expected length of stay (LOS) between 2 and 4 days. The information was given by all staff members involved in the patient treatment and care (surgeons, physiotherapists and nurses). In addition, the patients received the same information in a leaflet
Purpose / Aim of Study: Objectives: We aimed to investigate if a change in the preoperative information about expected LOS from 2-4 days to 1 day could reduce LOS without decreasing patient safety
Materials and Methods: Methods: A prospective comparative study on patients undergoing elective, primary unilateral THR was carried out.122 patients were consecutively included in the control group from April to August 2014. 122 patients were consecutively included in the intervention group from October to December 2014. All patients received the same standardized fast-track treatment and care. Both groups received identical information except the information related to the expected LOS: Expected LOS between 2-4 days (control group) and 1 day (intervention group). Patients in both groups stayed at hospital until they met the discharge criteria
Findings / Results: Results: Median LOS in the control and intervention groups was 2 (interquartile range (IQR), 1-3) and 1 (IQR 1-2) days (p<0.001). Within the first 90 days after THA, 7 (5.7%) patients from the control group and 10 (8.2%) patients from the intervention group were readmitted due to potentially surgery-related factors (p=0.45). No patient died within the first 90 days after surgery
Conclusions: Discussion: Our study shows that by changing the information regarding expected LOS, it is possible to reduce LOS without compromising patient safety within the first 90 days after primary THA
Per Hviid Gundtoft, Alma Pedersen, Henrik Carl Schønheyder, Jens Kjølseth Møller, Søren Overgaard
1. Ortopædkirurgisk Afd., Kolding 2. Ortopædkirurgisk Afd. Odense, 1. Kolding Sygehus, 2 OUH; Klinisk Epidemiologisk Afdeling, Aarhus; Klinisk Mikrobiologi, Aalborg; Klinisk Mikrobiologi, Vejle - en del af sygehus Lillebælt; Ortopædkirurgisk, Odense Universitetshospital
Background: To examine the change in rate of prosthetic joint infections (PJI) following primary total hip arthroplasty (THA) during the period 2005-2014 and the antimicrobial resistance of the bacteria causing these infections.
Purpose / Aim of Study: To examine the change in rate of prosthetic joint infections (PJI) following primary total hip arthroplasty (THA) during the period 2005-2014 and the antimicrobial resistance of the bacteria causing these infections.
Materials and Methods: We identified a population-based cohort of patients in the Danish Hip Arthroplasty Register (DHR) who had primary THA and received their surgery in Jutland or Funen between 2005 and 2014. We followed the patients until revision, death, or up to one-year of follow-up. Data from the DHR were combined with those from microbiology databases, the National Register of Patients, and the Civil Registration System. We estimated the cumulative one-year incidence of PJI for two 5-year periods; 2005-2009 and 2010- 2014. The hazard ratio of PJI as a measure of relative risk after adjusting for multiple risk factors was calculated.
Findings / Results: Of 48,867 primary THAs identified, 1,120 underwent revision within one year. Of these, 271 were due to PJI. The incidence of PJI was 0.53% (95% CI: 0.44; 0.63) during 2005-2009 and 0.57% (95% CI: 0.49; 0.67) during 2010-2014. The adjusted relative risk was 1.05 (95% CI: 0.82; 1.34) for the 2010-2014 period versus the 2005-2010 period. The most common micro-organisms identified in the 271 PJI were Staphylococcus aureus (36%) and coagulase-negative staphylococci (33%); Antimicrobial resistance to beta-lactams and gentamicin did not change during the study period.
Conclusions: The risk of PJI within one-year after primary THA and the antimicrobial resistance remained unchanged during the 2005-2014 study period.
1. Ortopædkirurgisk Afd., Kolding 2. Ortopædkirurgisk Afd. Odense, 1. Kolding Sygehus, 2 OUH; Klinisk Epidemiologisk Afdeling, Aarhus; Klinisk Mikrobiologi, Aalborg; Klinisk Mikrobiologi, Vejle - en del af sygehus Lillebælt; Ortopædkirurgisk, Odense Universitetshospital
Background: To examine the change in rate of prosthetic joint infections (PJI) following primary total hip arthroplasty (THA) during the period 2005-2014 and the antimicrobial resistance of the bacteria causing these infections.
Purpose / Aim of Study: To examine the change in rate of prosthetic joint infections (PJI) following primary total hip arthroplasty (THA) during the period 2005-2014 and the antimicrobial resistance of the bacteria causing these infections.
Materials and Methods: We identified a population-based cohort of patients in the Danish Hip Arthroplasty Register (DHR) who had primary THA and received their surgery in Jutland or Funen between 2005 and 2014. We followed the patients until revision, death, or up to one-year of follow-up. Data from the DHR were combined with those from microbiology databases, the National Register of Patients, and the Civil Registration System. We estimated the cumulative one-year incidence of PJI for two 5-year periods; 2005-2009 and 2010- 2014. The hazard ratio of PJI as a measure of relative risk after adjusting for multiple risk factors was calculated.
Findings / Results: Of 48,867 primary THAs identified, 1,120 underwent revision within one year. Of these, 271 were due to PJI. The incidence of PJI was 0.53% (95% CI: 0.44; 0.63) during 2005-2009 and 0.57% (95% CI: 0.49; 0.67) during 2010-2014. The adjusted relative risk was 1.05 (95% CI: 0.82; 1.34) for the 2010-2014 period versus the 2005-2010 period. The most common micro-organisms identified in the 271 PJI were Staphylococcus aureus (36%) and coagulase-negative staphylococci (33%); Antimicrobial resistance to beta-lactams and gentamicin did not change during the study period.
Conclusions: The risk of PJI within one-year after primary THA and the antimicrobial resistance remained unchanged during the 2005-2014 study period.
Jeannette Penny, Ming Ding, Ole Ovesen, Søren Overgaard
Dept. of orthopedics, Næstved and OUH; , Clinical Institute OUH; Dept. of orthopedics, OUH; Dept. of orthopedics, Clinical Institute OUH
Background: Most Metal-on-metal hips were abandoned due to high clinical failure rates likely caused by metal wear products.
Purpose / Aim of Study: We report 5 year results of a randomized study of RHA, LDH-THA and THA with implant micro motion, Cr & Co ions and BMD. Links between outcome measures is investigated
Materials and Methods: 19 RHA 17 THA and 15 LDH-THA for 5 year follow-up All were followed with Bone mass density RHA and THA had prospective Co and Co ions, LDH-THA only at 5 y. Marker based RSA of both RHA components. Cup only for LDH-THA. We used a total translation measure: TT= ã (x2+y2+z2). Data collected at baseline, 8 w, 6 m 1, 2 and 5 y Statistical tests: Pearson correlations. ANOVA and MANOVA
Findings / Results: Presented as: median (mean (s.e)) and quartiles RSA: The 5 y TT results were 1.1(1.3 (0.2))1.0 to 1.7 mm for the LDH-THA Cup, 0.6 (0.7(0.1)) 0.3 to 0.8 mm for the RHA Cup and 0.5 (0.8(0.3)) 0.3 to 0.6 mm for the RHA head. The migration between the cups differed at 5 but not at 2 years (p<0.05) Co ions were; RHA: 1.1(2.8 (0.7)) 0.8 to 4.9, THA: 0.2 (0.4 (0.1)) 0.1 to 0.4 and LDH-THA: 1.2 (1.4(0.3)) 0.7 to 2.9 ppb. Similar levels for Cr. LDH-THA and RHA ions did not differ at 5 year, Co was higher than THA (p<0.01) We found better preservation of the acetabular BMD in the LDH-RHA group (p<0.05) and an advantage of the RHA in the femoral Gruen zones 6 and 7 (p<0.01) TT migration correlated negatively with BMD in the femoral collum and proximal femur (p<0.05), but had no link to acetabular BMD or metal ions
Conclusions: In contrast to registered revision rates, we found significantly larger movement for the LDH-THA cup than the RHA cup. Despite this, the LDH-THA cup maintained the acetabular BMD best at 5 years. Movement of the implant may adversely affect the femoral BMD, but - in this study - does not increase metal ion release
Dept. of orthopedics, Næstved and OUH; , Clinical Institute OUH; Dept. of orthopedics, OUH; Dept. of orthopedics, Clinical Institute OUH
Background: Most Metal-on-metal hips were abandoned due to high clinical failure rates likely caused by metal wear products.
Purpose / Aim of Study: We report 5 year results of a randomized study of RHA, LDH-THA and THA with implant micro motion, Cr & Co ions and BMD. Links between outcome measures is investigated
Materials and Methods: 19 RHA 17 THA and 15 LDH-THA for 5 year follow-up All were followed with Bone mass density RHA and THA had prospective Co and Co ions, LDH-THA only at 5 y. Marker based RSA of both RHA components. Cup only for LDH-THA. We used a total translation measure: TT= ã (x2+y2+z2). Data collected at baseline, 8 w, 6 m 1, 2 and 5 y Statistical tests: Pearson correlations. ANOVA and MANOVA
Findings / Results: Presented as: median (mean (s.e)) and quartiles RSA: The 5 y TT results were 1.1(1.3 (0.2))1.0 to 1.7 mm for the LDH-THA Cup, 0.6 (0.7(0.1)) 0.3 to 0.8 mm for the RHA Cup and 0.5 (0.8(0.3)) 0.3 to 0.6 mm for the RHA head. The migration between the cups differed at 5 but not at 2 years (p<0.05) Co ions were; RHA: 1.1(2.8 (0.7)) 0.8 to 4.9, THA: 0.2 (0.4 (0.1)) 0.1 to 0.4 and LDH-THA: 1.2 (1.4(0.3)) 0.7 to 2.9 ppb. Similar levels for Cr. LDH-THA and RHA ions did not differ at 5 year, Co was higher than THA (p<0.01) We found better preservation of the acetabular BMD in the LDH-RHA group (p<0.05) and an advantage of the RHA in the femoral Gruen zones 6 and 7 (p<0.01) TT migration correlated negatively with BMD in the femoral collum and proximal femur (p<0.05), but had no link to acetabular BMD or metal ions
Conclusions: In contrast to registered revision rates, we found significantly larger movement for the LDH-THA cup than the RHA cup. Despite this, the LDH-THA cup maintained the acetabular BMD best at 5 years. Movement of the implant may adversely affect the femoral BMD, but - in this study - does not increase metal ion release
Marianne Tjur, Asger R. Pedersen, William Sloth, Kjeld Søballe, Nina D. Lorenzen, Maiken Stilling
Orthopaedic Research Unit, Aarhus University Hospital; Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University; Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University; Orthopaedic Research Unit, Aarhus University Hospital; Orthopaedic Research Unit, Aarhus University Hospital; Orthopaedic Research Unit, Aarhus University Hospital
Background: Anterolateral (AL) surgical approach in hip joint arthroplasty (HJA) necessitates division of the hip abductor muscle complex, which may compromise normal postoperative gait observed in the frontal plane moment (FPM).
Purpose / Aim of Study: To compare FPM during early and late stance after HJA by either AL or posterior (POST) surgical approach, and clarify if pain is a potential cause of decreased FPM.
Materials and Methods: 28 patients were prospectively included and randomized to AL (ad modum Watson) or POST (ad modum Moore) surgical approach with HJA. 3D gait analysis (Vicon) was performed before surgery (BL) and 3 and 12 months postoperative. Ground reaction force (GRF) was sampled at 2000 Hz using an OR6-7 AMTI force plate (FP). Peak GRF was extracted for early and late stance, respectively, after which FPM and lateral trunk inclination (TI) corresponding to peak GRF was defined. Patients self-reported pain (VAS) was obtained during clinical examinations related to the gait analysis. The overall difference between surgical approaches was tested with a linear mixed model.
Findings / Results: An overall different effect of surgical approach on FPM for the affected leg was found during early stance (p=0.006). From BL to 3 months, average FPM decreased by 125 Nmm/kg in the AL group (CI -213;-37.4), while no significant change of FPM was seen in the POST group (CI -81.6;78.4). From 3 to 12 months, the change of FPM in the AL group was not significant (CI -34.2;148), whereas FPM in the POST group increased by 136 Nmm/kg (CI 56.3;216). VAS scores did not differ between approach groups (p=0.69).
Conclusions: Hip FPM during early stance was decreased after HJA utilizing AL compared to POST surgical approach. No effect was found during late stance phase. There was no indication of postoperative pain being the cause of decreased FPM in early stance.
Orthopaedic Research Unit, Aarhus University Hospital; Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University; Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University; Orthopaedic Research Unit, Aarhus University Hospital; Orthopaedic Research Unit, Aarhus University Hospital; Orthopaedic Research Unit, Aarhus University Hospital
Background: Anterolateral (AL) surgical approach in hip joint arthroplasty (HJA) necessitates division of the hip abductor muscle complex, which may compromise normal postoperative gait observed in the frontal plane moment (FPM).
Purpose / Aim of Study: To compare FPM during early and late stance after HJA by either AL or posterior (POST) surgical approach, and clarify if pain is a potential cause of decreased FPM.
Materials and Methods: 28 patients were prospectively included and randomized to AL (ad modum Watson) or POST (ad modum Moore) surgical approach with HJA. 3D gait analysis (Vicon) was performed before surgery (BL) and 3 and 12 months postoperative. Ground reaction force (GRF) was sampled at 2000 Hz using an OR6-7 AMTI force plate (FP). Peak GRF was extracted for early and late stance, respectively, after which FPM and lateral trunk inclination (TI) corresponding to peak GRF was defined. Patients self-reported pain (VAS) was obtained during clinical examinations related to the gait analysis. The overall difference between surgical approaches was tested with a linear mixed model.
Findings / Results: An overall different effect of surgical approach on FPM for the affected leg was found during early stance (p=0.006). From BL to 3 months, average FPM decreased by 125 Nmm/kg in the AL group (CI -213;-37.4), while no significant change of FPM was seen in the POST group (CI -81.6;78.4). From 3 to 12 months, the change of FPM in the AL group was not significant (CI -34.2;148), whereas FPM in the POST group increased by 136 Nmm/kg (CI 56.3;216). VAS scores did not differ between approach groups (p=0.69).
Conclusions: Hip FPM during early stance was decreased after HJA utilizing AL compared to POST surgical approach. No effect was found during late stance phase. There was no indication of postoperative pain being the cause of decreased FPM in early stance.
Martin Lindberg-Larsen, Christoffer Jørgensen, Søren Solgaard, Anne Grete Kjersgaard, Henrik Kehlet
Department of Orthopaedic Surgery, Copenhagen University Hospital Bispebjerg; Section of Surgical Pathophysiology and The Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen Unversity Hospital Rigshospitalet; Department of Orthopaedic Surgery, Copenhagen University Hospital Gentofte; Department of Orthopaedic Surgery, Copenhagen University Hospital Gentofte; Section of Surgical Pathophysiology and The Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen University Hospital Rigshospitalet
Background: The use of uncemented fixation in total hip arthroplasty (THA) is increasing. Register studies have suggested an increased risk of revision of uncemented implants due to early periprosthetic femoral fractures.
Purpose / Aim of Study: To describe the incidence, consequences and potential risk factors associated with intra- and early postoperative (¡Ü 90 days) periprosthetic femoral fractures after THA.
Materials and Methods: Observational prospective study in 8 dedicated high-volume centers from February 2010 to November 2013. 90- days follow-up from the Danish Patient Registry and patient records. Intraoperative information from the Danish Hip Arthroplasty Register and surgical notes.
Findings / Results: In 7169 primary THA, 5482 (76.5%) were performed using uncemented femoral components. The total incidence of periprosthetic femoral fractures ¡Ü 90 days postoperatively was 2.1% (n=150). 70 (1.0%) fractures were intraoperative (46 required osteosynthesis and 14 limited weight bearing), 51 (0.7%) postoperative fractures occurred without trauma (42 re-operated) and 29 (0.4%) were postoperative fall-related fractures (27 re-operated). 134 (2.4%) fractures were found in uncemented vs 16 (0.9%) in cemented femoral components (p<0.001). 1674 (55.0%) uncemented femoral components were implanted in patients >70 years with a fracture incidence of 3.3% (n=56) vs 0.8% (n=11) in cemented components (p<0.001). Uncemented femoral component (OR 4.7, p<0.001), medically treated osteoporosis (OR 3.9, p<0.001) and female gender (OR 1.9, p=0.027) were associated with increased risk of periprosthetic femoral fracture in patients >70 years when analysed using multiple logistic regression.
Conclusions: Uncemented femoral components may increase the risk of early periprosthetic femoral fractures, especially in the elderly, osteoporotic and female patients.
Department of Orthopaedic Surgery, Copenhagen University Hospital Bispebjerg; Section of Surgical Pathophysiology and The Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen Unversity Hospital Rigshospitalet; Department of Orthopaedic Surgery, Copenhagen University Hospital Gentofte; Department of Orthopaedic Surgery, Copenhagen University Hospital Gentofte; Section of Surgical Pathophysiology and The Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen University Hospital Rigshospitalet
Background: The use of uncemented fixation in total hip arthroplasty (THA) is increasing. Register studies have suggested an increased risk of revision of uncemented implants due to early periprosthetic femoral fractures.
Purpose / Aim of Study: To describe the incidence, consequences and potential risk factors associated with intra- and early postoperative (¡Ü 90 days) periprosthetic femoral fractures after THA.
Materials and Methods: Observational prospective study in 8 dedicated high-volume centers from February 2010 to November 2013. 90- days follow-up from the Danish Patient Registry and patient records. Intraoperative information from the Danish Hip Arthroplasty Register and surgical notes.
Findings / Results: In 7169 primary THA, 5482 (76.5%) were performed using uncemented femoral components. The total incidence of periprosthetic femoral fractures ¡Ü 90 days postoperatively was 2.1% (n=150). 70 (1.0%) fractures were intraoperative (46 required osteosynthesis and 14 limited weight bearing), 51 (0.7%) postoperative fractures occurred without trauma (42 re-operated) and 29 (0.4%) were postoperative fall-related fractures (27 re-operated). 134 (2.4%) fractures were found in uncemented vs 16 (0.9%) in cemented femoral components (p<0.001). 1674 (55.0%) uncemented femoral components were implanted in patients >70 years with a fracture incidence of 3.3% (n=56) vs 0.8% (n=11) in cemented components (p<0.001). Uncemented femoral component (OR 4.7, p<0.001), medically treated osteoporosis (OR 3.9, p<0.001) and female gender (OR 1.9, p=0.027) were associated with increased risk of periprosthetic femoral fracture in patients >70 years when analysed using multiple logistic regression.
Conclusions: Uncemented femoral components may increase the risk of early periprosthetic femoral fractures, especially in the elderly, osteoporotic and female patients.
Eva Natalia Glassou, Alma Becic Pedersen, Torben Bæk Hansen
University clinic of hand, hip and knee surgery, Department of Orthopedic Surgery, Regional Hospital West Jutland; Department of Clinical Epidemiology, Aarhus University Hospital; University clinic of hand, hip and knee surgery, Department of Orthopedic Surgery, Regional Hospital West Jutland
Background: The incidence of total hip and knee arthroplasty (THA and TKA) has increased over the last decades. This increase may be explained by the aging of the population and an improved safety of the procedures, which has expanded the indications for surgery. Patients with several comorbid conditions are now considered suitable candidates for THA and TKA.
Purpose / Aim of Study: We examined changes in comorbidity over time and their impact on mortality following primary THA and TKA in patients with OA.
Materials and Methods: We used the Danish Arthroplasty Registers to identify THA and TKA patients from 1996 to 2013. From administrative databases we collected data on comorbidities, which were used to calculate the Charlson Comorbidity Index. Patients were divided into four comorbidity groups (none, low, moderate, high). We calculated the relative risk (RR) of mortality within 90 days post-surgery with a 95% confidence interval (CI) stratified by year of surgery.
Findings / Results: In total, 99,886 THAs and 63,718 TKAs were included. The proportion of THA patients with low, moderate and high comorbidity burden increased 3-4% during the period of interest. Compared to patients with no comorbidity, THA patients with low, moderate and high comorbidity burden had an RR of 90-day mortality of 1.9 (CI: 1.6-2.4), 1.9 (CI: 1.4-2.5), and 3.3 (CI: 2.6-4.2), respectively. Similar increases in proportions and RRs were observed in TKA patients with moderate and high comorbidity burden.
Conclusions: The number of THA and TKA procedures performed on patients with comorbidities increased over the past 18 years. The mortality risk was dependent of the comorbidity burden. Patients with moderate or severe comorbidity burden had an increased risk of dying within 90 days post-surgery regardless of year of surgery.
University clinic of hand, hip and knee surgery, Department of Orthopedic Surgery, Regional Hospital West Jutland; Department of Clinical Epidemiology, Aarhus University Hospital; University clinic of hand, hip and knee surgery, Department of Orthopedic Surgery, Regional Hospital West Jutland
Background: The incidence of total hip and knee arthroplasty (THA and TKA) has increased over the last decades. This increase may be explained by the aging of the population and an improved safety of the procedures, which has expanded the indications for surgery. Patients with several comorbid conditions are now considered suitable candidates for THA and TKA.
Purpose / Aim of Study: We examined changes in comorbidity over time and their impact on mortality following primary THA and TKA in patients with OA.
Materials and Methods: We used the Danish Arthroplasty Registers to identify THA and TKA patients from 1996 to 2013. From administrative databases we collected data on comorbidities, which were used to calculate the Charlson Comorbidity Index. Patients were divided into four comorbidity groups (none, low, moderate, high). We calculated the relative risk (RR) of mortality within 90 days post-surgery with a 95% confidence interval (CI) stratified by year of surgery.
Findings / Results: In total, 99,886 THAs and 63,718 TKAs were included. The proportion of THA patients with low, moderate and high comorbidity burden increased 3-4% during the period of interest. Compared to patients with no comorbidity, THA patients with low, moderate and high comorbidity burden had an RR of 90-day mortality of 1.9 (CI: 1.6-2.4), 1.9 (CI: 1.4-2.5), and 3.3 (CI: 2.6-4.2), respectively. Similar increases in proportions and RRs were observed in TKA patients with moderate and high comorbidity burden.
Conclusions: The number of THA and TKA procedures performed on patients with comorbidities increased over the past 18 years. The mortality risk was dependent of the comorbidity burden. Patients with moderate or severe comorbidity burden had an increased risk of dying within 90 days post-surgery regardless of year of surgery.
Peter Kloster Aalund, Eva Natalia Glassou, Torben Bæk Hansen
University clinic of hand, hip and knee surgery, Aarhus University, Department of Orthopedic Surgery, Regional Hospital West Jutland, Denmark; University clinic of hand, hip and knee surgery, Aarhus University, Department of Orthopedic Surgery, Regional Hospital West Jutland, Denmark; University clinic of hand, hip and knee surgery, Aarhus University, Department of Orthopedic Surgery, Regional Hospital West Jutland, Denmark
Background: Hip and knee arthroplasty are common surgical procedures with respectively 9.500 and 8.500 operations performed annually in Denmark. These operations are considered effective and successful in relation to complications, mortality and prosthesis survival. However using patient reported outcome measures up to 20 % of the patients are not satisfied with their outcome of the operation. To be able to act on this, it is important to find out why some patients experience impaired outcome after operation.
Purpose / Aim of Study: The purpose of the study was to investigate the impact of age on health related quality of life (HRQoL) after total hip athroplasty (THA), total knee athroplasty (TKA) and unicompartmental knee arthroplasty (UKA).
Materials and Methods: A cohort study was conducted with follow-up at 3-4 and 12 months. Data were collected from September 2008 to December 2013. 1283 THA, 736 TKA and 257 UKA were available for analysis. HRQoL was measured using the EQ-5D. Analysis were carried out with multiple linear regression and adjusted for relevant variables available in data.
Findings / Results: A significant positive association was found between age and HRQoL outcome for patients operated with THA at both 3-4 and 12 months of follow-up. A clinically relevant change was achieved with an increase of age at approximately ten years. Estimates for TKA and UKA were not found statistically significant regarding the association between age and HRQoL. However no statistically significant difference was found between estimates for THA, TKA and UKA.
Conclusions: Increasing age was associated with increasing HRQoL outcome for patient operated with THA. This association was not found for TKA and UKA. Contrary to expectations increasing age did not seem to have a negative impact on HRQoL outcome for any of the three types of operations.
University clinic of hand, hip and knee surgery, Aarhus University, Department of Orthopedic Surgery, Regional Hospital West Jutland, Denmark; University clinic of hand, hip and knee surgery, Aarhus University, Department of Orthopedic Surgery, Regional Hospital West Jutland, Denmark; University clinic of hand, hip and knee surgery, Aarhus University, Department of Orthopedic Surgery, Regional Hospital West Jutland, Denmark
Background: Hip and knee arthroplasty are common surgical procedures with respectively 9.500 and 8.500 operations performed annually in Denmark. These operations are considered effective and successful in relation to complications, mortality and prosthesis survival. However using patient reported outcome measures up to 20 % of the patients are not satisfied with their outcome of the operation. To be able to act on this, it is important to find out why some patients experience impaired outcome after operation.
Purpose / Aim of Study: The purpose of the study was to investigate the impact of age on health related quality of life (HRQoL) after total hip athroplasty (THA), total knee athroplasty (TKA) and unicompartmental knee arthroplasty (UKA).
Materials and Methods: A cohort study was conducted with follow-up at 3-4 and 12 months. Data were collected from September 2008 to December 2013. 1283 THA, 736 TKA and 257 UKA were available for analysis. HRQoL was measured using the EQ-5D. Analysis were carried out with multiple linear regression and adjusted for relevant variables available in data.
Findings / Results: A significant positive association was found between age and HRQoL outcome for patients operated with THA at both 3-4 and 12 months of follow-up. A clinically relevant change was achieved with an increase of age at approximately ten years. Estimates for TKA and UKA were not found statistically significant regarding the association between age and HRQoL. However no statistically significant difference was found between estimates for THA, TKA and UKA.
Conclusions: Increasing age was associated with increasing HRQoL outcome for patient operated with THA. This association was not found for TKA and UKA. Contrary to expectations increasing age did not seem to have a negative impact on HRQoL outcome for any of the three types of operations.
Mads Have, Søren Overgaard, Carsten Jensen
University of Southern Denmark, Institute of Clinical Research; Ortopeadic surgery and traumatology, Odense University Hospital; Ortopeadic surgery and traumatology, Odense University Hospital
Background: Preoperative patient characteristics may influence patient choice for participating in RCTs.
Purpose / Aim of Study: This study aimed to compare patient characteristics, level of pain, physical function and joint space width in patients with severe hip osteoarthritis (OA) who accepted or refused to participate in a RCT.
Materials and Methods: In this prospective cohort study a total of 137 patients with primary hip OA were asked to choose between surgical or non- surgical treatment. We then compared the characteristics of each patient cohort (demographics, pain level and duration, analgesic use, exercise habits), the radiographic hip OA state and their responses to Hip dysfunction and Osteoarthritis Outcome Score (HOOS, 0-100) and European Quality of Life Scale (EQ-5D-5L) questionnaires.
Findings / Results: The between-group HOOS scores were significantly different in three out of the five HOOS subscales analyzed; HOOSpain 6.1 (95% CI: 0.3 to 12.5), HOOSADL 8.3 (95% CI: 2.3 to 14.4) and HOOSsport/rec 8.6 (95% CI: 3.2 to 13.9) with higher scores recorded in the non-surgical patient cohort indicating less symptoms. Overall health status (EQ-5D-5L) showed surgical patients had more problems in all the dimensions except for the EQanxity/depression responses. The surgical patients had significantly reduced joint space width (1.2 ± 1.0 mm vs. 1.8 ± 1.2 mm, p = 0.004) and both cohorts had values below the defined 2 mm cut-off (Jacobsen et al.).
Conclusions: Patients, who choose surgical treatment had preoperatively more pain, reduced physical function, lower health status and joint space width compared with patients who choose non-surgical treatment.
University of Southern Denmark, Institute of Clinical Research; Ortopeadic surgery and traumatology, Odense University Hospital; Ortopeadic surgery and traumatology, Odense University Hospital
Background: Preoperative patient characteristics may influence patient choice for participating in RCTs.
Purpose / Aim of Study: This study aimed to compare patient characteristics, level of pain, physical function and joint space width in patients with severe hip osteoarthritis (OA) who accepted or refused to participate in a RCT.
Materials and Methods: In this prospective cohort study a total of 137 patients with primary hip OA were asked to choose between surgical or non- surgical treatment. We then compared the characteristics of each patient cohort (demographics, pain level and duration, analgesic use, exercise habits), the radiographic hip OA state and their responses to Hip dysfunction and Osteoarthritis Outcome Score (HOOS, 0-100) and European Quality of Life Scale (EQ-5D-5L) questionnaires.
Findings / Results: The between-group HOOS scores were significantly different in three out of the five HOOS subscales analyzed; HOOSpain 6.1 (95% CI: 0.3 to 12.5), HOOSADL 8.3 (95% CI: 2.3 to 14.4) and HOOSsport/rec 8.6 (95% CI: 3.2 to 13.9) with higher scores recorded in the non-surgical patient cohort indicating less symptoms. Overall health status (EQ-5D-5L) showed surgical patients had more problems in all the dimensions except for the EQanxity/depression responses. The surgical patients had significantly reduced joint space width (1.2 ± 1.0 mm vs. 1.8 ± 1.2 mm, p = 0.004) and both cohorts had values below the defined 2 mm cut-off (Jacobsen et al.).
Conclusions: Patients, who choose surgical treatment had preoperatively more pain, reduced physical function, lower health status and joint space width compared with patients who choose non-surgical treatment.
Arnar Oskar Bjarnison, Leif Broeng
Department of Orthopaedics, Zealand University hospital; Department of Orthopaedics, Zealand University hospital
Background: The standard treatment of chronic PJI in THA is removal of the alloplastic material together with the cement.
Purpose / Aim of Study: The purpose of this study was to examine the postoperative outcome of 8 patients, treated from 2012 until 2016, which had prosthetic joint infection(PJI) from their primary cemented THA with Exeter prosthesis, were 2 stage revisions were performed and the cement mantle in the femoral canal conserved. A positive diagnosis of late PJI was considered when 2 or more biopsies revealed a positive bacterial count.
Materials and Methods: Clinical and operative data were evaluated retrospectively. Age, sex, time from primary hip to revision, time from 1st to 2nd stage revision, followup and results of microbiological cultures was registered. The median age at the firsts tage revision procedure was 74(68 to 78). The median followup period was 14 months(12 to 40). At followup a radiological evaluation together with a clinical evaluation of pain and ability to walk, hip disability and osteoarthritis outcome score was obtained. Complications concerning soft tissue and antibiotic treatment was also registered. After the 1st stage revision antibiotics were administrated. The 1st 2 weeks intravenously followed by at least 4 weeks of per oral treatment. Patients had to be infection free before the 2nd stage revision for 4 to 6 weeks.
Findings / Results: From the 8 patients treated from 2012 until 2016, 7 were treated with successful eradication of the PJI, 1 required one soft tissue revision followed by 5 weeks of antibiotic treatment after the 2nd stage revision and one died from cardiac failure after the 1st stage revision.
Conclusions: 2stage revision with retention of femoral cement mantle in treatment of infected THA is an effective methood of treating infected cementet THA that show promising results.
Department of Orthopaedics, Zealand University hospital; Department of Orthopaedics, Zealand University hospital
Background: The standard treatment of chronic PJI in THA is removal of the alloplastic material together with the cement.
Purpose / Aim of Study: The purpose of this study was to examine the postoperative outcome of 8 patients, treated from 2012 until 2016, which had prosthetic joint infection(PJI) from their primary cemented THA with Exeter prosthesis, were 2 stage revisions were performed and the cement mantle in the femoral canal conserved. A positive diagnosis of late PJI was considered when 2 or more biopsies revealed a positive bacterial count.
Materials and Methods: Clinical and operative data were evaluated retrospectively. Age, sex, time from primary hip to revision, time from 1st to 2nd stage revision, followup and results of microbiological cultures was registered. The median age at the firsts tage revision procedure was 74(68 to 78). The median followup period was 14 months(12 to 40). At followup a radiological evaluation together with a clinical evaluation of pain and ability to walk, hip disability and osteoarthritis outcome score was obtained. Complications concerning soft tissue and antibiotic treatment was also registered. After the 1st stage revision antibiotics were administrated. The 1st 2 weeks intravenously followed by at least 4 weeks of per oral treatment. Patients had to be infection free before the 2nd stage revision for 4 to 6 weeks.
Findings / Results: From the 8 patients treated from 2012 until 2016, 7 were treated with successful eradication of the PJI, 1 required one soft tissue revision followed by 5 weeks of antibiotic treatment after the 2nd stage revision and one died from cardiac failure after the 1st stage revision.
Conclusions: 2stage revision with retention of femoral cement mantle in treatment of infected THA is an effective methood of treating infected cementet THA that show promising results.