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Hailer, N. (2018). 20 years of porous tantalum in primary and revision hip arthroplasty-time for a critical appraisal. Acta Orthopaedica, 89(3), 254-255
Open this publication in new window or tab >>20 years of porous tantalum in primary and revision hip arthroplasty-time for a critical appraisal
2018 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 89, no 3, p. 254-255Article in journal, Editorial material (Other academic) Published
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-357662 (URN)10.1080/17453674.2018.1463007 (DOI)000431519600002 ()29726759 (PubMedID)
Available from: 2018-08-23 Created: 2018-08-23 Last updated: 2018-08-23Bibliographically approved
Brüggemann, A., Mallmin, H. & Hailer, N. P. (2018). Do dual-mobility cups cemented into porous tantalum shells reduce the risk of dislocation after revision surgery?: A retrospective cohort study on 184 patients. Acta Orthopaedica, 89(2), 156-162
Open this publication in new window or tab >>Do dual-mobility cups cemented into porous tantalum shells reduce the risk of dislocation after revision surgery?: A retrospective cohort study on 184 patients
2018 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 89, no 2, p. 156-162Article in journal (Refereed) Published
Abstract [en]

Background and purpose Dual-mobility cups (DMCs) reduce the risk of dislocation and porous tantalum (TM) shells show favorable osseointegration after acetabular revision surgery, yet the combination of these implants has not been studied. We hypothesized that (1) cementing a DMC into a TM shell decreases the risk of dislocation; (2) DMCs cemented into TM shells are not at greater risk of re-revision; (3) liberation of tantalum ions is marginal after use of this combined technique.Patients and methods We investigated the outcome in 184 hips (184 patients) after acetabular revision surgery with TM shells, fitted either with DMCs (n = 69), or with standard polyethylene (PE) liners (n = 115). Chart follow-up was complete for all patients, and the occurrence of dislocations and re-revisions was recorded. 20 were deceased, 50 were unable to attend follow-up, leaving 114 for assessment of hip function after 4.9 (0.5-8.9) years, radiographs were obtained in 99, and tantalum concentrations in 84 patients.Results 1 patient with a DMC had a dislocation, whereas 14 patients with PE liners experienced at least 1 dislocation. 11 of 15 re-revisions in the PE group were necessitated by dislocations, whereas none of the 2 re-revisions in the DMC group was performed for this reason. Hence, dislocation-free survival after 4 years was 99% (95% CI 96-100) in the DMC group, whereas it was 88% (CI 82-94, p = 0.01) in the PE group. We found no radiographic signs of implant failure in any patient. Mean tantalum concentrations were 0.1 mu l/L (CI 0.05-0.2) in the DMC group and 0.1 mu g/L (CI 0.05-0.2) in the PE group.Interpretation Cementing DMCs into TM shells reduces the risk of dislocation after acetabular revision surgery without jeopardizing overall cup survival, and without enhancing tantalum release.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2018
National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-353002 (URN)10.1080/17453674.2018.1432927 (DOI)000429335700004 ()29400106 (PubMedID)
Available from: 2018-07-13 Created: 2018-07-13 Last updated: 2018-07-13Bibliographically approved
Eriksson, H. K., Nordström, J., Gabrysch, K., Hailer, N. P. & Lazarinis, S. (2018). Does the Alpha-defensin Immunoassay or the Lateral Flow Test Have Better Diagnostic Value for Periprosthetic Joint Infection?: A Systematic Review. Clinical Orthopaedics and Related Research, 476(5), 1065-1072
Open this publication in new window or tab >>Does the Alpha-defensin Immunoassay or the Lateral Flow Test Have Better Diagnostic Value for Periprosthetic Joint Infection?: A Systematic Review
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2018 (English)In: Clinical Orthopaedics and Related Research, ISSN 0009-921X, E-ISSN 1528-1132, Vol. 476, no 5, p. 1065-1072Article, review/survey (Refereed) Published
Abstract [en]

Background: Measuring alpha-defensin concentrations in synovial fluid may help to diagnose periprosthetic joint infection (PJI). There are two commercially available methods for measuring alpha-defensin in synovial fluid: the enzyme-linked immunosorbent assay-based Synovasure (R) alpha-defensin immunoassay, which gives a numeric readout within 24 hours, and the Synovasure lateral flow test, which gives a binary readout within 20 minutes. There is no compilation of the existing literature to support the use of one of these two tests over the other.

Questions/purposes: Does the immunoassay or the lateral flow test have better diagnostic value (sensitivity and specificity) in diagnosing PJI?

Methods: We followed PRISMA guidelines and identified all studies on alpha-defensin concentration in synovial fluid as a PJI diagnostic marker, indexed to April 14, 2017, in PubMed, JSTOR, Google Scholar, and OVID databases. The search retrieved 1578 records. All prospective and retrospective studies on alpha-defensin as a PJI marker (PJI classified according to the criteria of the Musculoskeletal Infection Society) after THA or TKA were included in the analysis. All studies used only one of the two commercially available test methods, but none of them was comparative. After excluding studies with overlapping patient populations, four studies investigating the alpha-defensin immunoassay and three investigating the lateral flow test remained. Alpha-defensin immunoassay studies included 482 joints and lateral flow test studies included 119. The quality of the trials was assessed according to the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The heterogeneity among studies was evaluated by the I-2 index, indicating that the heterogeneity of the included studies was low. Pooled sensitivity, specificity, positive and negative likelihood ratios, and receiver operating curves were calculated for each method and compared with each other.

Results: The alpha-defensin immunoassay had superior overall diagnostic value compared with the lateral flow test (area under the curve, 0.98 versus 0.75) with higher sensitivity (96% [90%-98%] versus 71% [55%-83%], p < 0.001), but no difference in specificity with the numbers available (96% [93%-97%] versus 90% [81%-95%], p = 0.060).

Conclusions: Measurement of alpha-defensin in synovial fluid is a valuable complement to existing diagnostic criteria, and the immunoassay test detects PJI more accurately than the lateral flow test. The lateral flow test has lower sensitivity, making it difficult to rule out infection, but its relatively high specificity combined with the advantage of a quick response time can make it useful to rule in infection perioperatively.

Level of Evidence: Level III, diagnostic study.

National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-357653 (URN)10.1007/s11999.0000000000000244 (DOI)000431411000027 ()29601381 (PubMedID)
Note

Correction in: Clinical Orthopaedics and Related Research, 2018, vol. 476, issue 7, page 1545

DOI: 10.1097/CORR.0000000000000362

Available from: 2018-08-28 Created: 2018-08-28 Last updated: 2018-11-27Bibliographically approved
Hailer, Y. & Hailer, N. P. (2018). Is Legg-Calve-Perthes Disease a Local Manifestation of a Systemic Condition?. Clinical Orthopaedics and Related Research, 476(5), 1055-1064
Open this publication in new window or tab >>Is Legg-Calve-Perthes Disease a Local Manifestation of a Systemic Condition?
2018 (English)In: Clinical Orthopaedics and Related Research, ISSN 0009-921X, E-ISSN 1528-1132, Vol. 476, no 5, p. 1055-1064Article in journal (Refereed) Published
Abstract [en]

Background: Osteochondrosis includes numerous diseases that occur during rapid growth, characterized by disturbances of endochondral ossification. One example, Legg-Calvé-Perthes disease, is characterized by disruption of the blood supply to the femoral head epiphysis, and a systemic etiology often has been suggested. If this were the case, secondary osteochondroses at locations other than the hip might be expected to be more common among patients with Legg-Calvé-Perthes disease, but to our knowledge, this has not been evaluated in a nationwide sample.

Questions/purposes: (1) Do patients with Legg-Calvé-Perthes disease have an increased prevalence of secondary osteochondroses at locations other than the hip? (2) Is the concept of Legg-Calvé-Perthes disease a systemic etiology supported by a higher prevalence of the metabolic diseases obesity and hypothyroidism?

Methods: We designed a retrospective population-based cohort study with data derived from the Swedish Patient Registry (SPR). The SPR was established in 1964 and collects information on dates of hospital admission and discharge, registered diagnoses (categorized along the International Classification of Diseases [ICD]), and applied treatments during the entire lifetime of all Swedish citizens with high validity. Analyzing the time span from 1964 to 2011, we identified 3183 patients with an ICD code indicative of Legg-Calvé-Perthes disease and additionally sampled 10 control individuals per patient with Legg-Calvé-Perthes disease, matching for sex, age, and residence, resulting in 31,817 control individuals. The prevalence of secondary osteochondroses, obesity, and hypothyroidism was calculated separately for patients with Legg-Calvé-Perthes disease and control individuals based on the presence of ICD codes indicative of these conditions. Using logistic regression analysis, we compared the adjusted relative risk of having either of these conditions develop between patients with Legg-Calvé-Perthes disease and their matched control subjects. The mean followup was 26.1 years (range, 2.8-65 years).

Results: The prevalence of secondary osteochondroses was greater among patients with Legg-Calvé-Perthes disease (3.11%) than among control subjects (0.31%), resulting in an increased adjusted risk of an association with such lesions in the patients (relative risk [RR], 10.3; 95% confidence interval [CI], 7.7-13.6; p < 0.001). When stratified by sex, we attained a similarly increased risk ratio for females (RR, 12.5; 95% CI, 6.1-25.8; p < 0.001) as for males (RR, 9.9; 95% CI, 7.3-13.5; p < 0.001). Patients with Legg-Calvé-Perthes disease had an increased adjusted risk of an association with obesity (RR, 2.8; 95% CI, 1.9-4.0; p < 0.001) or hypothyroidism (RR, 2.6; 95% CI, 1.7-3.8; p < 0.001) when compared with control subjects.

Conclusions: To our knowledge, this is the first population-based description of a robust association of Legg-Calvé-Perthes disease with osteochondroses at locations other than the hip, and we also found increased risk estimates for an association with obesity and hypothyroidism in patients with Legg-Calvé-Perthes disease. Our findings strengthen the hypothesis that Legg-Calvé-Perthes disease is the local manifestation of a systemic disease, indicative of an underlying common disease pathway that requires further investigation. Physicians should be aware that patients with Legg-Calvé-Perthes disease may present with secondary osteochondroses and metabolic comorbidities.

National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-356074 (URN)10.1007/s11999.0000000000000214 (DOI)000431411000026 ()29481348 (PubMedID)
Available from: 2018-07-13 Created: 2018-07-13 Last updated: 2018-07-13Bibliographically approved
Schizas, N., König, N., Andersson, B., Vasylovska, S., Hoeber, J., Kozlova, E. & Hailer, N. (2018). Neural crest stem cells protect spinal cord neurons from excitotoxic damage and inhibit glial activation by secretion of brain-derived neurotrophic factor. Cell and Tissue Research, 372(3), 493-505
Open this publication in new window or tab >>Neural crest stem cells protect spinal cord neurons from excitotoxic damage and inhibit glial activation by secretion of brain-derived neurotrophic factor
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2018 (English)In: Cell and Tissue Research, ISSN 0302-766X, E-ISSN 1432-0878, Vol. 372, no 3, p. 493-505Article in journal (Refereed) Published
Abstract [en]

The acute phase of spinal cord injury is characterized by excitotoxic and inflammatory events that mediate extensive neuronal loss in the gray matter. Neural crest stem cells (NCSCs) can exert neuroprotective and anti-inflammatory effects that may be mediated by soluble factors. We therefore hypothesize that transplantation of NCSCs to acutely injured spinal cord slice cultures (SCSCs) can prevent neuronal loss after excitotoxic injury. NCSCs were applied onto SCSCs previously subjected to N-methyl-d-aspartate (NMDA)-induced injury. Immunohistochemistry and TUNEL staining were used to quantitatively study cell populations and apoptosis. Concentrations of neurotrophic factors were measured by ELISA. Migration and differentiation properties of NCSCs on SCSCs, laminin, or hyaluronic acid hydrogel were separately studied. NCSCs counteracted the loss of NeuN-positive neurons that was otherwise observed after NMDA-induced excitotoxicity, partly by inhibiting neuronal apoptosis. They also reduced activation of both microglial cells and astrocytes. The concentration of brain-derived neurotrophic factor (BDNF) was increased in supernatants from SCSCs cultured with NCSCs compared to SCSCs alone and BDNF alone mimicked the effects of NCSC application on SCSCs. NCSCs migrated superficially across the surface of SCSCs and showed no signs of neuronal or glial differentiation but preserved their expression of SOX2 and Krox20. In conclusion, NCSCs exert neuroprotective, anti-apoptotic and glia-inhibitory effects on excitotoxically injured spinal cord tissue, some of these effects mediated by secretion of BDNF. However, the investigated NCSCs seem not to undergo neuronal or glial differentiation in the short term since markers indicative of an undifferentiated state were expressed during the entire observation period.

Keywords
Neuroprotection, Suppressed glial activation, Excitotoxicity, Apoptosis, Secretion of soluble factors
National Category
Cell Biology
Identifiers
urn:nbn:se:uu:diva-356852 (URN)10.1007/s00441-018-2808-z (DOI)000432109000004 ()29516218 (PubMedID)
Funder
Swedish Research Council, 20716Stiftelsen Olle Engkvist Byggmästare
Available from: 2018-08-16 Created: 2018-08-16 Last updated: 2018-08-16Bibliographically approved
Brüggemann, A., Fredlund, E., Mallmin, H. & Hailer, N. P. (2017). Are porous tantalum cups superior to conventional reinforcement rings?: A retrospective cohort study of 207 acetabular revisions. Acta Orthopaedica, 88(1), 35-40
Open this publication in new window or tab >>Are porous tantalum cups superior to conventional reinforcement rings?: A retrospective cohort study of 207 acetabular revisions
2017 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 88, no 1, p. 35-40Article in journal (Refereed) Published
Abstract [en]

Background and purpose - Porous tantalum cups have been introduced as an alternative to various reinforcement rings in revision hip surgery. We hypothesized that porous tantalum cups would be superior to muller acetabular roof reinforcement rings (MARRs) in revision hip surgery with re-revision for aseptic loosening as the primary outcome measure. Patients and methods - 207 hips operated with either a porous tantalum cup (TM cup, n = 111) or a MARR (n = 96) at index procedure were identified in our local arthroplasty register. Acetabular defects were classified according to Paprosky. There were 96 men and 111 women with a median age of 71 (35-95) years, presenting acetabular defect size type I in 39 cases, IIA in 22, IIB in 27, IIC in 43, IIIA in 32, and IIIB in 37 cases. Analysis of medical records identified all patients with subsequent re-revision and reasons for re-revisions. Kaplan-Meier survival functions were used to estimate implant survival. Results - With re-revision for aseptic loosening as the end-point, the 6-year unadjusted cumulative survival was 97% (95% CI: 94-100) for TM cups and 96% (CI: 92-100) for MARR (p = 0.6). Using re-revision for any reason as the endpoint, 6-year survival was 87% (CI: 81-94) for TM cups and 95% (CI: 90-99) for MARR (p = 0.06). The main reason for re-revision in the TM group was dislocation (n = 10), followed by loosening (n = 3), whereas the main reason for re-revision in the MARR group was aseptic loosening (n = 8). Duration of the index procedure and perioperative blood loss were lower in the TM group. Interpretation - Both TM and MARR lead to good 6-year results in acetabular revision surgery. The methods differ in their respective failure mechanisms. We conclude that TM cups are a valuable treatment option in acetabular revision surgery, but the reasons underlying dislocations after the use of TM cups must be analyzed further.

National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-316408 (URN)10.1080/17453674.2016.1248315 (DOI)000392736200007 ()27892748 (PubMedID)
Available from: 2017-03-02 Created: 2017-03-02 Last updated: 2018-01-13Bibliographically approved
Dahlstrand, H., Stark, A., Wick, M. C., Anissian, L., Hailer, N. & Weiss, R. J. (2017). Comparison of metal ion concentrations and implant survival after total hip arthroplasty with metal-on-metal versus metal-on-polyethylene articulations: a 16-year follow-up of a prospective randomized study. Acta Orthopaedica, 88(5), 490-495
Open this publication in new window or tab >>Comparison of metal ion concentrations and implant survival after total hip arthroplasty with metal-on-metal versus metal-on-polyethylene articulations: a 16-year follow-up of a prospective randomized study
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2017 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 88, no 5, p. 490-495Article in journal (Refereed) Published
Abstract [en]

Background and purpose - Large metal-on-metal (MoM) articulations are associated with metal wear and corrosion, leading to increased metal ion concentrations and unacceptable revision rates. There are few comparative studies of 28-mm MoM articulations with conventional metal-on-polyethylene (MoP) couplings. We present a long-term follow-up of a randomized controlled trial comparing MoM versus MoP 28-mm articulations, focused on metal ions and implant survival. Patients and methods - 85 patients with a mean age of 65 years at surgery were randomized to a MoM (Metasul) or a MoP (Protasul) bearing. After 16 years, 38 patients had died and 4 had undergone revision surgery. 13 patients were unavailable for clinical follow-up, leaving 30 patients (n = 14 MoM and n = 16 MoP) for analysis of metal ion concentrations and clinical outcome. Results - 15-year implant survival was similar in both groups (MoM 96% [95% CI 88-100] versus MoP 97% [95% CI 91-100]). The mean serum cobalt concentration was 4-fold higher in the MoM (1.5 mu g/L) compared with the MoP cohort (0.4 mu g/L, p < 0.001) and the mean chromium concentration was double in the MoM (2.2 mu g/L) compared with the MoP cohort (1.0 mu g/L, p = 0.05). Mean creatinine levels were similar in both groups (MoM 93 mu mol/L versus MoP 92 mu mol/L). Harris hip scores differed only marginally between the MoM and MoP cohorts. Interpretation - This is the longest follow-up of a randomized trial on 28-mm MoM articulations, and although implant survival in the 2 groups was similar, metal ion concentrations remained elevated in the MoM cohort even in the long term.

National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-333618 (URN)10.1080/17453674.2017.1350370 (DOI)000407612900006 ()
Available from: 2017-11-16 Created: 2017-11-16 Last updated: 2018-01-13Bibliographically approved
Schizas, N., Perry, S., Andersson, B., Wählby, C., Kullander, K. & Hailer, N. (2017). Differential neuroprotective effects of interleukin-1 receptor antagonist on spinal cord neurons after excitotoxic injury. Neuroimmunomodulation, 24, 220-230
Open this publication in new window or tab >>Differential neuroprotective effects of interleukin-1 receptor antagonist on spinal cord neurons after excitotoxic injury
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2017 (English)In: Neuroimmunomodulation, ISSN 1021-7401, E-ISSN 1423-0216, Vol. 24, p. 220-230Article in journal (Refereed) Published
National Category
Neurosciences Medical Image Processing
Research subject
Computerized Image Processing
Identifiers
urn:nbn:se:uu:diva-251475 (URN)10.1159/000484607 (DOI)000428694500004 ()29393213 (PubMedID)
Available from: 2018-01-26 Created: 2015-04-19 Last updated: 2018-06-20Bibliographically approved
Lazarinis, S., Mäkelä, K. T., Eskelinen, A., Havelin, L., Hallan, G., Overgaard, S., . . . Hailer, N. (2017). Does hydroxyapatite coating of uncemented cups improve long-term survival?: An analysis of 28,605 primary total hip arthroplasty procedures from the Nordic Arthroplasty Register Association (NARA). Osteoarthritis and Cartilage, 25(12), 1980-1987, Article ID S1063-4584(17)31137-8.
Open this publication in new window or tab >>Does hydroxyapatite coating of uncemented cups improve long-term survival?: An analysis of 28,605 primary total hip arthroplasty procedures from the Nordic Arthroplasty Register Association (NARA)
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2017 (English)In: Osteoarthritis and Cartilage, ISSN 1063-4584, E-ISSN 1522-9653, Vol. 25, no 12, p. 1980-1987, article id S1063-4584(17)31137-8Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: It is unclear whether hydroxyapatite (HA) coating of uncemented cups used in primary total hip arthroplasty (THA) improves bone ingrowth and reduces the risk of aseptic loosening. We therefore investigated survival of different uncemented cups that were available with or without HA coating.

METHOD: We investigated three different cup types used with or without HA coating registered in the Nordic Arthroplasty Register Association (NARA) database that were inserted due to osteoarthritis (n = 28,605). Cumulative survival rates and adjusted hazard ratios (HRs) for the risk of revision were calculated.

RESULTS: Unadjusted 13-year survival for cup revision due to aseptic loosening was 97.9% (CI: 96.5-99.4) for uncoated and 97.8% (CI: 96.3-99.4) for HA-coated cups. Adjusted HRs were 0.66 (CI 0.42-1.04) for the presence of HA coating during the first 10 years and 0.87 (CI 0.14-5.38) from year 10-13, compared with uncoated cups. When considering the endpoint cup revision for any reason, unadjusted 13-year survival was similar for uncoated (92.5% [CI: 90.1-94.9]) and HA-coated (94.7% [CI: 93.2-96.3]) cups. The risk of revision of any component due to infection was higher in THA with HA-coated cups than in THA with uncoated cups (adjusted HR 1.4 [CI 1.1-1.9]).

CONCLUSIONS: HA-coated cups have a similar risk of aseptic loosening as uncoated cups, thus the use of HA coating seems to not confer any added value in terms of implant stability. The risk of infection seemed higher in THA with use of HA-coated cups, an observation that must be investigated further.

Keywords
Arthroplasty, Cup, Hip, Hydroxyapatite, NARA, Uncemented
National Category
Orthopaedics Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:uu:diva-334157 (URN)10.1016/j.joca.2017.08.001 (DOI)000414873800007 ()28802851 (PubMedID)
Available from: 2017-11-21 Created: 2017-11-21 Last updated: 2018-02-20Bibliographically approved
Johansson, L., Hailer, N. P. & Rahme, H. (2017). High incidence of periprosthetic joint infection with propionibacterium acnes after the use of a stemless shoulder prosthesis with metaphyseal screw fixation: a retrospective cohort study of 241 patients propionibacter infections after eclipse TSA. BMC Musculoskeletal Disorders, 18, Article ID 203.
Open this publication in new window or tab >>High incidence of periprosthetic joint infection with propionibacterium acnes after the use of a stemless shoulder prosthesis with metaphyseal screw fixation: a retrospective cohort study of 241 patients propionibacter infections after eclipse TSA
2017 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 18, article id 203Article in journal (Refereed) Published
Abstract [en]

Background: A stemless shoulder prosthesis with humeral metaphyseal screw fixation was introduced in order to save bone-stock and to facilitate reconstruction of biomechanics (Eclipse (R)). The aim of this study was to analyze whether the risk of infection is different with this implant compared to conventional shoulder prosthesis.

Methods: Two hundred and forty-one patients (54.8% females) were operated with a shoulder arthroplasty and followed for median 2.0 (0.1-5.7) years. One hundred and two (42.3%) had received an Eclipse (R) prosthesis, the remaining patients were operated with other implants. There was an overrepresentation of males in the Eclipse (R) group (63.7% males) when compared with the control group (31.7% males).

Results: In the Eclipse (R) group 10 (9.8%) patients developed a periprosthetic joint infection, as opposed to 1 (0.7%) in the control group. The most common bacteria was Propionibacterium acnes. Unadjusted infection-free survival after 4 years was 88.8% (CI 82.5-95.7) for Eclipse (R) patients and 95.7% (CI 87.7-100.0) for controls (p = 0.002). After adjustment for age, gender, diagnosis, and type of shoulder prosthesis (total or hemi), the risk ratio for revision due to infection was 4.3 (CI 0.5-39.1) for patients with the Eclipse (R) prosthesis.

Conclusions: Deep infections seem to be more common after the use of the metaphyseally fixed Eclipse (R) prosthesis than after conventional shoulder implants, but a predominance of male gender and younger age in the Eclipse group may have biased our findings. Future studies on larger cohorts and in vitro investigations on bacterial adherence and biofilm formation are needed.

Keywords
Propionibacterium acnes, Shoulder arthroplasty, Periprosthetic infection, Biofilm formation, Orthopedic implant, TSA, TSR
National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-325700 (URN)10.1186/s12891-017-1555-8 (DOI)000401670700001 ()28526023 (PubMedID)
Note

Correction in: BMC Musculoskeletal Disorders, Volume 18, Article Number: 249.

DOI: 10.1186/s12891-017-1610-5

Available from: 2017-06-27 Created: 2017-06-27 Last updated: 2018-01-19Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-3233-2638

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