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We studied the effects of antibiotic prophylaxis, systemically and in bone cement, on the revision rate of cemented total hip arthroplasties (THAs) in data from the Norwegian Arthroplasty Register during the period 1987-2001. To have comparable groups, only THAs performed because of primary osteoarthritis, using cemented implants with documented good results, and high-viscosity cement were included. If systemic antibiotic prophylaxis had been given, only operations with cephalosporin or penicillin were selected. Cox-estimated survival relative revision risks (RR) are presented with adjustment for differences among groups in gender, age, cement brand, type of systemic antibiotic prophylaxis, type of prosthesis, type of operating room, and duration of the operation. Of 22,170 THAs studied, 696 THAs (3.1%) were revised, 440 (2.0%) for aseptic loosening and 102 (0.5%) for deep infection. We found the lowest risk of revision when the antibiotic prophylaxis was given both systemically and in the cement (15,676 THAs). Compared to this combined regime, patients who received antibiotic prophylaxis only systemically (5,960 THAs) had a 1.4 times higher revision rate with all reasons for revision as endpoint (pÊ= 0.001), 1.3 times higher with aseptic loosening (pÊ= 0.02) and 1.8 times higher with infection as the endpoint (pÊ= 0.01). With the combined antibiotic regime, the results were better if antibiotics were given 4 times on the day of surgery (2,194 THAs), as compared to once (1,424 THAs) (pÊ<0.001), twice (2,680 THAs) (pÊ<0.001), or 3 times (5,522 THAs) (pÊ= 0.02). Those who received systemic prophylaxis a single day 1, 2 or 3 times, as compared to 4 times, had a revision rate 1.8-3.5 times higher with all reasons for revision as endpoint, 1.5-3.1 times higher with aseptic loosening, and 2.7-6.8 times higher with infection. When we compared systemic prophylaxis 4 times in 1 day, no further improvement resulted in those given systemic prophylaxis for 2 days (1,928 THAs) or 3 days (717 THAs). In a subset of data including only the Charnley prosthesis, we obtained similar results. This observational study shows that the best results were recorded when antibiotic prophylaxis was given both systemically and in the bone cement, and if the systemic antibiotic was given 4 times on the day of surgery. [ABSTRACT FROM AUTHOR]

The effectiveness of bicycle helmets in preventing head injuries is well documented. There are different opinions about the effectiveness of helmets in preventing face injuries, and few studies have analyzed the effect of different types of helmets. This study was performed to examine the effect of different helmet types to head and face injuries. The use of helmets was analyzed in cyclists with head or face injuries and compared with two control groups. The main control group was cyclists that had injuries not including the head or neck, and another control group was cyclists that had been involved in an accident, regardless of whether they had sustained any injury. Cross-table and logistic regression analyses were applied to analyze the protective effect of helmets. A total of 991 injured patients served as a basis for this study. Most of the accidents, (82%) were single accidents with no other persons involved. Of patients with injuries to the head, excluding face, 11.4% had been using hard shell helmets, and 9.6% had been using foam helmets at the time of the accident. Among the emergency room controls, the proportion of hard shell helmet users and foam helmet users was 26.4% and 11.4%, respectively. Compared to non-helmet users, this gave an odds ratio of 0.36 (CI = 0.21-0.60) for getting head injuries if the cyclists had been using hard shell helmets at the time of the injury, and 0.83 (CI = 0.41-1.67) for users of foam helmets. The odds ratio for getting face injuries was 0.90 (CI = 0.58-1.41) among users of hard shell helmets, and 1.87 (CI = 1.03-3.40) for users of foam helmets. The use of hard shell helmets reduced the risk of getting injuries to the head. Children less than nine years old that used foam helmets had an increased risk of getting face injuries. All bicyclists should be recommended to use hard shell bicycle helmets while cycling. [ABSTRACT FROM AUTHOR]

Analyzes the postoperative mortality of patients undergoing total hip replacement for the year 1987 and 1999 in Norway. Use of thromboprophylaxis and combinations of drugs during the surgery by the hospitals; Proportion of mortality during the postoperative week.

We studied primary total knee replacements (TKRs), reported to the Norwegian Arthroplasty Register, operated on between 1994 and 2000. A Cox multiple regression model was used to evaluate differences in survival among the prosthesis brands, their types of fixation, and whether or not the patella was resurfaced. In Norway in 1999, the incidence of knee prosthesis operations was 35 per 100,000 inhabitants. Cement was used as fixation in 87% of the knees, 10% were hybrid and 2% uncemented implants. Bicompartmental (not resurfaced patella) prostheses were used in 65% of the knees. With all revisions as endpoint, no statistically significant differences in the 5-year survival were found among the cemented tricompartmental prostheses brands: AGC 97% (n 279), Duracon 99% (n 101), Genesis I 95% (n 654), Kinemax 98% (n 213) and Tricon 96% (n 454). The bicompartmental LCS prostheses had a 5-year survival of 97% (n 476). The type of meniscal bearing in LCS knees had no effect on survival. Survival with revision for all causes as endpoint showed no differences among types of fixation, or bi- or tricompartmental prostheses. Pain alone was the commonest reason for revision of cemented bicompartmental prostheses. The risk of revision because of pain was 5.7 times higher (p < 0.001) in cemented bicompartmental prostheses than cemented tricompartmental ones, but the revisions mainly involved insertion of a patellar component. In tricompartmental prostheses the risk of revision because of infection was 2.5 times higher than in bicompartmental ones (p = 0.03). Young age (< 60) and the sequelae after a fracture increased the risk of revision. The 5-year survival of the 6 most used cemented tricompartmental knee prostheses brands varied between 95% and 99%, but the differences were not statistically significant. There were more revisions because of pain in bicompartmental than in tricompartmental knees. In tricompartmental knees, however, there were more revisions because of an infection. The relatively few patients with uncemented and hybrid implants showed no improvements in results compared to cemented knee prostheses. [ABSTRACT FROM AUTHOR]

We have studied the mortality after total hip replacement (THR) of 39,543 patients, having a mean age of 69 years, who were reported to the Norwegian Arthroplasty Register. The median follow-up time was 5.2 (0-10.4) years. 323 of 6201 deaths occurred during the first 60 postoperative days. The patient mortality was compared with the mortality in the Norwegian population, using standardized mortality ratios (SMR). The SMRs were compared and adjusted for age, gender, and other possible confounders in a Cox regression model incorporating the population mortality. We observed a lower mortality in patients with THR than in the Norwegian population (8-year patient mortality was 25%, versus 30% in the corresponding Norwegian population. SMR = 0.81). There was an increased standardized mortality ratio in patients less than 50 years (SMR = 2.50), patients 50-59 years (SMR = 1.16), patients with THR due to rheumatoid arthritis (SMR = 1.48), and patients with femoral neck fracture (SMR = 1.11). The SMR decreased with increasing age at the time of THR surgery. After revision surgery, the SMR was similar to that after the first primary operation, whereas a second primary operation in the opposite hip was associated with a further reduction in the SMR (SMR = 0.65). During the first 60 postoperative days, all patient categories had a higher mortality than the general population (0.8% mortality, SMR = 1.39). [ABSTRACT FROM AUTHOR]