644 results on '"Søren Overgaard"'
Search Results
152. DEX-2-TKA - DEXamethasone twice for pain treatment after Total Knee Arthroplasty:Detailed statistical analysis plan for a randomized, blinded, three-group multicentre clinical trial
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Janus Christian Jakobsen, Jens Bagger, Kasper Højgaard Thybo, Kasper Smidt Gasbjerg, Henrik Morville Schrøder, Niels Anker Pedersen, Daniel Hägi-Pedersen, Ole Mathiesen, Peter Lindholm, Stig Brorson, Søren Overgaard, and Troels Haxholdt Lunn
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total knee arthroplasty ,Visual analogue scale ,Analgesic ,DEX-2-TKA ,dexamethasone ,Placebo ,Dexamethasone ,Drug Administration Schedule ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Single-Blind Method ,multimodal analgesia ,pain ,030212 general & internal medicine ,Arthroplasty, Replacement, Knee ,Adverse effect ,Glucocorticoids ,Pain, Postoperative ,business.industry ,detailed statistical analysis plan ,030208 emergency & critical care medicine ,General Medicine ,Clinical trial ,Regimen ,Anesthesiology and Pain Medicine ,post-operative pain ,Research Design ,Anesthesia ,Morphine ,business ,medicine.drug - Abstract
BACKGROUND: Optimization of post-operative pain treatment is of upmost importance. Multimodal analgesia is the main post-operative pain treatment principle, but the evidence on optimal analgesic combinations is unclear. With the "DEXamethasone twice for pain treatment after TKA" trial, we aim to investigate the role of one or two doses of glucocorticoid for post-operative pain treatment after total knee arthroplasty. To ensure transparency and minimization of bias, we present this article with a detailed statistical analysis plan, to be published before the last participant is enrolled.METHODS: "DEXamethasone twice for pain treatment after TKA" (DEX-2-TKA) is a randomized, blinded, three-group multicentre clinical trial. Participants will be randomized to one of three intervention groups: single dose of iv dexamethasone 24 mg, two consecutive doses of iv dexamethasone 24 mg or matching iv placebo. All three intervention groups will receive paracetamol, NSAID (ibuprofen) and local infiltration analgesia. Participants, treatment providers, outcome assessors, data managers, statisticians and conclusion drawers will be blinded to the allocated intervention. The primary outcome is total opioid consumption (iv morphine milligram equivalents) 0-48 hours post-operatively. Secondary outcomes are (1) visual analogue scale pain levels: (a) during active 45 degrees flexion of the knee at 24 and 48 hours post-operatively, (b) at rest at 24 and 48 hours post-operatively, and (c) during 0-24 hours (highest score) and 24-48 hours post-operatively (highest score); and (2) the proportion of participants with one or more adverse events within 48 hours post-operatively.DISCUSSION: The DEX-2-TKA trial will provide high quality data regarding benefits and harms of adding one or two high-doses of dexamethasone to a multimodal analgesic regimen.TRIAL REGISTRATION: EudraCT: 2018-001099-39 (08/06-18); ClinicalTrials.gov: NCT03506789 (24/04-2019).
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- 2020
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153. Comparisons of Efficacy between Autograft and Allograft on Defect Repair In Vivo in Normal and Osteoporotic Rats
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Rasmus Hestehave Pedersen, Søren Overgaard, Chris Halling Dreyer, Ming Ding, and Marina Rasmussen
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0301 basic medicine ,musculoskeletal diseases ,medicine.medical_specialty ,Article Subject ,Bone density ,Side effect ,medicine.medical_treatment ,Ovariectomy ,Osteoporosis ,Transplantation, Autologous ,General Biochemistry, Genetics and Molecular Biology ,Bone and Bones ,03 medical and health sciences ,0302 clinical medicine ,Bone Density ,medicine ,Animals ,Transplantation, Homologous ,Tibia ,Autografts ,Reduction (orthopedic surgery) ,030222 orthopedics ,Bone Transplantation ,General Immunology and Microbiology ,business.industry ,Histology ,General Medicine ,X-Ray Microtomography ,medicine.disease ,musculoskeletal system ,Allografts ,Surgery ,Rats ,Transplantation ,030104 developmental biology ,surgical procedures, operative ,Orthopedic surgery ,Medicine ,Female ,business ,Research Article - Abstract
Introduction. In the field of orthopaedic surgery, the use of osteogenic material in larger defects is essential. Autograft and allograft are both known methods, and autograft is believed to be the best choice. But autograft is associated with additional invasive procedures which can prove difficult in fragile patients and can cause local side effect after bone harvest. For feasible purposes, the use of allograft is hereby rising and comparing efficacies, and the differences between autograft and allograft are essential for the clinical outcome for the patients. Method. 24 female Norwegian brown rats were included, 12 normal rats and 12 induced with osteoporosis (OP). OP inducement was verified in vivo by bone volume fraction (BV/TV) at 90 days after ovariectomy (OVX). The primary surgery in each rat consisted of a 2.5×3 mm hole in the proximal tibia, bilaterally. Autograft and allograft were randomly allocated in the right and left tibia. After an observation of 21 days, the rats were sacrificed. Tibia samples were harvested, micro-CT scanned for bone inducement and microarchitectural properties, and then embedded for histology. Results. The OP induction was verified three months after the OVX by a reduction of 68.5% in the trabecular bone BV/TV compared to normal bone. Microarchitectural analysis and histology showed no significant differences in the bone-forming capabilities between autograft and allograft in normal or osteoporotic bone after 3 weeks. Conclusion. This study did not demonstrate any difference between autograft and allograft in a normal or osteoporotic rat tibial defect model after 21 days, suggesting allograft is a good alternative to autograft.
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- 2020
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154. Reduction in Upper Limb Joint Surgery among Rheumatoid Arthritis Patients:An Interrupted Time Series Analysis using Danish Health Care Registers
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Lene Dreyer, Samuel Hawley, Lars Erik Kristensen, Kristian Zobbe, Bolette Gylden Soussi, Pil Højgaard, René Cordtz, Søren Overgaard, Anders Odgaard, and Daniel Prieto-Alhambra
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Adult ,Male ,medicine.medical_specialty ,Joint replacement ,medicine.medical_treatment ,Denmark ,Elbow ,Population ,Arthritis ,Arthritis, Rheumatoid ,Upper Extremity ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Internal medicine ,medicine ,Humans ,Registries ,Arthroplasty, Replacement ,education ,Aged ,030203 arthritis & rheumatology ,education.field_of_study ,business.industry ,Interrupted Time Series Analysis ,Middle Aged ,medicine.disease ,Arthroplasty ,Confidence interval ,medicine.anatomical_structure ,Rheumatoid arthritis ,Antirheumatic Agents ,Upper limb ,Female ,business ,Delivery of Health Care ,Follow-Up Studies - Abstract
Objectives Joint replacement surgery is a proxy of severe joint damage in rheumatoid arthritis (RA). The aim of this study was to assess the impact of the introduction of biologic disease‐modifying antirheumatic drugs (bDMARDs) on the incidence rate (IR) of upper limb joint replacements among newly diagnosed RA patients. Methods Using the Danish National Patient Register, patients with incident RA from 1996–2012 were identified. Each patient was matched on age, sex, and municipality, with up to 10 general population controls. The age‐ and sex‐standardized 5‐year IR per 1,000 person‐years of a composite outcome of any first joint replacement of the finger, wrist, elbow, or shoulder was calculated, and an interrupted time‐series analysis was undertaken to investigate trends and changes of the IR in the pre‐bDMARD (1996–2001) and the bDMARD eras (2003–2012), with a 1‐year lag period in 2002. Results In total, 18,654 incident patients with RA were identified (mean age 57.6 years, 70.5% women). The IR of joint replacements among patients with RA was stable at 2.46 per 1,000 person‐years (95% confidence interval [95% CI] 1.96, 2.96) from 1996 to 2001 but started to decrease from 2003 onwards (–0.08 per 1,000 person‐years annually [95% CI –0.20, 0.02]). Compared with patients with RA, the IR among controls in 1996 was 1/17 and increased continuously throughout the study period. Conclusion The IR of upper limb joint replacements started to decrease among patients with RA from 2002 onwards, whereas it increased among controls. Our results suggest an association between the introduction of bDMARDs and a lower need of joint replacements among patients with RA.
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- 2020
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155. [Younger patients with hip joint pain]
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Christian, Dippmann, Peter, Albrecht-Olsen, Mikael, Boesen, Henrik, Chrintz, Per, Hölmich, Stig Storgaard, Jakobsen, Uffe, Jørgensen, Lars, Konradsen, Otto, Kraemer, Bent, Lund, Niels, Maagaard, Bjarne, Mygind-Klavsen, Søren, Overgaard, Ole, Ovesen, Jens, Stürup, Kjeld, Søballe, Torsten, Warming, Nikolaj, Winther, and Michael, Krogsgaard
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Treatment Outcome ,Humans ,Acetabulum ,Hip Joint ,Arthralgia ,Hip Dislocation, Congenital - Abstract
This review summarises the present knowledge of diagnosing and treating hip joint pain. The results of joint preserving surgery are good in symptomatic patients with hip dysplasia, acetabular retroversion or impingement (cam or pincer) without signs of osteoarthritis. Confirmation of intraarticular pathology as the cause of symptoms is established clinically, and the pathology can in many cases be visualised by a standing, standardised radiograph of the pelvis, which is the basis for admission to the relevant orthopaedic department. We present an algorithm for this. Dysplasia and retroversion can be treated by periacetabular osteotomy and impingement by arthroscopic procedures.
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- 2020
156. The future of TTOM
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Søren Overgaard
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Behavioral Neuroscience ,Neuropsychology and Physiological Psychology ,Physiology ,media_common.quotation_subject ,Ambiguity ,Sociology ,media_common ,Epistemology - Abstract
“Thinking through other minds,” or TTOM, is defined in two different ways. On the one hand, it refers to something people do – for example, inferences they make about others’ expectations. On the other hand, it refers to a particular theoretical model of those things that people do. If the concept of TTOM is to have any future, this ambiguity must be redressed.
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- 2020
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157. Perioperative Tranexamic Acid Treatment and Risk of Cardiovascular Events or Death After Total Hip Arthroplasty
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Anton Pottegård, Søren Overgaard, Alexander Steenberg Dastrup, and Jesper Hallas
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Male ,medicine.medical_specialty ,Time Factors ,Antifibrinolytic ,Databases, Factual ,medicine.drug_class ,Arthroplasty, Replacement, Hip ,Denmark ,medicine.medical_treatment ,Risk Assessment ,Cohort Studies ,Danish ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Perioperative Period ,Aged ,030222 orthopedics ,business.industry ,Venous Thromboembolism ,General Medicine ,Perioperative ,Middle Aged ,Arthroplasty ,Antifibrinolytic Agents ,language.human_language ,Tranexamic Acid ,Cardiovascular Diseases ,language ,Female ,Surgery ,business ,Risk assessment ,Tranexamic acid ,Cohort study ,Total hip arthroplasty ,medicine.drug - Abstract
BACKGROUND: There have been concerns that the antifibrinolytic drug tranexamic acid (TXA) might increase the postoperative risk of cardiovascular events. Our objective was to determine whether perioperative TXA use is associated with cardiovascular events and death within 30 days after primary total hip arthroplasty (THA).METHODS: We conducted a nationwide cohort study of cardiovascular outcomes after perioperative exposure to tranexamic acid during THA. We included 45,290 patients who had a THA in the study period of 2006 to 2013; 38,586 received perioperative TXA, and 6,704 did not. Propensity scores were calculated on the basis of age, sex, income, year of surgery, Elixhauser comorbidity index, and a variety of comorbidities and coprescribed medications. The primary outcome was venous thromboembolism. The secondary outcomes were deep venous thrombosis, pulmonary embolism, myocardial infarction, ischemic stroke, and all-cause mortality. Data were analyzed using Cox regression, either in a multivariable model with inclusion of covariates (full cohorts) or in propensity-score-matched cohorts.RESULTS: After propensity score matching, all prognostic covariates balanced well. In the matched cohort, TXA use was not found to significantly increase the risk of venous thromboembolism (hazard ratio [HR] = 1.18; 95% confidence interval [CI] = 0.83 to 1.68), deep vein thrombosis (HR = 1.15; CI = 0.78 to 1.68), pulmonary embolism (HR = 1.50; CI = 0.60 to 3.78), myocardial infarction (HR = 0.83; CI = 0.46 to 1.50), ischemic stroke (HR = 0.89; CI = 0.39 to 2.01), or all-cause mortality (HR = 0.73; CI = 0.41 to 1.28). Similar results were found in the multivariable Cox regression analyses.CONCLUSIONS: Our data do not support a detrimental effect of TXA on the risk of cardiovascular events or death following THA.LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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- 2018
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158. No Increase in Survival for 36-mm versus 32-mm Femoral Heads in Metal-on-polyethylene THA: A Registry Study
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Ove Furnes, Alma B Pedersen, Johan Kärrholm, Geir Hallan, Antti Eskelinen, Søren Overgaard, Maziar Mohaddes, Keijo T Mäkelä, Georgios Tsikandylakis, and Nils P. Hailer
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Male ,medicine.medical_specialty ,Arthroplasty, Replacement, Hip ,medicine.medical_treatment ,Population ,Kaplan-Meier Estimate ,Scandinavian and Nordic Countries ,Prosthesis Design ,Lower risk ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Clinical Research ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Registries ,030212 general & internal medicine ,education ,Aged ,Proportional Hazards Models ,ta3126 ,030222 orthopedics ,education.field_of_study ,business.industry ,Proportional hazards model ,Confounding ,Hazard ratio ,Femur Head ,General Medicine ,Middle Aged ,Arthroplasty ,Confidence interval ,Prosthesis Failure ,Surgery ,Treatment Outcome ,Metals ,Polyethylene ,Orthopedic surgery ,Female ,Hip Prosthesis ,business - Abstract
Background: During the past decade, the 32-mm head has replaced the 28-mm head as the most common head size used in primary THA in many national registries, and the use of 36-mm heads has also increased. However, it is unclear whether 32-mm and 36-mm heads decrease the revision risk in metal-on-polyethylene (MoP) THA compared with 28-mm heads. unclear whether 32-mm and 36-mm heads decrease the revision risk in metal-on-polyethylene (MoP) THA compared with 28-mm heads. Questions/purposes: (1) In the setting of the Nordic Arthroplasty Register Association database, does the revision risk for any reason differ among 28-, 32-, and 36- mm head sizes in patients undergoing surgery with MoP THA? (2) Does the revision risk resulting from dislocation decrease with increasing head diameter (28-36 mm) in patients undergoing surgery with MoP THA in the same registry? Methods: Data were derived from the Nordic Arthroplasty Register Association database, a collaboration among the national arthroplasty registries of Denmark, Finland, Norway, and Sweden. Patients with primary osteoarthritis who had undergone primary THA with a 28-, 32-, or 36-mm MoP bearing from 2003 to 2014 were included. Patients operated on with dual-mobility cups were excluded. In patients with bilateral THA, only the first operated hip was included. After applying the inclusion criteria, the number of patients and THAs with a complete data set was determined to be 186,231, which accounted for 51% of all hips (366,309) with primary osteoarthritis operated on with THA of any head size and bearing type during the study observation time. Of the included patients, 60% (111,046 of 186,231) were women, the mean age at surgery was 70 (± 10) years, and the median followup was 4.5 years (range, 0-14 years). A total of 101,094 patients had received a 28-mm, 57,853 a 32-mm, and 27,284 a 36-mm head with 32 mm used as the reference group. The revision of any component for any reason was the primary outcome and revision for dislocation was the secondary outcome. Very few patients are estimated to be lost to followup because emigration in the population of interest (older than 65-70 years) is rare. A Kaplan-Meier analysis was used to estimate THA survival for each group, whereas Cox regression models were fitted to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for THA revision comparing the 28- and 36-mm head diameters with the 32- mm head diameters adjusting for age, sex, year of surgery, type of cup and stem fixation, polyethylene type (crosslinked versus conventional), and surgical approach. Results: In the adjusted Cox regression model, there was no difference in the adjusted risk for revision for any reason between patientswith 28-mm (HR, 1.06; 95%CI, 0.97-0.16) and 32-mmheads, whereas the risk of revisionwas higher for patients with 36-mm heads (HR, 1.14; 95% CI, 1.04-1.26) compared with patients with 32-mm heads. Patients with 28-mm heads had a higher risk of revision for dislocation (HR, 1.67; 95% CI, 1.38-1.98) compared with 32 mm, whereas there was no difference between patients with 36-mm (HR, 0.85; 95% CI, 0.70-1.02) and 32-mm heads. Conclusions: After adjusting for relevant confounding variables, we found no benefits for 32-mm heads against 28 mm in terms of overall revision risk. However, when dislocation risk is considered, 32-mm heads would be a better option, because they had a lower risk of revision resulting from dislocation. There were no benefits with the use of 36-mm heads over 32 mm, because the transition from 32 to 36 mm was associated with a higher risk of revision for all reasons, which was not accompanied by a decrease in the risk of revision resulting from dislocation. The use of 32-mm heads appears to offer the best compromise between joint stability and other reasons for revision in MoP THA. Further studies with longer followup, especially of 36-mm heads, as well as better balance of confounders across head sizes and better control of patient related risk factors for THA revision are needed.
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- 2018
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159. Microcalorimetric detection of staphylococcal biofilm growth on various prosthetic biomaterials after exposure to daptomycin
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Inês Santos Ferreira, Christen Ravn, Andrej Trampuz, Søren Overgaard, and E. Maiolo
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0301 basic medicine ,biology ,Sonication ,030106 microbiology ,Biofilm ,chemistry.chemical_element ,biochemical phenomena, metabolism, and nutrition ,Polyethylene ,biology.organism_classification ,03 medical and health sciences ,chemistry.chemical_compound ,chemistry ,medicine ,Orthopedics and Sports Medicine ,Daptomycin ,Heat flow ,Bacteria ,Biofilm growth ,Biomedical engineering ,Titanium ,medicine.drug - Abstract
Primary aim of this in vitro study was to test the efficacy of daptomycin to eradicate staphylococcal biofilms on various orthopedic implant materials. Secondary aim was to quantitatively estimate the formation of staphylococcal biofilm. We tested six clinically important biomaterials: Cobalt chrome, pure titanium, grid-blasted titanium, porous plasma-coated titanium with/without hydroxyapatite, and polyethylene. Biofilms of S. aureus and S. epidermidis were formed on the samples and thereafter exposed to daptomycin. Samples were subsequently sonicated in order to detect dislodged biofilm bacteria and transferred to a microcalorimeter for real-time measurement of growth-related heat flow. Minimal biofilm eradication concentration (MBEC) was determined as the lowest concentration of daptomycin required to eradicate biofilm bacteria on the sample. Median MBEC of S. aureus biofilm on smooth metallic surfaces was lower than the rough metallic surfaces. In experiments with S. epidermidis, no pattern was seen in relation to the surface roughness. Regarding the quantitative estimation of staphylococcal biofilm formation on the sample, we found a significantly higher amount of biofilm growth on the rough surfaces than the smooth samples and polyethylene. In conclusion, the presented study showed that daptomycin could eradicate S. aureus biofilm at lower concentrations on the smooth surfaces compared to the rough surfaces, as well as polyethylene. In experiments with daptomycin against S. epidermidis biofilms, no pattern was seen in relation to the surface roughness. Furthermore, we demonstrated a faster detection of staphylococcal heat flow due to higher biofilm quantity on the rough surfaces compared to smooth samples and polyethylene. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2809-2816, 2018.
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- 2018
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160. Introduction of national guidelines for restrictive blood transfusion threshold for hip fracture patients––a consecutive cohort study based on complete follow-up in national databases
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Per Hviid Gundtoft, Jesper Schønnemann, Lis Røhl Andersen, Jens Lauritsen, Carsten Fladmose Madsen, Søren Overgaard, Lasse Pedersen, Bjarke Viberg, and Kjell Titlestad
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Male ,medicine.medical_specialty ,Blood transfusion ,lcsh:Diseases of the musculoskeletal system ,Databases, Factual ,Denmark ,medicine.medical_treatment ,Restrictive ,computer.software_genre ,law.invention ,Hip fracture ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,lcsh:Orthopedic surgery ,law ,medicine ,Humans ,Blood Transfusion ,Orthopedics and Sports Medicine ,Longitudinal Studies ,Prospective Studies ,030212 general & internal medicine ,Mortality ,Aged ,Aged, 80 and over ,030222 orthopedics ,Database ,Hip Fractures ,Proportional hazards model ,business.industry ,Transfusion ,Guideline ,medicine.disease ,lcsh:RD701-811 ,Practice Guidelines as Topic ,Orthopedic surgery ,Female ,Surgery ,Liberal ,lcsh:RC925-935 ,business ,computer ,Body mass index ,Research Article ,Follow-Up Studies ,Cohort study - Abstract
BACKGROUND: Randomized controlled trials have demonstrated that a restrictive red blood cell (RBC) transfusion strategy lowers transfusion frequency without affecting mortality. However, the external validity of these trials has not been tested in a large cohort. The purpose was to estimate the effect of introducing a National Clinical Guideline (NCG) for a restrictive hemoglobin transfusion threshold on transfusion frequency and mortality in hip fracture patients > 65 years old.METHODS: A consecutive cohort study of hip fracture patients > 65 years old residing in the southern region of Denmark was conducted using prospectively gathered data from registers during two separate 1-year time periods. The first period from October 1, 2012, to September 30, 2013, included 1494 patients and used a liberal transfusion threshold, whereas the second period from October 1, 2015, to September 30, 2016, including 1414 participants used a restrictive threshold from the NCG. Participant data for age, sex, body mass index, Charlson Comorbidity Index, time to surgery, and death were retrieved from the Danish Interdisciplinary Registry of Hip Fractures and were merged with RBC transfusion and medication data extracted from the Danish Transfusion and Odense Pharmacoepidemiological Databases, respectively. Cox proportional hazards models were used to test relative mortality risk for the restrictive group compared with the liberal group at 30 and 90 days.RESULTS: Overall RBC transfusions decreased from 42 to 30% (p CONCLUSION: These data suggest that the introduction of an NCG on restrictive blood transfusion leads to lower transfusion frequency in hip fracture patients > 65 years old. Even though this reduction is associated with decreased mortality at both 30 and 90 days, it may be explained by other issues than restrictive transfusion strategy. There has been an improvement in the mortality of hip fracture patients in Denmark, and we suggest that a restrictive transfusion strategy does not lead to increased mortality.
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- 2018
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161. Machine-learning vs. logistic regression for preoperative prediction of medical morbidity after fast-track hip and knee arthroplasty—a comparative study
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Christian Michelsen, Christoffer C. Jørgensen, Mathias Heltberg, Mogens H. Jensen, Alessandra Lucchetti, Pelle B. Petersen, Troels Petersen, Henrik Kehlet, The Center for Fast-track Hip Knee Replacement Collaborative group, Frank Madsen, Torben B. Hansen, Kirill Gromov, Thomas Jakobsen, Claus Varnum, Soren Overgaard, Mikkel Rathsach, and Lars Hansen
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Machine learning ,Risk assessment ,Hip replacement ,Knee replacement ,Enhanced recovery after surgery ,Perioperative care ,Anesthesiology ,RD78.3-87.3 - Abstract
Abstract Background Machine-learning models may improve prediction of length of stay (LOS) and morbidity after surgery. However, few studies include fast-track programs, and most rely on administrative coding with limited follow-up and information on perioperative care. This study investigates potential benefits of a machine-learning model for prediction of postoperative morbidity in fast-track total hip (THA) and knee arthroplasty (TKA). Methods Cohort study in consecutive unselected primary THA/TKA between 2014–2017 from seven Danish centers with established fast-track protocols. Preoperative comorbidity and prescribed medication were recorded prospectively and information on length of stay and readmissions was obtained through the Danish National Patient Registry and medical records. We used a machine-learning model (Boosted Decision Trees) based on boosted decision trees with 33 preoperative variables for predicting “medical” morbidity leading to LOS > 4 days or 90-days readmissions and compared to a logistical regression model based on the same variables. We also evaluated two parsimonious models, using the ten most important variables in the full machine-learning and logistic regression models. Data collected between 2014–2016 (n:18,013) was used for model training and data from 2017 (n:3913) was used for testing. Model performances were analyzed using precision, area under receiver operating (AUROC) and precision recall curves (AUPRC), as well as the Mathews Correlation Coefficient. Variable importance was analyzed using Shapley Additive Explanations values. Results Using a threshold of 20% “risk-patients” (n:782), precision, AUROC and AUPRC were 13.6%, 76.3% and 15.5% vs. 12.4%, 74.7% and 15.6% for the machine-learning and logistic regression model, respectively. The parsimonious machine-learning model performed better than the full logistic regression model. Of the top ten variables, eight were shared between the machine-learning and logistic regression models, but with a considerable age-related variation in importance of specific types of medication. Conclusion A machine-learning model using preoperative characteristics and prescriptions slightly improved identification of patients in high-risk of “medical” complications after fast-track THA and TKA compared to a logistic regression model. Such algorithms could help find a manageable population of patients who may benefit most from intensified perioperative care.
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- 2023
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162. Predictors of revision, prosthetic joint infection and mortality following total hip or total knee arthroplasty in patients with rheumatoid arthritis: a nationwide cohort study using Danish healthcare registers
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Anders Odgaard, Søren Overgaard, Lars Erik Kristensen, René Cordtz, Kristian Zobbe, Pil Højgaard, Hanne Merete Lindegaard, and Lene Dreyer
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Male ,Arthroplasty, Replacement, Hip ,Denmark ,medicine.medical_treatment ,Antirheumatic Agents/therapeutic use ,Osteoarthritis ,Arthritis, Rheumatoid ,Cohort Studies ,0302 clinical medicine ,Risk Factors ,Epidemiology ,Immunology and Allergy ,Registries ,Arthroplasty, Replacement, Knee ,030222 orthopedics ,Middle Aged ,Arthritis, Rheumatoid/drug therapy ,Antirheumatic Agents ,Rheumatoid arthritis ,Female ,Cohort study ,Reoperation ,musculoskeletal diseases ,medicine.medical_specialty ,Prosthesis-Related Infections ,Immunology ,General Biochemistry, Genetics and Molecular Biology ,03 medical and health sciences ,Rheumatology ,Internal medicine ,Osteoarthritis/drug therapy ,medicine ,Humans ,Glucocorticoids ,Survival analysis ,Aged ,030203 arthritis & rheumatology ,business.industry ,Arthroplasty, Replacement, Knee/adverse effects ,Glucocorticoids/administration & dosage ,medicine.disease ,Survival Analysis ,Arthroplasty ,Surgery ,Arthroplasty, Replacement, Hip/adverse effects ,Reoperation/statistics & numerical data ,Orthopedic surgery ,Prosthesis-Related Infections/epidemiology ,business ,Follow-Up Studies - Abstract
ObjectivesTo investigate predictors of 10-year risk of revision and 1-year risk of prosthetic joint infection (PJI) and death following total hip/total knee arthroplasty (THA/TKA) in (1) patients with rheumatoid arthritis (RA) compared with patients with osteoarthritis (OA); and (2) patients with RA treated with biological disease-modifying antirheumatic drugs (bDMARD) within 90 days preceding surgery compared with non-treated.MethodsRegister-based cohort study using the Danish National Patient Register, the DANBIO rheumatology register (RA-specific confounders and treatment episodes) and the Danish Hip and Knee Arthroplasty Registers. Survival analyses were used to calculate confounder-adjusted sub-HRs (SHR) and HRs.ResultsIn total, 3913 patients with RA with THA/TKA were compared with 120 499 patients with OA. Patients with RA had decreased risk of revision (SHR 0.71 (0.57–0.89)), but increased risk of PJI (SHR=1.46 (1.13–1.88)) and death (HR=1.25 (1.01–1.55)). In DANBIO, 345 of 1946 patients with RA with THA/TKA had received bDMARD treatment within 90 days preceding surgery. bDMARD-treated patients did not have a statistically significant increased risk of revision (SHR=1.49 (0.65–3.40)), PJI (SHR=1.61 (0.70–3.69)) nor death (HR=0.75 (0.24–2.33)) compared with non-treated. Glucocorticoid exposure (HR=2.87 (1.12–7.34)) and increasing DAS28 (HR=1.49 (1.01–2.20)) were risk factors for mortality.ConclusionPatients with RA had a decreased 10-year risk of revision while the risk of death and PJI was increased compared with patients with OA following THA/TKA. bDMARD exposure was not associated with statistically significant increased risk of neither PJI nor death in this study. Glucocorticoid exposure and increased disease activity were associated with an increased risk of death.
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- 2017
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163. Changes in clavicle length in acute fractures within 3 weeks: a prospective ultrasonographic study of 59 patients
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A. H. Thorsmark, Lars Henrik Frich, Søren Overgaard, O M Christensen, and S Torp-Pedersen
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,lcsh:Diseases of the musculoskeletal system ,Sports medicine ,Traumatology ,Length measurement ,Fractures, Bone ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Bone shortening ,Rheumatology ,Ultrasound ,medicine ,Humans ,Orthopedics and Sports Medicine ,Prospective Studies ,030212 general & internal medicine ,Aged ,Ultrasonography ,Aged, 80 and over ,Fracture Healing ,030222 orthopedics ,business.industry ,Middle Aged ,Acute surgery ,Clavicle ,Surgery ,medicine.anatomical_structure ,Orthopedic surgery ,Female ,lcsh:RC925-935 ,business ,Research Article - Abstract
BACKGROUND: Within traumatology a common indication for acute surgery of fractured clavicles is bone shortening over 2 cm. This indication is among but a few indications; which are recommended to be treated operatively within the very first weeks after a fracture. Theoretically clavicle fractures could become less shortened over time due to decreasing muscle pull. If this reduced shortening does indeed happen, some patients with initial bone shortening over 2 cm could perhaps be treated conservatively? However, it is unknown what happens to the length of the clavicle within the first weeks after a fracture. The aim of this study was to investigate if the length of the fresh fractured clavicles changes within the first three weeks.METHODS: Rested length measurements using navigation ultrasound were done on 59 patients with a fractured clavicle. Measurements were performed within the first three weeks after a lateral or mid-clavicular fracture. The inclusion period was from March 2014 to February 2016. Median age was 40 years and age range was 18-81 years. The data was analyzed using mixed linear models.RESULTS: The clavicle length showed no change within the first three weeks after fracture (p = 0.24).CONCLUSION: Fractured clavicles retain their length for the first three weeks.
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- 2017
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164. Optimizing combination of vascular endothelial growth factor and mesenchymal stem cells on ectopic bone formation in SCID mice
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Nicholas Ditzel, Chris Halling Dreyer, Ming Ding, Niklas Rye Jørgensen, Søren Overgaard, and Kristian Kjærgaard
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0301 basic medicine ,biology ,Angiogenesis ,Mesenchymal stem cell ,Metals and Alloys ,Biomedical Engineering ,Vimentin ,Staining ,Biomaterials ,Andrology ,Vascular endothelial growth factor ,03 medical and health sciences ,chemistry.chemical_compound ,030104 developmental biology ,0302 clinical medicine ,Tissue engineering ,chemistry ,030220 oncology & carcinogenesis ,Immunology ,Ceramics and Composites ,biology.protein ,Immunohistochemistry ,Bone regeneration - Abstract
Introduction: Insufficient blood supply may limit bone regeneration in bone defects. Vascular endothelial growth factor (VEGF) promotes angiogenesis by increasing endothelial migration. This outcome, however, could depend on time of application. Sheep mesenchymal stem cells (MSCs) in severe combined immunodeficient (SCID) mice were used in this study to evaluate optimal time points for VEGF stimulation to increase bone formation. Methods: Twenty-eight SCID (NOD.CB17-Prkdcscid/J) mice had hydroxyapatite (HA) granules seeded with 5x105 MSCs inserted subcutaneously. Pellets released VEGF on Days 1-7, Days 1-14, Days 1-21, Days 1-42, Days 7-14, and Days 21-42. After 8 weeks, the implant-bone-blocks were harvested, paraffin embedded, sectioned, and stained with both Haematoxylin Eosin (HE) and immunohistochemistry for human vimentin staining (hVim). Blood samples were collected for determination of bone-related biomarkers in serum. Results: The groups with 5x105 mesenchymal stem cells and VEGF stimulation on Days 1-14 and Days 1-21 showed more bone formation when compared to the control group of 5x105 mesenchymal stem cells alone (p
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- 2017
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165. Enactivism and the Perception of Others’ Emotions
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Søren Overgaard
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Enactivism ,Philosophy ,Perception ,media_common.quotation_subject ,060302 philosophy ,05 social sciences ,0501 psychology and cognitive sciences ,06 humanities and the arts ,0603 philosophy, ethics and religion ,Psychology ,050105 experimental psychology ,Cognitive psychology ,media_common - Published
- 2017
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166. Perceptual Error, Conjunctivism, and Husserl
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Søren Overgaard
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Philosophy ,media_common.quotation_subject ,05 social sciences ,Illusion ,06 humanities and the arts ,Modern philosophy ,0603 philosophy, ethics and religion ,050105 experimental psychology ,Epistemology ,Phenomenology (philosophy) ,Analytic philosophy ,Perception ,060302 philosophy ,Disjunctivism ,0501 psychology and cognitive sciences ,media_common - Abstract
Claude Romano (2012) and Andrea Staiti (2015) have recently discussed Husserl’s account of perception in relation to debates in current analytic philosophy between so-called “conjunctivists” and “disjunctivists”. Romano and Staiti offer strikingly different accounts of the nature of illusion and hallucination, and opposing readings of Husserl. Romano thinks hallucinations and illusions are fleeting, fragile phenomena, while Staiti claims they are inherently retrospective phenomena. Romano reads Husserl as being committed to a form of conjunctivism that Romano rejects in favour of a version of disjunctivism. Staiti, by contrast, claims that, from a Husserlian viewpoint, conjunctivism and disjunctivism are equally untenable. I suggest that both Romano and Staiti offer implausible accounts of illusions and hallucinations, and deliver premature verdicts on Husserl in relation to the analytic debates on perception.
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- 2017
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167. Effect of Teriparatide or Risedronate in Elderly Patients With a Recent Pertrochanteric Hip Fracture: Final Results of a 78-Week Randomized Clinical Trial
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Costantino Corradini, Pedro A García-Hernández, Umberto Tarantino, Søren Overgaard, José R. Caeiro, Kyriakos A. Papavasiliou, Jan J. Stepan, Eric Lespessailles, Per Aspenberg, Helmut Petto, Fernando Marin, Frede Frihagen, Jorge Malouf-Sierra, and Lars C. Borris
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musculoskeletal diseases ,medicine.medical_specialty ,Visual analogue scale ,Endocrinology, Diabetes and Metabolism ,Urology ,030209 endocrinology & metabolism ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Teriparatide ,medicine ,Clinical endpoint ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Femoral neck ,Hip fracture ,business.industry ,Repeated measures design ,medicine.disease ,3. Good health ,Surgery ,medicine.anatomical_structure ,Orthopedic surgery ,business ,medicine.drug - Abstract
We present final results of a study comparing teriparatide 20 μg every day (QD) with risedronate 35 mg once per week (QW) started within 2 weeks after surgery for a pertrochanteric hip fracture. Patients with BMD T-score ≤ -2.0 and 25OHD ≥9.2 ng/mL were randomized to receive 26-week double-dummy treatment plus calcium and vitamin D, followed by 52-week open-label treatment with the same assigned active drug. Primary endpoint was change from baseline in lumbar spine (LS) BMD at 78 weeks. Secondary and exploratory endpoints were change in BMD at the proximal femur, function, hip pain (Charnley score and 100 mm Visual Analog Scale [VAS]), quality of life (Short Form-36), radiology outcomes, and safety. Data were analyzed with mixed models for repeated measures (MMRM) and logistic regression. Totally, 224 patients were randomized; 171 (teriparatide: 86) contributed to the efficacy analyses (mean ± SD age: 77 ± 7.7 years, 77% females). Mean baseline LS, femoral neck (FN), and total hip (TH) T-scores were -2.16, -2.63, and -2.51, respectively. At 78 weeks, BMD increased significantly more with teriparatide compared to risedronate at the LS (+11.08% versus +6.45%; p < 0.001) and FN (+1.96% versus -1.19%; p = 0.003), with no significant between-group difference in TH BMD. Timed up-and-go (TUG) test was significantly faster with teriparatide at 6, 12, 18, and 26 weeks (differences: -3.2 to -5.9 s; p = 0.045 for overall difference). Hip pain during TUG test by 100 mm VAS was significantly lower with teriparatide at 18 weeks (adjusted difference: -11.3 mm, p = 0.033; -10.0 and -9.3 mm at 12 and 26 weeks, respectively; p = 0.079 for overall difference). Other secondary and exploratory outcomes were not different. Teriparatide group showed two new hip fractures versus seven with risedronate (p = 0.171) and more frequent hypercalcemia and hyperuricemia. In conclusion, 78-week treatment with teriparatide showed significantly greater increases in LS and FN BMD, less pain, and a faster TUG test versus risedronate. © 2016 American Society for Bone and Mineral Research.
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- 2017
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168. Reverse hybrid total hip arthroplasty
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Keijo T Mäkelä, Anne Marie Fenstad, Antti Eskelinen, Søren Overgaard, Johan Kärrholm, Göran Garellick, Alma B Pedersen, Ove Furnes, Helge Wangen, Geir Hallan, Leif Ivar Havelin, and Lars Nordsletten
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musculoskeletal diseases ,medicine.medical_specialty ,medicine.medical_treatment ,Periprosthetic ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Survival rate ,Orthopedic surgery ,ta3126 ,030222 orthopedics ,Proportional hazards model ,business.industry ,Incidence (epidemiology) ,General Medicine ,Femoral fracture ,medicine.disease ,Arthroplasty ,Surgery ,surgical procedures, operative ,Relative risk ,business ,RD701-811 ,Total hip arthroplasty - Abstract
Background and purpose - The use of a cemented cup together with an uncemented stem in total hip arthroplasty (THA) has become popular in Norway and Sweden during the last decade. The results of this prosthetic concept, reverse hybrid THA, have been sparsely described. The Nordic Arthroplasty Register Association (NARA) has already published 2 papers describing results of reverse hybrid THAs in different age groups. Based on data collected over 2 additional years, we wanted to perform in depth analyses of not only the reverse hybrid concept but also of the different cup/stem combinations used. Patients and methods - From the NARA, we extracted data on reverse hybrid THAs from January 1, 2000 until December 31, 2013. 38,415 such hips were studied and compared with cemented THAs. The Kaplan-Meier method and Cox regression analyses were used to estimate the prosthesis survival and the relative risk of revision. The main endpoint was revision for any reason. We also performed specific analyses regarding the different reasons for revision and analyses regarding the cup/stem combinations used in more than 500 cases. Results - We found a higher rate of revision for reverse hybrids than for cemented THAs, with an adjusted relative risk of revision (RR) of 1.4 (95% CI: 1.3-1.5). At 10 years, the survival rate was 94% (CI: 94-95) for cemented THAs and 92% (95% CI: 92-93) for reverse hybrids. The results for the reverse hybrid THAs were inferior to those for cemented THAs in patients aged 55 years or more (RR =1.1, CI: 1.0-1.3; p < 0.05). We found a higher rate of early revision due to periprosthetic femoral fracture for reverse hybrids than for cemented THAs in patients aged 55 years or more (RR =3.1, CI: 2.2-4.5; p < 0.001). Interpretation - Reverse hybrid THAs had a slightly higher rate of revision than cemented THAs in patients aged 55 or more. The difference in survival was mainly caused by a higher incidence of early revision due to periprosthetic femoral fracture in the reversed hybrid THAs.
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- 2017
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169. P120. Five-year patient reported outcomes ABM/P-15 versus allograft in non-instrumented posterolateral fusion
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Leah Y. Carreon, Michael Kjær Jacobsen, Mikkel Meyer Andersen, and Søren Overgaard
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medicine.medical_specialty ,Visual analogue scale ,business.industry ,Decompression ,Spinal stenosis ,Context (language use) ,medicine.disease ,Surgery ,law.invention ,Oswestry Disability Index ,Posterolateral fusion ,Lumbar ,Randomized controlled trial ,law ,medicine ,Orthopedics and Sports Medicine ,Neurology (clinical) ,business - Abstract
BACKGROUND CONTEXT Due to poor bone stock in the elderly, with concerns of screw pull-out, a non-instrumented fusion is commonly performed in Scandinavia when lumbar instability is present. Allograft bone is often used as graft extender with consequent low fusion rates. In an attempt to increase fusion rates, we conducted an RCT comparing ABM/P-15 versus allograft in non-instrumented lumbar fusion surgery. Despite obtaining an overall fusion rate of 59% in the ABM/P-15 group compared to 35% in the allograft graft group based on 1-year postoperative fine cut CT-scans, Patient Reported Outcomes (PROs) at 2 years post operatively were similar between the two groups. PURPOSE To compare 5-year PROs of patients with non-instrumented posterolateral fusion due to degenerative spondylolisthesis with either 15 amino acid residue (ABM/P-15) or allograft. STUDY DESIGN/SETTING Randomized clinical trial. PATIENT SAMPLE Patients 65 years or older with spinal stenosis and degenerative spondylolisthesis (DS) who previously underwent decompression and non-instrumented posterolateral fusion a minimum 5 years prior. OUTCOME MEASURES Oswestry Disability Index (ODI), Visual analog scales (VAS) for Back (BP) and Leg Pain (LP) and EuroQOL-5D (EQ5D). METHODS A total of 101 patients were enrolled in the study and randomized 1:1 to either ABM/P-15 (mixed 50/50, 5cc/level) or allograft bone (30g/level), both mixed with local bone graft. PROs were collected at baseline and at 12, 24 and 60 months postoperative. RESULTS The two groups were similar in terms of sex distribution, age and number of levels fused at baseline. There were 98 patients available for analysis after 1 year, 90 and 78 patients after 2 and 5 years. Patients in both groups reported clinically and statistically significant improvements in all PROs from baseline to postoperative on all outcome measures. At 5 years follow-up, no significant differences were reported on LP (ABM/P-15=25,8 vs 32,0, p=0,36) or EQ5D (ABM/P-15=0,81 vs 0,74, p=0,21) whereas ODI (ABM/P-15=18,6 vs 27,0, p= 0,04) and BP (ABM/P-15=22,5 vs 38,4, p=0,02) were statistically significant better in the ABM/P-15 group. CONCLUSIONS At the 5-year follow-up period, patients who had non-instrumented posterolateral fusion augmented with ABM/P-15 had better ODI and BP scores compared to the allograft only group, despite showing similar PROs at the 2-year follow-up period. FDA DEVICE/DRUG STATUS ABM/P-15 (Investigational/Not approved)
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- 2020
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170. A home-based exercise and activity modification program in patients with acetabular retroversion and excessive anterior pelvic tilt
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Søren Overgaard, Erik Poulsen, Anders Holsgaard-Larsen, Anders Falk Brekke, and Bo Redder Mussmann
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Pelvic tilt ,medicine.medical_specialty ,business.industry ,Rehabilitation ,Biophysics ,Medicine ,Orthopedics and Sports Medicine ,In patient ,Acetabular retroversion ,Home based exercise ,business ,Surgery - Abstract
INTRODUCTION: Acetabular retroversion (AR) is a variant of hip dysplasia,1 enhancing the risk of pincer-morphology femoroacetabular impingement syndrome (FAIS).2 FAIS is associated with pain,3 reduced level of function,4 decreased health-related quality of life,5 and early development of hip osteoarthritis (OA).6, 7 Symptoms may be exacerbated by anterior pelvic tilt (APT)8 as it functionally increases anterosuperior femoral head cover.1, 9, 10 Currently, the standard treatment for symptomatic AR is an invasive anteverting periacetabular osteotomy.11 Exercise aiming at reducing APT may be a less-invasive alternative treatment strategy. However, the impact of a targeted exercise intervention in patients with symptomatic AR, and excessive APT is unknown. RESEARCH QUESTION: What is the change in patient-reported symptoms and pelvic tilt in patients with AR and excessive APT of an 8-week targeted progressive home-based exercise intervention compared with a prior control period?METHODS: The sample size was n=36 patients (age 18-40 years) not eligible for surgery, with radiographic signs of AR on an anterior/posterior radiograph in standing position. Patients were recruited from Odense University Hospital outpatient clinic (Denmark) from November 2018 to December 2019. Exclusion criteria were; pelvic-tilt-ratio greater than 0.512 (the height of the obturator foramen divided by the height of the lesser pelvis) indicating posterior pelvic tilt, radiographic sign of hip OA, related surgery, and a body mass index (BMI) above 35. The intervention consisted of education, activity modification, stretching for posterior pelvic tilt mobility, strengthening muscles for tilting the pelvis posteriorly, improving body core stability, and pelvic movement control three times per week. The primary outcome was change in the Copenhagen Hip and Groin Outcome Score (HAGOS) pain subscale. Secondary outcomes included change in pelvic tilt in standing position measured by EOS® scanning, as the angle between a horizontal line and a line connecting the upper border of the symphysis with the sacral promontory.13RESULTS: Forty-two patients (39 women) (median [interquartile range], 20.5 [19 – 25 years] were included. Three patients were lost to follow-up. Between-period mean change scores were 5.2 points (95% confidence interval [CI]: [-0.3 – 10.6]), for the HAGOS-PAIN subscale and -1.6 degrees [-3.9 – 0.7] of anterior pelvic tilt. DISCUSSION: No statistical or clinically relevant changes in self-reported hip-related pain and APT were found. However, post-hoc responder analysis revealed that patients with moderate pain at baseline benefited from exercise. Patients had an excessive APT of 74° ±8 (mean ±SD) at baseline, which is 14° more than the defined neutral pelvic tilt.13 The current study is limited by a short and unsupervised training period, and measuring static pelvic tilt only. Future results from three-dimensional gait analysis will provide answers to whether patients' ability to dynamically tilt their pelvis posteriorly has changed.REFERENCES: 1. Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum. A cause of hip pain. J Bone Joint Surg Br. 1999;81(2):281-8.2. Siebenrock KA, Schoeniger R, Ganz R. Anterior femoro-acetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy. J Bone Joint Surg Am. 2003;85(2):278-86.3. Langlais F, Lambotte JC, Lannou R, Gedouin JE, Belot N, Thomazeau H, et al. Hip pain from impingement and dysplasia in patients aged 20-50 years. Workup and role for reconstruction. Joint Bone Spine. 2006;73(6):614-23.4. Rylander JH, Shu B, Andriacchi TP, Safran MR. Preoperative and postoperative sagittal plane hip kinematics in patients with femoroacetabular impingement during level walking. Am J Sports Med. 2011;39 Suppl:36S-42S.5. Clohisy JC, Baca G, Beaule PE, Kim YJ, Larson CM, Millis MB, et al. Descriptive epidemiology of femoroacetabular impingement: a North American cohort of patients undergoing surgery. Am J Sports Med. 2013;41(6):1348-56.6. Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003(417):112-20.7. Giori NJ, Trousdale RT. Acetabular retroversion is associated with osteoarthritis of the hip. Clin Orthop Relat Res. 2003(417):263-9.8. Riviere C, Hardijzer A, Lazennec JY, Beaule P, Muirhead-Allwood S, Cobb J. Spine-hip relations add understandings to the pathophysiology of femoro-acetabular impingement: A systematic review. Orthop Traumatol Surg Res. 2017;103(4):549-57.9. Dandachli W, Ul Islam S, Richards R, Hall-Craggs M, Witt J. The influence of pelvic tilt on acetabular orientation and cover: a three-dimensional computerised tomography analysis. Hip Int. 2013;23(1):87-92.10. Ross JR, Nepple JJ, Philippon MJ, Kelly BT, Larson CM, Bedi A. Effect of Changes in Pelvic Tilt on Range of Motion to Impingement and Radiographic Parameters of Acetabular Morphologic Characteristics. Am J Sports Med. 2014.11. Siebenrock KA, Schaller C, Tannast M, Keel M, Buchler L. Anteverting periacetabular osteotomy for symptomatic acetabular retroversion: results at ten years. J Bone Joint Surg Am. 2014;96(21):1785-92.12. Schwarz T, Benditz A, Springorum HR, Matussek J, Heers G, Weber M, et al. Assessment of pelvic tilt in anteroposterior radiographs by means of tilt ratios. Arch Orthop Trauma Surg. 2018.13. Tannast M, Murphy SB, Langlotz F, Anderson SE, Siebenrock KA. Estimation of pelvic tilt on anteroposterior X-rays--a comparison of six parameters. Skeletal Radiol. 2006;35(3):149-55.
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- 2020
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171. O 047 – The effectiveness of instrumented gait analysis for interdisciplinary interventions in young children with cerebral palsy – A randomised controlled trial
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Søren Overgaard, Vilhelm Engell, Lars Kjærsgaard Hansen, Anders Holsgaard-Larsen, Niels Wisbech Pedersen, Ulrike Dunkhase-Heinl, and Helle Mätzke Rasmussen
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medicine.medical_specialty ,business.industry ,Rehabilitation ,Biophysics ,Psychological intervention ,medicine.disease ,law.invention ,Cerebral palsy ,Physical medicine and rehabilitation ,Randomized controlled trial ,law ,Gait analysis ,medicine ,Orthopedics and Sports Medicine ,business - Published
- 2018
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172. Reframing the issue of direct social perception
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Søren Overgaard
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Social perception ,05 social sciences ,General Physics and Astronomy ,06 humanities and the arts ,Cognitive reframing ,0603 philosophy, ethics and religion ,050105 experimental psychology ,Experimental strategy ,Artificial Intelligence ,060302 philosophy ,0501 psychology and cognitive sciences ,Observability ,General Agricultural and Biological Sciences ,Psychology ,Social psychology - Published
- 2018
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173. Against a Clear Conscience
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Søren Overgaard
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Psychoanalysis ,Philosophy ,media_common.quotation_subject ,Conscience ,media_common - Published
- 2019
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174. Empowerment of whom? The gap between what the system provides and patient needs in hip fracture management: A healthcare professionals' lifeworld perspective
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Julie Santy-Tomlinson, Charlotte Myhre Jensen, Anthony C Smith, Jane Clemensen, Søren Overgaard, Pernille Ravn Jakobsen, and Uffe Kock Wiil
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System ,Lifeworld ,media_common.quotation_subject ,Health Personnel ,Hip fracture ,03 medical and health sciences ,0302 clinical medicine ,Habermas ,Nursing ,Healthcare professionals ,Health care ,Medicine ,Humans ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Empowerment ,Qualitative Research ,media_common ,Advanced and Specialized Nursing ,030222 orthopedics ,Health professionals ,business.industry ,Hip Fractures ,Perspective (graphical) ,Focus groups ,medicine.disease ,Focus group ,Content analysis ,Self-care ,Patient Participation ,business ,Follow-Up Studies - Abstract
Aims and objectives To use a Habermasian lifeworld theoretical perspective to illuminate a treatment gap for hip fracture patients in a Danish university hospital to guide future healthcare services. Background Most healthcare systems focus on systematised guidelines to help reduce hospital length of stay in response to increasing demand because of the ageing of the global population. For patients with hip fractures, a previous study demonstrated that there is a lack of patient empowerment and a gap between patients’ needs and wishes and what was provided by the healthcare system. Design In this follow-up study, the previous findings were introduced to a mixed group of health professionals (HPs) who participated in focus group discussions (n = 3, with a total of 18 HPs). Methods Data were analysed using qualitative content analysis. By analysing the discourse of the discussions using Habermas’ perspective, the lack of patient-empowerment was illuminated and facilitated, describing it in terms of the gap it creates in communicative actions between HPs and patients. Results Information and education of patients in systematised pathways, such as those for patients with hip fractures, are dominated by a biomedical discourse. Patients are overwhelmed by the psycho-social implications of the hip fracture, leaving them in a shock-like state of mind. Conclusion Empowerment of patients should involve empowerment of HPs by providing them with skills to support patients in a shock-like state of mind. There is also a need to provide HPs with a more individually targeted means of informing and educating patients.
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- 2019
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175. DEX-2-TKA-DEXamethasone twice for pain treatment after Total Knee Arthroplasty: A protocol for a randomized, blinded, three-group multicentre clinical trial
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Troels Haxholdt Lunn, Stig Brorson, Kasper Smidt Gasbjerg, Peter Lindholm, Jens Bagger, Ole Mathiesen, Henrik Morville Schrøder, Niels Anker Pedersen, Janus Christian Jakobsen, Kasper Højgaard Thybo, Daniel Hägi-Pedersen, and Søren Overgaard
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Analgesic ,Placebo ,Dexamethasone ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Clinical Protocols ,030202 anesthesiology ,law ,medicine ,Humans ,Arthroplasty, Replacement, Knee ,Pain, Postoperative ,business.industry ,030208 emergency & critical care medicine ,General Medicine ,Perioperative ,Clinical trial ,Regimen ,Anesthesiology and Pain Medicine ,Opioid ,Anesthesia ,business ,Methadone ,medicine.drug - Abstract
BACKGROUND: Multimodal analgesia is considered the leading principle for post-operative pain treatment, but no gold standard after total knee arthroplasty (TKA) exists.AIM: To investigate the beneficial and harmful effects of one or two doses of 24 mg intravenous dexamethasone (DXM) as part of a multimodal analgesic regimen (paracetamol, NSAID and perioperative local infiltration analgesia) after TKA. We hypothesize that addition of DXM will reduce post-operative opioid consumption.METHODS: DEXamethasone twice for pain treatment after TKA is a randomized, blinded, three-group multicentre clinical trial. Participants will be randomized to one of three groups: placebo, single dose of DXM or two consecutive doses of DXM. Participants, treatment providers and investigators will be blinded to the allocated intervention. The primary outcome is total opioid consumption (units of morphine equivalents) 0-48 hours post-operatively.INCLUSION CRITERIA: unilateral, primary TKA; age ≥18 years; American Society of Anesthesiologists-Score 1-3; Body Mass Index ≥18 and ≤40; for women-not pregnant; and written informed consent.EXCLUSION CRITERIA: allergy or contraindications against trial medication; daily use of high dose opioid and/or use of methadone/transdermal opioids; daily use of systemic glucocorticoids; dysregulated diabetes; and patients suffering from alcohol and/or drug abuse. Four-hundred-and-eighty-six eligible participants are needed to detect or discard a difference of 10 mg morphine equivalents 0-48 hours post-operatively maintaining a familywise error rate of 0.05 and a power of 90% for the three possible pairwise comparisons.DISCUSSION: Recruiting is planned to commence September 2018 and expected to finish March 2020.TRIAL REGISTRATION: EudraCT: 2018-001099-39 (08/06-18); ClinicalTrials.gov: NCT03506789 (24/04-2019). Editorial Comment This is the protocol for the largest randomized clinical trial investigating the effect of one or two doses of dexamethasones on pain treatment after total knee arthroplasty. Due to the pragmatic and rigerous design this study will deliver results of high quality and external validity.
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- 2019
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176. Risk factors for new chronic opioid use after hip fracture surgery: A Danish nationwide cohort study from 2005-2016
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Nina Mckinnon Edwards, Claus Varnum, Søren Overgaard, and alma b pedersen
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- 2019
177. Mismatch 'never events' in hip and knee arthroplasty:a cohort and intervention study
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Anders Troelsen, Mogens Berg Laursen, Frank Madsen, Søren Overgaard, Henrik Daa Schrøder, Kirill Gromov, Anders Odgaard, and P W Kristensen
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SURGERY ,medicine.medical_treatment ,Knee Prosthesis/adverse effects ,Arthroplasty, Replacement, Hip ,Denmark ,Arthroplasty, Replacement, Knee/instrumentation ,Prosthesis Failure/adverse effects ,Cohort Studies ,0302 clinical medicine ,Prosthesis Design/adverse effects ,Never event ,CONFIRMATION BIAS ,Hip Prosthesis/adverse effects ,Medicine ,Orthopedics and Sports Medicine ,Registries ,Arthroplasty, Replacement, Knee ,030222 orthopedics ,Medical Errors ,05 social sciences ,Prosthesis Failure ,REVISION ,Patient safety ,Mismatch ,Cohort ,Incompatibility ,Knee Prosthesis ,Cohort study ,medicine.medical_specialty ,ERRORS ,Prosthesis Design ,050105 experimental psychology ,Arthroplasty ,03 medical and health sciences ,Computer Systems ,Humans ,Knee ,0501 psychology and cognitive sciences ,Arthroplasty, Replacement, Hip/instrumentation ,Hip ,business.industry ,Implant ,Intervention studies ,Medical Errors/adverse effects ,Never events ,Physical therapy ,Surgery ,Hip Prosthesis ,business ,COSTS - Abstract
Aims The aim of this study was to give estimates of the incidence of component incompatibility in hip and knee arthroplasty and to test the effect of an online, real-time compatibility check. Materials and Methods Intraoperative barcode registration of arthroplasty implants was introduced in Denmark in 2013. We developed a compatibility database and, from May 2017, real-time compatibility checking was implemented and became part of the registration. We defined four classes of component incompatibility: A-I, A-II, B-I, and B-II, depending on an assessment of the level of risk to the patient (A/B), and on whether incompatibility was knowingly accepted (I/II). Results A total of 26 524 arthroplasties were analyzed. From 12 307 procedures that were undertaken before implementation of the compatibility check, 21 class A incompatibilities were identified (real- or high-risk combinations; 0.17%; 95% confidence interval (CI) 0.11 to 0.26). From 5692 hip and 6615 knee procedures prior to implementation of the compatibility check, we found rates of class A-I incompatibility (real- or high-risk combinations unknowingly inserted) of 0.14% (95% CI 0.06 to 0.28) and 0.17% (95% CI 0.08 to 0.30), respectively. From 14 217 procedures after the introduction of compatibility checking (7187 hips and 7030 knees), eight class A incompatibilities (0.06%; 95% CI 0.02 to 0.11) were identified. This difference was statistically significant (p = 0.008). Conclusion Our data presents validated estimates of the baseline incidence of incompatibility events for hip and knee arthroplasty procedures and shows that a significant reduction in class A incompatibility events is possible using a web-based recording system. Cite this article: Bone Joint J 2019;101-B:960–969.
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- 2019
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178. Reduced Revision Risk for Dual-Mobility Cup in Total Hip Replacement Due to Hip Fracture: A Matched-Pair Analysis of 9,040 Cases from the Nordic Arthroplasty Register Association (NARA)
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Jan-Erik Gjertsen, Geir Hallan, Ammar Jobory, Cecilia Rogmark, Søren Overgaard, Keijo T Mäkelä, Alma B Pedersen, and Johan Kärrholm
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Male ,Reoperation ,medicine.medical_specialty ,medicine.medical_treatment ,Arthroplasty, Replacement, Hip ,Matched-Pair Analysis ,Scandinavian and Nordic Countries ,Lower risk ,Prosthesis Design ,Femoral Neck Fractures ,medicine ,Humans ,Orthopedics and Sports Medicine ,Registries ,ARTHROPLASTY ,Propensity Score ,Aged ,Hip fracture ,business.industry ,Hip Fractures ,MORTALITY ,Hazard ratio ,General Medicine ,medicine.disease ,Arthroplasty ,Confidence interval ,Surgery ,Prosthesis Failure ,HEMIARTHROPLASTY ,DISLOCATION ,Propensity score matching ,Orthopedic surgery ,Female ,Hip Prosthesis ,FOLLOW-UP ,COMORBIDITY ,business ,FEMORAL-NECK FRACTURES - Abstract
BACKGROUND: The dual-mobility acetabular cup (DMC) has an additional bearing consisting of a mobile polyethylene component between the prosthetic head and the outer metal shell. This design has gained popularity in revision total hip arthroplasty (THA) and in primary treatment of femoral neck fractures with the anticipation of a reduced risk of THA instability. Our primary aim was to evaluate the overall revision risk of these cups on the basis of data from the Nordic Arthroplasty Register Association (NARA) database, and our secondary aim was to study specific revision causes including dislocation.METHODS: Propensity score matching for age, sex, fixation of the cup and stem, and the year of surgery (2001 to 2014) was used to match 4,520 hip fractures treated with a DMC to 4,520 hip fractures treated with conventional THA (control group). Competing risk regression analyses with revision or death as the end point were used. Revision was defined as a secondary surgical procedure in which any component of the implant was removed or exchanged. In addition, revision of the cup was analyzed.RESULTS: The DMCs had a lower risk of revision compared with conventional THA, with an adjusted hazard ratio (AHR) of 0.75 (95% confidence interval [CI] = 0.62 to 0.92). This was consistent after adjusting for surgical approach. DMCs had a lower risk of revision due to dislocation (AHR = 0.45 [95% CI = 0.30 to 0.68]) but we found no difference regarding revision for deep infection. Revision of the acetabular component, both in general and due to dislocation, was more frequent with the use of conventional cups. The risk of death was higher in the DMC group (AHR = 1.49 [95% CI = 1.40 to 1.59]).CONCLUSIONS: The use of a DMC as primary treatment for hip fracture was associated with a lower risk of revision in general and due to dislocation in particular. The total number of DMCs analyzed (4,520) likely exceeds any cohort of DMC-treated fractures published to date.LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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179. Homogeneity in prediction of survival probabilities for subcategories of hipprosthesis data: The Nordic Arthroplasty Register Association, 2000-2013
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Antti Eskelinen, Christoffer Bartz-Johannessen, Keijo T Mäkelä, Jeremy Mark Wilkinson, Henrik Malchau, Alma B Pedersen, Søren Overgaard, Stein Atle Lie, Ove Furnes, Johan Kärrholm, and Anne Marie Fenstad
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Head size ,Epidemiology ,medicine.medical_treatment ,MODELS ,Variance ,030204 cardiovascular system & hematology ,TOTAL HIP-ARTHROPLASTY ,Individual risk ,variance ,03 medical and health sciences ,0302 clinical medicine ,Statistics ,merging data sets ,Medicine ,hip replacement ,030212 general & internal medicine ,POPULATION ,Accuracy ,RISK ,Subcategory ,POLYETHYLENE ,accuracy ,business.industry ,MORTALITY ,Homogeneity (statistics) ,Methodology ,Small sample ,Precision ,Hip replacement ,Arthroplasty ,Arthroplasty registry ,arthroplasty registry ,Sample size determination ,METAL ,HEART-FAILURE ,KNEE ,precision ,Merging data sets ,business ,Prosthesis Survival - Abstract
Introduction: The four countries in the Nordic Arthroplasty Register Association (NARA) share geographic proximity, culture, and ethnicity. Pooling data from different sources in order to obtain higher precision and accuracy of survival-probability estimates is appealing. Nevertheless, survival probabilities of hip replacements vary between the countries. As such, risk prediction for individual patients within countries may be problematic if data are merged. In this study, our primary question was to address when data merging for estimating prosthesis survival in subcategories of patients is advantageous for survival prediction of individual patients, and at what sample sizes this may be advised.Methods: Patients undergoing total hip replacements for osteoarthritis between January 1, 2000 and December 31, 2013 in the four Nordic countries were studied. A total of 184,507 patients were stratified into 360 patient subcategories based on country, age-group, sex, fixation, head size, and articulation. For each patient category, we determined the sample size needed from a single country to obtain a more accurate and precise estimate of prosthesis-survival probability at 5 and 10 years compared to an estimate using data from all countries. The comparison was done using mean-square error.Results: We found large variations in the sample size needed, ranging from 40 to 2,060 hips, before an estimate from a single Nordic country was more accurate and precise than estimates based on the NARA data.Conclusion: Using pooled survival-probability estimates for individual risk prediction may be imprecise if there is heterogeneity in the pooled data sources. By applying mean-square error, we demonstrate that for small sample sizes, applying the larger NARA database may provide a more accurate and precise estimate; however, this effect is not consistent and varies with the characteristics of the subcategory.
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180. The effectiveness of instrumented gait analysis on family-centered services in children with cerebral palsy – a randomized controlled trial
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Søren Overgaard, Christina Esmann Fonvig, and Anders Holsgaard-Larsen
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Rehabilitation ,Biophysics ,Orthopedics and Sports Medicine - Published
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181. Orthopaedic registries with patient-reported outcome measures
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Ian Wilson, Michael J. Dunbar, Mark Wilkinson, Søren Overgaard, Ola Rolfson, Stephen Lyman, Annette W-Dahl, Eric Bohm, and Anne Lübbeke
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medicine.medical_specialty ,General Orthopaedics ,media_common.quotation_subject ,medicine.medical_treatment ,Prom ,Disease ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Patient-Reported Outcome ,Survivorship curve ,medicine ,Orthopedics and Sports Medicine ,Quality (business) ,030212 general & internal medicine ,Knee Arthroplasty ,Intensive care medicine ,Patient-reported outcome ,media_common ,030222 orthopedics ,business.industry ,Patient-reported outcome measure ,Patient-Reported Outcome Measure ,Hip Arthroplasty ,Joint registry ,Arthroplasty ,Knee arthroplasty ,Joint Registry ,Hip arthroplasty ,Surgery ,business ,Quality assurance - Abstract
Total joint arthroplasty is performed to decreased pain, restore function and productivity and improve quality of life. One-year implant survivorship following surgery is nearly 100%; however, self-reported satisfaction is 80% after total knee arthroplasty and 90% after total hip arthroplasty. Patient-reported outcomes (PROs) are produced by patients reporting on their own health status directly without interpretation from a surgeon or other medical professional; a PRO measure (PROM) is a tool, often a questionnaire, that measures different aspects of patient-related outcomes. Generic PROs are related to a patient’s general health and quality of life, whereas a specific PRO is focused on a particular disease, symptom or anatomical region. While revision surgery is the traditional endpoint of registries, it is blunt and likely insufficient as a measure of success; PROMs address this shortcoming by expanding beyond survival and measuring outcomes that are relevant to patients – relief of pain, restoration of function and improvement in quality of life. PROMs are increasing in use in many national and regional orthopaedic arthroplasty registries. PROMs data can provide important information on value-based care, support quality assurance and improvement initiatives, help refine surgical indications and may improve shared decision-making and surgical timing. There are several practical considerations that need to be considered when implementing PROMs collection, as the undertaking itself may be expensive, a burden to the patient, as well as being time and labour intensive. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180080
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182. MoM total hip replacements in Europe: a NORE report
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Keith Tucker, Ola Rolfson, Ioan Cristian Stoica, Liza N van Steenbergen, Bart G Pijls, Anne Marie Fenstad, Susanna Stea, Rob G H H Nelissen, Jorge Torre, Søren Overgaard, Jennifer Meessen, Anne Lübbeke, Maxim Goncharov, and Keijo T Mäkelä
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030222 orthopedics ,medicine.medical_specialty ,General Orthopaedics ,business.industry ,Incidence (epidemiology) ,Total hip replacement ,Joint registry ,Confidence interval ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Metal-on-metal total hip replacement ,medicine ,Joint Registry ,Orthopedics and Sports Medicine ,Metal-on-Metal Total Hip Replacement ,030212 general & internal medicine ,Large head ,National registry ,business - Abstract
The purpose of this paper is to determine the prevalence of metal-on-metal (MoM) total hip replacement (THR) in European registries, to assess the incidence of revision surgery and to describe the national follow-up guidelines for patients with MoM THR including resurfacings. Eleven registries of the Network of Orthopaedic Registries of Europe (NORE) participated totalling 54 434 resurfacings and 58 498 large stemmed MoM THRs. The resurfacings and stemmed large head MoM had higher pooled revision rates at five years than the standard total hip arthroplasties (THA): 6.0%, 95% confidence interval (CI) 5.3 to 6.8 for resurfacings; 6.9%, 95% CI 4.4 to 9.4 for stemmed large head MoM; and 3.0%, 95% CI 2.5 to 3.6 for conventional THA. The resurfacings and stemmed large head MoM had higher pooled revision rates at ten years than the standard THAs: 12.1%, 95% CI 11.0 to 13.3 for resurfacings; 15.5%, 95% CI 9.0 to 22 for stemmed large head MoM; and 5.1%, 95% CI 3.8 to 6.4 for conventional THA. Although every national registry reports slightly different protocols for follow-up, these mostly consist of annual assessments of cobalt and chromium levels in blood and MRI (MARS) imaging. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180078
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183. Benefits and harm of paracetamol and ibuprofen in combination for post-operative pain: Pre-planned subgroup analyses of the multicenter, randomized PANSAID trial
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Kasper Højgaard Thybo, Jørgen B. Dahl, Karina Jakobsen, Louise Ibsen, Hans Henrik Bülow, Ole Mathiesen, Niels Anker Pedersen, Daniel Hägi-Pedersen, Jørn Wetterslev, Søren Overgaard, and Janus Christian Jakobsen
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Male ,medicine.medical_specialty ,Population ,Analgesic ,Psychological intervention ,Subgroup analysis ,Ibuprofen ,Internal medicine ,medicine ,Humans ,Adverse effect ,education ,Acetaminophen ,Aged ,Aged, 80 and over ,education.field_of_study ,Pain, Postoperative ,Morphine ,business.industry ,organic chemicals ,General Medicine ,Middle Aged ,Regimen ,Anesthesiology and Pain Medicine ,Drug Therapy, Combination ,Female ,business ,medicine.drug - Abstract
Background: The “Paracetamol and Ibuprofen in Combination” (PANSAID) trial showed that combining paracetamol and ibuprofen resulted in lower opioid consumption than each drug alone and we did not find an increase in risk of harm when using ibuprofen vs paracetamol. The aim of this subgroup analysis was to investigate the differences in benefits and harms of the interventions in different subgroups. We hypothesized that the intervention effects would differ in subgroups with different risk of pain or adverse events. Methods: In these pre-planned subgroup analyses of the PANSAID trial population, we assessed subgroup heterogeneity in intervention effects between (a) subgroups (sex, age, use of analgesics, American Society of Anesthesiologists (ASA) score, and type of anesthesia) and morphine consumption, and (b) subgroups (sex, age, use of non-steroidal anti-inflammatory drugs (NSAIDs), and ASA score) and serious adverse events. Results: Test of interaction between age and the pairwise comparison between paracetamol 1 g vs paracetamol 0.5 g + ibuprofen 200 mg (P =.009) suggested lower morphine consumption in patients >65 years. However, post hoc analyses of related outcomes showed no interaction for this pairwise comparison. All other tests of interaction regarding both benefit and harm were not statistically significant. Conclusion: These pre-planned subgroup analyses did not suggest that patients in the investigated subgroups benefitted differently from a basic non-opioid analgesic regimen consisting of paracetamol and ibuprofen. Further, there was no evidence of subgroup heterogeneity regarding harm and use of ibuprofen. Because of reduced statistical power in subgroup analyses, we cannot exclude clinically relevant subgroup heterogeneity.
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184. The benefits of collaboration:The Nordic Arthroplasty Register Association
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Keijo T Mäkelä, Otto Robertsson, Björn Salomonsson, Henrik Morville Schrøder, Annette W-Dahl, Antti Eskelinen, Ville Äärimaa, Johan Kärrholm, Ove Furnes, Randi Hole, Ola Rolfson, Geir Hallan, Anne Marie Fenstad, Cecilia Rogmark, Søren Overgaard, Alma B Pedersen, and Jeppe V. Rasmussen
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Register (sociolinguistics) ,General Orthopaedics ,medicine.medical_specialty ,Quality management ,medicine.medical_treatment ,03 medical and health sciences ,0302 clinical medicine ,statistical analyses ,Medicine ,Orthopedics and Sports Medicine ,030203 arthritis & rheumatology ,030222 orthopedics ,business.industry ,revision surgery ,total joint arthroplasty ,minimal dataset ,Resurfacing arthroplasty ,Arthroplasty ,Clinical Practice ,Statistical analyses ,Register data ,Family medicine ,Orthopedic surgery ,Nordic Arthroplasty Register Association (NARA) ,Total joint arthroplasty ,Surgery ,Revision surgery ,business ,Minimal dataset ,Total hip arthroplasty - Abstract
The Nordic Arthroplasty Register Association (NARA) was established in 2007 by arthroplasty register representatives from Sweden, Norway and Denmark with the overall aim to improve the quality of research and thereby enhance the possibility for quality improvement with arthroplasty surgery. Finland joined the NARA collaboration in 2010. NARA minimal hip, knee and shoulder datasets were created with variables that all countries can deliver. They are dynamic datasets, currently with 25 variables for hip arthroplasty, 20 for knee arthroplasty and 20 for shoulder arthroplasty. NARA has published statistical guidelines for the analysis of arthroplasty register data. The association is continuously working on the improvement of statistical methods and the application of new ones. There are 31 published peer-reviewed papers based on the NARA databases and 20 ongoing projects in different phases. Several NARA publications have significantly affected clinical practice. For example, metal-on-metal total hip arthroplasty and resurfacing arthroplasty have been abandoned due to increased revision risk based on i.a. NARA reports. Further, the use of uncemented total hip arthroplasty in elderly patients has decreased significantly, especially in Finland, based on the NARA data. The NARA collaboration has been successful because the countries were able to agree on a common dataset and variable definitions. The collaboration was also successful because the group was able to initiate a number of research projects and provide answers to clinically relevant questions. A number of specific goals, set up in 2007, have been achieved and new one has emerged in the process. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180058
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185. OP0091 RISK OF MEDICAL COMPLICATIONS FOLLOWING TOTAL HIP OR KNEE ARTHROPLASTY IN PATIENTS WITH RHEUMATOID ARTHRITIS: A NATIONWIDE REGISTER-BASED COHORT STUDY
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René Cordtz, Søren Overgaard, Lars Erik Kristensen, Anders Odgaard, and Lene Dreyer
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musculoskeletal diseases ,medicine.medical_specialty ,COPD ,business.industry ,Proportional hazards model ,medicine.medical_treatment ,Incidence (epidemiology) ,medicine.disease ,Lower risk ,Arthroplasty ,Internal medicine ,Rheumatoid arthritis ,Propensity score matching ,medicine ,business ,Cohort study - Abstract
Background: Total hip and total knee arthroplasty (THA/TKA) are major surgeries carrying a risk of complications. Patients with rheumatoid arthritis (RA) are at increased risk of venous thromboembolism (VTE), arterial thromboembolic events (ATE), and infections in a non-surgical setting. Objectives: To investigate the risk of VTE, ATE, and non-surgical infection following THA/TKA in patients with RA compared with osteoarthritis (OA); and to explore the impact of biologics treatment. Methods: In a nationwide register-based study, patients with RA and OA who had elective THA/TKA in 2000-2014 were identified in the Danish Hip Arthroplasty Register/Danish Knee Arthroplasty Register and followed up to 90 days after surgery for the occurrence of VTE, ATE, and infections. Cox models stratified on sex and type of surgery (THA vs TKA) and adjusted for age, calendar period, history of chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM), cancer, VTE and CVD were carried out. Outcome information was obtained through linkage with the Danish National Patient Registry. In DANBIO, we identified RA patients treated with biologics within 90 days preceding surgery and estimated their risk of each outcome compared with non-biologics treated RA patients in a Cox model adjusted for the propensity score (PS) of receiving biologics as a restricted cubic spline covariate. The PS was conditional on age, sex, calendar period, use of methotrexate, other csDMARDs, and/or glucocorticoids, pre-surgical DAS28, HAQ-DI, VAS physician, and COPD, DM, cancer and/or VTE. Results: In total, 2899 and 112,571 patients with RA and OA were followed-up (Table). Conclusion: In this nationwide cohort study, RA patients were at increased risk of infection after THA/TKA compared to OA patients, but treatment with biologics did not further increase the risk. As seen in other studies RA patients had a lower risk of VTE following TKA when compared with OA patients, but our finding of an increased incidence of VTE in biologics-treated patients warrants further studies. Disclosure of Interests: Rene Cordtz: None declared, Lars Erik Kristensen Grant/research support from: UCB, Biogen, Janssen Pharmaceuticals, and Novartis, Consultant for: Consultant for AbbVie, Amgen, Biogen, BMS, Celgene, Eli Lilly, Janssen Pharmaceuticals, MSD, Novartis, Pfizer, Roche, Sanofi, and UCB Pharma., Speakers bureau: Pfizer, AbbVie, Amgen, UCB, BMS, Biogen, MSD, Novartis, Eli Lilly and Company, and Janssen Pharmaceuticals, Anders Odgaard: None declared, Soren Overgaard: None declared, Lene Dreyer Consultant for: MSD, UCB and Janssen Pharmaceuticals, Speakers bureau: MSD, UCB and Janssen Pharmaceuticals, Speakers bureau: UCB, MSD, Eli Lilly and Janssen Pharmaceuticals.
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186. THU0059 INCIDENCE OF JOINT REPLACEMENT SURGERY AMONG BIOLOGICS AND NON-BIOLOGICS TREATED PATIENTS WITH RHEUMATOID ARTHRITIS: A PROPENSITY SCORE MATCHED COHORT STUDY FROM DENMARK
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Søren Overgaard, Daniel Prieto-Alhambra, Samuel Hawley, Anders Odgaard, Lars Erik Kristensen, René Cordtz, and Lene Dreyer
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medicine.medical_specialty ,Patient registry ,Joint replacement ,business.industry ,Incidence (epidemiology) ,medicine.medical_treatment ,Hazard ratio ,medicine.disease ,Surgery ,Matched cohort ,Rheumatoid arthritis ,Propensity score matching ,medicine ,business ,Cohort study - Abstract
Background Biologics have improved several clinical, patient-reported and radiological outcomes in patients with rheumatoid arthritis (RA), but little is known about the potential impact on the need for joint replacement surgery. Objectives To investigate the incidence of joint replacement surgery among biologics treated compared with biologics naive patients with RA. Methods A nationwide, register-based propensity score matched cohort study. RA patients registered between 2006 and 2016 in the DANBIO register with a disease duration ≤ 2 years were identified. Patients initiating their first treatment series with biologics were followed up to 10 years for a first joint replacement of the hip, knee, shoulder, elbow and finger/wrist. Biologics naive patients were followed up for the same outcome from their first clinical visit registered in DANBIO. Following a 1:n propensity score matching, Cox-models were undertaken to calculate the hazard ratio (HR) for a first joint replacement surgery among biologics compared with non-biologics treated RA patients. Further, subgroup analyses based on within-strata propensity score matched patients were carried out. All information on surgical outcomes was obtained in the Danish National Patient Registry. Results In total, 1187 biologics treated were matched with 3666 non-biologics treated patients (See Table). During follow-up, 43 biologics-treated and 124 naive patients had a first joint replacement surgery corresponding to an overall HR of 0.95 (0.65 to 1.40) for biologics treated compared with naive patients (Figure 1). Patients with a DAS28-CRP Conclusion In this nationwide Danish cohort study, there was no difference in the incidence of joint replacement surgery among newly diagnosed RA patients selected for treatment with biologics compared with patients naive to biologics. References [1] Fleischmann, et al. DAS28-CRP and DAS28-ESR cut-offs for high disease activity in rheumatoid arthritis are not interchangeable. RMD Open 2017;3:2–6. Disclosure of Interests Rene Cordtz: None declared, Samuel Hawley: None declared, Daniel Prieto-Alhambra Grant/research support from: Grants from Amgen, UCB Biopharma and Servier outside the submitted work, Consultant for: UCB Biopharma, Speakers bureau: Amgen, Lars Erik Kristensen Grant/research support from: UCB, Biogen, Janssen Pharmaceuticals, and Novartis, Consultant for: Consultant for AbbVie, Amgen, Biogen, BMS, Celgene, Eli Lilly, Janssen Pharmaceuticals, MSD, Novartis, Pfizer, Roche, Sanofi, and UCB Pharma., Speakers bureau: Pfizer, AbbVie, Amgen, UCB, BMS, Biogen, MSD, Novartis, Eli Lilly and Company, and Janssen Pharmaceuticals, Soren Overgaard: None declared, Anders Odgaard: None declared, Lene Dreyer Consultant for: MSD, UCB and Janssen Pharmaceuticals, Speakers bureau: MSD, UCB and Janssen Pharmaceuticals, Speakers bureau: UCB, MSD, Eli Lilly and Janssen Pharmaceuticals.
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187. Risk factors for new chronic opioid use after hip fracture surgery: A Danish nationwide cohort study from 2005 to 2016
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Nina Mckinnon Edwards, Claus Varnum, Søren Overgaard, and alma b pedersen
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188. Effect of Combination of Paracetamol (Acetaminophen) and Ibuprofen vs Either Alone on Patient-Controlled Morphine Consumption in the First 24 Hours After Total Hip Arthroplasty: The PANSAID Randomized Clinical Trial
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Kasper Højgaard Thybo, Ole Mathiesen, Rune Frederiksen, Henrik Morville Schrøder, Jan Gottfrid Bjørck, Kamilla Skovmand, Mariam Nersesjan, Daniel Hägi-Pedersen, Jørn Wetterslev, Janus Christian Jakobsen, Laura Smedegaard Kruuse, Morten Buus-Nielsen, Niels Anker Pedersen, Charlotte Voss Sørensen, Harald Schmidt, Søren Overgaard, Peter Lindholm, and Jørgen B. Dahl
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Male ,Pain, Postoperative/drug therapy ,medicine.medical_treatment ,Arthroplasty, Replacement, Hip ,Administration, Oral ,Ibuprofen ,Placebo ,01 natural sciences ,law.invention ,Ibuprofen/administration & dosage ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Double-Blind Method ,law ,Acetaminophen/administration & dosage ,Statistical significance ,medicine ,Humans ,030212 general & internal medicine ,Analgesics, Non-Narcotic/administration & dosage ,0101 mathematics ,Adverse effect ,Acetaminophen ,Aged ,Pain Measurement ,Original Investigation ,Pain, Postoperative ,Analgesics, Opioid/administration & dosage ,Morphine ,business.industry ,organic chemicals ,010102 general mathematics ,General Medicine ,Analgesics, Non-Narcotic ,Middle Aged ,Arthroplasty ,Analgesics, Opioid ,Arthroplasty, Replacement, Hip/adverse effects ,Morphine/administration & dosage ,Anesthesia ,Drug Therapy, Combination ,Female ,business ,medicine.drug - Abstract
Importance: Multimodal postoperative analgesia is widely used but lacks evidence of benefit.Objective: Investigate beneficial and harmful effects of 4 nonopioid analgesics regimens.Design, Setting, and Participants: Randomized, blinded, placebo-controlled, 4-group trial in 6 Danish hospitals with 90-day follow-up that included 556 patients undergoing total hip arthroplasty (THA) from December 2015 to October 2017. Final date of follow-up was January 1, 2018.Interventions: Participants were randomized to receive paracetamol (acetaminophen) 1000 mg plus ibuprofen 400 mg (n = 136; PCM + IBU), paracetamol 1000 mg plus matched placebo (n = 142; PCM), ibuprofen 400 mg plus matched placebo (n = 141; IBU), or half-strength paracetamol 500 mg plus ibuprofen 200 mg (n = 140; HS-PCM + IBU) orally every 6 hours for 24 hours postoperatively, starting 1 hour before surgery.Main Outcomes and Measures: Two co-primary outcomes: 24-hour morphine consumption using patient-controlled analgesia in pairwise comparisons between the 4 groups (multiplicity-adjusted thresholds for statistical significance, P Results: Among 559 randomized participants (mean age, 67 years; 277 [50%] women), 556 (99.5%) completed the trial and were included in the analysis. Median 24-hour morphine consumption was 20 mg (99.6% CI, 0-148) in the PCM + IBU group, 36 mg (99.6% CI, 0-166) for PCM alone, 26 mg (99.6% CI, 2-139) for IBU alone, and 28 mg (99.6% CI, 2-145) for HS-PCM + IBU. The median difference in morphine consumption between the PCM + IBU group vs PCM alone was 16 mg (99.6% CI, 6.5 to 24; P Conclusions and Relevance: Among patients undergoing THA, paracetamol plus ibuprofen significantly reduced morphine consumption compared with paracetamol alone in the first 24 hours after surgery; there was no statistically significant increase in SAEs in the pooled groups receiving ibuprofen alone vs with paracetamol alone. However, the combination did not result in a clinically important improvement over ibuprofen alone, suggesting that ibuprofen alone may be a reasonable option for early postoperative oral analgesia.Trial Registration: ClinicalTrials.gov Identifier: NCT02571361.
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189. Can Tele-Health Support Self-Care and Empowerment? A Qualitative Study of Hip Fracture Patients’ Experiences With Testing an 'App'
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Jane Clemensen, Søren Overgaard, Uffe Kock Wiil, and Charlotte Myhre Jensen
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Telemedicine ,media_common.quotation_subject ,tele-health ,030209 endocrinology & metabolism ,Health literacy ,fragility fracture ,Learning styles ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Health care ,self-care ,medicine ,“app” ,Original Research Article ,030212 general & internal medicine ,Everyday life ,Empowerment ,General Nursing ,media_common ,lcsh:RT1-120 ,Hip fracture ,tablet ,lcsh:Nursing ,business.industry ,medicine.disease ,empowerment ,hip fracture ,tablet computer ,business ,Psychology ,application ,Qualitative research - Abstract
Telemedicine or tele-health is increasingly used to help meet challenges in health care linked to demographic changes and an aging population. This study aimed to investigate whether a tele-health solution, an “app” presented on a tablet, can assist patients in their recovery following a hip fracture and accommodate individual learning and health literacy needs to support them in self-care and empowerment. Twenty patients with a hip fracture were informed and educated using an app during hospital admission and for 3 to 4 weeks after discharge. A qualitative approach employed field observation and individual interviews with patients and their relatives. Data were analyzed using qualitative content analysis. Patients found that the app supported their ability to perform self-care and their desire for autonomy. They would not have downloaded the app by themselves but found the use of the app presented on a tablet very supportive in their everyday life while rehabilitating after a hip fracture. Findings indicate that health-care professionals can support information and education for patients with a hip fracture using an app that accommodates different learning styles. This demonstrates that apps used for the dissemination of health knowledge can be used by elderly hip fracture patients even if they are not used to technology.
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190. Effects of supervised exercise compared to non-supervised exercise early after total hip replacement on patient-reported function, pain, health-related quality of life and performance-based function – a systematic review and meta-analysis of randomized controlled trials
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Lone Ramer Mikkelsen, Sebrina Hansen, Inger Mechlenburg, Jens Aaboe, and Søren Overgaard
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030506 rehabilitation ,medicine.medical_specialty ,medicine.medical_treatment ,Arthroplasty, Replacement, Hip ,Total hip replacement ,Physical Therapy, Sports Therapy and Rehabilitation ,patient-reported outcome ,law.invention ,rehabilitation ,supervision ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Medicine ,Humans ,Exercise ,Supervised exercise ,Randomized Controlled Trials as Topic ,Health related quality of life ,Rehabilitation ,business.industry ,Arthralgia ,meta-analysis ,Meta-analysis ,Physical therapy ,Quality of Life ,Patient-reported outcome ,In degree ,0305 other medical science ,business ,030217 neurology & neurosurgery - Abstract
Background: The rehabilitation after a total hip replacement varies in degree of supervision; however, it remains unknown whether supervised programmes are more effective than non-supervised. Objective: This study compared the effectiveness of supervised exercise compared to non-supervised home-based exercise after total hip replacement on patient-reported function, hip-pain, health-related quality of life and performance-based function. Methods: A systematic review and meta-analysis of randomized controlled trials investigating the effect of supervised exercise compared to non-supervised home-based exercise. An electronic search was performed in Medline, Embase and CINAHL on 14 March 2018. The methodological quality was assessed using the Cochrane Risk of Bias tool. Results: Seven studies were included with a total of 389 participants. A small and non-significant difference in favour of the supervised groups was found in patient-reported function (standardized mean difference (SMD) −0.22 (95% confidence interval (CI) −0.46 to 0.02)), hip-related pain (SMD −0.03 (95% CI −0.27 to 0.21)), health-related quality of life (mean difference (MD) −3.08 (95% CI −6.29 to 0.14)) and performance-based function (SMD −0.26 (95% CI −0.68 to 0.17)) at end of treatment and in patient-reported function (MD −1.31 (95% CI −3.79 to 1.16)) at the 6- to 12-month follow-up. Limitations: The literature search was systematic, but limited to three databases. The overall quality of evidence was downgraded to moderate due to lack of blinding in included studies. Conclusion: Supervised exercise was not significantly effective compared to non-supervised home-based exercise on patient-reported function, pain, health-related quality of life and performance-based function after primary total hip replacement. Others: PROSPERO registration number: CRD42017055604.
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191. Optimal duration of anticoagulant thromboprophylaxis in total hip arthroplasty: new evidence in 55,540 patients with osteoarthritis from the Nordic Arthroplasty Register Association (NARA) group
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Alma B Pedersen, Ina Trolle Andersen, Ove Furnes, Stein Atle Lie, Anne Marie Fenstad, Jan-Erik Gjertsen, and Søren Overgaard
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Adolescent ,Arthroplasty, Replacement, Hip ,medicine.medical_treatment ,Population ,Scandinavian and Nordic Countries ,Chemoprevention ,Article ,Osteoarthritis, Hip ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Cumulative incidence ,Registries ,030212 general & internal medicine ,Child ,education ,Aged ,Proportional Hazards Models ,Aged, 80 and over ,Orthopedic surgery ,Hip surgery ,030222 orthopedics ,education.field_of_study ,business.industry ,Incidence ,Standard treatment ,Hazard ratio ,Absolute risk reduction ,Anticoagulants ,Venous Thromboembolism ,General Medicine ,Middle Aged ,Arthroplasty ,Female ,Surgery ,business ,RD701-811 ,Cohort study - Abstract
Background and purpose — The recommended optimal duration of the thromboprophylaxis treatment in total hip arthroplasty (THA) patients has been a matter of debate for years. We examined the association between short (1–5 days), standard (6–14 days), and extended (≥ 15 days) duration of thromboprophylaxis, with regards to the risk of venous thromboembolism (VTE), major bleeding, and death in unselected THA patients. Patients and methods — We performed a cohort study using prospectively collected data from the population-based hip arthroplasty registries, prescription databases, and patient administrative registries in Denmark and Norway. We included 55,540 primary THA patients with osteoarthritis Results — The 90-day cumulative incidence of VTE was 1.0% for patients with standard treatment (reference), 1.1% for those with short-term treatment (adjusted hazard ratio [aHR] of 1.1, 95% confidence interval (CI) 0.8–1.5) and 1.0% for those with extended treatment (aHR of 0.9, CI 0.8–1.2). The aHRs for major bleeding were 1.1 (CI 0.8–1.6) for short and 0.8 (CI 0.6–1.1) for extended vs. standard treatment. In addition, patients with short and extended treatment had aHRs for death of 1.2 (CI 0.8–1.8) and 0.8 (CI 0.5–1.1) vs. standard treatment, respectively. Patients who started short treatment postoperatively had an aHR for death of 1.8 (CI 1.1–3.1) and absolute risk difference of 0.2%, whereas patients who started short treatment preoperatively had an aHR for death of 0.5 (CI 0.2–1.2) and absolute risk difference of 0.3% compared with patients who had standard treatment with post- and preoperative start, respectively. Interpretation — In routine clinical practice, we observed no overall clinically relevant difference in the risks of VTE and major bleeding within 90 days of THA with respect to thromboprophylaxis duration. However, our data indicate that short-term thromboprophylaxis started postoperatively is associated with increased 90-day mortality. The significance of these data should be explored further. publishedVersion
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- 2019
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192. Collagen-hydroxyapatite composite substitute and bone marrow nuclear cells on posterolateral spine fusion in sheep
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Anna Tampieri, Ming Ding, Kariatta Esther Koroma, Jesper Roed Sørensen, Stig M. Jespersen, Monica Sandri, and Søren Overgaard
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bone marrow nuclear cells ,sheep ,Time Factors ,Collagen-hydroxyapatite ,0206 medical engineering ,Biomedical Engineering ,Bone Marrow Cells ,02 engineering and technology ,macromolecular substances ,Cell Line ,Biomaterials ,Spine fusion ,Bone Marrow ,medicine ,Hydroxyapatite composite ,Animals ,Cell Proliferation ,Bone Transplantation ,spine fusion ,Chemistry ,021001 nanoscience & nanotechnology ,equipment and supplies ,020601 biomedical engineering ,medicine.anatomical_structure ,Durapatite ,Spinal Fusion ,Treatment Outcome ,Bone Substitutes ,Models, Animal ,Bone marrow ,Collagen ,0210 nano-technology ,microarchitecture ,Biomedical engineering - Abstract
The effects of a large collagen-hydroxyapatite (COL-HA) substitute with or without isolated bone marrow nuclear cells (BMNC) on spine fusion were evaluated using a two-level posterolateral spinal fusion model in sheep. Six sheep each were included in both the COL-HA and autograft groups. In each animal, spine fusions were performed at two levels by randomization with or without BMNC. After an observation period of 4.5 months, the fusion blocks (length = 50 mm) were harvested and evaluated by micro-CT with respect to fusion rate and microarchitecture, and histology was performed to qualitatively assess new bone morphology. BMNC supplementation did not lead to significant differences in fusion rates or microarchitectural properties in the both groups (p = 0.56). Porosity decreased significantly in the COL-HA group (p = 0.002), suggesting a relatively fast degradation of COL-HA. Qualitative histology assessment revealed quick reabsorption of COL-HA replaced by newly formed bone, and this new bone morphology was similar to autograft. Interestingly, COL-HA generated significant amounts of new bone in vivo which were similar to autograft, and the presence of BMNC seemed to enhance this process. Apart from porosity, the comparable fusion rate and similar microarchitectural parameters suggested equal performance of COL-HA and autograft with respect to spine fusion and bone quality. In conclusion, the COL-HA with BMNC demonstrated comparable fusion rates as the autograft. COL-HA was capable of forming new bone and was revealed to be similar to the autograft with respect to microarchitectural properties apart from porosity of the fusion blocks.
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- 2019
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193. Outcome of 881 total hip arthroplasties in 747 patients 21 years or younger: data from the Nordic Arthroplasty Register Association (NARA) 1995-2016
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Lars B. Engesæter, Stephan M. Röhrl, Antti Eskelinen, Keijo T Mäkelä, Maziar Mohaddes, Johan Kärrholm, Søren Overgaard, Lars Nordsletten, Alma B Pedersen, Vera Halvorsen, Anne Marie Fenstad, Lääketieteen ja terveysteknologian tiedekunta - Faculty of Medicine and Health Technology, and Tampere University
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Male ,Reoperation ,musculoskeletal diseases ,medicine.medical_specialty ,Adolescent ,VDP::Medical disciplines: 700::Clinical medical disciplines: 750::Orthopedic surgery: 784 ,Arthroplasty, Replacement, Hip ,medicine.medical_treatment ,Kirurgia, anestesiologia, tehohoito, radiologia - Surgery, anesthesiology, intensive care, radiology ,Avascular necrosis ,Norwegian ,Osteoarthritis ,Scandinavian and Nordic Countries ,VDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Ortopedisk kirurgi: 784 ,Article ,Danish ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,lcsh:Orthopedic surgery ,medicine ,Humans ,Orthopedics and Sports Medicine ,Registries ,030212 general & internal medicine ,Young adult ,Societies, Medical ,030222 orthopedics ,Hip fracture ,business.industry ,Age Factors ,General Medicine ,medicine.disease ,Arthroplasty ,language.human_language ,Prosthesis Failure ,Surgery ,lcsh:RD701-811 ,Treatment Outcome ,surgical procedures, operative ,language ,Female ,Implant ,business - Abstract
Source at https://doi.org/10.1080/17453674.2019.1615263. Background and purpose — The literature is scarce on the outcome of the youngest patients with total hip arthroplasties (THAs). We analyzed register data, revision risk, and related factors in patients 21 years or younger with THAs in the Nordic Arthroplasty Register Association (NARA). Patients and methods — We included all THA patients 21 years or younger reported during 1995 through 2016 to the Danish, Finnish, Norwegian, and Swedish hip arthroplasty registers and merged these into the NARA dataset. Primary outcome was any implant revision. Results — We identified 881 THAs in 747 patients. Mean age at primary surgery was 18 years (9–21). The indications for THA were pediatric hip diseases (33%), systemic inflammatory disease (23%), osteoarthritis (4%), avascular necrosis (12%), hip fracture sequelae (7%), and other diagnoses (21%). Unadjusted 10-year survival for all THAs was 86%. Comparison between indications showed no differences in survival. Uncemented implants were used most frequently. Survival for uncemented and cemented implants was the same adjusted for sex, indication, head size, and time period for primary surgery. Aseptic loosening was the main cause of revision. Interpretation — Both cemented and uncemented fixations seem to be a viable option in this age group, but with a lower implant survival than in older patient groups.
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- 2019
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194. Do different types of bearings and noise from total hip arthroplasty influence hip-related pain, function, and quality of life postoperatively?: A cross-sectional study from the Danish Hip Arthroplasty Registry
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Søren Overgaard, Claus Varnum, Per Kjærsgaard-Andersen, and Alma B Pedersen
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musculoskeletal diseases ,medicine.medical_specialty ,Cross-sectional study ,medicine.medical_treatment ,Prom ,Osteoarthritis ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,medicine ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Orthopedic surgery ,030222 orthopedics ,business.industry ,Retrospective cohort study ,General Medicine ,medicine.disease ,Arthroplasty ,surgical procedures, operative ,Cohort ,Physical therapy ,Surgery ,Range of motion ,business ,RD701-811 - Abstract
Background and purpose - Patient-reported outcome (PRO) is recognized as an important tool for evaluating the outcome and satisfaction after total hip arthroplasty (THA). We wanted to compare patient-reported outcome measure (PROM) scores from patients with ceramic-on-ceramic (CoC) THAs and those with metal-on-metal (MoM) THAs to scores from patients with metal-on-polyethylene (MoP) THAs, and to determine the influence of THA-related noise on PROM scores. Patients and methods - We conducted a nationwide cross-sectional questionnaire survey in a cohort of patients identified from the Danish Hip Arthroplasty Registry. The PROMs included were: hip dysfunction and osteoarthritis and outcome score (HOOS), EQ-5D-3L, EQ VAS, UCLA activity score, and questions about noise from the THA. The response rate was 85% and the number of responders was 3,089. Of these, 45% had CoC THAs, 17% had MoM THAs, and 38% had MoP THAs, with a mean length of follow-up of 7, 5, and 7 years, respectively. Results - Compared to MoP THAs, the mean PROM scores for CoC and MoM THAs were similar, except that CoC THAs had a lower mean score for HOOS Symptoms than did MoP THA. 27% of patients with CoC THAs, 29% with MoM THAs, and 12% with MoP THAs reported noise from their hip. For the 3 types of bearings, PROM scores from patients with a noisy THA were statistically significantly worse than those from patients with a silent MoP THA. The exception was noisy CoC and MoM THAs, which had the same mean UCLA activity score as silent MoP THAs. Interpretation - A high proportion of patients reported noise from the THA, and these patients had worse PROM scores than patients with silent MoP THAs.
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- 2016
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195. Other minds embodied
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Søren Overgaard
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Merleau-Ponty ,Philosophy ,05 social sciences ,Merleau ponty ,06 humanities and the arts ,body ,0603 philosophy, ethics and religion ,050105 experimental psychology ,Sketch ,Epistemology ,Embodied cognition ,other minds ,060302 philosophy ,0501 psychology and cognitive sciences ,Political philosophy ,Faculty of Humanities ,Phenomenology (psychology) ,embodiment - Abstract
I distinguish three kinds of other minds problems—conceptual, epistemological and empirical. I argue that while Merleau-Ponty believes embodiment helps with tackling the conceptual and epistemological problems, he suggests that it is of no clear use in solving (an important variant of) the empirical problem. I sketch some considerations that could lend support to Merleau-Ponty’s claims about the conceptual and epistemological problems, without claiming that these are conclusive. I then proceed to argue that Merleau-Ponty’s take on the empirical problem is essentially correct.
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- 2016
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196. Agreement and precision of periprosthetic bone density measurements in micro-CT, single and dual energy CT
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Peter Traise, Bo Redder Mussmann, Trine Torfing, Søren Overgaard, Oke Gerke, and Poul Erik Andersen
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Bone mineral ,Materials science ,Bone density ,Intraclass correlation ,business.industry ,Periprosthetic ,Dual-Energy Computed Tomography ,Imaging phantom ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Orthopedics and Sports Medicine ,Dual energy ct ,Micro ct ,Nuclear medicine ,business - Abstract
The objective of this study was to test the precision and agreement between bone mineral density measurements performed in micro CT, single and dual energy computed tomography, to determine how the keV level influences density measurements and to assess the usefulness of quantitative dual energy computed tomography as a research tool for longitudinal studies aiming to measure bone loss adjacent to total hip replacements. Samples from 10 fresh-frozen porcine femoral heads were placed in a Perspex phantom and computed tomography was performed with two acquisition modes. Bone mineral density was calculated and compared with measurements derived from micro CT. Repeated scans and dual measurements were performed in order to measure between- and within-scan precision. Mean density difference between micro CT and single energy computed tomography was 72 mg HA/cm3. For dual energy CT, the mean difference at 100 keV was 128 mg HA/cm3 while the mean difference at 110–140 keV ranged from −84 to −67 mg HA/cm3 compared with micro CT. Rescanning the samples resulted in a non-significant overall between-scan difference of 13 mg HA/cm3. Bland–Altman limits of agreement were wide and intraclass correlation coefficients ranged from 0.29 to 0.72, while 95% confidence intervals covered almost the full possible range. Repeating the density measurements for within-scan precision resulted in ICCs >0.99 and narrow limits of agreement. Single and dual energy quantitative CT showed excellent within-scan precision, but poor between-scan precision. No significant density differences were found in dual energy quantitative CT at keV-levels above 110 keV. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1470–1477, 2017.
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- 2016
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197. The Danish Hip Arthroplasty Register
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Per Hviid Gundtoft, Claus Varnum, Søren Overgaard, and Alma B Pedersen
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validation ,musculoskeletal diseases ,030222 orthopedics ,medicine.medical_specialty ,Epidemiology ,business.industry ,Danish Hip Arthroplasty Register ,Review ,language.human_language ,Danish ,03 medical and health sciences ,Hip arthroplasty ,0302 clinical medicine ,Register (music) ,completeness ,Journal Article ,language ,Physical therapy ,Medicine ,030212 general & internal medicine ,business ,Total hip arthroplasty - Abstract
AIM OF DATABASE: The aim of the Danish Hip Arthroplasty Register (DHR) is to continuously monitor and improve the quality of treatment of primary and revision total hip arthroplasty (THA) in Denmark.STUDY POPULATION: The DHR is a Danish nationwide arthroplasty register established in January 1995. All Danish orthopedic departments - both public and private - report to the register, and registration is compulsory.MAIN VARIABLES: The main variables in the register include civil registration number, indication for primary and revision surgery, operation date and side, and postoperative complications. Completeness of primary and revision surgery is evaluated annually and validation of a number of variables has been carried out.DESCRIPTIVE DATA: A total of 139,525 primary THAs and 22,118 revisions have been registered in the DHR between January 1, 1995 and December 31, 2014. Since 1995, completeness of procedure registration has been high, being 97.8% and 92.0% in 2014 for primary THAs and revisions, respectively. Several risk factors, such as comorbidity, age, specific primary diagnosis and fixation types for failure of primary THAs, and postoperative complications, have been identified through the DHR. Approximately 9,000 primary THAs and 1,500 revisions are reported to the register annually.CONCLUSION: The DHR is important for monitoring and improvement of treatment with THA and is a valuable tool for research in THA surgery due to the high quality of prospective collected data with long-term follow-up and high completeness. The register can be used for population-based epidemiology studies of THA surgery and can be linked to a range of other national databases.
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- 2016
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198. 3D perfusion bioreactor-activated porous granules on implant fixation and early bone formation in sheep
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Susan Snoek Henriksen, Roberta Martinetti, Søren Overgaard, and Ming Ding
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0301 basic medicine ,medicine.medical_specialty ,Materials science ,0206 medical engineering ,Biomedical Engineering ,Synthetic graft ,02 engineering and technology ,Fibrous tissue ,020601 biomedical engineering ,Perfusion bioreactor ,Surgery ,Biomaterials ,Implant fixation ,03 medical and health sciences ,surgical procedures, operative ,030104 developmental biology ,Bone graft materials ,medicine ,Bone formation ,Implant ,Biomedical engineering ,Fixation (histology) - Abstract
Early fixation of total joint arthroplasties is crucial for ensuring implant survival. An alternative bone graft material in revision surgery is needed to replace the current gold standard, allograft, seeing that the latter is associated with several disadvantages. The incubation of such a construct in a perfusion bioreactor has been shown to produce viable bone graft materials. This study aimed at producing larger amounts of viable bone graft material (hydroxyapatite 70% and β-tricalcium-phosphate 30%) in a novel perfusion bioreactor. The abilities of the bioreactor-activated graft material to induce early implant fixation were tested in a bilateral implant defect model in sheep, with allograft as the control group. Defects were bilaterally created in the distal femurs of the animals, and titanium implants were inserted. The concentric gaps around the implants were randomly filled with either allograft, granules, granules with bone marrow aspirate or bioreactor-activated graft material. Following an observation time of 6 weeks, early implant fixation and bone formation were assessed by micro-CT scanning, mechanical testing, and histomorphometry. Bone formations were seen in all groups, while no significant differences between groups were found regarding early implant fixation. The microarchitecture of the bone formed by the synthetic graft materials resembled that of allograft. Histomorphometry revealed that allograft induced significantly more bone and less fibrous tissue (p
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- 2016
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199. Iodine-impregnated incision drape and bacterial recolonization in simulated total knee arthroplasty: A controlled, randomized experimental trial
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Claus Emmeluth, Nikolaj Milandt, Hans Jørn Kolmos, Søren Overgaard, and Tine Nymark
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musculoskeletal diseases ,medicine.medical_specialty ,medicine.medical_treatment ,Total knee arthroplasty ,Skin disinfection ,Preoperative care ,03 medical and health sciences ,0302 clinical medicine ,Contralateral knee ,Journal Article ,medicine ,Postoperative infection ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Prospective cohort study ,Orthopedic surgery ,030222 orthopedics ,business.industry ,General Medicine ,musculoskeletal system ,Arthroplasty ,Surgery ,business ,Surgical site infection ,RD701-811 - Abstract
Background and purpose - Iodine-impregnated incision drapes (IIIDs) are used to prevent surgical site infection (SSI). However, there is some evidence to suggest a potential increase in SSI risk as a result of IIID use, possibly from promotion of skin recolonization. A greater number of viable bacteria in the surgical field of an arthroplasty, and surgery in general, may increase the infection risk. We investigated whether IIID use increases bacterial recolonization compared to no drape use under conditions of simulated total knee arthroplasty (TKA). Methods - 20 patients scheduled for TKA were recruited. Each patient had 1 knee randomized for draping with IIID, while the contralateral knee was left bare. The patients thus served as their own control. The operating room conditions and perioperative procedures of a TKA were simulated. Cylinder samples were collected from the skin of each knee prior to disinfection, and again on 2 occasions after skin preparation-75 min apart. Quantities of bacteria were estimated using a spread plate technique under aerobic conditions. Results - We found similar quantities of bacteria on the intervention and control knees immediately after skin disinfection and after 75 min of simulated surgery. These quantities had not increased at the end of surgery when compared to baseline, so no recolonization was detected on the draped knees or on the bare knees. Interpretation - The use of IIIDs did not increase bacterial recolonization in simulated TKA. This study does not support the hypothesis that IIIDs promote bacterial recolonization and postoperative infection risk.
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- 2016
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200. Assessment of activated porous granules on implant fixation and early bone formation in sheep
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Søren Overgaard, Naseem Theilgaard, Ming Ding, and Susan Snoek Henriksen
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0301 basic medicine ,medicine.medical_specialty ,lcsh:Diseases of the musculoskeletal system ,Stromal cell ,implant fixation ,0206 medical engineering ,02 engineering and technology ,histomorphometry ,Implant fixation ,03 medical and health sciences ,Bone marrow aspirate ,Bone graft materials ,BMSC ,medicine ,3-dimensional perfusion bioreactor ,Orthopedics and Sports Medicine ,Bone formation ,Microarchitecture ,Porous scaffold granules ,Histomorphometry ,porous scaffold granules ,Chemistry ,Granule (cell biology) ,020601 biomedical engineering ,Porous scaffold ,Surgery ,030104 developmental biology ,Original Article ,Implant ,lcsh:RC925-935 ,microarchitecture ,Biomedical engineering - Abstract
Summary Background/Objective Despite recent progress in regeneration medicine, the repair of large bone defects due to trauma, inflammation and tumor surgery remains a major clinical challenge. This study was designed to produce large amounts of viable bone graft materials in a novel perfusion bioreactor to promote bone formation. Methods Cylindrical defects were created bilaterally in the distal femurs of sheep, and titanium implants were inserted. The concentric gap around the implants was randomly filled either with allograft, granules, granules with bone marrow aspirate (BMA) or bioreactor activated granule (BAG). The viable BAG consisted of autologous bone marrow stromal cells (BMSCs) seeded upon porous scaffold granules incubated in a 3D perfusion bioreactor for 2 weeks prior to surgery. 6 weeks after, the bone formation and early implant fixation were assessed by means of micro-CT, histomorphometry, and mechanical test. Results Microarchitectural analysis revealed that bone volume fraction and trabecular thickness in the allograft were not statistically different than those (combination of new bone and residue of granule) in the other 3 groups. The structure of the allograft group was typically plate-like, while the other 3 groups were combination of plate and rod. Histomorphometry showed that allograft induced significantly more bone and less fibrous tissue in the concentric gap than the other 3 granule groups, while the bone ingrowth to implant porous surface was not different. No significant differences among the groups were found regarding early implant mechanical fixation. Conclusion In conclusion, despite nice bone formation and implant fixation in all groups, bioreactor activated graft material did not convincingly induce early implant fixation similar to allograft, and neither bioreactor nor by adding BMA credited additional benefit for bone formation in this model.
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- 2016
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