Session 11: DOS Best Papers
Torsdag d. 25. oktober
15:50-17:00
Lokale: Stockholm/Copenhagen/Helsinki/Oslo
Chairmen: Ole Rahbek og Stig Brorson
Kristoffer W Barfod, Maria S Hansen, Per Hölmich, Morten T Kristensen, Anders Troelsen
Sports Orthopedic Research Center - Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Denmark. ; Physical Medicine and Rehabilitation Research – Copenhagen (PMR-C),Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital Hvidovre, Denmark. ; Sports Orthopedic Research Center - Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Denmark. ; Physical Medicine and Rehabilitation Research – Copenhagen (PMR-C),Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital Hvidovre, Denmark. ; Clinical Orthopedic Research Hvidovre (CORH), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Denmark.
Background: Early controlled ankle motion is widely used in the non-operative treatment of acute Achilles tendon rupture although its safety and efficacy has never been investigated in a randomized setup.
Purpose / Aim of Study: To investigate if early controlled motion (ECM) of the ankle was superior to immobilization (IM) in the treatment of acute Achilles tendon rupture.
Materials and Methods: The study was performed as an assessor blinded randomized controlled trial with patients allocated in a 1:1 ratio to one of two parallel groups. Patients aged 18 to 70 years were eligible for inclusion. The ECM group performed movements of the ankle 5 times a day from week 3 to 8 after rupture. The control group was immobilized (IM). The primary outcome was the Achilles tendon Total Rupture Score (ATRS) evaluated at 1 year post-injury. Secondary outcomes were: heel-rise-work test, Achilles tendon elongation and rate of re-rupture. Analysis was conducted as intention-to-treat with imputation of missing data. The full trial protocol was published in Trials Journal in 2016. ClinicalTrials.gov, identifier: NCT02015364.
Findings / Results: 189 patients were assessed for eligibility from February 2014 to December 2016. 130 were randomized and 122 available for 1 year follow up; 64 ECM and 58 IM. There was no statistically significant differences (p>0.3) between the ECM and the IM groups at 1 year; Mean (SD) ATRS was 74 (18) and 75 (18), respectively, the Heel-rise-work-test showed a total work performed of the injured limb (percent of uninjured) of 60% (21) and 60% (21), respectively, elongation was 18mm (13) and 16mm (11), respectively. Correspondingly, there were 6 and 7 re-ruptures.
Conclusions: ECM revealed no benefit to IM in any of the investigated outcomes. A re-rupture rate of 10% was seen and both groups had significant functional deficits in the injured limb.
Sports Orthopedic Research Center - Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Denmark. ; Physical Medicine and Rehabilitation Research – Copenhagen (PMR-C),Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital Hvidovre, Denmark. ; Sports Orthopedic Research Center - Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Denmark. ; Physical Medicine and Rehabilitation Research – Copenhagen (PMR-C),Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital Hvidovre, Denmark. ; Clinical Orthopedic Research Hvidovre (CORH), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Denmark.
Background: Early controlled ankle motion is widely used in the non-operative treatment of acute Achilles tendon rupture although its safety and efficacy has never been investigated in a randomized setup.
Purpose / Aim of Study: To investigate if early controlled motion (ECM) of the ankle was superior to immobilization (IM) in the treatment of acute Achilles tendon rupture.
Materials and Methods: The study was performed as an assessor blinded randomized controlled trial with patients allocated in a 1:1 ratio to one of two parallel groups. Patients aged 18 to 70 years were eligible for inclusion. The ECM group performed movements of the ankle 5 times a day from week 3 to 8 after rupture. The control group was immobilized (IM). The primary outcome was the Achilles tendon Total Rupture Score (ATRS) evaluated at 1 year post-injury. Secondary outcomes were: heel-rise-work test, Achilles tendon elongation and rate of re-rupture. Analysis was conducted as intention-to-treat with imputation of missing data. The full trial protocol was published in Trials Journal in 2016. ClinicalTrials.gov, identifier: NCT02015364.
Findings / Results: 189 patients were assessed for eligibility from February 2014 to December 2016. 130 were randomized and 122 available for 1 year follow up; 64 ECM and 58 IM. There was no statistically significant differences (p>0.3) between the ECM and the IM groups at 1 year; Mean (SD) ATRS was 74 (18) and 75 (18), respectively, the Heel-rise-work-test showed a total work performed of the injured limb (percent of uninjured) of 60% (21) and 60% (21), respectively, elongation was 18mm (13) and 16mm (11), respectively. Correspondingly, there were 6 and 7 re-ruptures.
Conclusions: ECM revealed no benefit to IM in any of the investigated outcomes. A re-rupture rate of 10% was seen and both groups had significant functional deficits in the injured limb.
Finn Johannsen, Robert Herzog, Peter Magnusson, Michael Kjær
Institute of sportsmedicine Copenhagen, Ortopæd kirurgisk afdeling, Bispebjerg Hospital; fysioterapien, Bispebjerg Hospital; Institute of sportsmedicine Copenhagen, Ortopæd kirurgisk afdeling, Bispebjerg Hospital; Institute of sportsmedicine Copenhagen, Ortopæd kirurgisk afdeling, Bispebjerg Hospital
Background: The plantar fascia is a flat tendon like structure under the foot, that is frequently overloaded resulting in plantar fasciitis (PF). The lifetime incidence is estimated to 10%.
Purpose / Aim of Study: Corticosteroid injections has shown good short-term effect on PF, but a deleterious effect in the long-term. Strength training however has a good long term effect. We hypothesized that combined strength training and corticosteroid injections would result in superior effect both in the short term and long term.
Materials and Methods: Ninety consecutive patients (20-65 years) with PF symptoms for at least 3 months, with ultrasound measured thickness above 4.0 mm, were elected and randomized into 3 groups: a) 3 month controlled Strength Training (ST), b) monthly corticosteroid injection, maximum 3 injections (Inj). c) combination of a) and b) (ST-Inj). Primary outcome was predefined as change from baseline until 6 months in pain during function on a 100 mm VAS score and Foot Function Index (FFI, range 0-230).
Findings / Results: All 3 groups improved significantly over time. At primary endpoint (6 months) the mean difference between the combined treatment and training only was 39.7 in FFI (95% confidence interval (CI): 62.8 to 16.4) and 20.0 for VAS pain during function (CI: 35.0 to 4.9). The mean difference between the combined treatment and corticosteroid injections only was 29.4 in FFI (CI: 52.1 to 6.6) and 16.8 for VAS pain during function (CI:31.6 to 2.0). All differences were not only highly significant but also clinical relevant, The combined treatment was superior at all timepoints: 3,6,12,24 months.
Conclusions: This is the first study to show a good short and long-term effect of corticosteroid injections in plantar fasciitis if combined with strength training. This treatment regime might be applicable to other tendinopathies in the body.
Institute of sportsmedicine Copenhagen, Ortopæd kirurgisk afdeling, Bispebjerg Hospital; fysioterapien, Bispebjerg Hospital; Institute of sportsmedicine Copenhagen, Ortopæd kirurgisk afdeling, Bispebjerg Hospital; Institute of sportsmedicine Copenhagen, Ortopæd kirurgisk afdeling, Bispebjerg Hospital
Background: The plantar fascia is a flat tendon like structure under the foot, that is frequently overloaded resulting in plantar fasciitis (PF). The lifetime incidence is estimated to 10%.
Purpose / Aim of Study: Corticosteroid injections has shown good short-term effect on PF, but a deleterious effect in the long-term. Strength training however has a good long term effect. We hypothesized that combined strength training and corticosteroid injections would result in superior effect both in the short term and long term.
Materials and Methods: Ninety consecutive patients (20-65 years) with PF symptoms for at least 3 months, with ultrasound measured thickness above 4.0 mm, were elected and randomized into 3 groups: a) 3 month controlled Strength Training (ST), b) monthly corticosteroid injection, maximum 3 injections (Inj). c) combination of a) and b) (ST-Inj). Primary outcome was predefined as change from baseline until 6 months in pain during function on a 100 mm VAS score and Foot Function Index (FFI, range 0-230).
Findings / Results: All 3 groups improved significantly over time. At primary endpoint (6 months) the mean difference between the combined treatment and training only was 39.7 in FFI (95% confidence interval (CI): 62.8 to 16.4) and 20.0 for VAS pain during function (CI: 35.0 to 4.9). The mean difference between the combined treatment and corticosteroid injections only was 29.4 in FFI (CI: 52.1 to 6.6) and 16.8 for VAS pain during function (CI:31.6 to 2.0). All differences were not only highly significant but also clinical relevant, The combined treatment was superior at all timepoints: 3,6,12,24 months.
Conclusions: This is the first study to show a good short and long-term effect of corticosteroid injections in plantar fasciitis if combined with strength training. This treatment regime might be applicable to other tendinopathies in the body.
Annette Bennedsgaard Jespersen, Andreas Andresen,, Michael Jakobsen, Mikkel Andersen, Leah Carreon
Dept of Spine and Research, Spine Center, Middelfart, Part of Lillebaelt Hospital; Dept of Spine and Research, Spine Center, Middelfart, Part of Lillebaelt Hospital; Dept of Spine and Research, Spine Center, Middelfart, Part of Lillebaelt Hospital; Dept of Spine and Research, Spine Center, Middelfart, Part of Lillebaelt Hospital; Dept of Spine and Research, Spine Center, Middelfart, Part of Lillebaelt Hospital
Background: Few studies have investigated the effects of parathyroid hormone (PTH) on fusion in patients undergoing spinal arthrodesis. Early studies showed a more robust fusion mass with PTH after spinal fusion surgery. But the efficiency of PTH on non-instrumented spinal fusion surgery remains unclear.
Purpose / Aim of Study: To evaluate if 90-day subcutaneous injections with 20 µg teriparatide (PTH) increases the volume and quality of the fusion mass compared to placebo based on 12 month postoperative fine cut CT-scans. The secondary objective is to evaluate if PTH increases fusion rates compared to placebo.
Materials and Methods: We performed a prospective, randomized double-blind placebo- controlled clinical trial. Patients with degenerative spondylolisthesis scheduled for non-instrumented posterolateral fusion were randomized to receive 90-day subcutaneous injections with 20 µg teriparatide (N=41) or placebo (N=46) in a 1:1 fashion. Fusion volume and quality was evaluated using 12 month postoperative fine cut CT scans.
Findings / Results: The fusion rate, the mean volume and robustness of the fusion mass were similar between the PTH and placebo groups. No effect could be demonstrated of the PTH treatment for all variables. Administration PTH treatment was well tolerated, but provided no additional benefit versus placebo.
Conclusions: 90-day subcutaneous administration of PTH does not improve lumbar fusion outcomes in elderly patients compared to placebo after non-instrumented spinal fusion surgery for degenerative spondylolisthesis.
Dept of Spine and Research, Spine Center, Middelfart, Part of Lillebaelt Hospital; Dept of Spine and Research, Spine Center, Middelfart, Part of Lillebaelt Hospital; Dept of Spine and Research, Spine Center, Middelfart, Part of Lillebaelt Hospital; Dept of Spine and Research, Spine Center, Middelfart, Part of Lillebaelt Hospital; Dept of Spine and Research, Spine Center, Middelfart, Part of Lillebaelt Hospital
Background: Few studies have investigated the effects of parathyroid hormone (PTH) on fusion in patients undergoing spinal arthrodesis. Early studies showed a more robust fusion mass with PTH after spinal fusion surgery. But the efficiency of PTH on non-instrumented spinal fusion surgery remains unclear.
Purpose / Aim of Study: To evaluate if 90-day subcutaneous injections with 20 µg teriparatide (PTH) increases the volume and quality of the fusion mass compared to placebo based on 12 month postoperative fine cut CT-scans. The secondary objective is to evaluate if PTH increases fusion rates compared to placebo.
Materials and Methods: We performed a prospective, randomized double-blind placebo- controlled clinical trial. Patients with degenerative spondylolisthesis scheduled for non-instrumented posterolateral fusion were randomized to receive 90-day subcutaneous injections with 20 µg teriparatide (N=41) or placebo (N=46) in a 1:1 fashion. Fusion volume and quality was evaluated using 12 month postoperative fine cut CT scans.
Findings / Results: The fusion rate, the mean volume and robustness of the fusion mass were similar between the PTH and placebo groups. No effect could be demonstrated of the PTH treatment for all variables. Administration PTH treatment was well tolerated, but provided no additional benefit versus placebo.
Conclusions: 90-day subcutaneous administration of PTH does not improve lumbar fusion outcomes in elderly patients compared to placebo after non-instrumented spinal fusion surgery for degenerative spondylolisthesis.
Jesper Sonntag, Linn Woythal, Per Rasmussen, Ulrik Branner, Anders Klahn, Per Hølmer, Andreas Kryger Jensen, Kai H. W. Lange, Stig Brorson
Dept. of Orthopaedic Surgery, Nordsjaellands Hospital ; Dept. of Orthopaedic Surgery, Nordsjaellands Hospital ; Dept. of Orthopaedic Surgery, Nordsjaellands Hospital ; Dept. of Orthopaedic Surgery, Nordsjaellands Hospital ; Dept. of Orthopaedic Surgery, Nordsjaellands Hospital ; Dept. of Orthopaedic Surgery, Nordsjaellands Hospital ; Dept. of Clinical Research, Nordsjaellands Hospital ; Dept. of Anaesthesia and Intensive Care, Nordsjaellands Hospital ; Dept. of Orthopaedic Surgery, Sjaellands University Hospital
Background: In volar plating of unstable distal radius fractures (DRF) many surgeons repair the pronator quadratus (PQ) muscle before skin closure. The evidence for the procedure is controversial and its clinical relevance has not previously been studied in a randomized clinical trial.
Purpose / Aim of Study: The purpose of this study was to compare the functional outcome after repairing the PQ muscle to non-repair in patients undergoing volar locked plating for DRF one year after surgery.
Materials and Methods: All patients at our hospital with unstable DRF managed with volar plating between14.02.2015 and 30.03.2016 were invited to participate. They were randomly allocated to either repair or non-repair of the PQ muscle. Primary outcome was Patient- rated wrist evaluation (PRWE) one year after surgery. PRWE is a questionnaire measuring pain and function and scores from 0-100; 0 being the best outcome and 100 the worst. Secondary outcomes were DASH, pronation strength, grip strength, ROM (pronation/supination), complications and surgical time. Patients and investigatorswere blinded to group allocation.
Findings / Results: 72 patients were included. 31 patients in the non-repair group and 32 in the repair group completed one-year follow-up. The mean PRWE in the non-repair group at one year was 12.90 compared to 18.38 in the repair group. The difference of 5.47 (CI-95% = [-14.96; 4.02]) was neither statistically nor clinically significant (p = 0.25). We also found no significant differences in any of the secondary outcomes.
Conclusions: We found no difference in functional outcome between repair and non-repair of the PQ muscle one year after volar locked plating for DRF.
Dept. of Orthopaedic Surgery, Nordsjaellands Hospital ; Dept. of Orthopaedic Surgery, Nordsjaellands Hospital ; Dept. of Orthopaedic Surgery, Nordsjaellands Hospital ; Dept. of Orthopaedic Surgery, Nordsjaellands Hospital ; Dept. of Orthopaedic Surgery, Nordsjaellands Hospital ; Dept. of Orthopaedic Surgery, Nordsjaellands Hospital ; Dept. of Clinical Research, Nordsjaellands Hospital ; Dept. of Anaesthesia and Intensive Care, Nordsjaellands Hospital ; Dept. of Orthopaedic Surgery, Sjaellands University Hospital
Background: In volar plating of unstable distal radius fractures (DRF) many surgeons repair the pronator quadratus (PQ) muscle before skin closure. The evidence for the procedure is controversial and its clinical relevance has not previously been studied in a randomized clinical trial.
Purpose / Aim of Study: The purpose of this study was to compare the functional outcome after repairing the PQ muscle to non-repair in patients undergoing volar locked plating for DRF one year after surgery.
Materials and Methods: All patients at our hospital with unstable DRF managed with volar plating between14.02.2015 and 30.03.2016 were invited to participate. They were randomly allocated to either repair or non-repair of the PQ muscle. Primary outcome was Patient- rated wrist evaluation (PRWE) one year after surgery. PRWE is a questionnaire measuring pain and function and scores from 0-100; 0 being the best outcome and 100 the worst. Secondary outcomes were DASH, pronation strength, grip strength, ROM (pronation/supination), complications and surgical time. Patients and investigatorswere blinded to group allocation.
Findings / Results: 72 patients were included. 31 patients in the non-repair group and 32 in the repair group completed one-year follow-up. The mean PRWE in the non-repair group at one year was 12.90 compared to 18.38 in the repair group. The difference of 5.47 (CI-95% = [-14.96; 4.02]) was neither statistically nor clinically significant (p = 0.25). We also found no significant differences in any of the secondary outcomes.
Conclusions: We found no difference in functional outcome between repair and non-repair of the PQ muscle one year after volar locked plating for DRF.
Peter Bo Jørgensen, Henrik Daugaard, Martin Lamm, Stig Storgaard Jakobsen, Kjeld Søballe, Maiken Stilling
Department of Orthopedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Gentofte Hospital; Department of Orthopedic Surgery, Aarhus University Hospital; Department of Orthopedic Surgery, Aarhus University Hospital; Department of Orthopedic Surgery, Aarhus University Hospital; Department of Orthopedic Surgery, Aarhus University Hospital
Background: In Denmark 86% of acetabular cups are cementless and 35% of these are coated with hydroxyapatite (HA). HA-coating increases bone ingrowth and early implant fixation. The effect on implant migration is questionable, and it is associated with high polyethylene wear-rates due to third-body wear. BoneMaster (BM) is a new, thin (5µ), evenly distributed, electrochemically deposited, and quickly resorbed hydroxyapatite implant-coating.
Purpose / Aim of Study: To evaluate early cup migration and functional outcomes of BM versus porous coated Exceed cups.
Materials and Methods: The study design was a prospective patient-blinded, randomized, controlled study. Based on a sample size calculation, 53 non-osteoporotic (pre-op DXA scan) patients with end-stage coxarthritis were block-randomized to either BM or porous coated Exceed cup (ZimmerBiomet). Patients were mean age 64 years (range 55-75). Stems were BM or porous coated Bimetric (ZimmerBiomet). Follow-up was performed at postop, 3 and 6 months, 1 and 2 years. Effect measures were cup migration measured with radiostereometry and PROMs.
Findings / Results: At 2-years follow-up migration in all 6 degrees of freedom were similar between groups (p>0.26). Mean proximal cup migration was 0.20 mm (SD 0.26) for BM and 0.12mm (SD 0.29) for porous coating. Oxford Hip Score (OHS) increased mean 17.3 points (SD 10.9) in both groups from baseline to 2-year follow-up with no difference between groups (p=0.14). At 2-years follow-up OHS (p=0.85, mean 41.6; SD 9.2) and VAS pain (p=0.51, mean 11; SD 23) were similar in the groups. There was one infection and two head/liner replacements related to dislocation and instability.
Conclusions: Based on evaluation of cup migration, OHS and VAS pain measures we found similar results for BM and porous coated Exceed cups at 2 years follow-up. Further 5-year evaluation is in progress.
Department of Orthopedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Gentofte Hospital; Department of Orthopedic Surgery, Aarhus University Hospital; Department of Orthopedic Surgery, Aarhus University Hospital; Department of Orthopedic Surgery, Aarhus University Hospital; Department of Orthopedic Surgery, Aarhus University Hospital
Background: In Denmark 86% of acetabular cups are cementless and 35% of these are coated with hydroxyapatite (HA). HA-coating increases bone ingrowth and early implant fixation. The effect on implant migration is questionable, and it is associated with high polyethylene wear-rates due to third-body wear. BoneMaster (BM) is a new, thin (5µ), evenly distributed, electrochemically deposited, and quickly resorbed hydroxyapatite implant-coating.
Purpose / Aim of Study: To evaluate early cup migration and functional outcomes of BM versus porous coated Exceed cups.
Materials and Methods: The study design was a prospective patient-blinded, randomized, controlled study. Based on a sample size calculation, 53 non-osteoporotic (pre-op DXA scan) patients with end-stage coxarthritis were block-randomized to either BM or porous coated Exceed cup (ZimmerBiomet). Patients were mean age 64 years (range 55-75). Stems were BM or porous coated Bimetric (ZimmerBiomet). Follow-up was performed at postop, 3 and 6 months, 1 and 2 years. Effect measures were cup migration measured with radiostereometry and PROMs.
Findings / Results: At 2-years follow-up migration in all 6 degrees of freedom were similar between groups (p>0.26). Mean proximal cup migration was 0.20 mm (SD 0.26) for BM and 0.12mm (SD 0.29) for porous coating. Oxford Hip Score (OHS) increased mean 17.3 points (SD 10.9) in both groups from baseline to 2-year follow-up with no difference between groups (p=0.14). At 2-years follow-up OHS (p=0.85, mean 41.6; SD 9.2) and VAS pain (p=0.51, mean 11; SD 23) were similar in the groups. There was one infection and two head/liner replacements related to dislocation and instability.
Conclusions: Based on evaluation of cup migration, OHS and VAS pain measures we found similar results for BM and porous coated Exceed cups at 2 years follow-up. Further 5-year evaluation is in progress.
Janni Kjærgaard Thillemann, Sepp De Raedt, Bo Munk, Torben Bæk Hansen, Maiken Stilling
Department of Orthopaedics, University Clinic of Hand, Hip and Knee Surgery, Hospital Unit West.; , Nordic Roentgen Technique, Aarhus.; Department of Orthopaedics, Aarhus Universityhospital.; Department of Orthopaedic, University Clinic of Hand, Hip and Knee Surgery, Hospital Unit West.; Department of Orthopaedics, Aarhus Universityhospital.
Background: The Triangular Fibrocartilage Complex (TFCC) is the main stabilizer of the distal radio ulnar joint(DRUJ). After lesion of the TFCC, stability of the DRUJ can be restored with different surgical techniques, but in-vivo methods to quantify and compare the stabilizing effect of these are missing. We have recently described and validated a new and precise digitally reconstructed radiograph(DRR) radiostereometric analysis(RSA) method named AutoRSA for evaluation of joint kinematics by use of CT bone-models.
Purpose / Aim of Study: To evaluate DRUJ stability before and after surgical TFCC reinsertion or reconstruction, respectively.
Materials and Methods: Ten human donor arms (8 males,mean age 78 y) were evaluated with RSA prior to intervention(native), after cutting the proximal and distal TFCC insertions (cut), and again after randomization to foveal reinsertion of the TFCC(n=5) or reconstruction ad modum Bryan Adams(n=5). During RSA imaging DRUJ stability was tested with the Piano Key test in a standardized test-rig. AutoRSA was used for analyses and standardised anatomical axes and coordinate systems of the forearm were used to describe the kinematics and stability.
Findings / Results: In all cadavers, the native DRUJ translated 1.76mm (CI95 0.61;2.90), increasing to 2.48mm (CI95 1.61;3.36) after inflicted TFCC lesion (p=0.04). Both foveal reinsertion and TFCC reconstruction reduced DRUJ translation towards stability of the native joint, with a tendency of overtightening compared to the native joints(p>0.25). Compared to the cut situation, the DRUJ translation was reduced noticeably after foveal TFCC reinsertion(p=0.007), while the effect of the Bryan Adams procedure was non-significant(p=0.35).
Conclusions: Foveal TFCC reinsertion stabilized the DRUJ markedly, but we did not find significant stabilizing effect of the Bryan Adams reconstruction.
Department of Orthopaedics, University Clinic of Hand, Hip and Knee Surgery, Hospital Unit West.; , Nordic Roentgen Technique, Aarhus.; Department of Orthopaedics, Aarhus Universityhospital.; Department of Orthopaedic, University Clinic of Hand, Hip and Knee Surgery, Hospital Unit West.; Department of Orthopaedics, Aarhus Universityhospital.
Background: The Triangular Fibrocartilage Complex (TFCC) is the main stabilizer of the distal radio ulnar joint(DRUJ). After lesion of the TFCC, stability of the DRUJ can be restored with different surgical techniques, but in-vivo methods to quantify and compare the stabilizing effect of these are missing. We have recently described and validated a new and precise digitally reconstructed radiograph(DRR) radiostereometric analysis(RSA) method named AutoRSA for evaluation of joint kinematics by use of CT bone-models.
Purpose / Aim of Study: To evaluate DRUJ stability before and after surgical TFCC reinsertion or reconstruction, respectively.
Materials and Methods: Ten human donor arms (8 males,mean age 78 y) were evaluated with RSA prior to intervention(native), after cutting the proximal and distal TFCC insertions (cut), and again after randomization to foveal reinsertion of the TFCC(n=5) or reconstruction ad modum Bryan Adams(n=5). During RSA imaging DRUJ stability was tested with the Piano Key test in a standardized test-rig. AutoRSA was used for analyses and standardised anatomical axes and coordinate systems of the forearm were used to describe the kinematics and stability.
Findings / Results: In all cadavers, the native DRUJ translated 1.76mm (CI95 0.61;2.90), increasing to 2.48mm (CI95 1.61;3.36) after inflicted TFCC lesion (p=0.04). Both foveal reinsertion and TFCC reconstruction reduced DRUJ translation towards stability of the native joint, with a tendency of overtightening compared to the native joints(p>0.25). Compared to the cut situation, the DRUJ translation was reduced noticeably after foveal TFCC reinsertion(p=0.007), while the effect of the Bryan Adams procedure was non-significant(p=0.35).
Conclusions: Foveal TFCC reinsertion stabilized the DRUJ markedly, but we did not find significant stabilizing effect of the Bryan Adams reconstruction.
Georgios Tsikandylakis, Johan Kärrholm, Nils P. Hailer, Antti Eskelinen, Keijo Mäkelä, Geir Hallan, Ove N. Furnes, Alma B. Pedersen, Søren Overgaard, Maziar Mohhades
Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Orthopaedics, Institute of Surgical Sciences, Uppsala University Hospital; Orthopaedics, Coxa Hospital of Joint Replacement; Orthopedics and Traumatology, Turku University Hospital; Orthopedic Surgery, Haukeland University Hospital; Clinical Medicine, University of Bergen; Clinical Epidemiology, Aarhus University Hospital; Clinical Research, University of Southern Denmark; Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg
Background: During the past years, the standard head size in THA has increased from 28 to 32mm in the Nordic countries and the use of 36mm is increasing. Registry studies have reported a reduced risk of revision with increasing head size up to 28mm but there is little evidence supporting the use of even larger heads.
Purpose / Aim of Study: To study if the transition from 28 to 32 and thereafter to 36mm heads was associated with a decreased revision risk.
Materials and Methods: 186,231 patients that had received a 28, 32 or 36mm metal on polyethylene THA due to osteoarthritis from 2003 to 2014 were analysed in the Nordic Arthroplasty Registry Association database. Median follow up was 4.5 years. A Kaplan Meier survival analysis was performed and Cox regression models were fitted to estimate the hazard ratios (HR) with 95% confidence interval (CI) between the three head size groups using revision for any reason and due to dislocation as the endpoints. Adjustments were made for age, sex, year of surgery, surgical approach, fixation and type of polyethylene.
Findings / Results: The 7-year THA survival with revision for any reason as the endpoint was similar for 28mm (96.4% [CI 96.2-96.6]) and 32mm (96.2% [CI 96.0-96.5]) but lower for 36mm (95.3% [CI 94.8-95.8]) heads. The HR was 1.06 (CI 0.97- 1.16) for 28mm and 1.14 (CI 1.04-1.26) for 36mm compared to 32mm. The 7-year THA survival setting revision due to dislocation as the endpoint was 99.2% (CI 99.1-99.3) for 32mm heads. It was lower for 28 mm (99.0% [CI 98.9-99.1]) and similar for 36mm (98.8% [CI 98.5-99.2]). The HR was 1.67 (CI 1.38- 1.98) for 28mm and 0.85 (CI 0.70-1.02) for 36mm compared to 32mm.
Conclusions: The transition from 28 to 32mm heads in THA was associated with a decreased risk of revision due to dislocation. However, 36mm heads were associated with an increased risk of THA revision compared to 32 mm.
Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Orthopaedics, Institute of Surgical Sciences, Uppsala University Hospital; Orthopaedics, Coxa Hospital of Joint Replacement; Orthopedics and Traumatology, Turku University Hospital; Orthopedic Surgery, Haukeland University Hospital; Clinical Medicine, University of Bergen; Clinical Epidemiology, Aarhus University Hospital; Clinical Research, University of Southern Denmark; Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg
Background: During the past years, the standard head size in THA has increased from 28 to 32mm in the Nordic countries and the use of 36mm is increasing. Registry studies have reported a reduced risk of revision with increasing head size up to 28mm but there is little evidence supporting the use of even larger heads.
Purpose / Aim of Study: To study if the transition from 28 to 32 and thereafter to 36mm heads was associated with a decreased revision risk.
Materials and Methods: 186,231 patients that had received a 28, 32 or 36mm metal on polyethylene THA due to osteoarthritis from 2003 to 2014 were analysed in the Nordic Arthroplasty Registry Association database. Median follow up was 4.5 years. A Kaplan Meier survival analysis was performed and Cox regression models were fitted to estimate the hazard ratios (HR) with 95% confidence interval (CI) between the three head size groups using revision for any reason and due to dislocation as the endpoints. Adjustments were made for age, sex, year of surgery, surgical approach, fixation and type of polyethylene.
Findings / Results: The 7-year THA survival with revision for any reason as the endpoint was similar for 28mm (96.4% [CI 96.2-96.6]) and 32mm (96.2% [CI 96.0-96.5]) but lower for 36mm (95.3% [CI 94.8-95.8]) heads. The HR was 1.06 (CI 0.97- 1.16) for 28mm and 1.14 (CI 1.04-1.26) for 36mm compared to 32mm. The 7-year THA survival setting revision due to dislocation as the endpoint was 99.2% (CI 99.1-99.3) for 32mm heads. It was lower for 28 mm (99.0% [CI 98.9-99.1]) and similar for 36mm (98.8% [CI 98.5-99.2]). The HR was 1.67 (CI 1.38- 1.98) for 28mm and 0.85 (CI 0.70-1.02) for 36mm compared to 32mm.
Conclusions: The transition from 28 to 32mm heads in THA was associated with a decreased risk of revision due to dislocation. However, 36mm heads were associated with an increased risk of THA revision compared to 32 mm.