Session 8: YODA Best Papers
Torsdag d. 26. oktober
Chairmen: Jakob Klit og Søren Ohrt-Nissen
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
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.
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
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.
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,
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.
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.
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
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
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.