Session 2: Best Poster
Onsdag den 24. oktober
11:00 – 12:00
Chairmen: Maiken Stilling og Thomas Jakobsen
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
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
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
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
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
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-
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
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-
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
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
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
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-
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
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
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
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)
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
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
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
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
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.