Acta orthopaedica Scandinavica最新文献

{"title":"Documentation of hip prostheses used in Norway: a critical review of the literature from 1996--2000.","authors":"Arild Aamodt, Lars Nordsletten, Leif I Havelin, Kari Indrekvam, Stein Erik Utvåg, Krystyna Hviding","doi":"10.1080/00016470410004021","DOIUrl":"10.1080/00016470410004021","url":null,"abstract":"<p><p>We have conducted a systematic review of the scientific literature concerning outcome and clinical effectiveness of prostheses used for primary total hip replacement (THR) in Norway. The study is based on two Health Technology Assessment reports from the UK (Faulkner et al. 1998, Fitzpatrick et al. 1998), reviewing the literature from 1980 to 1995. Using a similar search strategy, we have evaluated the literature from 1996 through 2000. We included 129 scientific and medical publications which were assessed according to a specific appraisal protocol. The majority (72%) were observational studies, whereas only 9% were randomized studies. We could not retrieve any peer-reviewed documentation for one third of the implants. The Charnley prosthesis had by far the best and most comprehensive evidence base with better than 90% implant survival after about 10 years. Survival of the Charnley prosthesis declines by about 10% during each of the two following decades. Except for the Charnley and Lubinus IP, no other prosthesis on the market in Norway has given long-term results (> 15 years). 5 other cemented implants have given comparable results at about 10 years of follow-up. Some uncemented stems have shown promising medium-term outcome, but no combination of uncemented cup and stem fulfilled the benchmark criterion of > or = 90% implant survival at 10 years, which we propose as a minimum requirement for unrestricted clinical use for prostheses used in primary THR. New or undocumented implants should be introduced through a four-step model including preclinical testing, small series evaluated by radiosterometry, randomized clinical trial involving comparison with a well-documented prosthesis, and finally, surveillance of clinical use through registers.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 6","pages":"663-76"},"PeriodicalIF":0.0,"publicationDate":"2004-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25001405","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":"Operating time and survival of primary total hip replacements: an analysis of 31,745 primary cemented and uncemented total hip replacements from local hospitals reported to the Norwegian Arthroplasty Register 1987-2001.","authors":"Arvid Småbrekke,&nbsp;Birgitte Espehaug,&nbsp;Leif I Havelin,&nbsp;Ove Furnes","doi":"10.1080/00016470410001376","DOIUrl":"https://doi.org/10.1080/00016470410001376","url":null,"abstract":"<p><strong>Background: </strong>Some studies have found a significant decrease in operating time as a result of standardizing programs for hip surgery. To study the influence of operating time (skin to skin) on survival of total hip replacements, we investigated the operating time in local hospitals in Norway. We have found no other large published series of THRs investigating operating time and revision.</p><p><strong>Patients and methods: </strong>The study was based on 31,745 primary THRs reported to the Norwegian Arthroplasty Register from 47 local hospitals during 1987-2001. Operating time was divided into 7 categories, and for each category separate Kaplan-Meier curves and adjusted failure rate ratios were calculated.</p><p><strong>Results: </strong>The mean operating time for all local hospitals in Norway was 96 (68-130) min. Increasing operating volume from less than 10 THRs/hospital/year to more than 200 THRs/hospital/year was associated with a 25-min decrease in mean operating time in cemented THRs and a 35-min decrease in the case of uncemented THRs. With the operating time category of 71-90 min as reference category, cemented THRs that lasted more than 150 min had a two-fold increased (95% CI: 1.6-2.6) revision rate. For uncemented implants, the revision rate was 1.3 times higher (95% CI: 0.8-2.2). Cemented implants with operating time under 51 min and over 90 min were associated with an increased risk of revision due to aseptic loosening. Cemented implants with operating time over 150 min were associated with an increased risk of revision due to infection.</p><p><strong>Interpretation: </strong>Hospitals with long operating times should consider the potential benefit of reducing these times, as this may lead to lower revision rates and increased operating volumes. Shorter operation times could be achieved by standardization programs, but one should bear in mind that for cemented implants very short operating times also increased revision risk due to aseptic loosening.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 5","pages":"524-32"},"PeriodicalIF":0.0,"publicationDate":"2004-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001376","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24786661","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":"Do we really need to routinely crossmatch blood before primary total knee or hip arthroplasty?","authors":"Gary M Mundy,&nbsp;Kate Hardiment,&nbsp;John Revill,&nbsp;Stuart J Birtwistle,&nbsp;Richard A Power","doi":"10.1080/00016470410001439","DOIUrl":"https://doi.org/10.1080/00016470410001439","url":null,"abstract":"<p><strong>Background: </strong>A maximum surgical blood ordering schedule may lead to wastage of valuable resources due to over-ordering of blood and/or under-utilisation. We audited the results of a group-and-save (GS) policy for primary hip (THR) and knee (TKR) arthroplasty to evaluate its safety and practicality.</p><p><strong>Patients and methods: </strong>We conducted a retrospective review of consecutive patients attending for THR (177) or TKR (137) over a period of 8 months (phase 1). Following introduction of a limited GS policy, 205 THR and 147 TKR were reviewed prospectively over a corresponding period of 8 months (phase 2). Corresponding THR and TKR groups in each phase were comparable with respect to age, gender, length of stay, operating surgeon, pre- and lowest postoperative hemoglobin, reason for and timing of transfusion. Quantities (units) of blood requested pre- and postoperatively, transfused and returned to the blood bank, were recorded.</p><p><strong>Results: </strong>77 and 62% of all blood requested for THR and TKR, respectively, in phase 1 was not used. 58 and 21% of patients undergoing THR and TKR, respectively, in phase 2 underwent preoperative GS, with 92% and 100% of all blood requested being used for transfusion. Overall, the quantity of blood returned was reduced by 25% for the THR group. Transfusion rates fell by 9% and 5% for the TKR and THR groups, respectively. We found no adverse events associated with blood from a GS sample. Cost savings of 37 800 euro were calculated estimated for the study period (phase 2).</p><p><strong>Interpretation: </strong>For routine primary THR/TKR, GS policy is a safe procedure. Reduction in non-utilisation of blood has economic and cost-saving implications for limited healthcare resources. Having subsequently introduced a group-and-save policy for all patients undergoing routine THR/TKR, considerable savings have been identified after only 2 months.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 5","pages":"567-72"},"PeriodicalIF":0.0,"publicationDate":"2004-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001439","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24786043","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":"Ligamentous reconstruction around the elbow using triceps tendon.","authors":"Denise Eygendaal","doi":"10.1080/00016470410001367","DOIUrl":"https://doi.org/10.1080/00016470410001367","url":null,"abstract":"<p><p>Posttraumatic instability of the elbow joint can be osseous or ligamentous. Ligamentous instability can be in valgus or in posterolateral rotatory direction. Rupture of both the lateral and medial collateral ligament of the elbow can be seen as an isolated injury, or it can be part of a more complex injury such as a dislocation. Persistent insufficiency of the lateral collateral ligament of the elbow results in posterolateral rotatory instability. Insufficiency of the medial collateral ligament, the anterior part in particular, results in valgus instability. Persistent symptoms after nonoperative treatment are an indication for reconstruction. In the past, ligamentous reconstruction at both the lateral and medial side was performed using palmaris tendon graft through bony drill holes. In this article I describe a new technique using ipsilateral triceps tendon, fixed in drill holes using bioabsorbable interference screws. This technique allows simplified graft tensioning and improved graft fixation, and avoids the risk of fracturing of the bony tunnels. An accelerated rehabilitation protocol can be applied. The final result depends on proper isometric reconstruction, associated lesions or degeneration of the elbow joint and adequate after-treatment. Taking these factors into account, the technique described shows promising short-term results.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 5","pages":"516-23"},"PeriodicalIF":0.0,"publicationDate":"2004-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001367","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24786660","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 flexion and reduced hospital stay with continuous intraarticular morphine and ropivacaine after primary total knee replacement: open intervention study of efficacy and safety in 154 patients.","authors":"Sten Rasmussen,&nbsp;Morten U Kramhøft,&nbsp;Kim P Sperling,&nbsp;Jens H L Pedersen","doi":"10.1080/00016470410001501","DOIUrl":"https://doi.org/10.1080/00016470410001501","url":null,"abstract":"<p><strong>Background: </strong>A single injection of bupivacaine after wound closure reduces the need for analgesics and increases flexion after total knee replacement (TKR). We have therefore studied the effect of continuous injection of morphine and ropivacaine after TKR on range of movement and length of hospital stay.</p><p><strong>Patients and methods: </strong>In an open intervention study, we assigned 154 consecutive patients who had primary unilateral TKR for osteoarthrosis. The intervention was continuous intraarticular injection of morphine 20 mg/mL, 0.5 mL plus ropivacaine 2 mg/mL, 100 mL; bolus 20 mL and 2 mL/hour from 24 to 72 hours postoperatively. Group 1 (10 women and 8 men) received standard postoperative analgesics and group 2 (11 women and 7 men) also received continuous intraarticular morphine and ropivacaine as described above. Group 3 (14 women and 4 men) received double this dose (4 mL/hour) from 24 to 72 hours postoperatively. To assess the safety of the intraarticular treatment, an additional group of 100 consecutive patients was followed (group 4).</p><p><strong>Results: </strong>At discharge, flexion was 70 degrees (60-100) in group 1, 100 degrees (70-115) in group 2 and 110 degrees (90-130) in group 3. Hospital stay was reduced from 9 (7-11) days in group 1, to 7 (5-10) days in groups 2 and 3. Number of days elapsed until the patient was walking with crutches was reduced from 5 (3-8) to 4 (3-6) and 3 (3-9), respectively. In the intervention groups, the need for analgesics was reduced during the hospital stay. Deep infection was registered in 1 patient.</p><p><strong>Interpretation: </strong>Continuous intraarticular morphine and ropivacaine reduce pain and enhance rehabilitation after total knee replacement. Before advocating this as a standard procedure, further large-scale randomized studies will be needed to assess the safety of this regimen.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 5","pages":"606-9"},"PeriodicalIF":0.0,"publicationDate":"2004-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001501","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24787786","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":"Laser-induced thermal stress and the heat shock response in neural cells.","authors":"Osa Emohare,&nbsp;Moustafa I Hafez,&nbsp;Ann Sandison,&nbsp;Richard R H Coombs,&nbsp;Ian D McCarthy","doi":"10.1080/00016470410001510","DOIUrl":"https://doi.org/10.1080/00016470410001510","url":null,"abstract":"<p><strong>Background: </strong>The Ho: YAG laser is used extensively in orthopedic surgery. It offers a minimally invasive method of ablating tissue with precision. Previous studies have explored the effects of laser use on temperature during experimental foraminoplasty. To date, there has been limited work on the effects of thermal stress on cells in this context. Material and methods Cells were exposed either to heated medium or the Ho: YAG laser in the high-power mode. Heated medium was used as a stressor by (I) exposing groups of cells to a constant temperature of 45 degrees C for varying lengths of time: 5, 10, 15 and 20 min, and (II) exposing cells for a fixed length of time (5 min) to varying temperatures: 45 degrees C, 55 degrees C, 65 degrees C with a control treated at 37 degrees C. A third group was subjected to direct laser treatment. The effects of the treatments were assessed using trypan blue staining as a measure of viability and immunocytochemistry was used to measure changes in heat shock protein (HSP) expression.</p><p><strong>Results: </strong>There was a negative correlation between cell viability and HSP expression, and between cell viability and the severity of the treatment.</p><p><strong>Interpretation: </strong>Our findings suggest a possible role for the Ho: YAG laser in spinal foraminoplasty based on the high level of cell viability in the treatment regimen that most closely mirrored the clinical application of the laser.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 5","pages":"610-7"},"PeriodicalIF":0.0,"publicationDate":"2004-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001510","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24787787","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":"Robotic total knee arthroplasty: the accuracy of CT-based component placement.","authors":"Jens Decking,&nbsp;Christoph Theis,&nbsp;Tobias Achenbach,&nbsp;Edgar Roth,&nbsp;Bernhard Nafe,&nbsp;Anke Eckardt","doi":"10.1080/00016470410001448","DOIUrl":"https://doi.org/10.1080/00016470410001448","url":null,"abstract":"<p><strong>Background: </strong>Accurate alignment of the components in total knee arthroplasty is important. By use of postoperative CT controls, we studied the ability of a robotic effector to accurately place and align total knee arthroplasty (TKA) components according to a purely CT-based preoperative plan.</p><p><strong>Patients and methods: </strong>Robotic TKA was performed in 13 patients (6 men) with primary gonarthrosis. Locator screws were placed into femur and tibia under spinal anesthesia. A CT-scan including the femoral head, knee and ankle was performed. In the preoperative planning software, virtual components were positioned into the CT volume. In a second operation, the robot milled femur and tibia with a high-speed milling tool according to the preoperative plan. On the 10th day, CT controls were performed following the same protocol as preoperatively.</p><p><strong>Results: </strong>The mean deviation of the postoperative from the preoperatively planned mechanical axis was 0.2 degrees (95% CI: -0.1 degrees to 0.5 degrees ). The accuracy of angular component placement in frontal, sagittal and transverse planes was within +/-1.2 degrees , and the accuracy of linear component placement in mediolateral, dorsoventral and caudocranial directions was within +/-1.1 mm.</p><p><strong>Interpretation: </strong>Robotic TKA allows placement of components with unparalleled accuracy, but further development is mandatory to integrate soft-tissue balancing into the procedure and make it faster, easier and cheaper.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 5","pages":"573-9"},"PeriodicalIF":0.0,"publicationDate":"2004-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001448","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24786044","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":"Selective botulinum toxin injection in the treatment of recurrent deformity following surgical correction of club foot: a preliminary report of 3 children.","authors":"Piers D Mitchell,&nbsp;Martin Tisdall,&nbsp;Hamid G Zadeh","doi":"10.1080/00016470410001538","DOIUrl":"https://doi.org/10.1080/00016470410001538","url":null,"abstract":"<p><p>Management of a child with club foot deformity that recurs after an apparently successful posteromedial soft tissue release remains a challenge. Revision surgery is often attempted, but this carries a high risk of significant scarring or neurovascular complications. We have treated 3 children (3 feet) with relapsed club foot and fixed deformities, using Botulinum toxin A (BTX-A) injection into muscle groups clinically thought to be responsible for recurrent deformity, followed by moulded plaster casts. Two cases have maintained a good foot position with an minimum follow-up of 18 months, and one other is also doing well having had a tibialis anterior tendon transfer as well as the BTX-A therapy. In our limited experience, targeted BTX-A injection with plaster casting has been safe, and may obviate the need for major revision surgery in a proportion of cases with recurrent club foot deformity following previous posteromedial soft tissue release.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 5","pages":"630-3"},"PeriodicalIF":0.0,"publicationDate":"2004-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001538","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24787789","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":"Bone grafting the scaphoid nonunion: a systematic review of 147 publications including 5,246 cases of scaphoid nonunion.","authors":"Bo Munk, Claus Falck Larsen","doi":"10.1080/00016470410001529","DOIUrl":"10.1080/00016470410001529","url":null,"abstract":"<p><p>In order to elucidate the history of scaphoid nonunion and to evaluate whether or not the problem has been solved, we have reviewed the literature from 1928 to 2003 for union rates, postoperative immobilization periods and complications of the different scaphoid bone grafting procedures. The outcomes of 5 246 scaphoid nonunions were evaluated in three treatment groups. In the first group involving nonvascularized bone grafting without internal fixation, we found a union rate of 80% (95% CI: 78-82) after an average immobilization period of 15 weeks. In the second group involving nonvascularized bone grafting with internal fixation, the figures were 84% (CI: 82-85) and 7 weeks, respectively. In the last group involving vascularized bone grafting with or without internal fixation, the figures were 91% (CI: 87-94) and 10 weeks, respectively. We found no prospective randomized studies comparing different operative treatments of scaphoid nonunion. We conclude that there still is a need for improvement in the treatment of scaphoid nonunion.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 5","pages":"618-29"},"PeriodicalIF":0.0,"publicationDate":"2004-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24787788","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":"The cause of subchondral bone cysts in osteoarthrosis: a finite element analysis.","authors":"Hans D Dürr,&nbsp;Heiner Martin,&nbsp;Christoph Pellengahr,&nbsp;Marcus Schlemmer,&nbsp;Markus Maier,&nbsp;Volkmar Jansson","doi":"10.1080/00016470410001411","DOIUrl":"https://doi.org/10.1080/00016470410001411","url":null,"abstract":"<p><strong>Background: </strong>The etiology of subchondral bone cysts in arthrotic joints is unclear.</p><p><strong>Materials and methods: </strong>We used two-dimensional finite element analysis to evaluate the hypothesis that subchondral bone cysts in the osteoarthrotic hip joint may be the result of microfractures caused by localized cartilage defects or a thinned layer of cartilage. We evaluated the equivalent bone stress (von Mises (VM) stress) in the cancellous bone as an indicator of potential microfractures and further development of cystic lesions.</p><p><strong>Results: </strong>Cartilage defects induced stress peaks in the subchondral bone. This peak stress distribution corresponded to the clinical observation of development of acetabular and femoral subchondral cysts in a \"kissing\" position. A femoral subchondral bone cyst induced a stress peak at the corresponding acetabular site, whereas subchondral acetabular cysts did not increase stress in the femoral head. Acetabular cysts showed an increased level of stress at the lateral and medial border of the lesion which was much higher than the stress levels in the femoral head, indicating a tendency to faster growth.</p><p><strong>Interpretation: </strong>Our study supports the theory that stress-induced bone resorption may cause development of subchondral bone cysts in osteoarthrosis.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 5","pages":"554-8"},"PeriodicalIF":0.0,"publicationDate":"2004-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001411","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24786041","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}