Session 11: DOS Best
Papers
Torsdag d. 25. oktober
15:50-17:00
Lokale: Stockholm/Copenhagen/Helsinki/Oslo
Chairmen: Ole Rahbek og Stig Brorson
79. Efficacy of early controlled motion of the ankle compared with no motion in non-operative treatment of patients with an acute Achilles tendon rupture. An assessor blinded randomized controlled trial.
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.
80. Combination of physical strength training and local corticosteroid injection is superior to each of these separately in treatment of plantar fasciitis: A randomized controlled trial.
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.
81. Does PTH after non-instrumented spinal fusion surgery improve fusion outcomes in elderly patients compared to placebo in patients with degenerative lumbar spondylolisthesis?
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.
82. Functional outcome after repair of the pronator quadratus muscle in volar locked plating of distal radius fractures. A randomised clinical trial.
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.
83. Fixation and functional outcomes of Exceed cups with porous compared to electrochemically applied hydroxyapatite coating (BoneMaster). A randomized clinical radiostereometry study
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.
84. Does the DRUJ regain stability after foveal reinsertion of the TFCC compared to reconstruction of the TFCC?
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.
85. The Risk of Revision after Metal on Polyethylene Total Hip Arthroplasty performed with 28, 32 and 36 mm heads. An analysis of 186,231 procedures in the Nordic Arthroplasty Registry Association.
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.