Session 13: Hip II
Fredag d. 26. oktober
09:00-10:30
Lokale: Stockholm/Copenhagen
Chairmen: Claus Varnum og Morten Bøgehøj
Stig Storgaard Jakobsen, Otto Kraemer, Bjarne Mygind-Klavsen
Department of Orthopedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Sports Orthopaedic Research Center – Copenhagen, Copenhagen University Hospital, Amager-Hvidovre, Denmark; Department of Orthopedic Surgery, Aarhus University Hospital
Background: Measurement of the Lateral (Wiberg) Center Edge Angle (LCE) is mandatory before planning treatment of both dysplastic and non-dysplastic patients with hip joint related pathologies. LCE measurement from a weight bearing antero-posterior (AP) pelvis x-ray is uncertain due to different factors such as interobserver variability and different methods of measurement of the angle.
Purpose / Aim of Study: The purpose of this short-form clinical guideline was to describe the mean interobserver variability of LCE measurement and establish “Good Clinical Practice” when measuring LCE.
Materials and Methods: A systematic search on PubMed and Embase was conducted and all references was analyzed for potentially eligible studies. Observer agreement and LCE measurement method was noted. Studies with no clear definition of LCE measurement method, non-weight bearing AP pelvis, only one observer and no Intra Class Correlation (ICC) between observers was excluded.
Findings / Results: Six observational studies were included, no randomized controlled studies were identified. The mean ICC between observers was 0.76 demonstrating a good or excellent agreement of the measuring method. Furthermore, two studies demonstrated mean differences in LCE- angle measurements between -2.3 and +3.7 (SD -3.2 - +3.8).
Conclusions: Despite the low evidence in accuracy of measuring LCE-angle it is recommended as “Good Clinical Practise” to measure the angle on weight bearing AP pelvis and to the lateral sourcil as described by Wiberg before planning surgical treatment of intraarticular hip pathologies. Surgeons need to be aware of +/- 3 degrees inaccuracy in measuring the LCE-angle.
Department of Orthopedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Sports Orthopaedic Research Center – Copenhagen, Copenhagen University Hospital, Amager-Hvidovre, Denmark; Department of Orthopedic Surgery, Aarhus University Hospital
Background: Measurement of the Lateral (Wiberg) Center Edge Angle (LCE) is mandatory before planning treatment of both dysplastic and non-dysplastic patients with hip joint related pathologies. LCE measurement from a weight bearing antero-posterior (AP) pelvis x-ray is uncertain due to different factors such as interobserver variability and different methods of measurement of the angle.
Purpose / Aim of Study: The purpose of this short-form clinical guideline was to describe the mean interobserver variability of LCE measurement and establish “Good Clinical Practice” when measuring LCE.
Materials and Methods: A systematic search on PubMed and Embase was conducted and all references was analyzed for potentially eligible studies. Observer agreement and LCE measurement method was noted. Studies with no clear definition of LCE measurement method, non-weight bearing AP pelvis, only one observer and no Intra Class Correlation (ICC) between observers was excluded.
Findings / Results: Six observational studies were included, no randomized controlled studies were identified. The mean ICC between observers was 0.76 demonstrating a good or excellent agreement of the measuring method. Furthermore, two studies demonstrated mean differences in LCE- angle measurements between -2.3 and +3.7 (SD -3.2 - +3.8).
Conclusions: Despite the low evidence in accuracy of measuring LCE-angle it is recommended as “Good Clinical Practise” to measure the angle on weight bearing AP pelvis and to the lateral sourcil as described by Wiberg before planning surgical treatment of intraarticular hip pathologies. Surgeons need to be aware of +/- 3 degrees inaccuracy in measuring the LCE-angle.
Julie Sandell Jacobsen, Kristian Thorborg, Per Hölmich, Lars Bolvig, Stig Storgaard Jakobsen, Kjeld Søballe, Inger Mechlenburg,
Department of Physiotherapy, Faculty of Health Sciences, VIA University College; Sports Orthopaedic Research Center-Copenhagen (SORC-C) , Copenhagen University Hospital, Amager-Hvidovre; Sports Orthopaedic Research Center-Copenhagen (SORC-C) , Copenhagen University Hospital, Amager-Hvidovre; Department of Radiology, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital; Centre of Research in Rehabilitation (CORIR), Institute of Clinical Medicine, Aarhus University ; ,
Background: Knowledge of physical activity profile among patients with hip dysplasia is lacking.
Purpose / Aim of Study: The aim of this study was to test if patients with hip dysplasia change the physical activity profile from before to 1 year after periacetabular osteotomy (PAO), measured by accelerometer-based sensors and self-reported physical activity. Furthermore, to estimate associations between change in accelerometer-based physical activity and change in self- reported ability to participate in preferred physical activities (PA).
Materials and Methods: Physical activity was objectively measured with accelerometer-based sensors, and self-reported PA was recorded with Copenhagen Hip and Groin Outcome Score (HAGOS) in 77 patients with hip dysplasia. Associations between accelerometer- based physical activity and self-reported PA was analyzed with linear regression analysis.
Findings / Results: Accelerometer-based measures showed that the percentage of time spent on physical activities at very low, low, moderate and high intensity levels remained unchanged 1 year post surgery compared to pre surgery (changes from 0.3% (95% CI -0.1; 0.8) to -1.6% (95% CI -4.1; 0.9), p>0.164). In contrast, self-reported PA increased 1 year post surgery compared to pre surgery (22 (95% CI 14; 29) HAGOS PA points, p<0.001). No association between accelerometer-based physical activity and self-reported PA was found (p>0.30).
Conclusions: Patients with hip dysplasia do not seem to change their physical activity profile 1 year after PAO if measured with objective accelerometer-based sensors. This is interesting since self-reported PA indicates that patients’ ability to participate in physical activity is increased; suggesting that this increased participatory capacity is not manifested as an increase in objectively measured physical activity.
Department of Physiotherapy, Faculty of Health Sciences, VIA University College; Sports Orthopaedic Research Center-Copenhagen (SORC-C) , Copenhagen University Hospital, Amager-Hvidovre; Sports Orthopaedic Research Center-Copenhagen (SORC-C) , Copenhagen University Hospital, Amager-Hvidovre; Department of Radiology, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital; Centre of Research in Rehabilitation (CORIR), Institute of Clinical Medicine, Aarhus University ; ,
Background: Knowledge of physical activity profile among patients with hip dysplasia is lacking.
Purpose / Aim of Study: The aim of this study was to test if patients with hip dysplasia change the physical activity profile from before to 1 year after periacetabular osteotomy (PAO), measured by accelerometer-based sensors and self-reported physical activity. Furthermore, to estimate associations between change in accelerometer-based physical activity and change in self- reported ability to participate in preferred physical activities (PA).
Materials and Methods: Physical activity was objectively measured with accelerometer-based sensors, and self-reported PA was recorded with Copenhagen Hip and Groin Outcome Score (HAGOS) in 77 patients with hip dysplasia. Associations between accelerometer- based physical activity and self-reported PA was analyzed with linear regression analysis.
Findings / Results: Accelerometer-based measures showed that the percentage of time spent on physical activities at very low, low, moderate and high intensity levels remained unchanged 1 year post surgery compared to pre surgery (changes from 0.3% (95% CI -0.1; 0.8) to -1.6% (95% CI -4.1; 0.9), p>0.164). In contrast, self-reported PA increased 1 year post surgery compared to pre surgery (22 (95% CI 14; 29) HAGOS PA points, p<0.001). No association between accelerometer-based physical activity and self-reported PA was found (p>0.30).
Conclusions: Patients with hip dysplasia do not seem to change their physical activity profile 1 year after PAO if measured with objective accelerometer-based sensors. This is interesting since self-reported PA indicates that patients’ ability to participate in physical activity is increased; suggesting that this increased participatory capacity is not manifested as an increase in objectively measured physical activity.
Julie Boje, Christina Krogner Caspersen, Stig Storgaard Jakobsen, Kjeld Søballe, Inger Mechlenburg
Department of Orthopaedic Surgery, Aarhus University Hospital, Denmark; Department of Orthopaedic Surgery, Aarhus University Hospital, Denmark; Department of Orthopaedic Surgery, Aarhus University Hospital, Denmark; Department of Orthopaedic Surgery, Aarhus University Hospital, Denmark; Department of Orthopaedic Surgery, Aarhus University Hospital, Denmark
Background: Symptomatic hip dysplasia is primarily treated surgically with periacetabular osteotomy (PAO). It is unclear whether changes in quality of life (QoL) and changes in hip function follow the same pattern of improvement as pain after PAO.
Purpose / Aim of Study: To investigate whether changes in pain are associated to changes in QoL and to changes in hip function 2 years after PAO. Furthermore, to examine patient satisfaction 2 year after PAO.
Materials and Methods: This is a follow-up study with prospectively collected data from the PAO database at Aarhus University Hospital. Pain was measured with Visuel Analog Skala (VAS), QoL with Short-Form 36 (SF-36) and hip function with Hip disability and Osteoarthritis Outcome Score (HOOS) preoperatively and 2 years after PAO by 321 patients. Multiple linear regressions were applied.
Findings / Results: Significant mean improvements in pain, QoL and hip function were found (p<0.05). Significant associations between “changes in pain” and respectively “changes in the physical component of QoL” and “changes in hip function” were found (p<0.05). A non- significant association between “changes in pain” and “changes in the mental component of QoL” was found (p=0.13). The majority of patients reported satisfaction and 84% would undergo PAO if they knew their result in advance. The study had a loss to follow-up of 26%.
Conclusions: Decreased pain is associated with increased QoL and with improved hip function 2 years after PAO. A non-significant association between decreased pain and increased mental component of QoL was found. Patients were in general satisfied with treatment and result 2 years after PAO.
Department of Orthopaedic Surgery, Aarhus University Hospital, Denmark; Department of Orthopaedic Surgery, Aarhus University Hospital, Denmark; Department of Orthopaedic Surgery, Aarhus University Hospital, Denmark; Department of Orthopaedic Surgery, Aarhus University Hospital, Denmark; Department of Orthopaedic Surgery, Aarhus University Hospital, Denmark
Background: Symptomatic hip dysplasia is primarily treated surgically with periacetabular osteotomy (PAO). It is unclear whether changes in quality of life (QoL) and changes in hip function follow the same pattern of improvement as pain after PAO.
Purpose / Aim of Study: To investigate whether changes in pain are associated to changes in QoL and to changes in hip function 2 years after PAO. Furthermore, to examine patient satisfaction 2 year after PAO.
Materials and Methods: This is a follow-up study with prospectively collected data from the PAO database at Aarhus University Hospital. Pain was measured with Visuel Analog Skala (VAS), QoL with Short-Form 36 (SF-36) and hip function with Hip disability and Osteoarthritis Outcome Score (HOOS) preoperatively and 2 years after PAO by 321 patients. Multiple linear regressions were applied.
Findings / Results: Significant mean improvements in pain, QoL and hip function were found (p<0.05). Significant associations between “changes in pain” and respectively “changes in the physical component of QoL” and “changes in hip function” were found (p<0.05). A non- significant association between “changes in pain” and “changes in the mental component of QoL” was found (p=0.13). The majority of patients reported satisfaction and 84% would undergo PAO if they knew their result in advance. The study had a loss to follow-up of 26%.
Conclusions: Decreased pain is associated with increased QoL and with improved hip function 2 years after PAO. A non-significant association between decreased pain and increased mental component of QoL was found. Patients were in general satisfied with treatment and result 2 years after PAO.
Julie Sandell Jacobsen, Kjeld Søballe, Kristian Thorborg, Lars Bolvig, Stig Storgaard Jakobsen, Per Hölmich, Inger Mechlenburg
Department of Physiotherapy, Faculty of Health Sciences, VIA University College; Department of Orthopaedic Surgery, Aarhus University Hospital; Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre; Department of Radiology, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital; Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre; Centre of Research in Rehabilitation (CORIR), Institute of Clinical Medicine, Aarhus University
Background: Hip dysplasia is traditionally considered a joint disease, where periacetabular osteotomy (PAO) is the well-established treatment option. At present, there is a lack of larger prospective studies investigating PAO with patient-reported measures developed for young patients.
Purpose / Aim of Study: The aim of this paper was prospectively to describe patient-reported outcome from before to 1 year after PAO; differences in muscle-tendon pain; and estimated associations between changes in patient- reported outcome and changes in muscle-tendon pain.
Materials and Methods: In a cohort of 82 patients, outcome after PAO was investigated with the Copenhagen Hip and Groin Outcome Score (HAGOS); muscle-tendon pain in the hip and groin region was identified with standardized clinical tests; while associations between the two were analysed with multivariable linear regressions.
Findings / Results: HAGOS subscales improved from before to 1 year after PAO (p<0.001) with medium to very large effect sizes (0.66-1.37). Muscle-tendon pain in the hip and groin region decreased from 74% (CI 64; 83) before PAO to 35% (CI 25; 47) 1 year after PAO (p<0.001). Significant associations were observed between change in HAGOS and change in muscle-tendon pain ranging from -4.7 (CI -8.4; -1.0) HAGOS points to -8.2 (CI -13.1; -3.3) HAGOS points (p<0.021).
Conclusions: PAO results in medium to very large patient-reported improvements 1 year after PAO; but compared with healthy subjects; self-reported hip function is low and negatively affected by muscle-tendon pain. We should therefore reconsider the traditional understanding of hip dysplasia as solely a joint disease, and address the role of muscle-tendon pain.
Department of Physiotherapy, Faculty of Health Sciences, VIA University College; Department of Orthopaedic Surgery, Aarhus University Hospital; Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre; Department of Radiology, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital; Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre; Centre of Research in Rehabilitation (CORIR), Institute of Clinical Medicine, Aarhus University
Background: Hip dysplasia is traditionally considered a joint disease, where periacetabular osteotomy (PAO) is the well-established treatment option. At present, there is a lack of larger prospective studies investigating PAO with patient-reported measures developed for young patients.
Purpose / Aim of Study: The aim of this paper was prospectively to describe patient-reported outcome from before to 1 year after PAO; differences in muscle-tendon pain; and estimated associations between changes in patient- reported outcome and changes in muscle-tendon pain.
Materials and Methods: In a cohort of 82 patients, outcome after PAO was investigated with the Copenhagen Hip and Groin Outcome Score (HAGOS); muscle-tendon pain in the hip and groin region was identified with standardized clinical tests; while associations between the two were analysed with multivariable linear regressions.
Findings / Results: HAGOS subscales improved from before to 1 year after PAO (p<0.001) with medium to very large effect sizes (0.66-1.37). Muscle-tendon pain in the hip and groin region decreased from 74% (CI 64; 83) before PAO to 35% (CI 25; 47) 1 year after PAO (p<0.001). Significant associations were observed between change in HAGOS and change in muscle-tendon pain ranging from -4.7 (CI -8.4; -1.0) HAGOS points to -8.2 (CI -13.1; -3.3) HAGOS points (p<0.021).
Conclusions: PAO results in medium to very large patient-reported improvements 1 year after PAO; but compared with healthy subjects; self-reported hip function is low and negatively affected by muscle-tendon pain. We should therefore reconsider the traditional understanding of hip dysplasia as solely a joint disease, and address the role of muscle-tendon pain.
Kristine Hjermitslev Lassen, Per Hviid Gundtoft, Søren Overgaard
Orthopedic surgery, Esbjerg Hospital; Orthopedic surgery, Kolding Hospital; Orthopedic surgery and Traumatology/Department of clinical research, Odense University Hospital/University of Southern Denmark
Background: Custom made femoral components for total hip arthroplasty (THA) have been developed in order to treat patients with anatomical abnormalities. CT 3D customized stems have shown to be the most precise method of production. Previous studies have shown good results with comparable revision rates to conventional stems. Limitations of these studies are that they have included cases with normal anatomy and are from a few clinics.
Purpose / Aim of Study: Our aim of this study was to evaluate the revision risk of cases with a custom made femoral stem.
Materials and Methods: Data was extracted from The Danish Hip Arthroplasty Registry from Jan 1st 2000 to Dec 31st 2017. All patients who received the Unique custom made femoral stem was identified and each case was matched on age and sex with 5 control cases with uncemented THA with components from Zimmer Biomet. The primary outcome was revision rate due to any cause of the Unique stem. The relative risk of revision was estimated with cox proportional hazard model.
Findings / Results: A total of 30 cases with the Unique prosthesis was identified and matched with 150 cases in the control group. In the Unique group 2 (6.7%) of 30 cases had a revision performed at 9 days and at 5 years postoperative, respectively. In the matched control group 12 (8%) of the 150 cases had undergone revision. The relative risk of revision was estimated to be 0.94 (CI 95%: 0,20; 4,29) for the Unique prosthesis compared to the uncemented THA.
Conclusions: We found low revision rate of the unique prosthesis with no significant difference in revision rate between patients receiving the custom made stem and a standard population group. It seems that a custom made stem is a good solution in patients with large anatomical abnormalities.
Orthopedic surgery, Esbjerg Hospital; Orthopedic surgery, Kolding Hospital; Orthopedic surgery and Traumatology/Department of clinical research, Odense University Hospital/University of Southern Denmark
Background: Custom made femoral components for total hip arthroplasty (THA) have been developed in order to treat patients with anatomical abnormalities. CT 3D customized stems have shown to be the most precise method of production. Previous studies have shown good results with comparable revision rates to conventional stems. Limitations of these studies are that they have included cases with normal anatomy and are from a few clinics.
Purpose / Aim of Study: Our aim of this study was to evaluate the revision risk of cases with a custom made femoral stem.
Materials and Methods: Data was extracted from The Danish Hip Arthroplasty Registry from Jan 1st 2000 to Dec 31st 2017. All patients who received the Unique custom made femoral stem was identified and each case was matched on age and sex with 5 control cases with uncemented THA with components from Zimmer Biomet. The primary outcome was revision rate due to any cause of the Unique stem. The relative risk of revision was estimated with cox proportional hazard model.
Findings / Results: A total of 30 cases with the Unique prosthesis was identified and matched with 150 cases in the control group. In the Unique group 2 (6.7%) of 30 cases had a revision performed at 9 days and at 5 years postoperative, respectively. In the matched control group 12 (8%) of the 150 cases had undergone revision. The relative risk of revision was estimated to be 0.94 (CI 95%: 0,20; 4,29) for the Unique prosthesis compared to the uncemented THA.
Conclusions: We found low revision rate of the unique prosthesis with no significant difference in revision rate between patients receiving the custom made stem and a standard population group. It seems that a custom made stem is a good solution in patients with large anatomical abnormalities.
Pelle Baggesgaard Petersen, Henrik Kehlet, Christoffer Calov Jørgensen
Section for Surgical Pathophysiology 7621, Rigshospitalet, University of Copenhagen; Section for Surgical Pathophysiology 7621, Rigshospitalet, University of Copenhagen; Section for Surgical Pathophysiology 7621, Rigshospitalet, University of Copenhagen
Background: Most international guidelines recommend pharmacological thromboprophylaxis after total hip and knee arthroplasty (THA/TKA) for 10 to 35 days. However, a recent cohort study on fast-track THA and TKA with early mobilization questioned the need for thromboprophylaxis after discharge when length of stay (LOS) is ≤ five days leading to changes in the official Danish recommendations.
Purpose / Aim of Study: We aimed at re-investigating the incidence of venous thromboembolism (VTE) in fast-track THA and TKA with in-hospital only thromboprophylaxis when LOS ≤ five days.
Materials and Methods: Prospective cohort study from 01 December 2011 – 30 October 2015 on elective unilateral THA/TKA with thromboprophylaxis only if length of stay (LOS) ≤5 days. Prospective information on comorbidity and complete follow-up on 90-days readmissions/mortality through the Danish National patient registry. Evaluation of discharge- and medical records in case of VTE. Patients with preoperative use of anticoagulants were excluded.
Findings / Results: Of 18,322 procedures, 17,559 (95.8%) had LOS ≤ 5 days (median 2 (IQR 2-3) days. The incidence of symptomatic VTE was 0.40 %, consisting of 28 (0.16%) pulmonary embolisms (PE) and 38 (0.22%) deep vein thrombosis (DVT) and 4 (0.02%) combined DVT and PE. There were two (0.01%) fatal PE. VTE-associated risk-factors with in-hospital only thromboprophylaxis were age > 85 years OR 3.7 (95% CI; 1.2 to 12.1, p=0.029), BMI 35 to 40 OR 2.6 (1.0 to 6.4, p=0.045) and > 40 OR 3.3 (1.0 to 10.5, p=0.047).
Conclusions: The incidence of VTE after fast-track THA and TKA with in-hospital only thromboprophylaxis is low (0.40%). Recommendations for prolonged thromboprophylaxis may be reserved for patients with LOS > five days. Further studies are required on the ideal type and duration of thromboprophylaxis in high-risk patients
Section for Surgical Pathophysiology 7621, Rigshospitalet, University of Copenhagen; Section for Surgical Pathophysiology 7621, Rigshospitalet, University of Copenhagen; Section for Surgical Pathophysiology 7621, Rigshospitalet, University of Copenhagen
Background: Most international guidelines recommend pharmacological thromboprophylaxis after total hip and knee arthroplasty (THA/TKA) for 10 to 35 days. However, a recent cohort study on fast-track THA and TKA with early mobilization questioned the need for thromboprophylaxis after discharge when length of stay (LOS) is ≤ five days leading to changes in the official Danish recommendations.
Purpose / Aim of Study: We aimed at re-investigating the incidence of venous thromboembolism (VTE) in fast-track THA and TKA with in-hospital only thromboprophylaxis when LOS ≤ five days.
Materials and Methods: Prospective cohort study from 01 December 2011 – 30 October 2015 on elective unilateral THA/TKA with thromboprophylaxis only if length of stay (LOS) ≤5 days. Prospective information on comorbidity and complete follow-up on 90-days readmissions/mortality through the Danish National patient registry. Evaluation of discharge- and medical records in case of VTE. Patients with preoperative use of anticoagulants were excluded.
Findings / Results: Of 18,322 procedures, 17,559 (95.8%) had LOS ≤ 5 days (median 2 (IQR 2-3) days. The incidence of symptomatic VTE was 0.40 %, consisting of 28 (0.16%) pulmonary embolisms (PE) and 38 (0.22%) deep vein thrombosis (DVT) and 4 (0.02%) combined DVT and PE. There were two (0.01%) fatal PE. VTE-associated risk-factors with in-hospital only thromboprophylaxis were age > 85 years OR 3.7 (95% CI; 1.2 to 12.1, p=0.029), BMI 35 to 40 OR 2.6 (1.0 to 6.4, p=0.045) and > 40 OR 3.3 (1.0 to 10.5, p=0.047).
Conclusions: The incidence of VTE after fast-track THA and TKA with in-hospital only thromboprophylaxis is low (0.40%). Recommendations for prolonged thromboprophylaxis may be reserved for patients with LOS > five days. Further studies are required on the ideal type and duration of thromboprophylaxis in high-risk patients
Alexander Dastrup, Anton Pottegård, Jesper Hallas, Søren Overgaard
Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Svendborg; 3. Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark; 3. Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital
Background: Non-steroid anti-inflammatory drugs (NSAID), a common class of analgesics, have been found to increase the risk of cardiovascular events.
Purpose / Aim of Study: Our objective was to estimate the postoperative risk of cardiovascular events and all-cause mortality after primary total hip arthroplasty (THA), in patients with different patterns of pre-surgical NSAID exposure. Our main outcome was venous thromboembolism (VTE). Secondary outcomes were deep venous thrombosis (DVT), pulmonary embolism (PE), myocardial infarction (MI), ischemic stroke and all-cause mortality.
Materials and Methods: Using the Danish Hip Arthroplasty Register, the Danish National Patient Register and the Danish National Database of Prescriptions we included a total of 65,188 primary THA patients. Propensity score matching on age, gender, year of surgery, known risk factors for cardiovascular disease, the Elixhauser Comorbidity Index and income resulted in three cohorts; 4,883 new-users, 19,169 chronic-users and 7,049 recent-users matched 1:2, 1:1 and 1:1 to non-users, respectively. Cox regression survival analysis was used to calculate hazard ratios (HR) and 95% confidence intervals (CI).
Findings / Results: New-use was associated with an increased risk of PE (HR = 2.34; 95% CI, 1.08-5.05). Chronic-use was associated with an increased risk of all-cause mortality (HR = 1.66; 95% CI, 1.11-2.48), and with a tendency of increased risk of PE (HR = 1.78; 95% CI, 0.93-3.43). Recent-use showed no statistically significant association.
Conclusions: Initiation of NSAIDs prior to primary THA is associated with an increased risk of pulmonary embolism, while chronic NSAID use is associated with an increased risk of all-cause mortality after primary THA. Recent use of NSAIDs prior to THA is not associated with an increased risk of cardiovascular events or all-cause mortality.
Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Svendborg; 3. Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark; 3. Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital
Background: Non-steroid anti-inflammatory drugs (NSAID), a common class of analgesics, have been found to increase the risk of cardiovascular events.
Purpose / Aim of Study: Our objective was to estimate the postoperative risk of cardiovascular events and all-cause mortality after primary total hip arthroplasty (THA), in patients with different patterns of pre-surgical NSAID exposure. Our main outcome was venous thromboembolism (VTE). Secondary outcomes were deep venous thrombosis (DVT), pulmonary embolism (PE), myocardial infarction (MI), ischemic stroke and all-cause mortality.
Materials and Methods: Using the Danish Hip Arthroplasty Register, the Danish National Patient Register and the Danish National Database of Prescriptions we included a total of 65,188 primary THA patients. Propensity score matching on age, gender, year of surgery, known risk factors for cardiovascular disease, the Elixhauser Comorbidity Index and income resulted in three cohorts; 4,883 new-users, 19,169 chronic-users and 7,049 recent-users matched 1:2, 1:1 and 1:1 to non-users, respectively. Cox regression survival analysis was used to calculate hazard ratios (HR) and 95% confidence intervals (CI).
Findings / Results: New-use was associated with an increased risk of PE (HR = 2.34; 95% CI, 1.08-5.05). Chronic-use was associated with an increased risk of all-cause mortality (HR = 1.66; 95% CI, 1.11-2.48), and with a tendency of increased risk of PE (HR = 1.78; 95% CI, 0.93-3.43). Recent-use showed no statistically significant association.
Conclusions: Initiation of NSAIDs prior to primary THA is associated with an increased risk of pulmonary embolism, while chronic NSAID use is associated with an increased risk of all-cause mortality after primary THA. Recent use of NSAIDs prior to THA is not associated with an increased risk of cardiovascular events or all-cause mortality.
Frederik Berstad Møse, Inger Mechlenburg, Charlotte Hartig-Andreasen, John Gelineck, Kjeld Søballe, Stig S. Jakobsen
Department of Orthopaedics, Örebro University Hospital; Department of Orthopaedics, Aarhus University Hospital; Department of Orthopaedics, Aarhus University Hospital; Department of Radiology, Aarhus University Hospital; Department of Orthopaedics, Aarhus University Hospital; Department of Orthopaedics, Aarhus University Hospital
Background: Labral pathology is seen in both dysplastic (CE<20) and borderline dysplastic hips (CE 20-25). The treatment of the former consists of correcting the dysplasia by periacetabular osteotomy (PAO). However, some authors have suggested that borderline dysplastic hips with concurrent labral pathology should be treated arthroscopically
Purpose / Aim of Study: The purpose of this study was to investigate the frequency of labral pathology between dysplastic and borderline dysplastic hips, whether center-edge (CE) angle is associated with labral pathology, and finally if pain and labral pathology are associated.
Materials and Methods: 99 symptomatic patients (104 hips) scheduled for PAO were examined. Five patients were excluded due to complaints from multiple joints and 4 failed to show at 2-year follow-up. 5 patients did not fill out questionnaires pre-operatively. Hips were characterized as dysplastic (CE angle<200) and borderline dysplastic (CE angle 200≤250). A Magnetic Resonance Arthrography was performed labral pathology was classified according to the Czerny classification. Association with the CE angle, the acetabular index and preoperative WOMAC pain score was tested by multiple linear regression.
Findings / Results: There was no significant difference in frequency of labral pathology when comparing the two groups. Across the cohort, 86 of 99 patients had labral pathology. The CE angle was associated with increasing severity of labral pathology whereas the AI angle and preoperative pain were not associated with labral pathology.
Conclusions: Decreased lateral coverage adversely loads the labrum, predisposing it to tears. We advocate reorienting the biomechanical forces through PAO, not arthroscopic treatment. Level of pain was not associated with labral pathology, suggesting that labral pathology may not alone explain the dysplastic pain complex.
Department of Orthopaedics, Örebro University Hospital; Department of Orthopaedics, Aarhus University Hospital; Department of Orthopaedics, Aarhus University Hospital; Department of Radiology, Aarhus University Hospital; Department of Orthopaedics, Aarhus University Hospital; Department of Orthopaedics, Aarhus University Hospital
Background: Labral pathology is seen in both dysplastic (CE<20) and borderline dysplastic hips (CE 20-25). The treatment of the former consists of correcting the dysplasia by periacetabular osteotomy (PAO). However, some authors have suggested that borderline dysplastic hips with concurrent labral pathology should be treated arthroscopically
Purpose / Aim of Study: The purpose of this study was to investigate the frequency of labral pathology between dysplastic and borderline dysplastic hips, whether center-edge (CE) angle is associated with labral pathology, and finally if pain and labral pathology are associated.
Materials and Methods: 99 symptomatic patients (104 hips) scheduled for PAO were examined. Five patients were excluded due to complaints from multiple joints and 4 failed to show at 2-year follow-up. 5 patients did not fill out questionnaires pre-operatively. Hips were characterized as dysplastic (CE angle<200) and borderline dysplastic (CE angle 200≤250). A Magnetic Resonance Arthrography was performed labral pathology was classified according to the Czerny classification. Association with the CE angle, the acetabular index and preoperative WOMAC pain score was tested by multiple linear regression.
Findings / Results: There was no significant difference in frequency of labral pathology when comparing the two groups. Across the cohort, 86 of 99 patients had labral pathology. The CE angle was associated with increasing severity of labral pathology whereas the AI angle and preoperative pain were not associated with labral pathology.
Conclusions: Decreased lateral coverage adversely loads the labrum, predisposing it to tears. We advocate reorienting the biomechanical forces through PAO, not arthroscopic treatment. Level of pain was not associated with labral pathology, suggesting that labral pathology may not alone explain the dysplastic pain complex.
Pernille Hasselbrinck Schmidt, Søren Overgaard, Per Kjærsgaard-Andersen, Claus Varnum
Section for Hip and Knee Replacement, Department of Orthopaedic Surgery, Vejle Sygehus, Sygehus Lillebælt; Orthopaedic Research Unit - Department of Clinical Research. Department of Orthopaedic Surgery and Traumatology., University of Southern Denmark. Odense University Hospital.; Section for Hip and Knee Replacement, Department of Orthopaedic Surgery, Vejle Sygehus, Sygehus Lillebælt; Section for Hip and Knee Replacement, Department of Orthopaedic Surgery, Vejle Sygehus, Sygehus Lillebælt
Background: The common problems following revision total hip arthroplasty (rTHA) include restoring offset, leg length discrepancy, and instability. To address these issues the cementless modular femoral components were developed.
Purpose / Aim of Study: We aimed to investigate the survival rate and causes for a second revision in patients with a cementless modular revision stem implanted during the first revision of a primary THA.
Materials and Methods: In the Danish Hip Arthroplasty Register, we identified all patients operated with a cementless modular revision stem during first revision of a THA from 1995 to 2016. Patients who had primary THA due to tumour or metastasis were excluded. All patients were followed for a minimum of 1 year. The Kaplan-Meier survival function was used to estimate the 5-year survivorship, and Cox regression adjusted for sex and age and with 95% confidence intervals (CI) was used to compare the relative risk (RR) for a second revision between different stem brands.
Findings / Results: In total, 1,908 rTHAs were included. 49% were female, and mean age was 72.2 (71.7- 72.7) years. The most frequently used stem was the ZMR (n= 638, 33%), followed by Arcos (n=382, 20%) and Profemur R (n=255, 13%). The shortest follow-up was for the ZMR XL (5.6 years), and the longest follow-up was found for the Restoration Modular (21.0 years). At 5-year follow-up was, the survival rate varied from 0.87 (0.81-0.91) for the Reach to 0.95 (0.88- 0.98) for the ZMR XL. The adjusted RR for any second revision was similar for the 5 brands used in more than 100 cases and the group of “others” compared to the ZMR. There was 167 second revisions (8.6%), and most frequent cause was dislocation (n=45) followed by infection (n=34).
Conclusions: We found similar survival and risk of second revision for all brands of cementless modular revision stems.
Section for Hip and Knee Replacement, Department of Orthopaedic Surgery, Vejle Sygehus, Sygehus Lillebælt; Orthopaedic Research Unit - Department of Clinical Research. Department of Orthopaedic Surgery and Traumatology., University of Southern Denmark. Odense University Hospital.; Section for Hip and Knee Replacement, Department of Orthopaedic Surgery, Vejle Sygehus, Sygehus Lillebælt; Section for Hip and Knee Replacement, Department of Orthopaedic Surgery, Vejle Sygehus, Sygehus Lillebælt
Background: The common problems following revision total hip arthroplasty (rTHA) include restoring offset, leg length discrepancy, and instability. To address these issues the cementless modular femoral components were developed.
Purpose / Aim of Study: We aimed to investigate the survival rate and causes for a second revision in patients with a cementless modular revision stem implanted during the first revision of a primary THA.
Materials and Methods: In the Danish Hip Arthroplasty Register, we identified all patients operated with a cementless modular revision stem during first revision of a THA from 1995 to 2016. Patients who had primary THA due to tumour or metastasis were excluded. All patients were followed for a minimum of 1 year. The Kaplan-Meier survival function was used to estimate the 5-year survivorship, and Cox regression adjusted for sex and age and with 95% confidence intervals (CI) was used to compare the relative risk (RR) for a second revision between different stem brands.
Findings / Results: In total, 1,908 rTHAs were included. 49% were female, and mean age was 72.2 (71.7- 72.7) years. The most frequently used stem was the ZMR (n= 638, 33%), followed by Arcos (n=382, 20%) and Profemur R (n=255, 13%). The shortest follow-up was for the ZMR XL (5.6 years), and the longest follow-up was found for the Restoration Modular (21.0 years). At 5-year follow-up was, the survival rate varied from 0.87 (0.81-0.91) for the Reach to 0.95 (0.88- 0.98) for the ZMR XL. The adjusted RR for any second revision was similar for the 5 brands used in more than 100 cases and the group of “others” compared to the ZMR. There was 167 second revisions (8.6%), and most frequent cause was dislocation (n=45) followed by infection (n=34).
Conclusions: We found similar survival and risk of second revision for all brands of cementless modular revision stems.
Pelle Baggesgaard Petersen, Henrik Kehlet, Christoffer Calov Jørgensen
Section for Surgical Pathophysiology 7621, Rigshospitalet, University of Copenhagen; Section for Surgical Pathophysiology 7621, Rigshospitalet, University of Copenhagen; Section for Surgical Pathophysiology 7621, Rigshospitalet, University of Copenhagen
Background: Postoperative stroke is a severe complication with a reported 30 days incidence of 0.4%–0.6% after total hip (THA) and knee arthroplasty (TKA). However, most data are based on diagnostic codes and with limited details on perioperative care, including the use of fast-track protocols.
Purpose / Aim of Study: To investigate incidence, risk-factors, and potential perioperative events leading to postoperative stroke.
Materials and Methods: Cohort study in consecutive unselected elective primary fast-track THA and TKA. Prospective collection of information on comorbidity and complete 90-days follow-up through the Danish Patient Registry. Medical records were evaluated for events potentially disposing to the stroke. Univariate logistic regression was used to identify preoperative risk factors. Incidence of stroke was compared with a Danish background population.
Findings / Results: Of 24,863 procedures with a median length of stay of 2 (IQR; 2-3) days, we found 27 (0.11%) and 43 (0.17%) strokes within 30 and 90 days after surgery, respectively. 90-days mortality in stroke patients was 14%. Risk factors for stroke ≤ 30 days were; age ≥ 85 years (OR: 4.3; 95%CI: 1.0-18.1), anaemia (2.6; 1.2-5.7), hypercholesterolemia (3.1;1.4-6.9), hypertension (3.1; 1.3-7.4), cardiovascular disease (2.8; 1.2-6.4), anticoagulant treatment (3.4; 1.5-7.5), and alcohol consumption >2 units/day (2.8; 1.1-7.5). Eight (29.6%) strokes ≤ 30 days were preceded by a cardiovascular event within the 2nd postoperative day. Incidence of stroke after the 30th postoperative day was similar to a Danish background population
Conclusions: 30-day incidence of postoperative stroke in fast- track THA and TKA was 0.11%. This might be further reduced with increased focus on avoiding perioperative cardiovascular events, treatment of anaemia, and by focusing on patients with preoperative anticoagulants.
Section for Surgical Pathophysiology 7621, Rigshospitalet, University of Copenhagen; Section for Surgical Pathophysiology 7621, Rigshospitalet, University of Copenhagen; Section for Surgical Pathophysiology 7621, Rigshospitalet, University of Copenhagen
Background: Postoperative stroke is a severe complication with a reported 30 days incidence of 0.4%–0.6% after total hip (THA) and knee arthroplasty (TKA). However, most data are based on diagnostic codes and with limited details on perioperative care, including the use of fast-track protocols.
Purpose / Aim of Study: To investigate incidence, risk-factors, and potential perioperative events leading to postoperative stroke.
Materials and Methods: Cohort study in consecutive unselected elective primary fast-track THA and TKA. Prospective collection of information on comorbidity and complete 90-days follow-up through the Danish Patient Registry. Medical records were evaluated for events potentially disposing to the stroke. Univariate logistic regression was used to identify preoperative risk factors. Incidence of stroke was compared with a Danish background population.
Findings / Results: Of 24,863 procedures with a median length of stay of 2 (IQR; 2-3) days, we found 27 (0.11%) and 43 (0.17%) strokes within 30 and 90 days after surgery, respectively. 90-days mortality in stroke patients was 14%. Risk factors for stroke ≤ 30 days were; age ≥ 85 years (OR: 4.3; 95%CI: 1.0-18.1), anaemia (2.6; 1.2-5.7), hypercholesterolemia (3.1;1.4-6.9), hypertension (3.1; 1.3-7.4), cardiovascular disease (2.8; 1.2-6.4), anticoagulant treatment (3.4; 1.5-7.5), and alcohol consumption >2 units/day (2.8; 1.1-7.5). Eight (29.6%) strokes ≤ 30 days were preceded by a cardiovascular event within the 2nd postoperative day. Incidence of stroke after the 30th postoperative day was similar to a Danish background population
Conclusions: 30-day incidence of postoperative stroke in fast- track THA and TKA was 0.11%. This might be further reduced with increased focus on avoiding perioperative cardiovascular events, treatment of anaemia, and by focusing on patients with preoperative anticoagulants.