Henriette Appel Holm, Per Wagner Kristensen, Lasse Enkebølle Rasmussen
Orthopedic department, Vejle; Orthopedic department, Vejle; Orthopedic department, Vejle
Background: Up to 20 % of all patients having a
TKR are less satisfied. Predicting long
term outcome would be of key
importance in meeting patients’ expectations.
Purpose / Aim of Study: The aim is to investigate whether preop
preop Oxford Knee Score (OKS), can
predict long term results for TKR
Materials and Methods: OKS was collected in a prospective
cohort study (preop, 1-5 and 10 years)
in 200 consecutive patients with
primary osteoarthritis, operated during
2006-9 with the Vanguard TKR. The
change in OKS was determined for
each patient. The patients were
divided in thirds depending on their preop
preop OKS: Lower (OKS < 21, Middle
(22 < OKS < 27), High (OKS > 27).
Differences between groups were
measured by Anova, followed by Tukeys
Tukeys Multiple Comparison post hoc a
Similarly, 1 year results were divided in
3 groups, Lower (patients with OKS <
40), Middle (41 < OKS < 44), high
(OKS > 45), to determine if 1 year
results predicts long term results.
Odds-ratio was measured using Babtista
Babtista Pike and Chi-square test.
Findings / Results: 91 females (average age 64.68, range
36-82, BMI = 29.88, range 21-47) and
109 males (average age 66.58, range
46-85, BMI = 29.18 range 19-43 were i
At 10 years, 46/200 (23%) was lost to
follow-up (38 dead, 8 for other re
reasons), 12 were revised.
Mean OKS increased from 23.15 p
points to a maximum of 44.84 points at 5
5 years with a small decline to 43.58 p
points at 10 years.
Median change over 10 years was
dependent of preop OKS, since preop
OKS < 21 changed 25.92 points; 22 < preop
preop OKS < 27 changed 19.94 points,
and preop OKS > 27 changed 14.78 p
points (p< 0.001 between the 3 g
At 10 years, comparing patients with
high and low preop OKS showed an
odds ratio = 3.054 (p=0.009) for an
OKS above 45 for patients with a high preop
Patients with an OKS > 45 at 1 year
had significantly higher OKS at 10 year
than the patients with an OKS < 45 at
1 year (p=0.0036)
Conclusions: The increase in OKS depends on the preop
preop score, with the highest gain for
patients with the lowest preop score.
Patients with a low preop OKS have s
significantly lower chance of getting an e
excellent long term result.
Overall, preop OKS somehow predicts
long term results and if known, may aid
in bridging patient expectations with
Anders El-Galaly, Clare Grazal, Andreas Kappel, Poul Torben Nielsen, Steen Lund Jensen, Jonathan A. Forsberg
Department of Orthopaedic Surgery, Aalborg University Hospital; Department of Surgery, Uniformed Services University-Walter Reed ; Department of Orthopaedic Surgery, Aalborg University Hospital; Department of Orthopaedic Surgery, Aalborg University Hospital; Department of Orthopaedic Surgery, Aalborg University Hospital; Department of Surgery, Uniformed Services University-Walter Reed
Background: TKA revision is a serious adverse event and as
the demand for TKA rises, reducing the risk of
revision TKA is increasingly important.
Predictive tools based on machine-learning
algorithms could reform clinical practice. Few
attempts have been made to combine machine-
learning algorithms with nationwide arthroplasty
registries and, to the authors’ knowledge, none
have tried to predict early TKA revision.
Purpose / Aim of Study: Can we build a preoperative clinical tool capable
of predicting early TKA revision?
Materials and Methods: From the Danish Knee Arthroplasty Registry
(DKR), we retrieved all available
preoperative variables of 25,104 TKAs
conducted from 2012 to 2015 and 6,170
TKAs conducted in 2016. All TKAs were
followed for 2 years with revision for any
indication as outcome. The models were
trained on data from 2012-2015 and
temporal validated on data from 2016. We
created four different predictive models; a
logistic regression-based model (LASSO),
two classification tree models (Random
Forest and Gradient Boosting Model) and a
supervised neural network. The models were
compared with each other and with a non-
informative model estimating no revisions for
all observations. The models’ performance
was evaluated by calibration plot, accuracy,
Brier’s score, ROC-curve and area under the
curve (AUC). The AUC depicts the models’
discriminative capacity and, a priori, an AUC
of 0.7 was chosen as threshold for a clinical
Findings / Results: The models’ calibration plot, accuracy and
Brier’s score was not significantly better than the
non-informative model and with AUCs ranging
from 0.55-0.60, none of the models reached the
predefined threshold for a successful model.
Conclusions: The inability to predict early TKA revision from
pre-operative information in the DKR highlighted
that (1) the rarity of revision makes it difficult to
predict and (2) the preoperative variables
collected in the DKR are not strongly associated
with early revision. Future models might benefit
from including other pre- and intraoperative
information, while the arthroplasty registries
might aid future models by providing an
anonymous surgeon identification variable.
Søren Kold, Marie Fridberg, Ole Rahbek
Interdiciplinary Orthopaedics, Aalborg University Hospital; Interdiciplinary Orthopaedics, Aalborg University Hospital; Interdiciplinary Orthopaedics, Aalborg University Hospital
Background: Medical thermography is an emerging
technology that uses an infrared
camera to register skin temperature. A
recent study found that infrared
quantitative skin temperature
measurement in routine wound
assessment provides a reliable method
to monitor wound infection status.
Purpose / Aim of Study: To investigate the positive predictive
value and reliability for infrared
thermography for pin-site infection.
Materials and Methods: Prospective study. Pin-sites were
graded with Modified Gordon Pin
Infection Classification from 0-6 by the
treating surgeon. Thermography of
each pin-site was performed under
standardized conditions after removal
dressings with a handheld FLIR C3
camera. The maximum skin
temperature around the pin-site was
assessed by an independent reviewer
blinded to the infection-grade. Double-
measurements was performed for 53
pin-sites. Clinical important infection
(defined as Gordon grade 3 or above)
was the gold standard thermography
was tested against in a contingency
table. Intra Class Correlation with 95%
CI was calculated in Stata.
Findings / Results: 13 (4 females, 9 males) consecutive
patients (age 9-72 years) were
included. Indications for frames: 4
fracture, 2 deformity correction, 1
lengthening, 6 bone transport. Days
from surgery to thermography ranged
from 27-385 days. Two patients had
two measurements on different days.
In total 231 pin-sites were included. 11
pin-sites were clinical abnormal: 5 sites
grade 1 (serous drainage), 5 sites
grade 2 (erythema), 1 site grade 3
(erythema and drainage). Mean pin-
site temperature varied between
patients from 29,0 to 35,4 C (mean
33,9). Mean temperature and range
were 32,8 (26,3-37,3); 34,3
(33,2-35,4); 34,8 (33,0-35,9); and 36,1
for grade 0, 1, 2 and 3 respectively. If
36,1 C was selected as cut-off value
for infection sensitivity was 100%,
specificity 98%, positive predictive
value 17% and negative predictive
value 100%. Intra-rater agreement for
thermography was ICC 0.85
Conclusions: Thermography was reliable. Only one
clinical important pin-site infection was
present in 231 pin-sites. Further
studies will show if thermography can
serve as an adjunct tool in homebased
pin-site infection surveillance.
Mikkel Rathsach Andersen, Winther Nikolaj, Schrøder Henrik Morville , Lind Thomas, Petersen Michael Mørk
Ortopædkirurgisk afd. Hvidovre Hospital, Hvidovre Hospital; Ortopædkirurgisk afd. RH, Rigshospitalet; Næstved Ortopædkirurgisk afd., Næstved Sygehus; Ortopædkirurgisk afd. , Herlev Gentofte Hospital; Ortopækirurgisk afd., Rigshospitalet
Background: Radiostereometric analysis (RSA) studies
have shown that continuous migration of tibia
components can predict aseptic loosening
after total knee replacement (TKA).
Purpose / Aim of Study: In this study we investigated if accurate size
and placement of the tibia components, could
be related to the degree of migration
evaluated objectively using RSA
Materials and Methods: We performed 2 year follow up of 116
patients who underwent TKA surgery with
cementless tibia components, Nexgen®
(N=55, Pegged design) and Vanguard®
(N=61, Keeled design).
Radiostereometric analysis (marker-
based) was performed postoperatively and
after 3, 6, 12 and 24 months.
Postoperative X-rays were evaluated with
respect to component sizing and
placement in the tibia, by experienced
knee surgeons blinded to migration data
and clinical outcome.
Statistics: Multivariate linear regression.
Findings / Results: We found that continuous migration (12-24
months MTPM) was related to tibia
component under-sizing (p=0.001), and that
subsidence was related to absence of
posterior cortical support (p=0.000),
postoperative varus malalignment (p=0.001)
and under-sizing (p=0.002). Posterior tilt was
related to under-sizing (p=0.002) and
absence of posterior cortical support
Conclusions: The findings of this study indicate that
undersized, varus aligned and anteriorly
placed cementless tibia components in TKA
are in risk of poor fixation with continuous
migration and therefore at higher risk of
aseptic loosening should be expected.
Anders Kjærsgaard Valen, Bjarke Viberg, Per Hviid Gundtoft, Rikke Thorninger
Department of Orthopaedic Surgery and Traumatology, Regional Hospital Randers, Denmark; Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark; Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark; Department of Orthopaedic Surgery and Traumatology, Regional Hospital Randers, Denmark
Background: Should trochanteric hip fractures (AO/OTA
31-A) be treated with a sliding hip screw
(SHS) or an intramedullary nail (IMN)? This
debate is still ongoing and while most
studies find no differences in post-operative
complication rates, recent studies suggest
an association between IMN and excess
mortality rates compared with SHS.
Purpose / Aim of Study: To compare mortality rates for IMN and SHS
in elderly patients with trochanteric hip
fractures (AO type 31-A).
Materials and Methods: This is a national registry study based on
data from DFDB. Data on patients aged 65
years and above treated for a non-
pathological AO-type 31-A trochanteric hip
fracture with either IMN or SHS from
January 2012 - December 2018 were
retrieved. Data from DFDB was merged with
data from the Danish Civil Registration
registry for time of death. Outcome
measures were mortality presented as 30-
day, 90-day, and 1-year mortality and the
relative mortality risk in crude numbers and
adjusted for age, sex, ASA-class, AO-type,
Findings / Results: A total of 9,547 patients were included. The
mean age was 83 years, 69.2% were
female, and 55.1% were ASA-class 3-5.
Most patients suffered a 31-A2 fracture
(56.1%), followed by 31-A1 fractures
(32.3%), and 31-A3 fractures (11.6%).
Stable 31-A1 fracture subtypes were
primarily treated with SHS (60.9%). Fracture
subtypes 31-A2 and 31-A3 were treated
with IMN in 90.2% and 96.6% of cases.
Implant of choice was IMN in 74.4% of
cases. The 30-day mortality for IMN-
patients was 12.2% (867/7105) and 10.2%
(248/2442) for SHS-patients. This trend
persists at 90 days (19.7% vs 17.4%) and 1
year (31.0% vs 29.3%).
Relative mortality risk for IMN compared
with SHS was 1.20 [95% CI 1.06; 1.35] at
30 days, 1.11 [1.01; 1.22] at 90 days, and
1.05 [0.98; 1.13] at 1 year. Adjusted relative
mortality risk for IMN compared with SHS
was 1.12 [0.96; 1.31] at 30 days, 1.03 [0.91;
1.17] at 90 days, and 1.01 [0.92; 1.11] at 1
Conclusions: We found an association between excess
mortality and the use of IMN versus SHS in
elderly patients with AO-type 31A fractures
at 30 days, 90 days and 1 year post-
operatively consistent with recent studies.
However, this association diminishes when
adjusting for sex, age, ASA-class, AO-type,
Pham That Minh
Department of Orthopedics and Traumatology, Odense University Hospital
Background: Intra-articular fractures are a major
cause of post-traumatic osteoarthritis
(PTOA). Despite adequate surgical
treatment, the long-term risk for PTOA
is high. Previous studies reported that
joint injuries initiate an inflammatory
cascade characterized by elevation of
synovial pro-inflammatory cytokines,
which can lead to cartilage degradation
and PTOA development.
Purpose / Aim of Study: This review will summarize the
literature on the post-injury regulation
of pro-inflammatory cytokines and the
markers of cartilage destruction in
patients suffering from intra-articular
Materials and Methods: We searched Medline, Embase, and
Cochrane databases (1960–February
2020) and included studies written in
English, German or Scandinavian that
were performed on human participants
and included control groups. Two
investigators assessed the quality of
the included studies using Covidence
and the Newcastle-Ottawa Scale. Six
cross-sectional studies were included
in the final qualitative synthesis.
Findings / Results: We found a significant elevation of
several synovial pro-inflammatory
cytokines including IL-1â, IL-6, IL-8, IL-12p70, IFN
12p70, IFN-y, and TNF-á in patients
suffering from intra-articular fractures
compared to control groups. We also
found a simultaneous elevation of anti-inflammatory cytokines such as IL
inflammatory cytokines such as IL-10
and IL-1RA. Most studies also reported
increased IL-2 concentrations while IL-13, CTXII,
13, CTXII, sGAG, and aggrecan
concentrations were not significantly
different in the compared cohorts.
Conclusions: We found that intra-articular fractures
are associated with an increase of
cytokines. However, more
standardized studies which focus on
the ratio of pro- and anti-inflammatory
cytokines at different time points are
Mindaugas Mikuzis, Knud Stenild Christensen, Søren Kold
Department of Orthopaedics, Aalborg University Hospital; Department of Orthopaedics, Aalborg University Hospital; Department of Orthopaedics, Aalborg University Hospital
Background: Intramedullary bone transport nails
have been introduced to treat
segmental bone defects. Only 5 cases
have been reported in the literature,
and no studies have reported
outcomes after nail removal.
Purpose / Aim of Study: We investigated the healing and the
complication rates in patients treated
for segmental bone defects with a
combined bone transport and
lengthening FITBONE® nail.
Materials and Methods: A retrospective case series with fifteen
patients (ten males, five females)
treated between 2012 and 2016.
Informed consent from patients and
approval by institutional board. The
segmental bone loss was due to
resection of non-union site in eight
femurs and four tibias, or traumatic
bone loss in two femurs and one tibia.
The bone gap was a mean of 4 (2-10)
cm. The total nail distraction (transport
and lengthening) was a mean of 5
(2-8) cm. Preoperative limb length
discrepancy was mean of 2 (0-6) cm.
Preoperative mechanical axis deviation
was from 88 mm varus to 7 mm
valgus. Mean follow-up after nail
removal was 45 (6-89) months.
Complications were severity graded
(Black et al). and rated as device or
non-device related (Song et al.)
Findings / Results: 9 of 10 femoral cases, and 4 of 5 tibial
cases healed with the bone transport
nail. The unhealed femoral case was
treated with shortening, bone graft and
trauma nail. The unhealed tibial case
was treated with external fixator and
bone graft. At latest follow-up all fifteen
patients have healed docking site and
regenerate. 23 complications (14
device-related and 9 non-device)
occurred in 15 patients. The number of
complications was: 0 in 4 patients, 1 in
4 patients, 2 in 4 patients, 3 in 1
patient, 4 in 2 patients. The average
number of complications per patient
was: type 1 (minimal intervention): 0.1
(0-2); type II (substantial change in
plan): 0.9 (0-3); type IIIA (failure to
achieve goal): 0.3 (0-1); type IIIB (new
pathology or permanent sequelae): 0.2
Conclusions: In selective cases, segmental bone
defects might heal with bone transport
nail. Future research should focus on
reducing device and non-device
related complications by optimized nail
design, patient selection and patient
Lars Lykke Hermansen, Bjarke Viberg, Søren Overgaard
Department of Orthopaedics & The Orthopaedic Research Unit, Hospital of South West Jutland, Esbjerg & Odense University Hospital; Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University hospital of Southern Denmark; The Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital
Background: Dislocation of total hip arthroplasties (THA)
leads to poorer quality of life for the
patients, but since dislocations are often
treated with closed reduction, they are
traditionally not registered in orthopedic
arthroplasty registers worldwide.
Purpose / Aim of Study: This study aimed to create an algorithm
designed to identify cases of dislocations of
THAs with high sensitivity (SN), specificity
(SP), and positive predictive value (PPV)
based on codes from the Danish National
Patient Register (DNPR).
Materials and Methods: All patients (n=31,762) with primary
osteoarthritis undergoing THA from
01.01.2010 to 31.12.2014 were included
from the Danish Hip Arthroplasty
Register (DHR). We extracted available
data for every hospital contact in the
DNPR during a two-year follow-up
period, both admissions to orthopaedic
and non-orthopaedic departments and
outpatient emergency room contacts.
We conducted a nationwide review of
5,096 patient files to register all
dislocations and applied codes. We
designed the algorithm using a stepwise
approach by adding codes in each step
to continuously increase SN, while at the
same time keeping the SP and PPV
Findings / Results: We identified 1,890 hip dislocations
among 1,094 of the included 31,762
THAs. More than 70 different diagnoses
and 55 procedural codes were coupled
to the hospital contacts with dislocation.
A combination of the correct codes
(DT840+KNFH20) yielded a SN of
62.7% and a PPV of 97.9%. Adding
alternative and often applied codes in
three steps (DS730,
KNFH(20;21;22;00;02)) increased the
SN to 91.3%, while the PPV was kept at
93.3%. An additional step (DT840 alone,
acute admissions) increased SN to
95.4% but at the expense of an
unacceptable decrease in the PPV to
81.8%. A minor effort in reviewing 0.3-
1% of patient files could raise the PPV to
96.6% in the last two steps. SP was, in
all steps, greater than 99%.
Conclusions: The developed algorithm demonstrated a
SN of 91.3% and a PPV at 93.3% for
identifying dislocations, which we consider
acceptable. Higher SN is possible but at the
expense of drastically lowering the PPV and
are not feasible for register studies. In
perspective, this kind of algorithm may be
used in Danish quality registers.
Emil Toft Petersen, Søren Rytter, Michael Skipper Andersen, Jesper Dalsgaard, Daan Koppens, Torben Bæk Hansen, Maiken Stilling
University Clinic for Hand, Hip and Knee Surgery, Holstebro Regional Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Materials and Production, Aalborg University; University Clinic for Hand, Hip and Knee Surgery, Holstebro Regional Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital; University Clinic for Hand, Hip and Knee Surgery, Holstebro Regional Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital
Background: Patients with knee osteoarthritis (OA) often
complain of pain and giving-way symptoms
during downhill gait. The kinematic
differences between level and downhill gait
in healthy and OA knees are not well
described but may be related to the
Purpose / Aim of Study: To investigate the tibiofemoral joint (TFJ)
kinematics of level and downhill gait in
patients with knee OA and healthy
Materials and Methods: Sixty-six patients with symptomatic knee OA
scheduled for TKA and twelve age-matched
healthy volunteers with asymptomatic knees
were included in this study. Dynamic RSA
was used to assess the TFJ kinematics
during treadmill level and downhill gait. ACL
lesions were graded by MRI in the OA
group. Clinical outcomes were assessed
with OKS. Statistical parametric mapping
and linear regression was used.
Findings / Results: Comparing level and downhill gait, both
groups revealed up to 25° (p<0.01) higher
knee flexion from midstance to mid-swing
phase. During most of the stance and initial
swing phase, both groups displaced similar
changes (p<0.01), with approx. 1.5mm tibial
medial shift, tibial anterior draw, and joint
distraction. In addition, the OA group
showed 3° of tibial internal rotation (p<0.01).
The OA group had kinematic differences
(p<0.02) during level and downhill gait
compared to healthy. The peak mean
differences were 4mm tibial lateral shift,
2.5mm tibial anterior draw, 4mm joint
narrowing, and 5° tibial external rotation.
Additionally, the OA group had 3° (p<0.02)
higher varus angles with intact ACL (N=20)
at mid-swing phase and with partiel ACL
lesion (N=25) at stance-phase. Also, ACL
lesions increased tibial internal rotation and
Clinical outcome for all subjects revealed
that varus angular excursion during a gait
cycle increased with giving-way symptoms
Conclusions: Knee kinematics during level and downhill
gait differed in patients with OA compared to
healthy. ACL lesions concealed a varus
malalignment in OA patients compared to
health, and giving-way symptoms is
associated with increased varus instability.
The findings aid to our understanding of
associations between knee symptoms and
kinematics in knee OA.
Lasse Ishøi, Per Hölmich, Kristian Thorborg, Jesper Bencke,
Sports Orthopedic Research Center - Copenhagen (SORC-C), Ortopædkirurgisk Afdeling, Hvidovre Hospital; Sports Orthopedic Research Center - Copenhagen (SORC-C), Ortopædkirurgisk Afdeling, Hvidovre Hospital; Sports Orthopedic Research Center - Copenhagen (SORC-C), Ortopædkirurgisk Afdeling, Hvidovre Hospital; Sports Orthopedic Research Center - Copenhagen (SORC-C), Ortopædkirurgisk Afdeling, Hvidovre Hospital; ,
Background: Athletes with femoroacetabular impingement
syndrome often report problems in sprinting
compared to walking and jogging. This discrepancy
may be related to the difference in peak moments
distributed across the hip joint.
Purpose / Aim of Study: In this cross-sectional study, we examined external
hip joint moments during walking, jogging, and sprint
Materials and Methods: We included 20 healthy sports active adults (mean
age 24.7 years). The primary outcome was external
hip joint peak moments for adduction, abduction,
flexion, and extension during: walking with a self-
paced speed; jogging with 8-11 km/h; and maximal
sprint acceleration. Data was collected in a 3D
Motion Analysis Laboratory with two floor-embedded
AMTI force platforms. The mean of three trials for
each activity was captured on the dominant leg for
Findings / Results: Maximal sprint acceleration resulted in higher
external peak moments than jogging and walking for
all external moments (p≤0.006). The increase from
walking and jogging to sprinting was 16-128 % for
adduction, 168-195 % for abduction, 105-148 % for
flexion, and 61-121 % for extension. Furthermore, a
36 % higher extension moment was observed for
walking compared to jogging (p<0.001), whereas a
96 % higher adduction moment was observed for
jogging compared to walking (p>0.001).
Conclusions: Substantially higher hip joint moments were
observed in sprint acceleration compared to walking
and jogging, whereas jogging only showed a higher
adduction moment compared to walking. This
information may explain why patients with
femoroacetabular impingement syndrome often
tolerate walking and jogging activities and to a lesser
Anders Troelsen, Mette Mikkelsen, Kirill Gromov
Dept. of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre; Dept. of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre; Dept. of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre
Background: There is solid evidence that medial
unikompartmental knee arthroplasty (UKA) offers
benefits over total knee replacement in eligible
patients without compromising revision rates
when using contemporary indications and
techniques. While there has been an increasing
adoption of UKA in Denmark with a usage rate of
almost 20 %, lateral UKA is used in <1% of knee
replacements, despite isolated lateral
compartment OA accounting for app. 10 % of OA
cases. It can be speculated that such low
utilization is due to sparse literature regarding its
potentially good outcome, inferior survival
reported in registries, and the lack of a strict
strategy for adoption.
Purpose / Aim of Study: To show the feasibility of adopting fixed bearing
lateral UKA as part of an overall surgical knee
arthroplasty strategy with optimized UKA utilization
we report the outcome of the first 41 cases.
Materials and Methods: We included all consecutive patients operated with
fixed bearing lateral UKA at one department since
the start of introduction in October 2016. It was an
overall strategy to offer UKA whenever possible. All
patients were operated in a well described fast-track
setup. Data was collected prospectively in the
departments arthroplasty database and included
demographic, patient reported outcomes measured
as Oxford Knee Score (OKS) and Forgotten Joint
Score (FJS) and reoperation data. Follow-up data at
3 months and 1 year are presented.
Findings / Results: 41 cases were included. Mean age was 67 years
and 75% were female. Median length of stay was 1
day. Mean (SD) preoperative OKS was 24 (7) and
increased to mean 35 (6) and 42 (5) at 3- and 12-
months follow-up respectively. Mean (SD) FJS was
48 (22) and 72 (19) at 3- and 12-months follow-up
respectively. One knee was reoperated with
repeated DAIR and was infection free at last follow-
Conclusions: The adoption of fixed bearing lateral UKA can be
successful with good clinical outcomes similar to that
reported for medial UKA. Maintaining a strict
strategy for adoption in an environment with
optimized UKA utilization is probably fundamental to
Mads Moss Jensen, Stefan Milosevic, Gustav Østerheden Andersen, Mikkel Mylius Rasmussen, Leah Carreon, Ane Simony, Mikkel Østerheden Andersen
Cense-Spine, Department of Neurosurgery, Aarhus University Hospital; Cense-Spine, Department of Neurosurgery, Aarhus University Hospital; Cense-Spine, Department of Neurosurgery, Aarhus University Hospital; Cense-Spine, Department of Neurosurgery, Aarhus University Hospital; Center for Spine Surgery & Research, Middelfart Hospital; Center for Spine Surgery & Research, Middelfart Hospital; Center for Spine Surgery & Research, Middelfart Hospital
Background: Coccydynia is pain originating in the coccyx and
surrounding tissue. Coccygectomy, which is surgical
amputation of the coccyx, is a way to relieve
patients from their debilitating symptoms if
nonoperative therapy fails to do so. The authors
investigate prognostication in a prospective cohort
of 134 coccygectomized patients who all suffered
from persistent coccydynia and were diagnosed with
instability of the coccyx. At present, no tool to
improve patient selection is available.
Purpose / Aim of Study: The purpose of this study is to identify prognostic
factors predictive of poor outcome following
coccygectomy on patients with persistent
coccydynia due to instability of the coccyx.
Materials and Methods: Through DaneSpine, the Danish National Spine
Registry, 134 consecutive patients were identified
from a single center experience on coccygectomy
performed from 2011 to 2019. Patient
demographics, including age, gender, body-mass-
index (BMI), smoking status, work status, welfare
payments as well as patient-reported outcomes
(PROs), including pain VAS-score (0-100), Oswestry
Disability Index (ODI), Euro-QoL-5D (EQ-5D), Short
Form-36 (SF-36) Physical Component Score (PCS)
and Mental Component Score (MCS) were obtained
at baseline and at 1-year follow-up. In addition,
patient satisfaction with the procedure was obtained
Findings / Results: A minimum of 1-year follow-up was available in 112
patients (84%). Mean age was 41.9 years (range
15-78) and 97 of the patients were female (87%).
Patients were divided into three groups based on
satisfaction. Regression showed no statistically
significant association between the investigated
prognostic factors and a poor outcome following
coccygectomy. The satisfied group showed a
statistically significant improvement in PROs at 1-
year follow-up from baseline, whereas the not
satisfied group did not show a significant
Conclusions: We did not identify factors prognostic for a poor
outcome following coccygectomy. This suggests that
neither of the included parameters should contradict
treatment with coccygectomy for patients who suffer
from persistent coccydynia with instability of the
Nicolas Jones Pedersen , Maria Lovisa Jönsson, Kira Riber Mygind, Thomas Giver Jensen, Troels Haxholdt Lunn, Henrik Palm, Anna Maria Weronica Gaki Lindestrand-Hansen
Department of Orthopaedic surgery , Bispebjerg Hospital ; Department of Orthopaedic surgery , Bispebjerg Hospital ; Department of Orthopaedic surgery , Bispebjerg Hospital ; Department of Orthopaedic surgery , Bispebjerg Hospital ; Department of Anesthesiology, Bispebjerg Hospital; Department of Orthopaedic surgery, Bispebjerg Hospital; Department of Orthopaedic surgery , Bispebjerg Hospital
Background: With aging populations, both hip fractures
and patients in Direct Oral Anticoagulants
(DOAC) are expected to increase. This
constitutes a surgical challenge as DOAC
might increase the risk of intraoperative
blood loss and postpone hip fracture surgery
beyond the nationally recommended 24
Few studies examine Hip fracture patients
receiving DOAC and there is no common
guideline on how to treat this group when it
comes to emergency surgery, which renders
optimizing fast track regimes challenging.
Purpose / Aim of Study: To examine time to surgery, postoperative
complications, intraoperative blood loss and
mortality in hip fracture patients receiving
Materials and Methods: All hip fracture patients from 2017 and partially
2018 at Bispebjerg Hospital were included. We
retrospectively collected data from patient
Findings / Results: 420 patients were included. The median age
was 81,9 and 72,4% were female. Median
time to surgery was 23 hours with a mean of
26,2 and 11,2% received DOAC.
Excluding clopidogrel and VKA’s showed that
the DOAC group had significantly longer time
to surgery >24 hours, compared with the
non-DOAC group (P ≤ .05)
There was no statistically significant
difference in post-operative complications
between the DOAC and non-DOAC group,
considering non-surgical infections, 30-day
reoperation rate, 30-day readmission and
acute kidney failure.
30,2% patients in the non-DOAC group
received blood transfusion during admission,
compared with 33,3% in the DOAC group
and was non-significant (P=0,8).
When categorising intraoperative blood loss
in >300 mL there was no significant
difference in the DOAC and non-DOAC
group. 30-day mortality was 6,7 % in the
DOAC group compared with 6,4% in the non-
DOAC grp and was non-significant (P=1).
Neither was the 90-day mortality significantly
Conclusions: Our study found that DOAC treatment delays
time to surgery but patients receiving DOAC
do not suffer higher mortality or complication
rates. It may be safe to perform surgery
within 24 hours in patients receiving DOAC.
We propose to formulate a protocol for hip
fracture patients in DOAC to enable fast
track regimes and reduce time to surgery.
The study is ongoing and further data will be
presented at DOS.
Lærke Hartvig Krarup, Sofie Langbo Bredtoft, Louise Strand, Inger Mechlenburg, Kirsten Nordbye-Nielsen
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, Department of Childrens Ortopaedic, Aarhus University Hospital, Denmark, Aarhus University Hospital, Denmark; Department of Orthopaedic Surgery, CPNorth: Living life with cerebral palsy in the Nordic countries, Aarhus University Hospital, Denmark,
Background: Despite preventive treatment, children with
Cerebral Palsy (CP) often develop muscle
contractures, which limits their joint motion.
This is problematic since reduced joint
motion composes a limiting factor for the
child’s functional capacity and motor skills,
which may result in limitations at activity and
participation. Furthermore, there is a strong
association between gross motor function
and quality of life. A greater understanding
of factors which contributes to the
development of ankle contractures may be
useful in the development of future
treatment strategies for children with CP.
Purpose / Aim of Study: The aim of this study was to investigate the
prevalence of ankle contractures among
children and adolescents with CP in
Denmark. Furthermore, to investigate how
the prevalence varied in accordance with
age, gross motor function, and spasticity.
Materials and Methods: The study is a cross sectional study based
on extracted data from the nationwide
clinical quality database (CPOP).
The study population was children aged 6-
14 years, who in the period from 2018-2019
had been systematically examined by a
physiotherapist and registered in the CPOP
Information on Gross Motor Function
System Expanded and Revised level
(GMFCS-E&R) and passive range of motion
in the ankle joint with an extended knee was
measured for 663 children. For 598 children
information on Modified Ashworth Scale
score (MAS) was registered.
The associations between the prevalence of
ankle contractures and age, GMFCS-E&R
level and MAS-score were estimated as
odds ratio (OR) and 95% confidence
intervals (95% CI) with the use of logistic
Findings / Results: 31% of the study population had an ankle
contracture. ORs for ankle contracture were
significant higher for children with GMFCS-
E&R level IV-V (OR: 1.82, 95% CI: 1.26;
2.62) relative to level I-III and MAS-score 2-
4 (OR: 2.37, 95% CI: 1.47; 3.82) relative to
MAS-score 0. There was no association
with the degree of spasticity. Ankle
contracture was not significantly associated
Conclusions: Ankle contractures are frequent in children
with CP. The study indicated that ankle
contracture was associated with level of
gross motor function.
Pelle Baggesgaard Petersen, Christoffer Calov Jørgensen, Kirill Gromov, Henrik Kehlet, on behalf of the Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group
Section for Surgical Pathophysiology, Rigshospitalet; Section for Surgical Pathophysiology, Rigshospitalet; Department of Orthopaedic Surgery,, Hvidovre Hospital; Section for Surgical Pathophysiology, Rigshospitalet; ,
Background: Unicompartmental knee arthroplasty (UKA) has
increased due to potential favourable complication
rates when compared to total knee arthroplasty
(TKA). Although venous thromboembolism (VTE) is
a well-documented complication after TKA limited
data is available after UKA and mostly presented as
secondary findings in observational comparisons to
TKA. There is a lack of fast-track UKA VTE studies
and no guidelines on thromboprophylaxis.
Purpose / Aim of Study: We aimed at describing in details the 90-day
incidence and time course of VTE after UKA within a
multicentre fast-track collaboration.
Materials and Methods: We used an observational cohort study design from
8 dedicated fast-track centres with prospective
collection of preoperative risk-factors, complete
follow-up on length of stay (LOS), 90-day
readmissions and mortality from the Danish National
Patient Registry and analysis of health records if
LOS > 2 days or an ICD-10 code of VTE. Due to
limited events we refrained from analysis of
Findings / Results: In 3,927 procedures (46.1% males, mean age 66.2
(SD 9.4) years) median LOS was 1 [IQR 0-1] day
and 7.5% had LOS > 2 days. The 90-day incidence
of VTE was 16 (0.41%) and 14 (0.37%) when
excluding preoperatively anticoagulated patients.
There were 5 (0.13%) pulmonary embolisms and 11
(0.28%) deep-vein thrombosis after median 18
[11.75-35.25] days. 90-day mortality was 3 (0.08%)
with no fatal PE or initial postoperative VTE.
Conclusions: The 90-day incidence of VTE after fast-track UKA
was 0.41% (0.37% when excluding preoperatively
anticoagulated patients), which is comparable to
reports of 0.39% VTEs after fast-track TKA in the
same departments. Investigations on risk-factors are
needed for optimizing thromboprophylaxis.
Naaja Petersson, Inger Mechlenburg, Per Aagaard, Stian Jørgensen, Troels Kjeldsen
Department of Sports Science and Clinical Biomechanics, University of Southern Denmark; Department of Orthopedic Surgery, Aarhus University Hospital; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark; Department of Occupational and Physical Therapy, Horsens Regional Hospital; Department of Orthopedic Surgery, Aarhus University Hospital
Background: Knee osteoarthritis (OA) negatively affects
skeletal muscle size and strength, which
impairs the capacity to perform activities of
daily living and results in a reduced quality
of life. Walking exercise with concurrent
lower limb blood flow restriction (BFR-
walking) has previously been shown to
increase muscle strength and improve
function in elderly Japanese individuals.
Purpose / Aim of Study: To evaluate changes in performance-based
functional capacity and self-reported knee
function after 8 weeks of BFR-walking in
elderly individuals with knee OA.
Materials and Methods: Fifteen elderly individuals (>60 years of
age) diagnosed with knee OA participated in
8 weeks of outdoor walking with partial
blood flow restriction of the leg suffering
from knee OA. Participants performed 20-
min horizontal walking (4km/h) for 4
times/week with one supervised session per
week. A pneumatic cuff system was applied
to the proximal part of the thigh of the
affected leg. The restrictive pressure
applied during walking was set to 60% of
the total arterial occlusion pressure for each
individual participant. 30-s sit-to-stand test
(30STS), Timed-Up & Go (TUG), 40-m fast-
paced walk test (40MWT), 11-step stair-
climb test, and Knee Osteoarthritis Outcome
Score (KOOS) were assessed pre and post
Findings / Results: Ten participants completed the BFR-walking
exercise (range 6-10 wk). Self-reported
knee function (KOOS) remained unchanged
following the intervention period. In contrast,
a strong tendency for positive change (-4%)
in 40-m fast-paced walk capacity was
observed (p = 0.06). Subsequently post hoc
analysis revealed improved (p < 0.05)
40MWT (-5%), 30STS (+16%) and TUG
(-8%) performance in participants
completing a minimum of 8 weeks of BFR-
walking (n = 9).
Conclusions: BFR-walking exercise of moderate duration
(6-10 wk) led to improved 40-m fast-paced
walking capacity in the present group of
elderly individuals with knee OA. Further,
participants with high training compliance (≥
8 wk BFR-walking) demonstrated significant
improvements in sit-to-stand mobility
(30STS, TUG) and horizontal walking ability
(40MWT), which is suggested to represent
an important functional adaptation in elderly
with knee OA.
Gustav Østerheden Andersen, Stefan Milosevic, Mads Moss Jensen, Mikkel Østerheden Andersen, Ane Simony, Mikkel Mylius Rasmussen, Leah Carreon
Student, Aarhus University ; Student, Aarhus University ; Student, Aarhus University; Center for Spine Surgery & Research, Middelfart Hospital; Center for Spine Surgery & Research, Middelfart Hospital; Cense-Spine, Department of Neurosurgery, Aarhus University Hospital; Center for Spine Surgery & Research, Middelfart Hospital
Background: Coccydynia is pain originating from the os coccygis,
a condition for which several treatments, of a more
or less invasive character, are being practised today.
Purpose / Aim of Study: Through a systematic review and meta-analysis this
study aims to evaluate the efficacy of available
treatment options for patients with persistent
Materials and Methods: Methods: Original peer-reviewed publications on
coccydynia and its treatment were identified
according to PRISMA guidelines by performing a
wide literature search of relevant bibliographic
databases, from their inception to January 17th,
2020, combined with other sources. Data on
extracted treatment outcome was pooled in suitable
categories to allow for meta-analysis of efficacy.
Outcome measures: All outcomes relevant to the
treatment efficacy of coccydynia were extracted. No
single measure of outcome was consistently present
among the included studies. For the main analysis
Visual Analogue Scale (VAS) of pain was evaluated.
Eligible studies: Studies with treatment outcome on
adult patients with persistent, primary coccydynia.
Findings / Results: In this review a total of 1980 patients across 64
studies were identified: 5 RCTs, 1 experimental
study, 1 quasi-experimental study, 11 prospective
studies, 45 retrospective studies and a pool of
unpublished data from the DaneSpine registry. The
greatest improvement in pain was achieved by
those patients who underwent RFT (VAS decreased
by 5.11 cm on average). A similar mean
improvement was achieved from ESWT (5.06),
Ganglion Block (4.92), Coccygectomy (4.86) and
Injection (4.22). Although improved, the mean
change was less for those who received
Stretching/Manipulation (2.19) and
Conservative/Usual Care (1.69).
Conclusions: Conservative therapy and stretching/manipulation
showed limited improvement. Interventional
treatments (ganglion impar block, injections, RFT
and ESWT) showed promising results and should
be considered before coccygectomy, which however
remains the most investigated treatment, and
despite varying complication rates consistently
demonstrates high efficacy when treating otherwise
Christian Fugl Hansen, Jonas Jensen, Volkert Siersma, Jonathan Comins, John Brodersen, Michael Rindom Krogsgaard
Section for Sports Traumatology M51, Bispebjerg and Frederiksberg Hospital; Section for Sports Traumatology M51, Bispebjerg and Frederiksberg Hospital; Research Unit and Section for General Practice, Department of Public Health, Copenhagen University; Section for Spots Traumatology M51, Bispebjerg and Frederisberg Hospital; Research Unit and Section for General Practice, University of Copenhagen and Region Zealand; Section for Sports Traumatology M51, Bispebjerg and Frederiksberg Hospital
Background: PROM-data are the most important
outcomes in musculoskeletal research.
Most PROMs are described as valid
and reliable. However, many have not
been developed with help from
relevant patients and very few have
been validated for construct validity
with proper statistical methods.
Purpose / Aim of Study: To assess the content and construct
validity of the most commonly used
PROMs in sports research, and to
produce a catalogue of these PROMs.
Materials and Methods: A PubMed search “patient reported
outcome measures sports” resulted in
915 articles published between July
29, 2011 and November 24, 2019.
Articles relevant to sports and with at
least one named PROM as outcome
were included, 439 articles. A total of
194 different PROMs had been used.
Condition specific PROMs that had
been used at least three times (42)
and PROMs that had been used once
or twice but were the only PROMs for
a specific condition (13) plus six
PROMs that were identified in a search
regarding RCTs in sports science,
were selected for analyses. Articles
describing development of these 61
PROMs were assessed for content
validity. All articles regarding construct
validity for each PROM (including all
published translations) (in total 622
articles) were analyzed.
Findings / Results: A catalogue with assessment of 61
PROMs and translated versions was
produced. The majority of these were
of inferior validity. Most commonly (in
53 of 61 PROMs (87%)) there was no
security of high content validity in
development. Another major reason for
inferior validity was that construct
validity had not been secured by
adequate statistical methods.
Conclusions: A majority of the assessed PROMs
have no proven validity as
measurement tools. Scientific results
obtained by use of these PROMs are
questionable. From this catalogue it is
possible to identify the most valid
PROMs as outcome measures for
specific studies in sports medicine and
sports traumatology. It is important that
a targeted effort is made to develop
valid PROMs for major
musculoskeletal conditions. In all
articles containing results obtained by
PROMs without proven content- and
construct validity, it should be
thoroughly discussed how this may
affect the results.
Liv Riisager Wahlsten, Stig Brorson, Henrik Palm
Orthopedic department , Herlev and Gentofte University Hospital; Orthopedic department , Zealand University Hospital; Orthopedic department, Bispebjerg University Hospital
Background: Sustaining a hip fracture is a life changing event for many elderlies. While doctors and researchers tend to be preoccupied with mortality and complication rates, patients are more concerned by other aspects e.g. loss of independence and ability to remain in their own home.
Purpose / Aim of Study: This study aimed to i) determine age-stratified one stratified one-year event rates of admission to nursing home after discharge, and ii) identify risk factors associated with nursing home admission.
Materials and Methods: Community dwelling patients aged 60-100 years undergoing their first hip fracture surgery in 2005 100 years undergoing their first hip fracture surgery in 2005 - 2015 were identified in nationwide administrative registries. Outcome was admission to nursing home within one year of discharge. To assess risk factors, we performed age-stratified cumulative incidence curves and multivariate cause specific cox regression models adjusted for age, sex, social factors, and comorbidities.
Findings / Results: A total of 53,157 patients were included. One-year risk increased with advancing age from 3.2% of patients aged 60 to 69, up to 22.4% in the eldest group aged 90-100 years. Living alone and dementia were strong risk factors HR 9.22 [95% CI 5.60-15.18, p = <0.0001] and HR 6.73 [95% CI 4.80 15.18, p = <0.0001] and HR 6.73 [95% CI 4.80- 9.44, p = 0.0001] respectively for patients aged 60 to 69 years, the effect decreased with higher age down to HR 2.75 [95% CI 2.12- 3.57, p = <0.0001] and HR 2.15 [95% CI 1.88- 2.46, p = <0.0001] for patients = 90 years. Other important risk factors were pre 2.46, p = <0.0001] for patients = 90 years. Other important risk factors were pre-injury home care, Parkinson’s disease and depression. Surprisingly, physical comorbidities i.e. kidney disease, chronic obstructive pulmonary disease, diabetes and cancer did not increase the risk of nursing home admission.
Conclusions: Future initiatives aimed to reduce loss of independence and nursing home admission, among patients with first time hip fracture, should devote attention to living settings and cognitive impairment rather than physical comorbidity.
Nikolaj winther, MArtin Kirkegaard, Ulrik Kragegaard, Kurt Skovgaard, Anders Odgaard, Michael Mørk Petersen
Department of Orthopaedic Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Orthopaedic Surgery , Rigshospitalet, Copenhagen, Denmark; Department of Orthopaedic Surgery , Rigshospitalet, Copenhagen, Denmark; Department of Orthopaedic Surgery , Rigshospitalet, Copenhagen, Denmark; Department of Orthopaedic Surgery , Rigshospitalet, Copenhagen, Denmark; Department of Orthopaedic Surgery , Rigshospitalet, Copenhagen, Denmark
Background: Increasing numbers of THA and TKA are
performed with expanding applications in a
younger and elderly population. Recurrent
complicated aseptic and septic revisions
and periprosthetic femoral fractures are
growing in numbers resulting in extensive
loss of femoral bone stock making it unable
to support revision implants. For these
complicated cases Total Femur
Replacement (TFR) is an alternative to
Purpose / Aim of Study: To assess the functional outcomes and the
complication associated with TFR used in
Materials and Methods: We retrospectively reviewed 21 non-tumour
cases that received a TFR for revision
surgery: mean age 71 (40-85) years,
F/M=12/10, mean follow-up 51 (12-180
months), mean number of previous
revisions 3.8 (1-12), history of periprosthetic
infection (n=11). The indications for TFR
were severe femoral bone loss because of
aseptic loosening (n=8), septic loosening
(n=6), periprosthetic fracture (n=6) and
Findings / Results: Mean operating time was 271 minutes (133-
600). Mean blood loss was 3417ml (560-
7300). 7 patients had a well-fixed
acetabulum component and 14 cases had
acetabular cup revision. 8 hips received a
constrained liner, 4 patients a dual mobility
cup and 9 cases had non-constraint liners.
None of the 8 cases with a constrained liner
dislocated, 8 of 13 patients (62%%) without
constraint liners dislocated. 11 patients had
no additional procedures and 10 patients
had additional surgical procedures with 6
patients revised for infection: 1 total
exchange of the TFR and 5 treated with
DAIR. No amputations were performed. 14
patients were on lifelong antibiotics, and at
end of follow-up 4 patients had died of
causes unrelated to surgery. We found good
patient satisfaction and low pain scores with
low activity level.
Conclusions: TFR for revision surgery in non-tumour
cases resulted in limb salvage in all patients
and with only 1 patient having total
exchange of the TFR implant. However,
minor revision for infection and hip
dislocation was common occurrences.
Laurits Taul-Madsen, Troels Kjeldsen, Søren Skou, Inger Mechlenburg, Ulrik Dalgas
Department of Public Health, Aarhus University; Department of Orthopedic Surgery, Aarhus University Hospital; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark; Department of Orthopedic Surgery, Aarhus University Hospital; Department of Public Health, Aarhus University
Background: Despite evidence supporting prescription of
exercise as medicine in several chronic
diseases, long-term adherence to exercise is a
persistent challenge. One concept, that has
been suggested and currently used clinically to
preserve exercise-induced effects, is exercise
booster sessions (EBS). Nonetheless, the
components and effects of these EBS still
remain to be reviewed.
Purpose / Aim of Study: The purpose of this systematic review was
therefore to summarize and synthesize 1) the
reported effects of EBS on physical function,
pain, quality of life, and societal costs and 2)
delineate the basic components of EBS
(frequency, intensity, type and time), in healthy
and clinical populations following an exercise
Materials and Methods: Seven databases were electronically searched
in December 2019. Included studies were
randomized controlled trials (RCTs) of exercise
interventions followed by a period of EBS or a
control group not receiving EBS. Abstracts and
full texts were independently screened and
selected for inclusion by two reviewers.
Methodological quality of the included studies
was assessed using the Cochrane risk of bias
tool version 2.0.
Findings / Results: Five studies on respectively knee osteoarthritis
(n=4) and lower back pain (n=1), reporting four
RCTs were included. One study found a positive
effect of EBS on the WOMAC score, -46.0
(-80.0, -12.0), whereas the others did not find
any differences. The frequency of EBS ranged
from 0.09-1 session/week, while no studies
reported exercise intensity. One study found
EBS to be cost-effective. All studies were
considered to have a high overall risk of bias.
Conclusions: Only sparse literature exist on EBS, generally
showing no exercise-induced effects on physical
function or pain. However, the low number of
trials, the potential risk of bias, plus the diversity
in trial interventions prevent a firm conclusion.
Further high-quality RCTs investigating the effect
of EBS on physical function, pain, quality of life
and societal costs are needed.
Kristine Bunyoz, Erik Malchau, Henrik Malchau, Anders Troelsen
Department of orthopaedics, Hvidovre Hospital; Department of orthopaedics, Sahlgrenska University Hospital; Department of orthopaedics, Sahlgrenska University Hospital; Department of orthopaedics, Hvidovre hospital
Background: Despite studies favoring cemented fixation
for patients > 75 years, a trend toward
increased use of uncemented fixation has
been described using arthroplasty registry
data from 2006 to 2010. Updated data are
needed to investigate contemporary trends
in the usage of uncemented fixation,
especially in patients > 75 years.
Purpose / Aim of Study: 1:Has percentage of primary THAs
performed with uncemented fixation
changed since 2010? 2:Has percentage of
primary THAs performed in patients > 75
years performed with uncemented fixation
changed since 2010? 3:After stratifying by
age, which fixation strategy (cemented vs
uncemented, hybrid vs uncemented) is
associated with lowest risk of revision?
Materials and Methods: National reports from hip arthroplasty
registers were identified, and data were
extracted if published in
English/Scandinavian language, with at
least 3 years of reported data from 2010-
2017. All cause rates of revisions related to
fixation and secondary to age groups, were
taken directly from the registers and no re-
analysis was done. Risk estimates were
presented as HR, rate per 100 component
years or K-M estimates of revision.
Findings / Results: Current use of uncemented fixation in
primary THAs varies between 24% and
71%. Increasing use is reported in Norway,
Denmark, and Sweden, whereas
decreasing use is reported in England-
Wales, Australia, New Zealand, and
Finland. In patients > 75 years, numbers are
stable in Netherlands, Sweden, New
Zealand, and England-Wales, whereas an
increasing trend is seen in Denmark and
Australia. In Finland, the use of uncemented
fixation has decreased (from 43 % to 24 %)
from 2010 to 2017. Compared with
uncemented fixation, risk of revision using
cemented fixation was lower in patients >
75 years for all registers surveyed, except
for the oldest males in the Finnish register,
where no difference was found.
Conclusions: Our findings should be used as feedback on
current THAs performed, to direct surgeons
to choose the right implant fixation,
especially in patients > 75 years, thereby
reducing revision risk and increasing the
long-term survival of primary THAs. Femoral
stem fixation may be the most important
revision risk factor in older patients, and
future studies should examine this
Mette Mikkelsen, Anqi Gao, Lina Holm Ingelsrud, David Beard, Anders Troelsen, Andrew Price
Dept. of Orthopedic Surgery, Clinical Orthopedic Research Hvidovre (CORH), Copenhagen University Hospital Hvidovre; Nuffield Dept. of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford; Dept. of Orthopedic Surgery, Clinical Orthopedic Research Hvidovre (CORH), Copenhagen University Hospital Hvidovre; Dept. of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford; Dept. of Orthopedic Surgery, Clinical Orthopedic Research Hvidovre (CORH), Copenhagen University Hospital Hvidovre; Dept. of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford
Background: With the increase in use of Patient Reported
Outcome Measurements in orthopedics, including
the introduction into registries, there is a need for
interpretative tools to contextualize our outcome.
Purpose / Aim of Study: The aim of this study was to create an interpretive
classification for the transition in the Oxford Knee
Score (OKS) from pre-operative to 6-months follow-
up (the change score) using the anchor-based
Materials and Methods: Registry data from 46094 total knee replacements
from the year 2014/15, accessed via the Health and
Social Care Information Centre (HSCIC) official
website. Data included pre-operative and 6-month
follow-up OKS and response to the transition anchor
question: “How are the problems now in the
operated knee compared to pre-operation?" Please
select one of the following: "much better", "a little
better", "about the same", "a little worse" and "much
worse". Categories were determined using Gaussian
approximation probability and k-fold cross-validation.
Findings / Results: 4 categories were identified with the corresponding
change score intervals; “1. Much Better” (≥ 16), “2. A
Little Better” (7-15), “3. About the Same” (1-6) and
“4. Much Worse” (≤ 0) based on the anchor
questions’ original 5 categories. The mean 10-fold
cross-validation error was 0.349 OKS points (95 %
confidence interval 0.511 to 0.632). Sensitivity
ranged from 0.34 to 0.68, specificity raged from 0.74
Conclusions: We have categorized the change score into a
clinically meaningful classification. We argue it
should be an addition to the continuous OKS
outcome to contextualize the outcomes and aid in
interpretation of research results.
Josephine Sandahl Michelsen , Christian Wong
Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre; Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre
Background: Studies have shown that 30 ¨C 70 % of
children with cerebral palsy (CP)
experience chronic pain, which
increases with age and is closely
interrelated to poor quality of life.
Despite this, pain is an overlooked and
undertreated clinical problem.
Botulinum toxin injections have for
more than 20 years been used to
diminish spasticity in children with CP
but the effect on pain has only sparsely
Purpose / Aim of Study: The aim of this study was to examine the analgesic effect of a single intramuscular injection of DYSPORT in the most painful muscles of the lower extremities.
Materials and Methods: OOur interim analysis is based on 14 children with spastic CP, age 5-17, GMFCS I-V. Participants were recruited from outpatient clinics of two regional hospitals. The most painful muscles during a clinical examination were the targets for treatment. The children had to have at least moderate muscle pain (r-FLACC=4) at inclusion to be enrolled in the study. Pain levels were measured before and 4 weeks after a single injection of botulinum toxin (Dysport). All measurements were performed by a single specially trained rater. The localized pain of the treated muscles was evaluated by r-FLACC. The effect on daily pain was evaluated by the Pediatric Pain Profile (PPP). The effect on clinically relevant problems was evaluated by individual SMART goals using the goal attainment scale. Funding for this research was provided by Ipsen.
Findings / Results: A significant pain reduction was observed 4 weeks post-treatment for localized muscle pain (6.71±1.77 vs 3.86±2.63, p:0.001) and the impact on daily activities (Z= -2.496, p:0.013). For PPP, an analgesic but non-significant trend was indicated for pain intensity (z=-1.811, p:0.07) and for pain-related behaviors (27.79±12.82 vs 21.23±14.39, p:0.075). Moreover, a clinically meaningful effect was seen since almost all participants achieved their therapeutic SMART goals (Z= -2.937, p:0.003).
Conclusions: Even though Dysport has been utilized for spasticity modulation in children with CP, it also appears to have a significant analgesic effect, when muscle pain is targeted. Moreover, the localized pain reduction seems to have a positive effect on activities of daily living.
Lasse Ishøi, Kasper Krommes, Mathias Neilsen, Kasper Thornton, Per Holmich, Per Aagaard, Jacob Penalver, Kristian Thorborg
Sports Orthopedic Research Center - Copenhagen (SORC-C), Ortopædkirurgisk Afdeling, Hvidovre Hospital; Sports Orthopedic Research Center - Copenhagen (SORC-C), Ortopædkirurgisk Afdeling, Hvidovre Hospital; Sports Orthopedic Research Center - Copenhagen (SORC-C), Ortopædkirurgisk Afdeling, Hvidovre Hospital; Sports Orthopedic Research Center - Copenhagen (SORC-C), Ortopædkirurgisk Afdeling, Hvidovre Hospital; Sports Orthopedic Research Center - Copenhagen (SORC-C), Ortopædkirurgisk Afdeling, Hvidovre Hospital; Department of Sports Science and Clinical Biomechanics, SDU; Sports Orthopedic Research Center - Copenhagen (SORC-C), Ortopædkirurgisk Afdeling, Hvidovre Hospital; Sports Orthopedic Research Center - Copenhagen (SORC-C), Ortopædkirurgisk Afdeling, Hvidovre Hospital
Background: Increasing age, high quadriceps strength, and low
hamstring strength are associated with hamstring
strain injury in football.
Purpose / Aim of Study: We aimed to assess the age-related variation in
maximal hamstring and quadriceps strength in male
elite football players from U-13 to the Senior level.
Materials and Methods: We included 125 Elite football players from a Danish
professional football club and associated youth
academy (1st tier) (U-13, n=19; U-14, n=16; U-15,
n=19; U-17, n=24; u-19, n=17; Senior, n=30).
Maximal isometric force (MVC) was assessed for the
hamstrings at 15o knee joint angle and for the
quadriceps at 60o knee joint angle (0o = full
extension) using an external-fixated handheld
dynamometer. Hamstring:Quadriceps (H:Q) strength
ratio as well as hamstring and quadriceps MVC
levels were compared across age groups (U-13 to
Findings / Results: Senior players showed 18-26% lower H:Q ratio
compared to all younger age groups (p≤0.026).
Specific H:Q ratios (mean [95% CI]) were: Senior,
0.45 [0.42;0.48]; U-19, 0.61 [0.55;0.66]; U-17, 0.56
[0.51;0.60]; U-15, 0.59 [0.54;0.64]; U-14, 0.54
[0.50;0.59]; U-13, 0.57 [0.51;0.62]. Hamstring
strength increased from U-13 to U-19 with a
significant drop from U-19 to the Senior level
(p=0.036), whereas quadriceps strength increased
linearly from U-13 to Senior level.
Conclusions: Elite senior football players demonstrates lower
Hamstring:Quadriceps strength ratio compared to
youth players, which is driven by lower hamstring
strength at the senior level compared to the U-19
level combined with a higher quadriceps strength.
This discrepancy in hamstring and quadriceps
strength capacity may place senior level players at
increased risk of hamstring strain injuries.
Hanne Hornshøj, Carten Juhl, Thomas Lind
Afdeling for Ergoterapi og Fysioterapi, Copenhagen University Hospital, Herlev and Gentofte; Afdeling for Ergoterapi og Fysioterapi, Copenhagen University Hospital, Herlev and Gentofte; Ortopædkirurgisk Afdeling, Copenhagen University Hospital, Herlev and Gentofte
Background: Reduced Range of Motion (ROM) in
the knee due to stiffness
(arthrofibrosis) after TKA is often
treated with manipulation under anaesthesia
Purpose / Aim of Study: To determine the effect of MUA after
TKA on ROM and to identify factors
affecting the final ROM after MUA
Materials and Methods: Patients receiving MUA at Gentofte
Hospital after TKA performed from
2011 to 2015 were included. Age,
gender, BMI, smoking, comorbidity,
type of operation (primary or re-TKA)
flexion and extension were extracted
from electronic patient records.
Assuming missing data is at random
multiple imputations were performed,
based on age, sex and post-operative
range of motion.
Findings / Results: In total 104 participants (57 women)
with at mean age of 60.7 years and
BMI at 27.8 were included. A mean
increase from before MUA to follow-up
at 3 months of 21.3 degrees (95% CI
16.6 to 25.9) in flexion to 102.3
degrees (95% CI 98.8 to 105.9) and a
mean decrease of 4.8 degrees (95%
CI 3.0 to 6.7) in extension deficit to 3.7
degrees (95% CI 2.7 to 4.6) at follow-up were found.
A subgroup of 14 participant reviewed more than one MUA, showing a mean increase from before MUA to follow
up were found.
A subgroup of 14 participant reviewed
more than one MUA, showing a mean
increase from before MUA to follow-up o
of 24,3 (95% CI 10.8 to 37.8) in flexion a
and a mean decrease of 6.8 (95% CI 2
2.4 to 11.0) in extension deficit.
The mean increase in flexion was 9.3
degrees (95% CI: -4.7 to 23.2), from f
first to last MUA. Mean flexion at final f
follow up was 99.6 degrees (95% CI: 8
88.1 to 111.2). The mean decrease in e
extension the was 3.2 degrees (95% C
CI: 7.5 to 1.1) from first to last MUA. M
Mean extension deficit at final follow u
up was 2.0 degrees (95% CI: 0.2 to 3
Patients with DM showed significant
improvement in flexion at mean 33.5
degrees (95% CI: 21.8 to 45.2) to
mean flexion at 100.9 degrees (95%
CI; 94.2 to 107.6) at final follow-up.
The extension-deficit reduced with 3.9
degrees (95% CI: -8.9 to 1.1) to a
mean deficit at 5 degrees (95% CI: 0.2
to 9.8) at final follow-up.
Conclusions: A clinical important increase in flexion an
and reduction in extension deficit was se
seen, even in those failing the first MU
MUA and patient with DM.
Bjarke Viberg, Frank Damborg, Lars Rotwitt, Anders Jordy, Michael Boelstoft Holte, Per Hviid Gundtoft
Department of Orthopaedic Surgery and Traumatology, Lillebaelt hospital, University Hospital of Southern Denmark; Department of Orthopaedic Surgery and Traumatology, Lillebaelt hospital, University Hospital of Southern Denmark; Department of Orthopaedic Surgery and Traumatology, Lillebaelt hospital, University Hospital of Southern Denmark; Department of Orthopaedic Surgery and Traumatology, Lillebaelt hospital, University Hospital of Southern Denmark; Department of Dental, Mouth, and Jaw surgery, Hospital of South West Jutland; Department of Orthopaedic Surgery and Traumatology, Lillebaelt hospital, University Hospital of Southern Denmark
Background: 3D-printing of bones is novel way in preoperative
planning giving the surgeon a real-size fracture to
evaluate by hand. There are studies from China
showing shorter operation time, decreased
intraoperative blood loss, and better functional
outcome but there are no studies assessing the
impact on the preoperative plan.
Purpose / Aim of Study: To assess the effect of 3D-printed proximal tibia
fractures in the preoperative plan. Secondarily, to
perform sub analyses of the effect divided on
Materials and Methods: Data on bicondylar proximal tibia fractures
treated with open reduction and internal fixation
including dual plating was retrieved for 2019. We
included 9 consultants in traumatology to do a
preoperative plan twice on the basis of CT-scan,
thereafter the 3D-print and divided them in to
senior (>10 years consultant) and junior (<10
years consultant). Data was entered in an
electronic database. We defined an alteration in
the preoperative plan as a change in the
operative starting point, arthroscopic use,
posterior plate, solitary screws, elevation of joint
surface through fenestra, and auto-/allograft.
Length of plates were also assessed and the
surgeons evaluated their confidence after each
preoperative plan. Chi-square test was used for
categorical group comparison between the 3D-
print and the second preoperative plan on the
Findings / Results: There were 9 3D-printed proximal tibia fractures,
mean age 60.1 (95% confidence interval, 52.4;67.8),
4 were female and 90% were min. Schatzker type 4.
The 3D-print lead to a change in 47% of the
preoperative plans with no difference between junior
or senior surgeons (p<0.29). The amount of
changes was median 1 (1-4). Including changes to
the length of plate, there was a change in 81% of the
preoperative plans with no differences among the
surgeon groups (p<0.512). There was a significant
improvement in the level of confidence with the
preoperative plan among junior surgeons (p<0.001)
but not among senior surgeons (p<0.24).
Conclusions: 3D-print of proximal tibia fractures has a significant
effect leading to a change in 47% of the
preoperative plans with no difference due to the
Nikolaj Winther, Michael Mørk Petersen, Jens Styrup
Department of Orthopaedic Surgery, Rigshospitalet; Department of Orthopaedic Surgery, Rigshospitalet; Department of Orthopaedic Surgery, Rigshospitalet
Background: Revision of a failed total hip arthroplasty
with massive acetabular bone loss and
pelvic discontinuity is a reconstructive
challenge. Treatment options includes
morselized bone graft and structural
allograft used with uncemented
hemispherical acetabular components,
cages, porous metal augments, and cup-
cage reconstruction. A custom-made
triflanged implant has recently been
introduced as a new option of treatment.
Purpose / Aim of Study: The purpose of this study was to evaluate
the use of a Custom made Triflanged
Implant in cases with pelvic discontinuity.
We monitored healing rate, migration and
overall survivorship defined as revision of
the implant for any reason.
Materials and Methods: We reviewed 42 consecutive patients, mean
age 68.7 (48-85 years) with a failed THA
and pelvic discontinuity. Mean follow-up was
45 (12-120) months. The implant for
acetabular reconstruction was custom
manufactured on the basis of a three-
dimensional model of the hemi-pelvis
created from computed tomography (CT).
The Harris Hip score was performed and
the acetabular bone defects were all
classified as type V according to the Gross
classification. Center of rotation (COR) was
calculated. Postoperative radiographs were
analyzed in relation to: Healed or unhealed
discontinuity and stable/unstable fixation.
Findings / Results: Mean per-operative blood loss was 1500 ml
(235-6500) and mean surgery time was 147
min. (72-331). COR was established in 36
of the patients and no major intraoperative
complications occurred. Mean Harris Hip
score was 80 (47-96). The discontinuity
healed in 40 (95%) of the cases.Thirty-five
patients (83%) had no additional
procedures. Seven patients experienced
dislocation (16%) five for these treated with
a constrained liner. We observed two septic
loosening (5 %) revised in 2 stage
procedures, and one re-infection (2%)
treated with life-long antibiotic.
40 (95%) of the implants was defined as
stable without any revision for aseptic
Conclusions: The 3D costum made Triflanged Implant
makes it possible to optimized screw and
implant positioning with high accuracy and
with rigid fit on bone fixation thus permitting
healing of the discontinuity and biological
fixation of the acetabular component.
Thomas Giver Jensen, Mostafa Aqeel Khudhair Almadareb, Maria Booth Nielsen, Emil Jesper Hansen, Martin Lindberg-Larsen
Ortopædkirurgisk , Bispebjerg Hospital; Ortopædkirurgisk , Bispebjerg Hospital; Ortopædkirurgisk, Bispebjerg Hospital; Ortopædkirurgisk , Bispebjerg Hospital; Ortopædkirurgisk, Bispebjerg Hospital
Background: Surgical treatment of lateral distal fibula fractures is
associated with a high rate of reoperation and
complications. Within the last decade anatomical
plates have been introduced.
Purpose / Aim of Study: The aim of this study is to report risks of reoperation
and wound healing problems ≤ 1 year after
treatment with one-third tubular plate, Locking
compression plate or distal anatomical locking
Materials and Methods: From 1. January 2010 until 31. December 2015 all
patients having osteosynthesis of distal fibula with a
one-third tubular plate, LCP or distal anatomical LCP
plate at Copenhagen University Hospital,
Bispebjerg, Denmark, were identified and
retrospectively evaluated with a follow up of at least
1 year. Data on patient characteristics, fracture
classification, surgical time, surgical delay and
weight bearing are registered.
Findings / Results: 601 patients were included. 417 were treated using
a one-third tubular plate with a reoperation risk of
11% (95% CI 8-14) (n=46) and 21% (95% CI 18-25)
(n=89) had wound healing problems. 114 received
an LCP plate with a reoperation risk of 20% (95% CI
13-28) (n=23) and 31% (95% CI 23-40) (35) had
wound healing problems. 57 had a distal anatomical
LCP plate with a reoperation risk of 23% (95% CI
14-35) (n=13) and 40% (95% CI 29-53) (n=23) had
wound healing problems. No difference was seen in
fracture classification (Weber) between one-third
tubular plate and distal anatomical LCP plate
Conclusions: Distal anatomical LCP plates seems to be
associated with higher risk of reoperation and wound
healing problems compared to the one-third tubular
plate. Further analysis including patient and fracture
related risk factors will be performed before
Christopher Jantzen, Lars B. Ebskov, Kim H. Andersen, Mostafa Benyahia, Peter Bro-Rasmusssen, Jens K. Johansen
Department of Orthopedic Surgery, Foot and Ankle Section , Hvidovre University Hospital, Copenhagen, Denmark; Department of Orthopedic Surgery, Foot and Ankle Section , Hvidovre University Hospital, Copenhagen, Denmark; Department of Orthopedic Surgery, Foot and Ankle Section , Hvidovre University Hospital, Copenhagen, Denmark; Department of Orthopedic Surgery, Foot and Ankle Section , Hvidovre University Hospital, Copenhagen, Denmark; Department of Orthopedic Surgery, Foot and Ankle Section , Hvidovre University Hospital, Copenhagen, Denmark; Department of Orthopedic Surgery, Foot and Ankle Section , Hvidovre University Hospital, Copenhagen, Denmark
Background: Total ankle replacement (TAR) is a rapidly growing
treatment for end-stage ankle arthritis. TAR is
generally performed as an inpatient procedure with
an average length of stay between 2.5-3.2 days.
Previous studies have shown that out-patient TAR is
safe and cost-effective but others have found
increased complication rates associated with out-
clinic surgery but the literature is sparse on this
Purpose / Aim of Study: To evaluate the admission length together with
complication, re-admission and non-scheduled
contact to the out-patient clinic rates in patients
operated with TAR at Hvidove University Hospital.
The study also aims at identifying risk factors
associated with admission length >1 day.
Materials and Methods: Since 11th of December 2015 all patients treated at
Hvidovre University Hospital with TAR have been
subjected to the fast track setting where discharge is
planned the first post-operative weekday after cast
application. For this study data was collected on all
patients treated during the period 11th of December
2015 to 1th of October 2019 with a minimum of three
months follow-up. Data was collected regarding age,
sex, ASA-score, BMI, co-morbidity, complications-,
re-admission rates and non-scheduled contact to the
Findings / Results: 151 patients were included. No difference was found
between patients discharged after one day when
compared with those admitted >1 day. 54.3% was
discharged one day after surgery while 32.4 % was
discharged after 2 days and 13.3 % after >2 days.
The overall readmission rate was 1.95 % while 5.96
% had a complication and 16.65 % had a non-
scheduled contact to the out-patient clinic. None of
the included variables was found associated with
admission length >1 day in both uni- and
multivariate logistic regression analysis.
Conclusions: Fast track TAR seems safe even though only 50 %
of the patients could cohere to this. The main
reasons for prolonged admission was soft-tissue
swelling not allowing cast application or surgery at
the end of the week delaying cast application. Also,
special attention has to be made regarding
analgesic treatment and cast application, in order to
reduce the number of non-scheduled contacts to the
Klaus Hanisch, Inge Hvass, Michael Boelstoft Holte, Niels Wedderkopp
Orthopedic, University Hospital of South West Jutland; Orthopedic, University Hospital of South West Jutland; Tand- mund og kæbekirurgi, University Hospital of South West Jutland; Orthopedic, University Hospital of South West Jutland
Background: Reverse total shoulder arthroplasty (RTSA) was
originally designed for older patients with rotator
cuff arthropathy and has over the years proven
good results in this patient group. Therefor
indications are expanding, and the prosthesis is
now also used for osteoarthritis - with glenoid
deformity, fracture sequela, rheumatoid arthritis
etc. The age group is also expanding especially
so that the prosthesis is now also used in
younger patients, thus here is a concern that the
RTSA might not prove as good results, as in the
group of older patients as recent publications
point to this. Ek el al from 2013 and S. Vancolen
Purpose / Aim of Study: The objective was to assess if there was a clinically
relevant difference between RTAS in younger and
older patients patients.
Materials and Methods: Younger patients, age below 65, and older
patients, age above 65, receiving a RTSA from
2014 to 2020 with follow-up data at University
Hospital of South West Jutland. WOOS and
Constant score was used for assessing results.
Continuous data are reported as means with
standard deviations if normal distributed, else
interquartile ranges, categorical data was
reported as numbers and proportions. WOOS
was dichotomized according to the Danish
WOOS validation where a score higher than 50%
(950) is considered “good”. Relative risk (RR) of
patients reaching 50% in the age-groups were
compared. Bivariate comparisons and
multivariate analyzes was performed mixed
linear and poisson regression with robust SE.
Findings / Results: 566 RTSA, 366 females and 200 males. Clinically
relevant improvements were found, and there was a
multivariate statistically significant but not clinically
relevant difference in the change over time between
groups, 12 months WOOS was 58 in the young and
71 in the older age-group, Constant score change
was 44 in the young compared to 43 in the older age
group. The young age-group had a non-significant
RR of 1.8 of not reaching good WOOS compared to
the old age-group.
Conclusions: RSA in younger patients seem to be a safe
procedure with good results, that provides clinically
relevant improvement in both WOOS and Constant
Christian Wong, Jens Adriansen, Jytte Jeppesen, Andreas Balslev-Clausen
Dept of Orthopedics, Hvidovre hospital; Dept of Radiology, Hvidovre hospital; Dept of Radiology, Hvidovre hospital; Dept of Orthopedics, Hvidovre hospital
Background: Adolescent idiopathic scoliosis (AIS) is a frequent
occurring spinal disorder in the adolescent female.
Serial radiographs are used to monitor for
progression but has a potential radiation-induced
oncogenic effect. We examined a low-dose
fluoroscopic technique (LDT) to perform radiographs
of AIS with inherent lower risk for malignancy.
Purpose / Aim of Study: The aim of the present study is to compare the LFT
with traditional radiographs for scoliosis (ORT), to
see if LFT is adequate for clinical radiographic
evaluation of AIS as well as having lower radiation
Materials and Methods: Image quality were evaluated using a pediatric trunk
phantom for LTF and ORT. We measured primary
physical characteristics for image quality evaluation
of noise, contrast, spatial resolution, SNR and CNR.
Three independent raters evaluated the images
quality by observer-based methods of ICS and
VGAS of 25 phantom images. Radiation doses were
evaluated by DAP measurements. Two raters
performed measurements of 6 radiographic
parameters once and separately for 342 LFT images
of 136 patients with AIS.
Findings / Results: The average noise and contrast were approximately
15-fold higher for the LFT. The SNR and CNR was
similar. Evaluating the 25 images of the phantom,
the overall ICS and VGAS were 3-fold higher for
ORT compared to LFT for L3 and similar for Th6.
For the clinical radiographs, the average
measurement of CA was 16.4 degrees (dg) with a
standard deviation of 12 dg. The absolute average
difference (MAD) was 1.67 dg. The standard error of
the mean of CA was 2.72 dg for the ORT and 2.69
dg for the LFT. ICC for CA (0.852) was almost
perfect, but for the other radiographic parameters
fair or worse. For radiation dose, the average DAP
and effective dose for the LFT were 8-fold lower
than for ORT.
Conclusions: In conclusion, the LFT are reliable for CA
measurements, thus being useful for follow-up
evaluation of scoliosis progression as in a clinical
setting. LFT is not adequate for appreciating details
and pathology of the spinal skeletal structures, thus
not useful for the initial evaluation of AIS. Even
though the image quality is lower for LFT than ORT,
the merits are the marked less radiation, thus in
accordance with the principles of ALARA.
Thomas Frydendal, Kristine Sloth Thomsen, Inger Mechlenburg, Lone Ramer Mikkelsen, Søren Overgaard, Kim Gordon Ingwersen, Corrie Myburgh
Department of Physiotherapy, Lillebaelt Hospital, Vejle Hospital, Vejle, Denmark.; Department of Physiotherapy, Lillebaelt Hospital, Vejle Hospital, Vejle, Denmark.; Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark; Elective Surgery Centre , Silkeborg Regional Hospital, Silkeborg, Denmark; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark; Department of Physiotherapy, Lillebaelt Hospital, Vejle Hospital, Vejle, Denmark.; Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
Background: Total hip arthroplasty (THA) and exercise
provide improved function and reduced pain
for hip osteoarthritis. Current treatment
selection is based on low evidence as no
randomised controlled trials (RCTs) are
available. Furthermore, low recruitment rates
and intervention crossover are common in
RCTs comparing surgery to exercise. Patient
and public involvement (PPI) may improve
trial design and implementation of research
findings. Thus, a PPI protocol was
embedded into the Progressive Resistance
Training versus Total Hip Arthroplasty in
Patients with End-stage Hip Osteoarthritis
Purpose / Aim of Study: To explore context-relevant key stakeholder
input in order to optimise the design and
execution of a planned comparative RCT.
Materials and Methods: Fourteen patients undergoing THA, two
orthopaedic surgeons and two physiotherapists,
and four political stakeholders were recruited.
Six focus group interviews were conducted
according to group status using semi-structured
interview guides. Interviews were recorded,
transcribed verbatim and thematic analysed.
Findings / Results: Three key themes emerged: (1) Patient
recovery expectations, (2) The influence of
professional authority, and (3) Inconsistent
health care provider communication.
Theme 1 suggested that patients
experienced their hip problem as disabling
and considered recovery without THA
unlikely. However, after THA, expectations
for a quick return to activities of daily living
were high. Theme 2 highlighted that both
surgeons and physiotherapists claimed
expert knowledge and clashed regarding
explanatory and management frameworks.
Therefore, patients may feel pressured into
choosing between THA or exercise. Finally,
theme 3 indicated that health care providers
tended to use a management narrative best
suited to their preferred intervention.
Therefore, patients risk being medicalised
Conclusions: Patients, orthopaedic surgeons and
physiotherapists may introduce systematic bias
into the PROHIP trial. Methodological
considerations to improve trial design may
include development of a neutral patient
information narrative delivered by an
independent health care provider group during
enrolment and a prospective cohort study
investigating the external validity.
Julie Krogh Pedersen
Ortopædkirurigsk afd, Køge Sygehus
Background: Posterior ankle impingement syndrome (PAIS) is a
syndrome characterized by pain in the hind foot that
occurs in forced plantar flexion, mostly seen in ballet
dancers. Dancing ballet requires extreme plantar
flexion of the talocrural joint and these positions may
lead to PAIS. Impingement syndrome can be
secondary to a painful os trigonum, which is a
common morphological variation associated with
PAIS in dancers.
Purpose / Aim of Study: The purpose of this literature review is to provide
knowledge about PAIS and to evaluate the results of
operative treatment of PAIS in ballet dancers.
Materials and Methods: A systematic search of PubMed was undertaken,
using the search words 'posterior ankle
impingement syndrome' and 'ballet'. A total of 29
publications were found of which af total of 10
publications evaluated the results of operative
treatment in ballet dancers. Reviews were excluded,
and in the end nine studies were included.
Primary outcome was the subjective degree of
satisfaction with the surgery from poor to excellent.
Secondary outcome was the time from surgery until
returning to dance.
Findings / Results: All of the included publications found post-operative
outcome better compared to pre-surgery in most
Three studies graduated satisfaction on a scale.
Two evaluated the degree of satisfaction on a scale
from poor to excellent with an average of 80,1% in
the good or excellent group, ranging from 73,2% to
90%. One study reported better or much better
postoperative outcome in 90,8% of cases.
All publications reported most patients back into
dance after surgery, ranging from 73,2% to 100%.
6 of 9 studies investigated the period of return to
dance after surgery, ranging from 5 to 10 weeks.
Only one study investigated time until pain free
dance with an average time of 17,7 weeks.
Conclusions: Operative treatment of PAIS in dancers, either open
or endoscopic, is a succesfull surgery providing
satisfactory pain relief and return to dance, in most
cases within a few months.
Future research should have a prospective design,
evaluating pre-operative pain score compared to
Marie Bagger Bohn, Bent Lund , Kasper Spoorendonk, Jeppe Lange
Orthopedic, Horsens Regional hospital; Orthopedic, Horsens Regional hospital; Physiotheraphy, Horsens Regional hospital; Orthopedic, Horsens Regional hospital
Background: Tendinopathy and tendon lesions of m.
gluteus medius and/or minimus insertions
insertions at the greater trochanter are often
often under- or misdiagnosed in
patients with lateral hip pain (LHP),
and thus, treated insufficiently.
Purpose / Aim of Study: The purpose of this study was to evaluate
evaluate baseline data in patients with
MRI-verified gluteal pathology, in order
to enhance the knowledge of this
patient group in the orthopedic co
Materials and Methods: Data were prospectively collected between
between September 2017 and June
2019. Patients with a positive MRI for gluteal
gluteal pathology were included in the study
study. Baseline testing included a
patient interview, pain scoring, clinical
tests, a 30-second chair stand test
(30-s CST) and patient reported outcome
outcome measures (Copenhagen hip
and groin score (HAGOS), Oxford Hip
score (OHS) and EQ-VAS.
Findings / Results: The cohort included 93 patients (94% women
women) with a median age of 53 years
years. Median duration of symptoms was
was 24 months. Typical complaints were
were present. Most patients had an insidious
insidious onset of LHP. Pain (NRS,
0-10) at rest was 3.8 (SD 2.6), during activity
activity 5.8 (SD 2.5), and worst pain at any
any given time 8.5 (SD 1.4). Two different
different pain profiles were identified. Palpation
Palpation of the greater trochanter was
positive in all patients, the Trendelenburg
Trendelenburg test was positive in
87% and the FADER test in 84%. Hip
range of motion and hip strength assessed
assessed by a handheld dynamometer showed
showed side-to-side differences.
Patients were able to perform 12
repetitions in the 30-s CST on
average. Patient reported outcomes showed
showed a decreased physical function
and quality of life.
Conclusions: This study indicates that patients with
LHP with an MRI-verified gluteal pathology
pathology display characteristic
symptoms, impaired physical function,
and poor subjective outcomes. The results
results are based on a heterogeneous study
study population in terms of stages of gluteal
gluteal pathology and co-morbidities
and should be interpreted with this in
Randi Gram Rasmussen, Julie Sandell Jacobsen, Birgitte Blaabjerg, Lene L. Miller, Martin Lind
Department of Physioterapy and Occupational Therapy, Aarhus University Hospital; Research Centre for Health and Welfare Technology and Department of Physiotherapy, VIA University College, Aarhus; Department of Physioterapy and Occupational Therapy, Aarhus University Hospital; Department of Physioterapy and Occupational Therapy, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital
Background: PCL injuries can be treated surgically
or with progressive exercises in
combination with a PCL support brace.
However, larger prospective studies
reporting outcome of exercise-related
treatment are lacking.
Purpose / Aim of Study: We aimed to investigate changes in
patient-reported and functional
outcome of a physiotherapy-led
progressive exercise program plus a
PCL support brace in patients with an
acute injury of the PCL over a 24-
months follow-up. Furthermore, to
report conversion to surgical
Materials and Methods: In a prospective case-series study, 50
patients were treated with a PCL
support brace for 12 weeks and
underwent a 16-week physiotherapy-
led progressive exercise program.
Changes in patient-reported outcome
was investigated with the International
Knee Documentation Committee
Subjective Knee Form (IKDC-SKF)
from baseline to 1 and 2 years.
Furthermore changes in isometric knee
flexion and extension strength was
measured from 16 weeks to 1 year.
Mean changes were analyzed with a
mixed effect model with patients as a
random factor and time as a fixed
Findings / Results: Seven patients converted to PCL
reconstruction and one patient
dropped out resulting in 42 patients for
1-year follow-up that completed the
combined brace and rehabilitation
treatment. Of the patients converting to
reconstruction, two patients had an
isolated ligament injury and five
patients had dislocation of the knee.
The IKDC-SKF score at baseline was
35 (SD 9.7) and at 2 years 62 (SD 15).
Isometric knee flexion strength of the
injured knee increased statistically
significantly from 0.93 (SD 0.36)
Nm/kg to 1.1 (SD 0.36) Nm/kg,
corresponding to an increase of 17%.
In contrary isometric knee extension
strength of the injured knee did not
change (0.10 (-0.022-0.21) Nm/kg,
Conclusions: Treatment resulted in a 14%
conversion rate to surgical treatment.
The treatment demonstrated clinically
relevant improvements in patient-
reported outcome and an improvement
of 17% in flexor strength.
Consequently, limited need for
conversion to surgical treatment,
clinically relevant improvements in
subjective outcome and strength after
PCL support brace treatment and a
progressive exercise program can be
expected in patients with an acute PCL
Peter Holmberg Jørgensen, Henrik Tingleff, Rikke Dyhre Bloch, Dorthe Hamilton, Klaus Kjær Petersen
Orthopedic surgery, Aarhus University Hospital; Bandagistcentret, Aarhus; Physio- and occupational therapy, Aarhus University Hospital; Physio- and occupational therapy, Aarhus University Hospital; Orthopedic surgery, Aarhus University Hospital
Background: Amputation of the thumb around the MP-joint,
leaves the patient without a pinch-grip which is a
severe handicap. Reconstructions have been
performed with a free toe graft, elongation of the
1. metacarpal bone or an external prosthesis
fixed to the hand with belts.
Implantation of an osseointegrated (OI)
prosthesis is another alternative which restores
the pinch-grip and gives the patient an
osseoperception. The OI-prosthesis, consists of
a fixture implanted in the 1. metacarpal bone and
an abutment protruding through the skin which is
connected to a custom made external prosthesis
Purpose / Aim of Study: To present our experience with reconstruction of the
amputated thumb with an OI-prosthesis.
Materials and Methods: 8 patients (3 female), median age 54 yrs (27-65)
were operated from november 2012 to july 2017.
Time since amputation was 9.3 yrs (2-27).
After 3 weeks the patients were equipped with an
external individually fit costum made prosthesis
(prosthetist). The patients went through a 3 months
rehabilitation program with gradually increased
mechanical loading of the prosthesis (occupational
Findings / Results: The patients restored the abduction/adduction
and opponens movement of the thump and got a
pinch grip enabling them to perform even heavy
physical activities. Transferral of the load from
the prosthesis to the bone gives the patients an
osseoperception allowing them to graduate the
strength of their regained grip force. The
prosthesis can be worn permanently and the
patients describe it as an integrated part of their
2 patients have been operated after 7 resp. one
year with removal of granulation tissue
at the interface between skin and prosthesis.
In 3 patients a Z-plasty of the interstitial tissue
was performed to increase the range of
In one patient the abutment was removed four
years after primary surgery due to permanent
No patients had infection of the prosthesis.
Conclusions: OI-prosthesis results in a firm and functional
reconstruction, with a restored pinch grip in thumb
amputees. The patients regain several daily
activities including return to work and report an
increased quality of life. The preoperative planning,
surgery and rehabilitation needs a multimodal team
Camilla Hattig Bonefeld, Anders Paulsen, Michael Mørk Petersen, Marianne Lind
Orthopedic Department, Rigshospitalet; Orthopedic Department, Rigshopitalet; Orthopedic Department, Rigshospitalet; Orthopedic Department, Rigshospitalet
Background: More than 60-65% of the surface area of the talus
bone is covered with articular cartilage, which limits
the intra-osseous blood supply. Talus account for 0.5
% of all fractures, and only 3% of all foot fractures.
The primary mechanism of injury is often severe,
and includes high energy, often making the patient
group multi-traumatic. Associated skeletal lower leg
injuries has been reported in 54% of all talus
fractures, and 8% were multi-traumatic with injuries
at other locations of the body. Sequelae such as
avascular osteonecrosis (54%) and post-traumatic
arthritis (25%) are common complications seen after
treatment of all types of talus fractures.
Purpose / Aim of Study: Describe the demography and early complication
rate after surgical treatment of both talar neck and
Materials and Methods: In 2010-2013 we operated 29 consecutive patients
(34 (14-54) years, F/M= 11/18) with 33 talus
fractures, 19 corpus fractures and 14 neck fractures.
All fractures were evaluated pre- and post-
operatively with plain X-rays and CT. The operative
technique was selected by the surgeon and was
either ORIF (n=29), external fixation (n=3) or
primary arthrodesis (n=1).
Findings / Results: Corpus fractures were classified by the Sneppen
classification (type 1 (n=3), type 2 (n=3), type 3
(n=3) type 5 (n=10)) and neck fractures by the
Hawkins classification (type 1 (n=7), type 2 (n=3),
type 3 (n=3) type 4 (n=1). 19 patients sustained their
injury in a high-energy trauma, 7 patients had an
open fracture, and 4 patients had bilateral fractures.
The number of associated injuries found were: 1-2
(n=15), 3-4 (n=5), 5 or more (n=2). 11 patients
required more than one surgery in order to gain soft
tissue coverage, infection control and ultimate
heling. 2 patients had secondary arthrodesis of the
ankle joint caused by AVN.
Conclusions: We found a higher number of associated injuries in
patients with talus fractures than seen in other
studies. The number of AVN was lower than
otherwise reported, however, we experienced a high
number of surgical interventions in order to archive
Anna Bertoli Borgognoni, Martin Gottliebsen, Klaus Kjær Petersen
Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital
Background: Septic arthritis demands prompt intervention due to
risk of cartilage destruction when treatment is
Purpose / Aim of Study: We present seven cases of septic arthritis in
combination with a communicating intraosseous
abscess. Our goal was to assess the impact on the
Materials and Methods: Seven male patients with median age 4 (range; 1-
22) years, were identified in a period from 2010 to
2018. Data from journals, radiology, blood samples
and cultures were retrospectively collected.
Findings / Results: All patients presented with a history of minor pain
from affected joints as well as subfebrilia and
discomfort. Median treatment delay was 2 months
(range; 1 day-12 months).
None of the patients were septic at admission, and
median CRP was 30 (2-102 mg/L).
Knee joint was involved in 5 cases and further 2
cases affecting elbow- and subtalar joints
Radiographs and MRI showed juxta-articular
intraosseous abscess communication into the joint
with effusion, synovitis and revealed no evidence of
3 patients were treated with arthroscopic
synovectomy and debridement of the abscess, 3
were treated with just debridement and washout of
the joint, one with open synovectomy.
Biopsies were taken from abscesses and synovia:
Staph. aureus was responsible for 3 cases,
Salmonella for one, and the remaining 3 cases had
All patients received antibiotics for 6 weeks.
Conclusions: Patients with septic arthritis due to a communicating
intraosseous abscess seem to avoid joint
destructions even in situations with considerable
Andreas Kiilerich Andresen, Christian Støttrup, Rune Paulsen, Peter Udby, Søren Fruensgaard, Leah Carreon
Department of Spine Surgery, Spine Centre of Southern Denmark, Middelfart; Department of Orthopeadics, Kolding Hospital; Department of Orthopeadics, Kolding Hospital; Department of Orthopeadics, Køge Hospital; Spine Surgery, Silkeborg Regional Hospital; Department of Spine Surgery, Spine Centre of Southern Denmark, Middelfart
Background: Lumbar Spinal Stenosis (LSS) with degenerative spondylolisthesis (DS) is a common condition in the elderly population which is associated with significant morbidity and decreased quality of life. For patients where pain and disability are unacceptable, surgical intervention with lumbar decompression is a commonly used treatment option, shown to provide relief of symptoms and pain.
Few studies have examined if a clinically relevant difference in function is obtained, and whether this effect is sustained at long term.
Purpose / Aim of Study: The aim of this study was to evaluate the patient reported outcomes, whether patients obtain a clinically relevant effect of surgery, and if the effect of treatment is sustained at one, two and five years postoperatively.
Materials and Methods: The study was performed as a multicentre registry-based retrospective cohort study, in collaboration between Silkeborg, Køge and Middelfart hospital, using data collected prospectively in the Danish national surgical spine database; DaneSpine.
All patients underwent decompression and un-instrumented fusion due to LSS with DS.
This study evaluates both preoperative and postoperative outcomes. All PRO measures were filled out preoperatively and at 1, 2 and 5 years postoperatively. Based on the outcome measures, the patients who obtained a minimal clinically relevant difference in outcome (MCID) were identified at one, two- and five- years post-surgery.
Outcome measures for the study included the Oswestry Disability Index (ODI), EuroQoL-5D-3L (EQ-5D), Visual Analogue Scale Leg Pain (VAS-leg) and Visual Analogue Scale Back Pain (VAS-back).
Findings / Results: We found a mean change from surgery to 5 years of -18.9 on ODI; a mean change of 0.29 on EQ.5D, -29.2 on VAS leg and -21.3 on VAS back.
We found that 83% of patients obtained a clinically relevant increase in one or more PROs. Apart from EQ-5D, there was no statistical difference in percentage of patients who obtained MCID at one, two- and five-years post-surgery.
Conclusions: Surgery for LSS with DS has favourable results, with many patients experiencing a clinically important change in outcome measures, and this change is maintained for at least 5 years.
Peter Hald, Jakob Klit
, University of Copengagen ; Department of Orthopedics, Zealand University Hospital, Køge
Background: Anterior cruciate ligament reconstruction (ACLR)
is a frequent surgery, that is performed 2500-
3000 times annually in Denmark. Rehabilitation
after ACLR is crucial to achieve satisfactory
results after the surgery.
Purpose / Aim of Study: The aim of this litterature study is to explore the
scientific basis behind key physiotherapeutic
modalities connected to ACLR rehabilitation.
Futhermore the purpose is to examine, how long
time the patient is associated with physical
therapy aswell as what allows return to sports.
Materials and Methods: The literature-search was performed in PubMed.
Five systematic reviews was included in this
study and the scientific quality was assessed
Findings / Results: No significant benefit is found using bracing, and the
effect of neuromuscular stimulation is inconclusive.
Home-training and supervised training is equally
effective. Early activation of the knee in full ROM and
isometric exercises from week 1 are concluded to be
beneficial. The difference in efficiency of CKC and
OKC seeks further studies. EMS
statistic significantly increases quadriceps-strength,
but long-term follow-up studies are required. The
optimal length of the rehabilitation program is
concluded to be 9-12 month, with a criterion of goal-
based progression and return to sports after
satisfactory results in a test-battery. Further studies
of what test-battery should contain are required.
Conclusions: Rehabilitation after ACLR is concluded to have a
optimal length of 9-12 months, the progression
should be goal-based and no brace is needed.
Return to sport is possible when satisfying
evalation in test-battery is obtained. Further
studies are required.
Camilla Holmenlund, Randi Bilberg, Maja Tang Jensen, Søren Overgaard, Claus Varnum
Department of Orthopaedic Surgery and Traumatology, Odense University Hospital; Department of Clinical Research, Unit of Clinical Alcohol Research, University of Southern Denmark; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital; Department of Orthopaedic Surgery and Traumatology and Department of Clinical Research, Faculty of Health Sciences, Odense University Hospital and University of Southern Denmark; Department of Orthopaedic Surgery, Section for Hip and Knee Replacement and Department of Regional Health Research, Vejle Hospital and University of Southern Denmark
Background: The Hip disability and Osteoarthritis
Outcome Score (HOOS) has previously
been recommended as a patient reported
outcome measure for patients with hip
osteoarthritis (OA) undergoing total hip
arthroplasty (THA). The HOOS is an
adaptation of the Knee injury and
Osteoarthritis Outcome Score which again
is an adaptation of the Western Ontario
and Macmaster Universities Osteoarthritis
index. The HOOS was developed 18
years ago with only partial patient
Purpose / Aim of Study: We aimed to evaluate if the HOOS contains
items that present-day patients undergoing
THA find relevant preoperatively and
postoperatively in a patient involvement study.
Materials and Methods: Patients aged 60-75 years, diagnosed with
primary OA, and receiving a THA was
included. We recruited patients for focus
group interviews preoperatively and at 3, and
12 months after primary THA from a
university and a regional hospital.
We conducted 6 focus group interviews with
28 patients in total. The interviews were
transcribed and analyzed using qualitative
inductive thematic content analysis.
Findings / Results: When comparing items identified from the
transcripts to the items of the HOOS, we
showed that 7 of 40 items were very
important or important at all 3 time
periods. They included walking, pain,
awareness of the hip and light domestic
duties. 8 of 40 items, including bending
the hip and rising from the bed, were not
mentioned at neither of the time periods.
25 items mentioned by the patients and
identified from the transcripts were not
represented in the HOOS. 5 of these,
including cycling and the ability to get on
the floor, were found to be very important
at all 3 time periods. Furthermore, 3 items
related to psychological health, including
fear of dislocation, were found to be
important at all 3 time periods.
Conclusions: According to present-day patients in a
Danish population, we showed that the
HOOS lacks several dimensions.
Furthermore, we showed that the HOOS
still have some items that are relevant to
present-day patients but also contains
several items not mentioned by the
In perspective, this study shows that
patient preferences may change over time
and may indicate a need for revision of the
HOOS score to get better content validity.
Ulrik Knudsen, Martin Kirkegaard, Kurt Skovgaard, Christina Holm, Anders Odgaard, Michael Mørk Petersen, Nikolaj Winther
Department of Orthopaedic Surgery , Rigshospitalet, Copenhagen, Denmark; Department of Orthopaedic Surgery , Rigshospitalet, Copenhagen, Denmark; Department of Orthopaedic Surgery , Rigshospitalet, Copenhagen, Denmark; Department of Orthopaedic Surgery , Rigshospitalet, Copenhagen, Denmark; Department of Orthopaedic Surgery , Rigshospitalet, Copenhagen, Denmark; Department of Orthopaedic Surgery , Rigshospitalet, Copenhagen, Denmark; Department of Orthopaedic Surgery , Rigshospitalet, Copenhagen, Denmark
Background: Mega-prosthetic joint replacement of the
distal femur is also an option for
management of massive bone loss in
revision total knee arthroplasty (TKA) and
for fractures. Even though this surgery is
challenging with high rate of infection,
patellar complications, and implant failure it
is often the only option to avoid knee
arthrodesis or amputation.
Purpose / Aim of Study: The purpose of this study was to evaluate
the complications and outcome after
implantation of mega-prostheses of the
distal femur in non-tumour cases.
Materials and Methods: We retrospectively reviewed 65 patients
mean age 66 (38-84) years, F/M=47/18,
mean follow-up 41 (12-220) months that
received a distal femoral resection and
reconstruction with a mega-prosthesis
because of a failed TKA due to
aseptic/septic loosening, periprosthetic
fracture or complications after a complex
fracture with failed osteosynthesis. 41
patients (64 %) had previous TKA revision
surgery and 19 patients (29%) previous
periprosthetic infection. In this cohort 19
patients were revised for aseptic loosening
and 12 patients for septic loosening. 18
patients were diagnosed with periprosthetic
fracture and 6 patients with pseudarthrosis.
6 cases with instability, 1 case with a
comminute distal femur fractur and in in 3
cases pain were the reason for revision.
Findings / Results: We found good patient satisfaction and low
pain scores with moderate to low activity
level. During the follow-up period 39
patients (60%) had no additional
procedures. 18 patients (27%) had major
revision defined as removal or exchange of
the femoral component because of aseptic
loosening (n=11), periprosthetic fracture
(n=4), septic loosening (n=2) and
amputation (n=2), and 13 patients had
minor revision due to instability, pain or
patellar complications. Survival analysis
shows that 70 % was free of major revision
after 5 years.
Conclusions: Mega-prosthetic joint replacement of the
distal femur is a good option for
management of non-tumor cases (revision
TKA and fractures) with massive bone loss,
and thus amputation and knee arthrodesis
can be avoided in most patients. However,
there is a high risk that the patients have to
undergo future additional surgery including
Kristoffer Riemer, Thomas Prynø, Jeppe Lange
Elective Surgery Center, Silkeborg Regional Hospital, HE Midt; Elective Surgery Center, Silkeborg Regional Hospital; Orthopaedic Surgery, Horsens Regional Hospital
Background: Treatment of early PJI remains a substantial
challenge to the orthopedic surgeon. Until
now debridement, antibiotics and implant
retention (DAIR) has been the gold
standard, but with a frequently reported
infection control rate of 60% there is room
Cementless one-stage revision of chronic
PJI by the CORIHA protocol has been
evaluated positively with a 93% success
rate. Whether this protocol can be used
advantageously in early PJI due to a more
thorough debridement and removal of
colonized implants needs to be evaluated.
Purpose / Aim of Study: To evaluate effectiveness of cementless
one-stage revision for early PJI in primary
THA regarding the risk of re-infection and
re-operation with exchange of implants.
Materials and Methods: We identified 19 patients in our center with
early (≤ 6 weeks postoperative) PJI after
primary THA treated with one-stage
cementless revision in the period January
2012 - March 2018. Treatment followed the
CORIHA-protocol. Primary outcome was
retention of implants at most recent follow
up. Secondary outcome was re-operation
for other reasons than infection. Patients
were followed for a minimum of 2 years.
Findings / Results: Mean follow up was 47,5 months (range:
19 of 19 patients (100%) retained their
implants, but two required superficial soft
tissue debridement due to persistent wound
seepage. One patient was re-operated due
to a periprosthetic fracture, not related to
the PJI treatment. The patient was treated
with open reduction and internal fixation
with no exchange of implants and no signs
of persistent infection.
Conclusions: Cementless one-stage revision appears to
be an effective treatment of early PJI after
primary THA, and at least an equal choice
of treatment compared with DAIR. Whether
the potential benefit of a lower re-revision
rate for postoperative PJI, outweighs the
increased surgical complexity of the
CORIHA procedure needs further
Thomas Linding Jakobsen, Mads Thorup Langelund, Thomas Bandholm, Kristian Thorborg
Section for Orthopaedic and Sports Rehabilitation (SOS-R), Health Centre Nørrebro, City of Copenhagen; Area of Health, UCL University College, Odense; Department of Orthopedic Surgery, Amager and Hvidovre Hospital; Department of Orthopedic Surgery, Amager and Hvidovre Hospital
Background: Blood flow restriction (BFR) resistance exercise is
considered to be a safe and effective rehabilitation
modality in increasing muscle mass and strength.
Purpose / Aim of Study: The aims of this study were to report changes in
thigh muscle mass and knee pain, as well as
adverse events during rehabilitation with BFR in a
large cohort of patients seen in clinical practice after
knee surgery or injury.
Materials and Methods: In this descriptive, retrospective, practice-based
study, we included 324 patients who performed
rehabilitation with BFR resistance exercise after
knee surgery or injury at an outpatient rehabilitation
center. From medical records, we extracted: Thigh
circumference (muscle mass proxy) and knee pain
during self-reported activity ((11-point numerical
rating scale (NRS)) before and after rehabilitation,
and any adverse events recorded.
Findings / Results: Thigh circumference difference between non-
affected and affected leg was significantly smaller
post- than pre-rehabilitation (1.1 vs 2.4; mean
difference, -1.3 cm, [95% CI = -1.7 to -0.9], p <
0.0001, n=76). Knee pain during activity was lower
post- compared to pre-rehabilitation (2.0 vs 3.7;
mean difference, -1.9 NRS-points, [95% CI = -2.3 to
-1.5], p < 0.0001, n=159). One patient fainted in
relation to BFR resistance exercise during the
rehabilitation period (n=324).
Conclusions: In this retrospective study, rehabilitation with BFR
resistance exercise applied in clinical practice after
knee surgery or injury appeared to increase thigh
muscle mass while reducing knee pain during
activity. Very few harms were reported suggesting
Maja Tang-Jensen, Camilla Holmenlund, Søren Overgaard, Claus Varnum, Randi Bilberg
Department of Orthopaedic Surgery and Traumatology, Odense University Hospital; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital; Department of Orthopaedic Surgery and Traumatology and Department of Clinical Research, Faculty of Health Sciences, Odense University Hospital and University of Southern Denmark; Department of Orthopaedic Surgery, Section for Hip and Knee Replacement and Department of Regional Health Research, ejle Hospital and University of Southern Denmark; Department of Clinical Research, Unit of Clinical Alcohol Research, University of Southern Denmark
Background: The forgotten joint score (FJS-12) is a questionarie
developed in 2012, based on the patient’s ability to
forget their artificial joint in everyday life. During the
development the patients were used as experts and
generated questions with content that is important
for them. FJS-12 was tested postoperatively and is
primarily used postoperatively beyond 6 months.
Therefore, the items may not be representative for
all periods of the pre- and postoperative phase and
may not represent the patients experience with
getting an artificial joint.
Purpose / Aim of Study: We performed focus group interviews with patients
to evaluate if the FJS-12 contains relevant items
preoperatively, and postoperatively at 3 and 12
months after THA.
Materials and Methods: Patients with primary osteoarthrosis, receiving a
THA aged 60-75 years, were recruited for focus
group interviews from Two Danish hospitals. We
recruited seven patients preoperatively, nine
patients at three months postoperatively, and twelve
patients at twelve months postoperatively, totaling
Findings / Results: By comparing the items identified in the interviews
with items from FJS-12, we showed that all items
from the FJS-12 is mentioned in one or more time
periods. Sleeping, housework or gardening, and
favorite sport were very important items in all three
Three items were identified as being very important
by the patients in all three time periods and were not
covered by the FJS-12: walking, pain in general,
and reaching down/getting up from the floor.
Walking was a very important item for patients in all
Conclusions: We showed that the FJS-12 contain items relevant
to the present-day patients both pre- and post-
operatively. Some additional categories to the FJS-
12 were identified, mainly pain and reaching
down/getting up from the floor. Because walking is
mentioned in two of the items in FJS-12 it was
difficult to assess in what category the patient
answered and it may be confusing for the patient.
Pain is indirectly linked to all items as patients have
to be free of pain to forget their artificial joint.
Anders Schou Tornøe, Jeppe Vejlgaard Rasmussen, Bo Sanderhoff Olsen
, Aasiaat Regionssygehus; Ortopædkirurgisk afdeling, Herlev-Gentofte Hospital; Ortopædkirurgisk afdeling, Herlev-Gentofte Hospital
Background: Non-traumatic elbow stiffness is a relatively
rare condition, occurring in only a small
fraction of the population. Osteoarthritis due
to prior trauma and arthritic changes are the
main causes. Many patients undergo
several surgical procedures of the elbow.
Knowledge of the long-term outcomes is
essential in determining the best course of
treatment for these patients.
Purpose / Aim of Study: The objective was to report the functional
outcome after release for non-traumatic
Materials and Methods: A total of 32 patients underwent surgery at
Herlev Hospital from 2010-2015, whereof 7
were lost to follow-up. 25 were included in
the study, 23 patients had open release and
2 patients had arthroscopic surgery. 11
patients had had no previous surgery in the
elbow, and 14 had undergone surgery at
least once, primarily arthroscopic capsular
release and removal of osteophytes.
At follow-up, patients were examined using
the Mayo Elbow Performance Score
(MEPS), flexion/extension arc, pain and the
Oxford Elbow Score (D-OES).
Findings / Results: The mean flexion/extension arc was 91°
preoperatively and 112° at follow-up. The
improvement of 21° was statistically
significant (p < 0.001). The subgroup of
patients with no previous elbow surgery
improved their flexion/extension arc from
98° to 119° (p = 0.056), and the subgroup of
patients with previous elbow surgery
improved from 86° to 106° (p < 0.006). Pain
was reduced in 16 patients, unchanged in 4
patients, and worsened in 2 patients.
At follow-up the average MEPS was 74.4. It
was 84.5 for the patients without previous
surgery and 66.4 the patients with previous
surgery. The average D-OES was 36.1. It
was 42.2 for the patients without previous
surgery and 31.3 the patients with previous
Conclusions: Capsular release and debridement done for
non-traumatic stiffness of the elbow is
associated with improved flexion/extension
arc and reduced pain. Patients with and
without previous surgery had similar
improvements, but the latter had a better
functional outcome. Both subgroups
probably benefit from surgical treatment.
Kirill Gromov, Pelle Petersen, Christoffer Jørgensen, Anders Troelsen, Henrik Kehlet
Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre; Section for Surgical Pathophysiology, Rigshospitalet; Lundbeck Foundation Centre for Fast-track Hip and Knee Arthroplasty, Rigshospitalet; Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre; Section for Surgical Pathophysiology, Rigshospitalet
Background: Unicompartmental knee arthroplasty (UKA) is a
treatment option for patients with unicompartmental
osteoarthritis, with up to 50% of patients scheduled
for knee replacement being eligible for UKA. It has
been shown that utilization of UKA >20% is required
in order to avoid unacceptably high revision rates,
however the effect of utilization on LOS as well as
other benefits of UKA has not been investigated.
Despite the potential advantages of UKA, and
recommended minimal usage, UKA is only utilized
in 9% of knee arthroplasty cases in UK, and its role
in a fast-track setup is not well-established
Purpose / Aim of Study: The aim of this prospective multicenter study was to
describe trends in length of stay (LOS) and early
complications and readmissions following UKA
performed at 8 different fast-track centers in
Denmark and to compare LOS between centers with
high and low utilization of UKA
Materials and Methods: We included data from 8 dedicated fast-track
centres all reporting UKA procedures to the same
database during 2010-2018. Complete (>99%) data
on LOS and 90-day readmission and mortality was
obtained over the entire time period. Specific
reasons for LOS > 2 days; LOS > 4 days; 30-day
and 90-day readmission were recorded. Utilization
of UKA were dichotomized into ≥ 20% UKA versus <
20% UKA () and ≥ 52 UKA annually versus < 52
Findings / Results: A total of 3,927 procedures was included. LOS
(mean 1.3 days, median 1) was unchanged over the
period. The proportion of procedures with LOS > 2
days was also largely unchanged other the period.
The percentage of patients discharged on day of
surgery varied greatly between centers (12-50%),
with centers with high UKA utilization (both usage
and volume) having a larger proportion on DOS
discharge. 30- and 90-days readmission was 4.2%
and 6.9% with 90 days mortality being 0.08%
Conclusions: Our findings suggest general underutilization of the
potential for quicker recovery following UKA in a
Casper Dragsted, Søren Ohrt-Nissen, Thomas Andersen, Niklas Tøndevold, Benny Dahl, Martin Gehrchen
Ortopædkirurgisk afdeling, Rigshospitalet; Ortopædkirurgisk afdeling, Rigshospitalet; Ortopædkirurgisk afdeling, Rigshospitalet; Ortopædkirurgisk afdeling, Rigshospitalet; Department of Orthopedics and Scoliosis Surgery, Texas Children’s Hospital, TX, USA; Ortopædkirurgisk afdelingen, Rigshospitalet
Background: Studies show morphometric changes of vertebrae in
the treatment of early-onset scoliosis with
distraction-based growth instrumentation. However,
no studies have assessed the bone quality of
vertebrae within the instrumentation with dual-
energy X-ray absorptiometry (DXA).
Purpose / Aim of Study: To investigate the feasibility of measuring bone
mineral density (BMD) in vertebrae within the
instrumentation of patients treated with magnetically
controlled growing rods (MCGR). Secondly, to
compare this with BMD vertebrae below the
instrumentation and total hip.
Materials and Methods: We conducted a cross-sectional study of BMD in
patients treated with MCGR at our institution.
Exclusion criteria were structural deformities at
the vertebrae of interest, conversion cases,
inability to stand and walk or patients who had
undergone definitive spinal fusion. Eleven
patients fulfilled the study criteria and underwent
DXA scans during 2018. We measured aBMD
(g/cm2) of both hips and in the spine using a
software to exclude high density pixels from
implant metal. aBMD was measured on the 3
vertebrae above the lower anchor point within
the instrumentation and the 3 vertebrae below
the instrumentation. We calculated individual
age-adjusted aBMD Z-scores (aBMDage Z-
score) and height-for-age adjusted aBMD Z-
scores (aBMDHAZ Z-score) from a reference
population. Results are reported with medians
and inter-quartile range [iqr].
Findings / Results: Age at examination was 13.5 [10.0-14.4] years.
aBMDHAZ Z-score for total hip was 0.9 [0.6, 1.2]
and for vertebrae within the instrumentation -2.5
[-3.1, -1.9]. We found a statistically significant lower
aBMD in the vertebrae within the instrumentation (p
= 0.002) and vertebrae below the instrumentation (p
= 0.031) compared with total hip aBMD. We found a
lower but not statistically significant aBMD for
vertebrae within the instrumentation compared with
vertebrae below the instrumentation (p = 0.063).
Conclusions: Measuring BMD of the instrumented vertebrae is
feasible; however, it comes with several limitations.
We found a lower aBMD of vertebrae within the
instrumentation compared with total hip aBMD but
no association with time from MCGR index surgery.
Lasse Ishøi, Kristian Thorborg, Joanne Kemp, Michael Reiman, Per Hölmich
Sports Orthopedic Research Center - Copenhagen (SORC-C), Ortopædkirurgisk Afdeling, Hvidovre Hospital; Sports Orthopedic Research Center - Copenhagen (SORC-C), Ortopædkirurgisk Afdeling, Hvidovre Hospital; La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University; Duke University Medical Center, Department of Orthopedic Surgery, Duke University; ports Orthopedic Research Center - Copenhagen (SORC-C), Ortopædkirurgisk Afdeling, Hvidovre Hospital
Background: Reduced sports function is often observed after hip
arthroscopy for femoroacetabular impingement
Purpose / Aim of Study: Impaired muscle strength could be reasons for this.
We aimed to investigate hip muscle strength after
hip arthroscopy for FAIS and its association with
levels of sports function and participation.
Materials and Methods: We included 45 patients (34 males; mean age: 30.6
± 5.9 years) after unilateral hip arthroscopy for FAIS
(mean follow-up [range]: 19.3 [9.8-28.4] months).
Maximal isometric hip muscle strength (Nm/kg)
including early- (0-100 ms) and late-phase (0-200)
rate of torque development (Nm/kg/s) for adduction,
abduction, flexion, and extension was measured
with an externally fixated handheld dynamometer
and compared between operated and non-operated
hip. Associations between muscle strength and self-
reported sports function and return to sport were
Findings / Results: For maximal hip muscle strength, no between-hip
differences were observed for adduction, abduction,
flexion, and extension (p≥0.102). For rate of torque
development, significantly lower values were
observed for the operated hip in flexion at both 0-
100 ms (mean difference: 1.58 Nm/kg/s, 95% CI
[0.39; 2.77], p=0.01) and 0-200 ms (mean
difference: 0.72 Nm/s/kg, 95% CI [0.09; 1.35],
p=0.027). Higher maximal hip extension strength
was significantly associated with greater ability to
participate fully in preinjury sport at preinjury level
(Odds ratio: 17.71 95% CI [1.77; 177.60]).
Conclusions: After hip arthroscopy for FAIS subjects show limited
impairments in maximal and explosive hip muscle
strength between operated and non-operated hip.
Higher muscle strength was positively associated
with higher sports function and ability to participate
Department of Orthopaedic Surgery, Viborg Regional Hospital
Background: Total hip arthroplasty (THA) is used to treat
osteoarthrosis in the hip as well as fractures of the
femoral neck. Instability followed by dislocation is a
common indication for THA revision surgery. A dual-
mobility acetabular component (DMC) has been
designed to address this issue and lower dislocation
rates in THA. A major concern with the DMC is
increased stress on the implant components and
therefore, accelerated polyethylene (PE) wear. It
has been proposed that the increased PE wear will
lead to a shorter survival of the prosthetic
components, but long-term follow-up studies on
DMC THA have yet to be performed.
Viborg Regional Hospital has since 2001 primarily
used the dual mobility cup in THA for patients over
the age of 70, presenting a unique possibility to
study the long-term revision rate for the DMC.
Purpose / Aim of Study: The aim of the study is to investigate the revision
rate of the dual mobility cup in total hip arthroplasty.
Furthermore we wish to investigate if the indication
for THA had any effect on survival of the prosthetic
Materials and Methods: A retrospective cohort study of all patients who
received a primary THA with a DMC at Viborg
Regional Hospital between 2001 and 2018 was
conducted. Information regarding revision
arthroplasty were obtained from the National
Registry of Patients and the Danish Hip Register.
Findings / Results: We found the 10-year survival rate for the DMC in
THA to be 91% (95% CI=7.43% to 10.90%). We
found no significant difference in revision rate
between THA performed due to arthrosis and THA
performed due to fractures (HR=1.28, CI 0.90 to
Conclusions: Our findings suggest that, when performing a
primary THA, the DMC is level with the
conventionally used liner regarding long-term
Kasper Krommes, Kristian Thorborg, Per Hölmich
Orthopedic Department, Sports Orthopedic Research Center - Copenhagen, Hvidovre Hospital; Orthopedic Department, Sports Orthopedic Research Center - Copenhagen, Hvidovre Hospital; Orthopedic Department, Sports Orthopedic Research Center - Copenhagen, Hvidovre Hospital
Background: One of the most common knee complaints during
adolescence, a crucial time for staying physically
active, is Osgood Schlatter. The recommended
types of modalities for conservative management of
Osgood Schlatter is abundant and conflicting, and
no level 1 evidence is available. For this emerging
area of research, knowing the contents of usual care
and its providers, are key to develop uniform and
effective management strategies.
Purpose / Aim of Study: To gain knowledge directly from Osgood Schlatter
patients and clinicians on what care is delivered in
Materials and Methods: Semi-structured interviews and surveys were
conducted in a specialized orthopedic clinic with OS
patients, and across sectors and professions with
clinicians managing OS patients.
Findings / Results: Thirty-three patients (age 13.5±1.7 years,
symptom-duration 23.6±16.1 months) and 8
clinicians (Physiotherapists, GPs, Pediatric
Orthopedic Surgeons) with a mean of 12.5 year
practicing and seeing median 15 (IQR:14-25) OS
patients per year, participated. Most patients had
been in the care of their GP (72%), a
physiotherapist (45%), or an orthopedic surgeon
(33%), among a total of 13 different professions.
For patients, the most common modalities
received where exercises (42%), advice to take a
break from sports (24%), topical analgesics
(24%), and cryotherapy (21%); followed by
stretching, taping, acupuncture, laser therapy,
shockwave therapy, and massage (12-18%); and
20 other types of modalities (>9%). Among the
eight clinicians the most common modalities
where cryotherapy (n=8), stretching of knee-
extensors (n=6), exercises (n=6), and NSAIDs
(n=5). All clinicians adviced on good/self-limiting
prognosis (n=8); and most (n=7) adviced on
‘change to less aggravating activities’, ‘only
participate with little pain’, ‘adjust physical activity
according to pain’, or that ‘increased activity will
Conclusions: Numerous different modalities are received by
Osgood Schlatter patients, but a set of
modalities/advice seems to be the most prevalent in
usual care: exercises, cryotherapy, stretching,
topical/oral analgesic, advice on favorable
prognosis, and advising a cautious approach to
Kaya Elkington, Lena Dietze, Nis Nissen, Bo Bregenhof, Bjarke Viberg
Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark; Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark; Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark; Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark; Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark
Background: MMA is a full-contact sport that involves
intensive training, sparring and competition,
which have raised concerns regarding risk
of serious injuries. Currently there are no
studies available on the topic from
Scandinavia and there is an ongoing debate
whether the sport should be legalized or not
due to its violent appearance.
Purpose / Aim of Study: To describe injuries sustained during adult
MMA training in Denmark.
Materials and Methods: All data was collected using a questionnaire
developed in cooperation with experts from
the MMA medical community. Data was
collected from October 2019 until April
2020. Participants were recruited by using
an information flyer/form distributed to MMA
clubs, during events and facebook pages
with link to an online questionnaire. Data
was collected and managed using Research
Electronic Data Capture (REDCap). The
questionnaire retrieved data on the
participants’ demographics and injuries
within the last 12 months. Descriptive data
was performed as well as chi-square tests
on categorical data.
Findings / Results: 88 participants completed the questionnaire
with a median age of 25 years (18-50) and
95% were male. There were 6%
professional athletes but 41% had combat
experience. 34% trained at least 7 hours per
week and 41% had at least 6 years of
52% had sustained an injury within the last
12 months with a median of 2 (1-5) injuries.
47% resulted in training pause of less than
14 days, and 41% did not seek professional
help. 52% of the injuries were to the lower
extremity, especially the knee. 65% did not
wear protective gear when sustaining the
injury. There was a trend between higher
amount of weekly MMA training and risk of
sustaining an injury (p<0.059) but not with
increasing age (p<0.53).
Conclusions: There is a high risk (52%) of sustaining
injury during training among MMA athletes
but almost half of the injuries were of minor
character. The risk of sustaining an injury
trends to be higher the more an athlete
does MMA training.
Lasse Ishøi, Kristian Thorborg, Marie Ørum, Joanne Kemp, Michael Reiman, Per Hölmich
Sports Orthopedic Research Center - Copenhagen (SORC-C), Ortopædkirurgisk Afdeling, Hvidovre Hospital; Sports Orthopedic Research Center - Copenhagen (SORC-C), Ortopædkirurgisk Afdeling, Hvidovre Hospital; Sports Orthopedic Research Center - Copenhagen (SORC-C), Ortopædkirurgisk Afdeling, Hvidovre Hospital; La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University; Duke University Medical Center, Department of Orthopedic Surgery, Duke University; Sports Orthopedic Research Center - Copenhagen (SORC-C), Ortopædkirurgisk Afdeling, Hvidovre Hospital
Background: Several studies show clinically relevant
improvements in hip function and pain after hip
arthroscopy for femoroacetabular impingement
syndrome. However, it is less clear how many
patients achieve an acceptable symptom state.
Purpose / Aim of Study: We aimed to investigate the proportion of patients
with an acceptable symptom state (PASS) 12-24
months after hip arthroscopy. Additionally, we aimed
to determine the cut-off scores of the two
recommended and valid patient-reported outcome
measures (the Copenhagen Hip and Groin Outcome
Score; (HAGOS) and the International Hip Outcome
Tool-33; (iHOT-33)) for which patients are most likely
to achieve PASS.
Materials and Methods: Eligible subjects were identified in the Danish Hip
Arthroscopy Registry. PASS, HAGOS, and iHOT-33
were collected with an online questionnaire. PASS
was measured using the anchor question: “Taking
into account your hip and groin function and pain,
and how it affects your daily life including your ability
to participate in sport and social activities, do you
consider that your current state is acceptable if it
remained like that for the rest of your life?” Receiver
Operating Characteristic curve analyses were
applied to identify the PASS cut-off values of
HAGOS and iHOT-33 scores.
Findings / Results: 137 patients (mean age at surgery: 35.3 ±9.4 y). At
follow-up, 64 subjects (46.7 %; 95 % CI [38.6; 55.1])
reported an acceptable symptom state (PASS).
HAGOS subscale and iHOT-33 cut-off scores
showed excellent to outstanding discriminative
ability in predicting PASS (Area Under the Curve:
0.82-0.92). These scores ranged from 42.5 for the
HAGOS QOL to 82.5 for the HAGOS ADL
Conclusions: Forty-six percent of subjects having hip arthroscopy
for femoroacetabular impingement syndrome
reported an acceptable symptom state at 12-24
months follow-up. Cut-off values at HAGOS
subscales and iHOT-33 showed excellent to
outstanding discriminative ability in predicting
subjects who have an acceptable symptom state.
Jamila Eriksen, Niels Søe, Merete Juhl Kønig, Eva Balslev, Xiong Xie, Dimitar Ivanov Radev
Department of Handsurgery, Aleris-Hamlet Hospital; Handsection, Department of Orthopaedic Surgery, Herlev and Gentofte University Hospital; Department of Radiology/Ultrasound and MR, Gentofte University Hospital; Department of Pathology, Herlev University Hospital; Department of Radiology/Ultrasound and MR, Gentofte University Hospital; Department of Radiology, Bispebjerg Hospital
Background: Clinical dorsal wrist ganglion is the most common
soft tissue tumour of the hand, found in about 20%
of patients with wrist pain. Recurrences have been
documented from 1-50% and are a burden to the
patient and healthcare system.
Purpose / Aim of Study: This study seeks to further our currently limited
understanding of the condition, thereby improving
Materials and Methods: 43 patients with previously untreated clinical dorsal
ganglia were consecutively included in the study
over 2 years. Standard radiology, ultrasound and
MRI of the wrist was performed before open surgical
excision in the 38 eligible patients. 5 patients with
remission of symptoms were not admitted for
surgery. Excised tissue was examined
microscopically after specific tissue staining
(hematoxylin/eosin and immunohistochemical
staining with vimentin, CD68, and D2-40). Of those
who were operated, three patients later dropped out
of the study for personal reasons. A clinical
examination was performed three and six months
postoperatively and a clinical examination as well
standard ultrasound and standard MRI was planned
one and two years postoperatively. 21 of the 35
operated patients (60%) still included in the study
have currently been seen at 1-year follow-up.
Findings / Results: Two different histopathologic changes were seen.
45% were ganglion cysts and 42% synovial
cysts/bursa cysts. In 13% of cases the excised
tissue was not diagnostic. Preliminary results show
that recurrences only occurred in patients with
synovial cysts (4 patients with clinical recurrence, 3
requiring reoperation and 1 patient with ultrasound-
verified recurrence, not requiring surgery). This
accounts for 24% of the patients seen at the 1-year
follow-up. MRI and ultrasound is able to diagnose
but does seem to differentiate the type of cysts.
Conclusions: The histological findings could be a help in finding
the patients that are of the risk of recurrence. We
propose to use the well-known histopathologic
changes of the ganglion and synovial cysts to
facilitate further study of clinical outcome and
attempt to optimize MRI and ultrasound.
Lis Røhl Andersen, Lisbeth Madsen Fredsholm, Heidi Grejsen
ortopædkirurgisk afd, SLB Kolding; Geriatrisk afd, SLB Kolding; ortopædkirurgisk afd., SLB Kolding
Background: Ortogeriatric units are well accepted
Worldwide as quality improvement in
treatment of frail elderly patients with
The population of people +65 years
are expected to rise significantly in the
Next decades and the incidence of hip
fracture as well. The consequence is a
highpressure on the Hospitals and that
challenge the ortogeriatric Wards
Purpose / Aim of Study: In our Aim to improve treatment of the
frail hip fracture pt.,we were able to
reduce Length of Stay(LOS), but is
there a limit, where LOS is to short and
interact with mortality and readmission
Materials and Methods: Improvement in treating the frail hip
fracture patients by intervention in
several aspects over time.
Involving a limited Group of doctors
with special interest in ortogeriatric
treatment, doing the Ward rounds.
Increasing exercise in Hospital.
Reducing time to Theatre.
Teamwork with Primary after
admission for 14 day's(Safe Discharge)
Participating in Learning and Quality
Teams in DK, learning from other
Hospitals an focus on improvement in
Findings / Results: We were able to reduce mortality from
2018 12% to 2019 6.6%
Reducing LOS 2018 6 to 2019 4.9.
Re-admission rate 2018 15% in 2019
Conclusions: In spite of continuous improvement of
quality in treatment of the frail patient
with hip fracture, that reduces the LOS,
we didn't see higher mortality or an
increasing re-admission rate.
We think that the combination of faster
way to Theatre and Teamwork both
between the team at Ward and the
teamwork with acute nurse in primary
sector, the first 14 days after
discharge, were of great importance.
Jorgen Baas, Nina Dyrberg Lorenten, Frank Skydsgaard Linde, Claus Sundstrup, Kristian Kibak Nielsen,
Orthopedics - Section for Foot and Ankle Surgery, Aarhus University Hospital; Orthopedics - Section for Foot and Ankle Surgery, Aarhus University Hospital; Orthopedics - Section for Foot and Ankle Surgery, Aarhus University Hospital; Orthopedics - Section for Foot and Ankle Surgery, Aarhus University Hospital; Orthopedics - Section for Foot and Ankle Surgery, Aarhus University Hospital; ,
Background: The classic Rheumatoid Arthritis (hereafter
RA) deformities include Hallux Valgus,
hammertoes and a collapse of the transverse
arch. The typical patient presents with
metatarsalgia as the main complaint, but also
pressure points from shoewear on bunion
and hammertoes. The goal of rheumatoid
forefoot surgery is to reduce pain and
normalize the foot to fit common shoewear
by correcting deformities. In our department,
this surgical correction has consisted of first
ray metatarsophalangeal arthrodesis, small
metatarsal head resection and hammertoe
correction by proximal interphalangeal
Purpose / Aim of Study: To establish a basic understanding of patient
satisfaction and surgical outcome of this surgical
procedure in our institution.
Materials and Methods: We report from a consecutive retrospective self-
controlled cohort study of 33 patients (50 feet)
operated with the same technique.
Findings / Results: 30 of the 33 patients confirmed willingness to
repeat surgery. 16 of 33 patients wore hand-
sewn shoes before surgery, postoperatively this
was reduced to 7 of 33. Solid
metatarsophalangeal fusion of the great toe was
found in 47 of 50 feet and the metatarsal
parabola was acceptable by radiological
Conclusions: This cohort showed a high level of patient
satisfaction and outcome. This cohort is non-
comparative and allows no conclusions on the
effects of surgery, but patient willingness to
repeat is good and we will continue to offer this
procedure to our patients with severe
rheumatoid forefoot deformities.
Christian Wong, Peter Buxbom, Andreas Balslev-Clausen
Dept of Orthopedics, Hvidovre hospital; Dept of Orthopedics, Hvidovre hospital; Dept of Orthopedics, Hvidovre hospital
Background: Hip subluxation occurs especially for the children
with severe cerebral palsy (CP), and surgical
procedures such as unidirectional pelvic and
varising femoral osteotomies may be necessary.
Guided growth surgery of the hip (GGH) by one
eccentric transphyseal screw might be an alternative
minor procedure for prevention of hip subluxation.
Purpose / Aim of Study: We wanted to examine the preliminary clinical and
radiological effects of GGH to see, if GGH is a safe
and effective procedure.
Materials and Methods: Children with CP, predominantly gross motor
function classification system (GMFCS) III–V and hip
subluxation of 30-40 % were included. GGH and soft
tissue releases were performed. Clinical, radiological
follow-up and radiostereometric analyses (RSA),
were obtained postoperative, after 6 and 12 months.
Findings / Results: Twelve hips of 8 children with CP, GFMCS 3-5
were included and analysed. The median age
was 9 years (5-11, male:female ratio was 1:1 and
mean follow-up 11.2 months. One child was
excluded due to a postoperative fracture. All
eccentric screws, but 1 were adequately placed
transphyseally. Seven screws showed signs of
slippage from the epiphyseal plate and in two
cases the screw was replaced. RSA analyses:
five hips had medial growth, 4 lateral and 2 were
excluded. The medial migration of the femoral
head was a mean of 0.29 mm (-2.44 - 1.89) mm.
All hips had superior migration with mean 3.23
mm (0.66-5.35). The mean condition number
was 624 and no further analyses of rotation were
performed. Analyses of radiographs: NSA
improved in 8 of 11 (mean; -7.0 dg.,), epiphysial
tilt worsened in 6 of 11 (mean; 3.2 dg.),
Southwick angle improved in 8 of 11 (mean; 5.2
dg.) and the articulotrochanteric distance
decreased in 6 of 11 (mean; 3.2 mm).
Conclusions: Effective guided growth of the hip by regular
cannulated screw 7.5 mm was not as yet clearly
demonstrated, and it is too soon from our
preliminary results to conclude whether or not GGH
is a safe and effective procedure, but our results are
indicative of that. However, surgical improvements
are warranted, and we have already implemented a
new custom made transepiphyseal screw.
Jamal Bech Bouknaitir, Leah Y. Carreon, Stig Brorson, Casper Friis , Mikkel Østerheden Andersen
Spine Unit, Department of Orthopedic Surgery, Zealand University Hospital, Køge, Denmark; Spine Surgery and Research, Spine Center of Southern Denmark – part of Lillebaelt Hospital, Denmark; Spine Unit, Department of Orthopedic Surgery, Zealand University Hospital, Køge, Denmark; Spine Surgery and Research, Spine Center of Southern Denmark – part of Lillebaelt Hospital, Denmark; Spine Surgery and Research, Spine Center of Southern Denmark – part of Lillebaelt Hospital, Denmark
Background: The optimal procedure for lumbar spinal stenosis
remains controversial. Studies have shown no
difference in short term outcomes among micro-
laminectomy, hemi-laminotomies, broad
laminectomy and laminectomy with instrumented
Purpose / Aim of Study: To report on outcomes in Lumbar spinal stenosis
patients who underwent wide laminectomy,
segmental bilateral laminotomy or unilateral
Materials and Methods: Patients with spinal stenosis who were enrolled in
the DaneSpine database from January 2010 until
May 2014 and underwent wide laminectomy,
segmental bilateral laminotomy or unilateral
hemilaminectomy were identified. Patients
completed standard questionnaires preoperatively
and 1, 2 and 5 years after surgery that included the
Oswestry Disability Index (ODI). Peri-operative data,
including ASA score, body mass index and smoking
status were also collected.
Findings / Results: Five hundred ten patients (265 males and 245
females) were included. Most patients were
operated with segmental bilateral laminectomy over
one level (n=283). Operative method (p=0.07) was
not found to be a predictor for patients achieving
MCID for ODI (12point change) from baseline to
one, two and five years follow up. ASA score
(p=0.036) and smoking status (p=0.015) were
associated with change in ODI above MCID after
one and two year.
Twenty-eight patients were re-operated on same
level after primary decompression alone, either
because of disc prolapse (n=3), dural tear (n=3), re-
decompression (n=17), hematoma (n=4) or fusion
(n=1). We did not find reoperation to be associated
with operative method (p=0.60), although age at
operation time seems to predict reoperation
Conclusions: There is no difference in MCID change in ODI with
either broad laminectomy, segmental bilateral
laminotomy or unilateral hemi laminectomy after
one, two and five years. Factors associated with
achieving ODI MCID were smoking status and ASA
score at one and two years follow up but without
significant difference at five years post-op. Age at
surgery was found to predict risk of reoperation after
Tara Padtoft, Stig Brorson
Department of Orthopaedic Surgery, Zealand University Hospital; Department of Orthopaedic Surgery, Zealand University Hospital
Background: Recently, it has been proposed that
stable fractures of the olecranon (Mayo
Type II) in elderly with low functional
demand can be managed non-surgically.
When non-surgical management is
considered, functional aspects of
bandaging as well as biomechanics and
pathoanatomy are taken into account.
We hypothesized that a thorough
understanding of these aspects can be
found in the rich late 18th and early 19th
century medical literature.
Purpose / Aim of Study: To provide a review of historical approaches
to the biomechanics, pathoanatomy,
functional bandaging and complications of
olecranon fractures in the pre-surgery
period (1750-1850) and to discuss whether
the historical sources can inform current
Materials and Methods: We searched in bibliographical databases,
national libraries and historical medical
encyclopedias. References from potentially
eligible monographs and articles were hand
searched. Drawings and engravings were
analyzed qualitatively by the authors.
Findings / Results: We found a comprehensive knowledge
of diagnostics, biomechanics and
pathoanatomy in the period 1750-1850.
The deforming force of the triceps
muscle on the proximal fragment was
well understood. Reduction of the
fragment was attempted, but retention
was difficult. Several ingenious devices
and functional bandages in different
degrees of extension and with direct
pressure were proposed for keeping the
fragments together. Anchylosis was a
known complication. A debate on
osseous versus fibrous healing of
olecranon fractures and the functional
consequences of fibrous healing can be
found in the early 19th century sources.
A collection of previous unknown
illustrations will be presented.
Conclusions: A rich literature on the biomechanics,
pathoanatomy, functional bandaging and
complications after olecranon fractures can
be found in the late 18th and early 19th
century. The discussion on fibrous versus
osseous healing as well as principles of
functional bandaging may have interest for
a modern reader.
Jenifan Anton Joseph Sebastiampillai, Klaus Hanisch, Inge Hvass, Niels Wedderkopp
Clinical dep., University of Southern Denmark; Orthopedic, University Hospital of South West Jutland; Orthopedic, University Hospital of South West Jutland; Orthopedic, University Hospital of South West Jutland
Background: With an increasing elderly population and longer life
expectancy, shoulder complications have become a
more common topic. Studies has shown a marginal
increase in surgical interventions like total shoulder
arthroplasty and revers total shoulder arthroplasty in
the last two decade.
Purpose / Aim of Study: This cohort study aims to describe the post-
operative outcome for patients with a shoulder
arthroplasty and determine the associations with
factors like age, diagnoses, sex and type of
arthroplasty of an “unfavorable” outcome.
Materials and Methods: All patients receiving a shoulder arthroplasty
from 2014 to 2020 with follow-up data at
University Hospital of South West Jutland.
WOOS and Constant score was used for
assessing results. Continuous data are reported
as means with standard deviations if normal
distributed, if not as medians with interquartile
ranges, categorical data was reported as
numbers and proportions. WOOS was
dichotomized according to the Danish WOOS
validation as reported by Rasmussen et al.,
where a score higher than 50% (950) is
Bivariate comparisons and multivariate analyzes
was performed mixed linear and logistic
Findings / Results: 533 females, 330 males received a shoulder
arthroplasty, age was from 33 to 93, baseline WOOS
and Constant score 28 and 23, 1-year scores 70 and
43. Mean WOOS on all diagnoses reached good
(above 50%), with the best results in osteoarthritis
patients. Whereas when comparing arthroplasties,
hemiarthroplasty for fracture treatment did not reach
WOOS above 50%. The multivariate marginal 12
months WOOS for fractures were for
hemiarthroplasties 31.1 and for Reverse
arthroplasties 65.1. There were 61 complications, 24
Conclusions: The PRO-scores after shoulder arthroplasty showed
good results except for hemiarthroplasty used in
fracture treatment, where the results were clearly
inferior compared to when the Reverse-arthroplasty
Rikke Steffensen Puggaard, Lina Holm Ingelsrud, Stine Jacobsen, Jakob Kjellberg, Thomas Bandholm, Per Hølmich, Mikael Boesen, Henning Bliddal, Søren T. Skou, Henrik Morville Schrøder, Susan Weng Larsen, Susanne Reventlow, Anders Troelsen
Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre; Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre; Department of Veterinary Clinical Sciences, University of Copenhagen; VIVE – The Danish Centre for Social Science Research, VIVE – The Danish Centre for Social Science Research; Department of Physical and Occupational Therapy, Clinical Research Center and Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre; Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark; Department of Radiology; Parker Institute, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark; Parker Institute, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics; Department of Physiotherapy and Occupational Therapy, University of Southern Denmark; Næstved-Slagelse-Ringsted Hospital; Department of Orthopaedic Surgery, Næstved Sygehus; Department of Pharmacy, University of Copenhagen; Section of General Practice, Department of Public Health, University of Copenhagen; Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre
Background: Patient and public involvement in research
is emphasized to increase clinical relevance
Purpose / Aim of Study: We aimed to identify, define and prioritize
important research topics, by including the
point of view of patients with osteoarthritis
Materials and Methods: We invited 1315 members of The Danish
Rheumatism Association user panel to
complete an electronic survey. The survey
included; a) an open-ended question on
important research topics (free-text
response option), b) 15 pre-defined
research topics to be rated for importance,
and c) the pre-defined topics grouped into
four categories in which the most important
was prioritized. The four categories
consisted of 1) Aetiology, prevention and
diagnosis, 2) Treatment, 3) Information and
shared decision-making, 4) Course of
treatment and societal consequence. Free
text responses were analysed using
qualitative content analysis. Importance
ratings and prioritization were calculated as
Findings / Results: Out of the 850 (65 %) respondents, 483 (57
%) had self-reported OA in any joint (mean
(SD) age 60.3 (±10.2) years, 91 % female).
The remaining 43 % with exclusively other
primary rheumatic diseases than OA were
excluded. From the free-text responses, we
identified seven main research topics; 1)
diagnosis, 2) prevention, 3) side-effects, 4)
treatment, 5) aetiology, 6) being young with
OA and 7) quality of life. For treatment, we
identified seven subtopics. Out of all topics
and subtopics, pain management was the
most frequently highlighted research topic.
All pre-defined topics were rated as “very
important” or “somewhat important” by more
than 75 % of the respondents. The top
prioritized topics within each category were
1) improving the diagnosis, 2) individualized
treatment, 3) shared decision-making and 4)
improving the collaboration between health
Conclusions: Using a survey approach proved a fruitful
way to identify important research topics in
the eyes of patients with OA. Pain
management was particularly emphasized
as an important research topic. Our findings
will contribute to the Clinical Academic
Group Research in OsteoArthritis
Denmark’s (CAG ROAD) future research in
Anna Bertoli Borgognoni, Katarina Louise Hjort, Klaus Kjær Petersen
Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital
Background: Septic arthritis and osteomyelitis of the pubic
symphysis are rare conditions with nonspecific
symptoms, leading to delay in diagnostic and
Purpose / Aim of Study: By presenting our experiences, focusing on
diagnosis and surgical treatment, we want to draw
attention to these rare conditions.
Materials and Methods: Retrospective analysis of patients records, radiology
Findings / Results: Twenty-four patients, 15 males, with median age 70
years (range; 48-89 yr), were surgically treated in
our department from 2009 to 2020.
Prior surgery for pelvic malignancy (prostate, vulva,
cervix, bladder and anal), or surgery for benign
conditions (prostate hypertrophy and urine
incontinence) were performed in all but two patients,
which presented with probably hematogenous
infection after sepsis.
Patients experienced pubic pain (65%),
intermittently fever (35%), pain with hip motion
(30%), painful gait (26%), groin pain (26%) and
lower back pain (17%). Diagnostic delay was up to 1
The diagnosis was confirmed by using different
imaging modalities (MRI, CT and PET-CT), which
showed joint accumulation and bony destructions,
edema and/or abscess in bone and/or muscles.
All patients underwent surgical debridement with
resection of the symphysis. Most surgeries were
performed with colleagues from other specialities.
Five patients had at least one revision surgery, due
to post-operative hematoma, relapse or wound-
healing problems in patients who had previously
undergone radiotherapy treatment.
Cultures from 7 patients were negative. The
remaining 17 showed a variety of different
pathogens, in some cases polymicrobial.
All patients received at least 2 weeks of intravenous
antibiotic, followed by 4 weeks of oral therapy.
The pain subsided postoperatively and after six
weeks most patients were able to walk without
Conclusions: Arthritis and osteomyelitis of the symphysis pubis
are rare conditions, occurring often after pelvic
surgery and presenting with symptoms such as
pelvic pain and impaired gait. The extend and
severity of the infection can be visualized by MR, CT
or PET-CT. Treatment of choice is early surgical
debridement, often in collaboration with surgeons
from other specialities, followed by antibiotics.
Inger Mechlenburg, Lisa Reimer, Troels Kjeldsen, Thomas Frydendal, Ulrik Dalgas
Department of Orthopaedic Surgery, , Aarhus University Hospital; Department of Orthopaedic Surgery , Aarhus University Hospital; Department of Clinical Medicine, Aarhus University; Department of Physiotherapy , Vejle Hospital; Exercise biology, Department of Public Health , Aarhus University
Background: Exercise may be a preventive, disease-
modifying, or alleviating treatment at
different stages of hip osteoarthritis (OA);
pre-clinical, mild-moderate hip OA, severe
hip OA and after hip arthroplasty (THA).
Purpose / Aim of Study: To summarize the effects of exercise as
primary, secondary and tertiary prevention
at different stages of hip OA and in patients
Materials and Methods: In a narrative review, we summarized the
evidence investigating exercise as a risk
factor in the development of hip OA
(primary prevention). Then, we
summarized secondary and tertiary
preventive effects of exercise in patients
having mild-moderate or severe hip OA.
Finally, we evaluated the effects of
exercise after THA (tertiary prevention).
Findings / Results: High exposure to exercise and sports
injuries can increase the risk of
developing hip OA, while moderate
levels of exercise oppositely can
decrease the risk of developing hip OA.
In mild to moderate hip OA, exercise
can reduce pain and improve function,
while sparse evidence suggest no
effect on quality of life. In severe hip OA
in patients scheduled for THA,
preoperative exercise may reduce pain
and improve function prior to THA,
while the postoperative effects remain
inconsistent or uncertain. We found no
results indicating that exercise has a
secondary preventive effect on hip OA.
However, it has been shown in mild to
moderate hip OA that avoidance of
exercise over time results in a reduction
of hip abductor muscle strength,
leading to functional limitations.
Postoperative exercise initiated within
one year after THA show improved
functional capacity and muscle
strength, while having little effect on
patient-reported function and quality of
Conclusions: Being moderately physically active and
maintaining muscle strength is primary
prevention of hip OA. Furthermore,
exercise may offer tertiary prevention in
mild-moderate and severe OA, as well
as in patients undergoing THA. There is
no data on exercise as secondary
prevention of hip OA. We propose
shifting the exercise paradigm towards
an increased focus in the pre-clinical
and mild-moderate stage where least is
known but the most profound effects
Casper Bindzus Foldager, Jeppe Barckman, Martin Gottliebsen
Ortopædkirurgi, Aarhus Universitetshospital; Ortopædkirurgi, Aarhus Universitetshospital; Ortopædkirurgi, Aarhus Universitetshospital
Background: Traumatic dislocation of the hip in children is rare.
Immediate closed reduction is important. Imaging
after reduction is important as tissue is at risk at
becoming intertwined in the joint space. Open repair
is usually necessary to address the posterior part of
the acetabulum. It is important to assure that the
surgical technique used takes into consideration the
need to protect the blood supply to the femoral
Purpose / Aim of Study: To present technical and clinical reasons for use of
safe surgical dislocation for treatment of inverted
labral lesions in children.
Materials and Methods: We present to cases (boys 9y + 11y) with inverted
labral lesions following traumatic hip dislocation
after high energy motocross injuries. Safe surgical
dislocation of the hip joint was performed in both
cases using paediatric technique.
Findings / Results: Use of safe surgical hip dislocation gave full access
to the acetabulum. The lesions were repaired using
suture anchors. In both cases the postoperative
course was uneventful. No signs AVN were
Conclusions: This rare traumatic lesion of the hip joint in children
can be repaired using safe surgical dislocation
technique. We advocate referral to a paediatric
trauma center with experience in the use of the
Simone Ejstrup, Bibi Gram, Carsten Juhl
Department of Occupational Therapy and Physiotherapy and Department of Sport Science and Clinical Biomechanics, Hospital of South West Jutland and University of Southern Denmark; Research Unit of Health Science, Hospital of South West Jutland and University of Southern Denmark; Department of Sport Science and Clinical Biomechanics, University of Southern Denmark
Background: Total knee arthroplasty (TKA) is one of the most common surgical interventions in Denmark, with around 8.500 TKA
performed every year. Despite a good prognosis some patients experience reduced knee range of motion (ROM) after
The treatment is intensive physiotherapy and in case of insufficient effect, manipulation under anesthesia (MUA) followed
by a combination of continuous passive motion (CPM) and physiotherapy.
Purpose / Aim of Study: To investigate the effect of MUA followed by
CPM and physiotherapy on knee ROM after
Materials and Methods: Patients were identified from electronical records using diagnostic code KNGT19 for MUA
between December 2014 and December 2019 at Hospital of South West Jutland, Denmark.
The following data was extracted: use of CPM, ROM before MUA, at discharge and follow-
up. Assuming missing data were at random, a multiple imputation was performed. Analysis
were performed in Stata 16.1.
Findings / Results: Of 97 patients identified, 27 were excluded as MUA was performed in an addition to other surgical
procedures. Mean age of the remaining 70 patients were 58 years (SD: 9) and 63% were women.
Before MUA extension deficit was 5 degrees (95% CI: 3 to 6) and flexion 80 degrees (95% CI: 77 to 83).
At discharge the extension deficit was 7 degrees (95% CI: 5 to 9) and flexion 105 degrees (95% CI: 103
Extension deficit increased with 0.6 degrees (95% CI: -2.8 to 1.9) and flexion increased with 17 degrees
(95% CI: 12 to 21) at follow-up.
Twenty-three patients received a regime with CPM from 7 a.m. to 22 p.m., and 7 patients used CMP for
48 hours, with only 3-4 hours break at night. The difference between the groups were at follow-up 2
degrees extension deficit (95% CI: -2 to 6) and 11 degrees flexion (95% CI: -24 to 2), in favors of the
Conclusions: MUA combined with CPM improved knee flexion with 17 degrees, but no reduction in extension deficit was seen.
Results show no difference between the groups, which may be due to lack of statistical power.
Results may be biased by using different type of measurement tool (goniometric or visual), and it was not always
clear if ROM were active or passive. Additionally, there were no adjustments for potential confounders like age and
Jesper Nielsen, Jakob Klit, Henrik Aagaard, Stig Brorson
Orthopedic Department, Zealand University Hospital, Køge; Orthopedic Department, Zealand University Hospital, Køge; Orthopedic Department, Zealand University Hospital, Køge; Orthopedic Department, Zealand University Hospital, Køge
Background: The effects of COVID-19 have permeated all
aspects of society. In Danish hospitals, the
impact of COVID-19 has extended to elective
orthopedic surgical procedures, with most
arthroscopic procedures being delayed for
months. It is widely accepted that symptoms
leading to arthroscopic orthopedic intervention
often change. Because all elective surgery has
been postponed in Denmark, this is a unique
opportunity to further investigate into these
patients’ potential changes in preferences for
surgery over time.
Purpose / Aim of Study: To investigate the impact of extended time on
waiting list under the COVID-19 pandemic on the
preference for surgery among patients planned for
Materials and Methods: We included all patients over the age of 18 years
planned for arthroscopic procedures in knee or
shoulder in Zealand University Hospital Køge, who
were postponed because of the Covid-19 outbreak.
The patients were asked by digital letter (e-boks)
about their preference for surgery before their
operation were re-scheduled. Patients who did not
answer the letter were contacted by telephone twice
and patients who did not answer the telephone call
were classified as non-responders.
Findings / Results: 56 consecutive patients were identified. One patient
had received treatment at another hospital leaving
55 patients for inclusion. Mean period on waiting list
was 68 days (range 37-190). 23 patients were
scheduled for shoulder arthroscopy (mean waiting
period 73 days (range 39-190)) and 33 were
scheduled for knee arthroscopy (mean waiting
period 64 days (range 37-133)). In total one patient
changed preference for surgery (1,8%). This patient
was scheduled for knee arthroscopy. Furthermore 2
patients in this group were non-responders.
Including these as changing preference for surgery
makes a total of 5,5% of knee arthroscopic patients
changing preference. No patients scheduled for
shoulder arthroscopy changed preference.
Conclusions: In this single center cohort only few patients
scheduled for arthroscopic surgery changed
preference for surgery due to the extended waiting
period under the COVID-19 pandemic.
Ulrik Kähler Olesen, Tobias Nygaard, Upender Martin Singh, Fuhuan Chen, Peter H Thaller
Trauma and reconstruction, orthopedic clinic, Rigshospitalet; Pediatrics, orthopedic clinic, Rigshospitalet; Trauma and reconstruction, orthopedic clinic, Rigshospitalet; Department of General- Trauma- and Reconstructive Surgery, University Hospital Ludwig-Maximilians-University (LMU), Munich, Germany; Department of General- Trauma- and Reconstructive Surgery, University Hospital Ludwig-Maximilians-University (LMU), Munich, Germany
Background: Seeking to improve the treatment, we present a
modified retrograde surgical technique to correct
short humeral length on a congenital or acquired
(syndromic, malignant, traumatic, infectious)
Purpose / Aim of Study: Our suggestions for indications is presented. The
retrograde surgical technique is presented and
discussed, compared to the antegrade technique.
Materials and Methods: 3 cases were retrospectively reviewed for functional
parameters, ROM (flex/ext, abduction) pre- and
post-op, complications are presented and
Findings / Results: Range of motion normalized at 1,5 year follow-up for
all patients. One patient needed nail replacement
due to implant failure. All 3 patients experienced
excellent results and only mild, temporary
complications (temporary parestesias, temporary
drophand). Shoulder function improved in two.
Conclusions: The presented cases suggest that the retrograde
humeral technique is superior to antegrade because
it allows osteotomy below the insertion of the deltoid
muscle and thus reduces pressure on rotator cuff
and tension on axillary nerve. Additional lengthening
is possible. Lengthening over 5 cm requires a more
careful approach, monitoring nerve function and
range of motion in the affected joints. Smaller
defects should only be corrected with specific
Kevin Zolfaghari Moghaddam, Jakob Klitt, Jonas Vestergård
, ; , ; ,
Background: Osteochondritis dissecans (OCD) is a rare but
debilitating condition with uncertainty about both
incidence, epidemiology and pathogenesis. Surgical
treatment for the unstable lesion does not guarantee a
good outcome. For the adolescent athlete, this can be
the end of a possible future career in sports.
Furthermore, the challenge despite operative treatment
may be secondary development of osteoarthritis (OA).
This challenge physicians when diagnosing and
especially treating the disease.
This study illustrates juvenile osteochondritis dissecans
(JOCD) and the surgical treatment of osteochondritis
dissecans in young athletes.
Purpose / Aim of Study: This study presents a case of juvenile
osteochondritis dissecans (JOCD) in a professional
soccer player along with a concise report of the
literature regarding surgical treatment of
osteochondritis dissecans in young athletes.
Materials and Methods: A systematic search in PubMed was performed. Furthermore, a case of JOCD in the
medial femoral condyle of a young professional soccer player is presented.
The following MeSH terms were chosen and combined: OCD knee, pathology,
etiology, adolescence, surgery.
The 39 publications were dissected and publications relevant regarding the research
question were selected.
Studies were included if they met the inclusion criteria
Findings / Results: Stable lesions are treated conservatively in 70% of
Unstable lesions and those who failed conservative
treatment are treated surgically.
A variety of surgical techniques are innovated and
utilized when the lesion is unstable.
Different validated outcome questionnaires are used
to access the functional outcomes of patients and
the effectiveness of treatment. ICRS and Lysholm
score is widely used.
The functional outcome may regress over time and
therefore long term follow up is important
Conclusions: JOCD is a multifactorial disorder were repetitive
microtrauma and genetic predisposition are believed
to be a major factor. Based on the level of evidence
the challenges lie in accurate MRI, advanced
surgical techniques and management. There are
numerous publications on all aspects regarding
JOCD in different joints but there is a lack of
scientifically reliable prospective randomized
Juozas Petruskevicius, Jan Duedal Rölfing
Department of Orthopedic Surgery, Aarhus University Hospital; Department of Orthopedic Surgery, Aarhus University Hospital
Background: Negative pressure wound therapy with
instillation (NPWTi) diminishes the number
of bacteria in chronic wounds and is thus
effective in its treatment, the more so when
soft tissue defects are substantial (Goss
2014, Lessing 2011).
Purpose / Aim of Study: Case report
Materials and Methods: A 56-year-old man with diabetic ulcer of the
heel (Ø 6 cm) and osteomyelitis of the
calcaneus presented with a bimalleolar
fracture and acute cellulitis. The limb was
scheduled for amputation due to the
severity of the 3 concomitant local threats to
the limb in conjunction with dis-regulated
diabetes, micro- and macroangiopathy,
neurophathy, BMI = 44, depression and
colostomy. The toe pressure was 65 mmHg.
Open reduction and internal fixation was not
a viable option, however the patient refused
Findings / Results: Initial treatment consisted of wound
debridement, spanning the ankle with
external ring fixation, and intravenous
antibiotics. Kamme biopsies verified
Enterococcus faecalis, Proteus mirabilis and
Escherichia coli. NPWTi treatment (V.A.C.
VERAFLO™) was initiated after 7 days.
NPWTi treatment consisted of Cleanse
Choice™ dressings and instillation of 20 ml
isotonic saline solution for 10 min followed
by 210 min of NPWT with 125 mmHg.
Vacuum dressings were changed every 3-4
After 11 days of NPWTi the ulcer and the
exposed calcaneus were covered by
granulation tissue and split skin
transplantation was performed. Ring fixation
spanning the ankle joint with weightbearing
as tolerated continued for 11 weeks in total
facilitating fracture- and soft tissue healing.
At frame removal, additional screw fixation
of medial malleolus was performed to allow
full weightbearing after 2 weeks of
immobilization in a cast.
Conclusions: The combined effect of NPWTi, ring fixation
and IV-antibiotics salvaged the limb despite
severe local (acute ankle fracture, chronic
foot ulcer and severe erysipelas) and
systemic threats (dysregulated diabetes
incl. neuropathy, colostomy, obesity). In the
present case, NPWTi was effective in the
management of a severe, multibacterial
wound infection and provided continued
postsurgical debridement and granulation
within a short time frame of less than two
Helle K. Østergaard, Inger Mechlenburg, Antti Launonen, Ville Ponkilainen
Department of Orthopaedic Surgery, Viborg Regional Hospital; Department of Orthopaedics , Aarhus University Hospital; Department of Orthopaedics, Tampere University Hospital; Department of Orthopaedics, Tampere University Hospital
Background: Proximal humerus fractures (PHF) and distal radius
fractures (DRF) are common among the elderly.
Recent randomised controlled trials (RCTs) support
non-surgical treatment. However, the evidence on
the most optimal rehabilitation strategy is sparse and
does not support clinical guidelines describing when
to initiate the post-fracture mobilisation.
Purpose / Aim of Study: To conduct a systematic review and meta-analysis to
assess the benefits and harms of early mobilisation
compared to late mobilisation after PHF and DRF.
Materials and Methods: A systematic search was performed in 8
electronic databases. The study population
consisted of adults (>= 18 years) sustaining a
PHF or DRF. The intervention and comparison
were defined as early mobilisation (<2 weeks
post fracture) vs. late mobilisation. The outcome
measures of interest were function, pain and
health-related quality of life (HRQoL). Two
independent reviewers conducted the screening,
eligibility assessment, inclusion and data
extraction. The overall quality of evidence of the
included studies was assessed using the
Cochrane Risk of Bias tool. Meta-analysis was
conducted when possible.
Findings / Results: Six RCTs with a total number of 348 participants
were included. A significant difference in favour
of early mobilisation after PHF was found in
function (standardized mean difference 0.73
(0.35;1.11) at 3 months follow-up. HRQoL was
presented only in one study reporting that two
dimensions of the Short-Form-36 were
significantly higher after early mobilisation at 3
months follow-up No nonunions were reported.
Meta-analysis could not be conducted on early
mobilisation after DRF. Overall, none of the
included studies presented significant differences
in function or pain between early and late
mobilisation after DRF. One study reported a
higher proportion of algoneurodystrophy (19%
vs. 4%) after late mobilisation. The quality of the
studies was low.
Conclusions: Early mobilisation after PHF resulted in a moderate
effect on function, whereas there was insufficient
evidence after DRF. The included studies show, that
it is safe to start the mobilisation within two weeks
after the fracture. To support the non-surgical
treatment strategy, there is a need for more high
Veronique Vestergaard, Henrik Morville Schrøder, Kristoffer Borbjerg Hare, Peter Toquer, Anders Troelsen, Alma Becic Pedersen
Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre; Department of Orthopaedic Surgery, Næstved Hospital; Department of Orthopaedic Surgery, Slagelse Hospital; Department of Orthopaedic Surgery, Køge Hospital; Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre; Department of Clinical Epidemiology, Aarhus University Hospital
Background: Few studies have described patient-reported outcomes (PROMs), prognoses and the current state of care of the knee fracture population. Studying risk factors of poor PROM scores is important in understanding the key drivers of poor outcome and in directing future quality
reported outcomes (PROMs),
prognoses and the current state of
care of the knee fracture population.
Studying risk factors of poor PROM
scores is important in understanding
the key drivers of poor outcome and in
directing future quality-improvement
Purpose / Aim of Study: 1) Report knee-specific and generic
median PROM scores after knee
fracture. 2) Identify risk factors for poor
outcome defined by low median PROM
Materials and Methods: In a Danish cross-sectional study of
7,133 distal femoral, patellar, and
proximal tibial fracture patients during
2011-2017, OKS, FJS-12, EQ5D-5L
Index and EQ5D-5L Visual Analogue
Scale (VAS) were collected
electronically via a national, CPR-linked digital mail system (response rate 53%; median age 60 years; 63% female). Poor outcome was defined as score lower than median PROM score. Poor outcome risk factors were estimated as odds ratios with 95% confidence intervals from binary logistic regression models.
linked digital mail system (response
rate 53%; median age 60 years; 63%
female). Poor outcome was defined as
score lower than median PROM score.
Poor outcome risk factors were
estimated as odds ratios with 95%
confidence intervals from binary
logistic regression models.
Findings / Results: At 0-1 years after knee fracture,
median PROM scores were 31 (OKS),
27 (FJS-12), 0.50 (EQ5D-5L Index)
and 74 (EQ5D-5L VAS). All four
PROM scores plateaued at 3-5 years
after knee fracture. At >5 years after
knee fracture, median PROM scores
were 40 (OKS), 54 (FJS-12), 0.76
(EQ5D-5L Index) and 80 (EQ5D-5L
VAS). Age >40 years was associated
with poor OKS and FJS-12 scores at
both short- and long-term follow-up
after knee fracture. Comorbidity
burden, distal femoral fracture and
treatment with external fixation and
knee arthroplasty were risk factors for
poor outcome at long-term follow-up,
for all four PROMs.
Conclusions: Knee fracture patients have relatively
high knee function and quality of life
(OKS, EQ5D-5L Index and EQ5D-5L
VAS), while their ability to forget about
the knee joint after knee fracture is
compromised (FJS-12). Risk factors for
poor outcome vary depending on the
PROM and follow-up period studied.
This study will further research in
ensuring high quality of care for all
patient groups regardless of their
associated patient-, fracture- and
treatment-related factors and in
informing patients on varying aspects
of expected outcome after knee
fracture, including the presented risk
factors which modulate their outcome.
Jonas Adjal, Ilija Ban
Orthopaedic Department, CORH, Hvidovre Hospital; Orthopaedic Department, CORH, Hvidovre Hospital
Background: Patella fractures requiring surgery are
traditionally treated using metallic implants,
which are associated with high re-operations
rates, mainly due to implant prominence.
Purpose / Aim of Study: To overcome the problem of prominent
metallic implants, we present a technique
based purely on braided sutures – the novel
Materials and Methods: The suture is passed through soft tissue
solely, that is: the quadriceps tendon, the
patellar ligament, and the medial and
lateral retinacula. Upon reposition the first
and second sutures are passed through
soft tissue in two distinct ways: “the
modified circular suture” and “the modified
figure-of-eight” suture, respectively. Both
sutures start in the upper lateral corner of
the quadriceps tendon where knots are
likewise tied. If comminution is present the
fracture is converted into a simple two-part
fracture with one or two “box sutures”
around the upper and lower pole,
Findings / Results: This technique is here described on our first
six patients treated with this technique at our
institution along with their clinical and
radiological follow up. It is furthermore
described in a step-wise, standardized way
that can be adapted to all types of patella
The described suture configuration allows
maintenance of inter-fragmentary reduction
until bony union without symptoms from the
Conclusions: We believe that the “KnotMe” technique is a
safe and promising alternative to traditional
metallic fixation methods.