To Örebro University

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

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

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

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

Introduction: Wrist arthroplasty is a motion-preserving procedure. However, despite improvements in implant design, implant failure remains an issue. The aim of this secondary analysis was to assess failures associated with synovitis and to report histopathological findings in an initial patient cohort (n = 40) reported previously.

Materials and Methods: Eleven cases of implant failure and synovitis were identified among hemi and total wrist arthroplasties with a carbon fiber reinforced poly-ether-ether-ketone (CFR-PEEK) articulation.

Results: Six cases had undergone component exchange/revision; of these, five were revised to a radiocarpal arthrodesis. Pronounced wear of the CFR-PEEK articulating surface was noted. Histopathological examination indicated that CFR-PEEK particles were incorporated by macrophages, but no giant cell reactions could be seen.

Conclusion: A high frequency of synovitis warranting reoperation was noted. We recommend caution and close monitoring of CFR-PEEK articulations in the wrist.

Objective: This study aimed to longitudinally assess the rate and timing of return to sports (RTS) and its predictors after primary anterior cruciate ligament reconstruction (ACL-R) in preinjury Tegner Activity Scale≥7 (TAS≥7) athletes.

Methods: This prospective, longitudinal, registry-based cohort study included 511 athletes aged 16–40 with a preinjury TAS≥7 registered in the Swedish National Knee Ligament Registry following primary ACL-R. The primary outcomes were RTS TAS≥7 and associated predictors. Secondary outcomes included RTS at preinjury TAS levels, associated predictors, secondary ACL injury rates and assessment of patient-reported outcome measures (PROMs). Associations were analysed using log-binomial and multivariable Cox regression.

Results: 62% (n=315) achieved RTS TAS≥7 after ACL-R within 12.3 months (SD 4.7), while only 51% achieved RTS preinjury TAS level within 12.7 months (SD 4.9). Negative predictors for RTS TAS≥7 included female sex, older age, low sporting level and delayed surgery. ACL-Return to Sports after Injury (ACL-RSI) score >4.2 at 3 months postoperatively was associated with higher likelihood of RTS TAS≥7 and RTS preinjury TAS level. No differences in secondary ACL injury rates were observed between RTS groups or sexes, with overall secondary ACL injury rates of 9.2% (n=47) within 24 months. Participants returning to TAS≥7 reported better PROMs.

Conclusion: Three out of five athletes returned to knee-demanding sports following ACL-R. Female sex, older age, lower sporting level and delayed surgery were associated with reduced RTS≥7 rates. Psychological readiness at 3 months post-surgery emerged as a potentially modifiable factor associated with RTS outcomes after ACL-R.

INTRODUCTION: This study aimed to compare preoperative education level, income level, and geographical birthplace between patients undergoing metal-on-metal hip resurfacing (MoM-HR) and those receiving a conventional uncemented total hip arthroplasty (THA).

METHODS: All patients with osteoarthritis who underwent a MoM-HR or an uncemented THA registered in the Swedish Arthroplasty Register 1999-2014 were included (n = 15,871). National databases provided additional information on household income and the highest achieved education. 1481 MoM-HR patients were matched to 1481 uncemented THA patients based on age, sex, and Charlson comorbidity index. Odds ratios (OR) of MoM-HR surgery depending on socioeconomic variables were calculated using logistic regression analysis.

RESULTS: The OR of having MoM-HR surgery was lower among patients with lower education level compared to those with a university degree. Also, 37% of the MoM-HR patients had an income in the 2 highest quintiles compared to 32% of uncemented THA patients. There was no difference in accessibility of MoM-HR surgery between patients born in or outside Sweden.

CONCLUSIONS: In Sweden, within a universal healthcare coverage system, lower socioeconomic status in terms of education level was associated with decreased accessibility to innovative hip surgery, i.e., MoM-HR.

Background: Primary total hip arthroplasty and total knee arthroplasty are common surgical procedures that require effective perioperative care to ensure early mobilisation, reduced complications, and shortened hospital stay. Effect-site target-controlled infusion (TCI) combined with SmartPilot View (SPV) is a novel approach to total intravenous anaesthesia that may improve anaesthetic precision and reduce postoperative side effects. However, it has not been thoroughly evaluated in joint arthroplasty. The aim of this study was to evaluate the early anaesthetic outcomes in hip and knee arthroplasty patients following the implementation of effect-site TCI and SPV.

Methods: We conducted a retrospective cohort study including 2316 procedures (2210 patients) at & Ouml;rebro University Hospital, Lindesberg, Sweden, between 2018 and 2023. Two groups were compared: pre-implementation (2018-2019, n = 1258) using plasma-targeted TCI without SPV, and post-implementation (2022-2023, n = 1058) using effect-site TCI with SPV. Patients from 2020 to 2021 were excluded due to the COVID-19 pandemic and the overlap of methods during implementation. Data were extracted from the Swedish Perioperative Register. The primary outcome was the incidence of postoperative nausea and vomiting (PONV). Secondary outcomes included length of stay in the post-anaesthesia care unit (phase II), postoperative pain, and surgical duration.

Results: PONV incidence decreased significantly from 8.4% to 3.0% after implementation (p < 0.001; adjusted OR: 0.36, 95% CI: 0.23-0.55). Median post-anaesthesia care unit stay decreased by 70 min (95% CI: 61-78 min; p < 0.001). Postoperative pain scores were slightly lower in the post-implementation group (median numeric rating scale 7 vs. 5; p < 0.001). Surgical duration increased marginally (84 vs. 87 min; p = 0.003).

Conclusions: Implementation of effect-site TCI and SPV in hip and knee arthroplasty was associated with significantly reduced PONV and shorter post-anaesthesia care unit stay, suggesting improved early postoperative recovery.

Clinical trial number: Not applicable.

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

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

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

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

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

Objective: The aim was to investigate starch-gelatin hydrogels as scaffolds for chondrogenesis and compare these with other materials currently in use regarding cell retention and growth.

Methods: Two variants of starch-gelatin-scaffolds and one chitosan-based scaffold were fabricated by casting and freeze-drying. The resulting materials were analyzed with respect to physicochemical and mechanical properties, cut to size, and seeded with human articular chondrocytes. Cell retention and proliferation were evaluated at 1, 14, and 42 days of culturing. Extracellular matrix production was analyzed by histo- and immunohistochemistry. Comparisons were made with that of commercially available hyaluronan- (Hyalofast®) and collagen-based (ChondroGide®) scaffolds, and synthesized chitosan hydrogels.

Results: The starch-gelatin materials exhibited highly porous structures stabilized by hydrogen bonding, with swelling behavior similar to native cartilage and favorable mechanical handling properties. Despite differences in initial cell retention, all materials except chitosan supported robust cell growth, reaching similar levels after 14 days. No significant changes were observed between 14 and 42 days with the exception of Hyalofast® showing decreased cell number. Chitosan-supported cell growth was more linear over the culture period, but resulted in only half the cell number by day 42 compared with the other materials. Without cells, Hyalofast and one variant of the starch/gelatin hydrogel degraded before day 42. starch/gelatin scaffolds showed collagen I, II, and aggrecan deposition.

Conclusion: Starch-gelatin scaffolds displayed favorable mechanical properties, supported cell growth comparable to commercial scaffolds, and promoted deposition of cartilage-specific extracellular matrix, highlighting their chondrogenic potential.

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

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

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

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

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

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

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

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

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.