Session 9: YODA Best Papers
Torsdag den 27. oktober
9:30 – 10:30
Lokale: Helsinki/Oslo
Chairmen: Søren Ohrt Nissen / Nanna Sillesen
Roshan Latifi, Kirill Gromov, Thomas Kallemose, Henrik Husted, Anders Troelsen
Orthopaedics, Hvidovre Hospital; Orthopaedics, Hvidovre Hospital; Orthopaedics, Hvidovre Hospital; Orthopaedics, Hvidovre Hospital; Orthopaedics, Hvidovre Hospital
Background: Malalignment of the primary Total Knee Arthroplasty (TKA) components has been shown to be a risk factor for implants failure and inferior patient reported outcomes. We hypothesised that surgeons are reluctant to deviate from the preoperative anatomical state of the knee and therefore easily identifiable preoperative radiographic features can predict postoperative implant positioning
Purpose / Aim of Study: To investigate whether preoperative features can predict the overall alignment of the knee, tibia and femoral components
Materials and Methods: We identified 772 consecutive and unselected patients undergoing primary unilateral or bilateral total knee arthroplasty between March 2013 and December 2014. All surgeries were performed using measured resection technique. Pre- and postoperative radiological parameters as well as BMI, age, sex and implant types were registered. Standard safe zones for postoperative tibia and femoral alignment were determined. Logistic regression analysis was performed to identify independent preoperative risk factors for each postoperative misalignment
Findings / Results: K-L grade 4 compared to 2 was an independent risk factor for placement of the tibia component outside the coronal safe zone(OR:1.55,CI:1.05-2.29,P:0.029). Male gender was an independent risk factor for placement of the femoral component outside the coronal safe zone(OR:0.68,CI: 0.50-0.93,P:0.018). Preoperative femoral coronal alignment outside the safe zone was an independent risk factor of postoperative femoral component placement outside of the safe zone(OR: 1.65,CI:1.18-2.32,P:0.004)
Conclusions: Surgeons tend to place the tibia component outside the safe zone more often in patients with severe osteoarthritis. This could be explained by altered bone morphology and inability to make sufficient lateral resection in varus knees with medial osteoarthritis
Orthopaedics, Hvidovre Hospital; Orthopaedics, Hvidovre Hospital; Orthopaedics, Hvidovre Hospital; Orthopaedics, Hvidovre Hospital; Orthopaedics, Hvidovre Hospital
Background: Malalignment of the primary Total Knee Arthroplasty (TKA) components has been shown to be a risk factor for implants failure and inferior patient reported outcomes. We hypothesised that surgeons are reluctant to deviate from the preoperative anatomical state of the knee and therefore easily identifiable preoperative radiographic features can predict postoperative implant positioning
Purpose / Aim of Study: To investigate whether preoperative features can predict the overall alignment of the knee, tibia and femoral components
Materials and Methods: We identified 772 consecutive and unselected patients undergoing primary unilateral or bilateral total knee arthroplasty between March 2013 and December 2014. All surgeries were performed using measured resection technique. Pre- and postoperative radiological parameters as well as BMI, age, sex and implant types were registered. Standard safe zones for postoperative tibia and femoral alignment were determined. Logistic regression analysis was performed to identify independent preoperative risk factors for each postoperative misalignment
Findings / Results: K-L grade 4 compared to 2 was an independent risk factor for placement of the tibia component outside the coronal safe zone(OR:1.55,CI:1.05-2.29,P:0.029). Male gender was an independent risk factor for placement of the femoral component outside the coronal safe zone(OR:0.68,CI: 0.50-0.93,P:0.018). Preoperative femoral coronal alignment outside the safe zone was an independent risk factor of postoperative femoral component placement outside of the safe zone(OR: 1.65,CI:1.18-2.32,P:0.004)
Conclusions: Surgeons tend to place the tibia component outside the safe zone more often in patients with severe osteoarthritis. This could be explained by altered bone morphology and inability to make sufficient lateral resection in varus knees with medial osteoarthritis
Mats Bue, Mikkel Tøttrup, Pelle Hanberg, Otto Langhoff, Hanne Birke-Sørensen, Kjeld Søballe
Department of Orthopaedic Surgery, Horsens Regional Hospital; Department of Orthopaedic Surgery, Randers Regional Hospital; Orthopaedic Research Unit, Aarhus University Hospital; Department of Orthopaedic Surgery, Horsens Regional Hospital; Orthopaedic Research Unit, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital
Background: High treatment failure rates and the need for prolonged antimicrobial therapy for osteomyelitis and implant-associated infections suggest that antimicrobial bone penetration may be incomplete. Assessment of the bone pharmacokinetics of antimicrobials is challenged by a lack of validated methods.
Purpose / Aim of Study: The objective of this study was to compare and describe plasma, subcutaneous tissue and bone pharmacokinetics of vancomycin in patients.
Materials and Methods: Postoperatively, 1,000 mg of vancomycin was administered to ten male patients undergoing total knee replacement as a single dose over 100 min. Plasma, subcutaneous tissue and bone pharmacokinetics were investigated over 8 hours. Microdialysis catheters were applied for collection of samples in bone and subcutaneous tissue. Venous samples were drawn from a venous catheter. The vancomycin concentration in microdialysates was determined using ultra-high performance liquid chromatography, whilst the free plasma concentration was determined using Cobas c501.
Findings / Results: For all extravascular tissue, an impaired penetration was demonstrated. Area under the concentration- time curve (AUC) were found lower for bone and subcutaneous tissue when compared to free plasma. The lowest AUC was found in cortical bone.
Conclusions: Bone penetration of vancomycin was found to be incomplete and delayed. Future studies should further focus on validating the applicability of microdialysis for assessment of antimicrobial bone pharmacokinetics.
Department of Orthopaedic Surgery, Horsens Regional Hospital; Department of Orthopaedic Surgery, Randers Regional Hospital; Orthopaedic Research Unit, Aarhus University Hospital; Department of Orthopaedic Surgery, Horsens Regional Hospital; Orthopaedic Research Unit, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital
Background: High treatment failure rates and the need for prolonged antimicrobial therapy for osteomyelitis and implant-associated infections suggest that antimicrobial bone penetration may be incomplete. Assessment of the bone pharmacokinetics of antimicrobials is challenged by a lack of validated methods.
Purpose / Aim of Study: The objective of this study was to compare and describe plasma, subcutaneous tissue and bone pharmacokinetics of vancomycin in patients.
Materials and Methods: Postoperatively, 1,000 mg of vancomycin was administered to ten male patients undergoing total knee replacement as a single dose over 100 min. Plasma, subcutaneous tissue and bone pharmacokinetics were investigated over 8 hours. Microdialysis catheters were applied for collection of samples in bone and subcutaneous tissue. Venous samples were drawn from a venous catheter. The vancomycin concentration in microdialysates was determined using ultra-high performance liquid chromatography, whilst the free plasma concentration was determined using Cobas c501.
Findings / Results: For all extravascular tissue, an impaired penetration was demonstrated. Area under the concentration- time curve (AUC) were found lower for bone and subcutaneous tissue when compared to free plasma. The lowest AUC was found in cortical bone.
Conclusions: Bone penetration of vancomycin was found to be incomplete and delayed. Future studies should further focus on validating the applicability of microdialysis for assessment of antimicrobial bone pharmacokinetics.
Christian Asmus Peter Asmussen, Mikkel Lindegaard Attrup, Kristian Thorborg, Per Hölmich
Sports Orthopedic Research Center Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre Denmark; Sports Orthopedic Research Center Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre Denmark; Sports Orthopedic Research Center Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre Denmark; Sports Orthopedic Research Center Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre Denmark
Background: Clinical and biomechanical studies show different results regarding the stability and possible elongation of adjustable fixation devices. This has lead to growing concern over the stability of ToggleLoc with ZipLoop used in ACLR in vivo.
Purpose / Aim of Study: This study aims to compare passive anterior knee stability 1 year after anterior cruciate ligament reconstruction (ACLR) in patients where Endobutton or ToggleLoc with ZipLoop was used for graft fixation.
Materials and Methods: Data from 3175 patients was included from the Danish Knee Ligament Reconstruction Register between June 2010 and September 2013. 2807 patients were operated with Endobutton and 368 were operated with ToggleLoc with ZipLoop. Data was retrieved from standardized anterior cruciate ligament forms. Knee stability was evaluated using one of two arthrometers – Rolimeter or KT1000 – and the pivot shift test.
Findings / Results: ACLR with both fixation devices resulted in increased knee stability (p < 0.001). A significant difference in mean postoperative anterior tibial translation between Endobutton (-1.25 mm, std. dev. 1.9 mm) and ToggleLoc with ZipLoop operated patients (-0.83 mm, std. dev. 1.7 mm) was found (p < 0.001). ToggleLoc with ZipLoop operated patients were found to have a better preoperative (p < 0.001) and postoperative (p < 0.001) pivot shift test score. Despite this, the level of improvement in pivot shift test scores for both devices was similar (p = 0.188).
Conclusions: Patients operated with ToggleLoc with ZipLoop have significantly larger passive knee stability with less anterior tibial translation and better pivot shift test scores 1 year after surgery. The use of either device is not expected to produce any differences of clinical importance and, therefore, will not affect the favorability of one device over the other.
Sports Orthopedic Research Center Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre Denmark; Sports Orthopedic Research Center Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre Denmark; Sports Orthopedic Research Center Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre Denmark; Sports Orthopedic Research Center Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre Denmark
Background: Clinical and biomechanical studies show different results regarding the stability and possible elongation of adjustable fixation devices. This has lead to growing concern over the stability of ToggleLoc with ZipLoop used in ACLR in vivo.
Purpose / Aim of Study: This study aims to compare passive anterior knee stability 1 year after anterior cruciate ligament reconstruction (ACLR) in patients where Endobutton or ToggleLoc with ZipLoop was used for graft fixation.
Materials and Methods: Data from 3175 patients was included from the Danish Knee Ligament Reconstruction Register between June 2010 and September 2013. 2807 patients were operated with Endobutton and 368 were operated with ToggleLoc with ZipLoop. Data was retrieved from standardized anterior cruciate ligament forms. Knee stability was evaluated using one of two arthrometers – Rolimeter or KT1000 – and the pivot shift test.
Findings / Results: ACLR with both fixation devices resulted in increased knee stability (p < 0.001). A significant difference in mean postoperative anterior tibial translation between Endobutton (-1.25 mm, std. dev. 1.9 mm) and ToggleLoc with ZipLoop operated patients (-0.83 mm, std. dev. 1.7 mm) was found (p < 0.001). ToggleLoc with ZipLoop operated patients were found to have a better preoperative (p < 0.001) and postoperative (p < 0.001) pivot shift test score. Despite this, the level of improvement in pivot shift test scores for both devices was similar (p = 0.188).
Conclusions: Patients operated with ToggleLoc with ZipLoop have significantly larger passive knee stability with less anterior tibial translation and better pivot shift test scores 1 year after surgery. The use of either device is not expected to produce any differences of clinical importance and, therefore, will not affect the favorability of one device over the other.
Hjalte Würtz, Sükriye Corap, Julie Erichsen, Bjarke Viberg
Department of Clinical Research, University of Southern Denmark; Department of Orthopaedic Surgery and Traumatology, Hospital of South West Jutland; Department of Orthopaedic Surgery and Traumatology, Kolding Hospital; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital
Background: To date, there has been insufficient evidence to determine the best possible method of closed reduction for distal radial fractures (DRF).
Purpose / Aim of Study: To compare reduction of DRF by finger-trap traction (FTT) with manual traction (MT) in terms of radiographic outcome and pain in RCTs.
Materials and Methods: Pubmed, Embase and Cochrane databases were searched on March 1st 2016. Two authors independently screened 4348 articles by title and abstract. 14 articles were reviewed full-text. Bias was assessed by the Cochrane Risk of Bias Tool. Meta-analysis was performed for radial shortening and dorsal tilt while it was not possible for pain assessment due to different outcome measures.
Findings / Results: 3 RCTs with a total of 483 patients were included, 240 FTT and 243 MT. Risk of bias was generally unclear. None of the studies reported any statistically or clinically significant differences in radiographic outcome. Forest plot of the dorsal tilt showed 0.43[0.25;0.61, p<0.00001] in favor of MT. Radial shortening forest plot showed -0.19[-0.37;-0.01, p=0.04] in favor of FTT. One study found FTT associated with less pain, even without anesthesia, and another found FTT to be associated with a better functional outcome.
Conclusions: FTT seems to be slightly superior in restoring radial length compared to MT whereas MT seems sligthly superior in restoring dorsal tilt compared to FTT. FTT might be less painful. The studies were very heterogenic and further studies are warranted.
Department of Clinical Research, University of Southern Denmark; Department of Orthopaedic Surgery and Traumatology, Hospital of South West Jutland; Department of Orthopaedic Surgery and Traumatology, Kolding Hospital; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital
Background: To date, there has been insufficient evidence to determine the best possible method of closed reduction for distal radial fractures (DRF).
Purpose / Aim of Study: To compare reduction of DRF by finger-trap traction (FTT) with manual traction (MT) in terms of radiographic outcome and pain in RCTs.
Materials and Methods: Pubmed, Embase and Cochrane databases were searched on March 1st 2016. Two authors independently screened 4348 articles by title and abstract. 14 articles were reviewed full-text. Bias was assessed by the Cochrane Risk of Bias Tool. Meta-analysis was performed for radial shortening and dorsal tilt while it was not possible for pain assessment due to different outcome measures.
Findings / Results: 3 RCTs with a total of 483 patients were included, 240 FTT and 243 MT. Risk of bias was generally unclear. None of the studies reported any statistically or clinically significant differences in radiographic outcome. Forest plot of the dorsal tilt showed 0.43[0.25;0.61, p<0.00001] in favor of MT. Radial shortening forest plot showed -0.19[-0.37;-0.01, p=0.04] in favor of FTT. One study found FTT associated with less pain, even without anesthesia, and another found FTT to be associated with a better functional outcome.
Conclusions: FTT seems to be slightly superior in restoring radial length compared to MT whereas MT seems sligthly superior in restoring dorsal tilt compared to FTT. FTT might be less painful. The studies were very heterogenic and further studies are warranted.
Nikolaj Erin-Madsen, Ilija Ban, Morten Grove Thomsen, Jens Noergaard, Peter Toft Tengberg
Department of Orthopedic Surgery, Slagelse Sygehus; Department of Orthopedic Surgery, Hvidovre Hospital; Department of Orthopedic Surgery, Hvidovre Hospital; Department of Orthopedic Surgery, Frederiksberg Hospital; Department of Orthopedic Surgery, Hvidovre
Background: The Noergaard technique is an atraumatic reduction method that has proven successful for reduction of anterior shoulder dislocations through several years of practice in the emergency department (ED). It can be performed by experienced ED nurses giving verbal instructions to the patient.
Purpose / Aim of Study: We describe the technique and evaluate the results of the technique through a retrospective analysis of patients admitted and treated in the ED in a 1-year period.
Materials and Methods: The patient is placed standing in an upright position in front of the rail on a hospital bed. Legs should be comfortably stretched with a wide well balanced stance. The patient is then instructed to bend forwards, resting the forehead on the back of the non-affected forearm, which is put on the rail. The affected arm should now be relaxed and stretched, hanging straight down toward the floor. The patient is then instructed to attempt to relax and make pendular and circular motions with the affected arm hanging down.
Findings / Results: Our results show a successrate of 77% when using the Noergaard technique. 114 patients were diagnosed with anterior dislocation. Reduction was primarily attempted in 67 patients by the means of the Noergaard technique, 22 patients had their shoulder reduced by means of a different reduction method and in 25 patients the reduction technique was not described. Successful reduction was achieved in a total of 52 by means of the Noergaard technique. 10 patients in whom the Noergaard technique was unsuccessful the shoulder was reduced by means of a different technique in the ED and another 5 were admitted for closed shoulder reduction under general anesthesia in the operating room.
Conclusions: Based on our results and experience we recommend the use of this technique as a first line of treatment in anterior shoulder dislocations.
Department of Orthopedic Surgery, Slagelse Sygehus; Department of Orthopedic Surgery, Hvidovre Hospital; Department of Orthopedic Surgery, Hvidovre Hospital; Department of Orthopedic Surgery, Frederiksberg Hospital; Department of Orthopedic Surgery, Hvidovre
Background: The Noergaard technique is an atraumatic reduction method that has proven successful for reduction of anterior shoulder dislocations through several years of practice in the emergency department (ED). It can be performed by experienced ED nurses giving verbal instructions to the patient.
Purpose / Aim of Study: We describe the technique and evaluate the results of the technique through a retrospective analysis of patients admitted and treated in the ED in a 1-year period.
Materials and Methods: The patient is placed standing in an upright position in front of the rail on a hospital bed. Legs should be comfortably stretched with a wide well balanced stance. The patient is then instructed to bend forwards, resting the forehead on the back of the non-affected forearm, which is put on the rail. The affected arm should now be relaxed and stretched, hanging straight down toward the floor. The patient is then instructed to attempt to relax and make pendular and circular motions with the affected arm hanging down.
Findings / Results: Our results show a successrate of 77% when using the Noergaard technique. 114 patients were diagnosed with anterior dislocation. Reduction was primarily attempted in 67 patients by the means of the Noergaard technique, 22 patients had their shoulder reduced by means of a different reduction method and in 25 patients the reduction technique was not described. Successful reduction was achieved in a total of 52 by means of the Noergaard technique. 10 patients in whom the Noergaard technique was unsuccessful the shoulder was reduced by means of a different technique in the ED and another 5 were admitted for closed shoulder reduction under general anesthesia in the operating room.
Conclusions: Based on our results and experience we recommend the use of this technique as a first line of treatment in anterior shoulder dislocations.