Session 8: YODA Best Papers

Torsdag d. 26. oktober
09:30-10:30
Lokale: Stockholm/Copenhagen/Helsinki/Oslo
Chairmen: Jakob Klit og Søren Ohrt-Nissen

62. A Systematic Review and Meta-analysis of treatment of Ankle Fractures with Syndesmotic Rupture; Suture- Button Fixation vs. Cortical Screw Fixation
Alexandra Claire McKenzie, Kristian Eskild Hesselholt,
Orthopedic surgery, Odense University Hospital; Orthopedic surgery, Odense University Hospital; ,


Background: Ankle fractures accompanied by syndesmotic rupture are a complex challenge for orthopedic surgeons. Sufficient reduction and stabilization of the syndesmosis is important to prevent early degeneration of the ankle joint and to optimize clinical outcomes.
Purpose / Aim of Study: To systematically review the literature comparing the suture-button fixation method to the cortical screw fixation method when treating syndesmotic rupture.
Materials and Methods: A systematic review of the literature including Cochrane, Pubmed and Embase was performed. Following search terms were used: ankle fractures, syndesmosis rupture, tibiofibular syndesmosis injury, ankle joint, tightrope and suture button. Inclusion criteria were comparison studies, acute ankle fractures with syndesmotic rupture, adult patients and Coleman score >60. Cadaveric studies, chronic instability, open fractures, polytraumas and arthropathies were excluded. Two investigators independently reviewed titles and relevant abstracts. Reoperation and malreduction rate were compared in a meta- analysis.
Findings / Results: Six studies with 275 patients were included: Two RCT’s, two prospective and two retrospective cohort studies. All studies used similar surgical techniques. Functional outcomes (AOFAS & OM) were not quantitative comparable. No significant less number of malreduction events were detected in the suture- button group (RR=0.19, (95% CI, 0.03;1.04) P=0.06). Significant lower reoperation rate was detected in the suture-button group (RR=0.21, (95% CI, 0.06;0.69) P=0.01).
Conclusions: The suture-button technique showed significant lower reoperation rate and tendency towards less malreduction and better AOFAS scores. This finding is clinical relevant, however, this conclusion is primarily based on two studies, and therefore, the issue demands further research.

63. Increased risk of revision in total knee arthroplasties following high tibial osteotomy is explained by patient demographics
Anders El-Galaly, Poul Torben Nielsen, Steen Lund Jensen, Andreas Kappel
Department of Orthopaedics Surgery, Aalborg University Hospital; Department of Orthopaedics Surgery, Aalborg University Hospital; Department of Orthopaedics Surgery, Aalborg University Hospital; Department of Orthopaedics Surgery, Aalborg University Hospital


Background: High tibial osteotomy (HTO) is used to treat primary osteoarthritis (OA) of the medial or lateral knee chamber in young active patients. The aim is to relief pain while preserving the knee joint thus postponing the need for arthroplasty. However, the influence of HTO on the survival of a subsequent total knee arthroplasty (TKA) is still debated.
Purpose / Aim of Study: We conducted this nation-wide registry study to evaluate the influence of HTO on the survival of TKA.
Materials and Methods: From the Danish Knee Arthroplasty Registry, we retrieved 1,049 TKA inserted from the 1st of January 1997 till the 31st of December 2015 in knees previously treated with HTO. We compared these with 63,954 de novo TKA without prior surgery. We analyzed demographics and calculated the estimated survival by Kaplan-Meier analyses and multi-variate Cox regression covering prior HTO, sex and age. In addition, we compared the indications of revision between the groups.
Findings / Results: The proportion of males were significantly higher in the prior-HTO group (57% vs 35%, p<0.001) and the patients were significantly younger at the time of TKA with a median age of 62 as opposed to 70 years (p<0.001). TKA inserted in knees previously treated with HTO had an inferior estimated survival (p<0.001) with a crude hazard ratio (HR) of 1.70 (95% CI: 1.38-2.10, p<0.001). However, after adjustment for the differences in sex and age the two groups had a similar risk of revision with an adjusted HR of 1.17 (95% CI: 0.96-1.42, p=0.11). Instability showed a trait of been more frequent in the prior-HTO group (25% vs 18%).
Conclusions: In this nation-wide registry study TKA following HTO were revised more often than de novo TKA. However, our analyses suggest that the increased risk of revision is due to younger age and increased percentage of males in this group rather than the prior HTO.

64. Resurfacing hemiarthroplasty versus reverse shoulder arthroplasty in treatment of cuff tear arthropathy - a matched-pair analysis
Mette Ammitzbøll, Jeppe V Rasmussen, Amin B Baram, Stig Brorson, Bo S Olsen,
Ortopædkirurgisk afdeling T, Herlev Hospital; Ortopædkirurgisk afdeling T, Herlev Hospital; Ortopædkirurgisk afdeling T, Herlev Hospital; Ortopædkirurgisk afdeling T, Herlev Hospital; Ortopædkirurgisk afdeling T, Herlev Hospital; ,


Background: Resurfacing hemiarthroplasty (RHA) has previously been used for cuff tear arthropathy (CTA). Reverse shoulder arthroplasty (RSA) has, however, emerged to be the treatment of choice for CTA. The efficacy and risk of revision of RSA have, however, never been compared with RHA.
Purpose / Aim of Study: To compare the patient-reported outcome and the number of revision between RHA and RSA for CTA.
Materials and Methods: We included CTA patients from the Danish Shoulder Arthroplasty Registry (DSR) from 1st January 2006 to 31st December 2013. 110 RHA cases were matched by age and sex with 219 RSA controls. The Western Ontario Osteoarthritis of the Shoulder (WOOS) Index at 1 year was used as primary outcome and revision, defined as removal or exchange of any component or the addition of a glenoid component, as secondary outcome.
Findings / Results: The mean WOOS of RHA and RSA were 53 (SD=28) and 70 (SD=25) respectively. The mean difference was 16, p<0,001, 95% CI (9; 24). The revision rate of RHA was 6% (n=6) and the revision rate of RSA was 7% (n=16), p=0,28. In patients below 70 years of age the median WOOS of both RHA (n=14) and RSA (n=25) was 56, p=0,72. In patients above 70 years of age the median WOOS of RHA (n=58) and RSA (n=118) was 48 and 79. The difference of 31 was statistically significant, p<0,001.
Conclusions: In this nationwide cohort RSA had a statistically significant better patient-reported outcome compared with RHA especially in patients older than 70 years. In patients under 70 years of age the WOOS score was low with no difference between RHA and RSA. The results support the use of RSA in the treatment of CTA in patients older than 70 years of age. The outcome of RHA and RSA in patients younger than 70 years was disappointing disregard arthroplasty type, and the treatment of CTA in young patients remain a challenge.

65. Preoperative systemic bone quality does not affect tibial component migration in knee arthroplasty. A 2 year RSA study of 101 consecutive patients.
Karina Nørgaard Linde, Katriina Bøcker Puhakka, Bente Lomholt Langdahl, Kjeld Søballe, Inger Krog-Mikkelsen, Frank Madsen, Maiken Stilling
Orthopaedic Research Unit, Department of Clinical Medicine, Aarhus University Hospital, Denmark; Department of Radiology, Aarhus University Hospital, Denmark; Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark; Department of Orthopaedic Surgery, Aarhus University Hospital, Denmark; Orthopaedic Research Unit, Aarhus University Hospital, Denmark; Department of Orthopaedic Surgery, Aarhus University Hospital, Denmark; Orthopaedic Research Unit, Department of Orthopaedic Surgery, Department of Clinical Medicine, Aarhus University Hospital, Denmark


Background: Bone quality and other preoperative predictive factors may affect the survival of knee arthroplasty. Early implant migration in the first 2 postoperative years measured with RSA has been shown to predict long- term implant survival of knee arthroplasty.
Purpose / Aim of Study: To explore the association between preoperative bone quality and tibial component (TC) migration.
Materials and Methods: Longitudinal case study investigating the predictors of TC migration (RSA) at 2 years postoperative follow up in 101 patients (65 female) with total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA). Three TCs were investigated: cementless NexGen trabecular-metal monoblock, cemented NexGen stemmed, and cemented Oxford medial UKA. Predictors comprised clinical risk factors for osteoporosis, DXA, bone turnover markers (BTMs), and osteoarthritis grade. Clinical outcome was assessed by OKS. The acceptable migration threshold at 1 year was set at 0.54mm MTPM according to Piljs et al. (Acta Orthop 2012).
Findings / Results: Patients had a mean age of 67.7 years (range 39-87), and 15 had osteoporosis. At 1 year, 52.5 % had a migration below the “acceptable” threshold, and the remaining TCs were considered “at risk” for later premature failure. There was no significant difference in BTMs and the grade of osteoarthritis between groups below and above the acceptable migration threshold (p>0.07), and mean total OKS score was similar between the two groups (p=0.65). We found no difference in TC MTPM at 2 years (3 implant types combined) comparing patients with and without osteoporosis (p=0.34). Implant sub-type TC MTPM migration was also alike for patients with and without osteoporosis (p>0.06).
Conclusions: Migration of tibial components was not affected by preoperative osteoporosis, bone turnover markers and local osteoarthritis grade in the knee.

66. Preoperative Patient Reported Outcome Measures in the Prediction of Outcome in Arthroplasty of the Basal Joint of the Thumb
Rasmus Wejnold Jørgensen, Jens-Christian Vedel, Anders Odgaard, Claus Hjorth Jensen
Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen; Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen; Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen; Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen


Background: Indication for thumb carpometacarpal joint (CMC-1) arthroplasty is clinical and radiographic osteoarthritis of the joint resistant to conservative treatment.
Purpose / Aim of Study: The purpose of this study was to evaluate Patient Reported Outcome Measures as a predictor of outcome.
Materials and Methods: 157 consecutive patients prospectively answered Quick-DASH questionnaire preoperatively and at 6 months following interposition arthroplasty of the basal joint of the thumb. Student T-test was used comparing pre- and postoperative values. The questionnaires ability to predict outcome was assessed using multiple regression analysis. P<0.05 was considered statistically significant.
Findings / Results: The mean preoperative Quick-DASH was 46.41 (SD 15.64). The mean postoperative Quick-DASH was 22.89 (SD 19.40). Showing an average improvement of 23.52 (SD 24.93), P < 0.0001. The mean improvement in Quick-DASH values for patients who were satisfied (n=122) or unsatisfied (n=35) was 28.89 (SD21.71) and 4.81 (SD 26.67), respectively, P = 0.00012. The multiple regression analysis showed a correlation between the preoperative Quick- DASH and the improvement in Quick- DASH, P < 0.0001. I.e. a higher preoperative score resulted in greater improvement. Age and gender did not correlate with the postoperative values P = 0.127 and 0.377, respectively. A preoperative Quick-DASH score of less than 30 resulted in improvement at follow-up in only 54 % of patients.
Conclusions: CMC-1 arthroplasty is an effective treatment of thumb CMC osteoarthritis. There is a strong correlation between the preoperative Quick DASH and the improvement in Quick- DASH at 6 months follow-up. Quick-DASH score may therefore assist in the decision making in the operative treatment of osteoarthritis of the basal joint of the thumb.