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Launonen, A. P., Fjalestad, T., Laitinen, M. K., Lahdeoja, T., Ekholm, C., Wagle, T., . . . Wolf, O. (2019). Nordic Innovative Trials to Evaluate osteoPorotic Fractures (NITEP) Collaboration: The Nordic DeltaCon Trial protocol-non-operative treatment versus reversed total shoulder arthroplasty in patients 65 years of age and older with a displaced proximal humerus fracture: a prospective, randomised controlled trial. BMJ Open, 9(1), Article ID e024916.
Open this publication in new window or tab >>Nordic Innovative Trials to Evaluate osteoPorotic Fractures (NITEP) Collaboration: The Nordic DeltaCon Trial protocol-non-operative treatment versus reversed total shoulder arthroplasty in patients 65 years of age and older with a displaced proximal humerus fracture: a prospective, randomised controlled trial
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 1, article id e024916Article in journal (Refereed) Published
Abstract [en]

Introduction The proximal humerus fracture (PHF) is one of the most common fractures in the elderly. The majority of PHFs are treated non-operatively, while 15%-33% of patients undergo surgical treatment. Recent randomised controlled trial (RCT) and meta-analyses have shown that there is no difference in outcome between non-operative treatment and locking plate or hemi-arthroplasty. During the past decade, reverse total shoulder arthroplasty (RTSA) has gained popularity in the treatment of PHF, although there is a lack of RCTs comparing RTSA to non-operative treatment. Methods This is a prospective, single-blinded, randomised, controlled, multicentre and multinational trial comparing RTSA with non-operative treatment in displaced proximal humeral fractures in patients 65-85 years. The primary outcome in this study is QuickDASH-score measured at 2 years. Secondary outcomes include visual analogue scale for pain, grip strength, Oxford shoulder score, Constant score and the number of reoperations and complications. The hypothesis of the trial is that operative treatment with RTSA produces better outcome after 2 and 5 years measured with QuickDASH. Ethics and dissemination In this protocol, we describe the design, method and management of the Nordic DeltaCon trial. The ethical approval for the trial has been given by the Regional Committee for Medical and Health Research Ethics, Norway. There have been several examples in orthopaedics of innovations that result in failure after medium-term follow-ups. In order to prevent such failures and to increase our knowledge of RSTA, we feel a large-scale study of the effects of the surgery on the outcome that focuses on the complications and reoperations is warranted. After the trial 2-year follow-up, the results will be disseminated in a major orthopaedic publication.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-390589 (URN)10.1136/bmjopen-2018-024916 (DOI)000471116800216 ()30700485 (PubMedID)
Available from: 2019-08-13 Created: 2019-08-13 Last updated: 2019-08-13Bibliographically approved
Kihlström, C., Moller, M., Lönn, K. & Wolf, O. (2017). Clavicle fractures: epidemiology, classification and treatment of 2 422 fractures in the Swedish Fracture Register; an observational study. BMC Musculoskeletal Disorders, 18, 1-9, Article ID 82.
Open this publication in new window or tab >>Clavicle fractures: epidemiology, classification and treatment of 2 422 fractures in the Swedish Fracture Register; an observational study
2017 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 18, p. 1-9, article id 82Article in journal (Refereed) Published
Abstract [en]

Background: Large multi-centre studies of clavicle fractures have so far been missing. The aim of this observational study was to describe the epidemiology, classification and treatment of clavicle fractures in the The Swedish Fracture Register (SFR) that collects national prospective data from large fracture populations. Methods: Data were retrieved from the SFR on all clavicle fractures sustained by patients >= 15 years of age in 2013-2014 (n = 2 422) with regards to date of injury, cause of injury, fracture classification and treatment. Results: Sixty-eight per cent of the clavicle fractures occurred in males. The largest subgroup was males aged 1524 years, representing 21% of clavicle fractures. At the ages of 65 years and above, females sustained more clavicle fractures than males. Same-level falls and bicycle accidents were the most common injury mechanisms. Displaced midshaft fractures constituted 43% of all fractures and were the most frequently operated fractures. Seventeen per cent of the patients underwent operative treatment within 30 days of the injury, where plate fixation was the choice of treatment in 94% of fractures. Conclusion: The largest patient group was young males. Displaced midshaft fractures were the most common type of clavicle fracture as well as the most frequently operated type of fracture.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2017
Keywords
Clavicle fracture, Epidemiology, Classification, Treatment, The Swedish Fracture Register
National Category
Orthopaedics Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:uu:diva-319095 (URN)10.1186/s12891-017-1444-1 (DOI)000395205600001 ()28202071 (PubMedID)
Available from: 2017-04-03 Created: 2017-04-03 Last updated: 2018-01-13Bibliographically approved
Aarnio, M., Appel, L., Fredriksson, M., Gordh, T., Wolf, O., Sörensen, J., . . . Linnman, C. (2017). Visualization of painful inflammation in patients with pain after traumatic ankle sprain using [(11)C]-D-deprenyl PET/CT.. Scandinavian Journal of Pain, 17, 418-424
Open this publication in new window or tab >>Visualization of painful inflammation in patients with pain after traumatic ankle sprain using [(11)C]-D-deprenyl PET/CT.
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2017 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 17, p. 418-424Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND AIMS: Positron emission tomography (PET) with the radioligand [(11)C]-D-deprenyl has shown increased signal at location of pain in patients with rheumatoid arthritis and chronic whiplash injury. The binding site of [(11)C]-D-deprenyl in peripheral tissues is suggested to be mitochondrial monoamine oxidase in cells engaged in post-traumatic inflammation and tissue repair processes. The association between [(11)C]-D-deprenyl uptake and the transition from acute to chronic pain remain unknown. Further imaging studies of musculoskeletal pain at the molecular level would benefit from establishing a clinical model in a common and well-defined injury in otherwise healthy and drug-naïve subjects. The aim of this study was to investigate if [(11)C]-D-deprenyl uptake would be acutely elevated in unilateral ankle sprain and if tracer uptake would be reduced as a function of healing, and correlated with pain localizations and pain experience.

METHODS: Eight otherwise healthy patients with unilateral ankle sprain were recruited at the emergency department. All underwent [(11)C]-D-deprenyl PET/CT in the acute phase, at one month and 6-14 months after injury.

RESULTS: Acute [(11)C]-D-deprenyl uptake at the injury site was a factor of 10.7 (range 2.9-37.3) higher than the intact ankle. During healing, [(11)C]-D-deprenyl uptake decreased, but did not normalize until after 11 months. Patients experiencing persistent pain had prolonged [(11)C]-D-deprenyl uptake in painful locations.

CONCLUSIONS AND IMPLICATIONS: The data provide further support that [(11)C]-D-deprenyl PET can visualize, quantify and follow processes in peripheral tissue that may relate to soft tissue injuries, inflammation and associated nociceptive signaling. Such an objective correlate would represent a progress in pain research, as well as in clinical pain diagnostics and management.

Keywords
Ankle injuries, Carbon-11, Deprenyl, Inflammation, PET, Pain
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-333782 (URN)10.1016/j.sjpain.2017.10.008 (DOI)000419851500070 ()29126847 (PubMedID)
Available from: 2017-11-16 Created: 2017-11-16 Last updated: 2018-04-09Bibliographically approved
Wolf, O., Åberg, H., Tornberg, U. & Jonsson, K. B. (2016). Do Orthogeriatric Inpatients Have a Correct Medication List?: A Pharmacist-Led Assessment of 254 Patients in a Swedish University Hospital. Geriatric Orthopaedic Surgery & Rehabilitation, 7(1), 18-22
Open this publication in new window or tab >>Do Orthogeriatric Inpatients Have a Correct Medication List?: A Pharmacist-Led Assessment of 254 Patients in a Swedish University Hospital
2016 (English)In: Geriatric Orthopaedic Surgery & Rehabilitation, E-ISSN 2151-4585, Vol. 7, no 1, p. 18-22Article in journal (Refereed) Published
Abstract [en]

Introduction: Comorbidities and polypharmacy complicate the treatment of geriatric patients with acute orthopedic injuries. A correct medication history and an updated medication list are a prerequisite for safe treatment of these debilitated patients. Published evidence suggests favorable outcomes with comanaged care. The aim of this study was to assess the accuracy of the inpatient medication lists generated at admission and investigate the efficacy of a dedicated ward-based pharmacist to find and correct mistakes in these lists. Methods: A total of 254 patients were enrolled. The ward-based pharmacist performed the assessment regarding the accuracy of the medication list generated at admission by the method of medication reconciliation. Number of discrepancies and types of discrepancy were noted. Results: The 254 patients (176 women) had a mean age of 85 years (standard deviation 7.4 years, range 42-100 years). The most common reason for orthopedic admission was hip fracture. The mean number of discrepancies was 2.1 for all patients (range 0-13). Omission of a prescribed drug was the most common mistake. Fifty-six (22%) of the 254 assessed patients had a correct medication list. Discussion: The many discrepancies in our study may have several explanations but highlight the difficulties in taking a correct medication history of patients in a stressful environment with an extremely high workload. Moreover, electronic medication lists create challenges. Implementing new electronic tools for health care requires feedback, redesign, and adaptation to meet various needs of the users. Conclusion: In conclusion, orthogeriatric patients have an unsatisfactory high number of discrepancies in their medication lists. Clinical pharmacists can accurately identify many of these mistakes.

Keywords
medication reconciliation, orthogeriatric, discrepancies, pharmacist, medication list
National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-312708 (URN)10.1177/2151458515625295 (DOI)000387781900003 ()26929852 (PubMedID)
Available from: 2017-01-12 Created: 2017-01-12 Last updated: 2018-01-13Bibliographically approved
Wolf, O., Mattsson, P., Milbrink, J., Larsson, S. & Mallmin, H. (2013). Effects of postoperative weight-bearing on body composition and bone mineral density after uncemented total hip arthroplasty. Journal of Rehabilitation Medicine, 45(5), 498-503
Open this publication in new window or tab >>Effects of postoperative weight-bearing on body composition and bone mineral density after uncemented total hip arthroplasty
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2013 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 45, no 5, p. 498-503Article in journal (Refereed) Published
Abstract [en]

Objective:

To investigate whether a postoperative weight-bearing regimen affects changes in bone mineral density and body composition after uncemented total hip arthroplasty, and to investigate the changes over a 5-year period after the surgical procedure.

Design:

Secondary analysis of a previous randomized controlled trial.

Methods:

A total of 39 patients were randomized to immediate full weight-bearing or partial weight-bearing for 3 months. Dual-energy X-ray absorptiometry was used to measure bone mineral density of the contralateral hip and both heels and to measure body composition.

Results:

The weight-bearing regimen had no effect on change in bone mineral density or body composition after 3 and 12 months. At 5 years, there was a decrease in bone mineral density of 3% in the total body and 2-3% in the contralateral hip regions. At 5 years we found a decrease in total body bone mineral content of 5%, but no changes in fat mass or lean mass compared with preoperative values.

Conclusion:

The postoperative weight-bearing regimen had no effect on changes in body composition or bone mineral density. Five years after total hip arthroplasty there was a decrease in bone mineral content and bone mineral density, but no changes in lean mass or fat mass.

Keywords
osteoarthritis of the hip; uncemented total hip arthroplasty; DXA; weight-bearing; body composition; bone mineral density
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-199774 (URN)10.2340/16501977-1140 (DOI)000320345700012 ()23571688 (PubMedID)
Available from: 2013-05-14 Created: 2013-05-14 Last updated: 2017-12-06Bibliographically approved
Wolf, O., Mattsson, P., Milbrink, J., Larsson, S. & Mallmin, H. (2012). The effects of different weight-bearing regimes on press-fit cup stability: a randomised study with five years of follow-up using radiostereometry. International Orthopaedics, 36(4), 735-740
Open this publication in new window or tab >>The effects of different weight-bearing regimes on press-fit cup stability: a randomised study with five years of follow-up using radiostereometry
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2012 (English)In: International Orthopaedics, ISSN 0341-2695, E-ISSN 1432-5195, Vol. 36, no 4, p. 735-740Article in journal (Refereed) Published
Abstract [en]

PURPOSE:

There is little evidence to support immediate weight bearing after uncemented total hip arthroplasty (THA).

METHODS:

Thirty-seven patients with unilateral osteoarthritis of the hip received a press-fit cup. Cup stability was assessed with radiostereometry (RSA) over five years. Patients were randomised to immediate full weight bearing, or partial weight bearing for three months.

RESULTS:

At five years, we found no difference in micromotion as assessed with radiostereometry. Numerically, there was more proximal translation and increased inclination with immediate weight bearing, but these values barely exceeded the precision limit for the method. Pooled data for the two groups revealed translations of 0.1-0.3 mm and rotations of 0.2-0.3° over the five year follow-up period.

CONCLUSIONS:

We found no adverse effects of immediate weight bearing after THA in relation to stability of these press-fit cups. Early mobilisation might have other advantages.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-164687 (URN)10.1007/s00264-011-1413-5 (DOI)22143314 (PubMedID)
Available from: 2011-12-22 Created: 2011-12-22 Last updated: 2017-12-08Bibliographically approved
Wolf, O., Mattsson, P., Milbrink, J., Larsson, S. & Mallmin, H. (2010). A randomized study using DXA and RSA in 38 patients followed for 5 years. Acta Orthopaedica, 81(3), 286-291
Open this publication in new window or tab >>A randomized study using DXA and RSA in 38 patients followed for 5 years
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2010 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 81, no 3, p. 286-291Article in journal (Refereed) Published
Abstract [en]

Background and purpose: There is no real consensus on the best rehabilitation regime after uncemented total hip arthroplasty. Theoretically, bone ingrowth into the implant should benefit from initial partial weight bearing. We investigated whether the degree of postoperative weight bearing influences the periprosthetic bone mineral density (BMD) and/or the stability of the CLS stem.

Patients and methods: 38 patients received an uncemented CLS stem and were randomized to either unrestricted postoperative weight bearing or to partial weight bearing for 3 months. Periprosthetic BMD was measured in the 7 Gruen zones with DXA and the stability of the femoral stem was assessed by radiostereometric analyses (RSA) after surgery and at 3, 12, 24, and 60 months.

Results: Periprosthetic BMD was not influenced by the type of postoperative weight bearing. BMD was reduced by 8-15% in all Gruen zones at 3 months. Restoration toward initial BMD was observed in all zones except in zone 7 (calcar region), where BMD was decreased by 22% at 5 years. Immediate weight bearing after surgery did not influence the stability of the CLS stem, as assessed by RSA.

Interpretation: Immediate full weight bearing after uncemented total hip arthroplasty is safe. There is no difference in the periprosthetic BMD or stability of the stem as measured with RSA compared to partial weight bearing for 3 months. BMD is decreased by more than 20% in the calcar region around a CLS stem after 5 years.

Keywords
weight bearing, DXA, periprosthetic BMD, RSA, uncemented CLS stem
National Category
Surgery
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-131005 (URN)10.3109/17453674.2010.487238 (DOI)20446828 (PubMedID)
Available from: 2010-09-21 Created: 2010-09-20 Last updated: 2017-12-12Bibliographically approved
Wolf, O. (2010). Osteoarthritis of the Hip and Uncemented Total Hip Arthroplasty: Effects of Immediate Weight Bearing on Implant Stability, Bone Mineral Density, and Body Composition. (Doctoral dissertation). Uppsala: Acta Universitatis Upsaliensis
Open this publication in new window or tab >>Osteoarthritis of the Hip and Uncemented Total Hip Arthroplasty: Effects of Immediate Weight Bearing on Implant Stability, Bone Mineral Density, and Body Composition
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The initial recommendation for the postoperative regime after uncemented total hip arthroplasty (THA) was 6-12 weeks of partial weight bearing (PWB) to obtain a stable implant position during bone ingrowth. In recent years patients with uncemented THA have increasingly practiced full weight bearing (FWB) after surgery, which has largely been based on clinical experience rather than on scientific evidence. The aim of this thesis was to investigate the effects of FWB versus PWB for 3 months on the stability of the implants and on bone mineral density (BMD), as well as body composition (BC) of the lower extremities.

We used radiostereometric analysis (RSA) to measure implant micromotion and dual X-ray absorptiometry (DXA) to measure BMD and BC. Forty-six patients with strictly unilateral osteoarthritis of the hip (OAH) received uncemented THA. These patients were then randomized to the FWB or PWB groups and followed for 5 years.

In a preoperative cross-sectional study the BMD of the hip and heel were compared between the OAH-affected side and the healthy side. The study showed an increase of BMD at the femoral neck and a decrease at the total hip and trochanter. The results of a RSA study of cup stability showed that there might be minimal movement in medial and proximal directions during the first postoperative week. These results indicate that the RSA baseline investigation of uncemented cups should be performed as early as possible after the first postoperative day. FWB had no adverse effects on the stability of the uncemented press-fit cups or the uncemented cementless Spotorno (CLS) femoral stems after a 5-year follow-up. There was no difference in periprosthetic BMD around the CLS stem regardless of the postoperative weight bearing regime. All zones around the femoral stem indicated a recovery in BMD toward baselines, except the calcar region, which showed progressive loss in BMD to -22% at 5 years post-surgery. FWB had no effect on the changes in BC after surgery.

In conclusion, FWB is safe in uncemented THA in terms of stability, BMD and BC. Furthermore, THA apparently counteracts age-related changes in BC but not in BMD.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. p. 72
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 600
Keywords
Osteoarthritis of the hip, uncemented, total hip arthroplasty, stability, RSA, BMD, DXA, body composition, weight bearing
National Category
Surgery
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-131092 (URN)978-91-554-7899-5 (ISBN)
Public defence
2010-11-05, Grönwallsalen, Akademiska sjukhuset, ingång 70, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2010-10-15 Created: 2010-09-22 Last updated: 2013-08-16Bibliographically approved
Wolf, O., Milbrink, J., Larsson, S., Mattson, P. & Mallmin, H. (2010). The optimal timing of baseline radiostereometric analysis of uncemented press fit cups. Scandinavian Journal of Surgery, 99(4), 244-249
Open this publication in new window or tab >>The optimal timing of baseline radiostereometric analysis of uncemented press fit cups
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2010 (English)In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 99, no 4, p. 244-249Article in journal (Refereed) Published
Abstract [en]

Background and Aims: The baseline Radiostereometric analysis (RSA) is usually performed during the first postoperative week. We investigated the micromotion of two uncemented press fit acetabular cups during the first week after total hip arthroplasty.

Material and Methods: All study patients had unilateral osteoarthritis of the hip and received an uncemented THA combination consisting of a CLS stem and either an Allofit or an Interop acetabular cup. The study group consisted of 24 patients who underwent RSA within 1 hour after skin closure, and at 1 and 7 days after surgery.

Results: The upper limit of the 95% confidence interval for micromotion was less than or close to the precision of the method for all studied directions during the first week after surgery. Mean values indicate proximal and medial translation of the uncemented cup at one week.

Conclusions: We found only minimal micromotion, barely above the precision limit, measured as medial and proximal translations of these uncemented cups. This indicates that the first postoperative RSA measurement following a primary THA with an uncemented press fit acetabular cup should be made as early as possible after the first postoperative day.

Keywords
RSA, baseline examination, THA, uncemented cup, optimal timing, micromotion, weight bearing, muscle tonus
National Category
Medical and Health Sciences
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-131033 (URN)000285817800013 ()
Available from: 2010-09-21 Created: 2010-09-21 Last updated: 2017-12-12Bibliographically approved
Wolf, O., Ström, H., Milbrink, J., Larsson, S. & Mallmin, H. (2009). Differences in hip bone mineral density may explain the hip fracture pattern in osteoarthritic hips. Acta Orthopaedica, 80(3), 308-313
Open this publication in new window or tab >>Differences in hip bone mineral density may explain the hip fracture pattern in osteoarthritic hips
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2009 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 80, no 3, p. 308-313Article in journal (Refereed) Published
Abstract [en]

Introduction In patients with osteoarthritis of the hip (OAH), trochanteric fractures are much more common than femoral neck fractures. One reason may be altered bone composition in the proximal femurs. OAH often leads to a fixed external rotation of the hip, leading to difficulties in positioning during DXA measurements. We compared BMD in OAH-affected legs and healthy legs. Patients and methods 40 patients with strictly unilateral OAH were cross-sectionally investigated with DXA at the hips and heels bilaterally as well as body composition of the legs. 3 regions of interest in the proximal femur were measured: femoral neck (FN), trochanter (TR), and total hip (TH). The design of the study allowed us to perform paired t-test between the OAH side and the healthy side. Results BMD was increased by 4.1% in FN, and reduced by 8.3% in TR and 4.1% in TH (p < 0.001 for all comparisons). Interpretation The differences in BMD, with decrease in the trochanter and increase in the femoral neck, may offer an explanation for the pattern of hip fractures seen in osteoarthritis. External rotation of the hip cannot explain the differences in BMD.

National Category
Surgery
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-111771 (URN)10.3109/17453670903039528 (DOI)000268569700009 ()19593721 (PubMedID)
Available from: 2009-12-21 Created: 2009-12-21 Last updated: 2017-12-12Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-6668-8715

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