uu.seUppsala universitets publikationer
Ändra sökning
Avgränsa sökresultatet
123456 1 - 50 av 299
RefereraExporteraLänk till träfflistan
Permanent länk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf
Träffar per sida
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sortering
  • Standard (Relevans)
  • Författare A-Ö
  • Författare Ö-A
  • Titel A-Ö
  • Titel Ö-A
  • Publikationstyp A-Ö
  • Publikationstyp Ö-A
  • Äldst först
  • Nyast först
  • Skapad (Äldst först)
  • Skapad (Nyast först)
  • Senast uppdaterad (Äldst först)
  • Senast uppdaterad (Nyast först)
  • Disputationsdatum (tidigaste först)
  • Disputationsdatum (senaste först)
  • Standard (Relevans)
  • Författare A-Ö
  • Författare Ö-A
  • Titel A-Ö
  • Titel Ö-A
  • Publikationstyp A-Ö
  • Publikationstyp Ö-A
  • Äldst först
  • Nyast först
  • Skapad (Äldst först)
  • Skapad (Nyast först)
  • Senast uppdaterad (Äldst först)
  • Senast uppdaterad (Nyast först)
  • Disputationsdatum (tidigaste först)
  • Disputationsdatum (senaste först)
Markera
Maxantalet träffar du kan exportera från sökgränssnittet är 250. Vid större uttag använd dig av utsökningar.
  • 1.
    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 universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Lund Univ, Orthopaed, Dept Clin Sci Lund, Lund, Sweden..
    The effect of asymmetrical limited hip flexion on seating posture, scoliosis and windswept hip distortion2017Ingår i: Research in Developmental Disabilities, ISSN 0891-4222, E-ISSN 1873-3379, Vol. 71, s. 18-23Artikel i tidskrift (Refereegranskat)
    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.

    Ladda ner fulltext (pdf)
    fulltext
  • 2. Al-Ani, Amer
    et al.
    Cederholm, Tommy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och 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 fracture2015Ingår i: European Journal of Clinical Investigation, ISSN 0014-2972, E-ISSN 1365-2362, Vol. 45, nr 8, s. 800-806Artikel i tidskrift (Refereegranskat)
    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.

  • 3. Al-Ani, Amer N.
    et al.
    Cederholm, Tommy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och 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 fracture2015Ingår i: European Journal of Clinical Investigation, ISSN 0014-2972, E-ISSN 1365-2362, Vol. 45, nr 8, s. 800-806Artikel i tidskrift (Refereegranskat)
    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.

  • 4.
    Alexandersson, Maria
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Nyköping Hosp, Dept Orthoped, Nyköping, Sweden.
    Wang, Eugen Yu-Hui
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Eriksson, Staffan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi. 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 study2019Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 27, nr 4, s. 1035-1042Artikel i tidskrift (Refereegranskat)
    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.

    Ladda ner fulltext (pdf)
    fulltext
  • 5.
    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 universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    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-up2018Ingår i: Journal of Bone and Joint Surgery. American volume, ISSN 0021-9355, E-ISSN 1535-1386, Vol. 100, nr 8, s. 633-639Artikel i tidskrift (Refereegranskat)
    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.

  • 6.
    Alim, Abdul
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Public Health and Caring Sciences.
    Mechanisms in Tendon Healing: Pain, Biomarkers and the Role of Mast Cells2019Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [sv]

    Senskador och tendinopati är vanliga problem, men de underliggande mekanismerna otillräckligt undersökta. Målet med denna avhandling är att öka kunskapen om mekanismer under läkningen av senor, och hur dessa relaterar till smärta och inflammation.

    Syftet med den första studien var att kvantifiera biomarkörer för läkning av Achillessena, genom analys av prokollagen typ I (PINP) och typ III (PIIINP) hos 65 patienter efter ruptur av Achillessenan. Två veckor efter achillesruptur kvantifierades PINP och PIIINP-nivåerna med mikrodialys följt av ELISA-analys. Ett år efter achillesruptur bedömdes patienternas upplevda besvär med användning av ett validerat formulär, Achilles Tendon Total Rupture Score. Ökad andel PINP och PIIINP av totala mängden protein vid två veckor var signifikant associerat med mindre smärta men ökad fatigue i skadat ben efter ett år.

    I nästa studie utvärderade vi effekten av intermittent pneumatisk kompression (IPC) under två veckor av senans läkning efter achillesruptur. Patienterna fick antingen tilläggsbehandling med IPC eller vanlig behandling i gipsskena utan IPC. Vi kunde visa att behandling med IPC signifikant ökade nivån av PINP i den skadade senan, vilket tyder på förbättrad läkning.

    I den tredje studien undersökte vi mastcellers roll under läkningen av Achillessena efter ruptur i en råttmodell. Tre veckor postoperativt visade vi ett ökat antal mastceller och en högre andel degranulerade av mastceller i den läkande senan jämfört med senan på den andra (den friska) sidan. Vi kunde också påvisa glutamatreceptorn NMDAR1 hos mastceller i den läkande senan.

    I den fjärde studien bedömde vi effekten av glutamatstimulering in-vitro, på mastceller från benmärg hos mus. Degranulering av mastceller kvantifierades genom frisättning av β-hexosaminidas. För att kvantifiera NMDAR på proteinnivå använde vi immunfluorescens, och för att studera uttrycket av NMDAR och associerade gener använde vi RT-qPCR/mikroarray. Vi kunde visa att glutamat inducerar uppreglering av glutamatreceptorer av både jonotropisk och metabotropisk typ i mastceller, både på mRNA- och proteinnivå. NMDAR1 samlokaliserade med glutamat i membranet på mastceller, vilket därmed bekräftar en interaktion mellan glutamat och dess receptor. Glutamat inducerade också uttryck av pro-inflammatoriska proteiner såsom IL-6 och CCL2, samt transkriptionsfaktorer såsom Egr2, Egr3 och FosB. Dessutom upphävde NMDA-kanalblockeraren MK-801 fullständigt effekten av glutamat på mastceller, vilket talar för en funktionell betydelse av interaktionen mellan glutamat och glutamatreceptorer i mastceller.

    Sammantaget visar de fynd som presenteras i denna avhandling möjliga mekanismer för läkning av Achillessena i relation till smärta och funktion och introducerar en ny princip för hur immunceller kan kommunicera med nervceller efter achillesruptur.

    Delarbeten
    1. Procollagen markers in microdialysate can predict patient outcome after Achilles tendon rupture.
    Öppna denna publikation i ny flik eller fönster >>Procollagen markers in microdialysate can predict patient outcome after Achilles tendon rupture.
    2016 (Engelska)Ingår i: BMJ open sport & exercise medicine, ISSN 2055-7647, Vol. 2, nr 1, artikel-id e000114Artikel i tidskrift (Refereegranskat) 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.

    Ort, förlag, år, upplaga, sidor
    London, UK: , 2016
    Nyckelord
    Achilles, Chronic, Collagen, Injuries, Tendon
    Nationell ämneskategori
    Ortopedi
    Forskningsämne
    Ortopedi
    Identifikatorer
    urn:nbn:se:uu:diva-395018 (URN)10.1136/bmjsem-2016-000114 (DOI)27900179 (PubMedID)
    Tillgänglig från: 2019-10-11 Skapad: 2019-10-11 Senast uppdaterad: 2020-02-19Bibliografiskt granskad
    2. Achilles tendon rupture healing is enhanced by intermittent pneumatic compression upregulating collagen type I synthesis
    Öppna denna publikation i ny flik eller fönster >>Achilles tendon rupture healing is enhanced by intermittent pneumatic compression upregulating collagen type I synthesis
    Visa övriga...
    2018 (Engelska)Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 26, nr 7, s. 2021-2029Artikel i tidskrift (Refereegranskat) 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.

    Nyckelord
    Achilles tendon rupture, Intermittent pneumatic compression devices, Microdialysis, Procollagen, Regeneration
    Nationell ämneskategori
    Kirurgi
    Identifikatorer
    urn:nbn:se:uu:diva-395017 (URN)10.1007/s00167-017-4621-8 (DOI)28668970 (PubMedID)
    Tillgänglig från: 2019-10-11 Skapad: 2019-10-11 Senast uppdaterad: 2020-02-19Bibliografiskt granskad
    3. Increased mast cell degranulation and co-localization of mast cells with the NMDA receptor-1 during healing after Achilles tendon rupture
    Öppna denna publikation i ny flik eller fönster >>Increased mast cell degranulation and co-localization of mast cells with the NMDA receptor-1 during healing after Achilles tendon rupture
    Visa övriga...
    2017 (Engelska)Ingår i: Cell and Tissue Research, ISSN 0302-766X, E-ISSN 1432-0878, Vol. 370, nr 3, s. 451-460Artikel i tidskrift (Refereegranskat) 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.

    Ort, förlag, år, upplaga, sidor
    Berlin Heidelberg: , 2017
    Nyckelord
    Achilles tendon healing, Mast cells, NMDA, Rats, Tryptase
    Nationell ämneskategori
    Cell- och molekylärbiologi
    Forskningsämne
    Ortopedi; Immunologi
    Identifikatorer
    urn:nbn:se:uu:diva-395522 (URN)10.1007/s00441-017-2684-y (DOI)000416358400010 ()28975451 (PubMedID)
    Tillgänglig från: 2019-10-20 Skapad: 2019-10-20 Senast uppdaterad: 2020-02-06Bibliografiskt granskad
    4. Glutamate Triggers the Expression of Functional Ionotropic and Metabotropic Glutamate Receptors in Mast Cells
    Öppna denna publikation i ny flik eller fönster >>Glutamate Triggers the Expression of Functional Ionotropic and Metabotropic Glutamate Receptors in Mast Cells
    Visa övriga...
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Nyckelord
    Glutamate, glutamate receptors, mast cells, NMDA-receptors, tryptase
    Nationell ämneskategori
    Cell- och molekylärbiologi Immunologi inom det medicinska området
    Forskningsämne
    Immunologi; Neurovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-394714 (URN)
    Tillgänglig från: 2019-10-09 Skapad: 2019-10-09 Senast uppdaterad: 2019-10-23
    Ladda ner fulltext (pdf)
    fulltext
    Ladda ner (jpg)
    presentationsbild
  • 7.
    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.2016Ingår i: BMJ open sport & exercise medicine, ISSN 2055-7647, Vol. 2, nr 1, artikel-id e000114Artikel i tidskrift (Refereegranskat)
    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.

  • 8.
    Andersen, Mikkel Österheden
    et al.
    Reg Southern Denmark, Ctr Spine Surg & Res, Middelfart, Denmark;Univ Southern Denmark, Odense, Denmark.
    Fritzell, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi. 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 Registers2019Ingår i: Global Spine Journal, ISSN 2192-5682, E-ISSN 2192-5690, Vol. 9, nr 8, s. 850-858Artikel i tidskrift (Refereegranskat)
    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.

    Ladda ner fulltext (pdf)
    FULLTEXT01
  • 9.
    Andjelkov, Nenad
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. 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 study2016Ingår i: Journal of Orthopaedic Surgery and Research, ISSN 1749-799X, E-ISSN 1749-799X, Vol. 11, artikel-id 23Artikel i tidskrift (Refereegranskat)
    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.

    Ladda ner fulltext (pdf)
    fulltext
  • 10.
    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 universitet, Medicinska och farmaceutiska vetenskapsområdet, 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 Activity2016Ingår i: Arthroscopy: The Journal of Arthroscopy And Related, ISSN 0749-8063, E-ISSN 1526-3231, Vol. 32, nr 8, s. 1631-+Artikel i tidskrift (Refereegranskat)
    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.

  • 11.
    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 universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    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 Abnormality2018Ingår i: Advances in Orthopedics, ISSN 2090-3464, E-ISSN 2090-3472, Vol. 2018, artikel-id 7060654Artikel, forskningsöversikt (Refereegranskat)
    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.

    Ladda ner fulltext (pdf)
    fulltext
  • 12. 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.2019Ingår i: Advances in Orthopedics, ISSN 2090-3464, E-ISSN 2090-3472, Vol. 2019, artikel-id 8634260Artikel i tidskrift (Refereegranskat)
  • 13.
    Augat, Peter
    et al.
    Trauma Ctr Murnau, Inst Biomech, Murnau, Germany; Paracelsus Med Univ, Inst Biomech, Salzburg, Austria.
    Larsson, Sune
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Plating of fractures: current treatments and complications2018Ingår i: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 49, s. S1-S1Artikel i tidskrift (Övrigt vetenskapligt)
  • 14.
    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
    Univ Hosp, Dept Orthopaed Surg, Uppsala, Sweden..
    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 Finland2016Ingår i: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 87, nr 6, s. 541-545Artikel i tidskrift (Refereegranskat)
    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.

    Ladda ner fulltext (pdf)
    fulltext
  • 15.
    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 universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Endokrinologi och mineralmetabolism.
    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 study2019Ingår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 30, nr 3, s. 601-609Artikel i tidskrift (Refereegranskat)
    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.

    Ladda ner fulltext (pdf)
    fulltext
  • 16.
    Bejhed, Rebecca S.
    et al.
    Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Tekniska sektionen, Institutionen för teknikvetenskaper, Fasta tillståndets fysik.
    Kharazmi, Mohammad
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi. Cent Hosp Vasteras, Vasteras, Sweden..
    Hallberg, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk farmakogenomik och osteoporos.
    Identification of Risk Factors for Bisphosphonate-Associated Atypical Femoral Fractures and Osteonecrosis of the Jaw in a Pharmacovigilance Database2016Ingår i: The Annals of Pharmacotherapy, ISSN 1060-0280, E-ISSN 1542-6270, Vol. 50, nr 8, s. 616-624Artikel i tidskrift (Refereegranskat)
    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.

  • 17.
    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 universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Pettersson-Kymmer, U.
    Umea Univ, Dept Pharmacol & Clin Neurosci, Umea, Sweden;Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden.
    Byberg, Liisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    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 universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi. 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 project2018Ingår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 29, nr 7, s. 1591-1599Artikel i tidskrift (Refereegranskat)
    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.

  • 18.
    Berglund, Britta
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Pettersson, Carina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Pigg, Maritta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för immunologi, genetik och patologi, Medicinsk genetik och genomik.
    Kristiansson, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Self-reported quality of life, anxiety and depression in individuals with Ehlers-Danlos syndrome (EDS): a questionnaire study2015Ingår i: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 16, artikel-id 89Artikel i tidskrift (Refereegranskat)
    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.

    Ladda ner fulltext (pdf)
    fulltext
  • 19.
    Bernhoff, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Incidence and outcome of popliteal artery injury associated with knee trauma: a nation-wide population-based cohort studyManuskript (preprint) (Övrigt vetenskapligt)
  • 20.
    Bernhoff, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Orthopaedic Patients with Lower Limb Vascular Injuries2016Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    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.

    Delarbeten
    1. Popliteal artery injury in knee arthroplasty: a population based, nationwide study
    Öppna denna publikation i ny flik eller fönster >>Popliteal artery injury in knee arthroplasty: a population based, nationwide study
    2013 (Engelska)Ingår i: Journal of Bone and Joint Surgery, ISSN 0301-620X, E-ISSN 2044-5377, Vol. 95, nr 12, s. 1645-1649Artikel i tidskrift (Övrigt vetenskapligt) 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.

    Nyckelord
    Vascular injury, popliteal artery, knee arthroplasty, complication, adverse event, pseudoaneurysm
    Nationell ämneskategori
    Ortopedi Kirurgi
    Forskningsämne
    Kirurgi
    Identifikatorer
    urn:nbn:se:uu:diva-194380 (URN)10.1302/0301-620X.95B12.31611 (DOI)000327788000010 ()24293594 (PubMedID)
    Forskningsfinansiär
    Vetenskapsrådet, K2010-65X-20406-04-3
    Tillgänglig från: 2013-02-13 Skapad: 2013-02-13 Senast uppdaterad: 2018-01-11Bibliografiskt granskad
    2. Iatrogenic popliteal artery injury in non arthroplasty knee surgery
    Öppna denna publikation i ny flik eller fönster >>Iatrogenic popliteal artery injury in non arthroplasty knee surgery
    2015 (Engelska)Ingår i: The Bone & Joint Journal, ISSN 2049-4394, E-ISSN 2049-4408, Vol. 97B, nr 2, s. 192-196Artikel i tidskrift (Refereegranskat) 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.

    Nationell ämneskategori
    Ortopedi
    Identifikatorer
    urn:nbn:se:uu:diva-246818 (URN)10.1302/0301-620X.97B2.34353 (DOI)000348613700010 ()25628281 (PubMedID)
    Tillgänglig från: 2015-03-13 Skapad: 2015-03-10 Senast uppdaterad: 2018-01-11Bibliografiskt granskad
    3. Patients’ experiences of life years after severe civilian lower extremity trauma with vascular injury
    Öppna denna publikation i ny flik eller fönster >>Patients’ experiences of life years after severe civilian lower extremity trauma with vascular injury
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Nationell ämneskategori
    Kirurgi Ortopedi
    Identifikatorer
    urn:nbn:se:uu:diva-296032 (URN)
    Tillgänglig från: 2016-06-13 Skapad: 2016-06-13 Senast uppdaterad: 2018-01-10
    4. Incidence and outcome of popliteal artery injury associated with knee trauma: a nation-wide population-based cohort study
    Öppna denna publikation i ny flik eller fönster >>Incidence and outcome of popliteal artery injury associated with knee trauma: a nation-wide population-based cohort study
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Nationell ämneskategori
    Ortopedi Kirurgi
    Identifikatorer
    urn:nbn:se:uu:diva-296034 (URN)
    Tillgänglig från: 2016-06-13 Skapad: 2016-06-13 Senast uppdaterad: 2018-01-10
    Ladda ner fulltext (pdf)
    fulltext
    Ladda ner (jpg)
    presentationsbild
  • 21.
    Bernhoff, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kärlkirurgi.
    Patients’ experiences of life years after severe civilian lower extremity trauma with vascular injuryManuskript (preprint) (Övrigt vetenskapligt)
  • 22.
    Bernhoff, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Patients’ experiences of life years after severe civilian lower extremity trauma with vascular injuryManuskript (preprint) (Övrigt vetenskapligt)
  • 23.
    Bernhoff, Karin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Björck, Martin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kärlkirurgi.
    Iatrogenic popliteal artery injury in non arthroplasty knee surgery2015Ingår i: The Bone & Joint Journal, ISSN 2049-4394, E-ISSN 2049-4408, Vol. 97B, nr 2, s. 192-196Artikel i tidskrift (Refereegranskat)
    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.

  • 24.
    Bernhoff, Karin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kärlkirurgi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Rudström, Håkan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kärlkirurgi.
    Gedeborg, Rolf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Björck, Martin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kärlkirurgi.
    Popliteal artery injury in knee arthroplasty: a population based, nationwide study2013Ingår i: Journal of Bone and Joint Surgery, ISSN 0301-620X, E-ISSN 2044-5377, Vol. 95, nr 12, s. 1645-1649Artikel i tidskrift (Övrigt vetenskapligt)
    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.

  • 25.
    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 universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    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 Aspiration2017Ingår i: 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, s. 101-111Kapitel i bok, del av antologi (Refereegranskat)
    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.

  • 26.
    Borg, Tomas
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Berg, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Fugl-Meyer, Kerstin
    Larsson, Sune
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Health-related quality of life and life satisfaction in patients following surgically treated pelvic ring fractures: A prospective observational study with two years follow-up2010Ingår i: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 41, nr 4, s. 400-404Artikel i tidskrift (Refereegranskat)
    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.

    Ladda ner fulltext (pdf)
    fulltext
  • 27.
    Borg, Tomas
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Hailer, Nils P
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Outcome 5 years after surgical treatment of acetabular fractures: a prospective clinical and radiographic follow-up of 101 patients2015Ingår i: Archives of Orthopaedic and Trauma Surgery, ISSN 0936-8051, E-ISSN 1434-3916, Vol. 135, nr 2, s. 227-233Artikel i tidskrift (Refereegranskat)
    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.

  • 28.
    Borg, Tomas
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Hernefalk, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Carlsson, Marianne
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap. Uppsala Univ, Dept Publ Hlth & Caring Sci, Uppsala, Sweden..
    Larsson, Sune
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Development of a pelvic discomfort index to evaluate outcome following fixation for pelvic ring injury2015Ingår i: Journal of Orthopaedic Surgery, ISSN 1022-5536, E-ISSN 2309-4990, Vol. 23, nr 2, s. 146-149Artikel i tidskrift (Refereegranskat)
    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

  • 29.
    Borg, Tomas
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Hernefalk, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Hailer, Nils P.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    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 years2019Ingår i: The Bone & Joint Journal, ISSN 2049-4394, E-ISSN 2049-4408, Vol. 101B, nr 4, s. 478-483Artikel i tidskrift (Refereegranskat)
    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.

  • 30.
    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 universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Endokrinologi och mineralmetabolism.
    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 Osteoporosis2016Ingår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 27, s. S60-S60Artikel i tidskrift (Övrigt vetenskapligt)
  • 31.
    Brüggemann, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Hip Revision Surgery: Identification of Genetic Markers and Evaluation of Novel Treatment Strategies2020Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [sv]

    Höftproteskirurgi är ett väldigt framgångsrikt kirurgiskt ingrepp och förbättrar livskvalité samtidigt som den minskar smärta hos den drabbade patienten. Tyvärr behöver ca 10 % av alla patienter genomgå en omoperation av höftleden, oftast eftersom protesen lossnar, men den konstgjorda leden kan även hoppa ur led (luxation).

    Vid omoperation av höften har under de senaste två decennierna två relativt nya implantat använts: cupar gjorda av poröst tantalum som ska minska risken för lossning och cupar med två artikulationsytor, så kallade dubbelcupar, som ska minska risken för luxation. Dessa två implantat är dock ej undersökta i jämförande studier. Likaså är det inte känt huruvida tantalum genom frisättning av joner kan påverka patienternas immunsystem. Vidare finns det antaganden att risken för att behöva genomgå omoperation ska vara ärftligt betingad.

    Denna avhandling undersökte i sina fyra delarbeten om cupar gjorda av tantalum visar en bättre överlevnad än de historiska behandlingsalternativen; om dubbelcupar visar det bättre utfallet avseende risken för luxation i jämförelse med standardcupar; om frisättning av tantaljoner förekommer efter användning av tantalumcupar och hur detta påverkar patienternas immunologi; om risken för reoperation är associerad med vissa riskgener.

    Implantatöverlevnad analyserades med hjälp av överlevnadskurvor. Tantalumjoner uppmättes och deras medianvärden jämfördes mellan olika grupper av patienter som opererades med proteser som innehöll tantalum och de som opererades med konventionella proteser. Därutöver relaterades tantalumjoner till särskilda markörer inom immunsystemet. För att hitta riskgener för omoperationer jämfördes genomet hos individer som genomgick reoperation efter protesinsättning med de som inte gjorde det.

    De mest intressanta fynden var att tantalumcupar visade ett lika gott resultat efter omoperation som deras historiska behandlingsalternativ. Dock luxerade höften hos en stor andel av patienterna. Höfter som opererades med dubbelcupar visade en lägre risk för luxation i jämförelse med standardcupar. Tantaljoner frisattes till viss mån, och vi fann enbart svaga korrelationer med vissa lymfocyter. Vi fann sex riskgener som ökade risken för reoperation oavsett orsak. Tre gener associerades med en ökad risk för reoperation på grund av lossning av implantaten. Många riskgener som var nära statistisk signifikans befann sig inom genen som kodar för ABO-grupperingen.

    Vår konklusion är att tantalumcupar är ett säkert och pålitligt alternativ vid reoperation men att man bör beakta risken för att protesen kan hoppa ur led. Detta kan hanteras genom användning av dubbelcupar i kombination med tantalumcupar. Tantalum påverkar ej patienters immunsystem. De identifierade riskgenerna behöver bekräftas i nya studier, men även en eventuell riskökning för omoperation för vissa blodgrupper bör studeras.

    Delarbeten
    1. Are porous tantalum cups superior to conventional reinforcement rings?: A retrospective cohort study of 207 acetabular revisions
    Öppna denna publikation i ny flik eller fönster >>Are porous tantalum cups superior to conventional reinforcement rings?: A retrospective cohort study of 207 acetabular revisions
    2017 (Engelska)Ingår i: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 88, nr 1, s. 35-40Artikel i tidskrift (Refereegranskat) 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.

    Nationell ämneskategori
    Ortopedi
    Identifikatorer
    urn:nbn:se:uu:diva-316408 (URN)10.1080/17453674.2016.1248315 (DOI)000392736200007 ()27892748 (PubMedID)
    Tillgänglig från: 2017-03-02 Skapad: 2017-03-02 Senast uppdaterad: 2020-01-09Bibliografiskt granskad
    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
    Öppna denna publikation i ny flik eller fönster >>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 (Engelska)Ingår i: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 89, nr 2, s. 156-162Artikel i tidskrift (Refereegranskat) 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.

    Ort, förlag, år, upplaga, sidor
    TAYLOR & FRANCIS LTD, 2018
    Nationell ämneskategori
    Ortopedi
    Identifikatorer
    urn:nbn:se:uu:diva-353002 (URN)10.1080/17453674.2018.1432927 (DOI)000429335700004 ()29400106 (PubMedID)
    Tillgänglig från: 2018-07-13 Skapad: 2018-07-13 Senast uppdaterad: 2020-01-09Bibliografiskt granskad
    3. Safety of Use of Tantalum in Total Hip Arthroplasty
    Öppna denna publikation i ny flik eller fönster >>Safety of Use of Tantalum in Total Hip Arthroplasty
    (Engelska)Ingår i: Journal of Bone and Joint Surgery. American volume, ISSN 0021-9355, E-ISSN 1535-1386Artikel i tidskrift (Refereegranskat) Epub ahead of print
    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

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Forskningsämne
    Ortopedi
    Identifikatorer
    urn:nbn:se:uu:diva-401793 (URN)10.2106/JBJS.19.00366 (DOI)
    Tillgänglig från: 2020-01-09 Skapad: 2020-01-09 Senast uppdaterad: 2020-02-05Bibliografiskt granskad
    4. Is the risk of revision after arthroplasty surgery associated with specific gene loci? A genome-wide association study of single nucleotide polymorphisms in 1,130 arthroplasty-treated twins.
    Öppna denna publikation i ny flik eller fönster >>Is the risk of revision after arthroplasty surgery associated with specific gene loci? A genome-wide association study of single nucleotide polymorphisms in 1,130 arthroplasty-treated twins.
    Visa övriga...
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Background:

    We aimed to identify single nucleotide polymorphisms (SNPs) associated with an increased risk of revision surgery following total joint replacement (TJR) within the setting of a genome-wide association study.

    Patients and Methods

    Genetic information was present on 1,130 twins in the Swedish Twin Registry’s TwinGene dataset who had been treated with TJR of the hip or knee. Of these, 94 underwent revision surgery for any reason, our primary outcome, and 75/94 underwent revision due to aseptic loosening, our secondary outcome. Genetic information was collected using the Illumina OmniExpress and Psych arrays and the Haplotype Reference Consortium served as the reference for gene imputation. Adjusted Cox regression models with a robust sandwich estimator were fitted to calculate hazard ratios (HRs) with 95% confidence intervals (CI) at a significance level of p<5*10-8.

    Results

    Six SNPs were statistically significantly associated with an increased risk for revision due to any reason, with the leading four located in a gene region coding for the sodium-dependent taurine and beta-alanine transporter. The first SNP, rs62233562, conferred a HR of undergoing revision surgery of 3.1 (95%CI 2.2-4.4, p=1.74*10-10). Similar HR were attained for the SNPs 3:14506680 (p=1.8*10-10), rs2289129 (p=1.8*10-10), and rs17309567 (p=3.16*10-10). The fifth SNP was located in the calmodulin-binding transcription activator 1 gene (rs11120968, HR 2.3; 95%CI 1.7-3.1, p=1.45*10-8), and the sixth, rs13081679, in an intron region (HR 2.9; 95%CI 2.0-4.1, p=2.63*10-8). When investigating aseptic loosening as the outcome, three SNP reached statistical significance: The previously identified rs17309567 remained significant (HR 3.35; 95%CI: 2.31-4.86, p=1.69*10-10), followed by two SNPs within the region coding for the ABO-system: rs7853989 (HR: 3.46; 95%CI 2.33-5.13, p=6.91*10-10), and 9:136126631 (HR: 2.82; 95%CI 1.95-4.07, p=3.35*10-8).

    Conclusions

    We identified novel SNPs conferring an increased risk of revision surgery after TJR, some with a potential connection to the pathophysiology underlying TJR loosening. Given the association of ABO-variants with complications after TJR, our findings of risk-SNPs within gene regions encoding for the ABO-system merit further investigation and replication.

    Nationell ämneskategori
    Ortopedi
    Identifikatorer
    urn:nbn:se:uu:diva-401795 (URN)
    Tillgänglig från: 2020-01-09 Skapad: 2020-01-09 Senast uppdaterad: 2020-01-09
    Ladda ner fulltext (pdf)
    fulltext
    Ladda ner (jpg)
    presentationsbild
  • 32.
    Brüggemann, Anders
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi. Uppsala University.
    Eriksson, Niclas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk farmakogenomik och osteoporos. Uppsala universitet, Science for Life Laboratory, SciLifeLab.
    Pedersen, Nancy L
    Michaëlsson, Karl
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Hailer, Nils
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Is the risk of revision after arthroplasty surgery associated with specific gene loci? A genome-wide association study of single nucleotide polymorphisms in 1,130 arthroplasty-treated twins.Manuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Background:

    We aimed to identify single nucleotide polymorphisms (SNPs) associated with an increased risk of revision surgery following total joint replacement (TJR) within the setting of a genome-wide association study.

    Patients and Methods

    Genetic information was present on 1,130 twins in the Swedish Twin Registry’s TwinGene dataset who had been treated with TJR of the hip or knee. Of these, 94 underwent revision surgery for any reason, our primary outcome, and 75/94 underwent revision due to aseptic loosening, our secondary outcome. Genetic information was collected using the Illumina OmniExpress and Psych arrays and the Haplotype Reference Consortium served as the reference for gene imputation. Adjusted Cox regression models with a robust sandwich estimator were fitted to calculate hazard ratios (HRs) with 95% confidence intervals (CI) at a significance level of p<5*10-8.

    Results

    Six SNPs were statistically significantly associated with an increased risk for revision due to any reason, with the leading four located in a gene region coding for the sodium-dependent taurine and beta-alanine transporter. The first SNP, rs62233562, conferred a HR of undergoing revision surgery of 3.1 (95%CI 2.2-4.4, p=1.74*10-10). Similar HR were attained for the SNPs 3:14506680 (p=1.8*10-10), rs2289129 (p=1.8*10-10), and rs17309567 (p=3.16*10-10). The fifth SNP was located in the calmodulin-binding transcription activator 1 gene (rs11120968, HR 2.3; 95%CI 1.7-3.1, p=1.45*10-8), and the sixth, rs13081679, in an intron region (HR 2.9; 95%CI 2.0-4.1, p=2.63*10-8). When investigating aseptic loosening as the outcome, three SNP reached statistical significance: The previously identified rs17309567 remained significant (HR 3.35; 95%CI: 2.31-4.86, p=1.69*10-10), followed by two SNPs within the region coding for the ABO-system: rs7853989 (HR: 3.46; 95%CI 2.33-5.13, p=6.91*10-10), and 9:136126631 (HR: 2.82; 95%CI 1.95-4.07, p=3.35*10-8).

    Conclusions

    We identified novel SNPs conferring an increased risk of revision surgery after TJR, some with a potential connection to the pathophysiology underlying TJR loosening. Given the association of ABO-variants with complications after TJR, our findings of risk-SNPs within gene regions encoding for the ABO-system merit further investigation and replication.

  • 33.
    Brüggemann, Anders
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Fredlund, Erik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Mallmin, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Hailer, Nils P.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Are porous tantalum cups superior to conventional reinforcement rings?: A retrospective cohort study of 207 acetabular revisions2017Ingår i: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 88, nr 1, s. 35-40Artikel i tidskrift (Refereegranskat)
    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.

    Ladda ner fulltext (pdf)
    fulltext
  • 34.
    Brüggemann, Anders
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Mallmin, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Hailer, Nils P
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Do dual-mobility cups cemented into porous tantalum shells reduce the risk of dislocation after revision surgery?: A retrospective cohort study on 184 patients2018Ingår i: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 89, nr 2, s. 156-162Artikel i tidskrift (Refereegranskat)
    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.

    Ladda ner fulltext (pdf)
    fulltext
  • 35.
    Byberg, Liisa
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Bellavia, Andrea
    Karolinska Inst, Unit Nutr Epidemiol, Inst Environm Med, Solna, Sweden.
    Orsini, Nicola
    Karolinska Inst, Unit Nutr Epidemiol, Inst Environm Med, Solna, Sweden.
    Wolk, Alicja
    Karolinska Inst, Unit Nutr Epidemiol, Inst Environm Med, Solna, Sweden.
    Michaëlsson, Karl
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Fruit and vegetable intake and risk of hip fracture: A cohort study of Swedish men and women2015Ingår i: Journal of Bone and Mineral Research, ISSN 0884-0431, E-ISSN 1523-4681, Vol. 30, nr 6, s. 976-984Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Dietary guidelines recommend a daily intake of five servings of fruit and vegetables. Whether such intakes are associated with a lower risk of hip fracture is at present unclear. The aim of the present study was to investigate the dose-response association between habitual fruit and vegetable intake and hip fracture in a cohort study based on 40,644 men from the Cohort of Swedish Men (COSM) and 34,947 women from the Swedish Mammography Cohort (SMC) (total n=75,591), free from cardiovascular disease and cancer, who answered lifestyle questionnaires in 1997 (age 45-83 years). Intake of fruit and vegetables (servings/day) was assessed by food frequency questionnaire and incident hip fractures were retrieved from the Swedish Patient Register (1998-2010). The mean follow-up time was 14.2 years. One third of the participants reported an intake of fruit and vegetables of >5 servings/day, one third >3 to ≤5 servings/day, 28% >1 to ≤3 servings/day, and 6% reported ≤1 serving/day. During 1,037,645 person-years we observed 3,644 hip fractures (2,266, 62%, in women). The doseresponse association was found to be strongly non-linear (P<0.001). Men and women with zero consumption had 88% higher rate of hip fracture compared with those consuming 5 servings/day; adjusted hazard ratio (HR), 1.88 (95% CI, 1.53-2.32). The rate was gradually lower with higher intakes; adjusted HR for 1 vs 5 servings/day, 1.35 (95% CI, 1.21-1.58). However, more than 5 servings/day did not confer additionally lower HRs (adjusted HR for 8 vs. 5 servings/day, 0.96 (95% CI, 0.90-1.03). Similar results were observed when men and women were analyzed separately. We conclude that there is a dose-response association between fruit and vegetable intake and hip fracture such that an intake below the recommended 5 servings/day confers higher rates of hip fracture. Intakes above this recommendation do not seem to further lower the risk.

    Ladda ner fulltext (pdf)
    fulltext
  • 36.
    Byberg, Liisa
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Gedeborg, Rolf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Cars, Thomas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Sundström, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Medicin.
    Berglund, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Kilander, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Melhus, Håkan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk farmakogenomik och osteoporos.
    Michaëlsson, Karl
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Prediction of fracture risk in men: A cohort study2012Ingår i: Journal of Bone and Mineral Research, ISSN 0884-0431, E-ISSN 1523-4681, Vol. 27, nr 4, s. 797-807Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    FRAX is a tool that identifies individuals with high fracture risk who will benefit from pharmacological treatment of osteoporosis. However, a majority of fractures among elderly occur in people without osteoporosis and most occur after a fall. Our aim was to accurately identify men with a high future risk of fracture, independent of cause. In the population-based Uppsala Longitudinal Study of Adult Men (ULSAM) and using survival analysis we studied different models' prognostic values (R(2) ) for any fracture and hip fracture within 10 years from age 50 (n = 2322), 60 (n = 1852), 71 (n = 1221), and 82 (n = 526). During the total follow-up period from age 50, 897 fractures occurred in 585 individuals. Of these, 281 were hip fractures occurring in 189 individuals. The rates of any fracture were 5.7/1000 person-years at risk from age 50 and 25.9/1000 person-years at risk from age 82. Corresponding hip fractures rates were 2.9 and 11.7/1000 person-years at risk. The FRAX model included all variables in FRAX except bone mineral density. The full model combining FRAX variables, comorbidity, medications, and behavioral factors explained 25-45% of all fractures and 80-92% of hip fractures, depending on age. The corresponding prognostic values of the FRAX model were 7-17% for all fractures and 41-60% for hip fractures. Net reclassification improvement (NRI) comparing the full model with the FRAX model ranged between 40 and 53% for any fracture and between 40 and 87% for hip fracture. Within the highest quintile of predicted fracture risk with the full model, 1/3 of the men will have a fracture within 10 years after age 71 years and 2/3 after age 82 years. We conclude that the addition of comorbidity, medication and behavioral factors to the clinical components of FRAX can substantially improve the ability to identify men at high risk of fracture, especially hip fracture. 

  • 37.
    Byberg, Liisa
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Michaëlsson, Karl
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Milk and other dairy foods and risk of hip fracture in men and women: Comments on Feskanich et al.2018Ingår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 29, nr 5, s. 1221-1222Artikel i tidskrift (Refereegranskat)
  • 38.
    Carrwik, Christian
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Murakami, Hideki
    Kanazawa University, Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa, Japan.
    Willander, Johan
    Gävle University, Department of Psychology, Gävle, Sweden.
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Potential harms of interventions for spinal metastatic disease2017Ingår i: Cochrane Database of Systematic Reviews, ISSN 1469-493X, E-ISSN 1469-493X, nr 7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:

    The primary objective of this review is to compare the potential harms of treatment for spinal metastatic disease for the following treatments:

    1. Surgical intervention.

    2. Surgical intervention with radiation therapy.

    3. Radiation therapy alone.

    Our secondary objectives are:

    1. comparing the harms of different surgical methods;

    2. comparing the harms between different radiation protocols.

    Ladda ner fulltext (pdf)
    fulltext
  • 39.
    Carrwik, Christian
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Olerud, Claes
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Predictive Scores Underestimate Survival of Patients With Metastatic Spine Disease: A Retrospective Study of 315 Patients in Sweden.2020Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 45, nr 6, s. 414-419Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    STUDY DESIGN: Retrospective cohort study.

    OBJECTIVE: To validate the precision of four predictive scoring systems for spinal metastatic disease and evaluate whether they underestimate or overestimate survival.

    SUMMARY OF BACKGROUND DATA: Metastatic spine disease is a common complication to malignancies. Several scoring systems are available to predict survival and to help the clinician to select surgical or nonsurgical treatment.

    METHODS: Three hundred fifteen adult patients (213 men, 102 women, mean age 67 yr) undergoing spinal surgery at Uppsala University Hospital, Sweden, due to metastatic spine disease 2006 to 2012 were included. Data were collected prospectively for the Swedish Spine Register and retrospectively from the medical records. Tokuhashi scores, Revised Tokuhashi Scores, Tomita scores, and Modified Bauer Scores were calculated and compared with actual survival data from the Swedish Population Register.

    RESULTS: The mean estimated survival time after surgery for all patients included was 12.4 months (confidence interval 10.6-14.2) and median 5.9 months (confidence interval 4.5-7.3). All four scores had significant correlation to survival (P < 0.0001) but tended to underestimate rather than overestimate survival. Modified Bauer Score was the best of the four scores to predict short survival, both regarding median and mean survival. Tokuhashi score was found to be the best of the scores to predict long survival, even though the predictions were inaccurate in 42% of the cases.

    CONCLUSION: Predictive scores underestimate survival for the patients which might affect important clinical decisions.

    LEVEL OF EVIDENCE: 3.

  • 40.
    Christersson, Albert
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Fractures of the distal radius: Factors related to radiographic evaluation, conservative treatment and fracture healing2017Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Distal radius fractures (DRFs) are one of the most common injuries encountered in orthopaedic practise. Such fractures are most often treated conservatively, but surgical treatment has become increasingly common. This trend is not entirely scientifically based

    The aims of this thesis were threefold: to increase measurement precision in dorsal angulation (DA) on radiographs and computer tomographies (CTs); to assess the results after shortened plaster cast fixation time in reduced DRFs; and to evaluate the feasibility and safety of applying Augment® (rhPDGF-BB/β-TCP) in DRFs.

    In Paper I and Appendix 1 and 2, a semi-automatic CT-based three-dimensional method was developed to measure change in DA over time in DRFs. This approach proved to be a better (more sensitive) method than radiography in determining changes in DA in fractures of the distal radius.

    In Paper II, a CT model was used to simulate lateral radiographic views of different radial directions in relation to the X-ray. Using an alternative reference point on the distal radius, precision and accuracy in measuring DA was increased.

    Paper III and IV are based on a prospective and randomised clinical study (the GitRa trial) that compares clinical and radiographic outcomes after plaster cast removal at 10 days versus 1 month in 109 reduced DRFs. Three patients in the early mobilised group were excluded because of fracture dislocation (n=2) or a feeling of fracture instability (n=1). For the remaining patients in the early mobilised group (51/54) a limited but temporary gain in range of motion, but a slight increase in radiographic displacement were observed. Our results suggest that plaster cast removal at 10 days after reduction of DRFs is not feasible.

    Paper V is based on a prospective, randomised clinical study (the GEM trial) in which 40 externally fixated DRFs were randomised to rhPDGF-BB/β-TCP into the fracture gap or to the control group. Augment® proved to be convenient and safe during follow-up (24 weeks). However, because of the nature of the study design, the effect on fracture healing could not be determined. A decrease in pin infections was seen in the Augment® group, a finding we could not explain.

    Delarbeten
    1. Comparison of 2D radiography and a semi-automatic CT-based 3D method for measuring change in dorsal angulation over time in distal radius fractures
    Öppna denna publikation i ny flik eller fönster >>Comparison of 2D radiography and a semi-automatic CT-based 3D method for measuring change in dorsal angulation over time in distal radius fractures
    Visa övriga...
    2016 (Engelska)Ingår i: Skeletal Radiology, ISSN 0364-2348, E-ISSN 1432-2161, Vol. 45, nr 6, s. 763-769Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Objective The aim of the present study was to compare the reliability and agreement between a computer tomography-based method (CT) and digitalised 2D radiographs (XR) when measuring change in dorsal angulation over time in distal radius fractures. Materials and methods Radiographs from 33 distal radius fractures treated with external fixation were retrospectively analysed. All fractures had been examined using both XR and CT at six times over 6 months postoperatively. The changes in dorsal angulation between the first reference images and the following examinations in every patient were calculated from 133 follow-up measurements by two assessors and repeated at two different time points. The measurements were analysed using Bland-Altman plots, comparing intra- and inter-observer agreement within and between XR and CT. Results The mean differences in intra- and inter-observer measurements for XR, CT, and between XR and CT were close to zero, implying equal validity. The average intra- and inter-observer limits of agreement for XR, CT, and between XR and CT were +/- 4.4 degrees, +/- 1.9 degrees and +/- 6.8 degrees respectively. Conclusions For scientific purpose, the reliability of XR seems unacceptably low when measuring changes in dorsal angulation in distal radius fractures, whereas the reliability for the semi-automatic CT-based method was higher and is therefore preferable when a more precise method is requested.

    Nationell ämneskategori
    Ortopedi Medicinsk bildbehandling
    Forskningsämne
    Datoriserad bildbehandling
    Identifikatorer
    urn:nbn:se:uu:diva-297776 (URN)10.1007/s00256-016-2350-6 (DOI)000374476200003 ()26922189 (PubMedID)
    Tillgänglig från: 2016-02-27 Skapad: 2016-06-28 Senast uppdaterad: 2018-05-14Bibliografiskt granskad
    2. Increased precision in the measurement of dorsal angulation in distal radius fractures using the dorsal-ulnar cornaer as the reference point versus Lister’s tubercle
    Öppna denna publikation i ny flik eller fönster >>Increased precision in the measurement of dorsal angulation in distal radius fractures using the dorsal-ulnar cornaer as the reference point versus Lister’s tubercle
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Nationell ämneskategori
    Ortopedi
    Identifikatorer
    urn:nbn:se:uu:diva-312929 (URN)
    Tillgänglig från: 2017-01-15 Skapad: 2017-01-15 Senast uppdaterad: 2018-01-13
    3. Radiographic results after plaster cast fixation for 10 days versus 1 month in reduced distal radius fractures: a prospective randomised study
    Öppna denna publikation i ny flik eller fönster >>Radiographic results after plaster cast fixation for 10 days versus 1 month in reduced distal radius fractures: a prospective randomised study
    2016 (Engelska)Ingår i: Journal of Orthopaedic Surgery and Research, ISSN 1749-799X, E-ISSN 1749-799X, Vol. 11, artikel-id 145Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    BACKGROUND: The aim of this study was to examine whether reduced distal radius fractures can be treated with early mobilisation without affecting the radiographic results.

    METHODS: In a prospective randomised study, 109 patients (mean age 65.8 (range 50-92)) with moderately displaced distal radius fractures were treated with closed reduction and plaster cast fixation for about 10 days (range 8-13 days) followed by randomisation to one of two groups: early mobilisation (n = 54, active group) or continued plaster cast fixation for another 3 weeks (n = 55, control group).

    RESULTS: For three patients in the active group (6%), treatment proved unsuccessful because of severe displacement of the fracture (n = 2) or perceived instability (n = 1). From 10 days to 1 month, i.e. the only period when the treatment differed between the two groups, the active group displaced significantly more in dorsal angulation (4.5°, p < 0.001), radial angulation (2.0°, p < 0.001) and axial compression (0.5 mm, p = 0.01) compared with the control group. However, during the entire study period (i.e. from admission to 12 months), the active group displaced significantly more than the controls only in radial angulation (3.2°, p = 0.002) and axial compression (0.7 mm, p = 0.02).

    CONCLUSIONS: Early mobilisation 10 days after reduction of moderately displaced distal radius fractures resulted in both an increased number of treatment failures and increased displacement in radial angulation and axial compression as compared with the control group. Mobilisation 10 days after reduction cannot be recommended for the routine treatment of reduced distal radius fractures.

    TRIAL REGISTRATION: ClinicalTrail.gov, NCT02798614 . Retrospectively registered 16 June 2016.

    Nationell ämneskategori
    Ortopedi
    Identifikatorer
    urn:nbn:se:uu:diva-312927 (URN)10.1186/s13018-016-0478-7 (DOI)000391332600001 ()27871284 (PubMedID)
    Tillgänglig från: 2017-01-15 Skapad: 2017-01-15 Senast uppdaterad: 2018-01-13Bibliografiskt granskad
    4. Clinical outcome after plaster cast fixation for 10 days versus 1 month in reduced distal radius fractures: A prospective randomized study.
    Öppna denna publikation i ny flik eller fönster >>Clinical outcome after plaster cast fixation for 10 days versus 1 month in reduced distal radius fractures: A prospective randomized study.
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Nationell ämneskategori
    Medicin och hälsovetenskap Ortopedi
    Identifikatorer
    urn:nbn:se:uu:diva-312928 (URN)
    Tillgänglig från: 2017-01-15 Skapad: 2017-01-15 Senast uppdaterad: 2018-01-13
    5. Prospective randomized feasibility trial to assess the use of rhPDGF-BB in treatment of distal radius fractures
    Öppna denna publikation i ny flik eller fönster >>Prospective randomized feasibility trial to assess the use of rhPDGF-BB in treatment of distal radius fractures
    2015 (Engelska)Ingår i: Journal of Orthopaedic Surgery and Research, ISSN 1749-799X, E-ISSN 1749-799X, Vol. 10, artikel-id 37Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    BACKGROUND: Recombinant human platelet-derived growth factor BB (rhPDGF-BB) combined with an osteoconductive scaffold (β-TCP) has been demonstrated to increase bone formation, but rhPDGF-BB has not been studied in human fractures. The purpose of this study was to evaluate the safety and potential use of locally administered rhPDGF-BB/β-TCP (Augment®) in acute wrist fractures.

    METHODS: Forty patients with unstable distal radial fracture were randomized to closed reduction and external fixation alone (n = 20) or combined with injection of rhPDGF-BB/β-TCP (Augment®) into the fracture (n = 20). All patients were followed for 24 weeks. Outcome was based on adverse events, fracture displacement on radiographs, fracture healing, range of motion, grip strength, pain, and the disability of the arm, shoulder and hand (DASH) score.

    RESULTS: There were no serious adverse events in the study, but the pin tract infection rate was significantly lower in the Augment® group. There was no difference between the groups in fracture healing time, based on number of healed cortices or fracture displacement. The Augment® group had an early temporary significant decrease in wrist flexion, but no difference in range of motion at 24 weeks. There were no differences between the two treatment groups for any other outcome variables.

    CONCLUSION: rhPDGF-BB/β-TCP (Augment®) is safe and convenient for local administration into wrist fractures. In this pilot study, we could not detect any reduced healing time in the Augment® group although potential efficacy should be addressed in larger studies.

    CLINICAL TRIAL REGISTRATION NUMBER: The clinical trial registration number for the study protocol is BMPI-2014-02-E.

    Nyckelord
    Distal radius fracture; External fixation; PDGF; Calcium phosphate; Radiographic evaluation; Clinical evaluation; Prospective; Randomized
    Nationell ämneskategori
    Ortopedi
    Identifikatorer
    urn:nbn:se:uu:diva-266609 (URN)10.1186/s13018-015-0174-z (DOI)000369737900001 ()25888774 (PubMedID)
    Tillgänglig från: 2015-11-10 Skapad: 2015-11-10 Senast uppdaterad: 2018-01-10Bibliografiskt granskad
    Ladda ner fulltext (pdf)
    fulltext
    Ladda ner (jpg)
    preview image
  • 41.
    Christersson, Albert
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Larsson, Sune
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Increased precision in the measurement of dorsal angulation in distal radius fractures using the dorsal-ulnar cornaer as the reference point versus Lister’s tubercleManuskript (preprint) (Övrigt vetenskapligt)
  • 42.
    Christersson, Albert
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Larsson, Sune
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Sanden, Bengt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Clinical outcome after plaster cast fixation for 10 days versus 1 month in reduced distal radius fractures: A prospective randomized study.Manuskript (preprint) (Övrigt vetenskapligt)
  • 43.
    Christersson, Albert
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Larsson, Sune
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Sandén, Bengt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Clinical outcome after plaster cast fixation for 10 days versus 1 month in reduced distal radius fractures: A prospective randomized study2018Ingår i: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 107, nr 1, s. 82-90Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: this study aimed to evaluate clinical results after plaster cast fixation for 10 days versus 1 month of moderately displaced and reduced distal radius fractures.Material and Methods: in a prospective randomized study, 109 patients with moderately displaced and conservatively treated distal radius fractures (age ≥50 years) were randomized 10 days after reduction to either removal of the plaster cast and immediate mobilization (active group) or to continued plaster cast fixation for another 3 weeks (control group). Grip strength, pincer strength, range of motion, and pain were assessed at 1, 4, and 12 months after reduction. Clinical outcome was evaluated using three functional assessment scores at 12 months.Results: treatment failed in 3/54 (6%) patients in the active group. one of these patients had the plaster cast reinstituted because of feelings of instability. the fractures in the other two patients displaced severely after mobilization and were therefore treated surgically. for the remaining 51 patients in the active group, the range of wrist motion was slightly better at 1 month compared with the controls, but there were no differences in grip or pincer strength or pain at the 1-month follow-up. there were no differences between the active and control group in any outcome at 4 or 12 months, including functional assessment scores at 12 months.Conclusion: treatment with mobilization 10 days after reduction of moderately displaced distal radius fractures resulted in a few treatment failures compared with none among controls. the only functional benefit for the remaining patients was a small and transient increase in range of motion at the 1-month follow-up. plaster cast removal 10 days after reduction in moderately displaced distal radius fractures is therefore not recommended.

  • 44.
    Christersson, Albert
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Larsson, Sune
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Östlund, Bengt
    Nyköping Hosp, Dept Orthoped, S-61185 Nyköping, Sweden.
    Sandén, Bengt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Radiographic results after plaster cast fixation for 10 days versus 1 month in reduced distal radius fractures: a prospective randomised study2016Ingår i: Journal of Orthopaedic Surgery and Research, ISSN 1749-799X, E-ISSN 1749-799X, Vol. 11, artikel-id 145Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The aim of this study was to examine whether reduced distal radius fractures can be treated with early mobilisation without affecting the radiographic results.

    METHODS: In a prospective randomised study, 109 patients (mean age 65.8 (range 50-92)) with moderately displaced distal radius fractures were treated with closed reduction and plaster cast fixation for about 10 days (range 8-13 days) followed by randomisation to one of two groups: early mobilisation (n = 54, active group) or continued plaster cast fixation for another 3 weeks (n = 55, control group).

    RESULTS: For three patients in the active group (6%), treatment proved unsuccessful because of severe displacement of the fracture (n = 2) or perceived instability (n = 1). From 10 days to 1 month, i.e. the only period when the treatment differed between the two groups, the active group displaced significantly more in dorsal angulation (4.5°, p < 0.001), radial angulation (2.0°, p < 0.001) and axial compression (0.5 mm, p = 0.01) compared with the control group. However, during the entire study period (i.e. from admission to 12 months), the active group displaced significantly more than the controls only in radial angulation (3.2°, p = 0.002) and axial compression (0.7 mm, p = 0.02).

    CONCLUSIONS: Early mobilisation 10 days after reduction of moderately displaced distal radius fractures resulted in both an increased number of treatment failures and increased displacement in radial angulation and axial compression as compared with the control group. Mobilisation 10 days after reduction cannot be recommended for the routine treatment of reduced distal radius fractures.

    TRIAL REGISTRATION: ClinicalTrail.gov, NCT02798614 . Retrospectively registered 16 June 2016.

    Ladda ner fulltext (pdf)
    fulltext
  • 45.
    Christersson, Albert
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Nysjö, Johan
    Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Matematisk-datavetenskapliga sektionen, Institutionen för informationsteknologi, Avdelningen för visuell information och interaktion. Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Matematisk-datavetenskapliga sektionen, Institutionen för informationsteknologi, Bildanalys och människa-datorinteraktion.
    Berglund, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Malmberg, Filip
    Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Matematisk-datavetenskapliga sektionen, Institutionen för informationsteknologi, Avdelningen för visuell information och interaktion. Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Matematisk-datavetenskapliga sektionen, Institutionen för informationsteknologi, Bildanalys och människa-datorinteraktion. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    Sintorn, Ida-Maria
    Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Matematisk-datavetenskapliga sektionen, Institutionen för informationsteknologi, Avdelningen för visuell information och interaktion. Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Matematisk-datavetenskapliga sektionen, Institutionen för informationsteknologi, Bildanalys och människa-datorinteraktion.
    Nyström, Ingela
    Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Matematisk-datavetenskapliga sektionen, Institutionen för informationsteknologi, Avdelningen för visuell information och interaktion. Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Matematisk-datavetenskapliga sektionen, Institutionen för informationsteknologi, Bildanalys och människa-datorinteraktion.
    Larsson, Sune
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Comparison of 2D radiography and a semi-automatic CT-based 3D method for measuring change in dorsal angulation over time in distal radius fractures2016Ingår i: Skeletal Radiology, ISSN 0364-2348, E-ISSN 1432-2161, Vol. 45, nr 6, s. 763-769Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective The aim of the present study was to compare the reliability and agreement between a computer tomography-based method (CT) and digitalised 2D radiographs (XR) when measuring change in dorsal angulation over time in distal radius fractures. Materials and methods Radiographs from 33 distal radius fractures treated with external fixation were retrospectively analysed. All fractures had been examined using both XR and CT at six times over 6 months postoperatively. The changes in dorsal angulation between the first reference images and the following examinations in every patient were calculated from 133 follow-up measurements by two assessors and repeated at two different time points. The measurements were analysed using Bland-Altman plots, comparing intra- and inter-observer agreement within and between XR and CT. Results The mean differences in intra- and inter-observer measurements for XR, CT, and between XR and CT were close to zero, implying equal validity. The average intra- and inter-observer limits of agreement for XR, CT, and between XR and CT were +/- 4.4 degrees, +/- 1.9 degrees and +/- 6.8 degrees respectively. Conclusions For scientific purpose, the reliability of XR seems unacceptably low when measuring changes in dorsal angulation in distal radius fractures, whereas the reliability for the semi-automatic CT-based method was higher and is therefore preferable when a more precise method is requested.

  • 46.
    Christersson, Albert
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Sandén, Bengt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Larsson, Sune
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Prospective randomized feasibility trial to assess the use of rhPDGF-BB in treatment of distal radius fractures2015Ingår i: Journal of Orthopaedic Surgery and Research, ISSN 1749-799X, E-ISSN 1749-799X, Vol. 10, artikel-id 37Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Recombinant human platelet-derived growth factor BB (rhPDGF-BB) combined with an osteoconductive scaffold (β-TCP) has been demonstrated to increase bone formation, but rhPDGF-BB has not been studied in human fractures. The purpose of this study was to evaluate the safety and potential use of locally administered rhPDGF-BB/β-TCP (Augment®) in acute wrist fractures.

    METHODS: Forty patients with unstable distal radial fracture were randomized to closed reduction and external fixation alone (n = 20) or combined with injection of rhPDGF-BB/β-TCP (Augment®) into the fracture (n = 20). All patients were followed for 24 weeks. Outcome was based on adverse events, fracture displacement on radiographs, fracture healing, range of motion, grip strength, pain, and the disability of the arm, shoulder and hand (DASH) score.

    RESULTS: There were no serious adverse events in the study, but the pin tract infection rate was significantly lower in the Augment® group. There was no difference between the groups in fracture healing time, based on number of healed cortices or fracture displacement. The Augment® group had an early temporary significant decrease in wrist flexion, but no difference in range of motion at 24 weeks. There were no differences between the two treatment groups for any other outcome variables.

    CONCLUSION: rhPDGF-BB/β-TCP (Augment®) is safe and convenient for local administration into wrist fractures. In this pilot study, we could not detect any reduced healing time in the Augment® group although potential efficacy should be addressed in larger studies.

    CLINICAL TRIAL REGISTRATION NUMBER: The clinical trial registration number for the study protocol is BMPI-2014-02-E.

    Ladda ner fulltext (pdf)
    fulltext
  • 47.
    Clarac, Francois
    et al.
    Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Biologiska sektionen, Institutionen för organismbiologi, Evolution och utvecklingsbiologi. Sorbonne Univ, CNRS, Inst Sci Terre Paris, UMR 7193, 4 Pl Jussieu,BC 19, F-75005 Paris, France;Sorbonne Univ, Dept Hist Terre, Museum Natl Hist Nat, Ctr Rech Paleontol Paris,CNRS,UMR 7207, Batiment Geol Paris, F-75231 Paris 05, France.
    Goussard, Florent
    Sorbonne Univ, Dept Hist Terre, Museum Natl Hist Nat, Ctr Rech Paleontol Paris,CNRS,UMR 7207, Batiment Geol Paris, F-75231 Paris 05, France.
    de Buffrenil, Vivian
    Sorbonne Univ, Dept Hist Terre, Museum Natl Hist Nat, Ctr Rech Paleontol Paris,CNRS,UMR 7207, Batiment Geol Paris, F-75231 Paris 05, France.
    Sansalone, Vittorio
    Univ Paris Est, Lab Modelisat & Simulat Multi Echelle, MSME LIMR 8208, CNRS, 61 Ave Gen Gaulle, F-94010 Creteil, France.
    The function(s) of bone ornamentation in the crocodylomorph osteoderms: a biomechanical model based on a finite element analysis2019Ingår i: Paleobiology, ISSN 0094-8373, E-ISSN 1938-5331, Vol. 45, nr 1, s. 182-200Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This paper aims at assessing the influence of the bone ornamentation and, specifically, the associated loss of bone mass on the mechanical response of the crocodylomorph osteoderms. To this end, we have performed three-dimensional (3D) modeling and a finite element analysis on a sample that includes both extant dry bones and well-preserved fossils tracing back to the Late Triassic. We simulated an external attack under various angles on the apical surface of each osteoderm and further repeated the simulation on an equivalent set of smoothed 3D-modeled osteoderms. The comparative results indicated that the presence of an apical sculpture has no significant influence on the von Mises stress distribution in the osteoderm volume, although it produces a slight increase in its numerical score. Moreover, performing parametric analyses, we showed that the Young's modulus of the osteoderm, which may vary depending on the bone porosity, the collagen fiber orientation, or the calcification density, has no impact on the von Mises stress distribution inside the osteoderm volume. As the crocodylomorph bone ornamentation is continuously remodeled by pit resorption and secondary bone deposition, we assume that the apical sculpture may be the outcome of a trade-off between the bone mechanical resistance and the involvement in physiological functions. These physiological functions are indeed based on the setup of a bone superficial vessel network and/or the recurrent release of mineral elements into the plasma: heat transfers during basking and respiratory acidosis buffering during prolonged apnea in neosuchians and teleosaurids; compensatory homeostasis in response to general calcium deficiencies. On a general morphological basis, the osteoderm geometric variability within our sample leads us to assess that the global osteoderm geometry (whether square or rectangular) does not influence the von Mises stress, whereas the presence of a dorsal keel would somewhat reduce the stress along the vertical axis.

  • 48.
    Cloodt, Erika
    et al.
    Lund Univ, Dept Hlth Sci Lund, Div Physiotherapy, Lund, Sweden..
    Rosenblad, Andreas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Rodby-Bousquet, Elisabet
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Lund Univ, Dept Clin Sci Lund, Orthopaed, Lund, Sweden..
    Demographic and modifiable factors associated with knee contracture in children with cerebral palsy2018Ingår i: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 60, nr 4, s. 391-396Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AimTo identify the prevalence of knee contracture and its association with gross motor function, age, sex, spasticity, and muscle length in children with cerebral palsy (CP). MethodCross-sectional data for passive knee extension were analysed in 3045 children with CP (1756 males, 1289 females; mean age 8y 1mo [SD 3.84]). CP was classified using the Gross Motor Function Classification System (GMFCS) levels I (n=1330), II (n=508), III (n=280), IV (n=449), and V (n=478). Pearson's chi(2) test and multiple binary logistic regression were applied to analyse the relationships between knee contracture and GMFCS level, sex, age, spasticity, hamstring length, and gastrocnemius length. ResultsKnee contracture greater than or equal to 5 degrees occurred in 685 children (22%). The prevalence of knee contracture was higher in older children and in those with higher GMFCS levels. Odds ratios (ORs) for knee contracture were significantly higher for children at GMFCS level V (OR=13.17), with short hamstring muscles (OR=9.86), and in the oldest age group, 13 years to 15 years (OR=6.80). InterpretationKnee contracture is associated with higher GMFCS level, older age, and shorter muscle length; spasticity has a small effect. Maintaining muscle length, especially of the hamstrings, is important for reducing the risk of knee contracture.

  • 49.
    Cnudde, Peter
    et al.
    Swedish Hip Arthroplasty Register, Gothenburg, Sweden;Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Orthopaed, Gothenburg, Sweden;Hywel Dda Univ Healthboard, Prince Philip Hosp, Dept Orthopaed, Llanelli, Wales.
    Bulow, Erik
    Swedish Hip Arthroplasty Register, Gothenburg, Sweden;Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Orthopaed, Gothenburg, Sweden.
    Nemes, Szilard
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Orthopaed, Gothenburg, Sweden.
    Tyson, Yosef
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi. Swedish Hip Arthroplasty Register, Gothenburg, Sweden.
    Mohaddes, Maziar
    Swedish Hip Arthroplasty Register, Gothenburg, Sweden;Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Orthopaed, Gothenburg, Sweden.
    Rolfson, Ola
    Swedish Hip Arthroplasty Register, Gothenburg, Sweden;Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Orthopaed, Gothenburg, Sweden.
    Association between patient survival following reoperation after total hip replacement and the reason for reoperation: an analysis of 9,926 patients in the Swedish Hip Arthroplasty Register2019Ingår i: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 90, nr 3, s. 226-230Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and purpose

    The association between long-term patient survival and elective primary total hip replacement (THR) has been described extensively. The long-term survival following reoperation of THR is less well understood. We investigated the relative survival of patients undergoing reoperation following elective THR and explored an association between the indication for the reoperation and relative survival.

    Patients and methods

    In this observational cohort study we selected the patients who received an elective primary THR and subsequent reoperations during 1999-2017 as recorded in the Swedish Hip Arthroplasty Register. The selected cohort was followed until the end of the study period, censoring or death. The indications for 1st- and eventual 2nd-time reoperations were analyzed and the relative survival ratio of the observed survival and the expected survival was determined.

    Results

    There were 9,926 1st-time reoperations and of these 2,558 underwent further reoperations. At 5 years after the latest reoperation, relative survival following 1st-time reoperations was 0.94% (95% CI 0.93-0.96) and 0.90% (CI 0.87-0.92) following 2nd-time reoperations. At 5 years patients with a 1st-time reoperation for aseptic loosening had higher survival than expected; however, reoperations performed for periprosthetic fracture, dislocation, and infection had lower survival.

    Interpretation

    The relative survival following 1st- and 2nd-time reoperations in elective THR patients differs by reason for reoperation. The impact of reoperation on life expectancy is more obvious for infection/dislocation and periprosthetic fracture.

    Ladda ner fulltext (pdf)
    fulltext
  • 50.
    Cnudde, Peter
    et al.
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Orthopaed, Gothenburg, Sweden;Ctr Registers Vastra Gotaland, Medicinargatan 15G, SE-41345 Gothenburg, Sweden.
    Rolfson, Ola
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Orthopaed, Gothenburg, Sweden;Ctr Registers Vastra Gotaland, Medicinargatan 15G, SE-41345 Gothenburg, Sweden.
    Timperley, A. John
    Royal Devon & Exeter Hosp, Princess Elizabeth Orthopaed Ctr, Hip Unit, Exeter, Devon, England.
    Garland, Anne
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi. Ctr Registers Vastra Gotaland, Medicinargatan 15G, SE-41345 Gothenburg, Sweden.
    Kaerrholm, Johan
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Orthopaed, Gothenburg, Sweden;Ctr Registers Vastra Gotaland, Medicinargatan 15G, SE-41345 Gothenburg, Sweden.
    Garellick, Goeran
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Orthopaed, Gothenburg, Sweden;Ctr Registers Vastra Gotaland, Medicinargatan 15G, SE-41345 Gothenburg, Sweden.
    Nemes, Szilard
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Orthopaed, Gothenburg, Sweden;Ctr Registers Vastra Gotaland, Medicinargatan 15G, SE-41345 Gothenburg, Sweden.
    Do Patients Live Longer After THA and Is the Relative Survival Diagnosis-specific?2018Ingår i: Clinical Orthopaedics and Related Research, ISSN 0009-921X, E-ISSN 1528-1132, Vol. 476, nr 6, s. 1166-1175Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Hip replacements are successful in restoring mobility, reducing pain, and improving quality of life. However, the association between THA and the potential for increased life expectancy (as expressed by mortality rate) is less clear, and any such association could well be influenced by diagnosis and patient-related, socioeconomic, and surgical factors, which have not been well studied. Questions/purposes (1) After controlling for birth year and sex, are Swedish patients who underwent THA likely to survive longer than individuals in the general population? (2) After controlling for relevant patient-related, socioeconomic/demographic factors and surgical factors, does relative survival differ across the various diagnoses for which THAs were performed in Sweden? Methods Data from the Swedish Hip Arthroplasty Register, linked to administrative health databases, were used for this study. We identified 131,808 patients who underwent THA between January 1, 1999, and December 31, 2012. Of these, 21,755 had died by the end of followup. Patient- and surgery-specific data in combination with socioeconomic data were available for analysis. We compared patient survival (relative survival) with age- and sex-matched survival data in the entire Swedish population according to Statistics Sweden. We used multivariable modeling proceeded with a Cox proportional hazards model in transformed time. Results Patients undergoing elective THA had a slightly improved survival rate compared with the general population for approximately 10 years after surgery. At 1 year after surgery, the survival in patients undergoing THA was 1% better than the expected survival (r = 1.01; 95% confidence interval [CI], 1.01-1.02; p < 0.001); at 5 years, this increased to 3% (r = 1.03; 95% CI, 1.03-1.03; p < 0.001); at 10 years, the difference was 2% (r = 1.02; 95% CI, 1.02-1.03; p < 0.001); and by 12 years, there was no difference between patients undergoing THA and the general population (r = 1.01; 95% CI, 0.99-1.02; p = 0.13). Using the diagnosis of primary osteoarthritis as a reference, hip arthroplasties performed for sequelae of childhood hip diseases had a similar survival rate (hazard ratio [HR], 1.02; 95% CI, 0.88-1.18; p = 0.77). Patients undergoing surgery for osteonecrosis of the femoral head (HR, 1.69; 95% CI, 1.60-1.79; p < 0.001), inflammatory arthritis (HR, 1.49; 95% CI, 1.38-1.61; p < 0.001), and secondary osteoarthritis (HR, 2.46; 95% CI, 2.03-2.99; p < 0.001) all had poorer relative survival. Comorbidities and the Elixhauser comorbidity index had a negative association with relative survival. Level of achieved education (middle level of education: HR, 0.90, 95% CI, 0.87-0.93, p < 0.001; high level: 0.76, 95% CI, 0.73-0.80, p < 0.001) and marital status (single status: HR, 1.33; 95% CI, 1.28-1.38; p < 0.001) were also negatively associated with survival. Conclusions Whereas it has been known that in most patients, THA improves quality of life, this study demonstrates that it also is associated with a slightly increased life expectancy that lasts for approximately 10 years after surgery, especially among patients whose diagnosis was primary osteoarthritis. This adds further proof of a health-economic value for this surgical intervention. The reasons for the increase in relative survival are unknown but are probably multifactorial.

123456 1 - 50 av 299
RefereraExporteraLänk till träfflistan
Permanent länk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf