To Örebro University

Introduction: Total wrist arthroplasty (TWA) is a motion-preserving treatment option for wrist arthritis. High-precision measurement methods for implant migration such as computed tomography motion-analysis (CTMA) can potentially detect poor implant fixation. The aim of this pilot study was to assess CTMA as a complementary method to diagnose aseptic loosening of TWA.

Materials and Methods: Three patients with a TWA and wrist pain during activity underwent induced displacement CT (CTMA) with alternated provocations as a complement to plain radiographs.

Results: Two of the three patients had displacement of the carpal component on CTMA. The radial component was stable in all cases. The tool was adapted to clinical routine use.

Conclusions: CT motion-analysis could be a valuable adjunct to plain radiographs in assessing component loosening in TWA.

Objective: To determine and compare the incidence rate (IR) of anterior cruciate ligament reconstruction (ACL-R) among higher-level athletes across six sports in the Swedish National Knee Ligament Registry (SNKLR).

Methods: Patient data from the SNKLR, between 2005 and 2020, was linked to team and event data of six sports (football, handball, basketball, ice hockey, floorball and alpine sports) to identify higher-level athletes aged 15-40 with ACL-R. Unadjusted and adjusted IR ratios (IRRs) with 99% CIs were calculated between sports, sex, age and divisions.

Results: Female athletes had a 3.3 times higher ACL-R IR compared with males (1.08 vs 0.32, IRR=3.33, 99% CI: 2.65 to 4.19) per 1000 athlete exposures (AE). Basketball had the largest difference in ACL-R IR per 1000 AE between females and males (1.26 vs 0.22, IRR=5.69, 99% CI: 2.79 to 11.60). Female second-division athletes had higher ACL-R IR per 1000 AE compared with female highest-division athletes (1.27 vs 0.76, IRR=1.67, 99% CI: 1.30 to 2.15). No significant association between age and IR was observed. Compared with football, lower ACL-R IR was observed in floorball and ice hockey in females, as well as in floorball, basketball and ice hockey in males.

Conclusion: Female athletes had higher ACL-R IRs than males and second-division female athletes had higher ACL-R IRs than highest-division female athletes. Lower ACL-R IRs were observed in floorball and ice hockey compared with football for both sexes. The remaining sports had ACL-R IRs similar to football, except basketball where rates were lower for male athletes.

PURPOSE: Genetic factors are considered important in the development of degenerative spine disease. The aim of this study was to determine the twin concordance rates for the common cervical spine diseases cervical disk herniation (CDH), cervical foraminal stenosis (CFS), and degenerative cervical myelopathy (DCM) requiring surgical treatment by studying monozygotic (MZ) and dizygotic (DZ) twin pairs.

METHODS: Patients, aged 18-85 years, operated for CDH, CFS, or DCM between 1996 and 2022 were identified in the national Swedish spine register (5962 CDH, 3801 CFS, and 3131 DCM) and matched with the Swedish twin registry to identify MZ and DZ twins. Concordance rates were calculated.

RESULTS: There were 64 twin pairs where one or both twins had surgical treatment for CDH. The corresponding numbers for surgically treated CFS and DCM were 37 twin pairs and 44 twin pairs respectively. For twins with CDH we found one concordant MZ pair and no concordant DZ pair (MZ probandwise concordance rate 0.12 [95% CI 0-0.33]). For twins with CFS we found one concordant MZ pair and no concordant DZ pair (MZ probandwise concordance rate 0.14 [95% CI 0-0.38]). In DCM patients we found no concordant twin pair.

CONCLUSIONS: In this national observational study, including 145 twin pairs, the concordance rates were low for surgically treated CDH, CFS, and DCM conditions. Our findings suggest that not only genetic factors, but also environmental factors and personal preferences are important whether a patient goes to surgery for this type of condition.

PURPOSE: Total wrist arthroplasty (TWA) is an established motion-preserving alternative to arthrodesis in the treatment of wrist arthritis, but post-TWA complications requiring additional surgery remain an issue. A new TWA design has been proposed. The purpose of this study was to report the outcome of a cohort study of 20 patients who underwent surgery using the new TWA design.

METHODS: Patients were assessed before surgery and at 1, 2, and 8 years after surgery for visual analog scale (VAS) pain scores, wrist range of motion, hand grip strength, and patient-reported outcome measures (PROMs). Radiographic examination was conducted for evidence of prosthetic loosening. Reasons for revision were analyzed.

RESULTS: In total, 24 reoperations were performed, including 12 revisions in 6 patients. Patient-reported outcome measures improved significantly at the 2-year follow-up compared with preoperative values. Hand grip strength, wrist extension, and VAS pain scores improved significantly at the 2-year follow-up. No radiographic loosening of the components was observed, but backing out of the carpal screws was noted in 16 of the 20 cases.

CONCLUSIONS: The new TWA resulted in improved VAS pain scores, PROMs, wrist extension, and hand grip strength. The high frequency of reoperation is a concern, and modification of the implant is needed.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

INTRODUCTION: Frailty is an age-related condition with increased risk for adverse health outcomes. Assessing frailty according to the Clinical Frailty Scale (CFS) based on data from medical records is useful for previously unassessed patients, but the validity of such scores in exclusively geriatric populations and in patients with dementia is relatively unknown.

METHODS: Patients admitted for the first time to one of two geriatric wards at Örebro University hospital between January 1st - December 31st, 2021, were included in this study if they had been appointed a CFS-score by anamnestic interview (CFSI) at admission. CFS scores based on medical records (CFSR) were appointed by a single medical student, who was blinded to the CFSI score. Score-agreement was evaluated with quadratic weighted Cohen's kappa (κ).

RESULTS: In total, 145 patients between the age of 55-101 were included in the study. The CFSR and CFSI scores agreed perfectly in 102 cases (0.7, 95% CI 0.65-0.77). There was no significant difference regarding age, sex, comorbidity, or number of patients diagnosed with dementia between the patients with complete agreement and the patients whose scores did not agree. Agreement between the scores was substantial, κ = 0.66, 95% CI 0.53-0.80.

CONCLUSIONS: CFS scores based on information from medical records can be generated with substantial agreement to CFS scores based on in-person anamnestic interviews. A dementia diagnosis does not influence the agreement between the scores. Therefore, these scores are a useful tool for assessing frailty in geriatric patients who previously lack a frailty assessment, both in clinical practice and future research. The results support previous findings, but larger studies are warranted.

BACKGROUND: Distal component loosening is a common mode of failure in total wrist arthroplasty (TWA). A radial hemi-wrist arthroplasty (RHWA) has the potential to avoid problems related to the distal component in TWA. The aim of this study is to investigate clinical outcomes following surgical treatment with a new RHWA design.

METHODS: In this pilot study of 20 consecutive RHWAs, patients were assessed preoperatively and postoperatively for range of motion, grip strength, Visual Analog Scale (VAS) pain scores, and functional scoring using Patient-Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder, and Hand (DASH), and Canadian Occupational Performance Measure. Radiographs were analyzed at 12 months and 5 years (mean, 5.1 years) postoperatively.

RESULTS: A total of 46 secondary surgeries were undertaken in 16 wrists, including 7 revisions. Another 6 patients are waiting for revision to radiocarpal arthrodesis. In non-revised patients, the DASH and PRWE scores improved, and wrist range of motion remained largely unchanged except for wrist flexion, which decreased. The VAS pain score during activity was reduced, and hand grip strength remained largely unchanged.

CONCLUSIONS: The new implant resulted in improved functional scoring and improved VAS pain scores in non-revised patients, but many cases needed secondary surgery due to persistent pain. The high revision rate is a major concern, and further use of the implant in its current form cannot be recommended.

OBJECTIVES: Prosthetic joint infection (PJI) is a serious complication following total hip arthroplasty (THA) entailing increased mortality, decreased quality of life and high healthcare costs.The primary aim was to investigate whether the national project: Prosthesis Related Infections Shall be Stopped (PRISS) reduced PJI incidence after primary THA; the secondary aim was to evaluate other possible benefits of PRISS, such as shorter time to diagnosis.

DESIGN: Cohort study.

SETTING: In 2009, a nationwide, multidisciplinary infection control programme was launched in Sweden, PRISS, which aimed to reduce the PJI burden by 50%.

PARTICIPANTS: We obtained data on patients undergoing primary THA from the Swedish Arthroplasty Registry 2012-2014, (n=45 723 patients, 49 946 THAs). Using personal identity numbers, this cohort was matched with the Swedish Prescribed Drug Registry. Medical records of patients with ≥4 weeks' antibiotic consumption were reviewed to verify PJI diagnosis (n=2240, 2569 THAs).

RESULTS: The cumulative incidence of PJI following the PRISS Project was 1.2% (95% CI 1.1% to 1.3%) as compared with 0.9% (95% CI 0.8% to 1.0%) before. Cox regression models for the PJI incidence post-PRISS indicates there was no statistical significance difference versus pre-PRISS (HR 1.1 (95% CI 0.9 to 1.3)). There was similar time to PJI diagnosis after the PRISS Project 24 vs 23 days (p=0.5).

CONCLUSIONS: Despite the comprehensive nationwide PRISS Project, Swedish PJI incidence was higher after the project and time to diagnosis remained unchanged. Factors contributing to PJI, such as increasing obesity, higher American Society of Anesthesiology class and more fractures as indications, explain the PJI increase among primary THA patients.

STUDY DESIGN: Retrospective analysis of prospectively collected data from the National Swedish Spine Register (Swespine).

OBJECTIVE: To evaluate the effects of symptomatic spinal epidural hematoma (SSEH) requiring reoperation on one-year patient-reported outcome measures (PROMs) in a large cohort of patients treated surgically for lumbar spinal stenosis (LSS).

SUMMARY OF BACKGROUND DATA: Studies exploring the outcomes of reoperations after SSEH are scarce and often lack validated outcome measures. As SSEH is considered a serious complication, understanding of the outcome following hematoma evacuation is important.

MATERIALS AND METHODS: After retrieving data from 2007 to 2017 from Swespine, we included all patients with LSS without concomitant spondylolisthesis who were treated surgically with decompression without fusion. Patients with evacuated SSEH were identified in the registry. Back/leg pain numerical rating scales (NRS), the Oswestry Disability Index (ODI), and EQ VAS were used for outcome assessment. PROMs before and one-year after decompression surgery were compared between evacuated patients and all other patients. Multivariate linear regression was performed to determine if hematoma evacuation predicted inferior one-year PROM scores.

RESULTS: A total of 113 patients with an evacuated SSEH were compared with 19527 patients with no evacuation. One-year after decompression surgery, both groups showed significant improvement in all PROMs. When comparing the two groups' one-year improvement there were no significant differences in any PROM. The proportion of patients achieving the minimum important change was not significantly different for any PROM. Multivariate linear regression found that hematoma evacuation significantly predicted inferior one-year ODI (β=4.35, P=0.043), but it was not a significant predictor of inferior NRS Back (β=0.50, P=0.105), NRS Leg (β=0.41, P=0.221), or EQ VAS (β=-1.97, P=0.470). CONCLUSIONS: A surgically evacuated SSEH does not affect outcome in terms of back/leg pain or health-related quality of life. Commonly used PROM surveys may not capture neurologic deficits associated with SSEH.

This study aimed to investigate the association of socioeconomic factors, country of birth and comorbidities with poor patient-reported outcome 1 year after a distal radial fracture. The patient population was obtained from the Swedish Fracture Register. In the study, 17,468 patients 18 years or older were included. Poor outcome was the dependent variable in a multivariate logistic regression analysis. The factors with the strongest association with poor outcome were country of birth outside the European Union (odds ratio (OR) = 2.28; 95% CI = 1.91-2.73), high-energy trauma mechanism (OR = 1.76; 95% CI = 1.46-2.12), a history of anxiety or depression (OR = 1.46; 95% CI = 1.26-1.70), and a Charlson comorbidity index ≥3 (OR = 1.51; 95% CI = 1.17-1.94). Alleviating the effects of these factors could potentially decrease the proportion of patients with a disability after a distal radial fracture.Level of evidence: III.

INTRODUCTION: Hip fracture patients, who are often frail, continue to be a challenge for healthcare systems with a high postoperative mortality rate. While beta-blocker therapy (BBt) has shown a strong association with reduced postoperative mortality, its effect in frail patients has yet to be determined. This study's aim is to investigate how frailty, measured using the Orthopedic Hip Frailty Score (OFS), modifies the effect of preadmission beta-blocker therapy on mortality in hip fracture patients.

METHODS: This retrospective register-based study included all adult patients in Sweden who suffered a traumatic hip fracture and subsequently underwent surgery between 2008 and 2017. Treatment effect was evaluated using the absolute risk reduction (ARR) in 30-day postoperative mortality when comparing patients with (BBt+) and without (BBt-) ongoing BBt. Inverse probability of treatment weighting (IPTW) was used to reduce potential confounding when examining the treatment effect. Patients were stratified based on their OFS (0, 1, 2, 3, 4 and 5) and the treatment effect was also assessed within each stratum.

RESULTS: A total of 127,305 patients were included, of whom 39% had BBt. When IPTW was performed, there were no residual differences in observed baseline characteristics between the BBt+ and BBt- groups, across all strata. This analysis found that there was a stepwise increase in the ARRs for each additional point on the OFS. Non-frail BBt+ patients (OFS 0) exhibited an ARR of 2.2% [95% confidence interval (CI) 2.0-2.4%, p < 0.001], while the most frail BBt+ patients (OFS 5) had an ARR of 24% [95% CI 18-30%, p < 0.001], compared to BBt- patients within the same stratum.

CONCLUSION: Beta-blocker therapy is associated with a reduced risk of 30-day postoperative mortality in frail hip fracture patients, with a greater effect being observed with higher Orthopedic Hip Frailty Scores.