Posters

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. expectations.
Purpose / Aim of Study: The aim is to investigate whether preop preop Oxford Knee Score (OKS), can predict long term results for TKR patients.
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 analysis. 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 included. 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 groups). 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 preop OKS. 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 outcome.

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 meaningful model.
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 (0.77-0.92).
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 measurements.
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 (p=0.014).
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, and department.
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 year.
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, and department.

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 fractures.
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 inflammation-related synovial cytokines. However, more standardized studies which focus on the ratio of pro- and anti-inflammatory cytokines at different time points are needed.

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 (0-1).
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 treatment.

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 high.
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 symptoms.
Purpose / Aim of Study: To investigate the tibiofemoral joint (TFJ) kinematics of level and downhill gait in patients with knee OA and healthy volunteers.
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 anterior draw. Clinical outcome for all subjects revealed that varus angular excursion during a gait cycle increased with giving-way symptoms (slope=0.57, p<0.01).
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 acceleration.
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 analyses.
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 extent sprinting.

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- up.
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 the results.

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 at follow-up.
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 improvement.
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 coccyx.

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 hours. 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 DOAC.
Materials and Methods: All hip fracture patients from 2017 and partially 2018 at Bispebjerg Hospital were included. We retrospectively collected data from patient records.
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 different.
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 database. Information on Gross Motor Function Classification 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 regression.
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 with age.
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 independent risk-factors.
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 training.
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 coccydynia.
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 refractory patients.

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 amputation.
Purpose / Aim of Study: To assess the functional outcomes and the complication associated with TFR used in revision arthroplasty.
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 osteomyelitis (n=1).
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 intervention.
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 perspective.

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 method.
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 to 0.95.
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 been investigated.
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 Senior).
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 anaesthesia (MUA).
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 3.8) 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 operative experience.
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 CT-scan.
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 surgeons’ experience.

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 loosening.
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 compression plate.
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 congress presentation.

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 topic.
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 out-patient clinic.
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 out-patient clinic.

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 et al.
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 scores.

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 dose.
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 (PROHIP) trial.
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 differently.
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 cases. 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 post-operative.

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 community.
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 mind.

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 reconstruction.
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 factor.
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, p=0.107).
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 injury.

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 therapist).
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 body. 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 abduction. In one patient the abutment was removed four years after primary surgery due to permanent pain. 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 setup.

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 corpus fractures.
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 healing.

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 delayed.
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 affected joints.
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 respectively. Radiographs and MRI showed juxta-articular intraosseous abscess communication into the joint with effusion, synovitis and revealed no evidence of joint destruction. 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 negative cultures. 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 therapeutic delay.

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 using AMSTAR-checklist.
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 involvement.
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 patients. 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 major revision.

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 for improvement. 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: 24-97 months). 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 evaluation.

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 underreporting.

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 28 patients.
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 time periods. 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 time periods.
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 elbow stiffness.
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 surgery.
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 UKA annually
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 fast-track setup

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 syndrome (FAIS).
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 investigated.
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 in sport.

Katrine Wade
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 components.
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 1.82)
Conclusions: Our findings suggest that, when performing a primary THA, the DMC is level with the conventionally used liner regarding long-term component survival.

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 clinical practice.
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 increase pain’.
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 physical activity/sports.

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 experience. 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 subscales.
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 patient outcomes.
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 hip fracture. 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 capacity.
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 local Teams.
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 14%
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 arthrodesis.
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 assessment.
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 fusion.
Purpose / Aim of Study: To report on outcomes in Lumbar spinal stenosis patients who underwent wide laminectomy, segmental bilateral laminotomy or unilateral hemilaminectomy
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 (p=0.039)
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 five years.

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 non-surgical management.
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 considered “good”. Bivariate comparisons and multivariate analyzes was performed mixed linear and logistic regression.
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 major.
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 was used.

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 and quality.
Purpose / Aim of Study: We aimed to identify, define and prioritize important research topics, by including the point of view of patients with osteoarthritis (OA).
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 percentages.
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 care professionals.
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 OA.

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 treatment.
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 and cultures.
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 year. 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 walking aids.
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 undergoing THA.
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 life.
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 are observed.

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 head.
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 observed.
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 technique.

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 rehabilitation. 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 TKA.
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 to 108). 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 intensive group.
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 sex.

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 arthroscopic surgery.
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) background.
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 discussed.
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 functional problems

Kevin Zolfaghari Moghaddam, Jakob Klitt, Jonas Vestergård
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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 patients. 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 studies.

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 amputation.
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 days. 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 weeks.

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 quality RCTs.

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 initiatives.
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 scores.
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 “KnotMe technique”.
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, respectively.
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 fractures. The described suture configuration allows maintenance of inter-fragmentary reduction until bony union without symptoms from the suture material.
Conclusions: We believe that the “KnotMe” technique is a safe and promising alternative to traditional metallic fixation methods.