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  • 1.
    Ackermann, Paul W.
    et al.
    Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden.;Karolinska Univ Hosp, Trauma Acute Surg & Orthopaed, S-17176 Stockholm, Sweden..
    Alim, Md Abdul
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology. Karolinska Inst, Dept Dent Med, Stockholm, Sweden.
    Pejler, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology. Swedish Univ Agr Sci, Dept Anat Physiol & Biochem, Uppsala, Sweden.
    Peterson, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Reg Uppsala, Acad Primary Hlth Care, Uppsala, Sweden.
    Tendon pain: what are the mechanisms behind it?2023In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 23, no 1, p. 14-24Article, review/survey (Refereed)
    Abstract [en]

    Objectives

    Management of chronic tendon pain is difficult and controversial. This is due to poor knowledge of the underlying pathophysiology of chronic tendon pain, priorly known as tendinitis but now termed tendinopathy. The objective of this topical review was to synthesize evolving information of mechanisms in tendon pain, using a comprehensive search of the available literature on this topic.

    Content

    This review found no correlations between tendon degeneration, collagen separation or neovascularization and chronic tendon pain. The synthesis demonstrated that chronic tendon pain, however, is characterized by excessive nerve sprouting with ingrowth in the tendon proper, which corresponds to alterations oberserved also in other connective tissues of chronic pain conditions. Healthy, painfree tendons are devoid of nerve fibers in the tendon proper, while innervation is confined to tendon surrounding structures, such as sheaths. Chronic painful tendons exhibit elevated amounts of pain neuromediators, such as glutamate and substance p as well as up-regulated expression and excitability of pain receptors, such as the glutamate receptor NMDAR1 and the SP receptor NK1, found on ingrown nerves and immune cells. Increasing evidence indicates that mast cells serve as an important link between the peripheral nervous system and the immune systems resulting in so called neurogenic inflammation.

    Summary

    Chronic painful tendons exhibit (1) protracted ingrowth of sensory nerves (2) elevated pain mediator levels and (3) up-regulated expression and excitability of pain receptors, participating in (4) neuro-immune pathways involved in pain regulation. Current treatments that entail the highest scientific evidence to mitigate chronic tendon pain include eccentric exercises and extracorporeal shockwave, which both target peripheral neoinnervation aiming at nerve regeneration.

    Outlook

    Potential mechanism-based pharmacological treatment approaches could be developed by blocking promotors of nerve ingrowth, such as NGF, and promoting inhibitors of nerve ingrowth, like semaphorins, as well as blocking glutamate-NMDA-receptor pathways, which are prominent in chronic tendon pain.

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  • 2.
    Adaikina, Alena
    et al.
    Univ Auckland, Liggins Inst, Auckland, New Zealand.;Univ Auckland, Liggins Inst, Bldg 505 level 2, 85 Pk Rd, Auckland 1042, Auckland, New Zealand..
    Derraik, José G. B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research. Univ Auckland, Liggins Inst, Auckland, New Zealand.;Chiang Mai Univ, Res Inst Hlth Sci, NCD Ctr Excellence, Chiang Mai, Thailand..
    Taylor, Janice
    Starship Childrens Hosp, Child Dev Unit, Auckland, New Zealand.;Starship Childrens Hosp, Newborn Serv, Auckland, New Zealand..
    O'Grady, Gina L.
    Starship Childrens Hosp, Paediat Neurol Dept, Auckland, New Zealand..
    Hofman, Paul L.
    Univ Auckland, Liggins Inst, Auckland, New Zealand..
    Gusso, Silmara
    Univ Auckland, Liggins Inst, Auckland, New Zealand.;Univ Auckland, Exercise Sci Dept, Auckland, New Zealand..
    Vibration Therapy as an Early Intervention for Children Aged 2-4 Years with Cerebral Palsy: A Feasibility Study2023In: Physical & Occupational Therapy in Pediatrics, ISSN 0194-2638, E-ISSN 1541-3144, Vol. 43, no 5, p. 564-581Article in journal (Refereed)
    Abstract [en]

    Aims: To evaluate the feasibility and acceptability of vibration therapy (VT) in preschool children with cerebral palsy (CP) and obtain preliminary data on its potential effectiveness.

    Methods: Nine children aged 2.5-4.8 years (4 boys) with CP GMFCS levels I-III participated in a single-group feasibility study, undergoing a 12-week control period without intervention, followed by 12 weeks of home-based VT (four times/week, 9 min/day, frequency 20 Hz). We assessed adherence to VT protocol, adverse events, and family acceptability of VT. Clinical assessments included motor function (GMFM-66), body composition (DXA), mobility (10-meter walk/run test), and health-related quality of life (PedsQL).

    Results: VT was well tolerated and acceptable to families, with high adherence levels reported (mean = 93%). There were no observed between-period differences (Delta Control vs Delta VT) except for an improvement in the PedsQL "Movement & Balance" dimension with VT (p = 0.044). Nonetheless, changes after the VT but not the Control period were suggestive of potential treatment benefits for mobility, gross motor function, and body composition (lean mass and legs bone mineral density).

    Conclusion: Home-based VT is feasible and acceptable for preschool children with CP. Our preliminary data suggest potential health benefits from VT for these children, supporting larger randomized trials to assess its effectiveness properly.

  • 3.
    Agustsson, Atli
    et al.
    Univ Iceland, Res Ctr Movement Sci, Sch Hlth Sci, Reykjavik, Iceland.;Endurhaefing Pekkingarsetur, Kopavogur, Iceland..
    Sveinsson, Thorarinn
    Univ Iceland, Res Ctr Movement Sci, Sch Hlth Sci, Reykjavik, Iceland..
    Pope, Pauline
    Endurhaefing Pekkingarsetur, Kopavogur, Iceland..
    Rodby-Bousquet, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland. Lund Univ, Div Orthopaed, Dept Clin Sci Lund, Lund, Sweden..
    Preferred posture in lying and its association with scoliosis and windswept hips in adults with cerebral palsy2019In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 41, no 26, p. 3198-3202Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to clarify the association of scoliosis and windswept hips with immobility, lying position, and time in lying, in adults with cerebral palsy (CP).

    Methods: This cross-sectional study included 830 adults (469 males and 361 females) with a diagnosis of CP, 16-73 years, and classified at levels I-V according to the Gross Motor Function Classification System (GMFCS). Subjects' Gross motor function classification system level, presence and severity of scoliosis, hip and knee joint range of movement, lying position, postural ability in lying, and time in lying were used to identify connections between them.

    Results: Adults who are immobile in the lying position have higher odds of both scoliosis and windswept hips. Spending more than 8 h daily in the same lying position, increased the odds of having scoliosis, while lying solely in a supine position, resulted in higher odds of windswept hips.

    Conclusions: The "preferred" habitual posture frequently observed in immobile adults with CP, leads to established distortion of their body shape. The results indicate the need for early introduction of appropriate posture control, in immobile individuals with CP, from a young age.

    IMPLICATIONS FOR REHABILITATION The preferred posture, observed in immobile adults with cerebral palsy, leads to a distortion of their body shape. One in four adults with cerebral palsy use only one position when in bed. The results indicate the need for early introduction of appropriate posture control in individuals unable to change position.

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  • 4.
    Agustsson, Atli
    et al.
    Univ Iceland, Sch Hlth Sci, Res Ctr Movement Sci, Reykjavik, Iceland..
    Sveinsson, Thorarinn
    Univ Iceland, Sch Hlth Sci, Res Ctr Movement Sci, Reykjavik, Iceland..
    Rodby-Bousquet, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Lund Univ, Orthopaed, Dept Clin Sci Lund, Lund, Sweden..
    The effect of asymmetrical limited hip flexion on seating posture, scoliosis and windswept hip distortion2017In: Research in Developmental Disabilities, ISSN 0891-4222, E-ISSN 1873-3379, Vol. 71, p. 18-23Article in journal (Refereed)
    Abstract [en]

    Background: Postural asymmetries with seating problems are common in adults with cerebral palsy.

    Aims: To analyse the prevalence of asymmetrical limited hip flexion (< 90) in adults with CP, and to evaluate the association between asymmetrical limited hip flexion and postural asymmetries in the sitting position.

    Methods and procedures: Cross-sectional data of 714 adults with CP, 16-73 years, GMFCS level I -V, reported to CPUP, the Swedish cerebral palsy national surveillance program and quality registry, from 2013 to 2015. Hip range of motion was analysed in relation to pelvic obliquity, trunk asymmetry, weight distribution, scoliosis and windswept hip distortion.

    Outcomes and results: The prevalence of asymmetrical limited hip flexion increased as GMFCS level decreased. Of adults at GMFCS level V, 22% had asymmetrical limited hip flexion (< 90). The odds of having an oblique pelvis (OR 2.6, 95% CI:1.6-2.1), an asymmetrical trunk (OR 2.1, 95% CI:1.1-4.2), scoliosis (OR 3.7, 95% CI:1.3-9.7), and windswept hip distortion (OR 2.6, 95% CI:1.2-5.4) were higher for adults with asymmetrical limited hip flexion compared with those with bilateral hip flexion > 90 degrees.

    Conclusions and implications: Asymmetrical limited hip flexion affects the seating posture and is associated with scoliosis and windswept hip distortion.

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  • 5.
    Ahonen, Matti
    et al.
    Univ Helsinki, Dept Pediat Surg Orthoped & Traumatol, Helsinki, Finland.;Helsinki Univ Hosp, Helsinki, Finland.;Univ Helsinki, Dept Pediat Surg Orthoped & Traumatol, Stenbackinkatu 9, Helsinki 00029, Finland.;Helsinki Univ Hosp, Stenbackinkatu 9, Helsinki 00029, Finland..
    Syvanen, Johanna
    Univ Turku, Dept Pediat Orthoped, Turku, Finland.;Turku Univ Hosp, Turku, Finland..
    Helenius, Linda
    Turku Univ Hosp, Turku, Finland.;Univ Turku, Dept Anesthes & Intens Care, Turku, Finland..
    Mattila, Mikko
    Univ Helsinki, Dept Pediat Surg Orthoped & Traumatol, Helsinki, Finland.;Helsinki Univ Hosp, Helsinki, Finland..
    Perokorpi, Tanja
    Univ Helsinki, Dept Pediat Surg Orthoped & Traumatol, Helsinki, Finland.;Helsinki Univ Hosp, Helsinki, Finland..
    Diarbakerli, Elias
    Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Reconstruct Orthoped, Stockholm, Sweden..
    Gerdhem, Paul
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences. Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Stockholm, Sweden.;Uppsala Univ Hosp, Dept Orthoped & Hand Surg, Uppsala, Sweden..
    Helenius, Ilkka
    Helsinki Univ Hosp, Helsinki, Finland.;Univ Helsinki, Dept Orthoped & Traumatol, Helsinki, Finland..
    Back Pain and Quality of Life 10 Years After Segmental Pedicle Screw Instrumentation for Adolescent Idiopathic Scoliosis2023In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 48, no 10, p. 665-671Article in journal (Refereed)
    Abstract [en]

    Study Design.Comparative cohort study. Objective.The aim of the present study was to evaluate pain and health-related quality of life (HRQoL) in surgically managed patients with a minimum follow-up of 10 years compared with patients with untreated adolescent idiopathic scoliosis (AIS) and a healthy control group. Summary of Background Data.Posterior spinal fusion with pedicle screws is the standard treatment for AIS, although it remains unclear whether this procedure results in improved long-term HRQoL compared with untreated patients with AIS. Patients and Methods.Sixty-four consecutive patients at a minimum follow-up of 10 years, who underwent posterior pedicle screw instrumentation for AIS were prospectively enrolled. Fifty-three (83%) of these patients completed Scoliosis Research Society (SRS) 24 questionnaires, clinical examination, and standing spinal radiographs. Pain and HRQoL were compared with age and sex-matched patients with untreated AIS and healthy individuals. Results.The mean major curve was 57 degrees preoperatively and 15 degrees at the 10-year follow-up. SRS-24 self-image domain score showed a significant improvement from preoperative to 2 years and remained significantly better at the 10-year follow-up (P < 0.001). Patients fused to L3 or below had lower pain, satisfaction, and total score than patients fused to L2 or above (P < 0.05), but self-image, function, and activity scores did not differ between groups at 10-year follow-up. Pain, self-image, general activity, and total SRS domains were significantly better at 10-year follow-up in the surgically treated patients as compared with untreated patients (all P < 0.05). Healthy controls had significantly higher total scores than those surgically treated at 10-year follow-ups (P < 0.001). Conclusion.Patients undergoing segmental pedicle screw instrumentation for AIS maintain high-level HRQoL during a 10-year follow-up. Their HRQoL was significantly better than in the untreated patients with AIS, except for the function domain. However, HRQoL remained at a lower level than in healthy controls.

  • 6. Al-Ani, Amer
    et al.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Säff, Maria
    Neander, Gustaf
    Blomfeldt, Richard
    Ekström, Wilhelmina
    Hedström, Margareta
    Low bone mineral density and fat free mass in young and middle-aged patients with a femoral neck fracture2015In: European Journal of Clinical Investigation, ISSN 0014-2972, E-ISSN 1365-2362, Vol. 45, no 8, p. 800-806Article in journal (Refereed)
    Abstract [en]

    Background

    Reduced bone mineral density (BMD) together with muscle wasting and dysfunction, that is sarcopenia, emerges as a risk factor for hip fracture. The aim of this study was to examine body composition and BMD and their relationship with trauma mechanisms in young and middle-aged patients with femoral neck fracture.

    Materials and methods

    Altogether, 185 patients with femoral neck fracture aged 20–69 were included. BMD, body composition and fat-free mass index (FFMI) were determined by dual-X-ray absorptiometry (DXA), and trauma mechanisms were registered.

    Results

    Ninety per cent of the whole study population had a femoral neck BMD below the mean for age. In the young patients (< 50 years), 27% had a Z-score of BMD ≤ −2 SD. More than half of the middle-aged patients (50–69 years) had osteopenia, that is T-score −1 to −2·5, and 35% had osteoporosis, that is T-score < −2·5, at the femoral neck. Patients with low-energy trauma, sport injury or high-energy trauma had a median standardised BMD of 0·702, 0·740 vs. 0·803 g/cm2 (= 0·03), and a median FFMI of 15·9, 17·7 vs. 17·5 kg/m2 (< 0·001), respectively. FFMI < 10th percentile of an age- and gender-matched reference population was observed in one-third.

    Conclusions

    A majority had low BMD at the femoral neck, and one-third had reduced FFMI (i.e. sarcopenia). Patients with fracture following low-energy trauma had significantly lower femoral neck BMD and FFMI than patients with other trauma mechanisms. DXA examination of both BMD and body composition could be of value especially in those with low-energy trauma.

  • 7. Al-Ani, Amer N.
    et al.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Saaf, Maria
    Neander, Gustaf
    Blomfeldt, Richard
    Ekstrom, Wilhelmina
    Hedstrom, Margareta
    Low bone mineral density and fat-free mass in younger patients with a femoral neck fracture2015In: European Journal of Clinical Investigation, ISSN 0014-2972, E-ISSN 1365-2362, Vol. 45, no 8, p. 800-806Article in journal (Refereed)
    Abstract [en]

    Background Reduced bone mineral density (BMD) together with muscle wasting and dysfunction, that is sarcopenia, emerges as a risk factor for hip fracture. The aim of this study was to examine body composition and BMD and their relationship with trauma mechanisms in young and middle-aged patients with femoral neck fracture. Materials and methods Altogether, 185 patients with femoral neck fracture aged 20-69 were included. BMD, body composition and fat-free mass index (FFMI) were determined by dual-X-ray absorptiometry (DXA), and trauma mechanisms were registered. Results Ninety per cent of the whole study population had a femoral neck BMD below the mean for age. In the young patients (<50years), 27% had a Z-score of BMD-2 SD. More than half of the middle-aged patients (50-69years) had osteopenia, that is T-score -1 to -25, and 35% had osteoporosis, that is T-score<-25, at the femoral neck. Patients with low-energy trauma, sport injury or high-energy trauma had a median standardised BMD of 0702, 0740 vs. 0803g/cm(2) (P=003), and a median FFMI of 159, 177 vs. 175kg/m(2) (P<0001), respectively. FFMI<10th percentile of an age- and gender-matched reference population was observed in one-third. Conclusions A majority had low BMD at the femoral neck, and one-third had reduced FFMI (i.e. sarcopenia). Patients with fracture following low-energy trauma had significantly lower femoral neck BMD and FFMI than patients with other trauma mechanisms. DXA examination of both BMD and body composition could be of value especially in those with low-energy trauma.

  • 8. Albrektsson, Madelene
    et al.
    Möller, Michael
    Wolf, Olof
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics and Handsurgery.
    Wennergren, David
    Sundfeldt, Mikael
    Acetabular fractures: Epidemiology and mortality based on 2,132 fractures from the Swedish Fracture Register2023In: Bone & Joint Open, E-ISSN 2633-1462, Vol. 4, no 9, p. 652-658Article in journal (Refereed)
    Abstract [en]

    AIMS: To describe the epidemiology of acetabular fractures including patient characteristics, injury mechanisms, fracture patterns, treatment, and mortality.

    METHODS: We retrieved information from the Swedish Fracture Register (SFR) on all patients with acetabular fractures, of the native hip joint in the adult skeleton, sustained between 2014 and 2020. Study variables included patient age, sex, injury date, injury mechanism, fracture classification, treatment, and mortality.

    RESULTS: In total, 2,132 patients with acetabular fractures from the SFR were included in the study. The majority of the patients were male (62%) and aged over 70 years old (62%). For patients aged > 70 years, the 30-day mortality was 8% and one-year mortality 24%. For patients aged ≤ 70 years, the 30-day mortality was 0.2% and one-year mortality 2%. Low-energy injuries (63%) and anterior wall fractures (20%) were most common. Treatment was most often non-surgical (75%).

    CONCLUSION: The majority of patients who sustain an acetabular fracture are elderly (> 70 years), of male sex, and the fracture most commonly occurs after a simple, low-energy fall. Non-surgical treatment is chosen in the majority of acetabular fracture patients. The one-year mortality for elderly patients with acetabular fracture is similar to the mortality after hip fracture, and a similar multidisciplinary approach to care for these patients should be considered.

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  • 9.
    Albrektsson, Madelene
    et al.
    Sahlgrens Univ Hosp, Dept Orthopaed, Gothenburg, Sweden.;Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Gothenburg, Sweden..
    Wolf, Olof
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Enocson, Anders
    Karolinska Univ Hosp, Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden..
    Sundfeldt, Mikael
    Sahlgrens Univ Hosp, Dept Orthopaed, Gothenburg, Sweden.;Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Gothenburg, Sweden..
    Validation of the classification of surgically treated acetabular fractures in the Swedish Fracture Register2022In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 53, no 6, p. 2145-2149Article in journal (Refereed)
    Abstract [en]

    Objectives

    To validate the classification of surgically treated acetabular fractures in the Swedish Fracture Register (SFR) and to investigate the intra- and interrater reliability of the Judet-Letournel / AO/OTA classification systems.

    Methods

    Surgically treated acetabular fractures were randomly selected from the SFR (n = 132) and 124 fractures were classified independently by three experienced orthopedic pelvic surgeons at two different occasions. A gold standard classification was established for each case after these two sessions or, if necessary, after a discussion session. The gold standard classification was compared to the registered SFR classification to assess the validity of SFR data. Accuracy and intra- and interrater agreement were evaluated using Cohen's kappa with interpretation according to Landis and Koch.

    Results

    There was moderate agreement between the established gold standard classification and the SFR (kappa 0.43). The level of agreement differed between classification groups. The intrarater agreement was substantial to almost perfect and interrater agreement was moderate to substantial.

    Conclusions

    The accuracy of acetabular fracture classifications in the SFR was moderate and comparable to previous validation studies from the SFR on other fracture types. As the accuracy differed between fracture groups, care should be taken when analyzing data from the SFR on specific acetabular fracture groups.

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  • 10.
    Alexandersson, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Nyköping Hosp, Dept Orthoped, Nyköping, Sweden.
    Wang, Eugen Yu-Hui
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Eriksson, Staffan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy. Umeå Univ, Dept Community Med & Rehabil, Physiotherapy, Umeå, Sweden.
    A small difference in recovery between total knee arthroplasty with and without tourniquet use the first 3 months after surgery: a randomized controlled study2019In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 27, no 4, p. 1035-1042Article in journal (Refereed)
    Abstract [en]

    Purpose: When a tourniquet is used during surgery on the extremities, the pressure applied to the muscles, nerves and blood vessels can cause neuromuscular damage that contributes to postoperative weakness. The hypothesis was that the rehabilitation-related results would be improved if total knee arthroplasty (TKA) is performed without the use of a tourniquet.

    Methods: 81 patients with osteoarthritis of the knee who underwent TKA surgery were randomized to surgery with or without tourniquet. Active flexion and extension of the knee, pain by visual analog scale (VAS), swelling by knee circumference, quadriceps function by straight leg raise, and timed up and go (TUG) test results were measured before and up to 3 months after surgery.

    Results: ANCOVA revealed no between-groups effect for flexion of the knee at day 3 postsurgery. Compared with the tourniquet group, the nontourniquet group experienced elevated pain at 24 h, with a mean difference of 16.6 mm, p = 0.005. The effect on mobility (TUG test) at 3 months was better in the nontourniquet group, with a mean difference of -1.1 s, p = 0.029.

    Conclusions: The hypothesis that the rehabilitation-related results would be improved without a tourniquet is not supported by the results. When the results in this study for surgery performed with and without tourniquet are compared, no clear benefit for either procedure was observed, as the more pain exhibited by the nontourniquet group was only evident for a short period and the improved mobility in this group was not at a clinically relevant level.

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  • 11.
    Ali, Muhanned
    et al.
    Kristianstad & Hässleholm Hosp, Dept Orthoped, Hässleholm, Sweden.
    Brogren, Elisabeth
    Skåne Univ Hosp, Dept Hand Surg, Malmö, Sweden;Kristianstad & Hässleholm Hosp, Dept Orthoped, Hässleholm, Sweden.
    Wagner, Philippe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Atroshi, Isam
    Lund Univ, Dept Clin Sci Orthoped, Lund, Sweden;Kristianstad & Hässleholm Hosp, Dept Orthoped, Hässleholm, Sweden.
    Association Between Distal Radial Fracture Malunion and Patient-Reported Activity Limitations: A Long-Term Follow-up2018In: Journal of Bone and Joint Surgery. American volume, ISSN 0021-9355, E-ISSN 1535-1386, Vol. 100, no 8, p. 633-639Article in journal (Refereed)
    Abstract [en]

    Background: The long-term effect of distal radial fracture malunion on activity limitations is unknown. Between 2001 and 2002, we conducted a prospective cohort study of all patients with distal radial fracture treated with casting or percutaneous fixation in northeast Scania in Sweden. In that original study, the patients completed the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire at baseline and at 2 years. We performed a long-term follow-up study of patients who were 18 to 65 years of age at the time of the fracture to investigate the association between fracture malunion and activity limitations. Methods: In this long-term follow-up, patients who had participated in the original study completed the DASH questionnaire and a visual analog scale (VAS) for pain and for satisfaction (scored, 0 [best] to 100) and underwent radiographic and physical examinations at 12 to 14 years after the fracture. We defined malunion as dorsal angulation of >= 10 degrees, ulnar variance of >= 3 mm, and/or radial inclination of <= 15 degrees. We also assessed the presence of radiocarpal osteoarthritis and ulnar styloid nonunion. The primary outcome was the change in DASH score from baseline. Secondary outcomes were DASH, pain, and satisfaction scores, wrist range of motion, and grip strength at the time of the follow-up. Results: Of 85 eligible patients, 63 (74%) responded to the questionnaires and underwent examinations. Mal union was found in 25 patients, osteoarthritis was found in 38 patients, and styloid nonunion was found in 9 patients. Compared with patients without malunion, those with malunion had significantly worse DASH scores from baseline to 12 to 14 years (p = 0.002); the adjusted mean difference was 11 points (95% confidence interval [CI], 4 to 17 points). Similarly, follow-up scores were significantly worse among patients with malunion; the adjusted mean difference was 14 points (95% CI, 7 to 22 points; p < 0.001) for DASH scores, 10 points (95% CI, 0 to 20 points; p = 0.049) for VAS pain scores, and 26 points (95% CI, 11 to 41 points; p = 0.001) for VAS satisfaction scores. No differences were found in range of motion or grip strength. Osteoarthritis (mostly mild) and styloid nonunion had no significant association (p > 0.05) with DASH scores, VAS pain or satisfaction scores, or grip strength. Conclusions: Patients who sustain a distal radial fracture at the age of 18 to 65 years and develop malunion are more likely to have worse long-term outcomes including activity limitations and pain.

  • 12.
    Alim, Abdul
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Public Health and Caring Sciences.
    Mechanisms in Tendon Healing: Pain, Biomarkers and the Role of Mast Cells2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Tendon injuries and tendinopathy are common disorders, but the underlying mechanisms are not well understood. The overall aim of this thesis was to better understand the mechanisms underlying tendon healing, pain, and inflammation.

    The aim of the first study was to assess biomarkers of tendon healing, including procollagen type I (PINP) and type III (PIIINP) in relation to patient outcome in 65 patients with Achilles tendon rupture (ATR). At two weeks post-ATR, PINP and PIIINP-levels were quantified using microdialysis followed by ELISA. At one-year post-ATR patient outcome was assessed using the validated Achilles tendon Total Rupture Score. We found that higher ratio of PINP and PIIINP to total protein were significantly associated with less pain but more fatigue in the affected limb.

    In the second study, we applied Intermittent Pneumatic Compression (IPC) therapy for two weeks to stimulate tendon healing. The patients received either adjuvant IPC treatment or treatment-as-usual in a plaster cast without IPC. We observed that IPC therapy significantly increased PINP levels in the injured tendon, suggesting enhanced healing response.

    In our third study, we investigated healing response and the role of mast cells (MCs) in-vivo using an ATR rat model. Three weeks postoperatively, we demonstrated an increased number of MCs and a higher proportion of degranulated MCs in the injured tendon compared to the control. We further established that MCs in the injured tendon were positive for the glutamate receptor NMDAR1.

    In our final study, we assessed the effect of glutamate stimulation on in-vitro-derived mouse bone marrow MCs. Mast cell degranulation was quantified through β-hexosaminidase release, immunofluorescence was used to quantify NMDARs at the protein level, and RT-qPCR/microarray was used to study the expression of NMDARs and associated genes. Glutamate induced a robust upregulation of glutamate receptors of both ionotropic and metabotropic type, both at the mRNA and at protein level. NMDAR1 co-localized with glutamate in the membrane of MCs, thereby confirming an interaction between glutamate and its receptor. Glutamate also induced expression of pro-inflammatory compounds such as IL-6 and CCL2 and transcription factors such as Egr2, Egr3 and FosB. Moreover, the NMDA-channel blocker MK-801 completely abrogated the response of MCs to glutamate, supporting a functional glutamate–glutamate receptor axis in MCs.

    Together, findings presented in this dissertation reveal possible mechanisms of tendon healing in relation to pain and function, and establish a novel principle for how immune cells can communicate with nerve cells after ATR.

    List of papers
    1. Procollagen markers in microdialysate can predict patient outcome after Achilles tendon rupture.
    Open this publication in new window or tab >>Procollagen markers in microdialysate can predict patient outcome after Achilles tendon rupture.
    2016 (English)In: BMJ open sport & exercise medicine, ISSN 2055-7647, Vol. 2, no 1, article id e000114Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: Patients who sustain acute Achilles tendon rupture (ATR) exhibit variable and mostly impaired long-term functional, and patient-reported outcomes. However, there exists a lack of early predictive markers of long-term outcomes to facilitate the development of improved treatment methods. The aim of this study was to assess markers of tendon callus production in patients with ATR in terms of outcome, pain, and fatigue.

    STUDY DESIGN AND SETTING: Prospective cohort study; level of evidence 2. Outpatient orthopaedic/sports medicine department.

    PATIENTS: A total of 65 patients (57 men, 8 women; mean age 41±7 years) with ATR were prospectively assessed.

    ASSESSMENTS: Markers of tendon callus production, procollagen type I N-terminal propeptide (PINP) and procollagen type III N-terminal propeptide (PIIINP), were assessed 2 weeks postoperatively using microdialysis followed by enzymatic quantification. Normalised procollagen levels (n-PINP and n-PIIINP) were calculated as the ratio of procollagen to total protein content. Pain and fatigue were assessed at 1 year using reliable questionnaires Achilles tendon Total Rupture Score (ATRS).

    RESULTS: Patients exhibited fatigue (77.6%) and pain (44.1%) to some extent. Higher levels of n-PINP (R=0.38, p=0.016) and n-PIIINP (R=0.33, p=0.046) were significantly associated with less pain in the limb. Increased concentrations of PINP (R=-0.47, p=0.002) and PIIINP (R=-0.37, p=0.024) were related to more self-reported fatigue in the leg. The results were corroborated by multiple linear regression analyses.

    CONCLUSIONS: Assessment of procollagen markers in early tendon healing can predict long-term patient-reported outcomes after ATR. These novel findings suggest that procollagen markers could be used to facilitate the development of improved treatment methods in patients who sustain ATR.

    TRIAL REGISTRATION NUMBERS: NCT01317160: Results. NCT02318472: Pre-results.

    Place, publisher, year, edition, pages
    London, UK: , 2016
    Keywords
    Achilles, Chronic, Collagen, Injuries, Tendon
    National Category
    Orthopaedics
    Research subject
    Orthopaedics
    Identifiers
    urn:nbn:se:uu:diva-395018 (URN)10.1136/bmjsem-2016-000114 (DOI)27900179 (PubMedID)
    Available from: 2019-10-11 Created: 2019-10-11 Last updated: 2020-02-19Bibliographically approved
    2. Achilles tendon rupture healing is enhanced by intermittent pneumatic compression upregulating collagen type I synthesis
    Open this publication in new window or tab >>Achilles tendon rupture healing is enhanced by intermittent pneumatic compression upregulating collagen type I synthesis
    Show others...
    2018 (English)In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 26, no 7, p. 2021-2029Article in journal (Refereed) Published
    Abstract [en]

    PURPOSE AND HYPOTHESIS: Adjuvant intermittent pneumatic compression (IPC) during leg immobilization following Achilles tendon rupture (ATR) has been shown to reduce the risk of deep venous thrombosis. The purpose of this study was to investigate whether IPC can also promote tendon healing.

    METHODS: One hundred and fifty patients with surgical repair of acute ATR were post-operatively leg immobilized and prospectively randomized. Patients were allocated for 2 weeks of either adjuvant IPC treatment (n = 74) or treatment-as-usual (n = 74) in a plaster cast without IPC. The IPC group received 6 h daily bilateral calf IPC applied under an orthosis on the injured side. At 2 weeks post-operatively, tendon healing was assessed using microdialysis followed by enzymatic quantification of tendon callus production, procollagen type I (PINP) and type III (PIIINP) N-terminal propeptide, and total protein content. 14 IPC and 19 cast patients (control group) consented to undergo microdialysis. During weeks 3-6, all subjects were leg-immobilized in an orthosis without IPC. At 3 and 12 months, patient-reported outcome was assessed using reliable questionnaires (ATRS and EQ-5D). At 12 months, functional outcome was measured using the validated heel-rise test.

    RESULTS: At 2 weeks post-rupture, the IPC-treated patients exhibited 69% higher levels of PINP in the ruptured Achilles tendon (AT) compared to the control group (p = 0.001). Interestingly, the IPC-treated contralateral, intact AT also demonstrated 49% higher concentrations of PINP compared to the non-treated intact AT of the plaster cast group (p = 0.002). There were no adverse events observed associated with IPC. At 3 and 12 months, no significant (n.s.) differences between the two treatments were observed using patient-reported and functional outcome measures.

    CONCLUSIONS: Adjuvant IPC during limb immobilization in patients with ATR seems to effectively enhance the early healing response by upregulation of collagen type I synthesis, without any adverse effects. Whether prolonged IPC application during the whole immobilization period can also lead to improved long-term clinical healing response should be further investigated. The healing process during leg immobilization in patients with Achilles tendon rupture can be improved through adjuvant IPC therapy, which additionally prevents deep venous thrombosis.

    LEVEL OF EVIDENCE: Randomized controlled trial, Level I.

    Keywords
    Achilles tendon rupture, Intermittent pneumatic compression devices, Microdialysis, Procollagen, Regeneration
    National Category
    Surgery
    Identifiers
    urn:nbn:se:uu:diva-395017 (URN)10.1007/s00167-017-4621-8 (DOI)28668970 (PubMedID)
    Available from: 2019-10-11 Created: 2019-10-11 Last updated: 2020-02-19Bibliographically approved
    3. Increased mast cell degranulation and co-localization of mast cells with the NMDA receptor-1 during healing after Achilles tendon rupture
    Open this publication in new window or tab >>Increased mast cell degranulation and co-localization of mast cells with the NMDA receptor-1 during healing after Achilles tendon rupture
    Show others...
    2017 (English)In: Cell and Tissue Research, ISSN 0302-766X, E-ISSN 1432-0878, Vol. 370, no 3, p. 451-460Article in journal (Refereed) Published
    Abstract [en]

    The role of inflammation and the mechanism of tendon healing after rupture has historically been a matter of controversy. The purpose of the present study is to investigate the role of mast cells and their relation to the NMDA receptor-1 (a glutamate receptor) during healing after Achilles tendon rupture. Eight female Sprague Dawley rats had their right Achilles tendon transected. Three weeks after rupture, histological quantification of mast cell numbers and their state of degranulation was assessed by histochemistry. Co-localization of mast cell tryptase (a mast cell marker) and NMDA receptor-1 was determined by immunofluorescence. The intact left Achilles tendon was used as control. An increased number of mast cells and a higher proportion of degranulated mast cells were found in the healing Achilles tendon compared to the intact. In addition, increased co-localization of mast cell tryptase and NMDA receptor-1 was seen in the areas of myotendinous junction, mid-tendon proper and bone tendon junction of the healing versus the intact tendon. These findings introduce a possible role for mast cells in the healing phase after Achilles tendon rupture.

    Place, publisher, year, edition, pages
    Berlin Heidelberg: , 2017
    Keywords
    Achilles tendon healing, Mast cells, NMDA, Rats, Tryptase
    National Category
    Cell and Molecular Biology
    Research subject
    Orthopaedics; Immunology
    Identifiers
    urn:nbn:se:uu:diva-395522 (URN)10.1007/s00441-017-2684-y (DOI)000416358400010 ()28975451 (PubMedID)
    Available from: 2019-10-20 Created: 2019-10-20 Last updated: 2020-02-06Bibliographically approved
    4. Glutamate triggers the expression of functional ionotropic and metabotropic glutamate receptors in mast cells
    Open this publication in new window or tab >>Glutamate triggers the expression of functional ionotropic and metabotropic glutamate receptors in mast cells
    Show others...
    2021 (English)In: Cellular & Molecular Immunology, ISSN 1672-7681, E-ISSN 2042-0226, Vol. 18, no 10, p. 2383-2392Article in journal (Refereed) Published
    Abstract [en]

    Mast cells are emerging as players in the communication between peripheral nerve endings and cells of the immune system. However, it is not clear the mechanism by which mast cells communicate with peripheral nerves. We previously found that mast cells located within healing tendons can express glutamate receptors, raising the possibility that mast cells may be sensitive to glutamate signaling. To evaluate this hypothesis, we stimulated primary mast cells with glutamate and showed that glutamate induced the profound upregulation of a panel of glutamate receptors of both the ionotropic type (NMDAR1, NMDAR2A, and NMDAR2B) and the metabotropic type (mGluR2 and mGluR7) at both the mRNA and protein levels. The binding of glutamate to glutamate receptors on the mast cell surface was confirmed. Further, glutamate had extensive effects on gene expression in the mast cells, including the upregulation of pro-inflammatory components such as IL-6 and CCL2. Glutamate also induced the upregulation of transcription factors, including Egr2, Egr3 and, in particular, FosB. The extensive induction of FosB was confirmed by immunofluorescence assessment. Glutamate receptor antagonists abrogated the responses of the mast cells to glutamate, supporting the supposition of a functional glutamate-glutamate receptor axis in mast cells. Finally, we provide in vivo evidence supporting a functional glutamate-glutamate receptor axis in the mast cells of injured tendons. Together, these findings establish glutamate as an effector of mast cell function, thereby introducing a novel principle for how cells in the immune system can communicate with nerve cells.

    Place, publisher, year, edition, pages
    Springer Nature, 2021
    Keywords
    Glutamate, Glutamate receptors, Mast cells, NMDA receptors, Tryptase
    National Category
    Immunology in the medical area
    Identifiers
    urn:nbn:se:uu:diva-434116 (URN)10.1038/s41423-020-0421-z (DOI)000527501500001 ()32313211 (PubMedID)
    Funder
    AFA InsuranceSwedish Research CouncilSwedish Cancer SocietyThe Swedish Heart and Lung AssociationKnut and Alice Wallenberg Foundation
    Available from: 2021-02-05 Created: 2021-02-05 Last updated: 2023-07-14Bibliographically approved
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  • 13.
    Alim, Md Abdul
    et al.
    Integrative Orthopedic Laboratory, Department of Molecular Medicine and Surgery , Karolinska Institutet , Stockholm , Sweden.
    Svedman, Simon
    Integrative Orthopedic Laboratory, Department of Molecular Medicine and Surgery , Karolinska Institutet , Stockholm , Sweden.
    Edman, Gunnar
    Department of Psychiatry , Tiohundra AB , Norrtälje , Sweden.
    Ackermann, Paul W.
    Integrative Orthopedic Laboratory, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Orthopedics, Karolinska University Hospital, Stockholm, Sweden.
    Procollagen markers in microdialysate can predict patient outcome after Achilles tendon rupture.2016In: BMJ open sport & exercise medicine, ISSN 2055-7647, Vol. 2, no 1, article id e000114Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Patients who sustain acute Achilles tendon rupture (ATR) exhibit variable and mostly impaired long-term functional, and patient-reported outcomes. However, there exists a lack of early predictive markers of long-term outcomes to facilitate the development of improved treatment methods. The aim of this study was to assess markers of tendon callus production in patients with ATR in terms of outcome, pain, and fatigue.

    STUDY DESIGN AND SETTING: Prospective cohort study; level of evidence 2. Outpatient orthopaedic/sports medicine department.

    PATIENTS: A total of 65 patients (57 men, 8 women; mean age 41±7 years) with ATR were prospectively assessed.

    ASSESSMENTS: Markers of tendon callus production, procollagen type I N-terminal propeptide (PINP) and procollagen type III N-terminal propeptide (PIIINP), were assessed 2 weeks postoperatively using microdialysis followed by enzymatic quantification. Normalised procollagen levels (n-PINP and n-PIIINP) were calculated as the ratio of procollagen to total protein content. Pain and fatigue were assessed at 1 year using reliable questionnaires Achilles tendon Total Rupture Score (ATRS).

    RESULTS: Patients exhibited fatigue (77.6%) and pain (44.1%) to some extent. Higher levels of n-PINP (R=0.38, p=0.016) and n-PIIINP (R=0.33, p=0.046) were significantly associated with less pain in the limb. Increased concentrations of PINP (R=-0.47, p=0.002) and PIIINP (R=-0.37, p=0.024) were related to more self-reported fatigue in the leg. The results were corroborated by multiple linear regression analyses.

    CONCLUSIONS: Assessment of procollagen markers in early tendon healing can predict long-term patient-reported outcomes after ATR. These novel findings suggest that procollagen markers could be used to facilitate the development of improved treatment methods in patients who sustain ATR.

    TRIAL REGISTRATION NUMBERS: NCT01317160: Results. NCT02318472: Pre-results.

  • 14.
    Andersen, Mikkel Österheden
    et al.
    Reg Southern Denmark, Ctr Spine Surg & Res, Middelfart, Denmark;Univ Southern Denmark, Odense, Denmark.
    Fritzell, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics. Capio St Goran Hosp, Stockholm, Sweden;Qulturum Ctr Learning & Innovat Healthcare, Jonkoping, Sweden.
    Eiskjaer, Sören Peter
    Aalborg Univ Hosp, Aalborg C, Denmark.
    Lagerbäck, Tobias
    Karolinska Univ Hosp, Huddinge, Sweden;Karolinska Inst, Huddinge, Sweden.
    Hägg, Olle
    Spine Ctr Goteborg, Gothenburg, Sweden.
    Nordvall, Dennis
    Qulturum Ctr Learning & Innovat Healthcare, Jonkoping, Sweden.
    Lönne, Greger
    Innlandet Hosp Trust, Lillehammer, Norway;Trondheim Reg & Univ Hosp, St Olavs Hosp, Trondheim, Norway.
    Solberg, Tore
    Univ Hosp Northern Norway, Tromso, Norway;Arctic Univ Norway, Tromso, Norway.
    Jacobs, Wilco
    van Hooff, Miranda
    Sint Maartenskliniek, Nijmegen, Netherlands;Radboud Univ Nijmegen, Med Ctr, Nijmegen, Netherlands.
    Gerdhem, Paul
    Karolinska Univ Hosp, Huddinge, Sweden;Karolinska Inst, Huddinge, Sweden.
    Gehrchen, Martin
    Univ Copenhagen, Rigshosp, Copenhagen, Denmark.
    Surgical Treatment of Degenerative Disk Disease in Three Scandinavian Countries: An International Register Study Based on Three Merged National Spine Registers2019In: Global Spine Journal, ISSN 2192-5682, E-ISSN 2192-5690, Vol. 9, no 8, p. 850-858Article in journal (Refereed)
    Abstract [en]

    Study Design: Observational study of prospectively collected data.

    Objectives: Patients with chronic low back pain resistant to nonoperative treatment often face a poor prognosis for recovery. The aim of the current study was to compare the variation and outcome of surgical treatment of degenerative disc disease in the Scandinavian countries based on The International Consortium for Health Outcomes Measurement core spine data sets.

    Methods: Anonymized individual level data from 3 national registers were pooled into 1 database. At the time of surgery, the patient reports data on demographics, lifestyle topics, comorbidity, and data on health-related quality of life such as Oswestry Disability Index, Euro-Qol-5D, and back and leg pain scores. The surgeon records diagnosis, type of surgery performed, and complications. One-year follow-ups are obtained with questionnaires. Baseline and 1-year follow-up data were analyzed to expose any differences between the countries.

    Results: A total of 1893 patients were included. At 1-year follow-up, 1315 (72%) patients responded. There were statistically significant baseline differences in age, smoking, comorbidity, frequency of previous surgery and intensity of back and leg pain. Isolated fusion was the primary procedure in all the countries ranging from 84% in Denmark to 76% in Sweden. There was clinically relevant improvement in all outcome measures except leg pain.

    Conclusions: In homogenous populations with similar health care systems the treatment traditions can vary considerably. Despite variations in preoperative variables, patient reported outcomes improve significantly and clinically relevant with surgical treatment.

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    FULLTEXT01
  • 15.
    Andersson, Peter
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Center for Clinical Research Dalarna. Karolinska Inst, Dept Clin Neurosci Psychol, Stockholm, Sweden..
    Lundberg, Johan
    Stockholm Hlth Care Serv, Stockholm, Sweden.;Karolinska Univ Hosp, Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, SE-17176 Stockholm, Sweden.;Karolinska Univ Hosp, Stockholm Hlth Care Serv, SE-17176 Stockholm, Sweden..
    Jarbin, Håkan
    Child & Adolescent Psychiat, Reg Halland, Halland, Sweden.;Lund Univ, Dept Clin Sci Lund, Child & Adolescent Psychiat, Lund, Sweden..
    Jokinen, Jussi
    Karolinska Univ Hosp, Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, SE-17176 Stockholm, Sweden.;Karolinska Univ Hosp, Stockholm Hlth Care Serv, SE-17176 Stockholm, Sweden.;Umeå Univ, Dept Clin Sci, Psychiat, Umeå, Sweden..
    Boström, Adrian E. Desai
    Stockholm Hlth Care Serv, Stockholm, Sweden.;Karolinska Univ Hosp, Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, SE-17176 Stockholm, Sweden.;Karolinska Univ Hosp, Stockholm Hlth Care Serv, SE-17176 Stockholm, Sweden.;Umeå Univ, Dept Clin Sci, Psychiat, Umeå, Sweden.;Karolinska Univ Hosp, Stockholm Hlth Care Serv, Reg Stockholm, SE-17176 Stockholm, Sweden..
    Inverse association of anti-inflammatory prescription fills and suicide-related mortality in young adults: Evidence from a nationwide study of Swedish regions, 2006-20212023In: Brain, Behavior, and Immunity - Health, E-ISSN 2666-3546, Vol. 31, article id 100665Article in journal (Refereed)
    Abstract [en]

    Background: This cross-sectional study examined nationwide real-world associations between anti-inflammatory agent fills and suicide-related death rates in 20-24-year-olds across the 21 Swedish regions during 2006-2021.

    Methods: Nationwide Swedish registers were used to compare regional year-wise suicide-related mortality (SRM) and dispensations for anti-inflammatory agents (ATC-code: M01) in 20-24-year-olds. Dispensations for paracetamol (ATC-code: N02BE01) was applied as a control variable. Associations between regional year-wise SRM and dispensation rates were analyzed by sex-stratified zero-inflated generalized linear mixed effect models (GLMM). Dispensation rates of paracetamol and inflammatory agents were designated as independent fixed effects variables, and year and region constituted random-intercept effects.

    Results: Acetic acid derivatives and related substances (M01AB) and propionic acid derivates (M01A3) accounted for-71% of measured dispensation fills for anti-inflammatory agents. Diclofenac fills constituted-98% of the former category, whereas dispensations for Ibuprofen (-21%), Naproxen (-62%) and Ketoprofen (-13%) constituted the most prescribed agents in the latter category. Regional yearly dispensation rates of anti-inflammatory agents in 20-24-year-old females were inversely associated with female SRM (& beta; = - 0.095, p = 0.0393, 95% CI-0.186,-0.005) - independent of paracetamol rates, which were unassociated to SRM (p = 0.2094). Results were confirmed in validation analyses for anti-inflammatory agents (OR = 0.7232, p = 0.0354, 95% CI [OR] 0.5347, 0.9781). No association was demonstrated in males (p = 0.833).

    Conclusion: Anti-inflammatory agent dispensation rates were independently associated to lower suicide-related death rates in female 20-24-year-olds. This adds to growing evidence implicating inflammatory processes in mental disorders, warranting trials focusing on the suicide preventative potential of anti-inflammatories in young adults.

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  • 16.
    Andjelkov, N.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland. Vastmanlands Reg Hosp, Dept Orthoped, Västerås, Sweden.; Örebro Univ, Sch Med Sci, Dept Orthopaed, Örebro, Sweden..
    Riyadh, H.
    Vastmanlands Reg Hosp, Dept Orthoped, Västerås, Sweden..
    Ivarsson, M.
    Univ Örebro, Dept Hlth Sci, Örebro, Sweden..
    Kacarevic-Popovic, Z.
    Univ Belgrade, Vinca Inst Nucl Sci, Dept Radiat Chem & Phys, Belgrade, Serbia..
    Krstic, J.
    Univ Belgrade, Vinca Inst Nucl Sci, Dept Radiat Chem & Phys, Belgrade, Serbia..
    Wretenberg, P.
    Örebro Univ, Sch Med Sci, Dept Orthopaed, Örebro, Sweden..
    The enhancement of cartilage regeneration by use of a chitosan-based scaffold in a 3D model of microfracture in vitro: a pilot evaluation2021In: JOURNAL OF EXPERIMENTAL ORTHOPAEDICS, ISSN 2197-1153, Vol. 8, no 1, article id 12Article in journal (Refereed)
    Abstract [en]

    Purpose: Even though various types of scaffolds have been used lately as a complement to microfracture, the exact mechanism of reported cartilage repair improvement when using scaffolds is still unclear. In this study, an effort has been made to identify the specific effects that scaffolds may have on the cells of reparation when using this technique. Methods: A 3-D model in vitro, representing microfracture and containing both chondrocytes and bone marrow-derived cells in different experimental conditions was made, and the cells were cultured for eight weeks. Subsequently, the constructs containing our 3-D model were removed from the cell culture medium, fixed in paraffin and analyzed with immunohistochemistry. Results: Bone marrow - derived cells migrated to the upper compartment of the construct through a perforated nylon membrane containing both enzymatically digested- and non-digested particulated cartilage. The histological sections were stained with hematoxylin, eosin, S-100, SOX-9, Gomori, and procollagen type I and II. When minced cartilage wasn't pretreated with collagenase, exclusively bone-derived cells have created new extracellular matrix as showed by the histological analysis. Conclusions: In this model of microfracture, bone-derived cells but not chondrocytes have shown to have an active role in new cartilage formation without predigestion with collagenase. Moreover, it seems that the addition of a chitosan-based scaffold may lead to the improvement of a new cartilage matrix synthesis and integration. This effect hasn't been seen without the use of scaffold or when a fibrin- or a collagen-based scaffold have been used.

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  • 17.
    Andjelkov, Nenad
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland. Vastmanland Cty Hosp, Dept Orthopaed, Vasteras, Sweden..
    Hamberg, Hans
    Vastmanland Cty Hosp, Dept Pathol, Vasteras, Sweden..
    Bjellerup, Per
    Vastmanland Cty Hosp, Dept Clin Chem, Vasteras, Sweden..
    No outgrowth of chondrocytes from non-digested particulated articular cartilage embedded in commercially available fibrin matrix: an in vitro study2016In: Journal of Orthopaedic Surgery and Research, E-ISSN 1749-799X, Vol. 11, article id 23Article in journal (Refereed)
    Abstract [en]

    Background: Commercially available fibrin is routinely being used as both a matrix in certain cartilage repair techniques and a method for scaffold fixation. Chondrocytes from non-digested particulated cartilage fragments are proposed as a possible source for new cartilage tissue formation in some operative techniques. The goal of this study was to test that chondrocytes from particulated articular cartilage embedded in fibrin have an active role in the process of cartilage repair, as well as if commercially available fibrin should be used as a suitable matrix. Methods: Articular cartilage was obtained from patients undergoing total knee replacement surgery. The biopsies were particulated in small, 1-2-mm(3) pieces and embedded in fibrin. Two groups were compared in our study, particulated articular cartilage with and without collagenase treatment. The specimens were analyzed by optical microscopy after 2-5 weeks of cultivation in a special construct embedded in a cell culture medium containing particulated cartilage embedded in fibrin in the upper phase and cancellous bone in the lower phase under the perforated nylon membrane. Results: None of the biopsies taken from four different patients showed the outgrowth of chondrocytes or bone marrow-originated cells into the fibrin matrix in our experimental model. Conclusions: It has been shown in our experimental model in vitro little to support the theory that articular chondrocytes from particulated articular cartilage embedded in fibrin have an active role in cartilage repair in its early stage.

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  • 18.
    Ardern, Clare L.
    et al.
    Linkoping Univ, Div Physiotherapy, Linkoping, Sweden.;Aspetar Orthopaed & Sports Med Hosp, Doha, Qatar.;La Trobe Univ, Sch Allied Hlth, Melbourne, Vic, Australia..
    Österberg, Annika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Div Physiotherapy, Linkoping, Sweden..
    Sonesson, Sofi
    Linkoping Univ, Div Physiotherapy, Linkoping, Sweden..
    Gauffin, Håkan
    Linkoping Univ, Dept Orthopaed, Linkoping, Sweden..
    Webster, Kate E.
    La Trobe Univ, Sch Allied Hlth, Melbourne, Vic, Australia..
    Kvist, Joanna
    Linkoping Univ, Div Physiotherapy, Linkoping, Sweden..
    Satisfaction With Knee Function After Primary Anterior Cruciate Ligament Reconstruction Is Associated With Self-Efficacy, Quality of Life, and Returning to the Preinjury Physical Activity2016In: Arthroscopy: The Journal of Arthroscopy And Related, ISSN 0749-8063, E-ISSN 1526-3231, Vol. 32, no 8, p. 1631-+Article in journal (Refereed)
    Abstract [en]

    Purpose: To assess whether patient-reported outcomes (psychological factors, appraisals of knee function, and physical activity participation) were associated with satisfaction with knee function after anterior cruciate ligament (ACL) reconstruction. Methods: Participants who were aged 18 to 45 years and a minimum 12 months post primary ACL reconstruction completed a questionnaire battery evaluating knee self-efficacy, knee-related quality of life, self-reported function, and physical activity participation. Participants' responses to the question "If you were to spend the rest of your life with your knee just the way it has been in the last week, would you feel.... (7-point ordinal scale; 1 = happy, 7 = unhappy)" were categorized as satisfied, mostly satisfied, or dissatisfied and used as the primary outcome. Ordinal regression was used to examine associations between independent variables and the primary outcome. Results: A total of 177 participants were included at an average of 3 years after primary ACL reconstruction. At follow-up, 44% reported they would be satisfied, 28% mostly satisfied, and 28% dissatisfied with the outcome of ACL reconstruction. There were significant differences in psychological responses and appraisal of knee function between the 3 groups (P = .001), and significantly more people in the satisfied group had returned to their preinjury activity (58%) than in the mostly satisfied (28%) and dissatisfied (26%) groups (P = .001). Multivariable analysis demonstrated that the odds of being satisfied increased by a factor of 3 with higher self-efficacy, greater knee-related quality of life, and returning to the preinjury activity. Conclusions: People who had returned to their preinjury physical activity and who reported higher knee-related self-efficacy and quality of life were more likely to be satisfied with the outcome of ACL reconstruction.

  • 19.
    Atesok, Kivanc
    et al.
    University of Alabama at Birmingham, Birmingham, USA.
    Tanaka, Nobuhiro
    Hiroshima University, Hiroshima, Japan.
    O'Brien, Andrew
    Royal Victoria Hospital and Royal Belfast Hospital for Sick Children, Belfast, UK.
    Robinson, Yohan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Pang, Dachling
    University of California, Davis, USA; Kaiser Permanente Hospitals, Oakland, USA; Great Ormond Street Hospital For Children, London, UK.
    Deinlein, Donald
    University of Alabama at Birmingham, Birmingham, USA.
    Manoharan, Sakthivel Rajaram
    University of Alabama at Birmingham, Birmingham, USA.
    Pittman, Jason
    University of Alabama at Birmingham, Birmingham, USA.
    Theiss, Steven
    University of Alabama at Birmingham, Birmingham, USA.
    Posttraumatic Spinal Cord Injury without Radiographic Abnormality2018In: Advances in Orthopedics, ISSN 2090-3464, E-ISSN 2090-3472, Vol. 2018, article id 7060654Article, review/survey (Refereed)
    Abstract [en]

    “Spinal Cord Injury without Radiographic Abnormality” (SCIWORA) is a term that denotes objective clinical signs of posttraumatic spinal cord injury without evidence of fracture or malalignment on plain radiographs and computed tomography (CT) of the spine. SCIWORA is most commonly seen in children with a predilection for the cervical spinal cord due to the increased mobility of the cervical spine, the inherent ligamentous laxity, and the large head-to-body ratio during childhood. However, SCIWORA can also be seen in adults and, in rare cases, the thoracolumbar spinal cord can be affected too. Magnetic resonance imaging (MRI) has become a valuable diagnostic tool in patients with SCIWORA because of its superior ability to identify soft tissue lesions such as cord edema, hematomas and transections, and discoligamentous injuries that may not be visualized in plain radiographs and CT. The mainstay of treatment in patients with SCIWORA is nonoperative management including steroid therapy, immobilization, and avoidance of activities that may increase the risk of exacerbation or recurrent injury. Although the role of operative treatment in SCIWORA can be controversial, surgical alternatives such as decompression and fusion should be considered in selected patients with clinical and MRI evidence of persistent spinal cord compression and instability.

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  • 20. Atesok, Kivanc
    et al.
    Tanaka, Nobuhiro
    Robinson, Yohan
    Pittman, Jason
    Theiss, Steven
    Current Best Practices and Emerging Approaches in the Management of Acute Spinal Trauma.2019In: Advances in Orthopedics, ISSN 2090-3464, E-ISSN 2090-3472, Vol. 2019, article id 8634260Article in journal (Refereed)
  • 21.
    Augat, Peter
    et al.
    Trauma Ctr Murnau, Inst Biomech, Murnau, Germany; Paracelsus Med Univ, Inst Biomech, Salzburg, Austria.
    Larsson, Sune
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Plating of fractures: current treatments and complications2018In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 49, p. S1-S1Article in journal (Other academic)
  • 22.
    Austevoll, Ivar Magne
    et al.
    Haukeland Hosp, Orthoped Dept, Kysthosp Hagevik, Bergen, Norway..
    Hellum, Christian
    Oslo Univ Hosp Ulleval, Div Orthoped Surg, Oslo, Norway..
    Försth, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics and Handsurgery.
    Letter to the Editor Regarding the Paper of Shukla and Colleagues on Laminectomy With Fusion is Associated With Greater Functional Improvement Compared With Laminectomy Alone for the Treatment of Degenerative Lumbar Spondylolisthesis2024In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 49, no 2, p. E17-E17Article in journal (Other academic)
  • 23.
    Ban, Ilija
    et al.
    Copenhagen Univ Hosp Hvidovre, Dept Orthopaed Surg, Copenhagen, Denmark.;Copenhagen Univ Hosp Hvidovre, Clin Orthoped Res Hvidovre, Copenhagen, Denmark..
    Nowak, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Virtanen, Kaisa
    Univ Helsinki, Cent Hosp, Dept Surg, Helsinki, Finland.;Univ Helsinki, Helsinki, Finland..
    Troelsen, Anders
    Copenhagen Univ Hosp Hvidovre, Dept Orthopaed Surg, Copenhagen, Denmark.;Copenhagen Univ Hosp Hvidovre, Clin Orthoped Res Hvidovre, Copenhagen, Denmark..
    Overtreatment of displaced midshaft clavicle fractures: A survey of hospitals in Sweden, Denmark, and Finland2016In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 87, no 6, p. 541-545Article in journal (Refereed)
    Abstract [en]

    Background and purpose The best treatment for displaced clavicle fractures has been debated for decades. Operative treatment has become more common. However, several randomized trials comparing non-operative and operative treatment have not shown any compelling evidence in favor of surgery. We identified the preferred treatment of displaced midshaft clavicle fractures at public hospitals in 3 countries in Scandinavia.Patients and methods A purpose-made multiple-choice questionnaire in English was sent to all public hospitals in Denmark, Sweden, and Finland. This was addressed to the orthopedic surgeon responsible for treatment of clavicle fractures, and completed questionnaires were obtained from 85 of 118 hospitals.Results In the 3 countries, 69 of the 85 hospitals that responded would treat displaced clavicle fractures operatively. Clear criteria for treatment allocation were used at 58 of the hospitals, with the remaining 27 using individual assessment in collaboration with the patient. Precontoured locking plates were mostly used, placed either superiorly (64/85) or anteriorly (10/85).Interpretation Displaced midshaft clavicle fractures are mainly treated operatively in Sweden, Denmark, and Finland. This treatment is not supported by compelling evidence.

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  • 24.
    Banefelt, J.
    et al.
    Quantify Res, Stockholm, Sweden.
    Akesson, K. E.
    Lund Univ, Dept Clin Sci Malmo, Clin & Mol Osteoporosis Res, Malmo, Sweden;Skane Univ Hosp, Dept Orthopaed, Malmo, Sweden.
    Spangeus, A.
    Linkoping Univ, Linkoping Univ Hosp, Linkoping, Sweden.
    Ljunggren, Östen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrinology and mineral metabolism.
    Karlsson, L.
    Quantify Res, Stockholm, Sweden.
    Strom, O.
    Quantify Res, Stockholm, Sweden;Karolinska Inst, Stockholm, Sweden.
    Ortsater, G.
    Quantify Res, Stockholm, Sweden.
    Libanati, C.
    UCB Biopharma Sprl, Allee Rech 60, B-1070 Brussels, Belgium.
    Toth, E.
    UCB Biopharma Sprl, Allee Rech 60, B-1070 Brussels, Belgium.
    Risk of imminent fracture following a previous fracture in a Swedish database study2019In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 30, no 3, p. 601-609Article in journal (Refereed)
    Abstract [en]

    The SummaryThis study examined the imminent risk of a future fracture within 1 and 2years following a first fracture in women aged 50years and older and assessed independent factors associated with risk of subsequent fractures. The study highlights the need to intervene rapidly after a fracture to prevent further fractures.IntroductionThis study aims to determine the imminent risk of subsequent fractures within 1 and 2years following a first fracture and to assess independent factors associated with subsequent fractures.MethodsRetrospective, observational cohort study of women aged 50years with a fragility fracture was identified from Swedish national registers. Clinical/demographic characteristics at the time of index fracture and cumulative fracture incidences up to 12 and 24months following index fracture were calculated. Risk factors for subsequent fracture were identified using multivariate regression analysis.ResultsTwo hundred forty-two thousand one hundred eight women (mean [SD] age 74 [12.5] years) were included. The cumulative subsequent fracture incidence at 12months was 7.1% (95% confidence interval [CI], 6.9-7.2) and at 24months was 12.0% (95% CI, 11.8-12.1). The rate of subsequent fractures was highest in the first month (similar to 15 fractures per 1000 patient-years) and remained steady between 4 and 24months (similar to 5 fractures/1000 patient-years). Higher age was an independent risk factor for imminent subsequent fractures (at 24months, sub-distribution hazard ratio [HR], 3.07; p<0.001 for women 80-89years [reference 50-59years]). Index vertebral fracture was a strong independent risk factor for subsequent fracture (sub-distribution HR, 2.72 versus hip fracture; p<0.001 over 12months; HR, 2.23; p<0.001 over 24months).ConclusionsOur findings highlight the need to intervene rapidly after any fragility fracture in postmenopausal women. The occurrence of a fragility fracture provides healthcare systems with a unique opportunity to intervene to reduce the increased risk of subsequent fractures.

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  • 25.
    Bejhed, Rebecca S.
    et al.
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences, Solid State Physics.
    Kharazmi, Mohammad
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics. Cent Hosp Vasteras, Vasteras, Sweden..
    Hallberg, Pär
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical pharmacogenomics and osteoporosis.
    Identification of Risk Factors for Bisphosphonate-Associated Atypical Femoral Fractures and Osteonecrosis of the Jaw in a Pharmacovigilance Database2016In: The Annals of Pharmacotherapy, ISSN 1060-0280, E-ISSN 1542-6270, Vol. 50, no 8, p. 616-624Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Atypical femoral fractures (AFs) and osteonecrosis of the jaw (ONJ) are well-known adverse drug reactions (ADRs) associated with bisphosphonates. To prevent these ADRs and to aid in the search for pathogenic mechanisms, knowledge of risk factors can be helpful. Objective: To identify risk factors for bisphosphonate-related ONJ and AF. Methods: In this case-control study of reports of bisphosphonate-related ADRs from February 16, 1984, to October 16, 2013, in the Swedish national database of ADRs, we compared characteristics for cases of ONJ (n = 167) and AF (n = 55) with all other bisphosphonate-related ADRs (n = 565) with regard to demographic variables, clinical characteristics, and concomitant drug treatments. We adjusted for multiple comparisons with Bonferroni correction. Results: Time to onset of ADRs differed statistically significantly between cases of AF and controls (2156 vs 111 days). For ONJ versus controls, differences were statistically significant for time to onset (1240 vs 111 days), intravenous administration (40% vs 20%), dental procedures (49% vs 0.2%) and prostheses (5% vs 0%), cancer disease (44% vs 12%), multiple myeloma (21% vs 1%), rheumatoid arthritis (14% vs 5%), and treatment with antineoplastic agents and oxycodone. Conclusion: These results lend further evidence to previously identified risk factors for ONJthat is, intravenous bisphosphonate administration; invasive dental procedures and dental prostheses; cancer disease, in particular multiple myeloma; and possibly, long-term bisphosphonate treatment. A putative further risk factor is rheumatoid arthritis. Only long-term bisphosphonate treatment was more common among AF cases. The lack of overlap of risk factors between ONJ and AF suggests different pathogenic mechanisms.

  • 26.
    Benetou, V.
    et al.
    Univ Athens, WHO Collaborating Ctr Nutr & Hlth, Unit Nutr Epidemiol & Nutr Publ Hlth, Dept Hyg Epidemiol & Med Stat,Sch Med, 75 Mikras Asias St, Athens 11527, Greece.
    Orfanos, P.
    Hellen Hlth Fdn, Athens, Greece;Univ Athens, WHO Collaborating Ctr Nutr & Hlth, Unit Nutr Epidemiol & Nutr Publ Hlth, Dept Hyg Epidemiol & Med Stat,Sch Med, 75 Mikras Asias St, Athens 11527, Greece.
    Feskanich, D.
    Harvard Med Sch, Boston, MA USA;Brigham & Womens Hosp, Dept Med, Channing Div Network Med, 75 Francis St, Boston, MA 02115 USA.
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Pettersson-Kymmer, U.
    Umea Univ, Dept Pharmacol & Clin Neurosci, Umea, Sweden;Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden.
    Byberg, Liisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Eriksson, S.
    Umea Univ, Dept Community Med, Umea, Sweden.
    Grodstein, F.
    Harvard Med Sch, Boston, MA USA;Brigham & Womens Hosp, Dept Med, Channing Div Network Med, 75 Francis St, Boston, MA 02115 USA.
    Wolk, Alicja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics. Karolinska Inst, Inst Environm Med, Div Nutr Epidemiol, Stockholm, Sweden.
    Jankovic, N.
    Wageningen Univ, Div Human Nutr, Wageningen, Netherlands;Univ Duisburg Essen, Inst Med Informat Biometry & Epidemiol, Ctr Clin Epidemiol, Fac Med, Essen, Germany.
    de Groot, L. C. P. G. M.
    Wageningen Univ, Div Human Nutr, Wageningen, Netherlands.
    Boffetta, P.
    Icahn Sch Med Mt Sinai, Inst Translat Epidemiol, New York, NY 10029 USA;Icahn Sch Med Mt Sinai, Tisch Canc Inst, New York, NY 10029 USA.
    Trichopoulou, A.
    Hellen Hlth Fdn, Athens, Greece.
    Mediterranean diet and hip fracture incidence among older adults: the CHANCES project2018In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 29, no 7, p. 1591-1599Article in journal (Refereed)
    Abstract [en]

    The association between adherence to Mediterranean diet (MD) and hip fracture incidence is not yet established. In a diverse population of elderly, increased adherence to MD was associated with lower hip fracture incidence. Except preventing major chronic diseases, adhering to MD might have additional benefits in lowering hip fracture risk. Hip fractures constitute a major public health problem among older adults. Latest evidence links adherence to Mediterranean diet (MD) with reduced hip fracture risk, but still more research is needed to elucidate this relationship. The potential association of adherence to MD with hip fracture incidence was explored among older adults. A total of 140,775 adults (116,176 women, 24,599 men) 60 years and older, from five cohorts from Europe and the USA, were followed-up for 1,896,219 person-years experiencing 5454 hip fractures. Diet was assessed at baseline by validated, cohort-specific, food-frequency questionnaires, and hip fractures were ascertained through patient registers or telephone interviews/questionnaires. Adherence to MD was evaluated by a scoring system on a 10-point scale modified to be applied also to non-Mediterranean populations. In order to evaluate the association between MD and hip fracture incidence, cohort-specific hazard ratios (HR), adjusted for potential confounders, were estimated using Cox proportional-hazards regression and pooled estimates were subsequently derived implementing random-effects meta-analysis. A two-point increase in the score was associated with a significant 4% decrease in hip fracture risk (pooled adjusted HR 0.96; 95% confidence interval (95% CI) 0.92-0.99, p(heterogeneity) = 0.446). In categorical analyses, hip fracture risk was lower among men and women with moderate (HR 0.93; 95% CI 0.87-0.99) and high (HR 0.94; 95% CI 0.87-1.01) adherence to the score compared with those with low adherence. In this large sample of older adults from Europe and the USA, increased adherence to MD was associated with lower hip fracture incidence.

  • 27.
    Bengtsson, Victor
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Physiotherapy and behavioral medicine.
    Aasa, Ulrika
    Umeå Univ, Community Med & Rehabil, Umeå, Sweden..
    Öhberg, Fredrik
    Umeå Univ, Dept Radiat Sci, Umeå, Sweden..
    Berglund, Lars
    Umeå Univ, Community Med & Rehabil, Umeå, Sweden..
    Thoracolumbar And Lumbopelvic Spinal Alignment During The Deadlift Exercise: A Comparison Between Men And Women2022In: International Journal of Sports Physical Therapy, E-ISSN 2159-2896, Vol. 17, no 6, p. 1063-1074Article in journal (Refereed)
    Abstract [en]

    Background: A neutral spinal alignment is considered important during the execution of the deadlift exercise to decrease the risk of injury. Since male and female powerlifters experience pain in different parts of their backs, it is important to examine whether men and women differ in spinal alignment during the deadlift.

    Objectives: The purpose of this study was to quantify the spinal alignment in the upper (thoracolumbar, T11-L2) and lower (lumbopelvic, L2-S2) lumbar spine during the deadlift exercise in male and female lifters. Secondary aims were to compare lumbar spine alignment during the deadlift to standing habitual posture, and determine whether male and female lifters differ in these aspects.

    Study Design: Observational, Cross-sectional.

    Methods: Twenty-four (14 men, 10 women) lifters performed three repetitions of the deadlift exercise using 70% of their respective one-repetition maximum. Spinal alignment and spinal range of motion were measured using three inertial measurement units placed on the thoracic, lumbar and sacral spine. Data from three different positions were analyzed; habitual posture in standing, and start and stop positions of the deadlift, i.e. bottom and finish position respectively.

    Results: During the deadlift, spinal adjustments were evident in all three planes of movement. From standing habitual posture to the start position the lumbar lordosis decreased 13 degrees in the upper and 20 degrees in the lower lumbar spine. From start position to stop position the total range of motion in the sagittal plane was 11 degrees in the upper and 22 degrees in the lower lumbar spine. The decreased lumbar lordosis from standing habitual posture to the start position was significantly greater among men.

    Conclusions: Men and women adjust their spinal alignment in all three planes of movement when performing a deadlift and men seem to make greater adjustments from their standing habitual posture to start position in the sagittal plane.

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  • 28.
    Berglund, Britta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Pettersson, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Pigg, Maritta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medicinsk genetik och genomik.
    Kristiansson, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Self-reported quality of life, anxiety and depression in individuals with Ehlers-Danlos syndrome (EDS): a questionnaire study2015In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 16, article id 89Article in journal (Refereed)
    Abstract [en]

    Background: Many individuals with Ehlers-Danlos Syndrome (EDS) are hypermobile, suffer from long term pain, and have complex health problems. Since these sometimes have no objective physical signs, individuals with EDS sometimes are referred for psychiatric evaluation. The aim was therefore to identify the level of anxiety and quality of life in a Swedish group of individuals with EDS. Methods: A postal survey in 2008 was distributed to 365 members over 18 years of the Swedish National EDS Association and 250 with EDS diagnosis responded. Two questionnaires, the Hospital Anxiety and Depression Scale (HADS) and SF-36, were used. A Swedish population study was used to compare results from SF-36. Independent Student's t-test was used to compare differences between groups, possible relationships were tested using Spearman's correlation coefficient and the General Linear Model was used for regression analyses. Higher scores on HADS represent higher levels of anxiety and depression and higher scores on SF-36 represent higher quality of health. Results: Of the respondents 74.8% scored high on anxiety and 22.4% scored high on depression on the HADS. Age, tiredness and back pain was independently associated with the HAD anxiety score in a multiple regression analysis, When comparing the SF-36 scores from the EDS group and a Swedish population group, the EDS group scored significantly lower, indicating lower health-related quality of health than the general population (p < 0.001). Conclusions: In comparison with a Swedish population group, a lower health-related quality of life was found in the EDS group. Also, higher levels of anxiety and depression were detected in individuals with EDS. The importance to explore the factors behind these results and what initiatives can be taken to alleviate the situation for this group is emphasized.

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  • 29.
    Bernhoff, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Incidence and outcome of popliteal artery injury associated with knee trauma: a nation-wide population-based cohort studyManuscript (preprint) (Other academic)
  • 30.
    Bernhoff, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Orthopaedic Patients with Lower Limb Vascular Injuries2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Vascular injuries in lower limbs are rare but serious events. If not detected and managed correctly and timely they can lead to permanent functional impairment and even limb loss. The increasing number of orthopaedic interventions, worldwide, makes awareness of this problem among orthopaedic surgeons important.

    The overall aim of this thesis was to describe lower limb orthopaedic injuries with associated concomitant arterial injuries, especially to the popliteal artery. Epidemiology, mechanisms of injury, management, outcomes and the patient perspective were all addressed. The research questions were generated from clinical praxis. 

    Vascular injuries are rare events, but by using as the National Patient (NPR) and National Vascular registries (Swedvasc) a relatively speaking large cohort was studied. Deep interviews with qualitative study method were used to investigate the patients’ perspective.

    In papers I and II iatrogenic popliteal artery injuries (PAI) in knee-replacements, and in non-knee-replacements, were investigated. The number of knee arthroplasties in Sweden increased 1987-2008, but not the frequency of iatrogenic PAI. The most common mechanism of injury was sharp, directly to the artery. One third of the injuries resulted in pseudo-aneurysms. This was an unexpected and important finding, since these patients were often diagnosed late, resulting in poor outcome.

    Paper III. The interviewed patients narrated substantial functional, cosmetic and psychological impairments,4-17 years after their accidents, yet they described their lives as “normal”. Patients with saved limbs reported a need for better interpersonal support in their rehabilitation and adaptation back to “normal” life.

    Paper IV. Popliteal artery injury is feared in knee dislocations and fractures. The proportion incidence of vascular injury was previously reported to be 2-60%. In this large population-based study, the incidence proportion in knee dislocations was 3.4-8.2%, depending on the definition of dislocation/ligamentous injury. In knee fractures the incidence proportion was lower, only 0.2%. The dominating cause of arterial injury in knee dislocations was fall, in knee fractures it was motor vehicle accidents. Amputation- free survival after arterial injury was inferior in knee fractures compared with knee dislocations.

    In conclusion, PAI is a serious injury but on sequences can be limited by awareness and timely action.

    List of papers
    1. Popliteal artery injury in knee arthroplasty: a population based, nationwide study
    Open this publication in new window or tab >>Popliteal artery injury in knee arthroplasty: a population based, nationwide study
    2013 (English)In: Journal of Bone and Joint Surgery, ISSN 0301-620X, E-ISSN 2044-5377, Vol. 95, no 12, p. 1645-1649Article in journal (Other academic) Published
    Abstract [en]

    Popliteal artery injury (PAI) is a feared but rare complication during knee arthroplasty (KA). The aim was to study PAI during KA: Type of injury, treatment and outcome.

    Thirty-two cases were identified in the national Swedish vascular registry (Swedvasc) and the Swedish Patient Insurance databases. Prospective data from the registries was supplemented with case-records, including long-term follow-up.

    Twenty-five injuries (78%) were due to penetrating, seven to blunt trauma. Three different presentations of injury were identified: Bleeding (n=14), ischaemia (n=7) and false aneurysm formation (n=11). Five (16%) cases were during revision KA. Twelve injuries (38%) were detected intraoperatively, eight (25%) within 24 hours (range 3-24) and twelve (38%) >24 hours postoperatively (range 2-90), 28 (88%) were treated with open surgery. Patency at 30 days was 97% (one amputation). Twenty-five (78%) patients had residual symptoms at the end of follow-up (median 546 days, range: 24-1251). Six of the seven patients with complete recovery had an early diagnosis of the PAI during the procedure, and were treated by a vascular surgeon in the same hospital.

    Outcome after popliteal artery injury during KA is often negatively affected by diagnostic and therapeutic delay. Bleeding and pseudoaneurysm were the most common clinical presentations.

    Keywords
    Vascular injury, popliteal artery, knee arthroplasty, complication, adverse event, pseudoaneurysm
    National Category
    Orthopaedics Surgery
    Research subject
    Surgery
    Identifiers
    urn:nbn:se:uu:diva-194380 (URN)10.1302/0301-620X.95B12.31611 (DOI)000327788000010 ()24293594 (PubMedID)
    Funder
    Swedish Research Council, K2010-65X-20406-04-3
    Available from: 2013-02-13 Created: 2013-02-13 Last updated: 2018-01-11Bibliographically approved
    2. Iatrogenic popliteal artery injury in non arthroplasty knee surgery
    Open this publication in new window or tab >>Iatrogenic popliteal artery injury in non arthroplasty knee surgery
    2015 (English)In: The Bone & Joint Journal, ISSN 2049-4394, E-ISSN 2049-4408, Vol. 97B, no 2, p. 192-196Article in journal (Refereed) Published
    Abstract [en]

    We have investigated iatrogenic popliteal artery injuries (PAI) during non arthroplasty knee surgery regarding mechanism of injury, treatment and outcomes, and to identify successful strategies when injury occurs. In all, 21 iatrogenic popliteal artery injuries in 21 patients during knee surgery other than knee arthroplasty were identified from the Swedish Vascular Registry (Swedvasc) between 1987 and 2011. Prospective registry data were supplemented with case-records, including long-term follow-up. In total, 13 patients suffered PAI during elective surgery and eight during urgent surgery such as fracture fixation or tumour resection. Nine injuries were detected intraoperatively, five within 12 to 48 hours and seven > 48 hours post-operatively (two days to 23 years). There were 19 open vascular and two endovascular surgical repairs. Two patients died within six months of surgery. One patient required amputation. Only six patients had a complete recovery of whom had the vascular injury detected at time of injury and repaired by a vascular surgeon. Patients sustaining vascular injury during elective procedures are more likely to litigate (p = 0.029). We conclude that outcomes are poorer when there is a delay of diagnosis and treatment, and that orthopaedic surgeons should develop strategies to detect PAI early and ensure rapid access to vascular surgical support.

    National Category
    Orthopaedics
    Identifiers
    urn:nbn:se:uu:diva-246818 (URN)10.1302/0301-620X.97B2.34353 (DOI)000348613700010 ()25628281 (PubMedID)
    Available from: 2015-03-13 Created: 2015-03-10 Last updated: 2018-01-11Bibliographically approved
    3. Patients’ experiences of life years after severe civilian lower extremity trauma with vascular injury
    Open this publication in new window or tab >>Patients’ experiences of life years after severe civilian lower extremity trauma with vascular injury
    (English)Manuscript (preprint) (Other academic)
    National Category
    Surgery Orthopaedics
    Identifiers
    urn:nbn:se:uu:diva-296032 (URN)
    Available from: 2016-06-13 Created: 2016-06-13 Last updated: 2018-01-10
    4. Incidence and outcome of popliteal artery injury associated with knee trauma: a nation-wide population-based cohort study
    Open this publication in new window or tab >>Incidence and outcome of popliteal artery injury associated with knee trauma: a nation-wide population-based cohort study
    (English)Manuscript (preprint) (Other academic)
    National Category
    Orthopaedics Surgery
    Identifiers
    urn:nbn:se:uu:diva-296034 (URN)
    Available from: 2016-06-13 Created: 2016-06-13 Last updated: 2018-01-10
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  • 31.
    Bernhoff, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Patients’ experiences of life years after severe civilian lower extremity trauma with vascular injuryManuscript (preprint) (Other academic)
  • 32.
    Bernhoff, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Patients’ experiences of life years after severe civilian lower extremity trauma with vascular injuryManuscript (preprint) (Other academic)
  • 33.
    Bernhoff, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Iatrogenic popliteal artery injury in non arthroplasty knee surgery2015In: The Bone & Joint Journal, ISSN 2049-4394, E-ISSN 2049-4408, Vol. 97B, no 2, p. 192-196Article in journal (Refereed)
    Abstract [en]

    We have investigated iatrogenic popliteal artery injuries (PAI) during non arthroplasty knee surgery regarding mechanism of injury, treatment and outcomes, and to identify successful strategies when injury occurs. In all, 21 iatrogenic popliteal artery injuries in 21 patients during knee surgery other than knee arthroplasty were identified from the Swedish Vascular Registry (Swedvasc) between 1987 and 2011. Prospective registry data were supplemented with case-records, including long-term follow-up. In total, 13 patients suffered PAI during elective surgery and eight during urgent surgery such as fracture fixation or tumour resection. Nine injuries were detected intraoperatively, five within 12 to 48 hours and seven > 48 hours post-operatively (two days to 23 years). There were 19 open vascular and two endovascular surgical repairs. Two patients died within six months of surgery. One patient required amputation. Only six patients had a complete recovery of whom had the vascular injury detected at time of injury and repaired by a vascular surgeon. Patients sustaining vascular injury during elective procedures are more likely to litigate (p = 0.029). We conclude that outcomes are poorer when there is a delay of diagnosis and treatment, and that orthopaedic surgeons should develop strategies to detect PAI early and ensure rapid access to vascular surgical support.

  • 34.
    Bernhoff, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Incidence and Outcome of Popliteal Artery Injury Associated with Knee Dislocations, Ligamentous Injuries, and Close to Knee Fractures: A Nationwide Population Based Cohort Study2021In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 61, no 2, p. 297-304Article in journal (Refereed)
    Abstract [en]

    Objective: Arterial injury in knee trauma is rare but can be devastating if the diagnosis is delayed. The frequency of concomitant arterial injury resulting from knee dislocations remains unclear, and from knee fractures it remains unknown. The primary aim was to investigate the incidence of arterial injury in knee trauma requiring hospitalisation. Secondary aims were to identify risk factors and describe outcome. Methods: Traumatic popliteal artery injury and knee trauma were identified by International Classification of Diseases (ICD)-10 codes from the Swedish National Inpatient registry (NPR), 1998-2014 and linked with data using the unique personal identification number with the National Registry for vascular surgery (Swedvasc). Risk factors for popliteal artery injury (PAI) such as cause of injury, comorbidities and injury severity were extracted from the NPR. Socio-economic status data and population count came from Statistics Sweden, and cause and date of death from the Swedish Cause of Death Registry. Results: A total of 71 149 admissions due to all knee trauma were identified, and 359 with simultaneous PAls. Some of those injuries were non-orthopaedic. The proportion of PAI after knee dislocation ranged between 3.4% (46/1370 dislocations or multiligamentous injuries) and 8.2% (46/564 dislocations), and 0.2% after fracture close to the knee (60/36 483). The most common causes of injury with PAI were falls causing knee dislocations and motor vehicle accidents (MVAs) causing fractures. The fact that all 46 injuries occurring after multiligamentous injuries were classified as knee dislocations is probably explained by the fact that the ICD codes are chosen retrospectively when the patient leaves the hospital. Conclusion: PAI after knee dislocation is not uncommon, and most frequently caused by a fall. PAI associated with knee fracture is rare and mostly caused by a MVA, while in low energy knee fractures PAI is practically non-existent.

  • 35.
    Bernhoff, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Rudström, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Gedeborg, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Popliteal artery injury in knee arthroplasty: a population based, nationwide study2013In: Journal of Bone and Joint Surgery, ISSN 0301-620X, E-ISSN 2044-5377, Vol. 95, no 12, p. 1645-1649Article in journal (Other academic)
    Abstract [en]

    Popliteal artery injury (PAI) is a feared but rare complication during knee arthroplasty (KA). The aim was to study PAI during KA: Type of injury, treatment and outcome.

    Thirty-two cases were identified in the national Swedish vascular registry (Swedvasc) and the Swedish Patient Insurance databases. Prospective data from the registries was supplemented with case-records, including long-term follow-up.

    Twenty-five injuries (78%) were due to penetrating, seven to blunt trauma. Three different presentations of injury were identified: Bleeding (n=14), ischaemia (n=7) and false aneurysm formation (n=11). Five (16%) cases were during revision KA. Twelve injuries (38%) were detected intraoperatively, eight (25%) within 24 hours (range 3-24) and twelve (38%) >24 hours postoperatively (range 2-90), 28 (88%) were treated with open surgery. Patency at 30 days was 97% (one amputation). Twenty-five (78%) patients had residual symptoms at the end of follow-up (median 546 days, range: 24-1251). Six of the seven patients with complete recovery had an early diagnosis of the PAI during the procedure, and were treated by a vascular surgeon in the same hospital.

    Outcome after popliteal artery injury during KA is often negatively affected by diagnostic and therapeutic delay. Bleeding and pseudoaneurysm were the most common clinical presentations.

  • 36.
    Blixt, Simon
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics and Handsurgery. Uppsala Univ Hosp, Dept Orthopaed & Hand Surg, Uppsala, Sweden; Karolinska Inst, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.
    Burmeister, Fabian
    Umeå Univ, Dept Surg & Perioperat Sci Orthopaed, Umeå, Sweden..
    Mukka, Sebastian
    Umeå Univ, Dept Surg & Perioperat Sci Orthopaed, Umeå, Sweden..
    Bobinski, Lukas
    Umeå Univ, Dept Surg & Perioperat Sci Orthopaed, Umeå, Sweden..
    Försth, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics and Handsurgery.
    Westin, Olof
    Univ Gothenburg, Inst Clin Sci, Sahlgrenska Acad, Dept Orthopaed, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Orthoped Clin, Spine Surg Unit, Gothenburg, Sweden..
    Gerdhem, Paul
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics and Handsurgery. Uppsala Univ Hosp, Dept Orthopaed & Hand Surg, Uppsala, Sweden.
    Reliability of thoracolumbar burst fracture classification in the Swedish Fracture Register2024In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 25, no 1, article id 281Article in journal (Refereed)
    Abstract [en]

    Background

    The Swedish Fracture Register (SFR) is a national quality register for all types of fractures in Sweden. Spine fractures have been included since 2015 and are classified using a modified AOSpine classification. The aim of this study was to determine the accuracy of the classification of thoracolumbar burst fractures in the SFR.

    Methods

    Assessments of medical images were conducted in 277 consecutive patients with a thoracolumbar burst fracture (T10-L3) identified in the SFR. Two independent reviewers classified the fractures according to the AOSpine classification, with a third reviewer resolving disagreement. The combined results of the reviewers were considered the gold standard. The intra- and inter-rater reliability of the reviewers was determined with Cohen’s kappa and percent agreement. The SFR classification was compared with the gold standard using positive predictive values (PPV), Cohen’s kappa and percent agreement.

    Results

    The reliability between reviewers was  high (Cohen’s kappa 0.70–0.97). The PPV for correctly classifying burst fractures in the SFR was high irrespective of physician experience (76–89%), treatment (82% non-operative, 95% operative) and hospital type (83% county, 95% university). The inter-rater reliability of B-type injuries and the overall SFR classification compared with the gold standard was low (Cohen’s kappa 0.16 and 0.17 respectively).

    Conclusions

    The SFR demonstrates a high PPV for accurately classifying burst fractures, regardless of physician experience, treatment and hospital type. However, the reliability of B-type injuries and overall classification in the SFR was found to be low. Future studies on burst fractures using SFR data where classification is important should include a review of medical images to verify the diagnosis.

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  • 37.
    Blixt, Simon
    et al.
    Karolinska Inst, Dept Clin Sci Intervent & Technol, K54, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Reconstruct Orthopaed, Huddinge, Sweden..
    Mukka, Sebastian
    Umeå Univ, Dept Surg & Perioperat Sci Orthopaed, Umeå, Sweden..
    Försth, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics and Handsurgery.
    Westin, Olof
    Univ Gothenburg, Inst Clin Sci, Dept Orthopaed, Sahlgrenska Acad, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Gothenburg, Sweden..
    Gerdhem, Paul
    Karolinska Inst, Dept Clin Sci Intervent & Technol, K54, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Reconstruct Orthopaed, Huddinge, Sweden..
    Study protocol: The SunBurst trial-a register-based, randomized controlled trial on thoracolumbar burst fractures2022In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 93, p. 256-263Article in journal (Refereed)
    Abstract [en]

    Background and purpose - The treatment for patients with thoracolumbar burst fractures without neurological deficit or complete rupture of the posterior ligament complex (PLC) is controversial and includes both surgical and non-surgical options. Current evidence on which treatment is optimal remains inconclusive. In this study we compare surgical with non-surgical treatment. Methods - The study is a nationwide, multicenter, register-based randomized controlled trial (R-RCT). Patients with a thoracolumbar burst fracture will be identified by the Swedish Fracture Register. The admitting physician will be notified during the registration process and the patient will be screened for eligibility. Patients, 18 to 66 years old without neurologic deficit to more than a single nerve root and without complete rupture of the PLC, are eligible for the study. 202 patients will be randomized in a 1:1 relation to either surgical or non-surgical treatment. Patient-reported outcome measures (PROMs), including the Oswestry Disability Index (ODI) and radiological data, will be collected at the time of injury, after 3-4 months, and after 1 year. Additional data from national health registries will be collected after 1 year. Outcome - The primary outcome is the ODI 1 year after injury. Secondary outcomes include additional PROMs, adverse events, drug consumption, sick leave, healthcare consumption, and imaging data. Interpretation - The primary outcome is the ODI 1 year after injury. Secondary outcomes include additional PROMs, adverse events, drug consumption, sick leave, healthcare consumption, and imaging data.

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  • 38.
    Blixt, Simon
    et al.
    Karolinska Inst, Dept Clin Sci Intervent & Technol, K54, S-14186 Stockholm, Sweden.;Karolinska Univ Hosp, Dept Reconstruct Orthopaed, K54, S-14186 Huddinge, Sweden..
    Mukka, Sebastian
    Umeå Univ, Dept Surg & Perioperat Sci Orthopaed, Umeå, Sweden..
    Försth, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Westin, Olof
    Univ Gothenburg, Dept Orthopaed, Inst Clin Sci, Sahlgrenska Acad, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Gothenburg, Sweden..
    Gerdhem, Paul
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences. Karolinska Inst, Dept Clin Sci Intervent & Technol, K54, S-14186 Stockholm, Sweden..
    Validity of the short musculoskeletal function assessment questionnaire in patients with a spine fracture2023In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 32, no 4, p. 1471-1479Article in journal (Refereed)
    Abstract [en]

    PurposeThe aim of this study was to validate the use of the Short Musculoskeletal Function Assessment (SMFA) questionnaire in patients with a spine fracture.MethodsCross-sectional cohort of individuals that had sustained a spine fracture (C1-L5) one year earlier. Patients were asked to fill out SMFA, Oswestry Disability Index (ODI), EQ-5D-3L and EQ-VAS. Spearman's rank correlation coefficient (rho) was used to assess convergent validity for each patient-reported outcome measure (PROM). Bland-Altman plots were used to assess PROM agreement.Results82 patients completed all questionnaires. The correlations between SMFA Dysfunction and Bother indices and ODI were 0.89 and 0.86, with EQ-5D-3L index 0.89 and 0.80, and with EQ-VAS 0.80 and 0.73, respectively. The correlation for separate categories of the SMFA dysfunction index (daily activities, emotional status, arm and hand function, mobility) ranged between 0.71-0.87 for ODI, 0.72-0.84 for EQ-5D-3L index, and 0.67-0.77 for EQ-VAS. A selection of the ten items of SMFA that had the highest correlations with ODI resulted in a correlation of 0.91. The agreements between SMFA indices and ODI in Bland-Altman plots were good with small differential biases and minimal proportional biases, but worse for SMFA and EQ-5D-3L index and EQ-VAS.ConclusionThe SMFA indices are highly correlated with ODI in patients with a spine fracture. The Dysfunction index and Bother index, or selected SMFA items, may be used to assess outcome in patients with spine fractures as an alternative to ODI.

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  • 39.
    Bojan, Alicja J.
    et al.
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Dept Orthopaed, Mölndal, Sweden..
    Stadelmann, Vincent A.
    Schulthess Klin, Dept Teaching Res & Dev, Zurich, Switzerland..
    Wu, Dan
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Materials Science and Engineering.
    Pujari-Palmer, Michael
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Materials Science and Engineering, Applied Material Science. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Insley, Gerard
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Materials Science and Engineering.
    Sundh, Daniel
    Univ Gothenburg, Inst Med, Dept Internal Med & Clin Nutr, Geriatr Med, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Geriatr Med, Mölndal, Sweden..
    Persson, Cecilia
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Materials Science and Engineering, Applied Material Science.
    Engqvist, Håkan
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Materials Science and Engineering, Applied Material Science.
    Procter, Philip
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Materials Science and Engineering, Applied Material Science.
    A new bone adhesive candidate- does it work in human bone?: An ex-vivo preclinical evaluation in fresh human osteoporotic femoral head bone2022In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 53, no 6, p. 1858-1866Article in journal (Refereed)
    Abstract [en]

    Introduction: The fixation of small intraarticular bone fragments is clinically challenging and an obvious first orthopaedic indication for an effective bone adhesive. In the present study the feasibility of bonding freshly harvested human trabecular bone with OsStic(R), a novel phosphoserine modified cement, was evaluated using a bone cylinder model pull-out test and compared with a commercial fibrin tissue adhesive. Methods: Femoral heads (n=13) were collected from hip fracture patients undergoing arthroplasty and stored refrigerated overnight in saline medium prior to testing. Cylindrical bone cores with a pre-inserted bone screw, were prepared using a coring tool. Each core was removed and glued back in place with either the bone adhesive (alpha-tricalcium phosphate, phosphoserine and 20% trisodium citrate solution) or the fibrin glue. All glued bones were stored in bone medium at 37 degrees C. Tensile loading, using a universal testing machine (5 kN load cell), was applied to each core/head. For the bone adhesive, bone cores were tested at 2 (n=13) and 24 (n=11) hours. For the fibrin tissue adhesive control group (n=9), bone cores were tested exclusively at 2 hours. The femoral bone quality was evaluated with micro-CT. Results: The ultimate pull-out load for the bone adhesive at 2 hours ranged from 36 to 171 N (mean 94 N, SD 42 N). At 24 hours the pull-out strength was similar, 47 to 198 N (mean 123 N, SD 43 N). The adhesive failure usually occurred through the adhesive layer, however in two samples, at 167 N and 198 N the screw pulled out of the bone core. The fibrin tissue adhesive group reached a peak force of 8 N maximally at 2 hours (range 2.8-8 N, mean 5.4 N, SD 1.6 N). The mean BV/TV for femoral heads was 0.15 and indicates poor bone quality. Conclusion: The bone adhesive successfully glued wet and fatty tissue of osteoporotic human bone cores. The mean ultimate pull-out force of 123 N at 24 hours corresponds to similar to 300 kPa shear stress acting on the bone core. These first ex-vivo results in human bone are a promising step toward potential clinical application in osteochondral fragment fixation. (C) 2022 The Authors. Published by Elsevier Ltd.

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  • 40.
    Bokrantz, Tove
    et al.
    Univ Gothenburg, Sahlgrenska Univ Hosp, Sahlgrenska Acad, Inst Med,Dept Mol & Clin Med, S-41345 Gothenburg, Sweden..
    Manhem, Karin
    Univ Gothenburg, Sahlgrenska Univ Hosp, Sahlgrenska Acad, Inst Med,Dept Mol & Clin Med, S-41345 Gothenburg, Sweden..
    Lorentzon, Mattias
    Australian Catholic Univ, Mary McKillop Inst Hlth Res, Melbourne, Vic, Australia.;Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Internal Med & Clin Nutr,Geriatr Med, Gothenburg, Sweden..
    Karlsson, Magnus
    Lund Univ, Skane Univ Hosp, Dept Orthoped & Clin Sci Malmö IKVM, Clin & Mol Osteoporosis Res Unit, Malmö, Sweden..
    Ljunggren, Östen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Ohlsson, Claes
    Univ Gothenburg, Sahlgrenska Acad, Ctr Bone & Arthrit Res, Inst Med,Dept Internal Med & Clin Nutr, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Dept Drug Treatment, Gothenburg, Region Vastra G, Sweden..
    Mellstrom, Dan
    Univ Gothenburg, Sahlgrenska Acad, Ctr Bone & Arthrit Res, Inst Med,Dept Internal Med & Clin Nutr, Gothenburg, Sweden..
    The association between peripheral arterial disease and risk for hip fractures in elderly men is not explained by low hip bone mineral density. Results from the MrOS Sweden study2022In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 33, no 12, p. 2607-2617Article in journal (Refereed)
    Abstract [en]

    In this prospective study in Swedish elderly men, PAD based on an ABI < 0.9 was associated with an increased risk of hip fracture, independent of age and hip BMD. However, after further adjustments for comorbidity, medications, physical function, and socioeconomic factors, the association diminished and was no longer statistically significant. Introduction To examine if peripheral arterial disease (PAD) is associated with an increased risk for hip fracture in men independent of hip BMD. Methods Ankle-brachial index (ABI) was assessed in the Swedish MrOS (Osteoporotic Fractures in Men) study, a prospective observational study including 3014 men aged 69-81 years at baseline. PAD was defined as ABI < 0.90. Incident fractures were assessed in computerized X-ray archives. The risk for hip fractures was calculated using Cox proportional hazard models. At baseline, BMD was assessed using DXA (Lunar Prodigy and Hologic QDR 4500) and functional measurements and blood samples were collected. Standardized questionnaires were used to collect information about medical history, falls, and medication. Results During 10 years of follow-up, 186 men had an incident hip fracture. The hazard ratio (HR) for hip fracture in men with PAD was 1.70 (95% CI 1.14-2.54), adjusted for age and study site. Additional adjustment for total hip BMD marginally affected this association (HR 1.64; 95% CI 1.10-2.45). In a final multivariate model, the HR attenuated to a non-significant HR 1.38 (95% CI 0.91-2.11) adjusted for age, site, hip BMD, BMI, falls, smoking, eGFR, handgrip strength, walking speed, former hip fracture, antihypertensive treatment, diabetes, education, and history of cardiovascular disease. Conclusion This study suggests that PAD is associated with an increased risk for hip fracture independently of hip BMD in elderly Swedish men. However, the high frequency of comorbidity and lower physical performance among men with PAD might partly explain this association.

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  • 41.
    Borens, Olivier
    et al.
    CHU Vaudois, Dept Musculoskeletal Syst, Orthopaed Trauma Unit, Dept Sept Surg, Lausanne, Switzerland.
    Corona, Pablo S
    Hosp Valle De Hebron, Dept Orthopaed Surg, Reconstruct & Sept Surg Unit, Barcelona, Spain.
    Frommelt, Lars
    Helios ENDO Klin, Hamburg, Germany.
    Lazarinis, Stergios
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Reed, Michael Richard
    Northumbria HelathCare NHS Fdn Trust, North Shields, England.
    Romano, Carlo Luca
    Ctr Reconstruct Surg & Osteoarticular, Milan, Italy; Inst Galeazzi, Orthopaed Res, Milan, Italy.
    Algorithm to Diagnose Delayed and Late PJI: Role of Joint Aspiration2017In: A Modern Approach to Biofilm-Related Orthopaedic Implant Infections: Advances in Microbiology, Infectious Diseases and Public Health Volume 5 / [ed] Drago, Lorenzo, Cham, Switzerland: Springer, 2017, p. 101-111Chapter in book (Refereed)
    Abstract [en]

    Total Joint Arthroplasty (TJA) continues to gain acceptance as the standard of care for the treatment of severe degenerative joint disease, and is considered one of the most successful surgical interventions in the history of medicine. A devastating complication after TJA is infection. Periprosthetic joint infection (PJI), represents one of the major causes of failure and remains a significant challenge facing orthopaedics today. PJI usually requires additional surgery including revision of the implants, fusion or amputations causing tremendous patient suffering but also a heavy health economics burden. PJI is at the origin of around 20–25 % of total knee arthroplasty (Bozic et al. 2010; de Gorter et al. 2015; Sundberg et al. 2015) and 12–15 % of total hip arthroplasty (Bozic et al. 2009; Garellick et al. 2014; de Gorter et al. 2015) failures.

  • 42.
    Borg, Tomas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Berg, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Fugl-Meyer, Kerstin
    Larsson, Sune
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Health-related quality of life and life satisfaction in patients following surgically treated pelvic ring fractures: A prospective observational study with two years follow-up2010In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 41, no 4, p. 400-404Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Pelvic ring fractures caused by high-energy trauma are severe injuries with well described radiological and clinical outcomes, whereas description from the patient's perspective is less well documented. The purpose of this study was to investigate patient-reported outcome following surgical treatment of pelvic fractures using quality of life instruments. METHODS: All 54 patients (28 male/26 female, ages 16-68) with pelvic fractures referred to our institution for surgical treatment 2003-2005 were prospectively included. The most common trauma was motor vehicle accident (44%). Additional injuries were seen in 74% and in 31% the ISS was >or=16. There were 31 B and 23 C type fractures. Patients were followed for two years using two validated questionnaires, SF-36 and LiSat-11, the latter an instrument consisting of 11 questions for evaluation of satisfaction with different aspects of life. RESULTS: 45 patients could be followed according to the study protocol for two years while 2 were untraceable and 1 died from unrelated causes. Of 6 nonresponders, 5 were unable due to psychiatric disorder. At two years pelvic fracture patients scored lower than the reference population in both physical and mental domains (SF-36). Highest mean score, 68, was in the domain Social Function (norm 89) while lowest mean score, 38, was in the domain Role Physical (norm 86). The mean score closest to the normative was for general health with 61 for patients and 78 for the normative group. In LiSat-11 pelvic fracture patients scored lower than the reference population in all areas. Satisfaction with life as a whole was 31% compared with 60% in the normative group. CONCLUSIONS: Two years after surgical treatment of pelvic ring fractures, patients reported substantially lower quality of life for both physical and mental domains, when compared with a reference population, even when radiological and clinical outcomes were considered favourable.

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  • 43.
    Borg, Tomas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Hailer, Nils P
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Outcome 5 years after surgical treatment of acetabular fractures: a prospective clinical and radiographic follow-up of 101 patients2015In: Archives of Orthopaedic and Trauma Surgery, ISSN 0936-8051, E-ISSN 1434-3916, Vol. 135, no 2, p. 227-233Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION:

    The aim of this study was to evaluate functional outcome after surgically treated acetabular fracture using radiography and patient-reported outcome measures, and to determine predictors of hip joint failure 5 years post-surgery.

    PATIENTS AND METHODS:

    All patients with acetabular fractures treated with open reduction and internal fixation (ORIF) at our unit are prospectively entered into a local register. 101 acetabular fractures in 112 patients treated from 2004 to 2007 were eligible for analysis 5 years after surgery. Radiographs and questionnaires regarding physical function (Short Form[SF]-36) and pelvic discomfort index (PDI, 100 % = worst outcome) were obtained. The primary outcome measure was "joint failure" defined as either secondary total hip arthroplasty (THA) or a Girdlestone situation. Univariable analysis was used to compare patients with joint failure to those without, and binary logistic regression analysis was performed to identify risk factors of joint failure.

    RESULTS:

    77 % of 101 followed patients had a preserved hip joint 5 years after surgery, and failure of the hip joint most often occurred within the first 2 years after injury. Patients with preserved hip joints had higher scores in the SF-36 physical function domain (median 75 vs. 48; p = 0.004) and better PDI (28 vs. 43 %, p = 0.03). Femoral head impaction was associated with an increased risk of joint failure [relative risk (RR) = 15.2, 95 % CI 3-95; p = 0.002], as was an age of ≥60 years at the time of injury (RR = 4.2, CI 1.3-15; p = 0.02).

    CONCLUSIONS:

    Patients with failed hip joints after surgery for acetabular fracture have inferior global and disease-specific functional outcomes, even after secondary arthroplasty surgery. We suggest that patients with predictors of joint failure could benefit from other treatment strategies than ORIF, and primary insertion of THA may be an alternative treatment strategy for this subgroup.

  • 44.
    Borg, Tomas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Hernefalk, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Carlsson, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala Univ, Dept Publ Hlth & Caring Sci, Uppsala, Sweden..
    Larsson, Sune
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Development of a pelvic discomfort index to evaluate outcome following fixation for pelvic ring injury2015In: Journal of Orthopaedic Surgery, ISSN 1022-5536, E-ISSN 2309-4990, Vol. 23, no 2, p. 146-149Article in journal (Refereed)
    Abstract [en]

    Purpose. To develop a pelvic discomfort index (PDI) to evaluate outcome following fixation for pelvic ring injury. Methods. 29 female and 44 male consecutive patients (mean age, 36 years) underwent internal fixation for pelvic ring injury of type B1 (n=10), B2 (n=22), B3 (n=15), C1 (n=18), C2 (n=5), and C3 (n=3), based on the AO/OTA classification. At postoperative 6, 12, and 24 months, patients were asked to assess their discomfort in the pelvis using a 14-item questionnaire. Three questions were open-ended, and responses were categorised by a single assessor. The remaining 11 questions were closed-ended and had 6 ordinal options from 'no discomfort' (score=0) to' extremely severe discomfort' (score=5). The content validity and relevance of the 11 closed-ended questions was determined. The 14-item questionnaire was compared with the 36-item Short Form Health Survey (SF-36). Results. Respectively at postoperative 6, 12, and 24 months, 78%, 71%, and 71% of the patients completed the 14-item questionnaire. Based on the factor analysis and responses to the open-ended questions, the number of items was reduced to 6 including pain, walking, mobility of the hips, loss of sensation in the legs, sexual life, and operation scar. Four factors could explain 96% of the total variance. The first factor involved the first 3 items (pain, walking, and hip motion) and addressed 'pelvis', whereas 3 factors involved the remaining items and each addressed peripheral neurology, sexual life, and operation scar. A PDI was developed using these 6 items. The PDI had high internal reliability (alpha=0.89), adequate content and criterion validity, and moderate correlation with the SF-36 total score or scores of physical function, bodily pain, and general health (r=0.50-0.77). Conclusion. The PDI provides valid, specific, and relevant information to assess

  • 45.
    Borg, Tomas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Hernefalk, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Hailer, Nils P.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Acute total hip arthroplasty combined with internal fixation for displaced acetabular fractures in the elderly: A short-term comparison with internal fixation alone after a minimum of two years2019In: The Bone & Joint Journal, ISSN 2049-4394, E-ISSN 2049-4408, Vol. 101B, no 4, p. 478-483Article in journal (Refereed)
    Abstract [en]

    Aims

    Displaced, comminuted acetabular fractures in the elderly are increasingly common, but there is no consensus on whether they should be treated non-surgically, surgically with open reduction and internal fixation (ORIF), or with acute total hip arthroplasty (THA). A combination of ORIF and acute THA, an approach called 'combined hip procedure' (CHP), has been advocated and our aim was to compare the outcome after CHP or ORIF alone.

    Patients and Methods

    A total of 27 patients with similar acetabular fractures (severe acetabular impaction with or without concomitant femoral head injury) with a mean age of 72.2 years (50 to 89) were prospectively followed for a minimum of two years. In all, 14 were treated with ORIF alone and 13 were treated with a CHP. Hip joint and patient survival were estimated. Operating times, blood loss, radiological outcomes, and patient-reported outcomes were assessed.

    Results

    No patient in the CHP group required further hip surgery, giving THA a survival rate of 100% (95% confidence interval (CI) 100 to 100) after three years, compared with 28.6% hip joint survival in the ORIF group (95% CI 12.5 to 65.4; p = 0.001). No dislocations or deep infections occurred in the CHP group. No patient died within the first year after index surgery, but patient survival was lower in the CHP group after three years. There were no relevant differences in patient-reported outcomes.

    Conclusion

    The CHP confers a considerably reduced need of further surgery when compared with ORIF alone in elderly patients with complex acetabular fractures. These findings encourage both further use of, and larger prospective studies on, the CHP.

  • 46.
    Borgström, F.
    et al.
    Quantify Res, Stockholm, Sweden..
    Olafsson, G.
    Quantify Res, Stockholm, Sweden..
    Jonsson, E.
    Quantify Res, Stockholm, Sweden..
    Ström, O.
    Quantify Res, Stockholm, Sweden..
    Ljunggren, Östen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrinology and mineral metabolism.
    Akesson, K.
    Skane Univ Hosp, Dept Orthoped, Lund, Sweden.;Lund Univ, Clin Sci Malmo, Lund, Sweden..
    Spangeus, A.
    Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden..
    Kanis, J. A.
    Univ Sheffield, Sch Med, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England..
    A Simulation Model For The Treatment Pathway Of Osteoporosis2016In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 27, p. S60-S60Article in journal (Other academic)
  • 47.
    Broden, Cyrus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics. Imperial Coll London, St Marys Hosp, Dept Surg & Canc, London, England.;Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Div Orthopaed, Stockholm, Sweden..
    Reilly, Peter
    Imperial Coll London, Dept Bioengn, London, England..
    Khanna, Monica
    Imperial Coll Healthcare NHS Trust, Dept Clin Imaging, London, England..
    Popat, Ravi
    Imperial Coll London, Dept Bioengn, London, England..
    Olivecrona, Henrik
    Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden..
    Griffiths, Dylan
    Imperial NHS Trust, Trauma & Orthopaed Dept, London, England..
    Skoldenberg, Olof
    Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Div Orthopaed, Stockholm, Sweden..
    Emery, Roger
    Imperial Coll London, St Marys Hosp, Dept Surg & Canc, London, England..
    CT-based micromotion analysis method can assess early implant migration and development of radiolucent lines in cemented glenoid components: a clinical feasibility study2022In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 93, p. 277-283Article in journal (Refereed)
    Abstract [en]

    Background and purpose - CT micromotion analysis (CTMA) has been considered as an alternative to radiostereometry (RSA) for assessing early implant migration of orthopedic implants. We investigated the feasibility of CTMA to assess early migration and the progression of radiolucent lines in shoulder arthroplasties over 24 months using sequential low-dose CT scans. Patients and methods - 7 patients were included and underwent 9 primary total shoulder arthroplasties. We made CT scans preoperatively, within 1 week postoperatively, and after 3, 6, 12, and 24 months. At each follow-up, postoperative glenoid migration and any development of radiolucent lines were assessed. Clinical outcomes were recorded at all time points except within 1 week postoperatively. Results - For the glenoid component, the median translation and median rotation were 0.00-0.10 mm and -1.53 degrees to 1.05 degrees at 24 months. Radiolucent lines could be observed around all glenoid components. The radiolucent lines developed from the periphery to the center of the implant for 6 glenoid components during follow-up. The Constant Score improved from a mean of 30 (21-51) preoperatively to 69 (41-88) at 24 months. Interpretation - CTMA can be used to identify early migration and the development of radiolucent lines over time in glenoid components. Clinical trials with a larger sample size and longer follow-up are needed to establish the relationship between migration, radiolucent lines, loosening, and clinical outcome.

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  • 48.
    Brodén, Cyrus
    et al.
    Imperial Coll London, Dept Surg & Canc, London, England; Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden.
    Sandberg, Olof
    ‎ Sectra, Linköping, Sweden.
    Sköldenberg, Olof
    Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden.
    Stigbrand, Hampus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Research and Development, Gävleborg. Länssjukhuset, Dept Orthoped Surg, Gävle, Sweden.
    Hänni, Mari
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Giles, Joshua W
    Univ Victoria, Dept Mech Engn, Victoria, BC, Canada.
    Emery, Roger
    St Marys Hosp, Dept Orthopaed Surg, London, England.
    Lazarinis, Stergios
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Nyström, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Olivecrona, Henrik
    Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden.
    Low-dose CT-based implant motion analysis is a precise tool for early migration measurements of hip cups: a clinical study of 24 patients2020In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 91, no 3, p. 260-265Article in journal (Refereed)
    Abstract [en]

    Background and purpose - Early implant migration is known to be a predictive factor of clinical loosening in total hip arthroplasty (THA). Radiostereometric analysis (RSA) is the gold standard used to measure early migration in patients. However, RSA requires costly, specialized imaging equipment and the image process is complex. We determined the precision of an alternative, commercially available, CT method in 3 ongoing clinical THA studies, comprising 3 different cups.

    Materials and methods - 24 CT double examinations of 24 hip cups were selected consecutively from 3 ongoing prospective studies: 2 primary THA (1 cemented and 1 uncemented) and 1 THA (cemented) revision study. Precision of the CT-based implant motion analysis (CTMA) system was calculated separately for each study, using both the surface anatomy of the pelvis and metal beads placed in the pelvis.

    Results - For the CTMA analysis using the surface anatomy of the pelvis, the precision ranged between 0.07 and 0.31 mm in translation and 0.20° and 0.39° for rotation, respectively. For the CTMA analysis using beads the precision ranged between 0.08 and 0.20 mm in translation and between 0.20° and 0.43° for rotations. The radiation dose ranged between 0.2 and 2.3 mSv.

    Interpretation - CTMA achieved a clinically relevant and consistent precision between the 3 different hip cups studied. The use of different hip cup types, different CT scanners, or registration method (beads or surface anatomy) had no discernible effect on precision. Therefore, CTMA without the use of bone markers could potentially be an alternative to RSA to measure early migration.

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  • 49.
    Brüggemann, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Hip Revision Surgery: Identification of Genetic Markers and Evaluation of Novel Treatment Strategies2020Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Total hip arthroplasty (THA) is, despite its overall good outcome, for some patients followed by hip revision surgery. This seems in parts to be because of genetic susceptibility to revision surgery. The most common reason for revision surgery is aseptic loosening followed by periprosthetic joint infection and dislocation. Cups made of porous tantalum (TM cups) were thought to be favorable in revision surgery to address aseptic loosening, but they seem to confer an increased risk of dislocation. The effectiveness and biocompatibility in vivo of TM cups have not been researched. Dual mobility cups (DMCs) with two articulating surfaces are proposed to prevent dislocation to a higher degree than standard polyethylene liners.

    Our hypotheses were that TM cups are superior to their historical treatment alternative in terms of re-revision rates; that the combination of DMC cemented into TM cups would decrease the risk for dislocation after revision surgery; that tantalum ion liberation is marginal after the use of TM cups; and that certain risk genes are associated with an increased risk for revision surgery after total joint arthroplasty.

    Studies I&II were register-based cohort studies comparing the implant survival of TM cups and conventional acetabular reinforcement rings (study I), and the combination of TM cups/DMC with TM cups/standard polyethylene liners (study II). We found that TM cups perform equally well as reinforcement rings, but that the two implants differ in their failure mechanisms. Cementing a DMC into TM cups adequately addressed the issue of recurrent dislocation. In study III we investigated whether tantalum ion liberation does occur after implantation of a TM cups and how this affects patients’ immunological response by comparison of three groups: primary non-tantalum THA, primary tantalum THA and revision tantalum THA. We found the highest concentration of tantalum ions in the revision cases, yet tantalum ions were not associated with an immunological response, and we found no signs of alteration in the investigated lymphocyte subsets. Study IV aimed to identify possible risk genes for revision surgery after total hip or knee replacement by a genome wide association study. We found six significant risk genes for the endpoint revision surgery for any reason, and three for the endpoint revision due to aseptic loosening. We found a variety of suggestive risk genes within the region coding for the ABO-system.

    In conclusion, the novel treatment options TM cups and DMC show good results in hip revision surgery, but longer follow-up is warranted. The use of porous tantalum seems not to be associated with the immunological activation that can be observed in metallosis. The risk for revision surgery is associated with certain risk genes.

    List of papers
    1. Are porous tantalum cups superior to conventional reinforcement rings?: A retrospective cohort study of 207 acetabular revisions
    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: 2020-01-09Bibliographically approved
    2. Do dual-mobility cups cemented into porous tantalum shells reduce the risk of dislocation after revision surgery?: A retrospective cohort study on 184 patients
    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: 2020-01-09Bibliographically approved
    3. Safety of Use of Tantalum in Total Hip Arthroplasty
    Open this publication in new window or tab >>Safety of Use of Tantalum in Total Hip Arthroplasty
    2020 (English)In: Journal of Bone and Joint Surgery. American volume, ISSN 0021-9355, E-ISSN 1535-1386, Vol. 102, no 5, p. 368-374Article in journal (Refereed) Published
    Abstract [en]

    Background:

    Tantalum implants have been used in >500,000 orthopaedic patients. Although the risks of metallosis and aseptic lymphocyte-dominated vasculitis-associated lesions (ALVAL) after total hip arthroplasty (THA) are being debated, we are not aware of any studies investigating the liberation of tantalum ions and their potential effects on the immune system. We evaluated whether tantalum concentrations are elevated after THA with acetabular tantalum implants and assessed potential alterations in T-cell subpopulations.

    Methods:

    After a mean follow-up of 4 years (range, 0.5 to 8.9 years) of 144 patients who had undergone THA, blood samples were analyzed regarding blood tantalum concentrations, total white blood-cell counts, and lymphocyte subsets in 3 groups of patients: those treated with non-tantalum primary THA (“primary non-tantalum,” n = 30), those treated with primary THA with a tantalum cup (“primary tantalum,” n = 30), and those who underwent revision surgery with a tantalum shell (“revision tantalum,” n = 84). Blood donors served as controls for immunological parameters (n = 59). Correlations between tantalum concentrations and human leukocyte antigen (HLA)-DR+ T cells were calculated, radiographic signs of implant loosening were assessed, and the Harris hip score (HHS) was used to evaluate hip function.

    Results:

    The median tantalum concentration was similar to the detection limit both in the primary non-tantalum group (0.05 µg/L, 95% confidence interval [CI] = 0.05 to 0.05 µg/L) and in the primary tantalum group (0.051 µg/L, 95% CI = 0.050 to 0.055 µg/L), and it was 0.091 µg/L (95% CI = 0.083 to 0.112 µg/L) in the revision tantalum group (p < 0.0001 in the group-wise comparison with both primary non-tantalum and primary tantalum). We found a weak negative correlation of higher tantalum concentration with the concentration of HLA-DR+/CD8+ T cells (r = −0.22, 95% CI = −0.35 to −0.05, p = 0.01) but no correlation of tantalum concentration with the concentration of HLA-DR+/CD4+ T cells (r = −0.11, 95% CI = −0.27 to 0.06, p = 0.24). The values for all lymphocyte subgroups were within normal ranges. No implants were deemed loose. The median HHS was good to excellent.

    Conclusions:

    Exposure to stable tantalum cups is associated with low blood concentrations of tantalum. Signs of T-cell activation typical of ALVAL seem to be lacking.

    Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence

    National Category
    Orthopaedics
    Research subject
    Orthopaedics
    Identifiers
    urn:nbn:se:uu:diva-401793 (URN)10.2106/JBJS.19.00366 (DOI)000526937600009 ()31895169 (PubMedID)
    Available from: 2020-01-09 Created: 2020-01-09 Last updated: 2020-06-10Bibliographically approved
    4. Risk of Revision After Arthroplasty Associated withSpecific Gene Loci: A Genomewide Association Study of Single-Nucleotide Polymorphisms in 1,130 TwinsTreated with Arthroplasty
    Open this publication in new window or tab >>Risk of Revision After Arthroplasty Associated withSpecific Gene Loci: A Genomewide Association Study of Single-Nucleotide Polymorphisms in 1,130 TwinsTreated with Arthroplasty
    2022 (English)In: Journal of Bone and Joint Surgery, ISSN 0301-620X, E-ISSN 2044-5377, Vol. 104, no 7, p. 610-620Article in journal (Refereed) Published
    Abstract [en]

    Background:

    The risk of revision surgery following total joint arthroplasty (TJA) may be influenced by genetic factors. Therefore, we sought to identify genetic variants associated with the risk of revision surgery in a genomewide association study

    Methods

    We investigated a cohort of 1,130 twins from the Swedish Twin Registry treated with TJA. During a mean of 9.4 years of follow-up, 75 individuals underwent revision surgery for aseptic loosening (the primary outcome) and 94, for any reason (the secondary outcome). Genetic information was collected using the Illumina OmniExpress and PsychArray panels, and the Haplotype Reference Consortium served as the reference for gene imputation. Adjusted Cox regression models were fitted to calculate hazard ratios (HRs) with 95% confidence intervals (CIs).

    Results

    Nine single-nucleotide polymorphisms (SNPs) reached genomewide significance for aseptic loosening. The first SNP, rs77149046, located in the endosome-lysosome associated apoptosis and autophagy regulator family member 2 (ELAPOR2) gene, conferred an HR of 5.40 (CI, 3.23-9.02; p = 1.32×10−10), followed by 4 SNPs within the region coding for sodium-dependent taurine and beta-alanine transporter (SLC6A6), with HRs ranging from 3.35 to 3.43. The sixth SNP, rs7853989 (HR, 3.46; CI, 2.33-5.13; p = 6.91×10−10), was located in a region coding for the ABO blood group system. This SNP has been described as predictive for blood type B. Seven significant SNPs were found for the risk of revision for any reason, with the first 4 again being located in the SLC6A6 region. The leading SNP, rs62233562, conferred an HR of 3.11 (CI, 2.19-4.40; p = 1.74×10−10) for revision surgery. Similar HRs were found for SNPs 3:14506680 (p = 1.78×10−10), rs2289129 (p = 1.78×10−10), and rs17309567 (p = 3.16×10−10). The fifth SNP, rs11120968, was located in the calmodulin-binding transcription activator 1 (CAMTA1) gene (HR, 2.34; CI, 1.74-3.13, p = 1.45×10−8).

    Conclusions

    We identified 12 unique SNPs associated with an increased risk of revision surgery. Among these, 2 were in ELAPOR2, which is closely linked to bone formation. Another SNP is located in a gene region encoding for the ABO system, which merits further studies of causal relationships.

    National Category
    Orthopaedics Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-401795 (URN)10.2106/JBJS.21.00750 (DOI)000778606600009 ()
    Available from: 2020-01-09 Created: 2020-01-09 Last updated: 2022-12-01Bibliographically approved
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  • 50.
    Brüggemann, Anders
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Eriksson, Niclas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Uppsala Clinical Research Center (UCR). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical pharmacogenomics and osteoporosis. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Medical epidemiology.
    Hailer, Nils
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Risk of Revision After Arthroplasty Associated withSpecific Gene Loci: A Genomewide Association Study of Single-Nucleotide Polymorphisms in 1,130 TwinsTreated with Arthroplasty2022In: Journal of Bone and Joint Surgery, ISSN 0301-620X, E-ISSN 2044-5377, Vol. 104, no 7, p. 610-620Article in journal (Refereed)
    Abstract [en]

    Background:

    The risk of revision surgery following total joint arthroplasty (TJA) may be influenced by genetic factors. Therefore, we sought to identify genetic variants associated with the risk of revision surgery in a genomewide association study

    Methods

    We investigated a cohort of 1,130 twins from the Swedish Twin Registry treated with TJA. During a mean of 9.4 years of follow-up, 75 individuals underwent revision surgery for aseptic loosening (the primary outcome) and 94, for any reason (the secondary outcome). Genetic information was collected using the Illumina OmniExpress and PsychArray panels, and the Haplotype Reference Consortium served as the reference for gene imputation. Adjusted Cox regression models were fitted to calculate hazard ratios (HRs) with 95% confidence intervals (CIs).

    Results

    Nine single-nucleotide polymorphisms (SNPs) reached genomewide significance for aseptic loosening. The first SNP, rs77149046, located in the endosome-lysosome associated apoptosis and autophagy regulator family member 2 (ELAPOR2) gene, conferred an HR of 5.40 (CI, 3.23-9.02; p = 1.32×10−10), followed by 4 SNPs within the region coding for sodium-dependent taurine and beta-alanine transporter (SLC6A6), with HRs ranging from 3.35 to 3.43. The sixth SNP, rs7853989 (HR, 3.46; CI, 2.33-5.13; p = 6.91×10−10), was located in a region coding for the ABO blood group system. This SNP has been described as predictive for blood type B. Seven significant SNPs were found for the risk of revision for any reason, with the first 4 again being located in the SLC6A6 region. The leading SNP, rs62233562, conferred an HR of 3.11 (CI, 2.19-4.40; p = 1.74×10−10) for revision surgery. Similar HRs were found for SNPs 3:14506680 (p = 1.78×10−10), rs2289129 (p = 1.78×10−10), and rs17309567 (p = 3.16×10−10). The fifth SNP, rs11120968, was located in the calmodulin-binding transcription activator 1 (CAMTA1) gene (HR, 2.34; CI, 1.74-3.13, p = 1.45×10−8).

    Conclusions

    We identified 12 unique SNPs associated with an increased risk of revision surgery. Among these, 2 were in ELAPOR2, which is closely linked to bone formation. Another SNP is located in a gene region encoding for the ABO system, which merits further studies of causal relationships.

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