Session 12: Best Papers
Torsdag d. 26. oktober
15:30-17:00
Lokale: Stockholm/Copenhagen/Helsinki/Oslo
Chairmen: Ole Rahbek og Klaus Hindsø
Maiken Stilling, Anders Odgaard, Claus Fink Jepsen, Kjeld Søballe, Per Wagner Kristensen, Frank Madsen
Department of Orthopaedics, Aarhus University Hospital; Department of Orthopaedics, Gentofte Hospital; Department of Orthopaedics, Aarhus University Hospital; Department of Orthopaedics, Aarhus University Hospital; Department of Orthopaedics, Vejle Hospital; Department of Orthopaedics, Aarhus University Hospital
Background: Cementless fixation of Oxford® Partial Knee Tibial Trays is gaining in pass on the market and has promising results.
Purpose / Aim of Study: To compare fixation of cementless and cemented (gold standard) Oxford® Partial Knee TT up to 5 years follow-up.
Materials and Methods: 79 patients (48 men) were randomly allocated to surgery with cementless (CL) hydroxyapatite-coated (n=25) or cemented (C) (n=54) Oxford® Partial Knee tibial trays (Biomet) in a multicenter study. Femoral components were either single-pegged or double-pegged in the cemented group and double-pegged in the cementless group. Refobacin bone cement (Biomet Inc.) was used. Evaluation of implant migration, and clinical outcomes (OKS) was performed at 6 weeks, 3 and 6 months, and 1, 2, and 5 years.
Findings / Results: CL migrated more than C at all follow-ups (p<0.01), however migration stabilized at 6 months follow-up. At 5 years CL (n=23) migrated 0.49mm (sd 0.34) and C (n=48) migrated 0.38mm (sd 0.63) mean total translation (p=0.01). 5 year subsidence was higher for CL compared to C (p=0.01). Between 2 and 5 years CL migrated 0.09mm (sd 0.10) and C migrated 0.13mm (sd 0.33) total translation (p=0.48). 16% of CL and 22% of C migrated more than 0.2mm total translation between 2 and 5 years follow-up (p=0.55). At 5 years mean OKS was 39 (range 12-48) and similar between groups (p=0.47) with comparable improvement from baseline (p=0.18). 91.6% with C and 94.1% with CL were satisfied with the result (p=0.91).
Conclusions: Cementless Oxford® Partial Knee tibial trays migrated initially but stabilized at 6 months probably due to osseointegration. Between 2 and 5 years follow-up cementless fixation was as good as cemented fixation (gold standard). Functional results were good and satisfaction high and equivalent in both groups.
Department of Orthopaedics, Aarhus University Hospital; Department of Orthopaedics, Gentofte Hospital; Department of Orthopaedics, Aarhus University Hospital; Department of Orthopaedics, Aarhus University Hospital; Department of Orthopaedics, Vejle Hospital; Department of Orthopaedics, Aarhus University Hospital
Background: Cementless fixation of Oxford® Partial Knee Tibial Trays is gaining in pass on the market and has promising results.
Purpose / Aim of Study: To compare fixation of cementless and cemented (gold standard) Oxford® Partial Knee TT up to 5 years follow-up.
Materials and Methods: 79 patients (48 men) were randomly allocated to surgery with cementless (CL) hydroxyapatite-coated (n=25) or cemented (C) (n=54) Oxford® Partial Knee tibial trays (Biomet) in a multicenter study. Femoral components were either single-pegged or double-pegged in the cemented group and double-pegged in the cementless group. Refobacin bone cement (Biomet Inc.) was used. Evaluation of implant migration, and clinical outcomes (OKS) was performed at 6 weeks, 3 and 6 months, and 1, 2, and 5 years.
Findings / Results: CL migrated more than C at all follow-ups (p<0.01), however migration stabilized at 6 months follow-up. At 5 years CL (n=23) migrated 0.49mm (sd 0.34) and C (n=48) migrated 0.38mm (sd 0.63) mean total translation (p=0.01). 5 year subsidence was higher for CL compared to C (p=0.01). Between 2 and 5 years CL migrated 0.09mm (sd 0.10) and C migrated 0.13mm (sd 0.33) total translation (p=0.48). 16% of CL and 22% of C migrated more than 0.2mm total translation between 2 and 5 years follow-up (p=0.55). At 5 years mean OKS was 39 (range 12-48) and similar between groups (p=0.47) with comparable improvement from baseline (p=0.18). 91.6% with C and 94.1% with CL were satisfied with the result (p=0.91).
Conclusions: Cementless Oxford® Partial Knee tibial trays migrated initially but stabilized at 6 months probably due to osseointegration. Between 2 and 5 years follow-up cementless fixation was as good as cemented fixation (gold standard). Functional results were good and satisfaction high and equivalent in both groups.
Ban Ilija, Kristensen Morten Tange , Barfod Kristoffer, Eschen Jacob , Kallemose Thomas , Troelsen Anders
Orthopedic Surgery, Clinical Orthopaedic Research Hvidovre, Hvidovre Hospital; Physical Therapy, Hvidovre Hospital; Orthopedic Surgery, Clinical Orthopaedic Research Hvidovre, Hvidovre Hospital; Orthopedic Surgery , Køge Hospital; Clinical Orthopaedic Research Hvidovre, Hvidovre Hospital; Orthopedic Surgery, Clinical Orthopaedic Research Hvidovre, Hvidovre Hospital
Background: Displaced, midshaft fractures represent approximately 50% of all clavicle fractures and have been the subject of an on-going debate as to what type of initial treatment is superior.
Purpose / Aim of Study: To investigate whether operative treatment (OT) compared to non-operative treatment (NOT) results in better patient-reported outcomes for displaced midshaft clavicle fractures in adults and to compare union and reoperation rates between the two groups.
Materials and Methods: A randomised controlled trial with recruitment of 120 healthy adults with an acute completely displaced midshaft fracture, at two Danish Hospitals. By randomisation, patients were allocated to either NOT (simple sling) or OT (locking plate). Follow-up was at 6 weeks, 6 and 12 months. Primary outcomes: DASH and Constant Scores. Secondary outcomes: fracture non-union rate and events leading to secondary surgical interventions.
Findings / Results: Nine were lost to follow-up. Characteristics: median age 38 years (18-63), 84% males and 69% Edinburgh type 2B1 fractures with no statistical difference between the groups. At 6 weeks DASH was better in the OT group (p < 0.001), but no between-group differences in DASH or Constant Scores were seen at 6 or 12-month follow-up (p=0.106). Secondary surgical intervention was needed in 15 (26%) patients in the NOT group compared to 14 (26%) in the OT group. The non- union rate was 14% (n=8) in the NOT group compared to 2% (n=1) in the OT group (p=0.004).
Conclusions: Short-term recovery is better, and the overall union rate is significantly higher following OT. Despite this, we found no difference in functional outcome between the groups at 6 and 12 months. None of the treatment options can claim absolute superiority, and it seems warranted that future treatment strategies involve stratified pathways instead of “all-OT” or “all- NOT” approaches.
Orthopedic Surgery, Clinical Orthopaedic Research Hvidovre, Hvidovre Hospital; Physical Therapy, Hvidovre Hospital; Orthopedic Surgery, Clinical Orthopaedic Research Hvidovre, Hvidovre Hospital; Orthopedic Surgery , Køge Hospital; Clinical Orthopaedic Research Hvidovre, Hvidovre Hospital; Orthopedic Surgery, Clinical Orthopaedic Research Hvidovre, Hvidovre Hospital
Background: Displaced, midshaft fractures represent approximately 50% of all clavicle fractures and have been the subject of an on-going debate as to what type of initial treatment is superior.
Purpose / Aim of Study: To investigate whether operative treatment (OT) compared to non-operative treatment (NOT) results in better patient-reported outcomes for displaced midshaft clavicle fractures in adults and to compare union and reoperation rates between the two groups.
Materials and Methods: A randomised controlled trial with recruitment of 120 healthy adults with an acute completely displaced midshaft fracture, at two Danish Hospitals. By randomisation, patients were allocated to either NOT (simple sling) or OT (locking plate). Follow-up was at 6 weeks, 6 and 12 months. Primary outcomes: DASH and Constant Scores. Secondary outcomes: fracture non-union rate and events leading to secondary surgical interventions.
Findings / Results: Nine were lost to follow-up. Characteristics: median age 38 years (18-63), 84% males and 69% Edinburgh type 2B1 fractures with no statistical difference between the groups. At 6 weeks DASH was better in the OT group (p < 0.001), but no between-group differences in DASH or Constant Scores were seen at 6 or 12-month follow-up (p=0.106). Secondary surgical intervention was needed in 15 (26%) patients in the NOT group compared to 14 (26%) in the OT group. The non- union rate was 14% (n=8) in the NOT group compared to 2% (n=1) in the OT group (p=0.004).
Conclusions: Short-term recovery is better, and the overall union rate is significantly higher following OT. Despite this, we found no difference in functional outcome between the groups at 6 and 12 months. None of the treatment options can claim absolute superiority, and it seems warranted that future treatment strategies involve stratified pathways instead of “all-OT” or “all- NOT” approaches.
Henriette Brink Christiansen, Pernille Bovbjerg, Jens Eggers, Jesper O. Schønnemann
Orthopaedic Clinic, Hospital of Southern Jutland; Orthopaedic Clinic, Hospital of Southern Jutland; Orthopaedic Clinic, Hospital of Southern Jutland; Orthopaedic Clinic, Hospital of Southern Jutland
Background: Malleolar fractures are often complicated by tissue swelling due to soft tissue injury, haemorrhage and secondary inflammation. This can lead to severe oedema and compromise the ability to perform surgery due to blister formation or the inability to close the skin after surgery. In this situation, the patient’s operation are typically delayed. To prevent this, studies has shown that the use of intermittent pneumatic compression (IPC) has the potential benefit of reducing oedema and tissue swelling.
Purpose / Aim of Study: The aim of this study was to investigate whether patients requiring surgery because of malleolar fractures, has a lower diagnosis-to-surgery time when using IPC, than patients without the IPC.
Materials and Methods: Patients were randomized to either in- cast IPC or only cast-immobilization. The attending orthopaedic surgeon decided when the patient was ready for surgery, and was based on objective findings. The IPC was used continuously until arrival at the OR and in both groups extremity was elevated. Based on prior data we performed a sample size calculation estimating a power of 80% (â:0,20) and a significance level of 5% (á:0,05) which estimated a total of 42 patients in each group.
Findings / Results: In the randomized cohort we included 97 patients, 57 women and 40 men with a mean age of 52 (19-83). 48 were randomized to both IPC and cast, and 49 to only cast. In the IPC and bandage group there were an average diagnosis-to-surgery time of 18 hours and in the bandage group 35 hours with a significant difference (P=0.004). We registered 3 delays due to swelling in the IPC and cast group and 13 delays due to swelling in the cast only group (P=0.007).
Conclusions: The use of in-cast intermittent pneumatic foot compression in this randomized study significantly reduced the diagnosis-to-surgery time.
Orthopaedic Clinic, Hospital of Southern Jutland; Orthopaedic Clinic, Hospital of Southern Jutland; Orthopaedic Clinic, Hospital of Southern Jutland; Orthopaedic Clinic, Hospital of Southern Jutland
Background: Malleolar fractures are often complicated by tissue swelling due to soft tissue injury, haemorrhage and secondary inflammation. This can lead to severe oedema and compromise the ability to perform surgery due to blister formation or the inability to close the skin after surgery. In this situation, the patient’s operation are typically delayed. To prevent this, studies has shown that the use of intermittent pneumatic compression (IPC) has the potential benefit of reducing oedema and tissue swelling.
Purpose / Aim of Study: The aim of this study was to investigate whether patients requiring surgery because of malleolar fractures, has a lower diagnosis-to-surgery time when using IPC, than patients without the IPC.
Materials and Methods: Patients were randomized to either in- cast IPC or only cast-immobilization. The attending orthopaedic surgeon decided when the patient was ready for surgery, and was based on objective findings. The IPC was used continuously until arrival at the OR and in both groups extremity was elevated. Based on prior data we performed a sample size calculation estimating a power of 80% (â:0,20) and a significance level of 5% (á:0,05) which estimated a total of 42 patients in each group.
Findings / Results: In the randomized cohort we included 97 patients, 57 women and 40 men with a mean age of 52 (19-83). 48 were randomized to both IPC and cast, and 49 to only cast. In the IPC and bandage group there were an average diagnosis-to-surgery time of 18 hours and in the bandage group 35 hours with a significant difference (P=0.004). We registered 3 delays due to swelling in the IPC and cast group and 13 delays due to swelling in the cast only group (P=0.007).
Conclusions: The use of in-cast intermittent pneumatic foot compression in this randomized study significantly reduced the diagnosis-to-surgery time.
Christopher Clemmesen, Troels Haxholdt Lunn, Morten Tange Kristensen, Henrik Palm, Nicolai Bang Foss
Department of Anaesthesiology, Hvidovre Hospital; Department of Anaesthesiology, Hvidovre Hospital; Departments of Physiotherapy & Orthopaedic Surgery, Hv; Department of Orthopaedic Surgery, Hvidovre ; Department of Anaesthesiology, Hvidovre Hospital
Background: Postoperative delirium is a common complication in elderly patients after hip fracture surgery. Neuroinflammation due to stress response might be a key element in the pathophysiological mechanisms to most postoperative delirium.
Purpose / Aim of Study: If prophylactic high single dose methylprednisolone could attenuate the stress response and thereby lower the severity of postoperative delirium in elderly patients after hip fracture surgery.
Materials and Methods: A randomised, double-blind, placebo-controlled trial. Patients were aged ≥ 65 years, admitted with hip fracture and able to give informed consent. They were allocated to receive either i.v. methylprednisolone (125 mg), or placebo as soon as possible after admission and confirmed hip fracture. The primary outcome was severity of postoperative delirium assessed once daily with the Confusion Assessment Method delirium severity scoring system for the first three postoperative days.
Findings / Results: 117 patients were included in modified intention-to- treat analyses of the primary outcome. There was no significant difference in median cumulated CAM-S score between the methylprednisolone group (1 [IQR 0-6]) and the placebo group (2 [IQR 0-9.5]), p= 0.294. The incidence of postoperative delirium (defined as CAM-S > 5) was significantly lower in the methylprednisolone group (10 out of 59 [16.7%]) compared with the placebo group (19 out of 58 [31.7%] odds ratio [OR] 2.39, 95%CI 1.00 to 5.72;p=0.048). The median cumulated postoperative fatigue score was significantly lower in the methylprednisolone group (5 [IQR 2-6]) compared with the placebo group (6[IQR 4-8]), p=0.008.
Conclusions: Prophylactic high-dose methylprednisolone to elderly patients with hip fracture might have a preventive effect on postoperative delirium and fatigue after surgery.
Department of Anaesthesiology, Hvidovre Hospital; Department of Anaesthesiology, Hvidovre Hospital; Departments of Physiotherapy & Orthopaedic Surgery, Hv; Department of Orthopaedic Surgery, Hvidovre ; Department of Anaesthesiology, Hvidovre Hospital
Background: Postoperative delirium is a common complication in elderly patients after hip fracture surgery. Neuroinflammation due to stress response might be a key element in the pathophysiological mechanisms to most postoperative delirium.
Purpose / Aim of Study: If prophylactic high single dose methylprednisolone could attenuate the stress response and thereby lower the severity of postoperative delirium in elderly patients after hip fracture surgery.
Materials and Methods: A randomised, double-blind, placebo-controlled trial. Patients were aged ≥ 65 years, admitted with hip fracture and able to give informed consent. They were allocated to receive either i.v. methylprednisolone (125 mg), or placebo as soon as possible after admission and confirmed hip fracture. The primary outcome was severity of postoperative delirium assessed once daily with the Confusion Assessment Method delirium severity scoring system for the first three postoperative days.
Findings / Results: 117 patients were included in modified intention-to- treat analyses of the primary outcome. There was no significant difference in median cumulated CAM-S score between the methylprednisolone group (1 [IQR 0-6]) and the placebo group (2 [IQR 0-9.5]), p= 0.294. The incidence of postoperative delirium (defined as CAM-S > 5) was significantly lower in the methylprednisolone group (10 out of 59 [16.7%]) compared with the placebo group (19 out of 58 [31.7%] odds ratio [OR] 2.39, 95%CI 1.00 to 5.72;p=0.048). The median cumulated postoperative fatigue score was significantly lower in the methylprednisolone group (5 [IQR 2-6]) compared with the placebo group (6[IQR 4-8]), p=0.008.
Conclusions: Prophylactic high-dose methylprednisolone to elderly patients with hip fracture might have a preventive effect on postoperative delirium and fatigue after surgery.
Martin Lind, Torsten Grønbech Nielsen, Peter Faunø, Ole Gade Sørensen, Bjarne Mygind-Klavsen, Kasper Sinding
Department of Orthopedics, Aarhus University Hospital; Department of Orthopedics, Aarhus University Hospital; Department of Orthopedics, Aarhus University Hospital; Department of Orthopedics, Aarhus University Hospital; Department of Orthopedics, Aarhus University Hospital; Department of Orthopedics, Aarhus University Hospital
Background: Anterior Cruciate Ligament reconstruction (ACLR) with quadricepstendon graft (QTB) has recently shown reduced donorsite morbidity compared to patellatendon graft. Hamstring graft is the most used graft type for ACLR. It is unknown if QTB graft also reduce donor site morbidity compared to hamstring graft and whether knee stability and function are similar to hamstring graft.
Purpose / Aim of Study: The purpose of this study was to compare clinical outcome including donorsite morbidity of ACLR using QTB or hamstring graft in a prospective randomized study. We hypothesized reduced donorsite morbidity for QTB grafts compared to hamstring grafts.
Materials and Methods: From 2013-15, a total of 99 patients were included in the present study. Inclusion criteria were isolated ACL injuries in adults. 50 patients were randomized to QTB grafts and 49 to hamstring grafts. Antero-posterior knee laxity measured with a KT-1000 arthrometer. Patient evaluated outcome were performed by KOOS, subjective IKDC score and Tegner function score. Donor site morbidity was evaluated by the validated ‘‘Donor-site-Related Functional Problems following ACL reconstruction score and a detailed questionnaire.
Findings / Results: Donor site symptoms were present in 30 % of patient in the QTB group and 52 % of patients in the hamstring group (p< 0.05). The donor site morbidity score was 82 and 74 for the two graft types (p< 0.05). At one- year follow-up there was no difference between the two groups regarding subjective patient outcome, knee function and objective knee laxity.
Conclusions: The use of the Quadriceps Tendon Bone graft results in less donor site morbidity than hamstring BTB grafts and has similar subjective and knee stability outcome. The QTB graft could be a better graft alternative for ACLR than hamstring grafts.
Department of Orthopedics, Aarhus University Hospital; Department of Orthopedics, Aarhus University Hospital; Department of Orthopedics, Aarhus University Hospital; Department of Orthopedics, Aarhus University Hospital; Department of Orthopedics, Aarhus University Hospital; Department of Orthopedics, Aarhus University Hospital
Background: Anterior Cruciate Ligament reconstruction (ACLR) with quadricepstendon graft (QTB) has recently shown reduced donorsite morbidity compared to patellatendon graft. Hamstring graft is the most used graft type for ACLR. It is unknown if QTB graft also reduce donor site morbidity compared to hamstring graft and whether knee stability and function are similar to hamstring graft.
Purpose / Aim of Study: The purpose of this study was to compare clinical outcome including donorsite morbidity of ACLR using QTB or hamstring graft in a prospective randomized study. We hypothesized reduced donorsite morbidity for QTB grafts compared to hamstring grafts.
Materials and Methods: From 2013-15, a total of 99 patients were included in the present study. Inclusion criteria were isolated ACL injuries in adults. 50 patients were randomized to QTB grafts and 49 to hamstring grafts. Antero-posterior knee laxity measured with a KT-1000 arthrometer. Patient evaluated outcome were performed by KOOS, subjective IKDC score and Tegner function score. Donor site morbidity was evaluated by the validated ‘‘Donor-site-Related Functional Problems following ACL reconstruction score and a detailed questionnaire.
Findings / Results: Donor site symptoms were present in 30 % of patient in the QTB group and 52 % of patients in the hamstring group (p< 0.05). The donor site morbidity score was 82 and 74 for the two graft types (p< 0.05). At one- year follow-up there was no difference between the two groups regarding subjective patient outcome, knee function and objective knee laxity.
Conclusions: The use of the Quadriceps Tendon Bone graft results in less donor site morbidity than hamstring BTB grafts and has similar subjective and knee stability outcome. The QTB graft could be a better graft alternative for ACLR than hamstring grafts.
Morten Lykke Olesen, Bjørn Borsøe Christensen, Casper Bindzus Foldager, Kris Chadwick Hede, Natasja Leth Jørgensen, Martin Lind
Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Aarhus University Hospital; Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Aarhus University Hospital; Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Aarhus University Hospital; Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Aarhus University Hospital; Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Aarhus University Hospital; Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Aarhus University Hospital
Background: Repair of chondral injuries by use of cartilage chips has recently demonstrated clinical feasibility. Autologous platelet-rich plasma (PRP), may offer promise in improving clinical outcomes as an adjunct to cartilage chips treatment.
Purpose / Aim of Study: To assess the histological quality of repair cartilage tissue after autologous cartilage chips treatment (CC) with and without repeated local injections of PRP for the treatment of full-thickness focal chondral defects of the knee.
Materials and Methods: Two full-thickness chondral defects (Ø = 6 mm) were surgically performed in the medial and lateral trochlea of each knee in six skeletally mature Göttingen minipigs. The two treatment groups were 1) CC with one weekly PRP injection for three weeks (n=12), and 2) CC alone (n=12). The animals were euthanized after six months. Samples of both whole blood and PRP were analysed with an automated hematology analyzer to determine the concentrations of platelets and nucleated cells. The composition of cartilage repair tissue was assessed using gross appearance as-sessment, histomorphometry and semi-quantitative scoring (ICRS II).
Findings / Results: The average fold increase in platelets was 6.8 ± 1.7. Leukocyte concentration decreased in PRP samples by an average fold change of 1.9 ± 0.8. Histological evaluation demonstrated no significant difference in hyalin cartilage (CC+PRP: 18.7% vs. CC: 19.6%), fibrocartilage (CC+PRP: 48.1% vs. CC: 51.8%) or fibrous tissue (CC+PRP: 22.7% vs. CC: 21.8%) between the treatment groups.
Conclusions: Four repeated local injections of leukocyte-reduced PRP after CC in the treatment of full-thickness cartilage injuries demonstrated no beneficial effects in terms of macroscopic and histological repair tissue quality.
Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Aarhus University Hospital; Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Aarhus University Hospital; Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Aarhus University Hospital; Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Aarhus University Hospital; Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Aarhus University Hospital; Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Aarhus University Hospital
Background: Repair of chondral injuries by use of cartilage chips has recently demonstrated clinical feasibility. Autologous platelet-rich plasma (PRP), may offer promise in improving clinical outcomes as an adjunct to cartilage chips treatment.
Purpose / Aim of Study: To assess the histological quality of repair cartilage tissue after autologous cartilage chips treatment (CC) with and without repeated local injections of PRP for the treatment of full-thickness focal chondral defects of the knee.
Materials and Methods: Two full-thickness chondral defects (Ø = 6 mm) were surgically performed in the medial and lateral trochlea of each knee in six skeletally mature Göttingen minipigs. The two treatment groups were 1) CC with one weekly PRP injection for three weeks (n=12), and 2) CC alone (n=12). The animals were euthanized after six months. Samples of both whole blood and PRP were analysed with an automated hematology analyzer to determine the concentrations of platelets and nucleated cells. The composition of cartilage repair tissue was assessed using gross appearance as-sessment, histomorphometry and semi-quantitative scoring (ICRS II).
Findings / Results: The average fold increase in platelets was 6.8 ± 1.7. Leukocyte concentration decreased in PRP samples by an average fold change of 1.9 ± 0.8. Histological evaluation demonstrated no significant difference in hyalin cartilage (CC+PRP: 18.7% vs. CC: 19.6%), fibrocartilage (CC+PRP: 48.1% vs. CC: 51.8%) or fibrous tissue (CC+PRP: 22.7% vs. CC: 21.8%) between the treatment groups.
Conclusions: Four repeated local injections of leukocyte-reduced PRP after CC in the treatment of full-thickness cartilage injuries demonstrated no beneficial effects in terms of macroscopic and histological repair tissue quality.
Alexander Dastrup, Anton Pottegård, Jesper Hallas, Søren Overgaard
Department of Orthopaedic Surgery, Odense University Hospital; Clinical Pharmacology and Pharmacy, University of Southern Denmark; Clinical Pharmacology and Pharmacy, University of Southern Denmark; Department of Orthopedic Surgery and Traumatology, Odense University Hospital
Background: There remain concerns that routine use of tranexamic acid (TXA) during primary total hip arthroplasty (THA) might increase the postoperative risk of cardiovascular events. We aimed to estimate the risks of primarily venous thromboembolism (VTE) and secondarily; deep vein thrombosis (DVT), pulmonary embolism (PE), myocardial infarction (MI), ischemic stroke and all-cause mortality within 30 days after surgery.
Purpose / Aim of Study: To determine the safety of perioperative tranexamic acid during primary THA in Denmark.
Materials and Methods: Using the Danish Hip Arthroplasty Register, the Danish National Patient Register and the Danish National Database of Prescriptions we included a total of 45,290 patients with primary THA from 2006 to 2013. 38,586 patients received perioperative TXA while 6704 did not. 1:2 Propensity score matching on age, gender, year of surgery, known risk factors for cardiovascular disease, the Elixhauser Comorbidity Index and income resulted in a final cohort of 6002 and 12,004 individuals, unexposed and exposed to TXA respectively. Cox regression survival analysis was used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for the validated outcomes.
Findings / Results: In the matched cohort we found no statistically significant effect on VTE (HR = 1.18; 95% CI, 0.83- 1.68), DVT (HR = 1.15; 95% CI, 0.78-1.68), PE (HR = 1.50; 95% CI, 0.60-3.78), MI (HR = 0.83; 95% CI, 0.46-1.50), ischemic stroke (HR = 0.89; 95% CI, 0.39-2.01) or all-cause mortality (HR = 0.73; 95% CI, 0.41-1.28).
Conclusions: Use of TXA is not associated with the risk of VTE, DVT, PE, MI, ischemic stroke or all-cause mortality after primary THA. Perioperative use of TXA for primary THA seems safe.
Department of Orthopaedic Surgery, Odense University Hospital; Clinical Pharmacology and Pharmacy, University of Southern Denmark; Clinical Pharmacology and Pharmacy, University of Southern Denmark; Department of Orthopedic Surgery and Traumatology, Odense University Hospital
Background: There remain concerns that routine use of tranexamic acid (TXA) during primary total hip arthroplasty (THA) might increase the postoperative risk of cardiovascular events. We aimed to estimate the risks of primarily venous thromboembolism (VTE) and secondarily; deep vein thrombosis (DVT), pulmonary embolism (PE), myocardial infarction (MI), ischemic stroke and all-cause mortality within 30 days after surgery.
Purpose / Aim of Study: To determine the safety of perioperative tranexamic acid during primary THA in Denmark.
Materials and Methods: Using the Danish Hip Arthroplasty Register, the Danish National Patient Register and the Danish National Database of Prescriptions we included a total of 45,290 patients with primary THA from 2006 to 2013. 38,586 patients received perioperative TXA while 6704 did not. 1:2 Propensity score matching on age, gender, year of surgery, known risk factors for cardiovascular disease, the Elixhauser Comorbidity Index and income resulted in a final cohort of 6002 and 12,004 individuals, unexposed and exposed to TXA respectively. Cox regression survival analysis was used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for the validated outcomes.
Findings / Results: In the matched cohort we found no statistically significant effect on VTE (HR = 1.18; 95% CI, 0.83- 1.68), DVT (HR = 1.15; 95% CI, 0.78-1.68), PE (HR = 1.50; 95% CI, 0.60-3.78), MI (HR = 0.83; 95% CI, 0.46-1.50), ischemic stroke (HR = 0.89; 95% CI, 0.39-2.01) or all-cause mortality (HR = 0.73; 95% CI, 0.41-1.28).
Conclusions: Use of TXA is not associated with the risk of VTE, DVT, PE, MI, ischemic stroke or all-cause mortality after primary THA. Perioperative use of TXA for primary THA seems safe.