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Wolf, O., Sjöholm, P., Hailer, N., Möller, M. & Mukka, S. (2020). Study protocol: HipSTHeR - a register-based randomised controlled trial - hip screws or (total) hip replacement for undisplaced femoral neck fractures in older patients. BMC Geriatrics, 20, Article ID 19.
Open this publication in new window or tab >>Study protocol: HipSTHeR - a register-based randomised controlled trial - hip screws or (total) hip replacement for undisplaced femoral neck fractures in older patients
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2020 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 20, article id 19Article in journal (Refereed) Published
Abstract [en]

Background: Femoral neck fractures (FNFs), which are common in the older population, are associated with high mortality and morbidity. Some 20% of FNFs are undisplaced (uFNFs). The routine surgical procedure for uFNFs is internal fixation (IF) with 2-3 screws/pins with a reported reoperation rate in older patients (age >= 75 years) of up to 21%. The reoperation rate for hemiarthroplasties for displaced fractures is lower than for undisplaced fractures operated with IF. This study will aim to determine whether the outcome for older patients with an uFNF can be improved by replacing the hip instead of preserving it.

Methods: A national multicentre, register-based, randomised controlled trial (rRCT) will be conducted. For this trial, 1440 patients, >= 75 years with an acute uFNF, will be allocated. Eligible patients will be identified by the Swedish Fracture Register (SFR) platform, which will notify the admitting orthopaedic surgeon of eligibility. After informed consent has been given and documented, patients will be randomised to either IF (control group) or arthroplasty (intervention group) within the SFR platform. Injury mechanism, fracture classification, date of injury, and type of treatment are registered in the SFR. Type and brand of arthroplasty, surgical approach, and fixation are obtained from the Swedish Hip Arthroplasty Register (SHAR). The study cohort from the SFR will be cross-checked with the National Patient Register and the SHAR for outcome variables at 2, 5, and 10 years.

The primary outcome will be a composite variable comprising reoperation rate and mortality at 2 years postoperatively. Secondary endpoints will include reoperation rate and mortality as stand-alone variables. In addition, secondary endpoints will be patient-reported outcomes as measured by the Short Musculoskeletal Functional Assessment questionnaire at 1 year postoperatively as routinely collected within the SFR. Further secondary endpoints will include the occurrence of adverse events such as pneumonia, stroke or myocardial infarction and evaluation of the external validity of the study.

Discussion: This large, multicentre, register-based randomised controlled trial could potentially shift the treatment of uFNFs in older patients towards primary hip arthroplasty in order to improve the outcome.

Place, publisher, year, edition, pages
BMC, 2020
Keywords
Hip fracture, Femoral neck fracture, Internal fixation, Hip arthroplasty, Register, Register-based randomised controlled trial
National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-408921 (URN)10.1186/s12877-020-1418-2 (DOI)000521304800001 ()31964340 (PubMedID)
Funder
Swedish Research CouncilSwedish Society of Medicine
Available from: 2020-04-27 Created: 2020-04-27 Last updated: 2020-04-27Bibliographically approved
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
Launonen, A. P., Sumrein, B. O., Reito, A., Lepola, V., Paloneva, J., Jonsson, K. B., . . . Mattila, V. M. (2019). Operative versus non-operative treatment for 2-part proximal humerus fracture: A multicenter randomized controlled trial. PLoS Medicine, 16(7), Article ID e1002855.
Open this publication in new window or tab >>Operative versus non-operative treatment for 2-part proximal humerus fracture: A multicenter randomized controlled trial
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2019 (English)In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 16, no 7, article id e1002855Article in journal (Refereed) Published
Abstract [en]

Background

Although increasingly used, the benefit of surgical treatment of displaced 2-part proximal humerus fractures has not been proven. This trial evaluates the clinical effectiveness of surgery with locking plate compared with non-operative treatment for these fractures.

Methods and findings

The NITEP group conducted a superiority, assessor-blinded, multicenter randomized trial in 6 hospitals in Finland, Estonia, Sweden, and Denmark. Eighty-eight patients aged 60 years or older with displaced (more than 1 cm or 45 degrees) 2-part surgical or anatomical neck proximal humerus fracture were randomly assigned in a 1:1 ratio to undergo either operative treatment with a locking plate or non-operative treatment. The mean age of patients was 72 years in the non-operative group and 73 years in the operative group, with a female sex distribution of 95% and 87%, respectively. Patients were recruited between February 2011 and April 2016. The primary outcome measure was Disabilities of Arm, Shoulder, and Hand (DASH) score at 2-year follow-up. Secondary outcomes included Constant–Murley score, the visual analogue scale for pain, the quality of life questionnaire 15D, EuroQol Group’s 5-dimension self-reported questionnaire EQ-5D, the Oxford Shoulder Score, and complications. The mean DASH score (0 best, 100 worst) at 2 years was 18.5 points for the operative treatment group and 17.4 points for the non-operative group (mean difference 1.1 [95% CI −7.8 to 9.4], p = 0.81). At 2 years, there were no statistically or clinically significant between-group differences in any of the outcome measures. All 3 complications resulting in secondary surgery occurred in the operative group. The lack of blinding in patient-reported outcome assessment is a limitation of the study. Our assessor physiotherapists were, however, blinded.

Conclusions

This trial found no significant difference in clinical outcomes at 2 years between surgery and non-operative treatment in patients 60 years of age or older with displaced 2-part fractures of the proximal humerus. These results suggest that the current practice of performing surgery on the majority of displaced proximal 2-part fractures of the humerus in older adults may not be beneficial.

National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-393140 (URN)10.1371/journal.pmed.1002855 (DOI)000478681800013 ()31318863 (PubMedID)
Available from: 2019-09-23 Created: 2019-09-23 Last updated: 2019-09-23Bibliographically approved
Sjöholm, P., Otten, V., Wolf, O., Gordon, M., Karsten, G., Sköldenberg, O. & Mukka, S. (2019). Posterior and anterior tilt increases the risk of failure after internal fixation of Garden I and II femoral neck fracture. Acta Orthopaedica, 90(6), 537-541
Open this publication in new window or tab >>Posterior and anterior tilt increases the risk of failure after internal fixation of Garden I and II femoral neck fracture
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2019 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 90, no 6, p. 537-541Article in journal (Refereed) Published
Abstract [en]

Background and purpose - Preoperative posterior tilt of the femoral head as seen on lateral radiographs has been reported to affect the risk of fixation failure in cases of minimally displaced femoral neck fractures (Garden I-II). We investigated radiological risk factors of treatment failure. Patients and methods - We included 417 patients (68% women, median age: 78 years (50-108) with a minimally displaced femoral neck fracture (Garden I-II) treated with internal fixation in a retrospective cohort study. The patients were followed for 3.4 years (2-14). Data on age, sex, housing, cognitive impairment, implant angulation, pre- and postoperative tilt, hip complications, and reoperations were recorded. The risk of fixation failure was assessed using Cox proportional hazards regression analysis. Results - The overall reoperation rate was 17%, and the rate of treatment failure (fixation failure, nonunion, avascular necrosis, or posttraumatic osteoarthritis) was 13%. Cox proportional hazard analysis revealed an increased risk of treatment failure with a preoperative posterior tilt of at least 20 degrees and a preoperative anterior tilt greater than 10 degrees. A failure occurred in 13 of the 65 patients with a posterior tilt of at least 20 degrees and in 5 of the 9 patients with an anterior tilt greater than 10 degrees. Interpretation - A preoperative posterior tilt of 20 degrees and an anterior tilt greater than 10 degrees in cases of Garden I and II femoral neck fractures increase the risk of fixation failure necessitating additional surgery. In this group of patients, there is a need for future interventional studies regarding the feasibility of primary hip arthroplasty.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2019
National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-398709 (URN)10.1080/17453674.2019.1637469 (DOI)000474308800001 ()31269853 (PubMedID)
Available from: 2019-12-12 Created: 2019-12-12 Last updated: 2019-12-12Bibliographically 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(1), 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, no 1, 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.

Place, publisher, year, edition, pages
Walter de Gruyter, 2017
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: 2019-09-25Bibliographically 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
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-6668-8715

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