Session 1: Hip I
Onsdag den 24. oktober
11:00 – 12:00
Lokale: Reykjavik
Chairmen: Søren Overgaard og Casper Foldager
1. Low migration in osteoarthritis patients treated with cemented and cementless Avantage Dual Mobility Total Hip Arthroplasty. A 2-Year Blinded Randomized Radiostereometric and Dual-energy X-Ray Absorptiometry Study.
Steffan Tabori Jensen, Sebastian Breddam, Torben Bæk Hansen, Maiken Stilling
University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Holstebro, Denmark, Hospital Unit West.; University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Holstebro, Denmark, Hospital Unit West.; University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Holstebro, Denmark, Hospital Unit West.; University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Holstebro, Denmark, Hospital Unit West.
Background: The advantage of cemented over cementless
cementing technique of dual-mobility cups in the
elderly population is still unclear, and the choice of
fixation method is mainly based on surgeons
preference
Purpose / Aim of Study: To investigate the early implant migration
pattern of cemented and cementless
Avantage dual-mobility (DM) cups in elderly
patients with osteoarthritis (OA)
Materials and Methods: In a prospective patient-blinded randomized clinical trial 60
patients (33 female) were allocated to cemented (n=30) or
cementless (n=30) cup fixation. Osteoporotic patients were
excluded by preoperative DXA scans. The lower age-limit
was 70 years (mean 75.1,range 70.2-83.0). Patients were
followed with radiosterometry, periprosthetic BMD
measurements, and PROMs (HHS, OHS, EQ-5D, VAS pain)
at post-op, 3, 12 and 24 months
Findings / Results: At 12 and 24 months, cementless cups had higher rotation around
the y-axis (p<0.04), total rotation (p<0.04) and maximum total point
motion (MTPM) (p<0.02) compared to cemented cups. Proximal cup
translation and MTPM did not differ from 12 to 24 month follow-up
(FU) within cemented (respectively p=0.61,p=0.52) and cementless
(respectively p=0.32, p=0.51) fixation. Proximal cup translation was
similar for cemented and cementless cup fixation when stratified for
normal or osteopenia bone (p>0.34). Cemented cups had higher
BMD in Wilkinson region of interest (ROI) 2 and 3 compared to
cementless cups (p<0.003) at postoperative, 3, 12 and 24 months
FU. PROMs improved similarly in both groups
Conclusions: The Avantage DM showed low implant migration and good clinical
outcomes suggesting that the Avantage DM cup can be used in OA
patients older than 70 years both with cemented and cementless
cup fixation method. From 12 to 24 months follow-up both fixation
methods showed no additional migration suggesting good lasting
fixation
2. PANSAID: Paracetamol and NSAID in Combination for Postoperative Analgesia
Kasper Thybo, Daniel Hägi-Pedersen, Jørgen B Dahl, Jørn Wetterslev, Hans Henrik Bülow, Niels Anker Pedersen, Søren Overgaard, Henrik Schrøder, Jan Bjørck, Ole Mathiesen
Anaesthesiology, Næstved Hospital; Anaesthesiology, Næstved Hospital; Anaesthesiology, Bispebjerg Hospital; Copenhagen Trial Unit, Rigshospitalet; Anaesthesiology, Holbæk Hospital; Anaesthesiology, Gilhøj Hospital; Orthopaedic Surgery and Traumatology, Odense Univerity Hospital; Orthopaedic Surgery , Næstved Hospital; Orthopaedic Surgery , Nykøbing Falster Hospital; Anaesthesiology, Zealand University Hospital, Køge
Background: Combinations of paracetamol and non-steroidal anti-
inflammatory drugs are frequently used for
postoperative pain management, though, with no
firm evidence regarding benefit or harm.
Purpose / Aim of Study: The aim of the PANSAID trial was therefore to
investigate the analgesic and harmful effects of four
multimodal analgesic regimens with paracetamol
and/or ibuprofen after total hip arthroplasty.
Materials and Methods: PANSAID was a multicenter, randomized, blinded
trial. Participants were randomized to Group A:
Paracetamol 1 g and ibuprofen 400 mg; B:
Paracetamol 1 g and placebo; C: Ibuprofen 400 mg
and placebo; or D: Paracetamol 0.5 g and ibuprofen
200 mg q.i.d. for 24 hours postoperatively. The co-
primary outcomes were 24-hours patient-controlled
morphine consumption, and proportion of patients
with one or more serious adverse event (SAE)
within 90 days in groups A, C and D (all receiving
ibuprofen) versus group B (paracetamol only).
Findings / Results: We analyzed 556 patient. The median 24-hour
morphine consumption in group A, B, C, and D was
20, 36, 26, and 28 mg, respectively. Median
differences: 16 mg (99.6% CI: 6.5 to 24, P<0.001)
(group A vs. B); 8 mg (99.6% CI: -1 to 14, P=0.0011)
(group B vs. D); and 6 mg (99.6% CI: -2 to 16,
P=0.0024) (group A vs. C). The proportion of
patients with SAEs in groups A+C+D was 15%, and
11% in group B; the relative risk was 1.44 (97.5%
CI: 0.79 to 2.45, P=0.18).
Conclusions: The combination of paracetamol and ibuprofen
reduced morphine consumption more than each
drug alone, however, the predefined minimal
important difference of 10 mg was reached between
the combination and paracetamol only. Using
ibuprofen the first postoperative day does not
statistically significantly increase the proportion of
SAEs (Clinicaltrials.gov number, NCT02571361).
3. The fate of biopsy negative and sonication positive cultures following revisions of total hip and knee arthroplasties
Christen Ravn, Michael Kemp, Per Kjærsgaard-Andersen, Søren Overgaard
Dep. of Orthopaedic Surgery and Traumatology / Dep. of Clinical Research, OUH / Sygehus Lillebælt / University of Southern Denmark; Dep. of Clinical Microbiology / Dep. of Clinical Research, Odense University Hospital / University of Southern Denmark ; Dep. of Orthopaedic Surgery, Sygehus Lillebælt, Vejle; Dep. of Orthopaedic Surgery and Traumatology / Dep. of Clinical Research, Odense University Hospital / University of Southern Denmark
Background: To improve the diagnostic sensitivity of prosthetic
joint infection (PJI), sonication has been introduced
and may dislodge biofilm bacteria from the implant
surface (Trampuz 2007). No previous study has
evaluated the clinical course of patients having
additional microbiological findings after sonication
fluid culture (SFC).
Purpose / Aim of Study: What is the fate of prosthetic join revision, when
tissue sample culture (TSC) is negative and SFC is
positive, in terms of re-revision?
Materials and Methods: We prospectively cultured tissue samples and
sonication fluid of 211 prosthetic revision of THA and
TKA during 1 year. Clinicians were blinded to the
SFC-results, which were not used for the
subsequent treatment. Patients were seen at 3 and
12 months. Medical records were checked for
infection and subsequent re-operation
Findings / Results: We identified 11 cases with positive SFC and
negative TSC. 8 cases with suspected PJI were
treated with revision and empirical antibiotics.
Another 3 cases with suspected aseptic failure,
partial 1-stage revisions were performed with no
subsequent antibiotic therapy.
Re-revisions were necessary in 5 cases of
expected PJI, and 2 of these ended up with
permanent Girdlestone. Antibiotic suppression
was implemented in 1 case. 1 patient diseased in
circulatory failure. In 3 cases the painful joint
prosthesis is still unsolved after 1 year, and only
1 case had an asymptomatic prosthesis at 1-year
follow-up. Culture results of the subsequent
revisions in this small cohort shows several links
to the microbiological findings in SFC.
Conclusions: 5/11 cases were re-revised with positive sonication
fluid and negative biopsies within one year after
revisions which is discouraging. In perspective,
knowledge and treatment of the microorganisms
identified by SFC seems to be of value and should
be used in the future when available.
4. Effects of supervised exercise compared to home-based exercise early after total hip replacement on patient-reported function, pain, heath-related quality of life and performance-based function - A Meta-Analysis of Randomised Controlled Trials
Sebrina Hansen, Jens Aaboe, Inger Mehlenburg, Søren Overgaard, Lone Mikkelsen
Library , University of Southern Denmark; National Guidelines, Sundhedsstyrelsen ; Centre of Research in Rehabilitation (CORIR), Department of Clinical Medicine, Aarhus Universitetshospital ; Orthopaedic research unit, Department of Orthopaedic Surgery and Traumatology, Department of Ckinical Research, Odense Universitets hospital ; Interdisciplinary Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital
Background: In practice, some patients with primary
total hip replacement are offered
outpatient home-based exercises and ot
others supervised
inpatient exercise, however it remains u
unknown whether supervised p
programmes are more
effective.
Purpose / Aim of Study: The study evaluated the effectiveness
of supervised exercise compared to
home-based exercise after total hip
replacement on patient-reported
function, hip-pain, health-related
quality of life and performance-based
function.
Materials and Methods: A systematic review and meta-analysis
of randomised controlled trials
investigating the effect of supervised
exercise to home-based exercise.. A e
electronic search was performed on M
March 14th 2018 from a predefined p
protocol (PROSPERO registration n
number: CRD42017055604).
The methodological quality was as
assessed using the Cochrane Risk of Bi
Bias tool. Mean difference (MD) or st
standard mean differences (SMD) with 95
95% confidence intervals were ca
calculated and pooled using random ef
effects models.
Findings / Results: Seven studies was included with a
total of 389 participants. A small and
non-significant difference in favour of
the supervised groups was found in
patient-reported function (SMD -0.22
[95% CI -0.46 to 0.02]), hip-related
pain (SMD -0.03 [95% CI –0.27 to
0.21]), health-related quality of life (MD -
-3.08 [95% CI -6.29 to 0.14]) and
performance-based function (SMD -
-0.26 [95% CI -0.68 to 0.17]) at end of
treatment and in patient-reported
function (MD -1.31 [95% CI -3.79 to
1.16]) at the 6 to 12-month follow-up.
Conclusions: In conclusion, supervised exercise was
not superior to home-based exercise
on patient-reported function, pain,
health-related quality of life and
performance-based function after
primary total hip replacement. This
review does not exclude that
supervised exercise may be beneficial
to some patient sub-groups.
5. Whole blood metal ion concentrations in metal-on-metal total hip arthroplasty and hip resurfacing: A randomised controlled trial with 5-year follow up including 75 patients
Peter Nyby Hersnaes, Kirill Gromov, Peter Henrik Gebuhr, Kristian Stahl Otte, Anders Troelsen
Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre; Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre; Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre; Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre; Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre
Background: The metal-on-metal large-diameter-head (MoM-
LDH) hip replacements increased in popularity
during the start of the 21st century. Subsequently
reports raised concerns regarding adverse reactions
due to elevated chromium (Cr) and cobalt (Co)
levels as well as high rates of other complications
and revisions.
Purpose / Aim of Study: The purpose was to compare Cr and Co levels at 5-
years follow up following Magnum (MoM-LDH total
hip arthroplasty) or Recap (MoM-LDH hip
resurfacing).
Materials and Methods: The study was conducted between November 2006
to January 2012 in a tertiary health care center in
Denmark. Patients with primary or secondary
osteoarthritis were randomly assigned to receive a
Magnum or Recap prosthesis. Randomization was
computer generated and allocation was concealed
in an opaque envelope. Patients and surgeons were
blinded until day of surgery. Primary outcome was
Cr and Co levels at 5-years follow up.
Findings / Results: 75 were included and allocated to the Magnum (n =
39) and Recap (n = 36) group. The study was
prematurely stopped due to numerous reports of
adverse events in patients with MoM hip
replacements. 25 in the Magnum and 20 in the
Recap group were eligible for primary outcome
analysis. Median Cr levels were 1.36 µg/L (IQR:
0.99 - 3.11) for Magnum and 1.21 µg/L (IQR: 0.88 -
3.03) for ReCap (p = 0.46). Median Co levels were
1.67 µg/L (IQR: 0.86 - 2.31) for Magnum and 0.92
µg/L (IQR: 0.64 - 1.49) for ReCap (p = 0.073).
Conclusions: Metal ion levels were similar in both groups at 5-
years follow up. No significant differences were
found when comparing Cr and Co levels in Magnum
with Recap at 5-years follow up.
6. Increasing risk of post-surgery infections among hip fracture patients: A nationwide study 2005-2016
Kaja E. Kjørholt, Søren P. Johnsen , Nickolaj R. Kristensen , Daniel Prieto-Alhambra , Alma B. Pedersen
Department of Clinical Epidemiology , Aarhus University Hospital; Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University ; Department of Clinical Epidemiology , Aarhus Universtiy Hospital ; Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford ; Department of Clinical Epidemiology , Aarhus University Hospital
Background: Post-surgery infections is a leading cause of death
among hip fracture patients, however, data on
recent time trends in the risk of infections is lacking.
Purpose / Aim of Study: We aimed to examine trends in the risk of infections
following hip fracture surgery, including hospital-
treated infections, as well as community-based
ones, in Denmark from 2005 to 2016.
Materials and Methods: We conducted a nationwide cohort study based on
individual-level record linkage of data from Danish
nationwide registries. We calculated cumulative
incidence considering death as competing risk and,
based on the pseudo-observation method, risk
ratios (RRs) with 95% confidence interval (CI).using
the period 2005-2006 as a reference. RRs were
adjusted or stratified by age, sex and comorbidity
measured with Charlson Comorbidity index (CCI).
Findings / Results: A total of 74,771 patients aged 65 years or older
with first time hip fracture surgery were included.
The 30 days cumulative incidence of all hospital-
treated infections increased from 10.8 % (95 % CI:
10.2-11.3) in 2005-2006 to 14.3% (95 % CI: 13.7-
15.0) in 2015-2016 [adjusted RR: 1.32 (95% CI:
1.23-1.42)]. The risk of infectious hospitalization
increased irrespective of patient’s age, sex and CCI
score. The 30 days cumulative incidence of
redeeming community-based antibiotic prescriptions
increased from 17.5 % (95 % CI: 16.8-18.2) in 2005-
2006 to 27.1 % (95 % CI: 26.3-27.9) in 2015-2016
[adjusted RR: 1.56 (95 % CI: 1.49-1.64)].
Conclusions: We found an increased risk of infection following hip
fracture surgery during the 12- year study period.
Given the high mortality following infections in the
elderly, further research is needed to identify
patients at increased risk to target preventive
treatment and potentially reduce complications and
mortality in hip fracture patients.
7. Bone remodeling around a short femoral neck stem - 5 years follow up of the Primoris®
Janus Duus Christiansen, Poul Torben Nielsen, Mogens Laursen, Gordon Blunn
Northern Ortopaedic Division, Aalborg University Hospital; Northern Ortopaedic Division, Aalborg University Hospital; Northern Ortopaedic Division, Aalborg University Hospital; University College London RNOHT, Stanmore, United Kingdom
Background: The use of conventional stems in total
hip arthroplasty gives a non-
physiological load pattern. In case of
revision, the bone stock left for
reimplantation may be compromised.
The Primoris ® stem is a development
of earlier conceived bone-saving
prosthesis in order to preserve bone
stock maintaining normal stress to the
proximal femur.
Purpose / Aim of Study: This study includes postoperative
changes in bone mineral densities
(BMD) in the proximal femur and
evaluation of bone stock preservation
in patients operated with the Primoris
® stem.
Materials and Methods: A prospective cohort study of 52
patients scheduled for surgery with the
femoral neck-preserving Primoris ®
stem was carried out. Patients were
studied with DXA-scans to evaluate
BMD around the implant. Results from
DXA-scanner were measured in 4
specific regions of interest (ROI) – the
area of the greater trochanter (ROI1),
a lateral area below the greater
trochanter (ROI2), a distal area of the
diaphysis (ROI3) and a medial region
of calcar and trochanter minor (ROI4).
Postoperative BMD results from day
one, 6 weeks, 6 months, 1 year, 2
years and 5 years were analyzed
including double measurements at 1
year FU.
Findings / Results: 3 patients were excluded, leaving 49
patients for BMD-analysis. A slightly
non significant decrease was found at
5 years FU compared to day 1 in
ROI1. A significant decrease was
found at 5 year FU compared to day 1
in ROI2. A non significant gain of BMD
was found at 5 years FU compared to
day 1 in ROI3 and ROI4.
Conclusions: As to bone preservation, the results
are encouraging supporting the
rationale of the Primoris® implant. With
special regard to the calcar area
(ROI4), bone stock has remained
stable throughout the follow up period.
If the proximal femoral bone stock is
preserved, the potential for successful
future revision is maximized.