DOS Best Posters
Anders Rottwitt, Nichlas Bek, Carsten Jensen, Bjarke Viberg
Department of Orthopaedic Surgery and Traumatology,, Lillebaelt Hospital, Kolding; Department of Orthopaedic Surgery and Traumatology,, Lillebaelt Hospital, Kolding; Department of Orthopaedic Surgery and Traumatology,, Lillebaelt Hospital, Kolding; Department of Orthopaedic Surgery and Traumatology,, Lillebaelt Hospital, Kolding
Background: Strengthening of the quadriceps musculature through high-load resistance training (HL-RT) is a cornerstone in knee rehabilitation. Despite decreasing symptoms and improving strength, HL-RT is unfeasible for some patients. Low-load blood flow restricted training (LL-BFRT) is an alternative, incorporating partial vascular occlusion. LL-BFRT has been found equal to HL-RT in terms of strength improvements, while being less stressful on the knee.
Purpose / Aim of Study: To assess the effect of an 8-week training protocol using LL-BFRT in patients with persisting knee pain.
Materials and Methods: Prospective cohort study consisting of participants with at least six months of persisting knee pain or at least three months of subjectively unsuccessful rehabilitation. The participants were instructed, by a physiotherapist in daily sessions of single-legged squats on the leg of the affected knee with blood flow restriction (BFR). Baseline and 8-week measurements for the Knee injury and Osteoarthritis Outcome Score (KOOS), isometric maximal voluntary contraction (iMVC) for quadriceps extensions, thigh girth and physical performance tests were performed. Results are given as mean with 95% confidence interval.
Findings / Results: 35 participants completed the study, two participants dropped out (one due to exercise related pain) and seven declined follow-up. The mean age was 38 years and 47% were female. The KOOS-subscale for Quality of Life. (QoL) increased by 5.6 [0.1 ; 11.2] points (p<0.04), iMVC strength by 14.6 [5.1 ; 24.0] Nm (p<0.01), one-leg jump for distance by 11.6 [0.8 ; 22.4] cm (p<0.04), in one-leg crossover jump by 25.9 [1.9 ; 49.9] cm (p<0.04), and one-leg 30 seconds side hop 7.2 [3.0 ; 11.3] (p<0.01). Among the participants who completed the study, the session adherence rate was 5.4 out of 7 weekly sessions, and the VAS score was 56.9 out of 100. No statistically significant im¬provements were observed in any other KOOS-subscales.
Conclusions: This is a novel study demonstrating that LL- BFRT is a feasible training form for patients otherwise unable to perform physiotherapy with improvements in the QoL subscale, iMVC and physical performance, but not in the subscale for pain.
Department of Orthopaedic Surgery and Traumatology,, Lillebaelt Hospital, Kolding; Department of Orthopaedic Surgery and Traumatology,, Lillebaelt Hospital, Kolding; Department of Orthopaedic Surgery and Traumatology,, Lillebaelt Hospital, Kolding; Department of Orthopaedic Surgery and Traumatology,, Lillebaelt Hospital, Kolding
Background: Strengthening of the quadriceps musculature through high-load resistance training (HL-RT) is a cornerstone in knee rehabilitation. Despite decreasing symptoms and improving strength, HL-RT is unfeasible for some patients. Low-load blood flow restricted training (LL-BFRT) is an alternative, incorporating partial vascular occlusion. LL-BFRT has been found equal to HL-RT in terms of strength improvements, while being less stressful on the knee.
Purpose / Aim of Study: To assess the effect of an 8-week training protocol using LL-BFRT in patients with persisting knee pain.
Materials and Methods: Prospective cohort study consisting of participants with at least six months of persisting knee pain or at least three months of subjectively unsuccessful rehabilitation. The participants were instructed, by a physiotherapist in daily sessions of single-legged squats on the leg of the affected knee with blood flow restriction (BFR). Baseline and 8-week measurements for the Knee injury and Osteoarthritis Outcome Score (KOOS), isometric maximal voluntary contraction (iMVC) for quadriceps extensions, thigh girth and physical performance tests were performed. Results are given as mean with 95% confidence interval.
Findings / Results: 35 participants completed the study, two participants dropped out (one due to exercise related pain) and seven declined follow-up. The mean age was 38 years and 47% were female. The KOOS-subscale for Quality of Life. (QoL) increased by 5.6 [0.1 ; 11.2] points (p<0.04), iMVC strength by 14.6 [5.1 ; 24.0] Nm (p<0.01), one-leg jump for distance by 11.6 [0.8 ; 22.4] cm (p<0.04), in one-leg crossover jump by 25.9 [1.9 ; 49.9] cm (p<0.04), and one-leg 30 seconds side hop 7.2 [3.0 ; 11.3] (p<0.01). Among the participants who completed the study, the session adherence rate was 5.4 out of 7 weekly sessions, and the VAS score was 56.9 out of 100. No statistically significant im¬provements were observed in any other KOOS-subscales.
Conclusions: This is a novel study demonstrating that LL- BFRT is a feasible training form for patients otherwise unable to perform physiotherapy with improvements in the QoL subscale, iMVC and physical performance, but not in the subscale for pain.
Louise Ujunma Kiesbye Holm, Thomas Jakobsen, Poul Torben Nielsen, Mathias Bæk Rasmussen, Anders El-Galaly
Department of Clinical Medicine; Department of Orthopaedic Surgery , Aalborg University; Aalborg University Hospital, Denmark; Department of Orthopaedic Surgery, Aalborg University Hospital, Denmark; Department of Orthopaedic Surgery, Aalborg University Hospital, Denmark; Department of Orthopaedic Surgery, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Department of Orthopaedic Surgery , Aalborg University; Aalborg University Hospital, Denmark
Background: The annual number of primary knee arthroplasties has increased in the past decades, however the future incidence and prevalence of primary knee arthroplasty in Denmark is unknown.
Purpose / Aim of Study: The aim of this study is to estimate the incidence of primary knee arthroplasty in Denmark from 2020 to 2050.
Materials and Methods: 138,298 primary knee arthroplasties conducted from 1997 to 2019 were retrieved from the Danish Knee Arthroplasty Registry. Censuses and mortality rates from 1997 to 2019 as well as population projections from 2020 through 2050 were collected from Statistics Denmark. The incidence, the absolute number and the estimated prevalence of primary knee arthroplasty – based on the cumulative sum of primary knee arthroplasties and Danish mortality rates - was calculated between 1997 and 2019. Several models (exponential, linear, logistic and Gompertz) were applied to the data and mean squared error was used as a quality estimator of the models’ fit to the data points. The incidence forecasts were presented with 95% confidence interval. From the incidence forecasts, we estimated the absolute yearly number of primary knee arthroplasties.
Findings / Results: The incidence from 1997 to 2009 has increased by more than 300%, but since 2009 the increase has stalled. Logistic and Gompertz regression had the lowest mean squared error and both assume an asymptote (i.e. a maximal incidence), wherefore these models were used to forecast the future incidence. Both regressions estimated that the incidence will soon reach a plateau and thus, the maximum incidence will be reached in 2025 at 250 (237-262) per 100,000 by logistic regression or in 2035 at 260 (241-279) per 100,000 by Gompertz regression. Due to the aging population, both scenarios will result in a rise in the annual number of knee arthroplasties ranging from 10,388 (logistic) to 10,819 (Gompertz).
Conclusions: The incidence seems to have plateaued or near its plateau, however the absolute number of primary knee arthroplasty will continue to increase as the Danish population gets older. The Danish healthcare system ought to prepare for an increase in primary knee arthroplasties as well as revisions in the future.
Department of Clinical Medicine; Department of Orthopaedic Surgery , Aalborg University; Aalborg University Hospital, Denmark; Department of Orthopaedic Surgery, Aalborg University Hospital, Denmark; Department of Orthopaedic Surgery, Aalborg University Hospital, Denmark; Department of Orthopaedic Surgery, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Department of Orthopaedic Surgery , Aalborg University; Aalborg University Hospital, Denmark
Background: The annual number of primary knee arthroplasties has increased in the past decades, however the future incidence and prevalence of primary knee arthroplasty in Denmark is unknown.
Purpose / Aim of Study: The aim of this study is to estimate the incidence of primary knee arthroplasty in Denmark from 2020 to 2050.
Materials and Methods: 138,298 primary knee arthroplasties conducted from 1997 to 2019 were retrieved from the Danish Knee Arthroplasty Registry. Censuses and mortality rates from 1997 to 2019 as well as population projections from 2020 through 2050 were collected from Statistics Denmark. The incidence, the absolute number and the estimated prevalence of primary knee arthroplasty – based on the cumulative sum of primary knee arthroplasties and Danish mortality rates - was calculated between 1997 and 2019. Several models (exponential, linear, logistic and Gompertz) were applied to the data and mean squared error was used as a quality estimator of the models’ fit to the data points. The incidence forecasts were presented with 95% confidence interval. From the incidence forecasts, we estimated the absolute yearly number of primary knee arthroplasties.
Findings / Results: The incidence from 1997 to 2009 has increased by more than 300%, but since 2009 the increase has stalled. Logistic and Gompertz regression had the lowest mean squared error and both assume an asymptote (i.e. a maximal incidence), wherefore these models were used to forecast the future incidence. Both regressions estimated that the incidence will soon reach a plateau and thus, the maximum incidence will be reached in 2025 at 250 (237-262) per 100,000 by logistic regression or in 2035 at 260 (241-279) per 100,000 by Gompertz regression. Due to the aging population, both scenarios will result in a rise in the annual number of knee arthroplasties ranging from 10,388 (logistic) to 10,819 (Gompertz).
Conclusions: The incidence seems to have plateaued or near its plateau, however the absolute number of primary knee arthroplasty will continue to increase as the Danish population gets older. The Danish healthcare system ought to prepare for an increase in primary knee arthroplasties as well as revisions in the future.
Sanne Høj Christensen, Andreas Kappel, Morgens Laursen
Orthopaedic Research Unit, Aalborg University Hospital, Denmark; Orthopaedic Research Unit, Aalborg University Hospital, Denmark; Orthopaedic Research Unit, Aalborg University Hospital, Denmark
Background: Standardized postoperative short knee radiographs radiographs serve as documentation and surgeon performance feedback following following total knee arthroplasty. Controversy Controversy regarding the relationship between between alignment measurements on postoperative and full-length radiographs radiographs are evident both scientifically scientifically and during daily conference conference with participation of non-knee knee surgeons. Measurement of mechanical mechanical coronal knee alignment from standing full-length lower-limb radiographs radiographs is gold standard, alignment alignment in the range from 177-183 is considered considered neutral.
Purpose / Aim of Study: To examine relationship between coronal coronal plane implant alignment measured measured from postoperative and follow follow-up full-length radiographs.
Materials and Methods: Retrospective study on a consecutive cohort cohort. Measurements of alignment using using TraumaCad™ guides. Examination Examination of intra- and inter-rater reliability reliability of the measurements, and agreement between short knee radiographs radiographs and full-length radiographs radiographs, with intraclass correlation coefficient coefficient. Evaluation of clinical relevance relevance from Bland Altman analysis and sensitivity analysis.
Findings / Results: 138 cases were included. Intra- and inter-rater reliability of the measurements measurements was excellent, with ICC above above .95. Agreement between the methods methods was good (ICC=.81(.74-.87)). Mean mechanical tibiofemoral alignment alignment from full-length radiographs ( (mTFA) = 179 ±2.9 degrees. Mean anatomical anatomical tibiofemoral alignment from the knee radiographs (aTFA) = 185 ± ±2.6 degrees. Mean difference between between methods = 5.8 (CI 5.4-6.1) and 95% limits of agreement 1.4 to 10 degrees degrees. Censoring of suboptimal projections projections and very short short films only only improved the results slightly. 32 full-length radiographs and 35 postoperative showed malalignment. Positive predictive value of a postoperative knee radiograph with malalignment malalignment was 54% and negative predictive predictive value was 87%.
Conclusions: Good agreement between the methods might might justify the cautiously use of short film anatomical angulations as surrogate surrogate measurement of alignment. Clinicians Clinicians should be aware of the wide limits of agreement and predictive power when evaluating postoperative TKA radiographs.
Orthopaedic Research Unit, Aalborg University Hospital, Denmark; Orthopaedic Research Unit, Aalborg University Hospital, Denmark; Orthopaedic Research Unit, Aalborg University Hospital, Denmark
Background: Standardized postoperative short knee radiographs radiographs serve as documentation and surgeon performance feedback following following total knee arthroplasty. Controversy Controversy regarding the relationship between between alignment measurements on postoperative and full-length radiographs radiographs are evident both scientifically scientifically and during daily conference conference with participation of non-knee knee surgeons. Measurement of mechanical mechanical coronal knee alignment from standing full-length lower-limb radiographs radiographs is gold standard, alignment alignment in the range from 177-183 is considered considered neutral.
Purpose / Aim of Study: To examine relationship between coronal coronal plane implant alignment measured measured from postoperative and follow follow-up full-length radiographs.
Materials and Methods: Retrospective study on a consecutive cohort cohort. Measurements of alignment using using TraumaCad™ guides. Examination Examination of intra- and inter-rater reliability reliability of the measurements, and agreement between short knee radiographs radiographs and full-length radiographs radiographs, with intraclass correlation coefficient coefficient. Evaluation of clinical relevance relevance from Bland Altman analysis and sensitivity analysis.
Findings / Results: 138 cases were included. Intra- and inter-rater reliability of the measurements measurements was excellent, with ICC above above .95. Agreement between the methods methods was good (ICC=.81(.74-.87)). Mean mechanical tibiofemoral alignment alignment from full-length radiographs ( (mTFA) = 179 ±2.9 degrees. Mean anatomical anatomical tibiofemoral alignment from the knee radiographs (aTFA) = 185 ± ±2.6 degrees. Mean difference between between methods = 5.8 (CI 5.4-6.1) and 95% limits of agreement 1.4 to 10 degrees degrees. Censoring of suboptimal projections projections and very short short films only only improved the results slightly. 32 full-length radiographs and 35 postoperative showed malalignment. Positive predictive value of a postoperative knee radiograph with malalignment malalignment was 54% and negative predictive predictive value was 87%.
Conclusions: Good agreement between the methods might might justify the cautiously use of short film anatomical angulations as surrogate surrogate measurement of alignment. Clinicians Clinicians should be aware of the wide limits of agreement and predictive power when evaluating postoperative TKA radiographs.
Gudrun Holm Jacobsen, Mads Holm Gude, Bjarke Viberg, 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
Background: Locking plate is designed for better stability in fractures with poor bone quality but is today widely used - also in patients with normal bone quality. The literature is sparse regarding the benefit of locking plate in ankle fractures.
Purpose / Aim of Study: The aim is to compare the risk of reoperation for locking plate with non-locking plate in patients with ankle fractures. Secondary, to investigate the distribution of locking plate use in Denmark.
Materials and Methods: The study is a population based register study. Data on patients with AO type 44A1/2 and 44B1/2 treated with either locking or non-locking plate were obtained from the Danish Fracture Database for the period March 15, 2012 to December 31, 2016. The follow-up period was 24 months. Data were linked with the Danish National Patient Registry to ensure complete information on reoperations, which were divided into major and minor complications. Major complications were defined as complications needing surgical intervention with the exception of simple hardware removal, which was defined as minor complications. Multivariate regression analysis was performed for relative risk (RR) adjusted for age, sex, American Society of Anesthesiologists Classification (ASA) and level of surgeons experience. All results are reported with 95% confidence interval.
Findings / Results: A total of 2,177 ankles fractures were included of which 718 (33%) were treated with locking plate and 1,459 (67%) with non-locking plate. The mean age was higher in the locking plate group (p<0.001) and locking plate was used more often in women (p=0.018), in patients with higher ASA-score (p<0.001), and in patients operated by consultants (p=0.018). In both groups the risk was 3% for major complications and 22% for minor. The adjusted RR of major reoperation was 1.00 (0.66;1.66) for locking plate compared to non-locking plate and 0.92 (0.76;1.11) for minor reoperation. The proportion of locking plate use varied widely between departments, ranging from 6% to 61%.
Conclusions: There is no difference in association to reoperation when comparing locking plate with non-locking plates in patients with surgical treated ankle fracture. The indication of locking plate use should be evaluated on all hospitals.
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
Background: Locking plate is designed for better stability in fractures with poor bone quality but is today widely used - also in patients with normal bone quality. The literature is sparse regarding the benefit of locking plate in ankle fractures.
Purpose / Aim of Study: The aim is to compare the risk of reoperation for locking plate with non-locking plate in patients with ankle fractures. Secondary, to investigate the distribution of locking plate use in Denmark.
Materials and Methods: The study is a population based register study. Data on patients with AO type 44A1/2 and 44B1/2 treated with either locking or non-locking plate were obtained from the Danish Fracture Database for the period March 15, 2012 to December 31, 2016. The follow-up period was 24 months. Data were linked with the Danish National Patient Registry to ensure complete information on reoperations, which were divided into major and minor complications. Major complications were defined as complications needing surgical intervention with the exception of simple hardware removal, which was defined as minor complications. Multivariate regression analysis was performed for relative risk (RR) adjusted for age, sex, American Society of Anesthesiologists Classification (ASA) and level of surgeons experience. All results are reported with 95% confidence interval.
Findings / Results: A total of 2,177 ankles fractures were included of which 718 (33%) were treated with locking plate and 1,459 (67%) with non-locking plate. The mean age was higher in the locking plate group (p<0.001) and locking plate was used more often in women (p=0.018), in patients with higher ASA-score (p<0.001), and in patients operated by consultants (p=0.018). In both groups the risk was 3% for major complications and 22% for minor. The adjusted RR of major reoperation was 1.00 (0.66;1.66) for locking plate compared to non-locking plate and 0.92 (0.76;1.11) for minor reoperation. The proportion of locking plate use varied widely between departments, ranging from 6% to 61%.
Conclusions: There is no difference in association to reoperation when comparing locking plate with non-locking plates in patients with surgical treated ankle fracture. The indication of locking plate use should be evaluated on all hospitals.
Peter Larsen, Christian Eriksen, Rasmus Elsøe
Orthopaedic Surgery, Aalborg University Hospital; Orthopaedic Surgery, Aalborg Universiy Hospital; Orthopaedic Surgery, Aalborg University Hospital
Background: Although a large number of studies aim to investigate the outcome in patients following tibial shaft fractures, the literature includes limited information on prospective reported patients with mid- to long-term follow-up.
Purpose / Aim of Study: The aim of the present study was to investigate prospectively the five-year development in patient-reported quality of life after intramedullary nailing of a tibial shaft fracture.
Materials and Methods: The design was a prospective, five-year follow-up cohort study. Quality of life (QOL) was measured with the questionnaire Eq5d- 5L and compared to one-year outcome and norm data from a Danish reference population. Secondary outcome measurements were: The Knee Injury and Osteoarthritis Outcome Score (KOOS), recordings of pain, gait and muscle strength.
Findings / Results: Twenty-nine patients were eligible for participation. The mean age at the time of the five-year follow-up was 46.3 years. The five-year postoperative mean Eq5d-5L index was 0.864 (95%CI: 0.809–0.918). The mean Eq5d-5L VAS was 88.4 (95%CI: 83.4–93.5). Compared with the same patients Eq5d-5L index scores at one-year follow-up (0.784), a significant increase was observed (P=0.014). A comparison to the Danish Eq5D reference population, showed no statistically significant difference.
Conclusions: Patient-reported quality of life among patients treated with intramedullary nailing following a tibial shaft fracture increase significantly between the one-year and five- year follow-ups. In contrast to the one-year patient-reported quality of life, results are comparable to those of a reference population at the five-year follow-up. In a clinical setting these results highlight that patients may expect a prolonged period to regain full recovery. However, patients can expect satisfactory outcome years after fracture and treatment.
Orthopaedic Surgery, Aalborg University Hospital; Orthopaedic Surgery, Aalborg Universiy Hospital; Orthopaedic Surgery, Aalborg University Hospital
Background: Although a large number of studies aim to investigate the outcome in patients following tibial shaft fractures, the literature includes limited information on prospective reported patients with mid- to long-term follow-up.
Purpose / Aim of Study: The aim of the present study was to investigate prospectively the five-year development in patient-reported quality of life after intramedullary nailing of a tibial shaft fracture.
Materials and Methods: The design was a prospective, five-year follow-up cohort study. Quality of life (QOL) was measured with the questionnaire Eq5d- 5L and compared to one-year outcome and norm data from a Danish reference population. Secondary outcome measurements were: The Knee Injury and Osteoarthritis Outcome Score (KOOS), recordings of pain, gait and muscle strength.
Findings / Results: Twenty-nine patients were eligible for participation. The mean age at the time of the five-year follow-up was 46.3 years. The five-year postoperative mean Eq5d-5L index was 0.864 (95%CI: 0.809–0.918). The mean Eq5d-5L VAS was 88.4 (95%CI: 83.4–93.5). Compared with the same patients Eq5d-5L index scores at one-year follow-up (0.784), a significant increase was observed (P=0.014). A comparison to the Danish Eq5D reference population, showed no statistically significant difference.
Conclusions: Patient-reported quality of life among patients treated with intramedullary nailing following a tibial shaft fracture increase significantly between the one-year and five- year follow-ups. In contrast to the one-year patient-reported quality of life, results are comparable to those of a reference population at the five-year follow-up. In a clinical setting these results highlight that patients may expect a prolonged period to regain full recovery. However, patients can expect satisfactory outcome years after fracture and treatment.
Liv Vesterby, Søren Ohrt-Nissen, Ilija Ban, Morten Grove Thomsen, Peter Toft Tengberg
Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark; Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark; Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark; Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark; Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
Background: Tension band wire (TBW) is a well-known method for treating displaced olecranon fractures. Recent studies, however, have reported high revision rates due to prominent metalwork, wound breakdown, infection and loss of reduction, when using this technique. A known method for treating displaced o olecranon fractures. Recent studies, h however, have reported high revision r rates due to prominent metalwork, w wound breakdown, infection and loss o of reduction, when using this technique. A standardised surgical method using t tension band suture fixation (TBSF) h has recently been published as an a alternative to TBW.
Purpose / Aim of Study: To evaluate the clinical and radiographic outcome in patients with displaced olecranon fractures treated with TBSF. Primary outcome was revision surgery at 6 month follow-up.
Materials and Methods: This was a single-center prospective c cohort study. TBSF was introduced in F February 2019 in our facility and p patients (>18 years) treated for d displaced olecranon fractures were c consecutively enrolled. Follow-up was performed at 2 weeks, 6 weeks, 3 months and 6 months postoperatively. Radiographs, range of motion (ROM), Quick-DASH and Oxford Elbow Score were used to evaluate outcome.
Findings / Results: A total of 24 patients were included. All patients completed 6 month follow-up, although, in 2 cases, only patient reported outcome measures and ROM were available due to covid-19-related delays. Median age was 64 years [IQR 39-72.5], 9 of 24 patients were males and median ASA score was 2 [IQR1-2]. 15 fractures were Mayo 2A and 9 were 2B with minor comminution. Surgical treatment was performed by 1 of 3 surgeons with a median duration of surgery of 41 min [IQR 32-55.25]. No patients were reoperated reoperated or scheduled for revision surgery at 6 month follow-up. At 6 month follow-up, the median Quick-DASH and Oxford Elbow Score were 2.3 [IQR 0 DASH and Oxford Elbow Score were 2.3 [IQR 0-4.5] and 47 [IQR 46-48], respectively. Median elbow extension and flexion deficit were 0 degrees [IQR 0-2.25] and 0 degrees [IQR 0-0], respectively. Radiographic union was achieved in all patients. 2 patients experienced loss of reduction and malunion. The malunions were asymptomatic and the patients had no functional deficits. 1 patient refractured the elbow because of a second trauma and was reoperated.
Conclusions: TBSF is a promising technique for Mayo 2A and 2B fractures with minor comminution. There were no surgical revisions within the first 6 months and we found good functional outcome and high union rate.
Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark; Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark; Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark; Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark; Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
Background: Tension band wire (TBW) is a well-known method for treating displaced olecranon fractures. Recent studies, however, have reported high revision rates due to prominent metalwork, wound breakdown, infection and loss of reduction, when using this technique. A known method for treating displaced o olecranon fractures. Recent studies, h however, have reported high revision r rates due to prominent metalwork, w wound breakdown, infection and loss o of reduction, when using this technique. A standardised surgical method using t tension band suture fixation (TBSF) h has recently been published as an a alternative to TBW.
Purpose / Aim of Study: To evaluate the clinical and radiographic outcome in patients with displaced olecranon fractures treated with TBSF. Primary outcome was revision surgery at 6 month follow-up.
Materials and Methods: This was a single-center prospective c cohort study. TBSF was introduced in F February 2019 in our facility and p patients (>18 years) treated for d displaced olecranon fractures were c consecutively enrolled. Follow-up was performed at 2 weeks, 6 weeks, 3 months and 6 months postoperatively. Radiographs, range of motion (ROM), Quick-DASH and Oxford Elbow Score were used to evaluate outcome.
Findings / Results: A total of 24 patients were included. All patients completed 6 month follow-up, although, in 2 cases, only patient reported outcome measures and ROM were available due to covid-19-related delays. Median age was 64 years [IQR 39-72.5], 9 of 24 patients were males and median ASA score was 2 [IQR1-2]. 15 fractures were Mayo 2A and 9 were 2B with minor comminution. Surgical treatment was performed by 1 of 3 surgeons with a median duration of surgery of 41 min [IQR 32-55.25]. No patients were reoperated reoperated or scheduled for revision surgery at 6 month follow-up. At 6 month follow-up, the median Quick-DASH and Oxford Elbow Score were 2.3 [IQR 0 DASH and Oxford Elbow Score were 2.3 [IQR 0-4.5] and 47 [IQR 46-48], respectively. Median elbow extension and flexion deficit were 0 degrees [IQR 0-2.25] and 0 degrees [IQR 0-0], respectively. Radiographic union was achieved in all patients. 2 patients experienced loss of reduction and malunion. The malunions were asymptomatic and the patients had no functional deficits. 1 patient refractured the elbow because of a second trauma and was reoperated.
Conclusions: TBSF is a promising technique for Mayo 2A and 2B fractures with minor comminution. There were no surgical revisions within the first 6 months and we found good functional outcome and high union rate.
Alma Becic Pedersen , Mailhac Aurelia, Andersen Ina T, Overgaard Søren , Fenstad Anne M, Lie Stein A, Gjersten Jens E, Furnes Ove
Department of Clinical Epidemiology, Aarhus University Hospital, DK, ; Department of Clinical Epidemiology, Aarhus University Hospital, DK, ; Department of Clinical Epidemiology, Aarhus University Hospital, DK, ; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, DK, ; The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, NO, ; Department of Clinical Medicine and Department of Clinical Dentistry, University of Bergen, NO, ; The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, NO, ; The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, NO,
Background: There are concerns that postoperative bleeding contribute to prolonged wound drainage and hematoma formation, may increase susceptibility to bacterial migration and revision due to prosthetic joint infection (PJI). Furthermore, it is unclear if longer duration of thromboprophylaxis plays a role in aseptic loosening of total hip arthroplasty (THA).
Purpose / Aim of Study: We examined whether short (1-5 days), medium (6- 14 days), and extended (≥ 14 days) duration of thromboprophylaxis is association with the revision rate after THA.
Materials and Methods: This cohort study was based on data from hip arthroplasty registries, prescription databases and patient registries in Denmark and Norway (2008- 2013). Outcome was revision; any, due to PJI, and due to aseptic loosening, respectively. We performed Cox regression analyses to estimate adjusted cause-specific hazard ratio (HR) of revision with 95% confidence interval for patients receiving short or extended vs medium duration of thromboprophylaxis.
Findings / Results: Among 50,482 primary THA patients with osteoarthritis, 8,333 received short, 17,009 received medium, and 25,140 received extended tromboprophylaxis. The HRs for any revision were 1.01 (0.88-1.17) for short and 0.96 (0.87- 1.07) for extended vs medium thromboprophylaxis. The HRs for revision due to PJI were 0.92 (0.69-1.24) for short and 1.04 (0.85-1.27) for extended thromboprophylaxis vs. medium thromboprophylaxis. However, HRs for revision due to PJI were pointing in opposite direction in the two countries. The HRs for revision due to aseptic loosening were 1.07 (0.75-1.52) for short and 1.27 (1.00-1.61) for extended thromboprophylaxis vs. medium thromboprophylaxis, being consistent on country level. In all cases, the absolute differences in cumulative incidences were less than 1% after 5 years.
Conclusions: Our data suggest no association between duration of anticoagulant thromboprophylaxis and revision rate within 5 years of THA. However, there is an indication that the extended thromboprophylaxis might be associated with increased revision rate due to aseptic loosening, and that country-specific factors plays role in the revision rate due to PJI.
Department of Clinical Epidemiology, Aarhus University Hospital, DK, ; Department of Clinical Epidemiology, Aarhus University Hospital, DK, ; Department of Clinical Epidemiology, Aarhus University Hospital, DK, ; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, DK, ; The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, NO, ; Department of Clinical Medicine and Department of Clinical Dentistry, University of Bergen, NO, ; The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, NO, ; The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, NO,
Background: There are concerns that postoperative bleeding contribute to prolonged wound drainage and hematoma formation, may increase susceptibility to bacterial migration and revision due to prosthetic joint infection (PJI). Furthermore, it is unclear if longer duration of thromboprophylaxis plays a role in aseptic loosening of total hip arthroplasty (THA).
Purpose / Aim of Study: We examined whether short (1-5 days), medium (6- 14 days), and extended (≥ 14 days) duration of thromboprophylaxis is association with the revision rate after THA.
Materials and Methods: This cohort study was based on data from hip arthroplasty registries, prescription databases and patient registries in Denmark and Norway (2008- 2013). Outcome was revision; any, due to PJI, and due to aseptic loosening, respectively. We performed Cox regression analyses to estimate adjusted cause-specific hazard ratio (HR) of revision with 95% confidence interval for patients receiving short or extended vs medium duration of thromboprophylaxis.
Findings / Results: Among 50,482 primary THA patients with osteoarthritis, 8,333 received short, 17,009 received medium, and 25,140 received extended tromboprophylaxis. The HRs for any revision were 1.01 (0.88-1.17) for short and 0.96 (0.87- 1.07) for extended vs medium thromboprophylaxis. The HRs for revision due to PJI were 0.92 (0.69-1.24) for short and 1.04 (0.85-1.27) for extended thromboprophylaxis vs. medium thromboprophylaxis. However, HRs for revision due to PJI were pointing in opposite direction in the two countries. The HRs for revision due to aseptic loosening were 1.07 (0.75-1.52) for short and 1.27 (1.00-1.61) for extended thromboprophylaxis vs. medium thromboprophylaxis, being consistent on country level. In all cases, the absolute differences in cumulative incidences were less than 1% after 5 years.
Conclusions: Our data suggest no association between duration of anticoagulant thromboprophylaxis and revision rate within 5 years of THA. However, there is an indication that the extended thromboprophylaxis might be associated with increased revision rate due to aseptic loosening, and that country-specific factors plays role in the revision rate due to PJI.
Lars Lykke Hermansen, Bjarke Viberg, Søren Overggard
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: Persistent instability after hip revision due to dislocation is a serious problem. In order to lower the risk of this complication, it is essential to identify risk factors.
Purpose / Aim of Study: Our aim was to analyze surgery- (liner type, extent of revision, head size) and patient- (age, sex, Charlson comorbidity index (CCI)) related risk factors for both new dislocation and re-revision any cause following a first-time revised hip due to dislocation.
Materials and Methods: We included patients with a primary THA due to osteoarthritis and a first-time revision due to dislocation registered in the Danish Hip Arthroplasty Register (DHR) from 1996-2016. Patients were followed from the day of the first revision to either Dec. 2018, re-revision, or death. We identified dislocations in the Danish National Patient Register based on a validated method and re-revisions in the DHR. Risk factors were analyzed by a Fine-Gray multiple regression analysis adjusting for the competing risk of death. Results are presented as sub-distribution hazard ratios (sHR) with 95% confidence intervals.
Findings / Results: We identified 1,678 first-time revisions due to dislocation and 22.4% of these had a new dislocation. 19.8% were re- revised for any reason. Median follow-up was 5.3 years. For new dislocations, the sHR was 0,36 (0.27-0.48) for those who had a constrained liner (CL) during revision and 0.21 (0.08-0.58) for dual mobility cups (DMC) meaning a lower risk of dislocations compared to regular liners. Changing only the head/liner increased the risk of dislocation (sHR=2.65 (2.05- 3.42)) compared to full cup revisions. Age, sex, CCI, and head size was not significant risk factors for new dislocations. Regarding risk of new re-revision, changing only head/liner resulted in an increased risk of re-revision (sHR=1.73 (1.34-2.23)). Patients <65 years had increased risk of re-revision compared to 65-75 years (sHR=1.36 (1.05-1.77)). Sex, CCI, head size and liner type were not significantly associated with re- revisions.
Conclusions: Patients revised with a DMC and CL were associated with a lower risk of dislocation after a first-time revision but not re-revision whereas only changing the head/liner was associated with higher risk of dislocation and re-revision.
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: Persistent instability after hip revision due to dislocation is a serious problem. In order to lower the risk of this complication, it is essential to identify risk factors.
Purpose / Aim of Study: Our aim was to analyze surgery- (liner type, extent of revision, head size) and patient- (age, sex, Charlson comorbidity index (CCI)) related risk factors for both new dislocation and re-revision any cause following a first-time revised hip due to dislocation.
Materials and Methods: We included patients with a primary THA due to osteoarthritis and a first-time revision due to dislocation registered in the Danish Hip Arthroplasty Register (DHR) from 1996-2016. Patients were followed from the day of the first revision to either Dec. 2018, re-revision, or death. We identified dislocations in the Danish National Patient Register based on a validated method and re-revisions in the DHR. Risk factors were analyzed by a Fine-Gray multiple regression analysis adjusting for the competing risk of death. Results are presented as sub-distribution hazard ratios (sHR) with 95% confidence intervals.
Findings / Results: We identified 1,678 first-time revisions due to dislocation and 22.4% of these had a new dislocation. 19.8% were re- revised for any reason. Median follow-up was 5.3 years. For new dislocations, the sHR was 0,36 (0.27-0.48) for those who had a constrained liner (CL) during revision and 0.21 (0.08-0.58) for dual mobility cups (DMC) meaning a lower risk of dislocations compared to regular liners. Changing only the head/liner increased the risk of dislocation (sHR=2.65 (2.05- 3.42)) compared to full cup revisions. Age, sex, CCI, and head size was not significant risk factors for new dislocations. Regarding risk of new re-revision, changing only head/liner resulted in an increased risk of re-revision (sHR=1.73 (1.34-2.23)). Patients <65 years had increased risk of re-revision compared to 65-75 years (sHR=1.36 (1.05-1.77)). Sex, CCI, head size and liner type were not significantly associated with re- revisions.
Conclusions: Patients revised with a DMC and CL were associated with a lower risk of dislocation after a first-time revision but not re-revision whereas only changing the head/liner was associated with higher risk of dislocation and re-revision.
Sidsel Fruergaard, Søren Ohrt-Nissen, Frederik Taylor Pitter, Kristian Høy, Martin Lindberg-Larsen, Søren Eiskjær, Benny Dahl, Martin Gehrchen
Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital; Spine Unit, Department of Orthopedic Surgery, Aarhus University Hospital; Orthopaedic research unit, Department of Orthopedic Surgery and Traumatology, Department of Clinical Research, Odense University Hospital, University of Southern Denmark; Department of Orthopedic Surgery, Aalborg University Hospital; Department of Orthopedic Surgery, Texas Children’s Hospital and Baylor College of Medicine; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital
Background: Extended length of stay (extLOS) and unplanned readmissions after pediatric deformity surgery pose a considerable challenge to both the patient and the healthcare system. In some cases, it may be preventable, and it would be helpful to identify potential risk factors.
Purpose / Aim of Study: To describe reasons for extLOS, 90-day readmission and mortality after primary pediatric deformity surgery.
Materials and Methods: Patients were identified by procedure and diagnosis code in the Danish National Patient Registry (DNPR). From DNPR, data on LOS, readmissions and mortality within 90 days were retrieved. Patients were categorized in six groups according to etiology. Medical records were reviewed for reason for extLOS (LOS >75th percentile according to etiology) and discharge summaries were reviewed for primary diagnosis upon readmission.
Findings / Results: For the 1310 patients, the median LOS was 8 days (IQR: 7–9). A total of 274 (21%) patients had extLOS. Overall, the most common reason was pain/mobilization issues but with considerable variation between etiologies; idiopathic (59%), congenital (30%), syndromic (44%), spondylolisthesis (38%) and Scheuermann kyphosis (91%). Pulmonary complications were the primary reason for extLOS in the neuromuscular group (22%). The 90-day readmission rate was 6%; 67% of readmissions were medical, mainly infections unrelated to the surgical site (23%); 33% of readmissions were surgical related and 14% of patients required revision surgery. Neuromuscular scoliosis, spondylolisthesis, Scheuermann kyphosis and extLOS>9 days were independent risk factors for readmission; OR 5.5(95% CI: 2.8–10.6, p<0.01), OR 3.0 (1.1- 8.5, p=0.03), OR 4.7 (1.7–13.3, p<0.01) and OR 1.8(1.1-3.1, p=0.04), respectively. The 90-day revision rate and mortality rate were 3% and 0.4%, respectively.
Conclusions: In this nationwide cohort, pain and mobilization issues were overall the most common reason for extLOS. The 90-day readmission rate was 6% and the most common reason was infection unrelated to the surgical site. Readmission after pediatric spine surgery is related to the etiology and increased focus should be directed towards patients operated for neuromuscular scoliosis, spondylolisthesis and Scheuermann kyphosis.
Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital; Spine Unit, Department of Orthopedic Surgery, Aarhus University Hospital; Orthopaedic research unit, Department of Orthopedic Surgery and Traumatology, Department of Clinical Research, Odense University Hospital, University of Southern Denmark; Department of Orthopedic Surgery, Aalborg University Hospital; Department of Orthopedic Surgery, Texas Children’s Hospital and Baylor College of Medicine; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital
Background: Extended length of stay (extLOS) and unplanned readmissions after pediatric deformity surgery pose a considerable challenge to both the patient and the healthcare system. In some cases, it may be preventable, and it would be helpful to identify potential risk factors.
Purpose / Aim of Study: To describe reasons for extLOS, 90-day readmission and mortality after primary pediatric deformity surgery.
Materials and Methods: Patients were identified by procedure and diagnosis code in the Danish National Patient Registry (DNPR). From DNPR, data on LOS, readmissions and mortality within 90 days were retrieved. Patients were categorized in six groups according to etiology. Medical records were reviewed for reason for extLOS (LOS >75th percentile according to etiology) and discharge summaries were reviewed for primary diagnosis upon readmission.
Findings / Results: For the 1310 patients, the median LOS was 8 days (IQR: 7–9). A total of 274 (21%) patients had extLOS. Overall, the most common reason was pain/mobilization issues but with considerable variation between etiologies; idiopathic (59%), congenital (30%), syndromic (44%), spondylolisthesis (38%) and Scheuermann kyphosis (91%). Pulmonary complications were the primary reason for extLOS in the neuromuscular group (22%). The 90-day readmission rate was 6%; 67% of readmissions were medical, mainly infections unrelated to the surgical site (23%); 33% of readmissions were surgical related and 14% of patients required revision surgery. Neuromuscular scoliosis, spondylolisthesis, Scheuermann kyphosis and extLOS>9 days were independent risk factors for readmission; OR 5.5(95% CI: 2.8–10.6, p<0.01), OR 3.0 (1.1- 8.5, p=0.03), OR 4.7 (1.7–13.3, p<0.01) and OR 1.8(1.1-3.1, p=0.04), respectively. The 90-day revision rate and mortality rate were 3% and 0.4%, respectively.
Conclusions: In this nationwide cohort, pain and mobilization issues were overall the most common reason for extLOS. The 90-day readmission rate was 6% and the most common reason was infection unrelated to the surgical site. Readmission after pediatric spine surgery is related to the etiology and increased focus should be directed towards patients operated for neuromuscular scoliosis, spondylolisthesis and Scheuermann kyphosis.
Arash Ghaffari, Søren Kold, Ole Rahbek
Interdisciplinary Orthopaedics, Aalborg University Hospital; Interdisciplinary Orthopaedics, Aalborg University Hospital; Interdisciplinary Orthopaedics, Aalborg University Hospital
Background: Avascular necrosis in the skeletally immature hip may result in a short femoral neck (coxa brevis). A triple femoral neck lengthening osteotomy has been described by Morscher to correct the deformity. The outcome has only been reported in small case series and no overview exists.
Purpose / Aim of Study: Provide an overview of the clinical and radiological outcomes of Morscher femoral neck lengthening osteotomy in patients with coxa brevis.
Materials and Methods: An extensive search of PubMed, CINAHL and Embase libraries for relevant terms of “proximal femoral deformity”, “hip dysplasia”, “coxa brevis”, “femoral neck lengthening osteotomy” and “Morscher osteotomy” performed, while no restrictions regarding date, design and language of the studies had been applied. Subsequently the detected articles were screened for eligibility by two authors. Studies reporting the outcomes of Morscher femoral neck osteotomy in patients with coxa brevis included. Clinical and radiological outcomes were extracted.
Findings / Results: After screening 456 initial articles were found, 77 were selected for full-text evaluation. 11 articles, reporting 149 operated hips in 143 patients (31% male, 64% female, 5% unspecified), were included. Average age of the patients was 20.1 years (7 years– 52 years). Indications were DDH (51%), LCPD (27%), infection (6%), post-traumatic (4%), congenital (2%), SCFE (1%), idiopathic (3%) and unspecified (6%). Follow up was 74 months (6 – 192 months). The average LLD reduced 12 mm (0 – 40 mm). 65% of 101 hips with pre-op positive Trendelenburg test experienced improvement of hip abductor strength. Satisfactory improvements could be found in functional hip scores, especially in ‘pain relief’ and ‘ability to walk’. ATD increased in average 24.3 mm. The results in incongruent hips were unsatisfying. Total twelve complications occurred (75% Category-I, 17% Category-II, 8% Category-IIIA, no Category-IIIB).
Conclusions: Femoral neck lengthening osteotomy of Morscher for coxa brevis shows good results with few complications in the literature. However, all studies are retrospective, and further prospective studies are needed.
Interdisciplinary Orthopaedics, Aalborg University Hospital; Interdisciplinary Orthopaedics, Aalborg University Hospital; Interdisciplinary Orthopaedics, Aalborg University Hospital
Background: Avascular necrosis in the skeletally immature hip may result in a short femoral neck (coxa brevis). A triple femoral neck lengthening osteotomy has been described by Morscher to correct the deformity. The outcome has only been reported in small case series and no overview exists.
Purpose / Aim of Study: Provide an overview of the clinical and radiological outcomes of Morscher femoral neck lengthening osteotomy in patients with coxa brevis.
Materials and Methods: An extensive search of PubMed, CINAHL and Embase libraries for relevant terms of “proximal femoral deformity”, “hip dysplasia”, “coxa brevis”, “femoral neck lengthening osteotomy” and “Morscher osteotomy” performed, while no restrictions regarding date, design and language of the studies had been applied. Subsequently the detected articles were screened for eligibility by two authors. Studies reporting the outcomes of Morscher femoral neck osteotomy in patients with coxa brevis included. Clinical and radiological outcomes were extracted.
Findings / Results: After screening 456 initial articles were found, 77 were selected for full-text evaluation. 11 articles, reporting 149 operated hips in 143 patients (31% male, 64% female, 5% unspecified), were included. Average age of the patients was 20.1 years (7 years– 52 years). Indications were DDH (51%), LCPD (27%), infection (6%), post-traumatic (4%), congenital (2%), SCFE (1%), idiopathic (3%) and unspecified (6%). Follow up was 74 months (6 – 192 months). The average LLD reduced 12 mm (0 – 40 mm). 65% of 101 hips with pre-op positive Trendelenburg test experienced improvement of hip abductor strength. Satisfactory improvements could be found in functional hip scores, especially in ‘pain relief’ and ‘ability to walk’. ATD increased in average 24.3 mm. The results in incongruent hips were unsatisfying. Total twelve complications occurred (75% Category-I, 17% Category-II, 8% Category-IIIA, no Category-IIIB).
Conclusions: Femoral neck lengthening osteotomy of Morscher for coxa brevis shows good results with few complications in the literature. However, all studies are retrospective, and further prospective studies are needed.
Lone Frandsen, Hanne Mainz, Peter Faunø, Martin Lind
Sports traumatology, Orthopedic Department , Aarhus University Hospital, Aarhus N, Denmark; Sports traumatology, Orthopedic Department , Aarhus University Hospital, Aarhus N, Denmark; Sports traumatology, Orthopedic Department, Aarhus University Hospital, Aarhus N, Denmark; Sports traumatology, Orthopedic Department, Aarhus University Hospital, Aarhus N, Denmark
Background: Comprehensive preoperative information is important to ensure that ACL patients are able to observe and respond to symptoms after discharge. Based on interviews, many patients express that these information meetings can be problematic due to difficulty of absence from school and that it is too much information during the meeting. Further, many patients were concerned after surgery and felt they were left alone with the problems.
Purpose / Aim of Study: The aim of this study was to investigate if it was possible to replace a personal pre-operative information meeting with a Web-program preparing for ACL reconstruction and to develop and implement an Action Guide to help patients to assess and address their post-operative concerns and problems.
Materials and Methods: A Web-program with all the pre- operative information was designed. To investigate how patients would like to be informed pre-operatively, 93 patients were allowed to choose between participating in the pre- operative information meeting or only to be informed by the Web-program. To address the patients` concerns after ACL surgery, we created an "Action Guide" based on the patients´ experienced problems, The purpose of the Action Guide was to help the patients to decide what to do in the post-operative period according to different problems. To evaluate the Action Guide, 76 patients participated in a survey before and after implementation of the Action Guide. As an estimate of their concerns patients were asked about their telephone call to the clinic two weeks after surgery.
Findings / Results: After implementation of the Web- program patients participating in the information meeting were reduced by 89%. Patients have expressed satisfaction with the Web-program and it does not appear to have impaired the quality of the treatment. A survey showed that the number of telephone calls from post-operative patients decreased by 34% after implementation of the Action Guide.
Conclusions: Most patients with anterior cruciate ligament injuries prefer information from a Web-program instead of a pre- operative information meeting. An Action Guide can help the patients to assess and address their post- operative concerns and problems, which again can reduce telephone calls to the clinic.
Sports traumatology, Orthopedic Department , Aarhus University Hospital, Aarhus N, Denmark; Sports traumatology, Orthopedic Department , Aarhus University Hospital, Aarhus N, Denmark; Sports traumatology, Orthopedic Department, Aarhus University Hospital, Aarhus N, Denmark; Sports traumatology, Orthopedic Department, Aarhus University Hospital, Aarhus N, Denmark
Background: Comprehensive preoperative information is important to ensure that ACL patients are able to observe and respond to symptoms after discharge. Based on interviews, many patients express that these information meetings can be problematic due to difficulty of absence from school and that it is too much information during the meeting. Further, many patients were concerned after surgery and felt they were left alone with the problems.
Purpose / Aim of Study: The aim of this study was to investigate if it was possible to replace a personal pre-operative information meeting with a Web-program preparing for ACL reconstruction and to develop and implement an Action Guide to help patients to assess and address their post-operative concerns and problems.
Materials and Methods: A Web-program with all the pre- operative information was designed. To investigate how patients would like to be informed pre-operatively, 93 patients were allowed to choose between participating in the pre- operative information meeting or only to be informed by the Web-program. To address the patients` concerns after ACL surgery, we created an "Action Guide" based on the patients´ experienced problems, The purpose of the Action Guide was to help the patients to decide what to do in the post-operative period according to different problems. To evaluate the Action Guide, 76 patients participated in a survey before and after implementation of the Action Guide. As an estimate of their concerns patients were asked about their telephone call to the clinic two weeks after surgery.
Findings / Results: After implementation of the Web- program patients participating in the information meeting were reduced by 89%. Patients have expressed satisfaction with the Web-program and it does not appear to have impaired the quality of the treatment. A survey showed that the number of telephone calls from post-operative patients decreased by 34% after implementation of the Action Guide.
Conclusions: Most patients with anterior cruciate ligament injuries prefer information from a Web-program instead of a pre- operative information meeting. An Action Guide can help the patients to assess and address their post- operative concerns and problems, which again can reduce telephone calls to the clinic.