YODA Best Paper
Johan Torle, Janni Kjærgaard Thillemann, Emil Toft Petersen, Frank Madsen, Kjeld Søballe, Maiken Stilling
Department of Clinical Medicine , Aarhus University Hospital; Department of Clinical Medicine , Aarhus University Hospital; Department of Clinical Medicine , Aarhus University Hospital; Department of Orthopedics, Aarhus University Hospital; Department of Clinical Medicine , Aarhus University Hospital; Department of Clinical Medicine , Aarhus University Hospital
Background: A modular polyethylene (PE) inlay in total knee arthroplasty (TKA) may wear on both sides. PE particles may induce osteolysis, which can lead to implant loosening. We hypothesized higher PE wear of a modular PE inlay compared to a monobloc PE inlay in TKA at 60-month follow-up.
Purpose / Aim of Study: The aim of this study was to examine how tibial component design, modularity and materials affect polyethylene wear and tibial component migration in cementless TKA.
Materials and Methods: In a prospective, patient-blinded trial, 50 patients were randomized to hybrid TKA surgery with either a cementless, high- porosity, trabecular-metal tibial component with a monobloc UHMWPE inlay (MONO- TM) or a cementless, low-porosity, screw- augmented, titanium fiber-mesh tibial component with a modular UHMWPE inlay (MODULAR-FM). Radiostereometry was used to measure PE wear and tibial component migration.
Findings / Results: At 60 months follow-up, the mean PE wear of the medial compartment was 0.24 mm and 0.61 mm and the mean PE wear of the lateral compartment was 0.31 mm and 0.82 mm for the MONO-TM and the MODULAR- FM groups, respectively (p<0.01). The PE wear rate was 0.05 mm (95% CI 0.03 – 0.08) in the MONO-TM group and 0.14 mm (95% CI 0.12 – 0.17) in the MODULAR-FM group (p<0.01). Total translation at 60 months was mean 0.30 mm (95% CI 0.10 – 0.51) less (p<0.01) for MONO-TM compared with MODULAR-FM tibial components. In both groups, the majority of tibial components migrated continuously (>0.2 mm MTPM) between 24-to-60-month follow-up (phase 3).
Conclusions: At mid-term follow-up, monobloc PE inlays had approximately 60% less PE wear compared to modular PE inlays, which suggest back-side wear of modular PE inlays is a significant contributor of PE wear in hybrid TKA.
Department of Clinical Medicine , Aarhus University Hospital; Department of Clinical Medicine , Aarhus University Hospital; Department of Clinical Medicine , Aarhus University Hospital; Department of Orthopedics, Aarhus University Hospital; Department of Clinical Medicine , Aarhus University Hospital; Department of Clinical Medicine , Aarhus University Hospital
Background: A modular polyethylene (PE) inlay in total knee arthroplasty (TKA) may wear on both sides. PE particles may induce osteolysis, which can lead to implant loosening. We hypothesized higher PE wear of a modular PE inlay compared to a monobloc PE inlay in TKA at 60-month follow-up.
Purpose / Aim of Study: The aim of this study was to examine how tibial component design, modularity and materials affect polyethylene wear and tibial component migration in cementless TKA.
Materials and Methods: In a prospective, patient-blinded trial, 50 patients were randomized to hybrid TKA surgery with either a cementless, high- porosity, trabecular-metal tibial component with a monobloc UHMWPE inlay (MONO- TM) or a cementless, low-porosity, screw- augmented, titanium fiber-mesh tibial component with a modular UHMWPE inlay (MODULAR-FM). Radiostereometry was used to measure PE wear and tibial component migration.
Findings / Results: At 60 months follow-up, the mean PE wear of the medial compartment was 0.24 mm and 0.61 mm and the mean PE wear of the lateral compartment was 0.31 mm and 0.82 mm for the MONO-TM and the MODULAR- FM groups, respectively (p<0.01). The PE wear rate was 0.05 mm (95% CI 0.03 – 0.08) in the MONO-TM group and 0.14 mm (95% CI 0.12 – 0.17) in the MODULAR-FM group (p<0.01). Total translation at 60 months was mean 0.30 mm (95% CI 0.10 – 0.51) less (p<0.01) for MONO-TM compared with MODULAR-FM tibial components. In both groups, the majority of tibial components migrated continuously (>0.2 mm MTPM) between 24-to-60-month follow-up (phase 3).
Conclusions: At mid-term follow-up, monobloc PE inlays had approximately 60% less PE wear compared to modular PE inlays, which suggest back-side wear of modular PE inlays is a significant contributor of PE wear in hybrid TKA.
Petersen Melbye , Per Hviid Gundtoft, Jens Christian Pörneki, Bjarke Viberg
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: Rupture of the anterior cruciate ligament (ACL) can be treated non-surgically which yields good short-term results in comparison to surgery. However, there are very few studies investigating the long-term effect and there are no large studies with long- term follow-up.
Purpose / Aim of Study: To compare the risk of long-term secondary surgical procedures after primary surgical and non-surgical treated ACL rupture in adult patients.
Materials and Methods: This is a population-based register study on patients aged 18-35 registered in the Danish National Patient Registry (DNPR) with an ACL-rupture (DS835, DS835B+E) between January 1, 1996 and December 31, 2000 with 20 years follow-up. The surgical treatment group was defined as receiving an ACL reconstruction (KNGE41, KNGE41B-E, KNGE45, KNGE45B-E) within 1 year after diagnosis. Major secondary surgical procedures were defined as subsequent ACL surgery (reconstruction/revision), arthroplasty, deep infection, arthrodesis and amputation. Minor procedures were defined as meniscal surgery, synovectomy and brisement. Multivariate regression analysis was performed for relative risk (RR) adjusted for age and sex. Results are reported with 95% confidence interval.
Findings / Results: In total, 7,539 patients had an ACL rupture and 1,970 patients were surgically treated. 4,773 (63%) were males and the mean age was 25.5 years (25.4; 25.6). There were 5.9% major secondary surgical procedures in the surgical group compared to 6.2% in the non-surgical group yielding an adjusted RR of 1.06 (0.86;1.31). The majority (86.5%) had only 1 major secondary surgery with no difference between the groups (p=0.171). There were 43.9% minor complications in the surgical treated group and 49.1% in the non-surgical group yielding an adjusted RR of 1.29 (1.20;1.39). A total of 37.3% had more than 1 minor secondary procedure with no difference between the groups (p=0.381).
Conclusions: We found no significant differences in major complications between surgically and non- surgically treated ACL patients with 20 years follow-up but the non-surgical group were associated with higher risk of minor secondary surgeries.
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: Rupture of the anterior cruciate ligament (ACL) can be treated non-surgically which yields good short-term results in comparison to surgery. However, there are very few studies investigating the long-term effect and there are no large studies with long- term follow-up.
Purpose / Aim of Study: To compare the risk of long-term secondary surgical procedures after primary surgical and non-surgical treated ACL rupture in adult patients.
Materials and Methods: This is a population-based register study on patients aged 18-35 registered in the Danish National Patient Registry (DNPR) with an ACL-rupture (DS835, DS835B+E) between January 1, 1996 and December 31, 2000 with 20 years follow-up. The surgical treatment group was defined as receiving an ACL reconstruction (KNGE41, KNGE41B-E, KNGE45, KNGE45B-E) within 1 year after diagnosis. Major secondary surgical procedures were defined as subsequent ACL surgery (reconstruction/revision), arthroplasty, deep infection, arthrodesis and amputation. Minor procedures were defined as meniscal surgery, synovectomy and brisement. Multivariate regression analysis was performed for relative risk (RR) adjusted for age and sex. Results are reported with 95% confidence interval.
Findings / Results: In total, 7,539 patients had an ACL rupture and 1,970 patients were surgically treated. 4,773 (63%) were males and the mean age was 25.5 years (25.4; 25.6). There were 5.9% major secondary surgical procedures in the surgical group compared to 6.2% in the non-surgical group yielding an adjusted RR of 1.06 (0.86;1.31). The majority (86.5%) had only 1 major secondary surgery with no difference between the groups (p=0.171). There were 43.9% minor complications in the surgical treated group and 49.1% in the non-surgical group yielding an adjusted RR of 1.29 (1.20;1.39). A total of 37.3% had more than 1 minor secondary procedure with no difference between the groups (p=0.381).
Conclusions: We found no significant differences in major complications between surgically and non- surgically treated ACL patients with 20 years follow-up but the non-surgical group were associated with higher risk of minor secondary surgeries.
Christian Bredgaard Jensen, Pelle Baggesgaard Petersen, Christoffer Calov Jørgensen, Henrik Kehlet, Anders Troelsen, Kirill Gromov, on behalf of the Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group
Department of Orthopaedic Surgery, Hvidovre Hospital; Section for Surgical Pathophysiology, Rigshospitalet; Section for Surgical Pathophysiology, Rigshospitalet; Section of Surgical Pathophysiology, Rigshospitalet; Department of Orthopaedic Surgery, Hvidovre Hospital; Department of Orthopaedic Surgery, Hvidovre Hospital; ,
Background: It is still debated whether unicompartmental (UKA) or total knee arthroplasty (TKA) is the best treatment for unicompartmental osteoarthritis. UKA potentially offers superior patient reported outcomes, faster recovery and fewer complications, however differences in preoperative comorbidity between TKA and UKA patients potentially affecting these outcomes are reported in multiple studies.
Purpose / Aim of Study: The aim of this study was to investigate differences in length of postoperative stay (LOS), readmissions and complications within 90 days of surgery between matched UKA and TKA patients.
Materials and Methods: UKA and TKA patients, operated in well-defined fast-track setup, from nine orthopaedic centers were included in this study. Propensity score matching (ratio = 1:3) was used to address differences in demographics and comorbidity between UKA and TKA patients resulting in a matched cohort of 3123 UKA patients and 9369 TKA patients. Univariable and multivariable linear or logistic regression models, and Chi-Squared test were used to investigate differences in LOS, readmission and complications between UKA and TKA patients.
Findings / Results: All significant differences in comorbidity between the groups were no longer present following propensity score matching. The UKA-group had a lower LOS compared to the TKA-group (median LOS 1 vs. 2 days, p<0.001). UKA patients were more likely to be discharged on DOS (OR = 64.06 [95% CI 44.76-84.64]) and less likely to have a LOS > 2 days (OR = 0.19 [95% CI 0.16-0.22]) compared to the TKA patients. There were no significant differences in the number of overall readmissions within 90 days. UKA patients were less likely to get a prosthetic joint infection (OR = 0.51 [95% CI 0.28-0.91]) or a reoperation (OR = 0.44 [0.23- 0.83]) compared to TKA patients. However, UKA patients were more likely to get a non-septic revision (OR = 4.52 [95% CI 1.85-11.07]) compared to TKA patients.
Conclusions: UKA patients had shorter hospital stays, a higher rate of discharge on the day of surgery, fewer prosthetic joint infections and reoperations compared to TKA patients. However, TKA patients had fewer non-septic revisions. Our findings support increasing utilization of UKA in a fast-track setup whenever indicated.
Department of Orthopaedic Surgery, Hvidovre Hospital; Section for Surgical Pathophysiology, Rigshospitalet; Section for Surgical Pathophysiology, Rigshospitalet; Section of Surgical Pathophysiology, Rigshospitalet; Department of Orthopaedic Surgery, Hvidovre Hospital; Department of Orthopaedic Surgery, Hvidovre Hospital; ,
Background: It is still debated whether unicompartmental (UKA) or total knee arthroplasty (TKA) is the best treatment for unicompartmental osteoarthritis. UKA potentially offers superior patient reported outcomes, faster recovery and fewer complications, however differences in preoperative comorbidity between TKA and UKA patients potentially affecting these outcomes are reported in multiple studies.
Purpose / Aim of Study: The aim of this study was to investigate differences in length of postoperative stay (LOS), readmissions and complications within 90 days of surgery between matched UKA and TKA patients.
Materials and Methods: UKA and TKA patients, operated in well-defined fast-track setup, from nine orthopaedic centers were included in this study. Propensity score matching (ratio = 1:3) was used to address differences in demographics and comorbidity between UKA and TKA patients resulting in a matched cohort of 3123 UKA patients and 9369 TKA patients. Univariable and multivariable linear or logistic regression models, and Chi-Squared test were used to investigate differences in LOS, readmission and complications between UKA and TKA patients.
Findings / Results: All significant differences in comorbidity between the groups were no longer present following propensity score matching. The UKA-group had a lower LOS compared to the TKA-group (median LOS 1 vs. 2 days, p<0.001). UKA patients were more likely to be discharged on DOS (OR = 64.06 [95% CI 44.76-84.64]) and less likely to have a LOS > 2 days (OR = 0.19 [95% CI 0.16-0.22]) compared to the TKA patients. There were no significant differences in the number of overall readmissions within 90 days. UKA patients were less likely to get a prosthetic joint infection (OR = 0.51 [95% CI 0.28-0.91]) or a reoperation (OR = 0.44 [0.23- 0.83]) compared to TKA patients. However, UKA patients were more likely to get a non-septic revision (OR = 4.52 [95% CI 1.85-11.07]) compared to TKA patients.
Conclusions: UKA patients had shorter hospital stays, a higher rate of discharge on the day of surgery, fewer prosthetic joint infections and reoperations compared to TKA patients. However, TKA patients had fewer non-septic revisions. Our findings support increasing utilization of UKA in a fast-track setup whenever indicated.
Malte Schmücker, Jørgen Harazuk, Per Hölmich, Kristoffer Weisskirchner Barfod
Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark; Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark; Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark; Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
Background: It has been indicated that anterior cruciate ligament reconstruction (ACLR) with quadriceps tendon (QT) graft has a higher risk of revision.
Purpose / Aim of Study: To investigate if in a high-volume center ACLR with QT graft had higher risk of graft failure and revision surgery compared to hamstring tendon (HS) graft. The hypothesis was no between group difference.
Materials and Methods: This was a registry study with review of medical records. Our study cohort consist of patients with primary ACLR using either QT or HS performed at Hvidovre Hospital from January 2015 to December 2018 and were retrieved from the Danish Knee Ligament Reconstruction Registry. This cohort was linked to the Danish National Patient Registry to identify all hospital contacts post-ACLR and review of medical records was performed. The outcome variables were graft failure (re-rupture or >3mm side difference in A-P laxity), revision ACLR, revision due to cy-clops, revision due to meniscal injury and revision due to any reason. Also, A-P laxity and pivot shift were assessed at 1 year. Using Kaplan-Meier estimates, the categorical events were eval- uated at 2 years and comparison performed with Cox regression analysis.
Findings / Results: 475 subjects (nHS =252, nQT =223) were identified and included. The risk of graft failure at 2 years was 9.4% for QT and 11.1% for HS (p=0.46). Respectively, the risk of revision ACLR was 2.3% and 1.6% (p=0.66), the risk of revision due to cyclops was 5.0% and 2.4% (p=0.13), and the risk of revision due to meniscal injury was 4.3% and 7.1% (p=0.16). The risk of revi-sion due to any reason was 20.5% and 23.6% (p=0.37). A-P laxity was 1.3 mm for QT and 1.4 mm for HS (p=0.35). The proportion with a positive pivot shift was 29% for both groups.
Conclusions: Quadriceps tendon and hamstring tendon grafts yield equal rates of graft failure and revision surgery at two years follow up after ACLR. Graft failure was found in 9-11%. QT was associated with higher risk of revision due to cyclops, and HS with higher risk of revision due to meniscal injury.
Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark; Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark; Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark; Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
Background: It has been indicated that anterior cruciate ligament reconstruction (ACLR) with quadriceps tendon (QT) graft has a higher risk of revision.
Purpose / Aim of Study: To investigate if in a high-volume center ACLR with QT graft had higher risk of graft failure and revision surgery compared to hamstring tendon (HS) graft. The hypothesis was no between group difference.
Materials and Methods: This was a registry study with review of medical records. Our study cohort consist of patients with primary ACLR using either QT or HS performed at Hvidovre Hospital from January 2015 to December 2018 and were retrieved from the Danish Knee Ligament Reconstruction Registry. This cohort was linked to the Danish National Patient Registry to identify all hospital contacts post-ACLR and review of medical records was performed. The outcome variables were graft failure (re-rupture or >3mm side difference in A-P laxity), revision ACLR, revision due to cy-clops, revision due to meniscal injury and revision due to any reason. Also, A-P laxity and pivot shift were assessed at 1 year. Using Kaplan-Meier estimates, the categorical events were eval- uated at 2 years and comparison performed with Cox regression analysis.
Findings / Results: 475 subjects (nHS =252, nQT =223) were identified and included. The risk of graft failure at 2 years was 9.4% for QT and 11.1% for HS (p=0.46). Respectively, the risk of revision ACLR was 2.3% and 1.6% (p=0.66), the risk of revision due to cyclops was 5.0% and 2.4% (p=0.13), and the risk of revision due to meniscal injury was 4.3% and 7.1% (p=0.16). The risk of revi-sion due to any reason was 20.5% and 23.6% (p=0.37). A-P laxity was 1.3 mm for QT and 1.4 mm for HS (p=0.35). The proportion with a positive pivot shift was 29% for both groups.
Conclusions: Quadriceps tendon and hamstring tendon grafts yield equal rates of graft failure and revision surgery at two years follow up after ACLR. Graft failure was found in 9-11%. QT was associated with higher risk of revision due to cyclops, and HS with higher risk of revision due to meniscal injury.
Adam Omari
Dept. of Orthopedic Surgery, Hvidovre Hospital
Background: Increasing global usage of cementless prostheses in total hip arthroplasty (THA) surgery presents a challenge, especially for elderly patients with increased revision rates, re-revision rates, and decrease in prosthetic survivorship when compared to cemented THAs. To reduce the risk of early periprosthetic femoral fractures (PFF), a new treatment algorithm for females >60 years undergoing primary THA was introduced.
Purpose / Aim of Study: The aim of this study was to determine the impact of the new treatment algorithm on the early risk of peri- and post-operative PFFs and guideline compliance.
Materials and Methods: A total of 2,405 consecutive THAs that underwent primary unilateral THA at out institution were retrospectively identified in the period January 1st 2013 to December 31st 2018. A new treatment algorithm was introduced on April 1st 2017 with female patients aged >60 years intended to receive cemented femoral components. Prior to this, all patients were scheduled to receiving cementless femoral components. Demographic data, number of peri- and post-operative PFFs and surgical compliance were recorded, analyzed and intergroup differences compared.
Findings / Results: The utilization of cemented components in female patients >60 years increased from 12.3% (n=102) to 82.5% (n=264). In females >60 years a significant reduction in the risk in early post-operative and peri- operative PFF following introduction of the new treatment algorithm was seen; (4.57% vs 1.25%, p=0.007) and (2.29% vs. 0.31%, p=0.02), respectively. Overall risk for post-operative and peri- operative fractures combined was also reduced in the entire cohort (4.1% vs 2.0%, p=0.01).
Conclusions: Use of cemented fixation of the femoral component in female patients >60 years significantly reduces the number of PFF. Our findings support use of cemented femoral fixation in elderly female patients.
Dept. of Orthopedic Surgery, Hvidovre Hospital
Background: Increasing global usage of cementless prostheses in total hip arthroplasty (THA) surgery presents a challenge, especially for elderly patients with increased revision rates, re-revision rates, and decrease in prosthetic survivorship when compared to cemented THAs. To reduce the risk of early periprosthetic femoral fractures (PFF), a new treatment algorithm for females >60 years undergoing primary THA was introduced.
Purpose / Aim of Study: The aim of this study was to determine the impact of the new treatment algorithm on the early risk of peri- and post-operative PFFs and guideline compliance.
Materials and Methods: A total of 2,405 consecutive THAs that underwent primary unilateral THA at out institution were retrospectively identified in the period January 1st 2013 to December 31st 2018. A new treatment algorithm was introduced on April 1st 2017 with female patients aged >60 years intended to receive cemented femoral components. Prior to this, all patients were scheduled to receiving cementless femoral components. Demographic data, number of peri- and post-operative PFFs and surgical compliance were recorded, analyzed and intergroup differences compared.
Findings / Results: The utilization of cemented components in female patients >60 years increased from 12.3% (n=102) to 82.5% (n=264). In females >60 years a significant reduction in the risk in early post-operative and peri- operative PFF following introduction of the new treatment algorithm was seen; (4.57% vs 1.25%, p=0.007) and (2.29% vs. 0.31%, p=0.02), respectively. Overall risk for post-operative and peri- operative fractures combined was also reduced in the entire cohort (4.1% vs 2.0%, p=0.01).
Conclusions: Use of cemented fixation of the femoral component in female patients >60 years significantly reduces the number of PFF. Our findings support use of cemented femoral fixation in elderly female patients.