Acta orthopaedica Scandinavica最新文献

{"title":"The impacted varus (A2.2) proximal humeral fracture: prediction of outcome and results of nonoperative treatment in 99 patients.","authors":"Charles M Court-Brown,&nbsp;Margaret M McQueen","doi":"10.1080/00016470410004111","DOIUrl":"https://doi.org/10.1080/00016470410004111","url":null,"abstract":"<p><strong>Unlabelled: </strong>BACKGROUND AND PATIENTS: The outcome of the impacted varus proximal humeral fracture has not been described. We present the results of a prospective analysis of 99 such fractures.</p><p><strong>Results: </strong>This fracture was relatively common in the elderly population and non-operative treatment sometimes resulted in increased varus angulation. Decreased shoulder function was associated with increasing age but not with increasing varus angulation. After nonoperative management the outcome was good, regardless of the degree of varus, 1 year after fracture. Age was the main predictor of outcome. Physiotherapy did not improve outcome.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 6","pages":"736-40"},"PeriodicalIF":0.0,"publicationDate":"2004-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410004111","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25002340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased risk of dislocation after primary total hip arthroplasty in inflammatory arthritis: a prospective observational study of 410 hips.","authors":"R. Zwartelé, R. Brand, C. Doets","doi":"10.1080/759369228","DOIUrl":"https://doi.org/10.1080/759369228","url":null,"abstract":"BACKGROUND\u0000It is unclear whether patients with inflammatory arthritis have a higher risk of dislocation after hip replacement.\u0000\u0000\u0000PATIENTS AND MATERIAL\u0000We carried out a prospective study assessing the incidence of dislocation within 2 years after surgery for patients diagnosed with inflammatory arthritis (IA) and osteoarthrosis (OA). One single type of prosthesis was implanted using a lateral approach. Both diagnostic groups were compared by univariate analysis with respect to dislocation, sex, age, diagnosis, prior hip surgery, experience of the surgeon and malposition of the acetabular component. In a multivariate logistic regression approach, the difference in dislocation incidence was assessed after adjusting for the effect of the potential confounders given above. Between 1996 and 1999, 410 THA were performed: 70 in IA and 340 in OA. After 2 years no patients were lost to follow-up, but 12 patients had died, and 5 revisions were carried out for reasons other than dislocation.\u0000\u0000\u0000RESULTS\u0000The dislocation rate in patients with IA was higher than in patients with OA: 10% (7 hips) in the IA group and 3% (10 hips) in the OA group (p = 0.006). No significant differences were found among the risk factors for dislocation between the two groups. Multivariate logistic regression analysis showed that IA is an independent risk factor for dislocation (odds ratio (OR) 3.7, 95% CI 1.3-11), together with malposition of the cup in more than 55 degrees abduction (OR 7.7, CI 2.3-26) and increased anteversion (OR 7.6, CI 1.4-42.4).\u0000\u0000\u0000INTERPRETATION\u0000Our findings clearly suggest that inflammatory arthritis has to be considered as an independent risk factor for dislocation after primary THA.","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 6 1","pages":"684-90"},"PeriodicalIF":0.0,"publicationDate":"2004-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60614704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parathyroid hormone--a drug for orthopedic surgery?","authors":"Ralf Skripitz,&nbsp;Per Aspenberg","doi":"10.1080/00016470410004012","DOIUrl":"https://doi.org/10.1080/00016470410004012","url":null,"abstract":"<p><p>Whereas continuous exposure to PTH results in bone resorption, administration at intermittent doses results in bone formation by increasing osteoblast number and activity. The anabolic action of PTH has also been demonstrated in clinical trials, in which PTH increased the bone mass and reduced fracture rate in patients with osteoporosis. In animal models of fracture healing and fixation of orthopedic implants, PTH increases the bone density in a dose-dependent manner, leading to faster repair and better fixation. The effect appears to be stronger on the new forming bone than on pre-existing bone. Based on these preclinical studies, we suggest that intermittent PTH treatment may also benefit fracture healing and implant fixation in patients.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 6","pages":"654-62"},"PeriodicalIF":0.0,"publicationDate":"2004-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410004012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25001404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Femoral cement pressurization in hip arthroplasty: a laboratory comparison of three techniques.","authors":"Birender Kapoor,&nbsp;Sandeep P Datir,&nbsp;Benjamin Davis,&nbsp;Charles H Wynn-Jones,&nbsp;Nicola Maffulli","doi":"10.1080/00016470410004076","DOIUrl":"https://doi.org/10.1080/00016470410004076","url":null,"abstract":"<p><strong>Background: </strong>Several cementing techniques are used for the proximal femur.</p><p><strong>Material and methods: </strong>We evaluated 3 femoral cement pressurization techniques (standard, pressurizer in situ, and thumb pressurization) in 12 plastic femurs, with 4 sets of observations for each technique. Intramedullary pressure readings were obtained using proximal and distal pressure monitoring transducers. The peak pressure and the length of time for which the pressure was above a particular cutoff level (5 KPa and 100 KPa) were compared for the different techniques.</p><p><strong>Results: </strong>We found significant differences between the 3 cementing techniques in the peak pressure and the length of time for which the pressure was above 100 KPa. The pressurizer in situ technique gave higher peak pressure (p < 0.001), both proximally (398) and distally (597). The standard technique produced a pressure of 100 KPa for a longer duration, both proximally and distally (mean 67 sec and 45 sec, p < 0.001) compared to the other two techniques (less than 5 and 17 sec for the thumb pressurization technique and the pressurizer in situ technique, respectively, both proximally and distally). Although the pressurizer in situ technique produced the highest peak pressure, the standard technique produced an optimum pressure of longer duration.</p><p><strong>Interpretation: </strong>The standard technique appears to be adequate for achievement of optimum pressurization during femoral cementing without increased risk of embolization.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 6","pages":"708-12"},"PeriodicalIF":0.0,"publicationDate":"2004-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410004076","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25002336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computer-assisted fluoroscopic navigation of pedicle screw insertion: an in vivo feasibility study.","authors":"Tsai-Sheng Fu,&nbsp;Li-Huei Chen,&nbsp;Chak-Bor Wong,&nbsp;Po-Liang Lai,&nbsp;Tsung-Ting Tsai,&nbsp;Chi-Chieh Niu,&nbsp;Wen-Jer Chen","doi":"10.1080/00016470410004102","DOIUrl":"https://doi.org/10.1080/00016470410004102","url":null,"abstract":"<p><strong>Background: </strong>Accurate placement of pedicle screws is difficult.</p><p><strong>Patients and methods: </strong>We evaluated the feasibility and accuracy of pedicle screw insertion assisted by a real-time, 2-dimensional (2D) image-guided navigation system in 12 patients who underwent thoraco-lumbar and/or lumbar stabilization. 66 pedicle screws were inserted either by senior spine surgeons or residents. The accuracy of positioning of the screws was evaluated using postoperative plain radiographs and thin-cut CT.</p><p><strong>Results: </strong>61 of the 66 screws were inserted successfully. 5 screw insertions showed structural violations: 4 on the medial and 1 on the lateral pedicle wall. The accuracy was higher in the sagittal plane than in the axial plain. There was no difference between the surgical error rates caused by the senior surgeons and the residents.</p><p><strong>Interpretation: </strong>Using computer-assisted 2D fluoroscopic image navigation, it is possible to achieve reliable and accurate pedicle screw insertion during low thoracic and lumbar spinal surgery.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 6","pages":"730-5"},"PeriodicalIF":0.0,"publicationDate":"2004-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410004102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25002339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pelvic orientation and assessment of hip dysplasia in adults.","authors":"Steffen Jacobsen,&nbsp;Stig Sonne-Holm,&nbsp;Bjarne Lund,&nbsp;Kjeld Søballe,&nbsp;Thomas Kiaer,&nbsp;Hans Rovsing,&nbsp;Henrik Monrad","doi":"10.1080/00016470410004094","DOIUrl":"https://doi.org/10.1080/00016470410004094","url":null,"abstract":"<p><strong>Background: </strong>The study was performed to qualify the source material of 4151 pelvic radiographs for the research into the relationship between unrecognised childhood hip disorders and the development of hip osteoarthrosis, and to investigate the effect of varying degrees of pelvic tilt and rotation on the measurements of radiographic indices of hip dysplasia.</p><p><strong>Material and methods: </strong>We investigated the effect of varying pelvic orientation on radiographic measurements of acetabular dysplasia using a cadaver model. Results from the cadaver study were used to validate the radiographic assessments of acetabular dysplasia in the longitudinal survey cohort of the Copenhagen City Heart Study (CCHS; Osteoarthrosis Sub-study). 1) Cadaver pelvises and proximal femurs from a male and a female donor were mounted anatomically in holding devices allowing independent inclination/reclination and rotation. An AP pelvic radiograph was recorded at each 3 degrees increment. The most widely used radiographic parameters of hip dysplasia were assessed. 2) Critical limits of acceptable rotation and inclination/reclination of pelvises were determined on 4151 standing, standardised pelvic radiographs of the CCHS cohort.</p><p><strong>Results: </strong>Wiberg's CE angle, Sharp's angle, the x-coordinate of Goodman's Cartesian coordinate system, and the acetabular depth ratio were significantly affected by varying rotation and inclination/reclination of the cadaver pelvises. Femoral head extrusion index was not significantly affected within the applied rotation and inclination/reclination of the cadaver study. Application of the corresponding critical limits of Tönnis' foramen obturator index of 0.7-1.8 meant that 188 of 4151 (4.5%) of the CCHS-III pelvic radiographs had to be omitted from further studies.</p><p><strong>Interpretation: </strong>To ensure a neutral starting point and reproducible readings, especially in epidemiological and clinical studies, and when performing preoperative planning and follow-up of patients undergoing redirectional pelvic osteotomies, it is important that all aspects of the radiographic examination are controlled and reproducible. Furthermore, we found that studies of acetabular dysplasia based on supine urograms or colon radiographs without information about pelvic orientation, centering of the X-ray beam and tube to film distance, run a serious risk of erroneous measurements.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 6","pages":"721-9"},"PeriodicalIF":0.0,"publicationDate":"2004-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410004094","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25002338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiographic case definitions and prevalence of osteoarthrosis of the hip: a survey of 4 151 subjects in the Osteoarthritis Substudy of the Copenhagen City Heart Study.","authors":"S. Jacobsen, S. Sonne-holm, K. Søballe, P. Gebuhr, B. Lund","doi":"10.1080/759369232","DOIUrl":"https://doi.org/10.1080/759369232","url":null,"abstract":"BACKGROUND\u0000The diagnosis of osteoarthrosis (OA) is founded on radiographic evidence of joint degeneration and characteristic subjective symptoms. Due to the lack of consensus radiographic case definitions, the prevalence and incidence of OA reported in the literature varies. The aims of the current study were to establish an accurate and workable radiographic definition of OA in hip joints and to examine the association of OA (thus defined) with self-reported pain.\u0000\u0000\u0000METHODS\u0000Radiographic features of hip OA were classified in pelvic radiographs of 3 807 subjects (1448 males and 2 359 females) according to the OA classifications of Kellgren and Lawrence (1957) and Croft (1990), and according to minimum joint space width (JSW) of 2.0 mm regardless of other radiographic features of OA. The relationships between these radiographic discriminators and self-reported hip pain were investigated.\u0000\u0000\u0000RESULTS\u0000Formation of cysts, osteophytes and subchondral sclerosis was significantly more frequent in men. Average minimum JSW was narrower in women than in men (p < 0.001). In both sexes, minimum JSW decreased after the fourth decade of life, but progressively more so in women. Women reported hip pain more frequently than men (p < 0.001). When the cut-off JSW value of 2.0 mm was applied regardless of other radiographic features of OA, prevalences of hip OA ranged from 4.4% to 5.3% in subjects > or = 60 years of age. The radiographic discriminator with the strongest association with self-reported hip pain in men and women > or = 60 years of age was minimum JSW < or = 2.0 mm; OR = 3.3 (95% CI 1.9-5.7) for men, and OR = 3.2 (95% CI 1.9-5.2) for women.\u0000\u0000\u0000INTERPRETATION\u0000We found that minimum JSW < or = 2.0 mm was the radiographic criterion having the closest association with self-reported hip pain. Using composite OA scores emphasizing the relatively inconsequential formation of cysts, osteophytes and subchondral sclerosis runs the risk of over-inflating the prevalence of hip OA in men and of underestimating hip OA prevalence in women.","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 6 1","pages":"713-20"},"PeriodicalIF":0.0,"publicationDate":"2004-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60614902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiographic case definitions and prevalence of osteoarthrosis of the hip: a survey of 4 151 subjects in the Osteoarthritis Substudy of the Copenhagen City Heart Study.","authors":"Steffen Jacobsen,&nbsp;Stig Sonne-Holm,&nbsp;Kjeld Søballe,&nbsp;Peter Gebuhr,&nbsp;Bjarne Lund","doi":"10.1080/00016470410004085","DOIUrl":"https://doi.org/10.1080/00016470410004085","url":null,"abstract":"<p><strong>Background: </strong>The diagnosis of osteoarthrosis (OA) is founded on radiographic evidence of joint degeneration and characteristic subjective symptoms. Due to the lack of consensus radiographic case definitions, the prevalence and incidence of OA reported in the literature varies. The aims of the current study were to establish an accurate and workable radiographic definition of OA in hip joints and to examine the association of OA (thus defined) with self-reported pain.</p><p><strong>Methods: </strong>Radiographic features of hip OA were classified in pelvic radiographs of 3 807 subjects (1448 males and 2 359 females) according to the OA classifications of Kellgren and Lawrence (1957) and Croft (1990), and according to minimum joint space width (JSW) of 2.0 mm regardless of other radiographic features of OA. The relationships between these radiographic discriminators and self-reported hip pain were investigated.</p><p><strong>Results: </strong>Formation of cysts, osteophytes and subchondral sclerosis was significantly more frequent in men. Average minimum JSW was narrower in women than in men (p < 0.001). In both sexes, minimum JSW decreased after the fourth decade of life, but progressively more so in women. Women reported hip pain more frequently than men (p < 0.001). When the cut-off JSW value of 2.0 mm was applied regardless of other radiographic features of OA, prevalences of hip OA ranged from 4.4% to 5.3% in subjects > or = 60 years of age. The radiographic discriminator with the strongest association with self-reported hip pain in men and women > or = 60 years of age was minimum JSW < or = 2.0 mm; OR = 3.3 (95% CI 1.9-5.7) for men, and OR = 3.2 (95% CI 1.9-5.2) for women.</p><p><strong>Interpretation: </strong>We found that minimum JSW < or = 2.0 mm was the radiographic criterion having the closest association with self-reported hip pain. Using composite OA scores emphasizing the relatively inconsequential formation of cysts, osteophytes and subchondral sclerosis runs the risk of over-inflating the prevalence of hip OA in men and of underestimating hip OA prevalence in women.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 6","pages":"713-20"},"PeriodicalIF":0.0,"publicationDate":"2004-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410004085","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25002337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Internal fixation of proximal humeral fractures with a locking compression plate: a retrospective evaluation of 72 patients followed for a minimum of 1 year.","authors":"Jan-Magnus Björkenheim,&nbsp;Jarkko Pajarinen,&nbsp;Vesa Savolainen","doi":"10.1080/00016470410004120","DOIUrl":"https://doi.org/10.1080/00016470410004120","url":null,"abstract":"<p><strong>Background: </strong>Proximal humeral fractures, particularly in osteoporotic patients, remain an unsolved problem as regards the durability of the osteosynthesis. The AO/ASIF group has developed a new technique which aims to preserve the biological integrity of the humeral head and secures the reduction using multiple locking screws with angular stability (Philos), thus allowing an early mobilization.</p><p><strong>Patients and outcome: </strong>We retrospectively reviewed the complications and functional outcome after a minimum follow-up of 1 year in 72 patients treated with this new method. 2 fractures failed to unite, and 3 patients developed an avascular necrosis of the humeral head. In addition, 2 implant failures were observed due to a technical error. According to the Constant score, the functional outcome was acceptable even in elderly patients.</p><p><strong>Interpretation: </strong>The Philos method appears to be safe and can be recommended for the treatment of proximal humeral fractures in patients with poor bone quality.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 6","pages":"741-5"},"PeriodicalIF":0.0,"publicationDate":"2004-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410004120","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25002341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why does outer joint motion predominate in bipolar hip prosthesis? Experimental and clinical studies.","authors":"S. Rowe, J. Chung, E. Moon, T. Yoon, H. Seo, Jae Joon Lee","doi":"10.1080/759369230","DOIUrl":"https://doi.org/10.1080/759369230","url":null,"abstract":"BACKGROUND\u0000Theoretically, the motion of a bipolar hip prosthesis is most likely to occur at the inner joint if the frictional coefficients are equal at both surfaces. However, many studies have suggested that most motion occurs at the outer joint.\u0000\u0000\u0000MATERIAL AND METHODS\u0000We performed an analysis of motion in a cadaveric bone model and in 50 patients during fluoroscopic examination, to determine how the motion is distributed between the two joints and what factors contribute to this distribution.\u0000\u0000\u0000RESULTS\u0000The motion distributions varied widely between the patients. However, there was a relative pre-ponderance (63-90%) of outer motion in all directions of leg movement in addition to a persistent coexistence of motion at both joints in 44 of 50 patients. This preponderance of outer motion was the result of an early impingement of the acetabular cup and structural differences between the two joints.\u0000\u0000\u0000INTERPRETATION\u0000An adjustment of the positive eccentricity and a decrease in the frictional torque of the inner joint as a result of better lubrication and smoothness can be expected to improve the motion distribution, thus reducing the amount of acetabular erosion.","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 6 1","pages":"701-7"},"PeriodicalIF":0.0,"publicationDate":"2004-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60614841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}