Session 2: Best Poster

Bjørn Borsøe Christensen, Casper Bindzus Foldager, Morten Lykke Olesen, Jonas Jensen, Martin Lind
Orthopedics, Horsens Regional Hospital; Orthopedics, Aarhus University Hospital; Orthopedics, Hospital of Southern Jutland; Radiology, Aarhus University Hospital; Orthopedics, Aarhus University Hospital


Background: Osteochondral defects are frequent and difficult to treat. There are numerous available treatment methods, but no gold standard treatment has been established. We present 5-year data on a one-step, autologous bone and articular cartilage chips transplantation, Autologous Dual-Tissue Transplantation (ADTT). ADTT is an easily applicable, low-cost treatment option for osteochondral repair.
Purpose / Aim of Study: To investigate the long-term subjective and functional clinical outcome of ADTT.
Materials and Methods: Eight patients (age 32 ± 7.5 years) suffering from osteochondritis dissecans (OCD) in the knee were enrolled. The OCD lesion was debrided filled with bone and particulated cartilage biopsies, and fixed with fibrin glue. Evaluation was performed using patient reported outcome scores preoperatively and at 1, 2 and 5 years postoperative. MRI and CT was used for evaluation pre-operatively and at one year.
Findings / Results: The IKDC score increased from 35.9 to 68.1, 75.4 and 78.2 after 1, 2 and 5 years, respectively (p<0.01). The Tegner score improved from 2.5 to 4.7, 5.1 and 5.1 at 1, 2 and 5 years (p<0.05). KOOS subscores Sport/rec, and quality of life improved at one year and the improvements persisted at two and five years (p<0.05). KOOS pain improved after 5 years (p<0.01). Cartilage tissue repair evaluated using MOCART score improved from 22.5 to 52.5 at one year (p<0.01). CT imaging demonstrated very good subchondral bone healing with all 8 patients having a bone filling of >80% at one year.
Conclusions: Treatment of OCD with ADTT resulted in very good subchondral bone restoration and good cartilage repair. Significant improvements in patient reported outcome was found at 1 year postoperative and the improvements persisted at two and five years. This study suggests ADTT as a promising, low-cost, treatment for osteochondral injuries.

Hanne Hornshøj, Carsten Juhl, Thomas Lind, Sara Svanholm
Department of Occupational and Physical Therapy, Copenhagen University Hospital, Herlev and Gentofte; Department of Occupational and Physical Therapy, Copenhagen University Hospital, Herlev and Gentofte; Department of Orthopaedic Surgery, Copenhagen University Hospital, Herlev and Gentofte Hospital; Department of Orthopaedic Surgery, Copenhagen University Hospital, Herlev and Gentofte Hospital


Background: Post-operative joint stiffness is a common complication to total knee arthroplasty (TKA) and the leading cause of manipulation under anaesthesia (MUA).
Purpose / Aim of Study: The aim was to estimate the impact of modifiable risk factors for MUA (i.e. postoperative flection and extension in the knee at discharge).
Materials and Methods: Patients received TKA at Gentofte Hospital due to osteoarthritis and were readmitted to MUA due to reduced ROM were included. A retrospective case-control study was conducted, where cases received MUA at Gentofte Hospital from January 2011 to December 2015. Controls were up to 4 random selected patients operated the same day as the TKA. The oddsratio (OR) of MUA was calculated for patient characteristic and pre-defined risk factor. Continuous variables were dichotomized according to previous studies; age at 65 years, BMI at 30 and ROM at 90 degrees flexion and at 5 degree extension deficit. Postoperative pain was dichotomized at 5. Data were analysed using an univariate and multivariate logistic regression analysis (adjusted for age, gender, BMI, type of surgery, comorbidity, post-operative extension and flexion, post-operative pain at rest and activity)
Findings / Results: Preoperative deficit in ROM, extension and flection did not significantly increase odds for MUA (OR = 1.39 (95% CI: 0.77; 2.51 and 1.95 (0.85; 4.46) respectively. However, reduced post-operative extension and flexion increased odds of MUA (OR = 4.36 (1.66; 11.44 and2.00 (1.04; 3.85)) respectively, after adjusting for postoperative pain at rest and activity. Additionally, adjusted for postoperative ROM, postoperative pain at rest (OR = 1.64 (0.58; 4.63)) and activity (OR = 1.67 (0.93; 3.0)) did not increase odds of MUA
Conclusions: Reduced post-operative ROM especially reduced extension is an independent risk factor for MUA.

Stine Bakkensen Bruun, Irene Petersen, Nickolaj Risbo Kristensen, Deirdre Cronin-Fenton, Alma Becic Pedersen
Department of Clinical Epidemiology, Aarhus University Hospital; Department of Primary Care and Population Health, University College London; Department of Clinical Epidemiology, Aarhus University Hospital; Department of Clinical Epidemiology, Aarhus University Hospital; Department of Clinical Epidemiology, Aarhus University Hospital


Background: Prescription medication use is common in elderly hip fracture patients. It is unknown whether selective serotonin reuptake inhibitor (SSRI) use is associated with adverse outcomes after hip fracture surgery.
Purpose / Aim of Study: To examine the association between SSRI use and mortality, postoperative complications, and quality of care in hip fracture patients.
Materials and Methods: We conducted a cohort study using Danish medical databases to identify hip fracture patients aged 65 years or older during 2006- 2016. Using Cox and Poisson regression, we estimated crude and adjusted hazard ratios (HR) for mortality and postoperative complications and relative risks (RR) for fulfilment of process performance measures with 95% confidence intervals (CI) comparing current and former SSRI users with non- users.
Findings / Results: Among 68,487 patients, 19% redeemed one SSRI prescription 90 days prior to surgery. The HR for 30-day mortality was 1.16 (CI 1.10-1.21) in current and 1.15 (CI 1.04-1.27) in former SSRI users compared with non- users. The HR for any readmission was 1.11 (CI 1.02-1.20) in current and 1.13 (CI 1.01- 1.27) in former SSRI users and for any reoperation 1.21 (CI 1.11-1.31) in current and 1.04 (CI 0.84-1.28) in former SSRI users compared with non-users. The risk of venous thromboembolism, myocardial infarction, stroke, and bleeding were similar irrespective of SSRI use. There was no association between SSRI use and quality of care.
Conclusions: In patients undergoing hip fracture surgery, 30-day mortality and overall readmission risk were elevated in both current and former SSRI users compared with non-users. Those currently using SSRI had a 26% increased reoperation risk compared with non-users. However, SSRI use was not associated with increased risk of other postoperative complications and lower quality of in-hospital care.

Mette Garval, Søren Thorgaard Skou, Carsten Holm, Helle Kjær Hvidtfeldt, Lone Ramer Mikkelsen
Department of physiotherapy, Elective Surgery Centre, Silkeborg Regional Hospital; Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals , Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark; Elective Surgery Centre, Silkeborg Regional Hospital; Elective Surgery Centre, Silkeborg Regional Hospital; Interdisciplinary Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital , Department of Clinical Medicine, Aarhus University


Background: Pain intensity and knee range of motion (ROM) early after total knee replacement (TKR) surgery is known to influence long- term outcomes. It is therefore important to determine individual risk factors for high pain and reduced ROM in order to identify high-risk patients before surgery.
Purpose / Aim of Study: The aim was to determine predictors of pain and knee ROM two weeks after TKR- surgery.
Materials and Methods: Patients scheduled for primary unilateral TKR were consecutively recruited from one orthopedic clinic. Possible predictors were identified by a systematic literature review and comprised of age, sex, BMI, Oxford Knee Score, General Self-Efficacy Scale, pain intensity in activity on a Visual Analog Scale (VAS), use of pain medication and ROM. Outcomes were pain intensity and ROM measured two weeks after TKR. We performed univariate and multiple linear regression analyses to identify predictors of short-term recovery after TKR.
Findings / Results: Overall, 114 patients were recruited. Two weeks after TKR, mean pain intensity was generally low at rest (VAS 1.9 [SD=1,5]) cm) and moderate in activity (VAS 4.3 [SD=2,3] cm). On average patients had 104° (SD=11) of knee flexion and median 4° (range 0-16) in knee extension deficit. Pre-operative use of opioids was a significant predictor of higher VAS score in activity (β = 2.36 [95%CI= 0.64;4.09]) and pre-operatively extension deficit was a significant predictor of worse knee extension (β=1.82 [95%CI=0.15;3.50]) two weeks after TKR.
Conclusions: Pre-operative use of opioids and extension deficits are significant predictors of worse outcome two weeks after TKR. The findings highlight the importance of evaluating indications for pre-operative medication usage and suggest it may be important to maximize range of extension before surgery.

Amalie H Simoni, Lone Nikolajsen, Anne E Olesen, Christian F Christiansen, Alma B Pedersen
Mech-Sense, Department of Gastroenterology & Hepatology, , Aalborg University Hospital; Department of Anesthesiology and Intensive Care, , Aarhus University Hospital,; Mech-Sense, Department of Gastroenterology & Hepatology, , Aalborg University Hospital; Department of Clinical Epidemiology,, Aarhus University Hospital; Department of Clinical Epidemiology,, Aarhus University Hospital


Background: Little is known about opioid use before and after hip fracture surgery.
Purpose / Aim of Study: The aim of the present study was to examine opioid use within a year after hip fracture surgery in patients with and without pre-surgery opioid use.
Materials and Methods: A population-based study was conducted including all primary hip fracture patients (aged ≥65) in Denmark (2005-2015). Data from the Danish Multidisciplinary Hip Fracture Database were linked to opioid prescriptions in the Danish Health Service Prescription Database. Proportions of opioid users, based on ≥1 prescription within six- month pre-surgery or four three-month post- surgery periods (quarters), were calculated among patients who were alive on the first day in each period. Proportion differences with 95% confidence intervals were calculated for opioid users in all quarters compared to pre-surgery. Proportions were separately calculated for patients with/without pre-surgery opioid use, including initiators after first quarter.
Findings / Results: The present study included 69,456 hip fracture patients. The proportion of opioid users increased 35.0% [34.5-35.5], 7.0% [6.5-7.5], 2.9% [2.4-3.4], and 1.4%-points [0.9-1.9] in the four post-surgery quarters compared to pre- surgery. Of pre-surgery non-opioid users 54.7%, 21.8%, 17.8%, and 16.8 % were opioid users in the four quarters after surgery. However, 3.2%, 6.6%, and 8.5 % of patients in the second to fourth quarter initiated the use of opioids more than a quarter after surgery.
Conclusions: The proportion of opioid users increased substantially shortly after hip fracture surgery, but was only 1.4 %-points increased after a year. However, 16.8 % of previous non-opioid users used opioids a year after surgery.

Anne Marie Nyholm, Henrik Palm, Håkon Sandholdt, Anders Troelsen, Kirill Gromov
CORH - Ortopædkirurgisk afdeling, Hvidovre Hospital; Ortopædkirurgisk afdeling, Bispebjerg Hospital; CORH - Ortopædkirurgisk afdeling, Hvidovre Hospital; CORH - Ortopædkirurgisk afdeling, Hvidovre Hospital; CORH - Ortopædkirurgisk afdeling, Hvidovre Hospital


Background: Optimal treatment of displaces femoral neck fractures (d-FNF) has been debated and primary arthroplasty proposed due to high failure rates after osteosynthesis.
Purpose / Aim of Study: To evaluate risk of revision within 1 year after osteosynthesis of d-FNFs.
Materials and Methods: All surgeries for a FNF with parallel implants and available x-rays were collected from the Danish Fracture Database. Data included age, gender, ASA score and surgical delay (SD). X-rays were analysed for initial displacement, quality of reduction, Cortical Thickness Index (CTI), protrusion of implants in the joint (POI) and angulation of implants to the femoral shaft. Nondisplaced fractures with posterior tilt (PT) <20° were excluded. Data on revision (to arthroplasty or femoral head removal) and vitality was collected from the Civil Registrational System. Data was analysed by adjusted cox- regression analysis.
Findings / Results: 654 cases were included. Mean age was 69 years and 59% were female. 54% were Garden 2 with PT >20° or Garden 3 and 46% were Garden 4. 28% had surgery within 12h, 78% within 24h and 89% within 36h. 38% were sufficiently reduced, while the fracture was still displaced or with >10° PT in 62%. POI was present in 18 cases. 124 (19%) cases were revised and 117 (18%) died within 1 year. Female gender (HR 1.71), SD between 12-24h vs <12h (HR 1.66), Garden 4 type fracture (HR 3.00), insufficient reduction (HR 1.70) and POI (HR 2.32) were associated with significantly increased risk of revision. No association between revision risk and age, CTI or the angulation of implants was found.
Conclusions: These findings indicate that risk of revision is linked mainly to displacement and reduction of the fracture, with no apparent effect of age or the quality of the bone estimated by CTI. We suggest considering primary arthroplasty in all highly displaced fractures.

Lars Lykke Hermansen, Martin Hagen Haubro, Bjarke Viberg, Søren Overgaard
Dept. of Orthopaedics, Esbjerg and The Orthopaedic Research Unit, OUH, Hospital of South West Jutland, Esbjerg; Dept. of Orthopaedics, Hospital of South West Jutland, Esbjerg; Department of Orthopaedic Surgery and Traumatology, Kolding Hospital; Orthopaedic research unit Department of Orthopaedic, Surgery and Traumatology, Odense University Hospital


Background: Total hip arthroplasty(THA) is a successful operation for patients suffering from debilitating end-stage hip osteoarthritis. However, severe complications do still occur, and hip dislocation remains one of the most common reasons for revision surgery. The decision whether to continue with a non-operative regime or to perform salvage surgery depends on several factors which may cause the dislocations but also the patient's perspective.
Purpose / Aim of Study: Since quality of life and subjective hip function is of major importance for the patient we performed a systematic review on Patient Reported Outcome(PRO) after dislocation of primary THA compared to patients without dislocation with a primary diagnosis of osteoarthritis(OA), in order to improve decision making before revising.
Materials and Methods: We searched Pubmed, Embase, SveMed and Cochrane databases in September 2017 and identified 3460 unique studies. The review was registered in PROSPERO and conducted independently by 2 researchers and reported following PRISMA statement.
Findings / Results: 2 studies met the a priori inclusion criteria's and they presented divergent results between patients with/without dislocation using a variety of well-known PRO measures. Extending the scope of the present review, we found no additional studies presenting PRO after a dislocation without comparisons to non-dislocators exclusively in THA patients with OA.
Conclusions: This review has revealed that knowledge of patient reported quality of life and subjective hip function post-dislocation is merely non- existing. Although arthroplasty surgeons may possess empirical assumptions on the matter, there is a need for additional and larger scale studies to examine the subject in order to properly inform THA patients with dislocation regarding what they can expect afterwards and when to recommend reoperation.

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: Acute myocardial infarction (MI) is a leading cause of mortality following total hip and knee arthroplasty (THA/TKA). The reported 30-days incidence of MI varies from 0.3%–0.9%. However, most data derive from administrational and insurance databases or large RCT’s with potential confounding pathogenic factors.
Purpose / Aim of Study: We aimed to investigate in detail the incidence of and potential modifiable risk factors for postoperative MI in a large, multicentre optimized “fast-track” THA/TKA setting.
Materials and Methods: Prospective cohort study on consecutive unselected elective primary unilateral THA and TKA. Prospective information on comorbidities and complete 90-days follow-up on readmissions from the Danish National patient registry. Evaluation of discharge summaries and complete medical records in case of suspected MI. Logistic regression analyses were performed for identification of preoperative risk factors.
Findings / Results: Of 24,863 procedures with a median length of stay 2 (IQR; 2-3) days, 30 and 90-days incidence of MI was 31 (0.12%) and 48 (0.19%). Independent preoperative risk factors for MI ≤ 90 days were age > 85 years (OR: 6.0; 95% CI; 2.3-15.7), male gender (2.2; 1.2-4.0), insulin-dependent diabetes-mellitus (IDDM) (3.6; 1.1-9.5) and cardiovascular disease (2.2; 1.1-4.2). In patients with MI ≤ 30 days 9 (37.5%) were treated with vasopressors for intraoperative hypotension and 27 had postoperative anaemia with median haemoglobin of 9.9 (8.1–11.3) g/dL.
Conclusions: The 30-days incidence of MI following fast-track THA and TKA was 0.12%. Risk factors for MI ≤ 90 days were Age > 85, male gender, IDDM and cardiovascular disease. Postoperative anaemia and intraoperative cardiovascular events may represent modifiable perioperative factors for improvement.

Erik Poulsen, Bent Lund, Ewa M. Roos, Eleanor Boyle
Department of Sports Science and Clinical Biomechanics, University of Southern Denmark; Department of Orthopaedic Surgery, Horsens Regional Hospital; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark


Background: Assessing completeness of the Danish Hip Arthroscopy Registry (DHAR), comparison to registrations in the Danish National Patient Registry (DNPR) as a gold standard, is necessary.
Purpose / Aim of Study: To report differences in proportions of hip arthroscopies registered in DHAR vs. DNPR pending choice of surgical and diagnosis codes registered in DNPR.
Materials and Methods: We present completeness of DHAR registrations to DNPR as percentages by year from 2012 to 2017 based on either: 1) surgical codes collected from a questionnaire among surgeons performing hip arthroscopy in Denmark, irrespectively of diagnosis code; 2) surgical codes recommended for hip arthroscopy by the Danish National Board of Health, irrespectively of diagnosis code; and 3) surgical codes collected from the questionnaire incorporating diagnosis codes but excluding registrations (surgeries) with diagnosis codes not relevant for hip arthroscopic surgery.
Findings / Results: Based on the first definition, the completion rate from 2012 until 2017 ranges and increases from 46% to 71% using a total number of 228 different codes for diagnosis. Using solely surgical codes recommended by the Danish National Board of Health, the completion rate ranges and increases from 73% to 107% with 151 different codes used for diagnosis. When including surgical codes provided by surgeons and matched with relevant diagnosis codes, the completion rate ranges and increase from 64% to 97% with 177 different codes used for diagnosis.
Conclusions: Although registration of hip arthroscopies in DHAR continue to improve, we recommend standardization when using surgical and diagnosis codes for the coding of hip arthroscopies in the DNPR.

Martin Martin Lind, Tim Spalding, Peter Thomson, Johannes Holz, Ansgar Ilg, Tobias Jung, Clemens Kösters, Lars Konradsen, Martin Polacek, Peter Verdonk, Karl Eriksson, Magnus Hägström
Dept. of Orthopedics, Aarhus University Hospital; Dept. of Orthopedics, Hospital of St Cross, Rugby, UK; Dept. of Orthopedics, Hospital of St Cross, Rugby, UK; Dept. of Orthopedics, Orthocentrum, Hamborg, Germany ; Dept. of Orthopedics, Orthocentrum, Hamborg, Germany ; Dept for Sports Traumatology, Charite University Hospital, Berlin, Germany; Dept. of Orthopedics, Universitetsklinikum, Münster, Germany; Ortolpædkirurgi, Bispebjerg hospital; Dept. of Orthopedics, Drammen Hospital, Norway; , Antwerp Orthopedic Center, Holland; Dept. of Orthopedics, Stockholm Southern Hospital, Sweden; , Sports medicine Umeå, Sweden


Background: Treatment of cartilage injuries in middle- aged patients with localized degenerative lesions with resurfacing condylar implants has shown early promise for these lesions.
Purpose / Aim of Study: To present prospective detailed results of patients undergoing treatment for femoral chondral defects using a patient specific 2nd generation individualized mini-metal implant.
Materials and Methods: Prospective outcome analysis of sequential patients from 13 European centers. Detailed specific MRI data was used to manufacture patient specific implants and guide instruments by a CAD/CAM process, to fit the unique anatomy of each individual knee. Implants were uncemented and made of chrome-cobalt, double coated with hydroxyapatite on top of Titanium. Demographic, operative and clinical scores (VAS and KOOS) were collected preop and at 6 months, 1 and 2 years postoperatively.
Findings / Results: 59 patients (25 men, 34 women) with focal cartilage lesions ICRS grade 3 or 4 underwent partial resurfacing, 48 on medial condyle, 4 lateral condyle and 7 on trochlea. Mean age 48 (27-67) years. 64% had failed previous cartilage surgery. Two patients (3.4%) underwent revision (at 9 months for infection and at 30 months for progression of arthritis). All mean KOOS domain scores were significantly improved at 1 and 2 years (p<0.05). Mean preoperative aggregated KOOS (37) improved to 62 at 12 months and 63 at 24 months (n=33), (p<0.05). Mean VAS score improved from 65 preoperatively to 36 at 24 months.
Conclusions: The study shows excellent early clinical results in the treatment of focal full thickness symptomatic cartilage lesions on the femoral condyles or trochlea with a second-generation patient specific metal implant and cutting guides. Adherence to strict indications has allowed for high patient reported scores and low early revision rate.

Melek Inal Hansen, Jeppe Staghøj, Nissa Khan, Lars Blønd, Kristoffer W. Barfod
Department of Orthopedic Surgery, Zealand University Hospital, Koege; Department of Orthopedic Surgery, Zealand University Hospital, Koege; Department of Orthopedic Surgery, Zealand Hospital, Holbaek; Arthroscopic Center Department of Orthopedic Surgery, Zealand University Hospital, Koege and Aleris-Hamlet Hospital; Sports Orthopedic Research Center - Copenhagen (SORC-C), Arthroscopic Center Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre.


Background: Open-wedge high tibia osteotomies (HTO) can be technically challenging. The HTO iBalance system was designed to reduce vascular complications and to avoid secondary plate removal.
Purpose / Aim of Study: To evaluate the performance of the HTO iBalance system in patients with symptomatic medial osteoarthritis and varus malalignment.
Materials and Methods: The study was performed as a retrospective cohort study investigating a consecutive series of patients who underwent HTO with the iBalance system performed by a single surgeon from August 2013 to March 2016 at Koege Hospital and Aleris-Hamlet Hospital. The primary outcome was the degree of realignment. The secondary outcome was KOOS. Follow up was performed at mean (SD) 25 (9.7) months. Weight-bearing long-leg standing radiographs were taken before surgery and at follow up. The degree of correction was calculated as the difference between the intended degree of correction and the actual degree of correction. Collapse of the HTO was defined as a correction <50% of the intended correction. Logistic regression was used to identify risk factors for failure.
Findings / Results: 46 patients, 49 knees, participated. Preoperatively the mechanical axis was mean (SD) 5.8° (2.9) varus and postoperatively 2.3° (3.7) varus (p<0.01). Collapse was present in 17 of 49 (35%). Patients with collapse showed no statistically significant differences to no- collapse in any KOOS sub-score (p>0.09). ASA score (p=0.01) and BMI (p=0.05) were correlated with failure, whereas bone transplantation and smoking were not.
Conclusions: 35% of the cases experienced collapse. This has led to a changed surgical technique focusing on a more correct placement of the Peek wedge and supplementary bone grafting. Increased BMI and ASA-score were the only risk factors associated with collapse, bone grafting and smoking were not.