Session 5: Best Posters
Onsdag den 25. oktober
11:00-12:00
Lokale: Stockholm/Copenhagen
Chairmen: Claus Varnum og Bo Sanderhoff Olsen
Anne Marie Nyholm, Henrik Palm, Thomas Kallemose, Anders Troelsen, Kirill Gromov
Ortopædkirurgisk Afdeling, Hvidovre Hospital; Ortopædkirurgisk Afdeling, Hvidovre Hospital; Forskningscenteret, Hvidovre Hospital; Ortopædkirurgisk Afdeling, Hvidovre Hospital; Ortopædkirurgisk Afdeling, Hvidovre Hospital
Background: Surgical delay (SD) in patients with hip fractures has been shown to increase mortality. However, the effect of increased SD on mortality following distal femoral fractures has been sparsely investigated.
Purpose / Aim of Study: To show if a) SD or b) educational level of surgeon (ELS) affect mortality rates for patients with a distal femoral fracture.
Materials and Methods: Patients aged ≥50 years registered in the Danish Fracture Database for undergoing surgery of a distal femoral fracture (AO33A-C), excluding pathological, open, or high-energy trauma fractures, were included. Data included age, gender, American Society of Anesthesiologists (ASA) score, type of fracture and, ELS and SD. ELS was defined as “attending or above as surgeon”, “attending or above as supervisor” or “below attending alone”. SD was defined as hours (h) from radiological diagnostics until onset of surgery. Mortality data was provided by The Civil Registration System. Mortality rates were calculated using multiple logistical regression analysis.
Findings / Results: Data on 392 surgeries were included: Mean age 76 years (range 50-101), 79% of patients were female and 65% had an extraarticular fracture (AO33A). 8% were operated within 12 h, 33% within 24 h, 67% within 48 h and 83% within 72 h. ELS was “attending or above as surgeon” in 56% of all cases and “attending or above as supervisor” in 33%. Mortality was 7.1% at day 30 and 12.5% at day 90. The logistical regression analysis did not demonstrate any association between SD or ELS and mortality following surgery for a distal femoral fracture. Increasing age, male gender and ASA score >2 significantly increased both 30-day and 90-day mortality.
Conclusions: No association between SD or ELS, and mortality was found. These findings do not support the development of guidelines for decreasing SD in this population.
Ortopædkirurgisk Afdeling, Hvidovre Hospital; Ortopædkirurgisk Afdeling, Hvidovre Hospital; Forskningscenteret, Hvidovre Hospital; Ortopædkirurgisk Afdeling, Hvidovre Hospital; Ortopædkirurgisk Afdeling, Hvidovre Hospital
Background: Surgical delay (SD) in patients with hip fractures has been shown to increase mortality. However, the effect of increased SD on mortality following distal femoral fractures has been sparsely investigated.
Purpose / Aim of Study: To show if a) SD or b) educational level of surgeon (ELS) affect mortality rates for patients with a distal femoral fracture.
Materials and Methods: Patients aged ≥50 years registered in the Danish Fracture Database for undergoing surgery of a distal femoral fracture (AO33A-C), excluding pathological, open, or high-energy trauma fractures, were included. Data included age, gender, American Society of Anesthesiologists (ASA) score, type of fracture and, ELS and SD. ELS was defined as “attending or above as surgeon”, “attending or above as supervisor” or “below attending alone”. SD was defined as hours (h) from radiological diagnostics until onset of surgery. Mortality data was provided by The Civil Registration System. Mortality rates were calculated using multiple logistical regression analysis.
Findings / Results: Data on 392 surgeries were included: Mean age 76 years (range 50-101), 79% of patients were female and 65% had an extraarticular fracture (AO33A). 8% were operated within 12 h, 33% within 24 h, 67% within 48 h and 83% within 72 h. ELS was “attending or above as surgeon” in 56% of all cases and “attending or above as supervisor” in 33%. Mortality was 7.1% at day 30 and 12.5% at day 90. The logistical regression analysis did not demonstrate any association between SD or ELS and mortality following surgery for a distal femoral fracture. Increasing age, male gender and ASA score >2 significantly increased both 30-day and 90-day mortality.
Conclusions: No association between SD or ELS, and mortality was found. These findings do not support the development of guidelines for decreasing SD in this population.
Sidsel Fruergaard, Søren Ohrt-Nissen, Benny Dahl, Martin Gehrchen
Orthopedic Department, Spine Unit, Rigshospitalet; Orthopedic Department, Spine Unit, Rigshospitalet; Orthopedic department, Texas Children's Hospital; Orthopedic Department, Spine Unit, Rigshospitalet
Background: MRI-verified neural axis abnormalities (NAA) have been described in adolescent idiopathic scoliosis (AIS) and several risk factors have been associated with the presence of NAA. The clinical significance of these findings, however, is not clear.
Purpose / Aim of Study: The purpose of the present study was to determine the prevalence of NAA in a large cohort of AIS patients and evaluate the clinical significance of previously proposed risk factors.
Materials and Methods: We prospectively included AIS patients referred to our tertiary facility for evaluation. A full-spine MRI scan was performed on all included patients irrespective of curve magnitude or proposed treatment modality. Clinical records and radiographs were retrospectively reviewed. MRI was considered pathologic if syrinx, hydromyelia, Chiari malformation, diastematomyelia, tethered cord or other abnormalities.
Findings / Results: The mean major curve angle was 39 degrees and 58 % were thoracic. NAA was observed in 32 of 381 patients (9.1%). Twenty-one patients had hydromyelia, nine patients had syringomyelia, one patient had an arachnoid cyst and one patient had Chiari Malformation. Six patients were referred to neurosurgical evaluation but none received any neurosurgical treatment. There were no statistical significant difference observed between the NAA and no-NAA groups in terms of gender, major curve size, thoracic kyphosis, curve type, curve convexity, length of curve, curve progression or level of pain (p ≥ 0.07).
Conclusions: To our knowledge, this is the largest consecutive cohort of patients with a diagnosis of AIS undergoing MRI, and we found no association between NAA and previously proposed radiographic and clinical parameters. MRI should not be implemented as a routine diagnostic tool in AIS evaluation, but may be indicated in specific subgroups of patients with AIS.
Orthopedic Department, Spine Unit, Rigshospitalet; Orthopedic Department, Spine Unit, Rigshospitalet; Orthopedic department, Texas Children's Hospital; Orthopedic Department, Spine Unit, Rigshospitalet
Background: MRI-verified neural axis abnormalities (NAA) have been described in adolescent idiopathic scoliosis (AIS) and several risk factors have been associated with the presence of NAA. The clinical significance of these findings, however, is not clear.
Purpose / Aim of Study: The purpose of the present study was to determine the prevalence of NAA in a large cohort of AIS patients and evaluate the clinical significance of previously proposed risk factors.
Materials and Methods: We prospectively included AIS patients referred to our tertiary facility for evaluation. A full-spine MRI scan was performed on all included patients irrespective of curve magnitude or proposed treatment modality. Clinical records and radiographs were retrospectively reviewed. MRI was considered pathologic if syrinx, hydromyelia, Chiari malformation, diastematomyelia, tethered cord or other abnormalities.
Findings / Results: The mean major curve angle was 39 degrees and 58 % were thoracic. NAA was observed in 32 of 381 patients (9.1%). Twenty-one patients had hydromyelia, nine patients had syringomyelia, one patient had an arachnoid cyst and one patient had Chiari Malformation. Six patients were referred to neurosurgical evaluation but none received any neurosurgical treatment. There were no statistical significant difference observed between the NAA and no-NAA groups in terms of gender, major curve size, thoracic kyphosis, curve type, curve convexity, length of curve, curve progression or level of pain (p ≥ 0.07).
Conclusions: To our knowledge, this is the largest consecutive cohort of patients with a diagnosis of AIS undergoing MRI, and we found no association between NAA and previously proposed radiographic and clinical parameters. MRI should not be implemented as a routine diagnostic tool in AIS evaluation, but may be indicated in specific subgroups of patients with AIS.
Julie Ladeby Erichsen, Carsten Jensen, Frank Damborg, Bjarke Viberg, Lonnie Froberg
Orthopaedic Surgery and Traumatology , Institution of Regional Health Research SDU/OUH/Kolding; Orthopaedic Surgery and Traumatology, Kolding Hospital and University hospital of Odense; Orthopaedic Surgery and Traumatology, Kolding Hospital; Orthopaedic Surgery and Traumatology, Institution of Regional Health Research/ Kolding Hospital; Orthopaedic Surgery, Institute of Regional Health Research SDU/University hospital of Odense
Background: The American Orthopedic Foot and Ankle Society score (AOFAS) and the “Self-reported Foot and Ankle Score” (SEFAS) are patient-reported outcome measures used to assess ankle pain and functional outcome. They have not earlyer been translated into Danish.
Purpose / Aim of Study: The aim of this study was to cross-culturally translate and adapt AOFAS-Da and SEFAS-Da into Danish and perform reliability testing.
Materials and Methods: The two questionnaires were cross-culturally translated and adapted into Danish by process guidelines including translation, synthesis, back translation, expert committee review, and pretesting. Face validity was accessed in 10 patients with ankle and foot disorders and 5 people with a medical education. 60 patients completed the two questionnaires 6 weeks post-operatively (test, T1) and again at mean 9 days after (retest, T2). Pearson ´s correlation was used to access test-retest and internal consistency was accessed with Cronbach´s Alpha. Floor and ceiling effects were considered present if > 15% of the patients achieved the worst score/floor effect or the best score/ceiling effect.
Findings / Results: Pearson´s correlation for SEFAS-Da was 0.93 (95%CI: 0.84-1.01) (n=60) and for AOFAS-Da, 0.92 (95%CI:0.83-1.02) while Cronbach´s alpha was 0.87 and 0.88 for SEFAS-Da and AOFAS-Da, respectively. No floor or ceiling effect was observed (T1: 0/48 for SEFAS and 1/60 for AOFAS. T2: 0/48 for SEFAS-Da and 1/60 for AOFAS-Da).
Conclusions: The Danish versions of AOFAS-Da and SEFAS-Da, showed strong reliability with internal consistency and test-retest reproducibility in patients with ankle related fractures.
Orthopaedic Surgery and Traumatology , Institution of Regional Health Research SDU/OUH/Kolding; Orthopaedic Surgery and Traumatology, Kolding Hospital and University hospital of Odense; Orthopaedic Surgery and Traumatology, Kolding Hospital; Orthopaedic Surgery and Traumatology, Institution of Regional Health Research/ Kolding Hospital; Orthopaedic Surgery, Institute of Regional Health Research SDU/University hospital of Odense
Background: The American Orthopedic Foot and Ankle Society score (AOFAS) and the “Self-reported Foot and Ankle Score” (SEFAS) are patient-reported outcome measures used to assess ankle pain and functional outcome. They have not earlyer been translated into Danish.
Purpose / Aim of Study: The aim of this study was to cross-culturally translate and adapt AOFAS-Da and SEFAS-Da into Danish and perform reliability testing.
Materials and Methods: The two questionnaires were cross-culturally translated and adapted into Danish by process guidelines including translation, synthesis, back translation, expert committee review, and pretesting. Face validity was accessed in 10 patients with ankle and foot disorders and 5 people with a medical education. 60 patients completed the two questionnaires 6 weeks post-operatively (test, T1) and again at mean 9 days after (retest, T2). Pearson ´s correlation was used to access test-retest and internal consistency was accessed with Cronbach´s Alpha. Floor and ceiling effects were considered present if > 15% of the patients achieved the worst score/floor effect or the best score/ceiling effect.
Findings / Results: Pearson´s correlation for SEFAS-Da was 0.93 (95%CI: 0.84-1.01) (n=60) and for AOFAS-Da, 0.92 (95%CI:0.83-1.02) while Cronbach´s alpha was 0.87 and 0.88 for SEFAS-Da and AOFAS-Da, respectively. No floor or ceiling effect was observed (T1: 0/48 for SEFAS and 1/60 for AOFAS. T2: 0/48 for SEFAS-Da and 1/60 for AOFAS-Da).
Conclusions: The Danish versions of AOFAS-Da and SEFAS-Da, showed strong reliability with internal consistency and test-retest reproducibility in patients with ankle related fractures.
Mads Holm Møller, Pernille Henszelman Jørsboe, Michael Stage Pedersen, Mostafa Benyahia, Thomas Kallemose, Jeannette Østergaard Penny
Ortopædkirurgisk afdeling, Hvidovre Hospital; Ortopædkirurgisk afdeling, Hvidovre Hospital; , Aleris Hamlet Hospital; Ortopædkirurgisk afdeling, Hvidovre Hospital; Clinical Orthopaedic Research Hvidovre, Hvidovre Hospital; Ortopædkirurgisk afdeling, Hvidovre Hospital
Background: Hallux rigidus treated with HemiCap arthroplasty aims to reduce pain and preserve motion, but no mid/long term results exist.
Purpose / Aim of Study: To examine the functionality, pain and the revision rate of HemiCap implants.
Materials and Methods: 106 patients were operated with HemiCap (n=114) from 2006-2014, median age 53 years (16-80), 37 dorsal flange (DF) implants. A retrospective journal review collected revision data. Preoperative arthrosis degree, hallux valgus (HV), intermetatarsal (IM) and Distal Metaphyseal Articular Angle (DMAA) were measured. Preoperative pain levels by Visuel Analog Skala (VAS 1-10), American Orthopaedic Foot and Ankle Score (AOFAS 0-100 points) and Range of Motion (ROM) were available for 51 patients. Of the initial 106, 70 were eligible for reexamination and 47 partook in a cross sectional follow up where Self-Reported Foot and Ankle Score (SEFAS 0-48 points) was added to the previous measures. Statistics: Kaplan-Meier survival analysis, Cox-regression and paired t-tests.
Findings / Results: At 3, 5 and 7 years, the implant survival was 85%, 83% and 78%. All revised due to pain. DF, gender, preoperative arthrosis degree, HV, IM or DMAA did not influence the result. At mean 5 year follow up (n=47) mean (sd) dorsal ROM was 46(17) degrees, AOFAS was 84(9), VAS 2(1) and SEFAS 42(6) points. The DF made no significant difference for ROM or PROMs. 23 with pre- op data were re-examined and preoperative dorsal ROM changed from 21(6) to 42(18) degrees, VAS from 7(2) to 2(2) and AOFAS from 61(11) to 87(11) (p < 0.001).
Conclusions: The survival rate was acceptable. No predictors influenced implant failure and new design with dorsal flange is not evident clinically. Un-revised patients have significantly less pain, greater ROM, and better foot and ankle function than preoperatively, but data are biased by missing numbers.
Ortopædkirurgisk afdeling, Hvidovre Hospital; Ortopædkirurgisk afdeling, Hvidovre Hospital; , Aleris Hamlet Hospital; Ortopædkirurgisk afdeling, Hvidovre Hospital; Clinical Orthopaedic Research Hvidovre, Hvidovre Hospital; Ortopædkirurgisk afdeling, Hvidovre Hospital
Background: Hallux rigidus treated with HemiCap arthroplasty aims to reduce pain and preserve motion, but no mid/long term results exist.
Purpose / Aim of Study: To examine the functionality, pain and the revision rate of HemiCap implants.
Materials and Methods: 106 patients were operated with HemiCap (n=114) from 2006-2014, median age 53 years (16-80), 37 dorsal flange (DF) implants. A retrospective journal review collected revision data. Preoperative arthrosis degree, hallux valgus (HV), intermetatarsal (IM) and Distal Metaphyseal Articular Angle (DMAA) were measured. Preoperative pain levels by Visuel Analog Skala (VAS 1-10), American Orthopaedic Foot and Ankle Score (AOFAS 0-100 points) and Range of Motion (ROM) were available for 51 patients. Of the initial 106, 70 were eligible for reexamination and 47 partook in a cross sectional follow up where Self-Reported Foot and Ankle Score (SEFAS 0-48 points) was added to the previous measures. Statistics: Kaplan-Meier survival analysis, Cox-regression and paired t-tests.
Findings / Results: At 3, 5 and 7 years, the implant survival was 85%, 83% and 78%. All revised due to pain. DF, gender, preoperative arthrosis degree, HV, IM or DMAA did not influence the result. At mean 5 year follow up (n=47) mean (sd) dorsal ROM was 46(17) degrees, AOFAS was 84(9), VAS 2(1) and SEFAS 42(6) points. The DF made no significant difference for ROM or PROMs. 23 with pre- op data were re-examined and preoperative dorsal ROM changed from 21(6) to 42(18) degrees, VAS from 7(2) to 2(2) and AOFAS from 61(11) to 87(11) (p < 0.001).
Conclusions: The survival rate was acceptable. No predictors influenced implant failure and new design with dorsal flange is not evident clinically. Un-revised patients have significantly less pain, greater ROM, and better foot and ankle function than preoperatively, but data are biased by missing numbers.
Oliver Zielinski, Rune Bech, Martin Gehrchen, Benny Dahl
HovedOrtoCenteret, Rigshospitalet; HovedOrtoCenteret, Rigshospitalet; HovedOrtoCenteret, Rigshospitalet; Division of Orthopedics, Texas Children's Hospital
Background: The epidemiology of spinal injuries is largely unknown. Most studies have focused on specific subpopulations of patients, specific trauma mechanisms, or specific spinal levels, and as such have not provided a complete overview of spinal injury epidemiology. Consequently, a comprehensive description of spinal injuries is of relevance.
Purpose / Aim of Study: Our study aimed to evaluate the epidemiology of spinal injuries in a general population. Specifically, we wanted to assess any difference in injury pattern amongst young and elderly patients.
Materials and Methods: All patients referred for a spinal injury to the Spine Unit at Rigshospitalet during a 4-month period, were prospectively registered regarding age, gender, trauma mechanism, and treatment. Younger patients were defined as patients ≤65 years of age.
Findings / Results: A total of 132 patients were registered during the study period corresponding to an annual incidence of 21.9/100,000. The ratio of male to female patients was 1:1.3, and 60% of patients were >65 years of age. 61% of injuries were the result of low-energy (LE) trauma, and significantly more female patients and patients >65 years of age sustained LE trauma (P<0.001). 25% of patients ≤65 years of age were treated surgically compared to 11% of patients >65 years of age. This difference, however, was not significant.
Conclusions: The incidence of elderly patients sustaining spinal injuries as a result of LE trauma, represent a group of considerable size in relation to total spinal injuries sustained in a general population, and one that is much larger than previously published. Further effort will be made to quantify the exact nature of this patient group, and the burden it represents compared to younger patients sustaining high- energy trauma.
HovedOrtoCenteret, Rigshospitalet; HovedOrtoCenteret, Rigshospitalet; HovedOrtoCenteret, Rigshospitalet; Division of Orthopedics, Texas Children's Hospital
Background: The epidemiology of spinal injuries is largely unknown. Most studies have focused on specific subpopulations of patients, specific trauma mechanisms, or specific spinal levels, and as such have not provided a complete overview of spinal injury epidemiology. Consequently, a comprehensive description of spinal injuries is of relevance.
Purpose / Aim of Study: Our study aimed to evaluate the epidemiology of spinal injuries in a general population. Specifically, we wanted to assess any difference in injury pattern amongst young and elderly patients.
Materials and Methods: All patients referred for a spinal injury to the Spine Unit at Rigshospitalet during a 4-month period, were prospectively registered regarding age, gender, trauma mechanism, and treatment. Younger patients were defined as patients ≤65 years of age.
Findings / Results: A total of 132 patients were registered during the study period corresponding to an annual incidence of 21.9/100,000. The ratio of male to female patients was 1:1.3, and 60% of patients were >65 years of age. 61% of injuries were the result of low-energy (LE) trauma, and significantly more female patients and patients >65 years of age sustained LE trauma (P<0.001). 25% of patients ≤65 years of age were treated surgically compared to 11% of patients >65 years of age. This difference, however, was not significant.
Conclusions: The incidence of elderly patients sustaining spinal injuries as a result of LE trauma, represent a group of considerable size in relation to total spinal injuries sustained in a general population, and one that is much larger than previously published. Further effort will be made to quantify the exact nature of this patient group, and the burden it represents compared to younger patients sustaining high- energy trauma.
Nicolai Sandau, Stig Brorson, Bo S. Olsen, Anne Kathrine Sørensen, Steen L. Jensen, Kim Schantz, Janne Ovesen, Jeppe V. Rasmussen
Dept. of Orthopedic Surgery, Herlev & Gentofte Hospital; Dept. of Orthopedic Surgery, Herlev & Gentofte Hospital; Dept. of Orthopedic Surgery, Herlev & Gentofte Hospital; Dept. of Orthopedic Surgery, Herlev & Gentofte Hospital; Dept. of Orthopedic Surgery, Aalborg Hospital; Dept. of Orthopedic Surgery, Køge Hospital; Dept. of Orthopedic Surgery, Aarhus Hospital; Dept. of Orthopedic Surgery, Herlev & Gentofte Hospital
Background: Visual evaluation of post-implant radiographs is often used to assess the restoration of glenohumeral joint anatomy after shoulder replacement surgery and is a part of the decision-making process, when evaluating patients with inferior clinical results. However, information about the reliability of such a visual evaluation is lacking.
Purpose / Aim of Study: The aim of this study was to investigate the inter- and intra-observer agreement among experienced shoulder surgeons assessing overstuffing, implant positioning and sizing following resurfacing hemiarthroplasty (RHA) using plain standardized radiographs.
Materials and Methods: Six experienced shoulder surgeons independently classified implant inclination angle, sizing of the implant and if the joint seemed overstuffed, in 219 cases of post- implant radiographs. All cases were classified twice three weeks apart. Only radiographs with an anterior-posterior projection with a freely visible joint space were used. Non-weighted Cohen's kappa values were calculated for each coder pair and the mean used as an estimate of the overall inter-observer agreement.
Findings / Results: The overall inter-observer agreement for implant sizing (kappa: 0.48 and 0.41) and inclination angle was moderate in both rounds (kappa: 0.46 and 0.44), but only fair agreement was found concerning the evaluation for stuffing of the joint (kappa: 0.24 and 0.28). Intra-observer agreement for implant size and stuffing ranged from fair to substantial while the agreement for inclination was moderate to substantial.
Conclusions: We advise caution using conclusions based on this method in the decision-making process regarding revision surgery and for using the term overstuffing as an explanation for poor functional outcome.
Dept. of Orthopedic Surgery, Herlev & Gentofte Hospital; Dept. of Orthopedic Surgery, Herlev & Gentofte Hospital; Dept. of Orthopedic Surgery, Herlev & Gentofte Hospital; Dept. of Orthopedic Surgery, Herlev & Gentofte Hospital; Dept. of Orthopedic Surgery, Aalborg Hospital; Dept. of Orthopedic Surgery, Køge Hospital; Dept. of Orthopedic Surgery, Aarhus Hospital; Dept. of Orthopedic Surgery, Herlev & Gentofte Hospital
Background: Visual evaluation of post-implant radiographs is often used to assess the restoration of glenohumeral joint anatomy after shoulder replacement surgery and is a part of the decision-making process, when evaluating patients with inferior clinical results. However, information about the reliability of such a visual evaluation is lacking.
Purpose / Aim of Study: The aim of this study was to investigate the inter- and intra-observer agreement among experienced shoulder surgeons assessing overstuffing, implant positioning and sizing following resurfacing hemiarthroplasty (RHA) using plain standardized radiographs.
Materials and Methods: Six experienced shoulder surgeons independently classified implant inclination angle, sizing of the implant and if the joint seemed overstuffed, in 219 cases of post- implant radiographs. All cases were classified twice three weeks apart. Only radiographs with an anterior-posterior projection with a freely visible joint space were used. Non-weighted Cohen's kappa values were calculated for each coder pair and the mean used as an estimate of the overall inter-observer agreement.
Findings / Results: The overall inter-observer agreement for implant sizing (kappa: 0.48 and 0.41) and inclination angle was moderate in both rounds (kappa: 0.46 and 0.44), but only fair agreement was found concerning the evaluation for stuffing of the joint (kappa: 0.24 and 0.28). Intra-observer agreement for implant size and stuffing ranged from fair to substantial while the agreement for inclination was moderate to substantial.
Conclusions: We advise caution using conclusions based on this method in the decision-making process regarding revision surgery and for using the term overstuffing as an explanation for poor functional outcome.
Amin Bakhtyar Baram, Mette Ammitzbøll, Bo Sanderhoff Olsen, Stig Brorson, Jeppe Vejlgaard Rasmussen
Orthopedic department, Herlev og Gentofte Hospital; Orthopedic department, Herlev og Gentofte Hospital; Orthopedic department, Herlev og Gentofte Hospital; Orthopedic department, Herlev og Gentofte Hospital; Orthopedic department, Herlev og Gentofte Hospital
Background: Reverse shoulder arthroplasty (RSA) is gaining increasingly popular. When used for cuff tear arthropathy the results are superior to that of hemiarthroplasty . Previous studies are, however, small and information about revision rates is limited
Purpose / Aim of Study: The aim of this study is to examine the patient- reported outcome and the risk of revision of RSA for CTA on a national level using data from the Danish Shoulder Arthroplasty Registry (DSR).
Materials and Methods: We reviewed all patients treated with RSA for CTA reported to the DSR from 2006 until 2012. Patient- reported outcome was assessed by a postal survey 12 months (10 to 14) post-operatively using the WOOS score. Revision rates were illustrated using the Kaplan Meier method and the hazard ratio was calculated using the cox regression model.
Findings / Results: The cumulative rate of revision within five years was 11,7%. The hazard ratio for men being revised was 3.6 (95% CI 1,9-7,0; p = <0,01). Common indications for revision were infection (2,2%) and luxation (2,6%). A complete questionnaire was returned by 372 patients (74%). The mean WOOS was 68. 14% had a WOOS score below 40 which is regarded as a clinical failure by the registry. There was no significant or clinical relevant difference in the mean WOOS between age groups (<65/>65 years) or gender. The Delta Mark III was a significant risk of clinical failure. Mean WOOS peaked to a maximum of 73 in 2010, but then decreased to 68 in 2012.
Conclusions: The incidence of RSA for CTA increased in the study period. The mean WOOS was acceptable, but has decreased in the most recent years. The high number of revisions in general and the high numbers of revision because of infection in particular are worrying It is important that RSA is used for the correct indications and with adequate surgical technique.
Orthopedic department, Herlev og Gentofte Hospital; Orthopedic department, Herlev og Gentofte Hospital; Orthopedic department, Herlev og Gentofte Hospital; Orthopedic department, Herlev og Gentofte Hospital; Orthopedic department, Herlev og Gentofte Hospital
Background: Reverse shoulder arthroplasty (RSA) is gaining increasingly popular. When used for cuff tear arthropathy the results are superior to that of hemiarthroplasty . Previous studies are, however, small and information about revision rates is limited
Purpose / Aim of Study: The aim of this study is to examine the patient- reported outcome and the risk of revision of RSA for CTA on a national level using data from the Danish Shoulder Arthroplasty Registry (DSR).
Materials and Methods: We reviewed all patients treated with RSA for CTA reported to the DSR from 2006 until 2012. Patient- reported outcome was assessed by a postal survey 12 months (10 to 14) post-operatively using the WOOS score. Revision rates were illustrated using the Kaplan Meier method and the hazard ratio was calculated using the cox regression model.
Findings / Results: The cumulative rate of revision within five years was 11,7%. The hazard ratio for men being revised was 3.6 (95% CI 1,9-7,0; p = <0,01). Common indications for revision were infection (2,2%) and luxation (2,6%). A complete questionnaire was returned by 372 patients (74%). The mean WOOS was 68. 14% had a WOOS score below 40 which is regarded as a clinical failure by the registry. There was no significant or clinical relevant difference in the mean WOOS between age groups (<65/>65 years) or gender. The Delta Mark III was a significant risk of clinical failure. Mean WOOS peaked to a maximum of 73 in 2010, but then decreased to 68 in 2012.
Conclusions: The incidence of RSA for CTA increased in the study period. The mean WOOS was acceptable, but has decreased in the most recent years. The high number of revisions in general and the high numbers of revision because of infection in particular are worrying It is important that RSA is used for the correct indications and with adequate surgical technique.
Frederik Taylor Pitter, Martin Lindberg-Larsen, Alma Pedersen, Benny Dahl, Martin Gehrchen
Rygsektionen, ortopædkirurgisk afdeling, Rigshospitalet; Ortopædkirurgisk afdeling, Odense Universitetshospital; Klinisk Epidemiologisk Afdeling, Århus Universitetshospital; Rygsektionen, ortopædkirurgisk afdeling, Rigshospitalet; Rygsektionen, ortopædkirurgisk afdeling, Rigshospitalet
Background: Adult spinal deformity (ASD) includes deformities in both the coronal and sagittal plane, with potential severe impact on health related quality of life. With increasing health care burden of ASD surgery, data on postoperative morbidity and mortality are highly relevant
Purpose / Aim of Study: To provide detailed information on postoperative morbidity measured by length of stay (LOS), readmissions and mortality within 90 days after instrumented surgery for ASD
Materials and Methods: A 10-year cohort study on all patients >18 years undergoing surgery for ASD in the Capital Region of Denmark. Patients were identified in the Danish National Patient Registry (DNPR) using procedure codes for instrumented spine surgery (KNAG/KNAK/KNAT*) and diagnosis of either kyphosis/lordosis or scoliosis (DM40, DM41, DM45*). Medical records were reviewed for all patients
Findings / Results: 366 patients were identified, with a mean age of 48.5 years (range 18 – 83) and a median LOS of 8 days (Interquartile range 6 – 11). LOS >11 days was observed in 104 procedures (28.4%) and was mainly caused by “medically” related issues (68.3%), including pain/mobilization difficulties. The 90-days readmission rate was 18.0 %. 68.2% readmissions were “medically” related due to opioid related side effects (18.2%) and pain/mobilization issues (15.2%). 31.8% of readmissions were “surgically” related and 16.7% required revision surgery. 90-days mortality was 0.8%, 2 patients died from cardiac arrest and 1 from surgical trauma
Conclusions: A median LOS of 8 days and a 90-day readmission rate of 18.0% indicate room for improvement regarding postoperative morbidity. A future focus on implementation of fast-track principles with early mobilization and opioid sparing analgesia may reduce LOS and postoperative morbidity as shown in hip and knee arthroplasty surgery
Rygsektionen, ortopædkirurgisk afdeling, Rigshospitalet; Ortopædkirurgisk afdeling, Odense Universitetshospital; Klinisk Epidemiologisk Afdeling, Århus Universitetshospital; Rygsektionen, ortopædkirurgisk afdeling, Rigshospitalet; Rygsektionen, ortopædkirurgisk afdeling, Rigshospitalet
Background: Adult spinal deformity (ASD) includes deformities in both the coronal and sagittal plane, with potential severe impact on health related quality of life. With increasing health care burden of ASD surgery, data on postoperative morbidity and mortality are highly relevant
Purpose / Aim of Study: To provide detailed information on postoperative morbidity measured by length of stay (LOS), readmissions and mortality within 90 days after instrumented surgery for ASD
Materials and Methods: A 10-year cohort study on all patients >18 years undergoing surgery for ASD in the Capital Region of Denmark. Patients were identified in the Danish National Patient Registry (DNPR) using procedure codes for instrumented spine surgery (KNAG/KNAK/KNAT*) and diagnosis of either kyphosis/lordosis or scoliosis (DM40, DM41, DM45*). Medical records were reviewed for all patients
Findings / Results: 366 patients were identified, with a mean age of 48.5 years (range 18 – 83) and a median LOS of 8 days (Interquartile range 6 – 11). LOS >11 days was observed in 104 procedures (28.4%) and was mainly caused by “medically” related issues (68.3%), including pain/mobilization difficulties. The 90-days readmission rate was 18.0 %. 68.2% readmissions were “medically” related due to opioid related side effects (18.2%) and pain/mobilization issues (15.2%). 31.8% of readmissions were “surgically” related and 16.7% required revision surgery. 90-days mortality was 0.8%, 2 patients died from cardiac arrest and 1 from surgical trauma
Conclusions: A median LOS of 8 days and a 90-day readmission rate of 18.0% indicate room for improvement regarding postoperative morbidity. A future focus on implementation of fast-track principles with early mobilization and opioid sparing analgesia may reduce LOS and postoperative morbidity as shown in hip and knee arthroplasty surgery
Helle Mätzke Rasmussen, Joachim Svensson, Maria Thorning, Niels Wisbech Pedersen, Søren Overgaard, Anders Holsgaard-Larsen
The Orthopedic Research Unit, 1) Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Denmark 2) Department of Clinical Research, University of Southern Denmark, Odense, Denmark; The Orthopedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; The Orthopedic Research Unit, Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Denmark ; The Orthopedic Research Unit, 1) Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Denmark 2) Department of Clinical Research, University of Southern Denmark, Odense, Denmark; The Orthopedic Research Unit, 1) Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Denmark 2) Department of Clinical Research, University of Southern Denmark, Odense, Denmark; The Orthopedic Research Unit, 1) Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Denmark 2) Department of Clinical Research, University of Southern Denmark, Odense, Denmark
Background: The Cerebral Palsy follow Up Program (CPOP) uses cut-off points (traffic light signals) to categorize passive range of motion (ROM) in: green, yellow and red in order to guide clinical decisions. The cut-off points are not evidence based and potential relationship with gross motor capacity and patient-reported gross motor function has never been established.
Purpose / Aim of Study: To investigate ROM and the traffic light categories for ankle dorsiflexion and their relationship with gross motor function in children with cerebral palsy (CP).
Materials and Methods: We conducted a cross-sectional study of 60 children with spastic CP at GMFCS level I-II, aged 5-9 years. ROM were measured as maximal ankle dorsiflexion with flexed and extended knee using goniometry and the categories applied using the cut-off points provided by CPOP. Furthermore 1-min walking distance (1-min walk), Gross Motor Function Measure (GMFM) and Pediatric Quality of Life Inventory Cerebral Palsy Module: movement and balance subscale (Pedsql) where collected. Correlations where investigated with Pearson correlation coefficients. Differences in the three groups based on the traffic light categories were investigated with one-way ANOVA.
Findings / Results: No significant correlation (r2 < 0.2, p>0.05) where documented between ROM versus 1-min walk, GMFM and Pedsql. Furthermore, the group mean values of the outcome measures in the traffic light categories did not differ.
Conclusions: Ankle dorsiflexion are not correlated with gross motor function, why the cut-off points used in CPOP are of limited clinical value in relation to gross motor capacity and patient-reported impairments in relation to movement and balance. As a consequence ROM and gross motor function may be considered as separate constructs, which may have impact on the decision-making of treatment for the patient group.
The Orthopedic Research Unit, 1) Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Denmark 2) Department of Clinical Research, University of Southern Denmark, Odense, Denmark; The Orthopedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; The Orthopedic Research Unit, Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Denmark ; The Orthopedic Research Unit, 1) Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Denmark 2) Department of Clinical Research, University of Southern Denmark, Odense, Denmark; The Orthopedic Research Unit, 1) Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Denmark 2) Department of Clinical Research, University of Southern Denmark, Odense, Denmark; The Orthopedic Research Unit, 1) Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Denmark 2) Department of Clinical Research, University of Southern Denmark, Odense, Denmark
Background: The Cerebral Palsy follow Up Program (CPOP) uses cut-off points (traffic light signals) to categorize passive range of motion (ROM) in: green, yellow and red in order to guide clinical decisions. The cut-off points are not evidence based and potential relationship with gross motor capacity and patient-reported gross motor function has never been established.
Purpose / Aim of Study: To investigate ROM and the traffic light categories for ankle dorsiflexion and their relationship with gross motor function in children with cerebral palsy (CP).
Materials and Methods: We conducted a cross-sectional study of 60 children with spastic CP at GMFCS level I-II, aged 5-9 years. ROM were measured as maximal ankle dorsiflexion with flexed and extended knee using goniometry and the categories applied using the cut-off points provided by CPOP. Furthermore 1-min walking distance (1-min walk), Gross Motor Function Measure (GMFM) and Pediatric Quality of Life Inventory Cerebral Palsy Module: movement and balance subscale (Pedsql) where collected. Correlations where investigated with Pearson correlation coefficients. Differences in the three groups based on the traffic light categories were investigated with one-way ANOVA.
Findings / Results: No significant correlation (r2 < 0.2, p>0.05) where documented between ROM versus 1-min walk, GMFM and Pedsql. Furthermore, the group mean values of the outcome measures in the traffic light categories did not differ.
Conclusions: Ankle dorsiflexion are not correlated with gross motor function, why the cut-off points used in CPOP are of limited clinical value in relation to gross motor capacity and patient-reported impairments in relation to movement and balance. As a consequence ROM and gross motor function may be considered as separate constructs, which may have impact on the decision-making of treatment for the patient group.
Simon Toftgaard Skov, Sebastiaan P.J. Wijdicks, Cody Bünger , René M. Castelein , Haisheng Li, Moyo C. Kruyt
Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, University Medical Clinic Utrecht, The Netherlands; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, University Medical Clinic Utrecht, The Netherlands; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, University Medical Clinic Utrecht, The Netherlands
Background: The magnetic controlled growing rod (MCGR) application in severe early onset scoliosis has increased over the last years worldwide, as they allow non-invasive lengthening. Disadvantages of the MCGR are the high initial costs and lack of apical control. To overcome these, we combined a single concave MCGR with a contralateral sliding rod system with apical control.
Purpose / Aim of Study: To investigate the feasibility, 3D correction, spinal growth and complications of this new MCGR-hybrid principle.
Materials and Methods: A consecutive series of patients treated with this new principle at two European spine centers were evaluated retrospectively, including all patients operated between Sept. 2014 and June 2016. Demographics and clinical parameters were recorded from patient files. Length, Cobb angles and rotation (Nash-Moe method), were measured on standard digital radiographs.
Findings / Results: Eighteen patients with a median age at treatment of 9 years with a median follow-up time of 24 months (range 11- 31). The frontal Cobb angle was reduced from mean 59 preoperative to 30 post- operatively and was maintained throughout follow-up. Rotation of the apical vertebra improved from mean 27 to 18 post-operatively but increased slightly to 20 during follow-up. Kyphosis decreased and lordosis was largely unaltered. Instrumented spine growth was maintained at a mean 12mm/year. One child had surgical revision due to progressive trunk shift. The same child fell and acquired T1 & T2 fractures that were treated conservatively. Another child is planned for revision due to MCGR distraction failure.
Conclusions: These early results show satisfactory 3D correction and maintained spinal growth with few complications. This new apical control single growth engine approach seems cost-effective in providing 3D correction and to maintain spinal growth in EOS.
Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, University Medical Clinic Utrecht, The Netherlands; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, University Medical Clinic Utrecht, The Netherlands; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, University Medical Clinic Utrecht, The Netherlands
Background: The magnetic controlled growing rod (MCGR) application in severe early onset scoliosis has increased over the last years worldwide, as they allow non-invasive lengthening. Disadvantages of the MCGR are the high initial costs and lack of apical control. To overcome these, we combined a single concave MCGR with a contralateral sliding rod system with apical control.
Purpose / Aim of Study: To investigate the feasibility, 3D correction, spinal growth and complications of this new MCGR-hybrid principle.
Materials and Methods: A consecutive series of patients treated with this new principle at two European spine centers were evaluated retrospectively, including all patients operated between Sept. 2014 and June 2016. Demographics and clinical parameters were recorded from patient files. Length, Cobb angles and rotation (Nash-Moe method), were measured on standard digital radiographs.
Findings / Results: Eighteen patients with a median age at treatment of 9 years with a median follow-up time of 24 months (range 11- 31). The frontal Cobb angle was reduced from mean 59 preoperative to 30 post- operatively and was maintained throughout follow-up. Rotation of the apical vertebra improved from mean 27 to 18 post-operatively but increased slightly to 20 during follow-up. Kyphosis decreased and lordosis was largely unaltered. Instrumented spine growth was maintained at a mean 12mm/year. One child had surgical revision due to progressive trunk shift. The same child fell and acquired T1 & T2 fractures that were treated conservatively. Another child is planned for revision due to MCGR distraction failure.
Conclusions: These early results show satisfactory 3D correction and maintained spinal growth with few complications. This new apical control single growth engine approach seems cost-effective in providing 3D correction and to maintain spinal growth in EOS.