Acta Orthopaedica最新文献

{"title":"Alcohol use is common in older patients with fall-related fractures: a secondary analysis from a prospective cohort study using PEth as an objective assessment of consumption.","authors":"Cecilia Rogmark, Linnea Malmgren, Anna Holmgren, Åsa Magnusson, Helmi-Sisko Pyrhönen","doi":"10.2340/17453674.2026.46961","DOIUrl":"10.2340/17453674.2026.46961","url":null,"abstract":"<p><strong>Background and purpose: </strong> Alcohol increases the risk of falls and complications, but data on alcohol intake among trauma patients is unreliable. Excessive alcohol use can contribute to excess frailty and confusion in frail individuals and increase fall risk in otherwise robust older people. Phosphatidylethanol (PEth) is a biomarker accumulating through repeated alcohol intake, i.e., suitable for screening long-term consumption. Our primary aim was to describe alcohol consumption in older individuals admitted after a fall-related fracture. Our secondary, exploratory aims were to investigate the association between alcohol, frailty, and short-term clinical outcomes in these individuals.</p><p><strong>Methods: </strong> This prospective observational cohort study included those ≥ 65 years admitted due to acute fall-related fracture February 1, 2023-August 31, 2024. PEth was taken at admission. Predefined norm values classified low/no consumption as < 0.05, intermediate 0.05-0.30 and hazardous consumption > 0.30 µmol/L. Frailty status was assessed by the Clinical Frailty Scale (CFS). Our secondary aim was addressed using multivariable logistic regression on a propensity score-matched cohort.</p><p><strong>Results: </strong> Of the 505 patients included, 13% had PEth indicating hazardous consumption, 8.9% intermediate consumption, and 78% had low/no consumption. Of the non-frail patients, 18% had hazardous and 11% intermediate consumption. 19% of all women and 29% of all men had continuous alcohol consumption (defined as PEth ≥ 0.05 µmol/L). In the matched cohort, alcohol consumption was associated with a higher odds ratio (OR) of hyponatremia (OR 2.3, 95% confidence interval [CI] 1.1-4.5, P = 0.02). A trend towards lower odds of 90-day mortality (OR 0.2, CI 0.1-1.0, P = 0.05) was seen.</p><p><strong>Conclusion: </strong> A minimum of 1/5 older patients with fall-related fractures have continuous alcohol consumption. Non-frail patients had a higher intake than frail individuals. Alcohol consumption was associated with higher odds of hyponatremia. Otherwise, no apparent negative effects were identified in the short term.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"743-750"},"PeriodicalIF":3.4,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219790","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":"Response to the Letter: Re-rupture is not the only failure: tendon elongation and the 6-week nonoperative protocol for Achilles tendon rupture.","authors":"Ville Happonen, Heikki Kröger","doi":"10.2340/17453674.2026.46976","DOIUrl":"10.2340/17453674.2026.46976","url":null,"abstract":"","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"742"},"PeriodicalIF":3.4,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219717","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":"Plasma calprotectin as infection biomarker in hip fracture patients: a prospective cohort study.","authors":"Helmi-Sisko Pyrhönen, Johan Tham, Anna Stefánsdóttir, Alicia Persson, Linnea Malmgren, Cecilia Rogmark","doi":"10.2340/17453674.2026.46719","DOIUrl":"10.2340/17453674.2026.46719","url":null,"abstract":"<p><strong>Background and purpose: </strong>We aimed to compare the diagnostic performance of plasma calprotectin in detecting infections following hip fracture surgery with 3 other biomarkers: procalcitonin (PCT), C-reactive protein (CRP), and white blood cell (WBC) count.</p><p><strong>Methods: </strong>This prospective cohort study included surgically treated hip fracture patients aged ≥ 65 years, admitted to our department from April 2023 to August 2024. Plasma calprotectin, PCT, CRP, and WBC count were measured on postoperative day 3. The outcome was any infection within 30 days (primary) and 7 days (secondary). Biomarker performance was evaluated using receiver operating characteristic analyses in a comparative framework.</p><p><strong>Results: </strong>166/550 individuals were analyzed (median age 85 years, 68% women). 19% (n = 31) and 12% (n = 20) had infection within 30 and respectively 7 days. For 30-day infections, calprotectin showed highest area under the curve (AUC) of 0.66 (95% confidence interval [CI] 0.54-0.77), followed by WBC count 0.60 (CCI 0.48-0.72), CRP 0.53 (CI 0.42-0.63), and PCT 0.51 (CI 0.40-0.63). Difference in AUC was largest between calprotectin and PCT (0.14, CI 0.00-0.29), followed by CRP (0.12, CI -0.01 to 0.26), while similar to WBC count (0.06, CI -0.05 to 0.16). For 7-day infections, AUCs were as following: calprotectin 0.70 (CI 0.58-0.82), WBC count 0.69 (CI 0.56-0.81), CRP 0.56 (CI 0.42-0.69), and PCT 0.48 (CI 0.33-0.63). Difference in AUC was largest between calprotectin and PCT (0.22, CI 0.05-0.39), followed by CRP (0.15, CI -0.02 to 0.31), while WBC count was similar (0.01, CI -0.09 to 0.12).</p><p><strong>Conclusion: </strong>Calprotectin demonstrated a trend towards superior discriminatory ability for infections compared with PCT and CRP, particularly for infections within 7 days. Calprotectin provided moderate diagnostic accuracy, likewise WBC count.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"751-757"},"PeriodicalIF":3.4,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219800","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":"Letter to the Editor: Re-rupture is not the only failure: tendon elongation and the 6-week nonoperative protocol for Achilles tendon rupture.","authors":"Filippo Spiezia, Francesco Oliva, Nicola Maffulli","doi":"10.2340/17453674.2026.46973","DOIUrl":"10.2340/17453674.2026.46973","url":null,"abstract":"","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"740-741"},"PeriodicalIF":3.4,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219743","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":"Ultrasound- and fluoroscopy-guided hip aspiration before revision total hip arthroplasty: procedural outcomes and diagnostic accuracy in sequential cohorts.","authors":"Thomas J A Van Schaik, Kevin May, Gerjon Hannink, Job L C Van Susante, Jon H M Goosen, H W Bart Schreuder, Wim H C Rijnen","doi":"10.2340/17453674.2026.46931","DOIUrl":"10.2340/17453674.2026.46931","url":null,"abstract":"<p><strong>Background and purpose: </strong> Hip aspiration remains essential in the diagnostic work-up of a painful total hip arthroplasty (THA) to assess for periprosthetic joint infection (PJI). In 2020, our institution transitioned from fluoroscopy-guided to ultrasound-guided aspiration. Our study aimed to describe dry-tap proportions, aspirated volumes, and complications, and explore diagnostic accuracy in sequential cohorts.</p><p><strong>Methods: </strong> This retrospective single-center study included 117 fluoroscopy-guided aspirations (December 2013-June 2020) and 90 ultrasound-guided aspirations (April 2020-March 2024) before revision THA. Procedural outcomes defined as dry taps, aspirated volumes, and complications within 14 days were assessed in the full cohorts, and diagnostic accuracy in procedures with a successful aspiration. Ultrasound-guided biopsy was performed in 39 patients.</p><p><strong>Results: </strong> The prevalence of PJI was 54/117 (46%) in the fluoroscopy cohort and 25/90 (28%) in the ultrasound cohort (difference -18 percentage points, 95% confidence interval [CI] -31 to -5). Dry taps occurred in 38/117 (32%) and 31/90 (34%) procedures, corresponding to an absolute difference of 2 percentage points (CI -11 to 16). Median aspirated volumes were 5 mL in the fluoroscopy cohort and 4 mL in the ultrasound cohort. No complications were recorded in the fluoroscopy cohort; 2 occurred in the ultrasound cohort, both among patients who underwent biopsy. Sensitivity was 16/34 (47%, CI 30-65) for fluoroscopy and 8/13 (62%, CI 32-86) for ultrasound; specificity was 41/44 (93%, CI 81-99) and 37/40 (93%, CI 80-98).</p><p><strong>Conclusion: </strong> Dry-tap proportions were similar in these sequential cohorts. 2 complications were recorded, both in patients who underwent biopsy. Specificity was high, whereas sensitivity could be assessed only in patients with a successful aspiration and available culture results, resulting in less precise estimates. The findings do not establish equivalence or superiority.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"734-739"},"PeriodicalIF":3.4,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126223","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":"Pathological fracture as initial manifestation of malignancy and survival based on diagnoses: a register-based cohort study from the Swedish Fracture Register and the Swedish Cancer Register.","authors":"Jonas Sundkvist, Jenny Giaever, David Wennergren, Sead Crnalic, Johan Wänman","doi":"10.2340/17453674.2026.46894","DOIUrl":"10.2340/17453674.2026.46894","url":null,"abstract":"<p><strong>Background and purpose: </strong>Pathological fracture as the initial manifestation of malignancy is a clinical challenge requiring rapid treatment despite limited prognostic information. We aimed to describe definitive diagnoses and survival in patients presenting with a pathological fracture as initial manifestation of malignancy.</p><p><strong>Methods: </strong>We performed a nationwide register-based cohort study using the Swedish Fracture Register (SFR) and Swedish Cancer Register (SCR), 2014-2023. We included patients with a pathological fracture classified as unknown in the SFR at treatment. Survival was analyzed using Kaplan-Meier and Cox regression.</p><p><strong>Results: </strong>We included 319 patients with a pathological fracture. Median age was 75 years (17-100), 50% men. A definitive tumor diagnosis was established in 215 patients (67%), most commonly a hematogenous malignancy. Age was associated with mortality (HR 1.03, 95% confidence interval [CI] 1.01-1.04). Compared with hematogenous malignancies, mortality was higher for bone (HR 2.9, CI 1.2-7.2), breast (HR 2.5, CI 1.2-5.1), kidney (HR 3.3, CI 1.7-6.5), lung (HR 6.3, CI 3.7-10.5), unknown (HR 8.1, CI 4.2-15.5), other (HR 10.3, CI 5.6-19.0), and gastrointestinal malignancies (HR 10.3, CI 4.5-23.7), and for patients without SCR registration (HR 19.7, CI 11.7-33.2). Prostate cancer, sex, fracture site, and treatment were not associated with increased mortality.</p><p><strong>Conclusion: </strong>Hematogenous and lung malignancies were the most common in pathological fracture as initial manifestation of malignancy. Survival was short and varied substantially by tumor type. Age and primary tumor site were prognostic factors, emphasizing the importance of comprehensive diagnostic work-up to guide acute treatment.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"727-733"},"PeriodicalIF":3.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126174","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":"Nonoperative treatment of Achilles tendon rupture with 6- versus 8-week protocol: a single-center cohort study from Finland.","authors":"Ville Happonen, Anu Koivisto, Anssi Härkönen, Heikki Kröger","doi":"10.2340/17453674.2026.46872","DOIUrl":"10.2340/17453674.2026.46872","url":null,"abstract":"<p><strong>Background and purpose: </strong> Although nonoperative treatment of Achilles tendon rupture (ATR) has become increasingly common, the optimal duration of immobilization and early functional rehabilitation remains uncertain. We aimed to compare outcomes of 8-week and 6-week nonoperative treatment protocols for ATR, with particular focus on re-rupture rates and treatment failure requiring surgery.</p><p><strong>Methods: </strong> This register study included all university hospital-treated ATRs in the Northern Savo region, Finland, between 2014 and 2023. Patients were identified using ICD-10 and NOMESCO procedure codes. We compared outcomes between an 8-week nonoperative treatment protocol used in 2014-2018 and a 6-week protocol used in 2019-2023. Outcomes included patient demographics, treatment distribution, indications for surgery, and complications.</p><p><strong>Results: </strong> Among 479 ATRs, 429/479 (90%) were treated nonoperatively. Operative treatment was mainly done in athletes. Operative treatment was performed in 32/251 (13%) patients in the 8-week protocol group and in 18/228 (7.9%) patients in the 6-week protocol group. Re-rupture rates were similar between the 8-week and 6-week protocols (7/251 [2.8%] vs 4/228 [1.8%] absolute risk difference -1.0 percentage point, 95% confidence interval -3.7 to 1.6). Operative treatment was mainly indicated for athletes, chronic ruptures, and re-ruptures, with a postoperative complication rate of 14%.</p><p><strong>Conclusion: </strong> Outcomes regarding re-rupture and treatment failure following the 6-week nonoperative protocol were comparable to those observed with the 8-week protocol However, larger comparative studies in more diverse populations are needed to confirm the generalizability of these findings.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"722-726"},"PeriodicalIF":3.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079338","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":"Editorial: In memoriam Göran Garellick.","authors":"Henrik Malchau","doi":"10.2340/17453674.2026.46886","DOIUrl":"https://doi.org/10.2340/17453674.2026.46886","url":null,"abstract":"","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"721"},"PeriodicalIF":3.4,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149068897","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":"When do patients resume driving after fast-track hip and knee arthroplasty: a cohort study of 408 patients.","authors":"Oddrún Danielsen, Jens Lauritsen, Martin Lindberg-Larsen","doi":"10.2340/17453674.2026.46649","DOIUrl":"10.2340/17453674.2026.46649","url":null,"abstract":"<p><strong>Background and purpose: </strong> Only scattered knowledge is available on when patients resume driving following surgery. We primarily aimed to investigate the timing of driving resumption and secondarily to investigate the influence of patients' and surgical factors after fast-track hip and knee arthroplasty.</p><p><strong>Methods: </strong> This prospective cohort study included patients undergoing primary total hip arthroplasty (THA), total knee arthroplasty (TKA), and medial unicompartmental knee arthroplasty (mUKA) in a fast-track setup at Odense University Hospital, Denmark, from September 2022 to July 2023. Eligible patients received a survey 3 to 12 months post-discharge, regarding timing of driving resumption.</p><p><strong>Results: </strong> 408 patients received the survey with a response rate of 88%. Within 2 weeks postoperatively, 13% (95% confidence interval [CI] 8-20) of THA, 11% (CI 6-19) of TKA, and 28% (CI 18-40) of mUKA resumed driving, which increased to 77% (CI 69-84) of THA, 65% (CI 55-74) of TKA, and 80% (CI 68-88) of mUKA by week 6. Median time to driving resumption was 6 weeks for THA and TKA, and 4 weeks for mUKA. The overall median time to resume driving was shorter for patients who underwent surgery on the left leg (4 weeks) than those who underwent surgery on the right leg (6 weeks). Female patients had a higher odds ratio of delayed (> 6 weeks) driving resumption (OR 3, CI 2-5).</p><p><strong>Conclusion: </strong> Overall, 65-80% of patients resumed driving within 6 weeks with median time being shorter (4 weeks) among mUKA patients and patients who underwent surgery on the left leg. Female sex was associated with delayed resumption of car driving beyond 6 weeks postoperatively.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"715-720"},"PeriodicalIF":3.4,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036001","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":"A comparison of revision risk between lateral knee replacement and total knee replacement: results from the Dutch Arthroplasty Register.","authors":"Iris Koenraadt-van Oost, Leonieke C Van Boekel, Alexander Hoorntje, Gino M M J Kerkhoffs, Paul G H Mulder, Liza N Van Steenbergen, Rutger C I Van Geenen","doi":"10.2340/17453674.2026.46374","DOIUrl":"10.2340/17453674.2026.46374","url":null,"abstract":"<p><strong>Background and purpose: </strong> Lateral knee replacement is not commonly performed. Possible explanations are the lower incidence of lateral knee osteoarthritis, relative technical complexity, and different biomechanics, which may affect failure modes and survival rates. We aimed to analyze the difference in risk of revision between lateral and total knee replacements (TKRs) using the Dutch Arthroplasty Register data.</p><p><strong>Methods: </strong> From 2007 to 2021, procedures were selected from the Dutch Arthroplasty Register. Unique patients based on their first procedure were identified. Procedures performed between 2014 and 2021 were analyzed separately because BMI and Charnley score were collected from 2014 onwards. We used ATT (Average Treatment effect on the Treated) weights based on the propensity score to estimate the average treatment effect in the lateral knee replacement group. The endpoint was revision, censored for death. Kaplan-Meier survival analyses were performed in propensity-based ATT-weighted cohorts of lateral knee replacement and TKR patients. Weighted univariable Cox regression models were used to estimate revision hazard ratios (HR).</p><p><strong>Results: </strong> In the total cohort, 847 lateral knee replacements and 240,047 TKR patients were included. In the subgroup, 560 lateral knee replacements and 155,621 TKR patients were included. The risk of revision in both the total cohort and the subgroup was higher for lateral knee replacements compared with TKRs with an ATT-adjusted HR for the total cohort of 2.15 (95% confidence interval [CI] 1.74-2.64, P < 0.001) and for the subgroup an ATT-adjusted HR of 1.55 (CI 1.08-2.21, P = 0.02). Comparison of these ATT-weighted effects with the conditional effect estimates from a regular multivariable Cox proportional hazards regression did not show large differences in this study.</p><p><strong>Conclusion: </strong> This study showed a significantly higher risk of revision for lateral knee replacements compared with TKRs.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"708-714"},"PeriodicalIF":3.4,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149035983","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}