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  • 1.
    Adolfsson, Lars
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Orthopedics, Linköping University, Linköping, Sweden.
    What keeps a shoulder stable - Is there an ideal method for anterior stabilisation?2024In: Shoulder & Elbow, ISSN 1758-5732, Vol. 16, no 1, p. 4-7Article, review/survey (Refereed)
    Abstract [en]

    The gleno-humeral joint is by far the most mobile in the human body but also afflicted by dislocations, predominantly anterior. Surgical stabilisation is often successful but failures not uncommon. The following review describes potential causes of failure and highlights the need of adapting surgical methods to pathomorphology.

  • 2.
    Ahl, Rebecka
    et al.
    Örebro University, School of Medical Sciences. Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden; Division of Surgery, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
    Mohammad Ismail, Ahmad
    Örebro University, School of Medical Sciences. Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.
    Borg, Tomas
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.
    Sjölin, Gabriel
    Örebro University, School of Medical Sciences. Örebro University Hospital. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Forssten, Maximilian Peter
    Örebro University, School of Medical Sciences. Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Wretenberg, Per
    Örebro University, School of Medical Sciences. Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    A nationwide observational cohort study of the relationship between beta-blockade and survival after hip fracture surgery2022In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 48, no 2, p. 743-751Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Despite advances in the care of hip fractures, this area of surgery is associated with high postoperative mortality. Downregulating circulating catecholamines, released as a response to traumatic injury and surgical trauma, is believed to reduce the risk of death in noncardiac surgical patients. This effect has not been studied in hip fractures. This study aims to assess whether survival benefits are gained by reducing the effects of the hyper-adrenergic state with beta-blocker therapy in patients undergoing emergency hip fracture surgery.

    METHODS: This is a retrospective nationwide observational cohort study. All adults [Formula: see text] 18 years were identified from the prospectively collected national quality register for hip fractures in Sweden during a 10-year period. Pathological fractures were excluded. The cohort was subdivided into beta-blocker users and non-users. Poisson regression with robust standard errors and adjustments for confounders was used to evaluate 30-day mortality.

    RESULTS: 134,915 patients were included of whom 38.9% had ongoing beta-blocker therapy at the time of surgery. Beta-blocker users were significantly older and less fit for surgery. Crude 30-day all-cause mortality was significantly increased in non-users (10.0% versus 3.7%, p < 0.001). Beta-blocker therapy resulted in a 72% relative risk reduction in 30-day all-cause mortality (incidence rate ratio 0.28, 95% CI 0.26-0.29, p < 0.001) and was independently associated with a reduction in deaths of cardiovascular, respiratory, and cerebrovascular origin and deaths due to sepsis or multiorgan failure.

    CONCLUSIONS: Beta-blockers are associated with significant survival benefits when undergoing emergency hip fracture surgery. Outlined results strongly encourage an interventional design to validate the observed relationship.

  • 3.
    Ahl, Rebecka
    et al.
    Örebro University, School of Medical Sciences. Department of Surgery, Division of Trauma and Emergency Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Sjölin, Gabriel
    Örebro University, School of Medical Sciences. Department of Surgery, Division of Trauma and Emergency Surgery, Örebro University Hospital, Örebro, Sweden.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery, Division of Trauma and Emergency Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Surgery, Division of Trauma and Emergency Surgery, Örebro University Hospital, Örebro, Sweden.
    Corrigendum to "Does early beta-blockade in isolated severe traumatic brain injury reduce the risk of post traumatic depression?": [Injury 48 (2017) 101–105]2017In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 48, no 11, p. 2612-2612Article in journal (Refereed)
  • 4.
    Ahl, Rebecka
    et al.
    Örebro University, School of Medical Sciences. Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Sjölin, Gabriel
    Örebro University, School of Medical Sciences. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden; Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Does early beta-blockade in isolated severe traumatic brain injury reduce the risk of post traumatic depression?2017In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 48, no 1, p. 101-105Article in journal (Refereed)
    Abstract [en]

    Introduction: Depressive symptoms occur in approximately half of trauma patients, negatively impacting on functional outcome and quality of life following severe head injury. Pontine noradrenaline has been shown to increase upon trauma and associated beta-adrenergic receptor activation appears to consolidate memory formation of traumatic events. Blocking adrenergic activity reduces physiological stress responses during recall of traumatic memories and impairs memory, implying a potential therapeutic role of beta-blockers. This study examines the effect of pre-admission beta-blockade on post-traumatic depression.

    Methods: All adult trauma patients (>= 18 years) with severe, isolated traumatic brain injury (intracranial Abbreviated Injury Scale score (AIS) >= 3 and extracranial AIS <3) were recruited from the trauma registry of an urban university hospital between 2007 and 2011. Exclusion criteria were in-hospital deaths and prescription of antidepressants up to one year prior to admission. Pre- and post-admission beta-blocker and antidepressant therapy data was requested from the national drugs registry. Post-traumatic depression was defined as the prescription of antidepressants within one year of trauma. Patients with and without pre-admission beta-blockers were matched 1: 1 by age, gender, Glasgow Coma Scale, Injury Severity Score and head AIS. Analysis was carried out using McNemar's and Student's t-test for categorical and continuous data, respectively.

    Results: A total of 545 patients met the study criteria. Of these, 15% (n = 80) were prescribed beta-blockers. After propensity matching, 80 matched pairs were analyzed. 33% (n = 26) of non beta-blocked patients developed post-traumatic depression, compared to only 18% (n = 14) in the beta-blocked group (p = 0.04). There were no significant differences in ICU (mean days: 5.8 (SD 10.5) vs. 5.6 (SD 7.2), p = 0.85) or hospital length of stay (mean days: 21 (SD 21) vs. 21 (SD 20), p = 0.94) between cohorts.

    Conclusion: beta-blockade appears to act prophylactically and significantly reduces the risk of posttraumatic depression in patients suffering from isolated severe traumatic brain injuries. Further prospective randomized studies are warranted to validate this finding.

  • 5.
    Al Dabbagh, Z.
    et al.
    Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
    Jansson, K. Å.
    Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
    Stiller, C. O.
    Department of Medicine, Clinical Pharmacology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Montgomery, Scott
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Weiss, R. J.
    Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
    Long-term pattern of opioid prescriptions after femoral shaft fractures2016In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 60, no 5, p. 634-641Article in journal (Refereed)
    Abstract [en]

    Background: The use of opioids in non-cancer-related pain following skeletal trauma is controversial due to the presumed risk of dose escalation and dependence. We therefore examined the pattern of opioid prescriptions, that is, those actually dispensed, in patients with femoral shaft fractures.

    Methods: We analysed data from the Swedish National Hospital Discharge Register and the Swedish Prescribed Drug Register between 2005 and 2008.

    Results: We identified 1471 patients with isolated femoral shaft fractures. The median age was 75 (16-102) years and 56% were female. In this cohort, 891 patients (61%) received dispensed opioid prescriptions during a median follow-up of 20 months (interquartile range 11-32). In the age- and sex-matched comparison cohort (7339 individuals) without fracture, 25% had opioid prescriptions dispensed during the same period. The proportions of patients receiving opioid analgesics at 6 and 12 months after the fracture were 45% (95% CI 42-49) and 36% (32-39), respectively. The median daily morphine equivalent dose (MED) was between 15 and 17 mg 1-12 months post-fracture. After 3 months, less than 5% used prescription doses higher than 20 mg MED per day. Older age (≥ 70 compared with < 70 years) was a significant predictor of earlier discontinuation of opioid use (Hazard ratio [HR] 1.9).

    Conclusion: A notable proportion of patients continued to receive dispensed prescriptions for opioids for over 6 months (45%) and more than a third of them (36%) continued treatment for at least 12 months. However, the risk of dose escalation seems to be small in opioid-naïve patients.

  • 6.
    Alipour, Akbar
    et al.
    Division of Intervention and Implementation Research, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden; Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
    Bodin, Lennart
    Division of Intervention and Implementation Research, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
    Bergström, Gunnar
    Division of Intervention and Implementation Research, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
    Jensen, Irene
    Division of Intervention and Implementation Research, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
    The transitional pattern of pain and disability, from perceived pain to sick leave: Experience from a longitudinal study2013In: Journal of Back and Musculoskeletal Rehabilitation, ISSN 1053-8127, E-ISSN 1878-6324, Vol. 26, no 4, p. 411-419Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate the prospective value of the transitional and dynamic patterns of pain disability over time on sick leave in chronic recurrent back/neck pain cases.

    Methods: The material used was based on a longitudinal study with three repeated measurements. The graded Chronic Pain Scale was used to assess levels of pain disability. The relationship between the transitional patterns of the pain disability score ( ten defined states of decrease, increase or no change, between two time points) and sick leave was analyzed for 909 chronic/recurrent cases in three different models using logistic regression.

    Results: Those with high level of pain disability have a more transitional pattern and their pain level changed during the time period studied. When adjusting for age, gender, education and previous sick leave, the final model indicated that the current level of pain disability was a risk factor in taking sick leave. The likelihood of sick leave was highest in the transition of pain into the highest levels of disability, independent of past disability level of pain. Earlier sick leave remained as an important predictor of sick leave.

    Conclusions: From a clinical and prognostic perspective the probability of sick leave will be different and can be predicted based on previous sick leave but not from former history of pain disability level or its transitional pattern.

  • 7.
    Allvin, Renée
    et al.
    Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Kling, Anna-Maria
    Statistical and Epidemiology Unit, Örebro University Hospital, Örebro, Sweden.
    Idvall, Ewa
    Faculty of Health and Society, Malmö and Skåne University Hospital, Malmö University, Malmö, Sweden.
    Svensson, Elisabeth
    Örebro University, Swedish Business School at Örebro University.
    Patient Reported Outcome Measures (PROMs) after total hip- and knee replacement surgery evaluated by the Postoperative Recovery Profile questionnaire (PRP): improving clinical quality and person-centeredness2012In: The International Journal of Person Centered Medicine, ISSN 2043-7730, E-ISSN 2043-7749, Vol. 2, no 3, p. 368-376Article in journal (Refereed)
    Abstract [en]

    Rationale and aims: The importance of evaluating postoperative recovery with consideration to the patient’s perspectivehas been emphasized. The aim of this study was to demonstrate how the recovery-specific Postoperative Recovery Profile(PRP) questionnaire can be used to evaluate patient-reported outcome measures (PROMs) after hip- and knee replacementin the enhancement of clinical quality and the person-centeredness of clinical services.

    Method: Patients undergoing primary total knee- and hip replacement were eligible for this longitudinal follow-up study. The participants completed the PRP questionnaire on repeated occasions. In this paper, data from Day 3 and Month 1 afterdischarge were used. The change in recovery, between the two measurement occasions, on item-, dimensional- and globallevels, both for each patient and for the group, were evaluated.

    Results: A total number of 75 patients were included. One month after discharge the median PRP score was 13 (partly recovered) out of 19. Recovery changes towards lower levels of problems/difficulties were shown in both item-, dimensional- and global levels of recovery month 1 after discharge, as compared with Day 3. The group of patients washomogenous in change.

    Conclusions: We demonstrated that the PRP questionnaire can be used to evaluate postoperative recovery after hip- andknee replacement surgery on item-, dimensional- and global levels. Data from each recovery level can be useful for quality development and in informing increases in the person-centeredness of clinical services. The global population scores can beused to evaluate treatment effect on a group of patients. It can also be used to define endpoints in follow-up studies.

  • 8.
    Amer, Ahmed
    et al.
    University Health Care Research Center.
    Hermansson, Liselotte
    Örebro University, School of Health Sciences. Dept of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Eliasson, Ann-Christin
    4Neuropediatric Research Unit, Karolinska Institutet, Stockholm, Sweden .
    Jarl, Gustav
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Dept of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Translation and Cross-cultural Validation of Children’s Hand-use Experience Questionnaire (CHEQ) 2.0: Arabic Language Version2019In: Prosthetics and Orthotics International, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 43, no 1 suppl., p. 233-233Article in journal (Other academic)
  • 9.
    Amer, Ahmed
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Rehabilitation Research, Örebro County Council, Örebro, Sweden.
    Jarl, Gustav M
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Rehabilitation Research, Örebro County Council, Örebro, Sweden; Department of Prosthetics and Orthotics, Örebro County Council, Örebro, Sweden.
    Hermansson, Liselotte M. N.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Rehabilitation Research, Örebro County Council, Örebro, Sweden; Department of Prosthetics and Orthotics, Örebro County Council, Örebro, Sweden.
    The effect of insoles on foot pain and daily activities2014In: Prosthetics and Orthotics International, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 38, no 6, p. 474-480Article in journal (Other academic)
    Abstract [en]

    BACKGROUND:

    Foot pain decreases individuals' ability to perform daily activities. Insoles are often prescribed to reduce the pain which, in turn, may promote return to normal activities.

    OBJECTIVES:

    To evaluate the effects of insoles on foot pain and daily activities, and to investigate the relationship between individuals' satisfaction with insoles and actual use of them.

    STUDY DESIGN:

    A 4-week pre-post intervention follow-up.

    METHODS:

    Brief Pain Inventory, International Physical Activity Questionnaire and Lower Extremities Functional Status were used as outcome measures. Client Satisfaction with Device was used in the follow-up.

    RESULTS:

    A total of 67 participants answered the questionnaires (81% women). Overall, a reduction in Pain Severity (p = 0.002) and Pain Interference (p = 0.008) was shown. Secondary analyses revealed a significant effect only in women. No changes in daily activities (Walking, p = 0.867; Total Physical Activity, p = 0.842; Lower Extremities Functional Status, p = 0.939) could be seen. There was no relation between Client Satisfaction with Device measures and duration of insole use. A difference in sex was shown; women scored higher than men on Pain Severity.

    CONCLUSION:

    Insoles reduce pain and pain interference with daily activities for women with foot pain. Satisfaction with the insoles is not a predictor of actual insole use. The effect of insoles on activity performance needs further study.

    CLINICAL RELEVANCE:

    This study provides evidence for prescribing insoles to people with foot pain. Nonetheless, insoles are not enough to increase their physical activity level in the short term. Satisfaction with insoles and duration of use are not correlated and cannot be inferred from each other.

  • 10.
    Andjelkov, Nenad
    et al.
    Department of Orthopedics, Västmanlands Regional Hospital, Västerås, Sweden; Centre for Clinical Research, Uppsala University, Västmanlands Regional Hospital, Västerås, Sweden; Department of Orthopedics, University Hospital Örebro, Örebro, Sweden.
    Riyadh, Hasan
    Department of Orthopedics, Västmanlands Regional Hospital, Västerås, Sweden.
    Wretenberg, Per
    Department of Orthopedics, University Hospital Örebro, Örebro, Sweden.
    Neuralgic and Nociceptive Pain in the Knee as a Cause of the Treatment Failure after Cartilage Repair Surgery: Two Case Reports2018In: Journal of Pain & Relief, ISSN 2167-0846, Vol. 7, no 4, article id 325Article in journal (Refereed)
    Abstract [en]

    Objective: Cartilage injuries are one of the most frequent causes of knee pain. Other causes such as meniscus tears, synovial plica, synovitis, partial and total ligament ruptures are rather easy to identify by standard diagnostic methods and diagnostic arthroscopy. In this study we are describing two other clinical states, which could be the cause of the knee pain and should be addressed before a decision for operative treatment of cartilage injury has been made by a surgeon.

    Materials and Methods: Two patients with isolated focal defects due to previous trauma to the knee were diagnosed both using magnetic resonance imaging preoperatively and intraoperatively during arthroscopy. These were operated arthroscopically with standard procedure for micro fracture. Both patients had treatment failure without a sign of significant improvement after six and twelve months.

    Results: Second look arthroscopy was performed in both cases due to the treatment failure and close to normal cartilage was found in the patella in first case and both in trochlea and medial femoral condyle in other case. No other cause of pain could be identified both with second look arthroscopy and magnetic resonance imaging done 6-12 months postoperatively. The patients were diagnosed with neuralgic pain in one case, and nociceptive pain in other case.

    Conclusion: These states are rare, but have to be addressed by the surgeon before making the decision about the operative treatment. By doing so, one could avoid eventual treatment failure and exposition of the patient to an unnecessary risk of complications during the surgery.

  • 11.
    Axén, Iben
    et al.
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    Bergström, Gunnar
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    Bodin, Lennart
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    Using few and scattered time points for analysis of a variable course of pain can be misleading: an example using weekly text message data2014In: The spine journal, ISSN 1529-9430, E-ISSN 1878-1632, Vol. 14, no 8, p. 1454-1459Article in journal (Refereed)
    Abstract [en]

    Background context: Because low back pain (LBP) is a fluctuating condition, the diversity in the prediction literature may be due to when the outcome is measured.

    Purpose: The objective of this study was to investigate the prediction of LBP using an outcome measured at several time points.

    Study design/setting: A multicenter clinical observational study in Sweden.

    Patient sample: Data were collected on 244 subjects with nonspecific LBP. The mean age of the subjects was 44 years, the mean pain score at inclusion was 4.4/10, and 51% of the sample had experienced LBP for more than 30 days the previous year.

    Outcome measures: The outcome used in this study was the “number of days with bothersome pain” collected with weekly text messages for 6 months.

    Methods: In subjects with nonspecific LBP, weekly data were available for secondary analyses. A few baseline variables were chosen to investigate prediction at different time points: pain intensity, the presence of leg pain, duration of LBP the previous year, and self-rated health at baseline. Age and gender acted as additional covariates.

    Results: In the multilevel models, the predictive variables interacted with time. Thus, the risk of experiencing a day with bothersome LBP varied over time. In the logistic regression analyses, the predictive variable's previous duration showed a consistent predictive ability for all the time points. However, the variables pain intensity, leg pain, and self-rated health showed inconsistent predictive patterns.

    Conclusions: An outcome based on frequently measured data described the variability in the prediction of future LBP over time. Prediction depended on when the outcome was measured. These results may explain the diversity of the results of the predictor studies in the literature.

  • 12.
    Axén, Iben
    et al.
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, The Karolinska Institutet, Stockholm, Sweden.
    Bodin, Lennart
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, The Karolinska Institutet, Stockholm, Sweden.
    Bergström, Gunnar
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, The Karolinska Institutet, Stockholm, Sweden.
    Halasz, Laszlo
    Private practise, Lund, Sweden.
    Lange, Fredrik
    Private practise, Stockholm, Sweden.
    Lövgren, Peter W.
    Private practise, Stockholm, Sweden.
    Rosenbaum, Annika
    Private practise, Linköping, Sweden.
    Leboeuf-Yde, Charlotte
    Institute of Regional Health Research, Spine Centre of Southern Denmark, Hospital Lillebælt, University of Southern Denmark, Kolding, Denmark.
    Jensen, Irene
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, The Karolinska Institutet, Stockholm, Sweden.
    Clustering patients on the basis of their individual course of low back pain over a six month period2011In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 12, article id 99Article in journal (Refereed)
    Abstract [en]

    Background: Several researchers have searched for subgroups in the heterogeneous population of patients with non-specific low back pain (LBP). To date, subgroups have been identified based on psychological profiles and the variation of pain.

    Methods: This multicentre prospective observational study explored the 6- month clinical course with measurements of bothersomeness that were collected from weekly text messages that were sent by 176 patients with LBP. A hierarchical cluster analysis, Ward's method, was used to cluster patients according to the development of their pain.

    Results: Four clusters with distinctly different clinical courses were described and further validated against clinical baseline variables and outcomes. Cluster 1, a "stable" cluster, where the course was relatively unchanged over time, contained young patients with good self- rated health. Cluster 2, a group of "fast improvers" who were very bothered initially but rapidly improved, consisted of patients who rated their health as relatively poor but experienced the fewest number of days with bothersome pain of all the clusters. Cluster 3 was the "typical patient" group, with medium bothersomeness at baseline and an average improvement over the first 4-5 weeks. Finally, cluster 4 contained the "slow improvers", a group of patients who improved over 12 weeks. This group contained older individuals who had more LBP the previous year and who also experienced most days with bothersome pain of all the clusters.

    Conclusions: It is possible to define clinically meaningful clusters of patients based on their individual course of LBP over time. Future research should aim to reproduce these clusters in different populations, add further clinical variables to distinguish the clusters and test different treatment strategies for them.

  • 13.
    Baumbach, L.
    et al.
    Res. Unit for Musculoskeletal Function and Physiotherapy, Dept. of Sports Sci. and Clinical Biomechanics, Univ. of Southern Denmark, Odense, Denmark.
    Ankerst, D.
    Dept. of Mathematics and Sch.of Life Sci. Technical Univ. of Munich, Munich, Germany.
    Nyberg, Lillemor A.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Cottrell, E.
    Primary Care Ctr. Versus Arthritis, Keele Univ., Keele, United Kingdom.
    Roos, E. M.
    Res. Unit for Musculoskeletal Function and Physiotherapy, Dept. of Sports Sci. and Clinical Biomechanics, Univ. of Southern Denmark, Odense, Denmark.
    Lykkegaard, J.
    Dept. of Publ. Hlth., Res. Unit for Gen. Practice, Univ. of Southern Denmark, Odense, Denmark.
    ASSOCIATION BETWEEN RECEIVING DIFFERENT ELEMENTS OF CARE AND SATISFACTION WITH CARE IN PATIENTS WITH KNEE OSTEOARTHRITIS TREATED BY THEIR GENERAL PRACTITIONER2020In: Osteoarthritis and Cartilage, ISSN 1063-4584, E-ISSN 1522-9653, Vol. 28, p. S450-S450, article id 670Article in journal (Refereed)
  • 14.
    Baumbach, Linda
    et al.
    Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    Ankerst, Donna
    Department of Mathematics and School of Life Sciences, Technical University of Munich, Munich, Germany.
    Roos, Ewa M.
    Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
    Nyberg, Lillemor A.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Cottrell, Elizabeth
    Primary Care Centre Versus Arthritis, Keele University, Keele, UK.
    Lykkegaard, Jesper
    Department of Public Health, Research Unit for General Practice, University of Southern Denmark, Odense, Denmark.
    Association between received treatment elements and satisfaction with care for patients with knee osteoarthritis seen in general practice in Denmark2021In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 39, no 2, p. 257-264Article in journal (Refereed)
    Abstract [en]

    Objective: While education, exercise, and weight reduction when indicated, are recommended first-line treatments for knee osteoarthritis patients, they remain poorly implemented in favour of pain killer treatment, imaging and referral to surgery. A reason could be that patients are more satisfied with receiving these adjunctive treatment elements. This study aimed to investigate the associations between the received elements of care and the patient's satisfaction with the care for knee osteoarthritis in general practice.

    Design: Cross-sectional study.

    Setting: A Danish general practice.

    Subjects: All consecutive patients >= 30 years of age who consulted the general practitioner (GP) with chronic knee complaints during 18 months and who replied to a mailed questionnaire (n = 136).

    Main outcome measures: The questionnaire addressed patient's knee-related quality of life, and overall satisfaction with care, as well as reception of seven types of information, which are known quality indicators. Information on reception of adjunctive treatment elements was obtained from electronic medical records.

    Results: Patient satisfaction (versus neutrality/dissatisfaction) was positively associated with reception of information on: physical activity and exercise (relative risks [RR] 1.38, 95% bootstrap percentile interval [BPI] 1.02-4.33), and the relationship between weight and osteoarthritis (1.38, 1.01-4.41). No significant associations were found for the five remaining types of information and all the adjunctive treatment elements.

    Conclusion: Providing information as education to patients with knee osteoarthritis as part of the treatment is positively associated with satisfaction with care.

  • 15.
    Baumbach, Linda
    et al.
    Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Department of Health Economics and Health, Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    Roos, Ewa M.
    Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
    Ankerst, Donna
    Department of Mathematics and Life Science Systems, Technical University of Munich, Munich, Germany.
    Nyberg, Lillemor A.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Cottrell, Elizabeth
    Primary Care Centre Versus Arthritis, Keele University, Keele, UK.
    Lykkegaard, Jesper
    Research Unit for General Practice Institute of Public Health, University of Southern Denmark, Odense, Denmark.
    Changes in received quality of care for knee osteoarthritis after a multicomponent intervention in a general practice in Denmark2021In: Health Science Reports, E-ISSN 2398-8835, Vol. 4, no 4, article id e402Article in journal (Refereed)
    Abstract [en]

    Objective: First-line treatment for patients with knee osteoarthritis should ideally prescribe patient education, exercise, and if needed, weight loss. In practice, however, adjunctive treatments, including painkillers and referrals to specialists, are typically introduced before these measures. This study evaluated interventions to sustainably improve general practitioner delivered care for patients with knee osteoarthritis.

    Design: Comparison of impacts of knee osteoarthritis care during four half-year periods: before, 6, 12, and 18 months after primary intervention based on electronic medical records (EMR) and patient questionnaires.

    Setting: Danish general practitioners (GPs) treating 6240 patients.

    Participants: Four GPs, two GP trainees, and six staff members.

    Interventions: Six pre-planned primary interventions: patient leaflet, GP and staff educational session, knee osteoarthritis consultation, two functional tests monitoring patient function, EMR phrase aiding consultation, and waiting room advertisement and three supportive follow-up interventions.

    Main outcome measures: Usage of first-line and adjunctive treatment elements, the functional tests, and the EMR phrase.

    Results: Approximately 50 knee osteoarthritis cases participated in each of the four half-year periods. Primary interventions had only transient effects lasting <12 months on the knee osteoarthritis care. Functional tests and EMR phrases were used predominantly during the first 6 months, where a transient drop in the referral rate to orthopedics was observed. Use of educational elements was moderate and without significant change during follow-up.

    Conclusion: More routine use of the primary or inclusion of novel increased-adherence interventions is needed to sustainably improve care for knee osteoarthritis patients in Danish general practice.

  • 16.
    Benoit, Daniel L
    et al.
    nstitution for Surgical Sciences, Section of Sports Medicine, Karolinska Institute, Stockholm, Sweden; Department of Orthopaedics, Karolinska Hospital, Stockholm, Sweden; Department of Mechanical Engineering, University of Delaware, 106 Spencer Lab, Newark, DE 19711, United States.
    Ramsey, Dan K
    Department of Physical Therapy, University of Delaware, Newark, DE, United States.
    Lamontagne, Mario
    School of Human Kinetics, University of Ottawa, Ottawa, Canada; Department of Mechanical Engineering, University of Ottawa, Ottawa, Canada.
    Xu, Lanyi
    School of Human Kinetics, University of Ottawa, Ottawa, Canada.
    Wretenberg, Per
    Örebro University Hospital. Department of Orthopaedics, Karolinska Hospital, Stockholm, Sweden; Institution for Surgical Sciences, Section of Orthopaedics, Karolinska Institute, Stockholm, Sweden.
    Renström, Per
    Institution for Surgical Sciences, Section of Sports Medicine, Karolinska Institute, Stockholm, Sweden; Department of Orthopaedics, Karolinska Hospital, Stockholm, Sweden.
    Effect of skin movement artifact on knee kinematics during gait and cutting motions measured in vivo2006In: Gait & Posture, ISSN 0966-6362, E-ISSN 1879-2219, Vol. 24, no 2, p. 152-164Article in journal (Refereed)
    Abstract [en]

    Eight healthy male subjects had intra-cortical bone-pins inserted into the proximal tibia and distal femur. Three reflective markers were attached to each bone-pin and four reflective markers were mounted on the skin of the tibia and thigh, respectively. Roentgen-stereophotogrammetric analysis (RSA) was used to determine the anatomical reference frame of the tibia and femur. Knee joint motion was recorded during walking and cutting using infrared cameras sampling at 120Hz. The kinematics derived from the bone-pin markers were compared with that of the skin-markers. Average rotational errors of up to 4.4 degrees and 13.1 degrees and translational errors of up to 13.0 and 16.1mm were noted for the walk and cut, respectively. Although skin-marker derived kinematics could provide repeatable results this was not representative of the motion of the underlying bones. A standard error of measurement is proposed for the reporting of 3D knee joint kinematics.

  • 17.
    Benoit, Daniel L
    et al.
    School of Rehabilitation Sciences, University of Ottawa, Canada; School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ont.; Canada.
    Ramsey, Dan K
    Department of Physical Therapy, University of Delaware, Newark, DE, United States.
    Lamontagne, Mario
    School of Human Kinetics, University of Ottawa, Ottawa, Ont., Canada.
    Xu, Lanyi
    School of Human Kinetics, University of Ottawa, Ottawa, Ont., Canada.
    Wretenberg, Per
    Örebro University Hospital. Institution for Surgical Sciences, Section of Orthopaedics, Karolinska Institute, Stockholm, Sweden; Section of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden.
    Renström, Per
    Institution for Surgical Sciences, Section of Orthopaedics, Karolinska Institute, Stockholm, Sweden; Section of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden.
    In vivo knee kinematics during gait reveals new rotation profiles and smaller translations2007In: Clinical Orthopaedics and Related Research, ISSN 0009-921X, E-ISSN 1528-1132, Vol. 454, p. 81-88Article in journal (Refereed)
    Abstract [en]

    In order to identify abnormal or pathological motions associated with clinically relevant questions such as injury mechanisms or factors leading to joint degeneration, it is essential to determine the range of normal tibiofemoral motion of the healthy knee. In this study we measured in vivo 3D tibiofemoral motion of the knee during gait and characterized the nonsagittal plane rotations and translations in a group of six healthy young adults. The subjects were instrumented with markers placed on intracortical pins inserted into the tibia and femur as well as marker clusters placed on the skin of the thigh and shank. The secondary rotations and translation excursions of the knee were much smaller than those derived from skin markers and previously described in the literature. Also, for a given knee flexion angle, multiple combinations of transverse and frontal plane knee translation or rotation positions were found. This represents normal knee joint motions and ensemble averaging of gait data may mask this important subject-specific information.

  • 18.
    Bergkvist, Anna
    et al.
    Örebro University, School of Medical Sciences. Department of Orthopedics, Örebro University School of Medical Sciences, Örebro, Sweden; Örebro University Hospital, Örebro, Sweden.
    Lundqvist, Eva
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Orthopedics.
    Pantzar-Castilla, Evelina
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Orthopedics.
    Distal radius fractures in children aged 5-12 years: a Swedish nationwide register-based study of 25 777 patients2023In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 24, no 1, article id 560Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Distal radius fracture (DRF) is the most common type of fracture in children. There is no clear consensus on primary treatment for complete DRFs. Kirschner wire (K-wire) fixation has been recommended, to avoid the risk of redislocation. However, recent studies have indicated that casting can be sufficient, at least for children with two or more years left to grow. There is no recent study regarding pediatric DRFs and the extent of K-wire fixations in the Swedish population. The purpose of this study was to investigate epidemiology and treatment of pediatric DRFs registered in the Swedish Fracture Register (SFR).

    METHODS: In this retrospective study, based on data from SFR for children aged 5-12 years with DRF between January 2015 and October 2022, we investigated epidemiology and choice of treatment. Sex, age, type of DRF, treatment, cause and mechanism of injury, were analyzed.

    RESULTS: In total, 25,777 patients were included, 7,173 (27%) with complete fractures. Number and peak age of girls vs. boys with fractures were 11,742 (46%), 10 years, and 14,035 (54%), 12 years, respectively. Odds ratio (OR) for a K-wire fixation in girls vs. boys was 0.81 (95% confidence interval (CI) 0.74-0.89, p < .001). With age 5 -7 years as reference, OR for age group 8-10 years was 0.88 (95% CI 0.80-0.98 p = .019) and OR for age group 11-12 years was 0.81 (95% CI 0.73-0.91 p =  < .001.

    CONCLUSION: Casting only was the preferred treatment for all fractures (76%). Boys acquired DRFs more often than girls, with a peak age of 12 years. Younger children and boys with a complete fracture were more likely than older children and girls to receive a K-wire. Further research regarding indications for K-wiring of DRFs in the pediatric population is needed.

  • 19.
    Bergström, Cecilia
    et al.
    Division of Intervention and Implementation Research, Department of Public Health, Karolinska Institutet, Stockholm, Sweden.
    Hagberg, Jan
    Division of Intervention and Implementation Research, Department of Public Health, Karolinska Institutet, Stockholm, Sweden.
    Bodin, Lennart
    Division of Intervention and Implementation Research, Department of Public Health, Karolinska Institutet, Stockholm, Sweden.
    Jensen, Irene
    Division of Intervention and Implementation Research, Department of Public Health, Karolinska Institutet, Stockholm, Sweden.
    Bergström, Gunnar
    Division of Intervention and Implementation Research, Department of Public Health, Karolinska Institutet, Stockholm, Sweden.
    Using a psychosocial subgroup assignment to predict sickness absence in a working population with neck and back pain2011In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 12, article id 81Article in journal (Refereed)
    Abstract [en]

    Background: The overall objective was to evaluate the predictive validity of a subgroup classification based on the Swedish version of the MPI, the MPI-S, among gainfully employed workers with neck pain (NP) and/or low back pain (LBP) during a follow-up period of 18 and 36 months.

    Methods: This is a prospective cohort study that is part of a larger longitudinal multi-centre study entitled Work and Health in the Process and Engineering Industries (AHA). The attempt was to classify individuals at risk for developing chronic disabling NP and LBP. This is the first study using the MPI-questionnaire in a working population with NP and LBP.

    Results: Dysfunctional individuals (DYS) demonstrated more statistically significant sickness absence compared to adaptive copers (AC) after 36 months. DYS also had a threefold increase in the risk ratio of long-term sickness absence at 18 months. Interpersonally distressed (ID) subgroup showed overall more sickness absence compared to the AC subgroup at the 36-month follow-up and had a twofold increase in the risk ratio of long-term sickness absence at 18 months. There was a significant difference in bodily pain, mental and physical health for ID and DYS subgroups compared to the AC group at both follow-ups.

    Conclusions: The present study shows that this multidimensional approach to the classification of individuals based on psychological and psychosocial characteristics can distinguish different groups in gainfully employed working population with NP/LBP. The results in this study confirm the predictive validity of the MPI-S subgroup classification system.

  • 20.
    Bitar, Christian
    et al.
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Orthopedics, Karolinska University Hospital, Stockholm, Sweden.
    Krupic, Ferid
    Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Felländer-Tsai, Li
    Division of Orthopedics and Biothechnology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Orthopedics, Karolinska University Hospital, Stockholm, Sweden.
    Crnalic, Sead
    Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, Umeå, Sweden.
    Wretenberg, Per
    Örebro University, School of Medical Sciences. Department of Orthopaedics, Örebro University Hospital, Örebro, Sweden.
    Living with a recalled implant: a qualitative study of patients' experiences with ASR hip resurfacing arthroplasty2021In: Patient Safety in Surgery, E-ISSN 1754-9493, Vol. 15, no 1, article id 2Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Total hip arthroplasty is the traditional treatment for osteoarthritis in the hip joint. Hip resurfacing arthroplasty, with metal on metal bearing, is a modern concept initially developed mainly for young active people. The metal-on-metal hip arthroplasty implant, Articular Surface Replacement (ASR), was implanted in approximately 93,000 patients before it was recalled in 2010 due to a high complication rate. This study aimed to evaluate patients' own experiences living with an implant that they knew had a high complication rate and had been recalled from the market.

    METHODS: A total of 14 patients, still living with the implant, of a cohort of 34 patients were available for follow-up. Qualitative semi-structured interviews were conducted with 14 patients where a majority actively sought for metal-on-metal hip resurfacing arthroplasty (HRA), and subsequently underwent HRA with an ASR prosthesis between 11/21/2006 and 09/28/2009. The responses were analyzed using content analysis described by Graneheim and Lundman to compress text and identify categories and subcategories.

    RESULTS: The results showed that most patients had already decided that they wanted a metal-on-metal HRA implant before meeting the surgeon. They expressed that the implant made it possible to live an active life. A majority did not think about the fact that they had a hip implant, because they lacked subjective pain. Most of the patients were positive about the annual exams at the hospital and wanted them to continue. None of them felt that their trust towards the healthcare system had changed after the implant recall. They expressed a belief that they would need new surgery sooner than they first thought.

    CONCLUSIONS: Despite all the attention when the ASR prosthesis was recalled, patients with ASR-HRA did not report themselves negatively affected by the recall in this group of patients where a majority had actively sought for an HRA procedure. The healthcare system has an obligation to continue the annual exams, even if the implant provider does not continue reimbursement.

  • 21.
    Bitar, Christian
    et al.
    Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden; Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden.
    Moberg, Ivan
    Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, Umeå, Sweden.
    Krupic, Ferid
    Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Wretenberg, Per
    Örebro University, School of Medical Sciences. Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden; Department of Orthopaedics, School of Medical Sciences, Örebro University and Örebro University Hospital, Örebro, Sweden.
    Otten, Volker
    Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, Umeå, Sweden.
    Crnalic, Sead
    Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, Umeå, Sweden.
    11-Year outcomes in patients with metal-on-metal ASR hip arthroplasty2022In: Journal of Orthopaedics, ISSN 0972-978X, E-ISSN 2589-9082, Vol. 32, p. 98-103Article in journal (Refereed)
    Abstract [en]

    Background: We analysed the long-term revision rate, clinical outcomes and metal ion concentrations in blood over time in patients who had undergone metal-on-metal Articular Surface Replacement (ASR) hip arthroplasty.

    Methods: A total of 38 patients (43 hips) were included: 24 patients (28 hips) underwent large-head total hip arthroplasty (XL THA), and 14 patients (15 hips) underwent hip resurfacing arthroplasty (HRA). The median follow-up time was 11 (range 7-12) years.

    Results: None of 15 HRA implants were revised. Nine of 28 XL THA implants (32%) in 8 patients were revised. The Co ion levels significantly increased in the XL THA group (p=0.009) over a median time period of 84 (25-97) months.

    Conclusion: The levels of Co ions in blood were higher in the patients who had undergone XL THA and increased significantly over time.

  • 22. Bjorling, Patrik
    et al.
    Fischer, Per
    Örebro University, School of Medical Sciences.
    Sagerfors, Marcus
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Pettersson, Kurt
    Ten Year Follow-up After Total Wrist Arthroplasty2017Conference paper (Refereed)
    Abstract [en]

    Hypothesis Total wrist arthroplasty (TWA) is an option in the management of wrist arthritis. The aim of the study was to evaluate the long-term results of TWA.

    Methods In this cohort study, we followed 56 cases that underwent TWA (Avanta, Biax, Universal 2 and Maestro) between 2005 and 2006 at a single-center. Data was collected preoperatively and 10 years postoperatively. Patient-related outcome measures, grip strength, range of motion (ROM), VAS pain scores were analyzed.

    Results VAS pain scores and patient-related measures were significantly improved at the 10-year follow-up. Jamar grip strength was also significantly improved. ROM remained largely unchanged, except for extension which improved significantly at the 10-year follow-up. Five of 56 TWAs were revised. Five patients died of unrelated causes and 10 were lost to follow-up.

    Summary Points This study shows good long-term results after TWA with a high level of patient satisfaction. The revision rate was acceptable.

  • 23.
    Björk, Marie
    et al.
    Dep of Hand Surgery, Örebro University Hospital (Örebro).
    Niklasson, Johan
    Dep of Hand Surgery, Örebro University Hospital (Örebro).
    Westerdahl, Elisabeth
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Sagerfors, Marcus
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Self-efficacy corresponds to wrist function after combined plating of distal radius fractures2019In: Abstract book IFSHT, Freiburg: Intercongress GmbH , 2019, article id IFSHT19-1054Conference paper (Refereed)
    Abstract [en]

    Clinical issue/s: Self-efficacy (SE) refers to beliefs in ones capabilities to organize and execute the courses of action required to produce given goals. High SE is an important factor for recovery from injury/illness; people who believe in their capability willmore likely reach a good outcome. The distal radius fracture (DRF) is the most common fracture in adults constituting 18% of all fractures in an orthopedic trauma unit. To our knowledge there are no reports investigating the role of patient-reported self-efficacy in the rehabilitation of surgically treated DRFs. A tool that could identify patients in need of increased postoperative rehabilitation could potentially improve the allocation of rehabilitation resources.

    Clinical reasoning: The aim of this study was to examine if SE has an effect on physical functioning, pain and patient-rated wrist function three months postoperatively in patients who underwent combined plating with a volar and dorsal plate due to a distal radius fracture (DRF).

    innovative, analytical or new approach: Methods: This prospective study involved 67 patients. Follow-up results were available for 55 of them. The patients rated SE at the first appointment with the physiotherapist. The three months follow-up contained the outcome values: Patient-Rated Wrist Evaluation (PRWE), pain-scores, hand grip-strength and range of motion. Thestudy was approved by the regional ethical committee.

    Results: Three months after surgery the average wrist motion was 62-93 percent and hand grip-strength was 58 percent compared to the uninjured hand. Patients who rated high SE showed significantly better ROM for flexion and supination, handgrip-strength and PRWE-scores.

    Contribution to advancing HT practice: Discussion: Patients with a high SE are more likely to have a better wrist functionthree months postoperatively compared to patients with a low SE. Conclusion: SE can be a tool to assist the hand therapist in the allocation of rehabilitation resources.

  • 24.
    Björk, Marie
    et al.
    Faculty of Medicine and Health, Department of Hand Surgery, Örebro University, Örebro, Sweden.
    Niklasson, Johan
    Faculty of Medicine and Health, Department of Hand Surgery, Örebro University, Örebro, Sweden.
    Westerdahl, Elisabeth
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of Physiotherapy.
    Sagerfors, Marcus
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Hand Surgery.
    Self-efficacy corresponds to wrist function after combined plating of distal radius fractures2020In: Journal of Hand Therapy, ISSN 0894-1130, E-ISSN 1545-004X, Vol. 33, no 3, p. 314-319Article in journal (Refereed)
    Abstract [en]

    STUDY DESIGN: A prospective cohort single-center study.

    INTRODUCTION: Self-efficacy (SE) refers to beliefs in ones capabilities to organize and execute the courses of action required to produce given goals. High SE is an important factor for recovery from injury/illness; people who believe in their capability will more likely reach a good outcome.

    PURPOSE OF THE STUDY: The aim of this study was to examine if SE has an effect to physical functioning, pain and patient-rated wrist function three months postoperatively in patients undergoing plating due to a distal radius fracture.

    METHODS: Sixty-seven patients undergoing plating for a distal radius fracture rated SE at the first appointment with the physiotherapist. At the three-month follow-up, the following assessments were administered: Patient-Rated Wrist Evaluation (PRWE), pain-scores, hand grip strength, and range of motion.

    RESULTS: The group with a high SE showed significantly better range of motion for flexion (P = .046) and supination (P = .045), hand grip strength (P = .001) and PRWE scores (P = .04). The NRS pain during activity was lower, although not significantly lower (P = .09). Using Spearman's rank correlation coefficient, there was a moderate correlation between SE and pain during activity, wrist flexion, and PRWE score.

    DISCUSSION: SE corresponds to wrist function after combined plating of distal radius fractures.

    CONCLUSION: Measurement of SE could possibly be useful to identify patients in special need of support during the postoperative rehabilitation.

  • 25. Björksved, Margitha
    et al.
    Magnuson, Anders
    Bazargani, Silvia Miranda
    Lindsten, Rune
    Bazargani, Farhan
    Authors' response2019In: American Journal of Orthodontics and Dentofacial Orthopedics, ISSN 0889-5406, E-ISSN 1097-6752, Vol. 156, no 1, p. 9-10Article in journal (Refereed)
  • 26.
    Borg, Tomas
    et al.
    Uppsala University Hospital, Uppsala, Sweden.
    Berg, Per
    Uppsala University Hospital, Uppsala, Sweden.
    Fugl-Meyer, Kerstin
    Karolinska University Hospital, Stockholm, Sweden40.
    Larsson, Sune
    Uppsala University Hospital, Uppsala, Sweden.
    Health-related quality of life and life satisfaction in patients following surgically treated pelvic ring fractures. A prospective observational study with two years follow-up2010In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 41, no 4, p. 400-404Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Pelvic ring fractures caused by high-energy trauma are severe injuries with well described radiological and clinical outcomes, whereas description from the patient's perspective is less well documented. The purpose of this study was to investigate patient-reported outcome following surgical treatment of pelvic fractures using quality of life instruments.

    METHODS: All 54 patients (28 male/26 female, ages 16-68) with pelvic fractures referred to our institution for surgical treatment 2003-2005 were prospectively included. The most common trauma was motor vehicle accident (44%). Additional injuries were seen in 74% and in 31% the ISS was >or=16. There were 31 B and 23 C type fractures. Patients were followed for two years using two validated questionnaires, SF-36 and LiSat-11, the latter an instrument consisting of 11 questions for evaluation of satisfaction with different aspects of life.

    RESULTS: 45 patients could be followed according to the study protocol for two years while 2 were untraceable and 1 died from unrelated causes. Of 6 nonresponders, 5 were unable due to psychiatric disorder. At two years pelvic fracture patients scored lower than the reference population in both physical and mental domains (SF-36). Highest mean score, 68, was in the domain Social Function (norm 89) while lowest mean score, 38, was in the domain Role Physical (norm 86). The mean score closest to the normative was for general health with 61 for patients and 78 for the normative group. In LiSat-11 pelvic fracture patients scored lower than the reference population in all areas. Satisfaction with life as a whole was 31% compared with 60% in the normative group.

    CONCLUSIONS: Two years after surgical treatment of pelvic ring fractures, patients reported substantially lower quality of life for both physical and mental domains, when compared with a reference population, even when radiological and clinical outcomes were considered favourable.

  • 27.
    Borg, Tomas
    et al.
    Uppsala University, Uppsala, Sweden.
    Berg, Per
    Larsson, Sune
    Quality of life after operative fixation of displaced acetabular fractures2012In: Journal of Orthopaedic Trauma, ISSN 0890-5339, E-ISSN 1531-2291, Vol. 26, no 8, p. 445-450Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to determine quality of life (QoL) changes over time after internal fixation of acetabular fractures.

    DESIGN: This pertains to a prospective cohort study, which was single centered.

    SETTING: The study was conducted at the University Hospital.

    PATIENTS: One hundred thirty-six patients (108 men, 28 women), age 17-83 years operated for an acetabular fracture during 2004-2008 were prospectively included and followed up for 2 years.

    MAIN OUTCOME MEASURES: QoL was evaluated via Short Form-36 (SF-36) and Life Satisfaction-11 at 6, 12, and 24 months. Radiographs were evaluated according to Matta at 2 years.

    RESULTS: The most frequent fracture types were posterior wall (n31), associated anterior-posterior hemitransverse (n34), and associated both column (n29). One hundred twenty-nine patients could be assessed at 2 years, 4 did not respond, and 3 had died. The patients scored lower than norms in all 8 SF-36 domains with improvement over time for Physical Function (P < 0.0001) and Role Physical (P < 0.0001). The patients with postop reduction 0-1 mm scored better (P < 0.001-0.039) in 7 domains, all except vitality (P = 0.07), when compared with patients with residual displacement of ≥2 mm. Life satisfaction did not change with time and showed lower scores than normative in 9 of 11 items. Nineteen patients had undergone total hip replacement, and the strongest predictor was acetabular or femoral head impaction.

    CONCLUSIONS: QoL in surgically treated patients with displaced acetabular fracture keeps improving in physical SF-36 domains over a 2-year period although still lower than norms, and anatomical reduction results in better QoL outcome in most dimensions.

    LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  • 28.
    Borg, Tomas
    et al.
    Uppsala University, Uppsala, Sweden.
    Carlsson, Marianne
    Uppsala University, Uppsala, Sweden.
    Larsson, Sune
    Uppsala University, Uppsala, Sweden.
    Questionnaire to assess treatment outcomes of acetabular fractures2012In: Journal of Orthopaedic Surgery, ISSN 1022-5536, E-ISSN 2309-4990, Vol. 20, no 1, p. 55-60Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To construct a questionnaire to assess outcomes in patients who underwent internal fixation for acetabular fractures.

    METHODS: 27 female and 100 male consecutive patients (mean age, 50 years) who underwent internal fixation for acetabular fractures were included. Patients were asked to report their outcomes at months 6, 12, and 24 using a questionnaire. The initial questionnaire was constructed by an expert group. There were 11 closed questions, each came with 6 responses from ?no discomfort? to ?very severe discomfort?. Three open questions were added to cover topics that were not included. The content validity and relevance of the 11 closed questions was determined using factor analysis to determine the number of factors involved. Factorability of the correlation matrix was measured via the Bartlett test of sphericity and Kaiser-Meyer- Olkin (KMO) measure of sampling sufficiency. Factor loadings of <0.50 were considered acceptable for factor representation. Reliability in terms of internal consistency was expressed as Cronbach alpha coefficients. The responses to the 3 open questions were analysed and categorised by a single assessor.

    RESULTS: 120 (94%) of the patients completed at least one questionnaire, and 92 (72%) completed all 3 questionnaires during the follow-up period. Based on responses to the 6-month questionnaire, responses to the 11 closed questions were significantly intercorrelated (Spearman 0.17-0.80). After factor analysis and analysis of responses to open questions, the number of questions was reduced to 6 and included questions related to pain, walking, hip motion, leg numbness, sexual life, and operation scar. Reliability of the questionnaire was estimated to alpha=0.89. Criterion validity was adequate with a high correlation with the Short Form 36 (r=0.56-0.80).

    CONCLUSION: Patients treated with acetabular fractures can be adequately assessed using the 6-item questionnaire and one global question concerning impact on activities of daily living.

  • 29.
    Borg, Tomas
    et al.
    Uppsala University, Uppsala, Sweden.
    Hailer, Nils P
    Uppsala University, Uppsala, Sweden.
    Outcome 5 years after surgical treatment of acetabular fractures: a prospective clinical and radiographic follow-up of 101 patients2015In: Archives of Orthopaedic and Trauma Surgery, ISSN 0936-8051, E-ISSN 1434-3916, Vol. 135, no 2, p. 227-233Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: The aim of this study was to evaluate functional outcome after surgically treated acetabular fracture using radiography and patient-reported outcome measures, and to determine predictors of hip joint failure 5 years post-surgery.

    PATIENTS AND METHODS: All patients with acetabular fractures treated with open reduction and internal fixation (ORIF) at our unit are prospectively entered into a local register. 101 acetabular fractures in 112 patients treated from 2004 to 2007 were eligible for analysis 5 years after surgery. Radiographs and questionnaires regarding physical function (Short Form[SF]-36) and pelvic discomfort index (PDI, 100 % = worst outcome) were obtained. The primary outcome measure was "joint failure" defined as either secondary total hip arthroplasty (THA) or a Girdlestone situation. Univariable analysis was used to compare patients with joint failure to those without, and binary logistic regression analysis was performed to identify risk factors of joint failure.

    RESULTS: 77 % of 101 followed patients had a preserved hip joint 5 years after surgery, and failure of the hip joint most often occurred within the first 2 years after injury. Patients with preserved hip joints had higher scores in the SF-36 physical function domain (median 75 vs. 48; p = 0.004) and better PDI (28 vs. 43 %, p = 0.03). Femoral head impaction was associated with an increased risk of joint failure [relative risk (RR) = 15.2, 95 % CI 3-95; p = 0.002], as was an age of ≥60 years at the time of injury (RR = 4.2, CI 1.3-15; p = 0.02).

    CONCLUSIONS: Patients with failed hip joints after surgery for acetabular fracture have inferior global and disease-specific functional outcomes, even after secondary arthroplasty surgery. We suggest that patients with predictors of joint failure could benefit from other treatment strategies than ORIF, and primary insertion of THA may be an alternative treatment strategy for this subgroup.

  • 30.
    Borg, Tomas
    et al.
    Department of Surgical Sciences, Section of Orthopaedics, Uppsala University Hospital, Uppsala, Sweden.
    Hernefalk, B.
    Department of Surgical Sciences, Section of Orthopaedics, Uppsala University Hospital, Uppsala, Sweden.
    Hailer, N. P.
    Department of Surgical Sciences, Section of Orthopaedics, Uppsala University Hospital, Uppsala, Sweden.
    Acute total hip arthroplasty combined with internal fixation for displaced acetabular fractures in the elderly: a short-term comparison with internal fixation alone after a minimum of two years2019In: The Bone & Joint Journal, ISSN 2049-4394, E-ISSN 2049-4408, Vol. 101-B, no 4, p. 478-483Article in journal (Refereed)
    Abstract [en]

    AIMS: Displaced, comminuted acetabular fractures in the elderly are increasingly common, but there is no consensus on whether they should be treated non-surgically, surgically with open reduction and internal fixation (ORIF), or with acute total hip arthroplasty (THA). A combination of ORIF and acute THA, an approach called 'combined hip procedure' (CHP), has been advocated and our aim was to compare the outcome after CHP or ORIF alone.

    PATIENTS AND METHODS: A total of 27 patients with similar acetabular fractures (severe acetabular impaction with or without concomitant femoral head injury) with a mean age of 72.2 years (50 to 89) were prospectively followed for a minimum of two years. In all, 14 were treated with ORIF alone and 13 were treated with a CHP. Hip joint and patient survival were estimated. Operating times, blood loss, radiological outcomes, and patient-reported outcomes were assessed.

    RESULTS: No patient in the CHP group required further hip surgery, giving THA a survival rate of 100% (95% confidence interval (CI) 100 to 100) after three years, compared with 28.6% hip joint survival in the ORIF group (95% CI 12.5 to 65.4; p = 0.001). No dislocations or deep infections occurred in the CHP group. No patient died within the first year after index surgery, but patient survival was lower in the CHP group after three years. There were no relevant differences in patient-reported outcomes.

    CONCLUSION: The CHP confers a considerably reduced need of further surgery when compared with ORIF alone in elderly patients with complex acetabular fractures. These findings encourage both further use of, and larger prospective studies on, the CHP.

  • 31.
    Borg, Tomas
    et al.
    Uppsala University, Uppsala, Sweden.
    Hernefalk, Björn
    Uppsala University, Uppsala, Sweden.
    Carlsson, Marianne
    Uppsala University, Uppsala, Sweden.
    Larsson, Sune
    Uppsala University, Uppsala, Sweden.
    Development of a pelvic discomfort index to evaluate outcome following fixation for pelvic ring injury2015In: Journal of Orthopaedic Surgery, ISSN 1022-5536, E-ISSN 2309-4990, Vol. 23, no 2, p. 146-149Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To develop a pelvic discomfort index (PDI) to evaluate outcome following fixation for pelvic ring injury.

    METHODS: 29 female and 44 male consecutive patients (mean age, 36 years) underwent internal fixation for pelvic ring injury of type B1 (n=10), B2 (n=22), B3 (n=15), C1 (n=18), C2 (n=5), and C3 (n=3), based on the AO/OTA classification. At postoperative 6, 12, and 24 months, patients were asked to assess their discomfort in the pelvis using a 14-item questionnaire. Three questions were open-ended, and responses were categorised by a single assessor. The remaining 11 questions were closed-ended and had 6 ordinal options from 'no discomfort' (score=0) to 'extremely severe discomfort' (score=5). The content validity and relevance of the 11 closed-ended questions was determined. The 14-item questionnaire was compared with the 36-item Short Form Health Survey (SF-36).

    RESULTS: Respectively at postoperative 6, 12, and 24 months, 78%, 71%, and 71% of the patients completed the 14-item questionnaire. Based on the factor analysis and responses to the open-ended questions, the number of items was reduced to 6 including pain, walking, mobility of the hips, loss of sensation in the legs, sexual life, and operation scar. Four factors could explain 96% of the total variance. The first factor involved the first 3 items (pain, walking, and hip motion) and addressed 'pelvis', whereas 3 factors involved the remaining items and each addressed peripheral neurology, sexual life, and operation scar. A PDI was developed using these 6 items. The PDI had high internal reliability (α=0.89), adequate content and criterion validity, and moderate correlation with the SF-36 total score or scores of physical function, bodily pain, and general health (r=0.50-0.77).

    CONCLUSION: The PDI provides valid, specific, and relevant information to assess outcome following fixation for pelvic ring injury.

  • 32.
    Borg, Tomas
    et al.
    Uppsala University, Uppsala, Sweden.
    Holstad, M.
    Uppsala University, Uppsala, Sweden.
    Larsson, S.
    Uppsala University, Uppsala, Sweden.
    Quality of life in patients operated for pelvic fractures caused by suicide attempt by jumping2010In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 99, no 3, p. 180-186Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: jumping from great height is an aggressive method of suicide attempt where the frequent combination of psychiatric disorder and somatic injuries makes treatment difficult. Our aim was to evaluate survival rate and get patient-reported outcome in patients operated for a pelvic or acetabular fracture sustained when jumping from a height as a suicide attempt.

    PATIENTS AND METHODS: during the period 2003-2004, 12 patients (11 women) of whom eight were below 30 years of age, were prospectively included. At two years HRQoL (Health-Related Quality of Life) questionnaires (SF-36 and LiSat-11) were used to describe outcome, and at four years a structured psychiatric interview SCID-I (Structured Clinical Interview for DSM-IV Axis I Disorders) was done.

    RESULTS: at four years all patients were alive. One patient had made a new suicide attempt. Eight patients gave adequate reply on SF-36 and LiSat-11 at two years. In all domains patients scored lower than a norm group with the relatively lowest values in physical domains. Younger patients assessed life as better when compared with middle aged patients.

    CONCLUSIONS: this study showed a very low recurrence rate into suicidal behaviour in a group of jumpers and all patients were alive at four years after a suicidal attempt by jumping. The high proportion of psychiatric disorder in these patients highlights the need for a combined treatment effort between orthopaedic and psychiatric expertise.

  • 33.
    Borg, Tomas
    et al.
    Östersund Hospital, Östersund, Sweden.
    Larsson, Sune
    Uppsala University Hospital, Uppsala, Sweden.
    Lindsjö, Ulf
    Uppsala University Hospital, Uppsala, Sweden.
    Percutaneous plating of distal tibial fractures: Preliminary results in 21 patients2004In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 35, no 6, p. 608-614Article in journal (Refereed)
    Abstract [en]

    We describe the surgical technique and report the outcome after closed reduction and percutaneous plating in 21 closed extraarticular distal tibial fractures using titanium LC-DCP. A long plate was pushed subcutaneously through a small incision at the medial malleolus and fixed with screws through stab incisions. Fracture reduction was anatomical or nearly anatomical without angular displacement in 14 cases, and considered acceptable in four cases. Two patients were reoperated because of malreduction. Seventeen fractures healed within 6 months. There were two delayed unions, and two non-unions. There were two deep infections, both in diabetic patients. Follow-up by an independent observer at on average 14 (5-25) months showed various symptoms such as slightly reduced ankle mobility (9/20), reduced walking ability (11/20) or tenderness around the plate (11/20). No patient complained of knee symptoms related to the surgery. Operative treatment of closed distal tibial shaft fractures with a long titanium plate provided good anatomical results and allowed in most patients early weight-bearing. In patients with soft tissues in good condition and no risk factor for infection percutaneous plate osteosynthesis might become an attractive treatment option for fractures in the distal tibia.

  • 34.
    Borg, Tomas
    et al.
    Uppsala University Hospital, Uppsala, Sweden; Unit of the County Council of Jämtland, Sweden.
    Melander, T.
    Östersund hospital, Östersund, Sweden.
    Larsson, S.
    Uppsala University Hospital, Uppsala, Sweden .
    Poor retention after closed reduction and cast immobilization of low-energy tibial shaft spiral fractures2002In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 91, no 2, p. 191-194Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: The aim of this retrospective study was to analyze retention in cast after closed reduction of low-energy two-fragment tibial shaft fractures.

    MATERIAL AND METHODS: The material consisted of 72 closed tibial shaft fractures AO/ ASIF type A treated with closed reduction and plaster cast. Fractures were subgrouped according to the AO/ASIF classification and the initial fracture displacement was measured. Final alignment and the frequency of operative intervention due to early loss of reduction were analyzed.

    RESULTS: 40% of all fractures lost reduction and were operated on. The largest subgroup was A1.2 fractures, a spiral tibial shaft fracture with a fibular fracture at another level. Out of the 28 fractures in this group 61% were converted from cast to early operative intervention.

    CONCLUSION: Closed reduction and cast treatment of spiral tibial shaft fractures AO/ ASIF type A1.2 had a high failure rate.

  • 35.
    Burkard, Theresa
    et al.
    ETH Zurich, Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, Zurich, Switzerland.
    Holmberg, Dag
    Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Wretenberg, Per
    Örebro University, School of Medical Sciences. Department of Orthopaedics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Thorell, Anders
    Department of Clinical Science, Danderyd Hospital, Karolinska Institutet; Stockholm, Sweden; Department of Surgery, Ersta Hospital, Stockholm, Sweden.
    Hügle, Thomas
    Department of Rheumatology, Lausanne University Hospital, And University of Lausanne, Lausanne, Switzerland.
    Burden, Andrea M.
    ETH Zurich, Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, Zurich, Switzerland.
    The associations between bariatric surgery and hip or knee arthroplasty, and hip or knee osteoarthritis: Propensity score-matched cohort studies2022In: Osteoarthritis and cartilage open, ISSN 2665-9131, Vol. 4, no 2, article id 100249Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the associations between bariatric surgery and hip or knee arthroplasty, and secondary care hip or knee osteoarthritis (OA).

    METHODS: We performed cohort studies using data from Swedish nationwide healthcare registries. Patients aged 18-79 years who underwent bariatric surgery between 2006 and 2019 were matched on their propensity score (PS) to up to 2 obese patients ("unexposed episodes") in risk-set sampling. After a 1-year run-in period, episodes were followed in an "as-treated" approach. Using Cox proportional hazard regression, we calculated hazard ratios (HR) with 95% confidence intervals (CIs) of hip or knee arthroplasty overall and in subgroups of age, sex, joint location, arthroplasty type, bariatric surgery type, and by duration of follow-up if proportional hazard assumptions were violated. In a secondary cohort, we assessed the outcome incident secondary care hip or knee osteoarthritis (OA).

    RESULTS: Among 39'392 bariatric surgery episodes when compared to 61'085 ​PS-matched unexposed episodes (47'594 unique patients), the risk of hip or knee arthroplasty was strongest increased within the first three years of follow-up (HR 1.79, 95% CI 1.56-2.07), decreased thereafter, but remained elevated throughout follow-up. In a secondary cohort of 37'929 exposed when compared to 58'600 ​PS-matched unexposed episodes, the risk of hip or knee osteoarthritis was decreased (HR 0.84, 95% CI 0.79-0.90).

    CONCLUSION: Bariatric surgery is associated with increased risks of hip or knee arthroplasty, but also with decreased risks of secondary care OA. This contradiction supports the hypothesis that bariatric surgery may act as an enabler for hip or knee arthroplasty.

  • 36.
    Cao, Yang
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
    Forssten, Maximilian Peter
    Örebro University, School of Medical Sciences. Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.
    Mohammad Ismail, Ahmad
    Örebro University, School of Medical Sciences. Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.
    Borg, Tomas
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.
    Ioannidis, Ioannis
    Örebro University, School of Medical Sciences. Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Predictive Values of Preoperative Characteristics for 30-Day Mortality in Traumatic Hip Fracture Patients2021In: Journal of Personalized Medicine, E-ISSN 2075-4426, Vol. 11, no 5, article id 353Article in journal (Refereed)
    Abstract [en]

    Hip fracture patients have a high risk of mortality after surgery, with 30-day postoperative rates as high as 10%. This study aimed to explore the predictive ability of preoperative characteristics in traumatic hip fracture patients as they relate to 30-day postoperative mortality using readily available variables in clinical practice. All adult patients who underwent primary emergency hip fracture surgery in Sweden between 2008 and 2017 were included in the analysis. Associations between the possible predictors and 30-day mortality was performed using a multivariate logistic regression (LR) model; the bidirectional stepwise method was used for variable selection. An LR model and convolutional neural network (CNN) were then fitted for prediction. The relative importance of individual predictors was evaluated using the permutation importance and Gini importance. A total of 134,915 traumatic hip fracture patients were included in the study. The CNN and LR models displayed an acceptable predictive ability for predicting 30-day postoperative mortality using a test dataset, displaying an area under the ROC curve (AUC) of as high as 0.76. The variables with the highest importance in prediction were age, sex, hypertension, dementia, American Society of Anesthesiologists (ASA) classification, and the Revised Cardiac Risk Index (RCRI). Both the CNN and LR models achieved an acceptable performance in identifying patients at risk of mortality 30 days after hip fracture surgery. The most important variables for prediction, based on the variables used in the current study are age, hypertension, dementia, sex, ASA classification, and RCRI.

  • 37.
    Costa, Adriana
    et al.
    Department of Pediatrics, Hospital Prof. Doutor Fernando Fonseca EPE, Amadora, Portugal.
    Martins, Andreia
    Department of Pediatrics, Hospital Prof. Doutor Fernando Fonseca EPE, Amadora, Portugal.
    Machado, Catarina
    Department of Pediatrics, Hospital Prof. Doutor Fernando Fonseca EPE, Amadora, Portugal.
    Lundberg, Elena
    Department of Pediatrics, Institution of Clinical Science, Umeå University, Umeå, Sweden.
    Nilsson, Ola
    Örebro University, School of Medical Sciences. Division of Pediatric Endocrinology and Center for Molecular Medicine, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Department of Medical Sciences, Örebro University Hospital, Örebro, Sweden.
    Wang, Fan
    Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, and Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden.
    Costantini, Alice
    Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, and Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden.
    Tournis, Symeon
    Laboratory for Research of the Musculoskeletal System "Th. Garofalidis", Medical School, University of Athens, Athens, Greece.
    Höppner, Jakob
    Department of Pediatrics, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany; Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
    Grasemann, Corinna
    Department of Pediatrics, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany.
    Mäkitie, Outi
    Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, and Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden; Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Children's Hospital and Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland.
    PLS3 Mutations in X-Linked Osteoporosis: Clinical and Genetic Features in Five New Families2023In: Calcified Tissue International, ISSN 0171-967X, E-ISSN 1432-0827, Vol. 114, p. 157-170Article in journal (Refereed)
    Abstract [en]

    Childhood-onset osteoporosis is a rare but clinically significant condition. Studies have shown pathogenic variants in more than 20 different genes as causative for childhood-onset primary osteoporosis. The X-chromosomal PLS3, encoding Plastin-3, is one of the more recently identified genes. In this study, we describe five new families from four different European countries with PLS3-related skeletal fragility. The index cases were all hemizygous males presenting with long bone and vertebral body compression fractures. All patients had low lumbar spine bone mineral density (BMD). The age at the first clinical fracture ranged from 1.5 to 13&nbsp;years old. Three of the identified PLS3 variants were stop-gain variants and two were deletions involving either a part or all exons of the gene. In four families the variant was inherited from the mother. All heterozygous women reported here had normal BMD and no bone fractures. Four patients received bisphosphonate treatment with good results, showing a lumbar spine BMD increment and vertebral body reshaping after 10 months to 2 years of treatment. Our findings expand the genetic spectrum of PLS3-related osteoporosis. Our report also shows that early treatment with bisphosphonates may influence the disease course and reduce the progression of osteoporosis, highlighting the importance of early diagnosis for prompt intervention and appropriate genetic counseling.

  • 38.
    Deminger, Anna
    et al.
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Klingberg, Eva
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lorentzon, Mattias
    Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
    Geijer, Mats
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Radiology, Örebro University Hospital, Örebro, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden.
    Göthlin, Jan
    Department of Radiology, Sahlgrenska University Hospital, Mölndal, Sweden.
    Hedberg, Martin
    Section of Rheumatology, Södra Älvsborg Hospital, Borås, Sweden.
    Rehnberg, Eva
    Section of Rheumatology, Alingsås Hospital, Alingsås, Sweden.
    Carlsten, Hans
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Jacobsson, Lennart T.
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Forsblad-d'Elia, Helena
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå, Sweden.
    Which measuring site in ankylosing spondylitis is best to detect bone loss and what predicts the decline: results from a 5-year prospective study2017In: Arthritis Research & Therapy, ISSN 1478-6354, E-ISSN 1478-6362, Vol. 19, article id 273Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Studies have shown increased prevalence of osteoporosis and increased risk for vertebral fractures in patients with ankylosing spondylitis (AS). Measurements of bone mineral density (BMD) in the lumbar spine anterior-posterior (AP) projection may be difficult to interpret due to the ligamentous calcifications, and the lateral projection might be a better measuring site. Our objectives were to investigate BMD changes after 5 years at different measuring sites in patients with AS and to evaluate disease-related variables and medications as predictors for BMD changes.

    METHODS: In a longitudinal study, BMD in Swedish AS patients, 50 ± 13 years old, was measured with dual-energy x-ray absorptiometry (DXA) at the hip, the lumbar spine AP and lateral projections, and the total radius at baseline and after 5 years. Patients were assessed with questionnaires, blood samples, and spinal radiographs for grading of AS-related alterations in the spine with the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) and assessment of vertebral fractures by the Genant score. Multiple linear regression analyses were used to investigate predictors for BMD changes.

    RESULTS: Of 204 patients included at baseline, 168 (82%) were re-examined after 5 years (92 men and 76 women). BMD decreased significantly at the femoral neck and radius and increased significantly at the lumbar spine, both for AP and lateral projections. Mean C-reactive protein during follow-up predicted a decrease in the femoral neck BMD (change in %, β = -0.15, p = 0.046). Use of bisphosphonates predicted an increase in BMD at all measuring sites (p < 0.001 to 0.013), except for the total radius. Use of tumor necrosis factor inhibitors (TNFi) predicted an increase in AP spinal BMD (β = 3.15, p = 0.012).

    CONCLUSION: The current study (which has a long follow-up, many measuring sites, and is the first to longitudinally assess the lateral projection of the spine in AS patients) surprisingly showed that lateral projection spinal BMD increased. This study suggests that the best site to assess bone loss in AS patients is the femoral neck and that inflammation has an adverse effect, and the use of bisphosphonates and TNFi has a positive effect, on BMD in AS patients.

  • 39.
    Dettmer, Anne
    et al.
    Department of Biomedical and Clinical Science, Linköping University, Linköping, Sweden; Department of Orthopaedics, Kalmar County Hospital, Kalmar, Sweden.
    Melander, Marcus
    Department of Clinical Science, Karolinska Institutet, Division of Orthopaedics, Danderyd Hospital, Stockholm, Sweden.
    Björnsson Hallgren, Hanna C.
    Department of Biomedical and Clinical Science, Linköping University, Linköping, Sweden; Department of Orthopaedics, Linköping University Hospital, Linköping, Sweden .
    Adolfsson, Lars E.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Orthopaedics, Linköping University Hospital, Linköping, Sweden; Department of Orthopaedics, Örebro University, Örebro, Sweden.
    Salomonsson, Björn
    Department of Clinical Science, Karolinska Institutet, Division of Orthopaedics, Danderyd Hospital, Stockholm, Sweden; Division of Orthopaedics, Danderyd Hospital, Stockholm, Sweden .
    The Choice of Antibiotic Prophylaxis Influences the Infection Reoperation Rate in Primary Shoulder Arthroplasty: Analysis From the Swedish Shoulder Arthroplasty Register2023In: Clinical Orthopaedics and Related Research, ISSN 0009-921X, E-ISSN 1528-1132, Vol. 481, no 4, p. 728-734Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Periprosthetic joint infection is a serious complication and a major reason for revision surgery after primary shoulder arthroplasty. The prophylactic antibiotics for primary shoulder arthroplasty that have predominantly been used in Sweden are cloxacillin and clindamycin. To address Cutibacteriumacnes, benzylpenicillin has recently increasingly been added to cloxacillin, but it is unclear which antibiotic prophylaxis regimen is the most effective to prevent periprosthetic joint infection.

    QUESTIONS/PURPOSES: After controlling for baseline differences among patients such as age, gender, previous surgery, cement fixation, and arthroplasty type, was the risk of reoperation for infection higher in patients who received cloxacillin than in those who received clindamycin or the combination of benzylpenicillin and cloxacillin?

    METHODS: Data from the Swedish Shoulder Arthroplasty Register were used for this study. The inclusion criterion was registered antibiotic prophylaxis in primary arthroplasty. Between January 1, 1999, and December 31, 2019, 22,470 primary shoulder arthroplasties, including total shoulder, hemiarthroplasty, and reverse shoulder arthroplasties, were entered into the Swedish Shoulder Arthroplasty Register. Reporting of antibiotic prophylaxis to the register was introduced on January 1, 2013. Since then, the completeness of information on the type of antibiotic prophylaxis in the reports has been 85.3%. Consequently, 10,706 arthroplasties were eligible and fulfilled the inclusion criterion of reported antibiotic prophylaxis. A further 129 were excluded because of unusual prophylaxis regimens, leaving 10,577 shoulder arthroplasties for analysis. The Swedish Shoulder Arthroplasty Register gathers information from all 60 hospitals performing shoulder arthroplasty in Sweden, and through a comparison with the National Patient Register, it has been estimated that more than 90% of all primary shoulder arthroplasties and shoulder reoperations are reported to the register. The age of the study population ranged between 16 and 98 years; the mean age at the primary surgery was 70 ± 10 years for the entire cohort, with a mean age of 67 ± 10 years and 72 ± 9 years for men and women, respectively. The mean observation period was 989 ± 669 days. From 2013 to 2019, there was a clear change in prophylaxis; in particular, the use of the combination of benzylpenicillin and cloxacillin increased dramatically and the use of cloxacillin alone decreased. Clindamycin prophylaxis increased moderately. The primary study endpoint was reported reoperation for infection. In the register, this is defined as repeat procedures of any kind, including biopsy, lavage of the joint, or revision, defined as secondary surgery in which a component was exchanged, removed, or added. To compare the reoperation rate in relation to the different antibiotics used, which changed over time, we controlled for age, gender, previous surgery, cement fixation, and arthroplasty type using a Cox proportional hazards model.

    RESULTS: When adjusting for age, gender, previous surgery, cement fixation, and arthroplasty type, cloxacillin prophylaxis was associated with an increased relative risk of reoperation for infection compared with the combination of cloxacillin and benzylpenicillin (hazard ratio [HR] 2.40 [95% confidence interval (CI) 1.35 to 4.25]; p = 0.003) and compared with clindamycin alone (HR 1.78 [95% CI 1.11 to 2.85]; p = 0.02). No difference was found between the cloxacillin and benzylpenicillin combination and clindamycin (HR 0.74 [95% CI 0.42 to 1.32]; p = 0.31).

    CONCLUSION: Our results indicate that prophylaxis against C. acnes may be warranted in shoulder arthroplasty. Because the absolute number of infections was low and infections could have been underreported to the register, our results should be interpreted with caution. There is no available information about the causative microorganisms. The study lays the groundwork for further investigations of antibiotic prophylaxis regimens in shoulder arthroplasty. Because large randomized controlled trials would be impractical to perform, prospective register-based randomized controlled studies might be a viable method.

    LEVEL OF EVIDENCE: Level Ⅲ, therapeutic study.

  • 40.
    Eklund, Andreas
    et al.
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Bergström, Gunnar
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Bodin, Lennart
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Axén, Iben
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Research Department, Spine Center of Southern Denmark, Hospital Lillebaelt, Institute of Regional Health Research, Middelfart, Denmark.
    Do psychological and behavioral factors classified by the West Haven-Yale Multidimensional Pain Inventory (Swedish version) predict the early clinical course of low back pain in patients receiving chiropractic care?2016In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 17, no 1, article id 75Article in journal (Refereed)
    Abstract [en]

    Background: To investigate if psychological and behavioral factors (as determined by the Swedish version of the West Haven-Yale Multidimensional Pain Inventory, MPI-S) can predict the early clinical course of Low Back Pain (LBP).

    Methods: MPI-S data from patients (18–65 years of age) seeking chiropractic care for recurrent and persistent LBP were collected at the 1st visit. A follow-up questionnaire was administered at the 4th visit. The predictive value of the MPI-S subgroups Adaptive Copers (AC), Interpersonally Distressed (ID) and Dysfunctional (DYS) was calculated against the subjective improvement at the 4th visit and clinically relevant difference in pain intensity between the 1st and 4th visit.

    Results: Of the 666 subjects who were included at the 1st visit, 329 completed the questionnaire at the 4th visit. A total of 64.7 % (AC), 68.0 % (ID) and 71.3 % (DYS) reported a definite improvement. The chance of “definite improvement”, expressed as relative risk (95 % CI) with the AC group as reference, was 1.05 (.87–1.27) for the ID and 1.10 (.93–1.31) for the DYS groups, respectively. The DYS and ID groups reported higher values in pain intensity both at the 1st and the 4th visit. The proportion of subjects who reported an improvement in pain intensity of 30 % or more (clinically relevant) were 63.5 % AC, 72.0 % ID and 63.2 % DYS. Expressed as relative risk (95 % CI) with the AC group as reference, this corresponded to 1.26 (.91–1.76) for the ID and 1.09 (.78–1.51) for the DYS groups, respectively.

    Conclusions: The MPI-S instrument could not predict the early clinical course of recurrent and persistent LBP in this sample of chiropractic patients.

  • 41.
    Eklund, Andreas
    et al.
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    Bergström, Gunnar
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    Bodin, Lennart
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    Axén, Iben
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden; Research Department, Spine Center of Southern Denmark, Institute of Regional Health Research, Hospital Lillebælt, Middelfart, Denmark.
    Psychological and behavioral differences between low back pain populations: a comparative analysis of chiropractic, primary and secondary care patients2015In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 16, article id 306Article in journal (Refereed)
    Abstract [en]

    Background: Psychological, behavioral and social factors have long been considered important in the development of persistent pain. Little is known about how chiropractic low back pain (LBP) patients compare to other LBP patients in terms of psychological/behavioral characteristics.

    Methods: In this cross-sectional study, the aim was to investigate patients with LBP as regards to psychosocial/behavioral characteristics by describing a chiropractic primary care population and comparing this sample to three other populations using the MPI-S instrument. Thus, four different samples were compared. A: Four hundred eighty subjects from chiropractic primary care clinics. B: One hundred twenty-eight subjects from a gainfully employed population (sick listed with high risk of developing chronicity). C: Two hundred seventy-three subjects from a secondary care rehabilitation clinic. D: Two hundred thirty-five subjects from secondary care clinics. The Swedish version of the Multidimensional Pain Inventory (MPI-S) was used to collect data. Subjects were classified using a cluster analytic strategy into three pre-defined subgroups (named adaptive copers, dysfunctional and interpersonally distressed).

    Results: The data show statistically significant overall differences across samples for the subgroups based on psychological and behavioral characteristics. The cluster classifications placed (in terms of the proportions of the adaptive copers and dysfunctional subgroups) sample A between B and the two secondary care samples C and D.

    Conclusions: The chiropractic primary care sample was more affected by pain and worse off with regards to psychological and behavioral characteristics compared to the other primary care sample. Based on our findings from the MPI-S instrument the 4 samples may be considered statistically and clinically different.

  • 42.
    Ericson, A
    et al.
    Department of Orthopaedics, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden.
    Arndt, A
    Department of Orthopaedics, Karolinska Institute, Huddinge University, Stockholm, Sweden.
    Stark, A
    Department of Orthopaedics, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden.
    Wretenberg, Per
    Örebro University Hospital. Department of Orthopaedics, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden.
    Lundberg, A
    Department of Orthopaedics, Karolinska Institute, Huddinge University, Stockholm, Sweden.
    Variation in the position and orientation of the elbow flexion axis2003In: Journal of Bone and Joint Surgery, ISSN 0301-620X, E-ISSN 2044-5377, Vol. 85B, no 4, p. 538-544Article in journal (Refereed)
    Abstract [en]

    We analysed the axis of movement in the normal elbow during flexion in vivo using radiostereometric analysis (RSA). The results show an intraindividual variation in the inclination of the axis ranging from 2.1 degrees to 14.3 degrees in the frontal and from 1.6 degrees to 9.8 degrees in the horizontal plane analysed at 30 degrees increments. The inclination of the mean axis of rotation varied within a range of 12.7 degrees in the frontal and 4.6 degrees in the horizontal plane. In both planes, the mean axes were located close to a line joining the centres of the trochlea and capitellum. The intra- and interindividual variations of the axes of flexion of the elbow were greater than previously reported. These factors should be considered in the development of elbow prostheses.

  • 43.
    Essving, Per
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Orthopedic Surgery, University Hospital, Örebro, Sweden.
    Axelsson, Kjell
    Department of Anesthesiology and Intensive Care, Örebro University, University Hospital, Örebro, Sweden.
    Otterborg, Lena
    Department of Orthopedic Surgery, Örebro University, University Hospital, Örebro, Sweden.
    Spännar, Henrik
    Department of Physiotherapy, Örebro University, University Hospital, Örebro, Sweden.
    Gupta, Anil
    Department of Anesthesiology and Intensive Care, Örebro University, University Hospital, Örebro, Sweden.
    Magnuson, Anders
    Department of Clinical Epidemiology and Biostatistics, Örebro University, University Hospital, Örebro, Sweden.
    Lundin, Anders
    Department of Orthopedic Surgery, Örebro University, University Hospital, Örebro, Sweden.
    Minimally invasive surgery did not improve outcome compared to conventional surgery following unicompartmental knee arthroplasty using local infiltration analgesia A randomized controlled trial with 40 patients2012In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 83, no 6, p. 634-641Article in journal (Refereed)
    Abstract [en]

    Background and purpose: There has recently been interest in the advantages of minimally invasive surgery (MIS) over conventional surgery, and on local infiltration analgesia (LIA) during knee arthroplasty. In this randomized controlled trial, we investigated whether MIS would result in earlier home-readiness and reduced postoperative pain compared to conventional unicompartmental knee arthroplasty (UKA) where both groups received LIA.

    Patients and methods: 40 patients scheduled for UKA were randomized to a MIS group or a conventional surgery (CON) group. Both groups received LIA with a mixture of ropivacaine, ketorolac, and epinephrine given intra-and postoperatively. The primary endpoint was home-readiness (time to fulfillment of discharge criteria). The patients were followed for 6 months.

    Results: We found no statistically significant difference in home-readiness between the MIS group (median (range) 24 (21-71) hours) and the CON group (24 (21-46) hours). No statistically significant differences between the groups were found in the secondary endpoints pain intensity, morphine consumption, knee function, hospital stay, patient satisfaction, Oxford knee score, and EQ-5D. The side effects were also similar in the two groups, except for a higher incidence of nausea on the second postoperative day in the MIS group.

    Interpretation: Minimally invasive surgery did not improve outcome after unicompartmental knee arthroplasty compared to conventional surgery, when both groups received local infiltration analgesia. The surgical approach (MIS or conventional surgery) should be selected according to the surgeon's preferences and local hospital policies.

  • 44.
    Fischer, Per
    et al.
    Örebro University, School of Medical Sciences.
    Pettersson, Kurt
    Wagner, Eric
    Hooke, Alexander W.
    Rizzo, Marco
    Functional and kinematic analysis of a wrist radial hemiarthroplasty design2017Conference paper (Refereed)
    Abstract [en]

    Hypothesis A radial hemiarthroplasty could obviate difficulties related to distal component loosening of the total wrist arthroplasty. The aim of this study is to investigate kinematically, the feasibility of a new design for radial wrist hemiarthroplasty.

    Methods Six, fresh-frozen cadaveric wrist specimens were used. Testing was performed on the native wrist, after insertion of a radial hemi-arthroplasty with intact proximal carpal row (Hemi) and with proximal row carpectomy (Hemi+PRC). Each wrist was fixed to an experimental table with the tendons of the extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), extensor carpi ulnaris (ECU), flexor carpi radialis (FCR), flexor carpi ulnaris (FCU), and abductor pollicis longus (APL) attached to the apparatus. Range of motion, axis of rotation, and muscle moment arms were recorded in manually controlled movements in wrist flexion/extension, radial/ulnar deviation, dart throwers motion, and circumduction.

    Results A statistically significant decrease in flexion range of motion occurred between the intact and Hemi conditions and between the intact and Hemi+PRC conditions with no significant differences in flexion range of motion occurring between the Hemi and Hemi+PRC conditions. No statistically significant changes in range of motion occurred in extension, radial deviation, ulnar deviation, flexion/ulnar deviation component of the dart throw, extension/radial deviation component of the dart throw, or circumduction functional tests.

    Summary Points This study indicates that the new wrist radial hemiarthroplasty can produce a stable wrist with range of motion similar to the native wrist. Overall, wrist kinematics appears to be equally acceptable in hemiarthroplasty with and without resection of the proximal row.

  • 45.
    Fischer, Per
    et al.
    Örebro University, School of Medical Sciences. Department of Hand Surgery.
    Sagerfors, Marcus
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Hand Surgery.
    Brus, Ole
    Örebro University, School of Medical Sciences.
    Pettersson, Kurt
    Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Revision Arthroplasty of the Wrist in Patients With Rheumatoid Arthritis, Mean Follow-Up 6.6 Years2018In: Journal of Hand Surgery-American Volume, ISSN 0363-5023, E-ISSN 1531-6564, Vol. 43, no 5, p. 489.e1-489.e7Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Management of failed total wrist arthroplasty (TWA) can be challenging; surgical treatment options include salvage arthrodesis, revision arthroplasty, and resection arthroplasty. There are few studies regarding salvage arthrodesis, and revision arthroplasty has been infrequently investigated. The aim of the study was to report the outcome after revision arthroplasty of the wrist.

    METHODS: A retrospective cohort of 16 revision TWAs was evaluated between 2003 and 2016. Data were collected before surgery and 1 and 5 years after surgery. The indication for revision arthroplasty was failed TWA. The primary end point was implant survival. Secondary outcome measures included visual analog scale (VAS) pain scores, range of motion, handgrip strength, and functional scoring with the Canadian Occupational Performance Measure (COPM), Patient-Rated Wrist Evaluation (PRWE), and Disabilities of the Arm, Shoulder, and Hand (DASH).

    RESULTS: Mean follow-up was 6.6 years. Synthetic bone graft was used in 9 cases, allograft corticocancellous bone graft in 1 case, and cement in 6 cases. Of the 16 revision TWAs, 4 were re-revised, 1 because of infection, and 3 cases underwent total wrist arthrodesis. In the non-re-revised cases, range of motion and grip strength was preserved compared with preoperative results. The VAS pain score in activity improved, but not significantly, at 1 (median, 1; range, 0-4.5) and 5 years after surgery (median, 0) compared with before surgery (median, 5). The COPM performance and satisfaction as well as PRWE scores improved significantly at 1 year (median COPM performance, 4.8; COPM satisfaction, 5.6; and PRWE, 24) and improved, but not significantly, at the 5-year follow (median COPM performance, 4.8; COPM satisfaction, 5.0; and PRWE, 37) in the non-re-revised cases.

    CONCLUSIONS: Revision arthroplasty of the wrist is a valid motion-preserving option to wrist arthrodesis in the management of failed TWA. However, the outcome is uncertain and as many as 25% require additional surgery.

    TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

  • 46.
    Fischer, Per
    et al.
    Örebro University, School of Medical Sciences. Department of Hand Surgery.
    Sagerfors, Marcus
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Hand Surgery.
    Jakobsson, H.
    Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Pettersson, K.
    Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Total Wrist Arthroplasty: A 10-Year Follow-Up2020In: Journal of Hand Surgery-American Volume, ISSN 0363-5023, E-ISSN 1531-6564, Vol. 45, no 8, p. 780.e1-780.e10Article in journal (Refereed)
    Abstract [en]

    Purpose: To assess long-term implant survival in total wrist arthroplasty (TWA), comparing 4 different implants.

    Methods: In a prospective cohort of 124 patients, 136 TWAs were evaluated 5 years and 10 years after surgery. The TWAs were implanted between 2005 and 2009. The primary outcome was implant survival. Survival analysis was performed with revision and radiographic loosening as the final end point. Revision was defined as exchange of whole or parts of the prosthesis. Implant loosening was assessed using radiographic examination at the 5-year and 10-year follow-up. Secondary outcome measures included wrist range of motion, hand grip strength, visual analog scale (VAS) pain scores, and patient-related outcome measures, including Disabilities of the Arm, Shoulder, and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE), and Canadian Occupational Performance Measure (COPM).

    Results: Total cumulative implant survival was 92% with revision as the primary end point. When including a nonrevised radiographic loose implant as a failure, total implant survival was 75%. Radiographic loosening differed significantly between the implants with a range in frequency from 0% to 37.5%. At the 10-year follow-up, assessing the nonrevised TWAs, range of motion was preserved compared with preoperative values. Significant improvement was recorded for hand grip strength, VAS pain scores, and patient-related outcome measures at the 10-year follow-up compared with preovperative values.

    Conclusions: High 10-year implant survival was found when defining the primary end point as revision of any cause. When including radiographic loosening of the implant in the survival analysis, implant survival was considerably lower. However, radiographic loosening does not seem to correlate with changes in secondary outcome measures, questioning the need for revision surgery in these cases.

  • 47.
    Forssten, Maximilian Peter
    et al.
    Örebro University, School of Medical Sciences. Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.
    Bass, Gary Alan
    Örebro University, School of Medical Sciences. Division of Traumatology, Emergency Surgery and Surgical Critical Care, University of Pennsylvania, Philadelphia, USA.
    Mohammad Ismail, Ahmad
    Örebro University, School of Medical Sciences. Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Predicting 1-Year Mortality after Hip Fracture Surgery: An Evaluation of Multiple Machine Learning Approaches2021In: Journal of Personalized Medicine, E-ISSN 2075-4426, Vol. 11, no 8, article id 727Article in journal (Refereed)
    Abstract [en]

    Postoperative death within 1 year following hip fracture surgery is reported to be up to 27%. In the current study, we benchmarked the predictive precision and accuracy of the algorithms support vector machine (SVM), naïve Bayes classifier (NB), and random forest classifier (RF) against logistic regression (LR) in predicting 1-year postoperative mortality in hip fracture patients as well as assessed the relative importance of the variables included in the LR model. All adult patients who underwent primary emergency hip fracture surgery in Sweden, between 1 January 2008 and 31 December 2017 were included in the study. Patients with pathological fractures and non-operatively managed hip fractures, as well as those who died within 30 days after surgery, were excluded from the analysis. A LR model with an elastic net regularization were fitted and compared to NB, SVM, and RF. The relative importance of the variables in the LR model was then evaluated using the permutation importance. The LR model including all the variables demonstrated an acceptable predictive ability on both the training and test datasets for predicting one-year postoperative mortality (Area under the curve (AUC) = 0.74 and 0.74 respectively). NB, SVM, and RF tended to over-predict the mortality, particularly NB and SVM algorithms. In contrast, LR only over-predicted mortality when the predicted probability of mortality was larger than 0.7. The LR algorithm outperformed the other three algorithms in predicting 1-year postoperative mortality in hip fracture patients. The most important predictors of 1-year mortality were the presence of a metastatic carcinoma, American Society of Anesthesiologists(ASA) classification, sex, Charlson Comorbidity Index (CCI) ≤ 4, age, dementia, congestive heart failure, hypertension, surgery using pins/screws, and chronic kidney disease.

  • 48.
    Forssten, Maximilian Peter
    et al.
    Örebro University, School of Medical Sciences. Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital. Clinical Epidemiology and Biostatistics.
    Mohammad Ismail, Ahmad
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Orthopedic Surgery.
    Ioannidis, Ioannis
    Örebro University, School of Medical Sciences. Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.
    Tennakoon, Lakshika
    Department of Surgery, Section of Trauma and Acute Care Surgery, Stanford University School of Medicine, Stanford, CA, USA.
    Spain, David A.
    Department of Surgery, Section of Trauma and Acute Care Surgery, Stanford University School of Medicine, Stanford, CA, USA.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Sheik Shakhbout Medical City - Mayo Clinic, Abu Dhabi, United Arab Emirates.
    Validation of the orthopedic frailty score for measuring frailty in hip fracture patients: a cohort study based on the United States National inpatient sample2023In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 49, no 5, p. 2155-2163Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Orthopedic Frailty Score (OFS) has been proposed as a tool for measuring frailty in order to predict short-term postoperative mortality in hip fracture patients. This study aims to validate the OFS using a large national patient register to determine its relationship with adverse outcomes as well as length of stay and cost of hospital stay.

    METHODS: All adult patients (18 years or older) registered in the 2019 National Inpatient Sample Database who underwent emergency hip fracture surgery following a traumatic fall were eligible for inclusion. The association between the OFS and mortality, complications, and failure-to-rescue (FTR) was determined using Poisson regression models adjusted for potential confounders. The relationship between the OFS and length of stay and cost of hospital stay was instead determined using a quantile regression model.

    RESULTS: An estimated 227,850 cases met the study inclusion criteria. There was a stepwise increase in the rate of complications, mortality, and FTR for each additional point on the OFS. After adjusting for potential confounding, OFS 4 was associated with an almost ten-fold increase in the risk of in-hospital mortality [adjusted IRR (95% CI): 10.6 (4.02-27.7), p < 0.001], a 38% increased risk of complications [adjusted IRR (95% CI): 1.38 (1.03-1.85), p = 0.032], and an almost 11-fold increase in the risk of FTR [adjusted IRR (95% CI): 11.6 (4.36-30.9), p < 0.001], compared to OFS 0. Patients with OFS 4 also required a day and a half additional care [change in median length of stay (95% CI): 1.52 (0.97-2.08), p < 0.001] as well as cost approximately $5,200 more to manage [change in median cost of stay (95% CI): 5166 (1921-8411), p = 0.002], compared to those with OFS 0.

    CONCLUSION: Patients with an elevated OFS display a substantially increased risk of mortality, complications, and failure-to-rescue as well as a prolonged and more costly hospital stay.

  • 49.
    Forssten, Maximilian Peter
    et al.
    Örebro University, School of Medical Sciences. Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Trivedi, Dhanisha Jayesh
    School of Medical Sciences, Örebro University, Örebro, Sweden; Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden .
    Ekestubbe, Lovisa
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Borg, Tomas
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.
    Bass, Gary Alan
    Örebro University, School of Medical Sciences. Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
    Mohammad Ismail, Ahmad
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Developing and validating a scoring system for measuring frailty in patients with hip fracture: a novel model for predicting short-term postoperative mortality2022In: Trauma surgery & acute care open, E-ISSN 2397-5776, Vol. 7, no 1, article id e000962Article in journal (Refereed)
    Abstract [en]

    Objectives: Frailty is common among patients with hip fracture and may, in part, contribute to the increased risk of mortality and morbidity after hip fracture surgery. This study aimed to develop a novel frailty score for patients with traumatic hip fracture that could be used to predict postoperative mortality as well as facilitate further research into the role of frailty in patients with hip fracture.

    Methods: The Orthopedic Hip Frailty Score (OFS) was developed using a national dataset, retrieved from the Swedish National Quality Registry for Hip Fractures, that contained all adult patients who underwent surgery for a traumatic hip fracture in Sweden between January 1, 2008 and December 31, 2017. Candidate variables were selected from the Nottingham Hip Fracture Score, Sernbo Score, Charlson Comorbidity Index, 5-factor modified Frailty Index, as well as the Revised Cardiac Risk Index and ranked based on their permutation importance, with the top 5 variables being selected for the score. The OFS was then validated on a local dataset that only included patients from Orebro County, Sweden.

    Results: The national dataset consisted of 126,065 patients. 2365 patients were present in the local dataset. The most important variables for predicting 30-day mortality were congestive heart failure, institutionalization, non-independent functional status, an age ≥85, and a history of malignancy. In the local dataset, the OFS achieved an area under the receiver-operating characteristic curve (95% CI) of 0.77 (0.74 to 0.80) and 0.76 (0.74 to 0.78) when predicting 30-day and 90-day postoperative mortality, respectively.

    Conclusions: The OFS is a significant predictor of short-term postoperative mortality in patients with hip fracture that outperforms, or performs on par with, all other investigated indices.

    Level of evidence: Level III, Prognostic and Epidemiological.

  • 50.
    Forssten, Maximilian Peter
    et al.
    Örebro University, School of Medical Sciences. Department of Orthopedics Surgery, Örebro University Hospital, Örebro, Sweden.
    Ioannidis, Ioannis
    Örebro University, School of Medical Sciences. Department of Orthopedics Surgery, Örebro University Hospital, Örebro, Sweden.
    Mohammad Ismail, Ahmad
    Örebro University, School of Medical Sciences. Department of Orthopedics Surgery, Örebro University Hospital, Örebro, Sweden.
    Bass, Gary Alan
    Örebro University, School of Medical Sciences. Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Penn Presbyterian Medical Center, Philadelphia, PA, USA.
    Borg, Tomas
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Orthopedics Surgery, Örebro University Hospital, Örebro, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Dementia is a surrogate for frailty in hip fracture mortality prediction2022In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 48, no 5, p. 4157-4167Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Among hip fracture patients both dementia and frailty are particularly prevalent. The aim of the current study was to determine if dementia functions as a surrogate for frailty, or if it confers additional information as a comorbidity when predicting postoperative mortality after a hip fracture.

    METHODS: All adult patients who suffered a traumatic hip fracture in Sweden between January 1, 2008 and December 31, 2017 were considered for inclusion. Pathological fractures, non-operatively treated fractures, reoperations, and patients missing data were excluded. Logistic regression (LR) models were fitted, one including and one excluding measurements of frailty, with postoperative mortality as the response variable. The primary outcome of interest was 30-day postoperative mortality. The relative importance for all variables was determined using the permutation importance. New LR models were constructed using the top ten most important variables. The area under the receiver-operating characteristic curve (AUC) was used to compare the predictive ability of these models.

    RESULTS: 121,305 patients were included in the study. Initially, dementia was among the top ten most important variables for predicting 30-day mortality. When measurements of frailty were included, dementia was replaced in relative importance by the ability to walk alone outdoors and institutionalization. There was no significant difference in the predictive ability of the models fitted using the top ten most important variables when comparing those that included [AUC for 30-day mortality (95% CI): 0.82 (0.81-0.82)] and excluded [AUC for 30-day mortality (95% CI): 0.81 (0.80-0.81)] measurements of frailty.

    CONCLUSION: Dementia functions as a surrogate for frailty when predicting mortality up to one year after hip fracture surgery. The presence of dementia in a patient without frailty does not appreciably contribute to the prediction of postoperative mortality.

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