Session 6: YODA Best Papers
Torsdag den 25. oktober
09:30-10:30
Lokale: Stockholm/Copenhagen/Helsinki/Oslo
Chairmen: Dennis Winge Hallager og Søren Ohrt-Nissen
Rasmus Kreipke, Alexander Dastrup, Søren Overgaard, Alma B. Pedersen
Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Denmark; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Denmark; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Danish Hip Arthroplasty Register, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark, Danish Hip Arthroplasty Register, Aarhus, Denmark
Background: Total hip arthroplasty (THA) as the primary treatment option for patients with femoral neck fractures (FNF) is debated. THA may be associated with less pain, better function and lower rates of re-operation compared to hemiarthroplasty, but higher rates of dislocation. Dual mobility cups (DMC) have in recent years gained popularity as an alternative to the standard metal-on-polyethylene cup (MoP) in order to reduce dislocation.
Purpose / Aim of Study: We investigated whether DMC in primary THA patients with proximal FNF was associated with an increased risk of any revision and revision due to specific causes compared to MoP cups.
Materials and Methods: Using the Danish Hip Arthroplasty Register we conducted a nationwide cohort study. We included patients with a primary THA due to acute or sequelae from proximal FNF treated with MoP bearings (n=7.432) or DMC bearings (n=3.274) during the study period 1995-2015. We used Cox regression with first revision as outcome to calculate adjusted hazard rations (AHR) with 95 % confidence intervals (CI). We adjusted for age, sex, implant fixation technique, surgical approach, duration of surgery and comorbidity through Charlson Comorbidity Index. Minimum follow-up was 2 years.
Findings / Results: Risk of any revision was 4.50 % in the DMC and 7.01 % in MoP group. Patients treated with DMC cups had a lower risk of revision for any reasons (AHR, 95% CI=0.75; 0.62-0.91), revision due to aseptic loosening (AHR, 95% CI=0.52; 0.29-0.91) and dislocation (AHR, 95% CI=0.32; 0.21-0.48). There was no difference in revision due to deep infection, periprosthetic fractures, pain or due to other reasons.
Conclusions: Patients treated with a DMC were associated with a lower risk of revision for any reason and specific causes. The use of DMC may be the preferred treatment of patients with proximal femoral fracture in primary THA.
Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Denmark; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Denmark; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Danish Hip Arthroplasty Register, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark, Danish Hip Arthroplasty Register, Aarhus, Denmark
Background: Total hip arthroplasty (THA) as the primary treatment option for patients with femoral neck fractures (FNF) is debated. THA may be associated with less pain, better function and lower rates of re-operation compared to hemiarthroplasty, but higher rates of dislocation. Dual mobility cups (DMC) have in recent years gained popularity as an alternative to the standard metal-on-polyethylene cup (MoP) in order to reduce dislocation.
Purpose / Aim of Study: We investigated whether DMC in primary THA patients with proximal FNF was associated with an increased risk of any revision and revision due to specific causes compared to MoP cups.
Materials and Methods: Using the Danish Hip Arthroplasty Register we conducted a nationwide cohort study. We included patients with a primary THA due to acute or sequelae from proximal FNF treated with MoP bearings (n=7.432) or DMC bearings (n=3.274) during the study period 1995-2015. We used Cox regression with first revision as outcome to calculate adjusted hazard rations (AHR) with 95 % confidence intervals (CI). We adjusted for age, sex, implant fixation technique, surgical approach, duration of surgery and comorbidity through Charlson Comorbidity Index. Minimum follow-up was 2 years.
Findings / Results: Risk of any revision was 4.50 % in the DMC and 7.01 % in MoP group. Patients treated with DMC cups had a lower risk of revision for any reasons (AHR, 95% CI=0.75; 0.62-0.91), revision due to aseptic loosening (AHR, 95% CI=0.52; 0.29-0.91) and dislocation (AHR, 95% CI=0.32; 0.21-0.48). There was no difference in revision due to deep infection, periprosthetic fractures, pain or due to other reasons.
Conclusions: Patients treated with a DMC were associated with a lower risk of revision for any reason and specific causes. The use of DMC may be the preferred treatment of patients with proximal femoral fracture in primary THA.
Hans-Christen Husum, Michel Hellfritzsch, Nina Hardgrib, Bjarne Møller-Madsen, Ole Rahbek
Department of Orthopedics, Aalborg University Hospital; Department of Radiology, Aarhus University Hospital; Department of Pediatrics, Aarhus University Hospital; Department of Children's orthopedics, Aarhus University Hospital; Department of Children's Orthopedics, Aarhus University Hospital
Background: The current screening program for DDH in Denmark is insufficient in detecting all children with DDH. The Pubofemoral distance (PFD) has been proposed as a new, simple and inexpensive screening tool which could pave the way for a new cost-effective universal screening program for DDH in Denmark,
Purpose / Aim of Study: to validate pubo-femoral distance (PFD) as an indicator for instability of the hip in lateral position in Danish newborns screened for developmental dysplasia of the hip (DDH).
Materials and Methods: All participants had undergone ultrasonographic diagnostics using the modified Graf technique. In addi-tion, PFD measurements in lateral position were performed. Results were compared between 25 infants who had been treated for DDH because of dysplastic appearance on ultrasound combined with instability and a control group consisting of 100 untreated infants screened for DDH. Sensitivity, specificity and cut-off points were determined using Receiver operating characteristics (ROC) analysis
Findings / Results: We found a mean PFD of 6,83mm (6,2-7,4mm) in the treated group with the control group PFD of 3,44mm (3,3-3,6mm) (p < 0,005). A PFD value above a threshold of 4,4mm yielded a sensitivity of 100% and a speci-ficity of 93% for detecting instable DDH
Conclusions: PFD measured in lateral position was shown to be significantly increased in hips of children treated for DDH with Dennis Browne hip brace compared to healthy children with unaffected stable hips. Furthermore, the PFD measurement is characterized by a high level of sensitivity and specificity at a cut-off value of 4,4mm. A cut-off value of 6.00 mm has been previously reported as the gold standard in su-pine position. We suggest that 4.4 mm is used in lateral position.
Department of Orthopedics, Aalborg University Hospital; Department of Radiology, Aarhus University Hospital; Department of Pediatrics, Aarhus University Hospital; Department of Children's orthopedics, Aarhus University Hospital; Department of Children's Orthopedics, Aarhus University Hospital
Background: The current screening program for DDH in Denmark is insufficient in detecting all children with DDH. The Pubofemoral distance (PFD) has been proposed as a new, simple and inexpensive screening tool which could pave the way for a new cost-effective universal screening program for DDH in Denmark,
Purpose / Aim of Study: to validate pubo-femoral distance (PFD) as an indicator for instability of the hip in lateral position in Danish newborns screened for developmental dysplasia of the hip (DDH).
Materials and Methods: All participants had undergone ultrasonographic diagnostics using the modified Graf technique. In addi-tion, PFD measurements in lateral position were performed. Results were compared between 25 infants who had been treated for DDH because of dysplastic appearance on ultrasound combined with instability and a control group consisting of 100 untreated infants screened for DDH. Sensitivity, specificity and cut-off points were determined using Receiver operating characteristics (ROC) analysis
Findings / Results: We found a mean PFD of 6,83mm (6,2-7,4mm) in the treated group with the control group PFD of 3,44mm (3,3-3,6mm) (p < 0,005). A PFD value above a threshold of 4,4mm yielded a sensitivity of 100% and a speci-ficity of 93% for detecting instable DDH
Conclusions: PFD measured in lateral position was shown to be significantly increased in hips of children treated for DDH with Dennis Browne hip brace compared to healthy children with unaffected stable hips. Furthermore, the PFD measurement is characterized by a high level of sensitivity and specificity at a cut-off value of 4,4mm. A cut-off value of 6.00 mm has been previously reported as the gold standard in su-pine position. We suggest that 4.4 mm is used in lateral position.
Melissa Hornbæk Pedersen, Wahlsten Liv Riisager, Grønborg Henrik , Gislason Gunnar , Mørk Petersen Michael , Bonde Anders Nissen
Department of Orthopedic Surgery & Trauma Center, Rigshospitalet, University of Copenhagen; Department of Orthopedic Surgery, Herlev-Gentofte Hospital, University of Copenhagen; Trauma Center, Rigshospitalet, University of Copenhagen; Department of Cardiology , Herlev-Gentofte Hospital, University of Copenhagen; Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen; Department of Cardiology , Herlev-Gentofte Hospital, University of Copenhagen
Background: Venous thromboembolism (VTE) is a well- known complication to Achilles tendon rupture (ATR), and carries high risk of morbidity and mortality. There are currently no guidelines recommending thromboprophylaxis to ATR patients.
Purpose / Aim of Study: We investigated incidence of symptomatic VTE and identified patient specific risk factors associated with VTE in ATR patients.
Materials and Methods: By crosslinking nationwide registers, we identified all patients diagnosed with ATR in Denmark from 1997 to 2015. We divided patients into four groups by age and treatment modality i.e. surgery or conservative treatment. The outcome was VTE within 180 days. We calculated incidence rates and considered age, sex, year, and certain comorbidities and medications as risk factors for VTE in Poisson regression models.
Findings / Results: We included 28,425 patients, 389 (1.37%) were hospitalized with VTE during the follow-up period. Incidence rates were highest during the first month and ranged from 4.6 to 14.8 events per 100 person- years. VTEs were most frequent among conservatively treated patients aged ≥50 years. In Poisson regression analyses, hormonal contraceptives were associated with increased risk of VTE among patients aged <50 years (No surgery: incidence rate ratio (IRR (95% confidence interval)=5.15 (2.32-11.44). Surgery: IRR=5.13 (1.94- 13.54)) and so were previous VTE in both groups aged <50 years (No surgery: IRR=7.63 (2.39-24.38). Surgery: IRR=9.35 (1.25-69.85)) and in conservatively treated patients aged ≥50 years (IRR=6.21 (3.70- 10.43)) compared to patients in the same group without the equivalent risk factor.
Conclusions: The overall incidence of VTE was low but use of hormonal contraception, previous VTE, and age ≥50 years were associated with increased risk of VTE. Focus on risk stratification and initiatives to prevent VTE might be warranted.
Department of Orthopedic Surgery & Trauma Center, Rigshospitalet, University of Copenhagen; Department of Orthopedic Surgery, Herlev-Gentofte Hospital, University of Copenhagen; Trauma Center, Rigshospitalet, University of Copenhagen; Department of Cardiology , Herlev-Gentofte Hospital, University of Copenhagen; Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen; Department of Cardiology , Herlev-Gentofte Hospital, University of Copenhagen
Background: Venous thromboembolism (VTE) is a well- known complication to Achilles tendon rupture (ATR), and carries high risk of morbidity and mortality. There are currently no guidelines recommending thromboprophylaxis to ATR patients.
Purpose / Aim of Study: We investigated incidence of symptomatic VTE and identified patient specific risk factors associated with VTE in ATR patients.
Materials and Methods: By crosslinking nationwide registers, we identified all patients diagnosed with ATR in Denmark from 1997 to 2015. We divided patients into four groups by age and treatment modality i.e. surgery or conservative treatment. The outcome was VTE within 180 days. We calculated incidence rates and considered age, sex, year, and certain comorbidities and medications as risk factors for VTE in Poisson regression models.
Findings / Results: We included 28,425 patients, 389 (1.37%) were hospitalized with VTE during the follow-up period. Incidence rates were highest during the first month and ranged from 4.6 to 14.8 events per 100 person- years. VTEs were most frequent among conservatively treated patients aged ≥50 years. In Poisson regression analyses, hormonal contraceptives were associated with increased risk of VTE among patients aged <50 years (No surgery: incidence rate ratio (IRR (95% confidence interval)=5.15 (2.32-11.44). Surgery: IRR=5.13 (1.94- 13.54)) and so were previous VTE in both groups aged <50 years (No surgery: IRR=7.63 (2.39-24.38). Surgery: IRR=9.35 (1.25-69.85)) and in conservatively treated patients aged ≥50 years (IRR=6.21 (3.70- 10.43)) compared to patients in the same group without the equivalent risk factor.
Conclusions: The overall incidence of VTE was low but use of hormonal contraception, previous VTE, and age ≥50 years were associated with increased risk of VTE. Focus on risk stratification and initiatives to prevent VTE might be warranted.
David Gøttsche, Kirill Gromov, Petra Viborg, Elvira Bräuner, Alma Pedersen, Anders Troelsen
Ortopædkirurgisk Afdeling, Hvidovre Hospital; Ortopædkirurgisk Afdeling, Hvidovre Hospital; , The Danish Clinical Registries (RKKP); Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen; Department of Clinical Epidemiology, Aarhus University Hospital; Ortopædkirurgisk Afdeling, Hvidovre Hospital
Background: Obesity is a rising issue worldwide and growing evidence supports poor postoperative outcome amongst obese following total knee arthroplasty (TKA).
Purpose / Aim of Study: Using nationwide registries we investigated the association between body weight and risk of revision of primary TKA.
Materials and Methods: All primary TKA performed during 1997-2015, weight at time of primary TKA and subsequent TKA revisions were identified in the Danish Knee Arthroplasty Register (DKR). Data on comorbidities and a-prior selected confounding variables were collected from Nationwide registries. The association between weight and first time TKA revision were calculated as both crude and adjusted hazard ratios (aHR) with 95% confidence intervals (CI) using Cox Regression.
Findings / Results: Of 67,810 identified primary TKAs, 4.8% were revised within median follow-up time of 5.4 years. No association between weight and risk of any revision in patients age 18-54 and 55-70 years was found. Increased risk of any revision was seen in patients >70 years, 80-89 kg (aHR=1.48, CI: 1.22-1.79), 90-99 kg (aHR=1.68, CI: 1.34-2.11) and patients >99 kg (aHR=1.60, CI: 1.25-2.05), as well as those weighing 45-60 kg (aHR= 1.40, CI: 1.05-1.87) compared with same aged patients weighing 70-79 kg.
Conclusions: We found an increased risk of any revision following primary TKA in patients older than 70 years of age, whereas weight did not affect risk of any revision in younger patients.
Ortopædkirurgisk Afdeling, Hvidovre Hospital; Ortopædkirurgisk Afdeling, Hvidovre Hospital; , The Danish Clinical Registries (RKKP); Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen; Department of Clinical Epidemiology, Aarhus University Hospital; Ortopædkirurgisk Afdeling, Hvidovre Hospital
Background: Obesity is a rising issue worldwide and growing evidence supports poor postoperative outcome amongst obese following total knee arthroplasty (TKA).
Purpose / Aim of Study: Using nationwide registries we investigated the association between body weight and risk of revision of primary TKA.
Materials and Methods: All primary TKA performed during 1997-2015, weight at time of primary TKA and subsequent TKA revisions were identified in the Danish Knee Arthroplasty Register (DKR). Data on comorbidities and a-prior selected confounding variables were collected from Nationwide registries. The association between weight and first time TKA revision were calculated as both crude and adjusted hazard ratios (aHR) with 95% confidence intervals (CI) using Cox Regression.
Findings / Results: Of 67,810 identified primary TKAs, 4.8% were revised within median follow-up time of 5.4 years. No association between weight and risk of any revision in patients age 18-54 and 55-70 years was found. Increased risk of any revision was seen in patients >70 years, 80-89 kg (aHR=1.48, CI: 1.22-1.79), 90-99 kg (aHR=1.68, CI: 1.34-2.11) and patients >99 kg (aHR=1.60, CI: 1.25-2.05), as well as those weighing 45-60 kg (aHR= 1.40, CI: 1.05-1.87) compared with same aged patients weighing 70-79 kg.
Conclusions: We found an increased risk of any revision following primary TKA in patients older than 70 years of age, whereas weight did not affect risk of any revision in younger patients.
Sahar Moeini, Jeppe Vejlgaard Rasmussen, Björn Salomonsson, Erica Arverud, Randi Hole, Steen Lund Jensen, Stig Brorson
Orthopedic Department, Herlev Hospital; Orthopedic Department, Herlev Hospital; Department of Clinical Sciences, Division of Orthopaedics, Danderyd Hospital; Department of Clinical Sciences, Division of Orthopaedics, Danderyd Hospital; Orthopedic Department, Haukeland University Hospital; Orthopedic Department, Aalborg University Hospital; Orthopedic Department, Zealand University Hospital
Background: The use of reverse shoulder arthroplasty has increased and the indications have expanded, but the incidence of revision due to infection may be higher than for other arthroplasty types.
Purpose / Aim of Study: The aim of this registry-based study was to estimate the risk of infection after primary reverse shoulder arthroplasty compared to anatomical types.
Materials and Methods: The Nordic Arthroplasty Register Association (NARA) is a common set of prospectively collected data from the national shoulder arthroplasty registries in Denmark, Norway and Sweden. We included 17,730 primary shoulder arthroplasties reported between 2004 and 2013. The Kaplan Meier method was used to illustrate the 10-year cumulative rate of revision due to infection and the Cox regression model was used to calculate the hazard ratios as a measure of the relative risk of revision due to infection.
Findings / Results: There were 188 (1.1%) revisions reported due to infection with a mean follow-up of 3 years and 9 months. The 10-year cumulative rate of revision due to infection was 1.4 % (standard error, <0.01) overall, but 3.1% (standard error, <0.01) for patients with reverse shoulder arthroplasty and 8.0% (standard error, 0.02) for men with reverse shoulder arthroplasty. Patients with reverse shoulder arthroplasty had an increased risk of revision due to infection (unadjusted relative risk, 3.78, [95% confidence interval, 2.23 to 6.41]; p<0.01), also when adjusted for age, gender, primary diagnosis and year of surgery (relative risk, 2.41, [95% confidence interval, 1.26 to 5.59]; p<0.01).
Conclusions: The overall incidence of revision due to infection was low. However, specific attention is required on the risk associated with reverse shoulder arthroplasty, especially in men.
Orthopedic Department, Herlev Hospital; Orthopedic Department, Herlev Hospital; Department of Clinical Sciences, Division of Orthopaedics, Danderyd Hospital; Department of Clinical Sciences, Division of Orthopaedics, Danderyd Hospital; Orthopedic Department, Haukeland University Hospital; Orthopedic Department, Aalborg University Hospital; Orthopedic Department, Zealand University Hospital
Background: The use of reverse shoulder arthroplasty has increased and the indications have expanded, but the incidence of revision due to infection may be higher than for other arthroplasty types.
Purpose / Aim of Study: The aim of this registry-based study was to estimate the risk of infection after primary reverse shoulder arthroplasty compared to anatomical types.
Materials and Methods: The Nordic Arthroplasty Register Association (NARA) is a common set of prospectively collected data from the national shoulder arthroplasty registries in Denmark, Norway and Sweden. We included 17,730 primary shoulder arthroplasties reported between 2004 and 2013. The Kaplan Meier method was used to illustrate the 10-year cumulative rate of revision due to infection and the Cox regression model was used to calculate the hazard ratios as a measure of the relative risk of revision due to infection.
Findings / Results: There were 188 (1.1%) revisions reported due to infection with a mean follow-up of 3 years and 9 months. The 10-year cumulative rate of revision due to infection was 1.4 % (standard error, <0.01) overall, but 3.1% (standard error, <0.01) for patients with reverse shoulder arthroplasty and 8.0% (standard error, 0.02) for men with reverse shoulder arthroplasty. Patients with reverse shoulder arthroplasty had an increased risk of revision due to infection (unadjusted relative risk, 3.78, [95% confidence interval, 2.23 to 6.41]; p<0.01), also when adjusted for age, gender, primary diagnosis and year of surgery (relative risk, 2.41, [95% confidence interval, 1.26 to 5.59]; p<0.01).
Conclusions: The overall incidence of revision due to infection was low. However, specific attention is required on the risk associated with reverse shoulder arthroplasty, especially in men.