Acta Orthopaedica最新文献

{"title":"Incidence and risk factors of adverse events after distal radius fracture fixation with volar locking plates: retrospective analysis of 2,790 cases.","authors":"Henri Vasara, Antti Stenroos, Petra Tarkiainen, Anni Aavikko, Panu H Nordback, Turkka Anttila, Jussi Kosola, Samuli Aspinen","doi":"10.2340/17453674.2024.42302","DOIUrl":"10.2340/17453674.2024.42302","url":null,"abstract":"<p><strong>Background and purpose: </strong> 12-18% of patients encounter adverse events after distal radius fracture (DRF) surgery with volar locking plates (VLPs). Risk factors for which preventive measures could be administered are currently scarce. We aimed to examine the incidence of postoperative adverse events and assess the causes and risk factors for the adverse events after VLP fixation of DRFs.</p><p><strong>Methods: </strong> We performed a single-center retrospective cohort study evaluating all adult DRF patients treated with VLP fixation between 2009 and 2019 at Helsinki University Hospital. Patients with previous disabilities or ulnar fractures, other than styloid process fractures, in the affected extremity were excluded. We examined each patient's treatment using the electronic medical records system and identified postoperative adverse events defined as any deviation from the ordinary postoperative course, showcasing clinical symptoms. We used multivariable binary logistic regression to assess the risk for adverse events.</p><p><strong>Results: </strong> 2,790 cases of DRF were included. The incidence of adverse events was 16%. Hardware complications (8.3%), predominantly intra-articular screws (4.9%), were the most commonly encountered adverse events. Other frequent adverse events included carpal tunnel syndrome (2.8%), tendon complications (2.8%), and surgical site infections (1.5%). In the multivariable analysis, smoking, higher body mass index (BMI), alcohol abuse, C-type fractures, residual intra-articular displacement, and dorsal tilt were found as risk factors for adverse events.</p><p><strong>Conclusion: </strong> The incidence of adverse events was 16% after VLP fixation of DRFs. We identified several new risk factors for adverse events, which included residual dorsal tilt, intra-articular dislocation, insufficiently corrected inclination, smoking, alcohol abuse, and higher BMI.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"95 ","pages":"645-653"},"PeriodicalIF":2.5,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142646740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The completeness of national hip and knee replacement registers.","authors":"Jonathan M R French, Kevin Deere, Michael R Whitehouse, Derek J Pegg, Enrico Ciminello, Riccardo Valentini, Marina Torre, Keijo Mäkelä, Anne Lübbeke, Eric R Bohm, Anne Marie Fenstad, Ove Furnes, Geir Hallan, Jinny Willis, Søren Overgaard, Ola Rolfson, Adrian Sayers","doi":"10.2340/17453674.2024.42303","DOIUrl":"https://doi.org/10.2340/17453674.2024.42303","url":null,"abstract":"<p><strong>Background and purpose: </strong> National joint replacement registries were developed for prospective monitoring of outcomes and post-market surveillance of implants. Increasingly registry data informs practice. However, analysis of a registry can only be as good as the data it captures on the population of interest. We aimed to analyze completeness of reporting of hip and knee replacement procedures for all national registries worldwide.</p><p><strong>Methods: </strong>We analyzed annual reports and data provided following written requests to all active national hip and knee replacement registries. Coverage was defined as the proportion of hospitals in the country that participate in the registry. Procedure completeness was defined as the proportion of procedures successfully captured by the registry.</p><p><strong>Results: </strong> 14 national registries were included, spanning years 2004 to 2022. Coverage was complete in 10. Median procedure completeness for primary hip and knee replacement across all years was 96.5% (interquartile range [IQR] 94.0-97.7%). Median procedure completeness for revisions was 88.5% (IQR 81.0-92.5%). The terminology used and method of calculation of completeness estimates in the registries were variable.</p><p><strong>Conclusion: </strong> National hip and knee replacement registry data generally reflects excellent coverage (full in 10 of 14 registries) and completeness (primary procedures 96.5% and revisions 88.5%) over the last 2 decades.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"95 ","pages":"654-660"},"PeriodicalIF":2.5,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can KOOS-PS be replaced with a simple anchor question in patients after total knee arthroplasty?: an agreement study of 2,478 primary surgeries.","authors":"Siri Bjørgen Winther, Anders Sjøstrøm, Sølvi Liabakk-Selli, Olav A Foss, Tina S Wik, Jomar Klaksvik","doi":"10.2340/17453674.2024.42098","DOIUrl":"10.2340/17453674.2024.42098","url":null,"abstract":"<p><strong>Background and purpose: </strong> Physical function and pain are the most important outcomes following total knee arthroplasty (TKA). These can be evaluated by patient-reported outcome measures (PROMs), or by an anchor question. The primary aim of the study was to evaluate whether a simple anchor question can replace KOOS-PS in assessing postoperative knee function until 1-year follow-up, evaluated by analyzing the agreement between the 2 methods using the diagnostic odds ratio (DOR). Secondary aims were pain (NRS) at rest and during mobilization.</p><p><strong>Methods: </strong> This is a diagnostic accuracy study with primary TKAs performed between 2010 and 2022. The surgeries were categorized as improved (I) or worsened (W) based on a dichotomized anchor question related to self-perceived change in physical function, and the dichotomized change in KOOS-PS until 1-year follow-up. This led to 4 groups: (II, IW, WI, and WW).</p><p><strong>Results: </strong> Agreement was found with a DOR of 11.3 (CI 7.9-16.2). 2,335 (94%) reported improved function on the anchor question and 143 (6%) worsened function. Among those with improved anchor 2,132 (91%) had improved KOOS-PS, but among those with worsened anchor only 74 (52%) had worsened KOOS-PS. Pain at 1-year follow-up was lower in the groups reporting improved anchor.</p><p><strong>Conclusion: </strong> The KOOS-PS can be replaced with an anchor question to assess change in function until 1 year. However, the KOOS-PS might be a valuable supplement in patients reporting worsened anchor as only half of those had worsened KOOS-PS.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"95 ","pages":"639-644"},"PeriodicalIF":2.5,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11558857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142611765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: Regional variation in low-value musculoskeletal surgery: a nationwide study from the Finnish Care Register.","authors":"Ville Ponkilainen, Anniina Laurema, Ville M Mattila, Teemu Karjalainen","doi":"10.2340/17453674.2024.42413","DOIUrl":"https://doi.org/10.2340/17453674.2024.42413","url":null,"abstract":"<p><p>We would like to inform of an error in the reported incidences in our published article, Regional variation in low-value musculoskeletal surgery: a nationwide study from the Finnish Care Register. Specifically, the incidences for rotator cuff repair, partial meniscectomy, ankle arthroscopy, distal radius fracture fixation, and wrist arthroscopy surgeries were calculated using a too small population size. Accordingly, corrected calculations resulted in higher incidence values for these surgeries, impacting Table 3 and Figure 3, which now show accurate incidence rates. We have also updated Figure 6 and the corresponding sections of the results accordingly. These corrections did not affect any other figures or tables, not the overall conclusions, and the text in the discussion section remains unchanged. The correct data further emphasizes the findings in our original article. We apologize for any confusion caused by these errors and appreciate the opportunity to correct the publication.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"95 ","pages":"633-638"},"PeriodicalIF":2.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142611768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Major surgery for metastatic bone disease is not a risk for 30-day mortality: a population-based study from Denmark.","authors":"Thea H Ladegaard,&nbsp;Michala S Sørensen,&nbsp;Michael M Petersen","doi":"10.2340/17453674.2023.18394","DOIUrl":"https://doi.org/10.2340/17453674.2023.18394","url":null,"abstract":"<p><strong>Background and purpose: </strong>Surgery for bone metastases in the appendicular skeleton (aBM) is a trade-off between limb function and survival. A previous study from a highly specialized center found that extended surgery is not a risk for 30-day mortality and hypothesized that wide resection and reconstruction might reduce postoperative mortality. The study aimed to investigate whether parameters describing the surgical trauma (blood loss, duration of surgery, and degree of bone resection) pose a risk for 30-day mortality in patients treated with endoprostheses (EPR) or internal fixation (IF) in a population-based cohort.</p><p><strong>Patients and methods: </strong>A population-based cohort having EPR/IF for aBM in the Capital Region of Denmark 2014-2019 was retrospectively assessed. Intraoperative variables and patient demographics were evaluated for association with 30-day mortality by logistic regression analysis. Kaplan-Meier estimate was used to evaluate survival with no loss to follow-up.</p><p><strong>Results: </strong>437 patients had aBM surgery with EPR/IF. No parameters describing the magnitude of the surgical trauma (blood loss/duration of surgery/degree of bone resection) were associated with mortality. Overall 30-day survival was 85% (95% confidence interval [CI] 81-88). Univariate analysis identified ASA group 3+4, Karnofsky score < 70, fast-growth primary cancer, and visceral and multiple bone metastases as risk factors for 30-day mortality. Male sex (OR 2.8, CI 1.3-6.3), Karnofsky score < 70 (OR 4.2, CI 2.1-8.6), and multiple bone metastases (OR 3.4, CI 1.2-9.9) were independent prognostic factors for 30-day-mortality in multivariate analysis.</p><p><strong>Conclusion: </strong>The parameters describing the surgical trauma were not associated with 30-day mortality but, instead, general health status and extent of primary cancer influenced survival post-surgery.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"94 ","pages":"447-452"},"PeriodicalIF":3.7,"publicationDate":"2023-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cb/74/ActaO-94-18394.PMC10448382.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10101354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient injury claims for posterior cruciate ligament injury: a nationwide registry study in Finland.","authors":"Kirsi-Maaria Nyrhinen,&nbsp;Teemu Helkamaa,&nbsp;Ville Bister,&nbsp;Arne Schlenzka,&nbsp;Henrik Sandelin,&nbsp;Jerker Sandelin,&nbsp;Arsi Harilainen","doi":"10.2340/17453674.2023.18265","DOIUrl":"https://doi.org/10.2340/17453674.2023.18265","url":null,"abstract":"<p><strong>Background and purpose: </strong>Posterior cruciate ligament (PCL) injuries usually occur in combination with other ligamentous knee injuries. The outcome varies and may be poor due to suboptimal treatment. We investigated claims following PCL injury treatment on a nationwide scale.</p><p><strong>Patients and methods: </strong>All patient PCL injury claims filed in Finland from 1997 to 2015 were collected from the Patient Insurance Centre (PIC) register. We reviewed and analyzed all records to determine the causes of claims. General background data were obtained from the National Care Register for Social Welfare and Health Care (HILMO).</p><p><strong>Results: </strong>We found out from HILMO background data that, during the 19-year study period, 1,891 PCL and 1,380 multiligament reconstructions were performed in 99 different hospitals. The number of PCL injuries treated conservatively is unknown. During this same period, 49 claims arrived at the PIC, and 39/49 of these patients were operated on. 12/49 claims were compensated. Of these 12 claims, 6 were compensated for technical errors and 4 were compensated for diagnostic delays.</p><p><strong>Conclusion: </strong>The number of patient injury claims was few, and compensated claims were even fewer. Technical errors and diagnostic delays were the most common reasons for reimbursement.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"94 ","pages":"426-431"},"PeriodicalIF":3.7,"publicationDate":"2023-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/55/c5/ActaO-94-18265.PMC10436284.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10037714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recommendations for physiotherapy and physical activity for children with Legg-Calvé-Perthes disease: a survey of pediatric orthopedic surgeons and physiotherapists in Sweden.","authors":"Louise Melin,&nbsp;Zlatica Rendek,&nbsp;Yasmin D Hailer","doi":"10.2340/17453674.2023.18341","DOIUrl":"https://doi.org/10.2340/17453674.2023.18341","url":null,"abstract":"<p><strong>Background and purpose: </strong>Physiotherapy, restrictions of physical activity, and weightbearing are part of the treatment of children with Legg-Calvé-Perthes disease (LCPD). Prescription practices are widely discussed and vary between pediatric orthopedic surgeons (POSs) and physiotherapists (PTs). The purpose of this study was to identify recommendations for treatment methods in clinical practice to find some consensus and elaborate guidelines.</p><p><strong>Patients and methods: </strong>A web-based questionnaire including 3 cases of LCPD (initial, fragmentation, and reossification stages) was answered by 25 POSs and 19 PTs. They were asked to describe their preferred recommendations for physiotherapy, including stretching, strengthening, weightbearing, and physical activities in relation to, e.g., range of motion (ROM) pain, sex, and disease stage.</p><p><strong>Results: </strong>ROM was considered to be important when recommending physiotherapy; PTs also recognized pain and disease stage. Sex was reported as a factor with low importance. Stretching exercises were recommended for all disease stages. Recommendations for strengthening exercises varied for the initial and fragmentation stages. None of the participants recommended total non-weightbearing. Most restricted trampolining, running, ball sports, and gymnastics in the first 2 stages of the disease and allowed swimming, short walks, cycling, and horse riding without restrictions for all stages.</p><p><strong>Conclusion: </strong>We found high agreement on recommending stretching exercises for all disease stages, but controversies regarding recommendations for strengthening exercises in the initial and fragmentation stages. No non-weightbearing treatment for the affected hip was recommended by any participants at any stage of the disease. There was no clear consensus regarding the appropriate timeline for resuming full activities.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"94 ","pages":"432-437"},"PeriodicalIF":3.7,"publicationDate":"2023-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10436286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10037712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical approach had minor association with femoral stem migration in total hip arthroplasty: radiostereometric analysis of 61 patients after 5-year follow-up.","authors":"Kristin Haugan,&nbsp;Olav A Foss,&nbsp;Otto S Husby,&nbsp;Vigdis S Husby,&nbsp;Svein Svenningsen,&nbsp;Siri B Winther","doi":"10.2340/17453674.2023.18264","DOIUrl":"https://doi.org/10.2340/17453674.2023.18264","url":null,"abstract":"<p><strong>Background and purpose: </strong>Total hip arthroplasty (THA) is usually performed using 1 of 3 surgical approaches: direct lateral (DLA), posterior (PA), or anterior (AA). AA is different from DLA and PA owing to limited intraoperative visibility of the femoral canal. This could affect stem positioning and therefore migration. We aimed to perform an exploratory radiostereometric analysis (RSA) study with 3 groups for surgical approach assessing stem migration up to 5 years postoperatively.</p><p><strong>Patients and methods: </strong>61 patients with unilateral osteoarthritis of the hip were included. 21 patients were allocated to the DLA, 20 to the PA, and 20 to the AA group. All patients received an uncemented, collarless, double-tapered, fully hydroxyapatite-coated Profemur Gladiator stem. Migration was measured with model-based RSA. Baseline RSA was on day 1 postoperatively. The follow-ups were at day 8, at 5 weeks, and at 3, 6, 12, 24, and 60 months after surgery. Generalized linear mixed models were used to analyze maximum total point motion (MTPM) migrations.</p><p><strong>Results: </strong>Group mean differences in MTPM were 0.4 mm (95% confidence interval [CI] -1.5 to 2.4) for DLA vs. PA, 1.1 mm (CI -1.0 to 3.3) for AA vs. DLA, and 1.6 mm (CI -0.8 to 3.9) for AA vs. PA, when adjusted for sex and age as covariates. 2 stems in the AA group had excessive early migration. For all stems the migrations occurred mainly within 5-week follow-up and then stabilized.</p><p><strong>Conclusion: </strong>At 5-year follow-up, there were no statistically significant differences in stem migration associated with the 3 surgical approaches used in this study.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"94 ","pages":"410-415"},"PeriodicalIF":3.7,"publicationDate":"2023-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4b/ee/ActaO-94-18264.PMC10416221.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9989531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of antibiotic-loaded bone cement and systemic antibiotic prophylactic use in 2,971,357 primary total knee arthroplasties from 2010 to 2020: an international register-based observational study among countries in Africa, Europe, North America, and Oceania.","authors":"Tesfaye H Leta,&nbsp;Anne Marie Fenstad,&nbsp;Stein Håkon L Lygre,&nbsp;Stein Atle Lie,&nbsp;Martin Lindberg-Larsen,&nbsp;Alma B Pedersen,&nbsp;Annette W-Dahl,&nbsp;Ola Rolfson,&nbsp;Erik Bülow,&nbsp;James A Ashforth,&nbsp;Liza N Van Steenbergen,&nbsp;Rob G H H Nelissen,&nbsp;Dylan Harries,&nbsp;Richard De Steiger,&nbsp;Olav Lutro,&nbsp;Emmi Hakulinen,&nbsp;Keijo Mäkelä,&nbsp;Jinny Willis,&nbsp;Michael Wyatt,&nbsp;Chris Frampton,&nbsp;Alexander Grimberg,&nbsp;Arnd Steinbrück,&nbsp;Yinan Wu,&nbsp;Cristiana Armaroli,&nbsp;Marco Molinari,&nbsp;Roberto Picus,&nbsp;Kyle Mullen,&nbsp;Richard Illgen,&nbsp;Ioan C Stoica,&nbsp;Andreea E Vorovenci,&nbsp;Dan Dragomirescu,&nbsp;Håvard Dale,&nbsp;Christian Brand,&nbsp;Bernhard Christen,&nbsp;Joanne Shapiro,&nbsp;J Mark Wilkinson,&nbsp;Richard Armstrong,&nbsp;Kate Wooster,&nbsp;Geir Hallan,&nbsp;Jan-Erik Gjertsen,&nbsp;Richard N Chang,&nbsp;Heather A Prentice,&nbsp;Elizabeth W Paxton,&nbsp;Ove Furnes","doi":"10.2340/17453674.2023.17737","DOIUrl":"https://doi.org/10.2340/17453674.2023.17737","url":null,"abstract":"<p><strong>Background and purpose: </strong>Antibiotic-loaded bone cement (ALBC) and systemic antibiotic prophylaxis (SAP) have been used to reduce periprosthetic joint infection (PJI) rates. We investigated the use of ALBC and SAP in primary total knee arthroplasty (TKA).</p><p><strong>Patients and methods: </strong>This observational study is based on 2,971,357 primary TKAs reported in 2010-2020 to national/regional joint arthroplasty registries in Australia, Denmark, Finland, Germany, Italy, the Netherlands, New Zealand, Norway, Romania, South Africa, Sweden, Switzerland, the UK, and the USA. Aggregate-level data on trends and types of bone cement, antibiotic agents, and doses and duration of SAP used was extracted from participating registries.</p><p><strong>Results: </strong>ALBC was used in 77% of the TKAs with variation ranging from 100% in Norway to 31% in the USA. Palacos R+G was the most common (62%) ALBC type used. The primary antibiotic used in ALBC was gentamicin (94%). Use of ALBC in combination with SAP was common practice (77%). Cefazolin was the most common (32%) SAP agent. The doses and duration of SAP used varied from one single preoperative dosage as standard practice in Bolzano, Italy (98%) to 1-day 4 doses in Norway (83% of the 40,709 TKAs reported to the Norwegian arthroplasty register).</p><p><strong>Conclusion: </strong>The proportion of ALBC usage in primary TKA varies internationally, with gentamicin being the most common antibiotic. ALBC in combination with SAP was common practice, with cefazolin the most common SAP agent. The type of ALBC and type, dose, and duration of SAP varied among participating countries.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"94 ","pages":"416-425"},"PeriodicalIF":3.7,"publicationDate":"2023-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f9/55/ActaO-94-17737.PMC10416222.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9984408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No difference in risk of revision due to infection between clindamycin and cephalosporins as antibiotic prophylaxis in cemented primary total knee replacements: a report from the Norwegian Arthroplasty Register 2005-2020.","authors":"Karola Pawloy,&nbsp;Anne Marie Fenstad,&nbsp;Tesfaye Leta,&nbsp;Geir Hallan,&nbsp;Jan-Erik Gjertsen,&nbsp;Håvard Dale,&nbsp;Stein Atle Lie,&nbsp;Ove Furnes","doi":"10.2340/17453674.2023.16907","DOIUrl":"https://doi.org/10.2340/17453674.2023.16907","url":null,"abstract":"<p><strong>Background and purpose: </strong>Systemic antibiotic prophylaxis with clindamycin, which is often used in penicillin- or cephalosporin-allergic patients', has been associated with a higher risk of surgical revision for deep prosthetic joint infection (PJI) than cloxacillin in primary total knee replacement (TKR). We aimed to investigate whether clindamycin increases the risk of surgical revisions due to PJI compared with cephalosporins in primary cemented TKR.</p><p><strong>Patients and methods: </strong>Data from 59,081 TKRs in the Norwegian Arthroplasty Register (NAR) 2005-2020 was included. 2,655 (5%) received clindamycin and 56,426 (95%) received cephalosporins. Cox regression analyses were performed with adjustment for sex, age groups, diagnosis, and ASA score. Survival times were calculated using Kaplan-Meier estimates and compared using Cox regression with revision for PJI as endpoint. The cephalosporins cefalotin and cefazolin were also compared.</p><p><strong>Results: </strong>Of the TKRs included, 1.3% (n = 743) were revised for PJI. 96% (n = 713) had received cephalosporins and 4% (n = 30) clindamycin for perioperative prophylaxis. Comparing cephalosporins (reference) and clindamycin, at 3-month follow-up the adjusted hazard ratio rate (HRR) for PJI was 0.7 (95% confidence interval [CI] 0.4-1.4), at 1 year 0.9 (CI 0.6-1.5), and at 5 years 0.9 (CI 0.6-1.4). Analysis using propensity score matching showed similar results. Furthermore, comparing cefalotin (reference) and cefazolin, HRR was 1.0 (CI 0.8-1.4) at 3 months and 1.0 (CI 0.7-1.3) at 1-year follow-up.</p><p><strong>Conclusion: </strong>We found no difference in risk of revision for PJI when using clindamycin compared with cephalosporins in primary cemented TKRs. It appears safe to continue the use of clindamycin in penicillin- or cephalosporin-allergic patients.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"94 ","pages":"404-409"},"PeriodicalIF":3.7,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/36/1b/ActaO-94-16907.PMC10391533.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9925721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}