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Høpfner Jensen LW, Kold S, Dinesen B, Husum HC, Skals RG, Eiskjær SP, Elsøe R, Rahbek O. Team-based digital communication reduced patient-initiated phone calls to the hospital and improved patient satisfaction after orthopedic surgery: a randomized controlled trial in 70 patients. Acta Orthop 2024; 95:225-232. [PMID: 38757681 PMCID: PMC11100491 DOI: 10.2340/17453674.2024.40707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND AND PURPOSE Post-discharge inquiries to the hospital are predominantly conducted through phone calls. The rigid timing of these calls is inconvenient for patients and disrupts the workflows of healthcare professionals. The aim of this study was to investigate the effect of a team-based digital communication intervention (eDialogue) facilitated through a messenger-like commercial solution on patient-initiated phone calls to the hospital after discharge. Secondarily, we investigated other patient-initiated contacts, patients' perception of continuity of care, and their perception of feeling safe and satisfied after hospital discharge. METHODS On the day of discharge, 70 surgically treated orthopedic patients were randomized to the intervention group with access to eDialogue (n = 35) or the control group with standard communication pathways by phone call (n = 35) for the following 8 weeks. Through eDialogue, the intervention group had access to team-based asynchronous digital communication in text and photos with healthcare professionals across disciplines and sectors. Inclusion criteria were discharge to own home and receipt of rehabilitation services from both hospital and primary care after discharge. RESULTS We found a significant reduction in the mean number of patient-initiated phone calls to the hospital from 2.3 (95% confidence interval [CI] 1.4-4.1) in the control group to 0.5 (CI 0.3-1.0) in the intervention group (P = 0.004). Across groups, patients reported similar perceptions of continuity of care; however, the participants in the intervention group expressed significantly improved perceptions of, and satisfaction with, access to healthcare after discharge. CONCLUSION Access to eDialogue reduced patient-initiated phone calls to the hospital, enhanced patient satisfaction with healthcare accessibility, and did not compromise patients' perception of continuity of care after discharge compared with standard communication pathways.
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Affiliation(s)
- Lili Worre Høpfner Jensen
- Interdisciplinary Orthopaedics, Department of Orthopaedics, Aalborg University Hospital, Aalborg; Laboratory for Welfare Technologies - Digital Health & Rehabilitation, ExerciseTech, Department of Health Science and Technology, Aalborg University, Aalborg East.
| | - Søren Kold
- Interdisciplinary Orthopaedics, Department of Orthopaedics, Aalborg University Hospital, Aalborg
| | - Birthe Dinesen
- Laboratory for Welfare Technologies - Digital Health & Rehabilitation, ExerciseTech, Department of Health Science and Technology, Aalborg University, Aalborg East
| | - Hans-Christen Husum
- Interdisciplinary Orthopaedics, Department of Orthopaedics, Aalborg University Hospital, Aalborg
| | | | - Søren Peter Eiskjær
- Interdisciplinary Orthopaedics, Department of Orthopaedics, Aalborg University Hospital, Aalborg
| | - Rasmus Elsøe
- Interdisciplinary Orthopaedics, Department of Orthopaedics, Aalborg University Hospital, Aalborg
| | - Ole Rahbek
- Interdisciplinary Orthopaedics, Department of Orthopaedics, Aalborg University Hospital, Aalborg
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Abood AA, Rölfing JD, Halloum A, Ringgaard S, Byskov JS, Kold S, Rahbek O. An Innovative Plate Concept for Rotational Guided Growth: A Porcine Pilot Study. Cureus 2024; 16:e58169. [PMID: 38616978 PMCID: PMC11015357 DOI: 10.7759/cureus.58169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 04/16/2024] Open
Abstract
Background Rotational deformities in children are currently treated with an osteotomy, acute de-rotation, and surgical fixation. Meanwhile, guided growth is now the gold standard in pediatric coronal deformity correction. This study aimed to evaluate the feasibility of a novel implant intended for rotational guided growth (RotOs Plate) in a large porcine animal model. Methodology A submuscular plate was inserted on the medial and lateral aspect of the distal femoral physis of the left femur in 6 pigs. Each plate was anchored with a screw in the metaphysis and epiphysis respectively. The plates were expected to rotate the femur externally. The right femur acted as a control in a paired design. The animals were housed for 12 weeks after surgery. MRI scanning of both femora was performed before euthanasia after 12 weeks. Rotation was determined as the difference in the femoral version on MRI between the operated and non-operated femur after 12 weeks. Results External rotation in all operated femurs was observed. The mean difference in the femoral version on MRI between operated and non-operated femurs was 12.5° (range 9°-16°). No significant changes in axial growth were detected. Conclusions This study shows encouraging results regarding rotational guided growth, which may replace current invasive surgical treatment options for malrotation in children. However, further studies addressing potential secondary deformities are paramount and should be carried out.
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Affiliation(s)
- Ahmed A Abood
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, DNK
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, DNK
| | - Jan D Rölfing
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, DNK
| | - Ahmed Halloum
- Department of Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, DNK
| | | | - Jeppe S Byskov
- Department of Additive Manufacturing, Danish Technological Institute, Aarhus, DNK
| | - Søren Kold
- Department of Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, DNK
| | - Ole Rahbek
- Department of Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, DNK
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Jensen LWH, Rahbek O, Lauritsen REK, Kold S, Dinesen B. Patient Perspectives on Communication Pathways After Orthopedic Surgery and Discharge and Evaluation of Team-Based Digital Communication: Qualitative Exploratory Study. JMIR Hum Factors 2024; 11:e49696. [PMID: 38551641 PMCID: PMC11015373 DOI: 10.2196/49696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 01/29/2024] [Accepted: 02/20/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND The transition from hospital to home after orthopedic surgery requires smooth communication and coordination between patients and their team of care to avoid fragmented care pathways. Digital communication is increasingly being used to facilitate easy and accessible asynchronous communication between patients and health care professionals across settings. A team-based approach to digital communication may provide optimized quality of care in the postoperative period following orthopedic surgery and hospital discharge. OBJECTIVE This study was divided into two phases that aimed to (1) explore the perspectives of patients undergoing orthopedic surgery on current communication pathways at a tertiary hospital in Denmark and (2) test and explore patients' experiences and use of team-based digital communication following hospital discharge (eDialogue). METHODS A triangulation of qualitative data collection techniques was applied: document analysis, participant observations (n=16 hours), semistructured interviews with patients before (n=31) and after (n=24) their access to eDialogue, and exploration of use data. RESULTS Findings show that patients experience difficult communication pathways after hospital discharge and a lack of information due to inadequate coordination of care. eDialogue was used by 84% (26/31) of the patients, and they suggested that it provided a sense of security, coherence, and proximity in the aftercare rearranging communication pathways for the better. Specific drivers and barriers to use were identified, and these call for further exploration of eDialogue. CONCLUSIONS In conclusion, patients evaluated eDialogue positively and suggested that it could support them after returning home following orthopedic surgery.
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Affiliation(s)
- Lili Worre Høpfner Jensen
- Interdisciplinary Orthopaedics, Orthopaedic Surgery Department, Aalborg University Hospital, Aalborg, Denmark
| | - Ole Rahbek
- Interdisciplinary Orthopaedics, Orthopaedic Surgery Department, Aalborg University Hospital, Aalborg, Denmark
| | | | - Søren Kold
- Interdisciplinary Orthopaedics, Orthopaedic Surgery Department, Aalborg University Hospital, Aalborg, Denmark
| | - Birthe Dinesen
- Laboratory for Welfare Technologies - Digital Health & Rehabilitation, Sport Sciences - Performance & Technology, Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
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Jensen LWH, Rahbek O, Lauritsen REK, Kold S, Dinesen B. Health Care Professionals' Perspectives Before and After Use of eDialogue for Team-Based Digital Communication Across Settings: Qualitative Study. JMIR Hum Factors 2024; 11:e53391. [PMID: 38457798 PMCID: PMC10960209 DOI: 10.2196/53391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/21/2023] [Accepted: 01/31/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Orthopedic surgical treatment is a transversal task that requires the active involvement of patients, relatives, and health care professionals (HCPs) across various settings. However, after hospital discharge, communication is challenged and undertaken primarily by phone. New digital communication solutions have the potential to create a space for seamless and patient-centered dialogue across discipline and sector boundaries. When evaluating new communication solutions, knowledge about HCPs' needs and perspectives of use must be explored, as it is they who are responsible for implementing changes in practice. OBJECTIVE This study aimed to (1) investigate HCPs' perceptions of current communication pathways (phase 1) and (2) explore their experiences of using a simple messenger-like solution (eDialogue) for team-based digital communication across settings (phase 2). METHODS We used a triangulation of qualitative data collection techniques, including document analysis, observations, focus groups, and individual interviews of HCPs before (n=28) and after (n=12) their use of eDialogue. Data collection and analysis were inspired by the Consolidated Framework for Implementation Research (CFIR) to specifically understand facilitators and barriers to implementation as perceived by HCPs. RESULTS HCPs perceive current communication pathways as insufficient for both patients and themselves. Phone calls are disruptive, and there is a lack of direct communication modalities when communication crosses sector boundaries. HCPs experienced the use of eDialogue as a quick and easy way for timely interdisciplinary interaction with patients and other HCPs across settings; however, concerns were raised about time consumption. CONCLUSIONS eDialogue can provide needed support for interdisciplinary and cross-sectoral patient-centered communication. However, future studies of this solution should address its impact and the use of resources.
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Affiliation(s)
- Lili Worre Høpfner Jensen
- Interdisciplinary Othopaedics, Orthopaedic Surgery Department, Aalborg University Hospital, Aalborg, Denmark
| | - Ole Rahbek
- Interdisciplinary Othopaedics, Orthopaedic Surgery Department, Aalborg University Hospital, Aalborg, Denmark
| | | | - Søren Kold
- Interdisciplinary Othopaedics, Orthopaedic Surgery Department, Aalborg University Hospital, Aalborg, Denmark
| | - Birthe Dinesen
- Laboratory for Welfare Technologies-Digital Health and Rehabilitation, ExerciseTech, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Sperling PK, Launa N, Ghaffari A, Rømer H, Sørensen MPB, Rahbek O, Kold S, Bisgaard J. Neuropathic pain after orthopaedic surgery with continuous peripheral nerve block. Dan Med J 2024; 71:A09230581. [PMID: 38445315 DOI: 10.61409/a09230581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Continuous peripheral nerve blocks (cPNBs) have shown favourable post-operative pain control results but may be associated with a risk for long-term neurological complications. This study sought to examine factors associated with persistent post-operative pain and potential neuropathy after orthopaedic lower-limb surgery with the use of post-operative cPNB. METHODS Patients who underwent lower limb orthopaedic procedures with cPNBs between November 2021 to May 2022 were included. Patient demographics and perioperative data were noted. At discharge, patients completed the PainDetect (PD) questionnaire and were followed up six months after discharge. RESULTS Seventy-seven patients with a total of 171 catheters completed the follow up. The median time to follow-up was 214 days after catheter removal, and 18 patients (23%) had a PD score ≥ 13. Univariate analysis showed that multiple variables were associated with a PD score ≥ 13 at the six-month follow-up. Multiple logistic regression showed that a high PD score at discharge, high BMI and longer duration of cPNBs were associated with higher risk of having a PD score ≥ 13 at the six-month follow-up. CONCLUSION Several factors were associated with a higher risk of having possible neuropathy after six months. BMI, duration of catheter and PD score at discharge were correlated with risk of possible neuropathic pain. FUNDING None. TRIAL REGISTRATION The study was a quality control project and therefore did not require registration under Danish law.
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Affiliation(s)
| | - Nicolai Launa
- Department of Clinical Medicine, Aalborg University
- Department of Orthopaedic Surgery, Aalborg University Hospital, Denmark
| | - Arash Ghaffari
- Department of Orthopaedic Surgery, Aalborg University Hospital, Denmark
| | - Helle Rømer
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital
| | | | - Ole Rahbek
- Department of Orthopaedic Surgery, Aalborg University Hospital, Denmark
| | - Søren Kold
- Department of Orthopaedic Surgery, Aalborg University Hospital, Denmark
| | - Jannie Bisgaard
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital
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Tirta M, Hjorth MH, Jepsen JF, Rahbek O, Kold S. Are percutaneous epiphysiodesis and Phemister technique effective in the treatment of leg-length discrepancy? A systematic review. J Pediatr Orthop B 2024:01202412-990000000-00177. [PMID: 38324644 DOI: 10.1097/bpb.0000000000001160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Epiphysiodesis is considered the preferred treatment for children predicted to have leg length discrepancies (LLDs) 2-5 cm at maturity. The aim of this study was to systematically review the existing literature on the effectiveness of permanent epiphysiodesis for LLD treatment, and secondarily to address the reported complications of permanent epiphysiodesis techniques. This systematic review was performed according to PRISMA guidelines. We searched MEDLINE (PubMed), Embase, Cochrane Library, Web of Science and Scopus for studies on skeletally immature patients with LLD treated with permanent epiphysiodesis. The extracted outcome categories were effectiveness of epiphysiodesis (LLD measurements pre/post-operatively, successful/unsuccessful), physeal fusion/arrest, and complications that were graded on severity. Forty-nine studies (3051 patients) were included, 1550 underwent Phemister/modified Phemister epiphysiodesis and 1501 percutaneous epiphysiodesis (PE). Total successful permanent epiphysiodesis surgeries (16 studies) were 73.7% (516/700). Only 13 out of 23 studies had a mean final LLD of less than 1.5 cm. In total, 17.5% (513/2936) of complications were reported. 57 angular deformities were reported (1.9%). Phemister technique had higher percentage of complications (39%) than PE (19.1%) in total, but when failure to achieve adequate reduction in LLD was not included, complication rates for both were close to 14%. However, severe complications were 10.2% for Phemister group and 5.1% for PE. The high complication rates and the relative low success rate call for optimization of the timing and the applied techniques when treating LLD with permanent epiphysiodesis. Phemister technique was found to have higher percentage of severe complications than PE. Registration: PROSPERO (CRD42023435177).
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Affiliation(s)
- Maria Tirta
- Interdisciplinary Orthopaedics, Aalborg University Hospital
| | | | | | - Ole Rahbek
- Interdisciplinary Orthopaedics, Aalborg University Hospital
| | - Søren Kold
- Interdisciplinary Orthopaedics, Aalborg University Hospital
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Halloum A, Kold S, Rölfing JD, Abood AA, Rahbek O. Correction of rotational deformities in long bones using guided growth: a scoping review. EFORT Open Rev 2024; 9:119-128. [PMID: 38308954 PMCID: PMC10873243 DOI: 10.1530/eor-23-0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2024] Open
Abstract
Purpose The objective of this scoping review was to describe the extent and type of evidence of using guided growth to correct rotational deformities of long bones in children. Methods This scoping review was conducted in accordance with the JBI methodology for scoping reviews. All published and unpublished studies investigating surgical methods using guided growth to perform gradual rotation of long bones were included. Results Fourteen studies were included: one review, three clinical studies, and ten preclinical studies. In the three clinical studies, three different surgical methods were used on 21 children. Some degree of rotation was achieved in all but two children. Adverse effects reported included limb length discrepancy (LLD), knee stiffness and rebound of rotation after removal of tethers. Of the ten preclinical studies, two were ex vivo and eight were in vivo. Rotation was achieved in all preclinical studies. Adverse effects reported included implant extrusions, LLD, articular deformities, joint stiffness and rebound of rotation after removal of tethers. Two of the studies reported on histological changes. Conclusions All studies conclude that guided growth is a potential treatment for rotational deformities of long bones. There is great variation in animal models and surgical methods used and in reported adverse effects. More research is needed to shed light on the best surgical guided growth method, its effectiveness as well as the involved risks and complications. Based on current evidence the procedure is still to be considered experimental. Level of evidence 4.
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Affiliation(s)
- Ahmed Halloum
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Hobrovej, Aalborg, Denmark
| | - Søren Kold
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Hobrovej, Aalborg, Denmark
| | - Jan Duedal Rölfing
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard, Aarhus, Denmark
| | - Ahmed A Abood
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Hobrovej, Aalborg, Denmark
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard, Aarhus, Denmark
| | - Ole Rahbek
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Hobrovej, Aalborg, Denmark
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Husum HC, Hellfritzsch MB, Maimburg RD, Møller-Madsen B, Henriksen M, Lapitskaya N, Kold S, Rahbek O. Pubofemoral distances correlate to acetabular morphology and sonological instability in screening for hip dysplasia. Bone Jt Open 2024; 5:3-8. [PMID: 38164740 PMCID: PMC10758888 DOI: 10.1302/2633-1462.51.bjo-2023-0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Aims The present study seeks to investigate the correlation of pubofemoral distances (PFD) to α angles, and hip displaceability status, defined as femoral head coverage (FHC) or FHC during manual provocation of the newborn hip < 50%. Methods We retrospectively included all newborns referred for ultrasound screening at our institution based on primary risk factor, clinical, and PFD screening. α angles, PFD, FHC, and FHC at follow-up ultrasound for referred newborns were measured and compared using scatter plots, linear regression, paired t-test, and box-plots. Results We included 2,735 newborns, of whom 754 received a follow-up hip ultrasound within six weeks of age. After exclusion, 1,500 hips were included for analysis. Sex distribution was 372 male and 380 female, and the mean age at examination was 36.6 days (4 to 87). We found a negative linear correlation of PFD to α angles (p < 0.001), FHC (p < 0.001), and FHC during provocation (p < 0.001) with a 1 mm increase in PFD corresponding to a -2.1° (95% confidence interval (CI) -2.3 to -1.9) change in α angle and a -3.4% (95% CI -3.7 to -3.0) change in FHC and a -6.0% (-6.6 to -5.5) change in FHC during provocation. The PFD was significantly higher with increasing Graf types and in displaceable hips (p < 0.001). Conclusion PFD is strongly correlated to both α angles and hip displaceability, as measured by FHC and FHC during provocation, in ultrasound of newborn hips. The PFD increases as the hips become more dysplastic and/or displaceable.
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Affiliation(s)
- Hans-Christen Husum
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
- Danish Paedatric Orthopaedic Research, Aarhus University Hospital, Aarhus, Denmark
| | - Michel B. Hellfritzsch
- Danish Paedatric Orthopaedic Research, Aarhus University Hospital, Aarhus, Denmark
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Rikke D. Maimburg
- Danish Paedatric Orthopaedic Research, Aarhus University Hospital, Aarhus, Denmark
- Department of Children’s Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
| | - Bjarne Møller-Madsen
- Danish Paedatric Orthopaedic Research, Aarhus University Hospital, Aarhus, Denmark
- Department of Midwifery, University College of Northern Denmark, Aalborg East, Denmark
| | - Mads Henriksen
- Danish Paedatric Orthopaedic Research, Aarhus University Hospital, Aarhus, Denmark
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Natallia Lapitskaya
- Danish Paedatric Orthopaedic Research, Aarhus University Hospital, Aarhus, Denmark
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Kold
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
- Danish Paedatric Orthopaedic Research, Aarhus University Hospital, Aarhus, Denmark
| | - Ole Rahbek
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
- Danish Paedatric Orthopaedic Research, Aarhus University Hospital, Aarhus, Denmark
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Larsen P, Studstrup MS, Kold S, Elsøe R. Experimental treatment with bone void filler for lower extremity insufficiency fractures in rheumatoid arthritis patients - Early clinical results. J Orthop Case Rep 2024; 14:68-74. [PMID: 38292091 PMCID: PMC10823811 DOI: 10.13107/jocr.2024.v14.i01.4162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/08/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction The aim is to report early clinical results of an experimental surgical procedure, injecting bone void filler, for patients with lower extremity rheumatoid arthritis (RA) insufficiency fractures. Case Report We used a cross-sectional design with retrospective follow-up. Patient-reported outcomes were reported by the body-region specific questionnaires, knee injury and osteoarthritis outcome score (KOOS), or foot and ankle outcome score (FOAS). The Eq5D-5L questionnaire reported overall health-related quality of life (QoL). Furthermore, patient satisfaction (semi-structured interview), pain reactions, and adverse events were reported.Results from the first five patients were included. The median age was 70 years (range 50-80). Fracture localizations were proximal tibia (2), distal tibia (2), and distal femur (1). Four out of five patients reported a high degree of patient satisfaction following treatment. Four out of five patients at follow-up reported no pain from the fracture location. The median improvement from baseline to follow-up on the KOOS/FAOS subscale scores was pain 65 (range 42-69), symptoms 39 (range 25-50), the activity of daily living 41 (range 29-51), sport and recreational activities (sport/rec) 48 (range 40-60), and QoL 60 (range 57-72). The median improvement for the Eq5D index was 0.30 (range 0.26-0.36). Conclusion Surgical treatment of insufficiency fractures in RA patients with bone void filler seems promising. Four out of five patients reported considerable improvement in function and QoL and substantially lower pain scores following treatment. More research is needed to investigate the efficacy of this novel surgical procedure.
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Affiliation(s)
- Peter Larsen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg Denmark
- Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg Denmark
| | | | - Søren Kold
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg Denmark
| | - Rasmus Elsøe
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg Denmark
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Tirta M, Hellfritzsch MB, Maimburg RD, Henriksen M, Lapitskaya N, Kold S, Møller-Madsen B, Rahbek O, Husum HC. Birthweight correlates to pubo-femoral distances and α angles in hip ultrasound of newborns at 6 weeks of age: a retrospective cohort study. Acta Orthop 2023; 94:594-599. [PMID: 38093629 PMCID: PMC10720353 DOI: 10.2340/17453674.2023.26188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/05/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND AND PURPOSE There is inconsistency in the literature regarding the relationship between increased birthweight and risk of developmental dysplasia of the hip (DDH). We aimed to investigate the correlation between birthweight and pubo-femoral distance (PFD), as well as Graf's α angle in newborns undergoing hip ultrasound examination at 6 weeks of age. PATIENTS AND METHODS Basic newborn characteristics and ultrasound measurements were retrospectively collected during a 1-year study period. We excluded multiple births, newborns born at less than 37 gestational weeks, and incomplete information. Simple and multiple linear regression analyses were performed to evaluate the correlation of birthweight and PFD, and, second, birthweight and α angles including a stratified regression analysis investigating the potential effect modification of sex. RESULTS 707 newborns (1,414 hips) were included. Mean birthweight was significantly higher for male newborns (P < 0.001). Increased birthweight was positively correlated to PFD values (crude coefficient 0.21, 95% confidence interval [CI] 0.10-0.32) and the correlation was still present after adjusting for sex, family history, and breech presentation (adjusted coefficient 0.18, CI 0.07-0.29). The stratified α angle model for the males was significant for both the crude coefficient (-0.73, CI -1.28 to -0.19) and the adjusted (-0.59, CI -1.15 to -0.03), and also for the females (crude coefficient -1.14, CI -1.98 to -0.31 and adjusted coefficient -1.15, CI -1.99 to -0.31). CONCLUSION We found that increased birthweight positively correlated to PFD, and negatively correlated to α angle, but this was not of clinical significance.
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Affiliation(s)
- Maria Tirta
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg.
| | - Michel Bach Hellfritzsch
- Danish Paediatric Orthopaedic Research, Aarhus University Hospital, Aarhus; Department of Radiology, Aarhus University Hospital, Aarhus
| | - Rikke Damkjær Maimburg
- Danish Paediatric Orthopaedic Research, Aarhus University Hospital, Aarhus; Department of Midwifery, University College of Northern Denmark, Aalborg; Department of Clinical Medicine, Aarhus University, Aarhus; Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus
| | - Mads Henriksen
- Danish Paediatric Orthopaedic Research, Aarhus University Hospital, Aarhus; Department of Radiology, Aarhus University Hospital, Aarhus
| | - Natallia Lapitskaya
- Danish Paediatric Orthopaedic Research, Aarhus University Hospital, Aarhus; Department of Radiology, Aarhus University Hospital, Aarhus
| | - Søren Kold
- IInterdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg; Danish Paediatric Orthopaedic Research, Aarhus University Hospital, Aarhus
| | - Bjarne Møller-Madsen
- Danish Paediatric Orthopaedic Research, Aarhus University Hospital, Aarhus; Department of Children's Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
| | - Ole Rahbek
- IInterdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg; Danish Paediatric Orthopaedic Research, Aarhus University Hospital, Aarhus
| | - Hans-Christen Husum
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg; Danish Paediatric Orthopaedic Research, Aarhus University Hospital
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Ghaffari A, Kildahl Lauritsen RE, Christensen M, Rolighed Thomsen T, Mahapatra H, Heck R, Kold S, Rahbek O. Exploring the feasibility and usability of smartphones for monitoring physical activity in orthopedic patients: A prospective observational study. JMIR Mhealth Uhealth 2023. [PMID: 37283228 DOI: 10.2196/44442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Smartphones are often equipped with inertial sensors that measure individuals' physical activities. However, their role in remote monitoring of the patients' physical activities in telemedicine needs to be adequately explored. OBJECTIVE The main objective of this study was to explore the correlation between a participant's actual daily step counts and the daily step counts reported by their smartphone. In addition, we inquired about the usability of using smartphones for collecting physical activity data. METHODS This prospective observational study was conducted on patients undergoing lower limb orthopedic surgery and a group of non-patients as control. The data from the patients were collected from 2 weeks before surgery until four weeks after the surgery, while the data collection period for the non-patients was two weeks. The participant's daily step count was recorded by physical activity trackers employed 24/7. In addition, a smartphone application collected the number of daily steps registered by the participants' smartphones. We compared the cross-correlation between the daily steps time-series taken from the smartphones and physical activity trackers in different groups of participants. We also employed mixed modeling to estimate the total number of steps, using smartphone step counts and the characteristics of the patients as independent variables. The System Usability Scale was used to evaluate the participants' experience with the smartphone application and the physical activity tracker. RESULTS Overall, 1067 days of data were collected from 21 patients (11 females) and 10 non-patients (6 females). The median and IQR for the cross-correlation coefficient on the same day was 0.70 [0.53-0.83]. The correlation in the non-patients was slightly higher than in the patients (0.74 [0.60-0.90] and 0.69 [0.52-0.81], respectively). The likelihood ratio tests on the models fitted by mixed effect methods demonstrated that the smartphone step count was positively correlated with the physical activity tracker's total number of steps (χ2 = 34.7, p < .00001). In addition, the usability score for the smartphone app was 78 [73-88] compared to 73 [68-80] for the PA tracker. CONCLUSIONS Considering the ubiquity, convenience, and practicality of smartphones, the high correlation between the smartphones and the total daily step count time-series highlights the potential usefulness of smartphones in detecting the change in the number of steps in remote monitoring of the patient's physical activity. CLINICALTRIAL
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Affiliation(s)
- Arash Ghaffari
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Hobrovej 18 - 22, Aalborg, DK
| | | | | | - Trine Rolighed Thomsen
- Danish Technological Institute, Aarhus, DK
- Department of Chemistry and Bioscience, Aalborg Uuniversity, Aalborg, DK
| | | | | | - Søren Kold
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Hobrovej 18 - 22, Aalborg, DK
| | - Ole Rahbek
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Hobrovej 18 - 22, Aalborg, DK
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12
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Ghaffari A, Rasmussen J, Kold S, Lauritsen REK, Kappel A, Rahbek O. Accelerations Recorded by Simple Inertial Measurement Units with Low Sampling Frequency Can Differentiate between Individuals with and without Knee Osteoarthritis: Implications for Remote Health Care. Sensors (Basel) 2023; 23:2734. [PMID: 36904954 PMCID: PMC10006888 DOI: 10.3390/s23052734] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/20/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
Determining the presence and severity of knee osteoarthritis (OA) is a valuable application of inertial measurement units (IMUs) in the remote monitoring of patients. This study aimed to employ the Fourier representation of IMU signals to differentiate between individuals with and without knee OA. We included 27 patients with unilateral knee osteoarthritis (15 females) and 18 healthy controls (11 females). Gait acceleration signals were recorded during overground walking. We obtained the frequency features of the signals using the Fourier transform. The logistic LASSO regression was employed on the frequency domain features as well as the participant's age, sex, and BMI to distinguish between the acceleration data from individuals with and without knee OA. The model's accuracy was estimated by 10-fold cross-validation. The frequency contents of the signals were different between the two groups. The average accuracy of the classification model using the frequency features was 0.91 ± 0.01. The distribution of the selected features in the final model differed between patients with different severity of knee OA. In this study, we demonstrated that using logistic LASSO regression on the Fourier representation of acceleration signals can accurately determine the presence of knee OA.
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Affiliation(s)
- Arash Ghaffari
- Interdisciplinary Orthopaedics, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - John Rasmussen
- Department of Materials and Production, Aalborg University, 9220 Aalborg East, Denmark
| | - Søren Kold
- Interdisciplinary Orthopaedics, Aalborg University Hospital, 9000 Aalborg, Denmark
| | | | - Andreas Kappel
- Interdisciplinary Orthopaedics, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Ole Rahbek
- Interdisciplinary Orthopaedics, Aalborg University Hospital, 9000 Aalborg, Denmark
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13
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Tirta M, Rahbek O, Kold S. Case Report of Femoral Neck Stress Fracture in X-linked Hypophosphatemic Rachitis Patient Treated with Mechanical Axis Correction and a Literature Review. J Orthop Case Rep 2023; 13:5-9. [PMID: 37144065 PMCID: PMC10152938 DOI: 10.13107/jocr.2023.v13.i02.3534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/15/2022] [Indexed: 05/06/2023] Open
Abstract
Introduction X-linked hypophosphatemic rachitis (XLHR) is the most common cause of hereditary rickets that can lead to long bone deformities requiring multiple surgical correction procedures. In addition, high rates of fractures are reported in adult XLHR patients. This study aimed to report a case of femoral neck stress fracture in XLHR patient treated with mechanical axis correction. No previous studies demonstrating a combined valgus correction and cephalomedullary nail fixation were identified in the literature. Case Report A 47-year-old male patient with XLHR attended the outpatient clinic with severe left hip pain. X-rays revealed a left proximal femoral varus deformity and a femoral neck stress fracture. After 1 month without improvement of pain, and no radiographic sign of healing, correction of the proximal femoral varus deformity and fixation of the cervical neck fracture was achieved by a cephalomedullary nail. At 8 months follow-up, hip pain relief was achieved with radiographic healing of the femoral neck stress fracture and the proximal femoral osteotomy. Conclusion A review of the literature was performed to identify any case report of femoral neck fractures fixation due to coxa vara in an adult. Both coxa vara and XLHR can cause femoral neck stress fracture. This study presented the surgical technique for treating a rare case of femoral neck stress fracture in a XLHR patient with coxa vara. Pain relief and bone healing were achieved by combined deformity correction and fracture fixation with a femoral cephalomedullary nail. The technique for deformity correction and cephalomedullary nail insertion in the patient with coxa vara is shown.
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Affiliation(s)
- Maria Tirta
- Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
- Address of Correspondence: Dr. Maria Tirta, Department of Orthopaedics, Aalborg University Hospital, Aalborg 9000, Denmark. E-mail:
| | - Ole Rahbek
- Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Kold
- Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
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14
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Clemmensen SLK, Kragholm K, Tayal B, Torp-Pedersen C, Kold S, Søgaard P, Riahi S. Risk of pacemaker implantation after femur fracture in patients with and without a history syncope: a Danish nationwide registry-based follow-up study. J Geriatr Cardiol 2022; 19:712-718. [PMID: 36284681 PMCID: PMC9548056 DOI: 10.11909/j.issn.1671-5411.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND It has previously been described that fall-associated injuries including fractures are commonly observed among patients with bradyarrhythmia. However, knowledge on the risk of pacemaker implantation after admission due to femur fracture from large population-based epidemiologic data is lacking. Therefore, we investigated the risk of pacemaker implantation following femur fracture in patients with and without a history of previous syncope. METHODS All patients with femur fracture between 2005-2017 were identified using the Danish Nationwide Patient Registry. Among these, patients already having a pacemaker were excluded. Primary outcome was one-year risk of pacemaker implantation and secondary outcome was one-year all-cause mortality. Multivariable logistic regression was used to obtain absolute and relative risks of the study endpoint in relation to patients with versus without history of syncope and standardized to the age, sex, selected comorbidity and pharmacotherapy distribution of all patients. RESULTS Of 93,093 patients with femur fracture, 5508 (5.9%) had a history of syncope within five years. Patients with prior syncope were slightly older (84 vs. 83 years), more often male (33.6% vs. 29.4%), and had more often comorbidities relative to those without history of syncope. All-cause mortality was significantly higher among those with previous history of syncope compared to those without previous syncope (29.9% vs. 28.6%, P = 0.021). The relative mortality risk was 1.05 (95% CI: 1.01-1.09, P = 0.021). A total of 695 (0.8%) patients underwent pacemaker implantation within 5 years following femur fracture, and a significantly higher proportion of patients with syncope had a pacemaker implanted within one year (1.6% vs. 0.7%, P < 0.001; relative risk, 2.01 [95% CI: 1.55-2.46]). CONCLUSIONS In patients with femur fracture, a history of syncope was significantly associated with a higher one-year risk of pacemaker implantation.
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Affiliation(s)
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Bhupendar Tayal
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Kold
- Department of Orthopedics, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
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15
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Jensen LWH, Ghaffari A, Dinesen BI, Rahbek O, Kold S. Scoping review protocol to map the use of text-based two-way communication between patients and healthcare professionals after hospital discharge and identify facilitators and barriers to implementation. BMJ Open 2022; 12:e062087. [PMID: 36137634 PMCID: PMC9511569 DOI: 10.1136/bmjopen-2022-062087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION After discharge, patients face multiple risks where timely communication with healthcare professionals is required. eHealth has proposed new possibilities for asynchronous text-based two-way communication between patients and healthcare professionals during this time, and studies show positive effects on clinical outcomes, care coordination and patient satisfaction. However, there are challenges to the adoption of text-based two-way communication, potentially undermining the positive effects in clinical practice. Knowledge of these factors may inform future research and implementations. No reviews have provided an overview of the use of text-based two-way communication after discharge and the identified facilitators and barriers. Therefore, the objective of this scoping review is to systematically identify and map available research that assess the use of text-based two-way communication between patients and healthcare professionals after hospital discharge, including facilitators and barriers to implementation. METHODS AND ANALYSIS We will include all studies describing the use of text-based two-way communication between patients and healthcare professionals after discharge from hospital. A preliminary search of PubMed (PubMed.gov), EMBASE (Elsevier), CINAHL (EBSCO), PsycINFO (Ovid), Cochrane Library (Wiley), Web of Science (Clarivate) and Scopus (Elsevier) was undertaken on 9 November 2021. The search will be updated for the full scoping review, and reference lists of relevant papers reviewed. Two reviewers will independently screen the literature for inclusion. Data will be extracted and charted in accordance with a data extraction form developed from the research questions and inspired by Consolidated Framework Implementation Research. Findings will be presented in tabular format and a descriptive summary, and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. ETHICS AND DISSEMINATION This scoping review will not require ethics approval. The dissemination strategy involves peer review publication and presentation at conferences.
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Affiliation(s)
| | - Arash Ghaffari
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | | | - Ole Rahbek
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Kold
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
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Frost MW, Rahbek O, Fridberg M, Mikužis M, Kold S. Do Surgeons Agree on Severity and Origin of Complications in Bone-lengthening Nails? An Inter- and Intra-rater Reliability Study. Strategies Trauma Limb Reconstr 2022; 17:153-158. [PMID: 36756297 PMCID: PMC9886029 DOI: 10.5005/jp-journals-10080-1571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 11/02/2022] [Indexed: 01/01/2023] Open
Abstract
Background Bone-lengthening nails result in various complications with different severity and origin. However, no universal reporting system for complications has been agreed upon, making it difficult to compare different nail designs and patient populations. This study aimed to assess the inter- and intra-rater agreement of a classification system of complications according to severity and origin. Materials and methods Four orthopaedic surgeons assessed 48 complications retrieved from patient charts in a single-centre cohort and 49 literature complications cases. Complications were classified according to severity grading (I, II, IIIA and IIIB) from Black et al. and origin with eight main types and 33 subtypes. A blinded independent assessment was performed twice at least six weeks apart. Cohen/Congers kappa estimated for the inter- and intra-rater agreement was interpreted after Svanholm et al. Results The surgeons had a good inter-rater agreement for complication severity with a kappa value of 0.68 [95% confidence interval (CI): 0.56-0.79] and complication origin with a kappa value of 0.63 (CI: 0.53-0.73), respectively, on the cohort cases. In literature cases, a good agreement on complication severity and origin grading was shown by kappa values of 0.64 (CI: 0.53-0.75) and 0.74 (CI: 0.65-0.83). The intra-rater assessment of complication severity and origin grading had good to excellent agreement with kappa values ranging from 0.51 to 0.97. Conclusion and clinical significance The study presents the first structured complication classification on severity and origin in intramedullary bone-lengthening nails. A good reproducibility agreement in both severity and origin was found between four orthopaedic surgeons for both cohort and literature complication cases. For clinical and research purposes, a shared language for communicating complications is essential. We encourage future studies to use a structured and validated complication classification. How to cite this article Frost MW, Rahbek O, Fridberg M, et al. Do Surgeons Agree on Severity and Origin of Complications in Bone-lengthening Nails? An Inter- and Intra-rater Reliability Study. Strategies Trauma Limb Reconstr 2022;17(3):153-158.
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Affiliation(s)
| | - Ole Rahbek
- Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Marie Fridberg
- Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Mindaugas Mikužis
- Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Kold
- Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark
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17
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Paludan CG, Thomsen KKV, Rahbek O, Kold S. Complications of orthopedic treatment in patients diagnosed with X-linked hypophosphatemic rickets. J Pediatr Endocrinol Metab 2022; 35:1003-1009. [PMID: 35700440 DOI: 10.1515/jpem-2021-0775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/23/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES XLHR in children with a Rickets Severity Score ≥2 can now be treated with the new antibody drug, Burosumab, which prevents bone deformities and increases gait endurance. This study illustrates the extent of complications in the traditional orthopedic treatment of XLHR. The impact of surgery and severity of complications in this patient population has not been systematically assessed before. METHODS The search strategy resulted in 215 studies and data were collected from 19 eligible studies and complications were categorized. Four medical charts of patients with XLHR at Aalborg University Hospital were assessed. RESULTS One complication occurred on average per surgical procedure for XLHR in the published literature. The 168 reported complications were categorized as follows: Type I (n=79): Complications with minimal intervention required and treatment goal still achieved, Type II (n=41): Complications with substantial change in treatment plan and treatment goal still achieved, Type IIIA (n=23): Complications with failure to achieve treatment goal and no new pathology or permanent sequelae, Type IIIB (n=25): Complications with failure to achieve treatment goal and/or new pathology or permanent sequelae. CONCLUSIONS In average, one complication occurred per surgery and the severity of complications were substantial. The treatment goal was not achieved in 28% of surgeries whereof half of them resulted in permanent sequalae or new pathology. Our findings support the use of Burosumab for treatment of the skeletal changes in XLHR as the reported side-effects in Burosumab treatment appear negligible compared to the impact of surgeries and related complications (Imel EA, Glorieux FH, Whyte MP, Munns CF, Ward LM, Nilsson O, et al. Burosumab versus conventional therapy in children with X-linked hypophosphataemia: a randomised, active-controlled, open-label, phase 3 trial. Lancet 2019;393:2416-27). However, orthopedic surgery might still be needed for correcting deformities restricting activities of daily living in XLHR patients.
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Affiliation(s)
- Carl Gustaf Paludan
- Department of Orthopaedics, Interdisciplinary Orthopedics, Aalborg University Hospital, Aalborg, Nordjylland, Denmark
| | | | - Ole Rahbek
- Department of Orthopaedics, Interdisciplinary Orthopedics, Aalborg University Hospital, Aalborg, Nordjylland, Denmark
| | - Søren Kold
- Department of Orthopaedics, Interdisciplinary Orthopedics, Aalborg University Hospital, Aalborg, Nordjylland, Denmark
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18
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Ghaffari A, Rahbek O, Lauritsen REK, Kappel A, Kold S, Rasmussen J. Criterion Validity of Linear Accelerations Measured with Low-Sampling-Frequency Accelerometers during Overground Walking in Elderly Patients with Knee Osteoarthritis. Sensors (Basel) 2022; 22:5289. [PMID: 35890969 PMCID: PMC9322915 DOI: 10.3390/s22145289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
Sensors with a higher sampling rate produce higher-quality data. However, for more extended periods of data acquisition, as in the continuous monitoring of patients, the handling of the generated big data becomes increasingly complicated. This study aimed to determine the validity and reliability of low-sampling-frequency accelerometer (SENS) measurements in patients with knee osteoarthritis. Data were collected simultaneously using SENS and a previously validated sensor (Xsens) during two repetitions of overground walking. The processed acceleration signals were compared with respect to different coordinate axes to determine the test-retest reliability and the agreement between the two systems in the time and frequency domains. In total, 44 participants were included. With respect to different axes, the interclass correlation coefficient for the repeatability of SENS measurements was [0.93-0.96]. The concordance correlation coefficients for the two systems' agreement were [0.81-0.91] in the time domain and [0.43-0.99] in the frequency domain. The absolute biases estimated by the Bland-Altman method were [0.0005-0.008] in the time domain and [0-0.008] in the frequency domain. Low-sampling-frequency accelerometers can provide relatively valid data for measuring the gait accelerations in patients with knee osteoarthritis and can be used in the future for remote patient monitoring.
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Affiliation(s)
- Arash Ghaffari
- Interdisciplinary Orthopaedics, Aalborg University Hospital, 9000 Aalborg, Denmark; (O.R.); (R.E.K.L.); (A.K.); (S.K.)
| | - Ole Rahbek
- Interdisciplinary Orthopaedics, Aalborg University Hospital, 9000 Aalborg, Denmark; (O.R.); (R.E.K.L.); (A.K.); (S.K.)
| | | | - Andreas Kappel
- Interdisciplinary Orthopaedics, Aalborg University Hospital, 9000 Aalborg, Denmark; (O.R.); (R.E.K.L.); (A.K.); (S.K.)
| | - Søren Kold
- Interdisciplinary Orthopaedics, Aalborg University Hospital, 9000 Aalborg, Denmark; (O.R.); (R.E.K.L.); (A.K.); (S.K.)
| | - John Rasmussen
- Department of Materials and Production, Aalborg University, 9220 Aalborg East, Denmark;
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Jensen SS, Jensen NM, Gundtoft PH, Kold S, Zura R, Viberg B. Risk factors for nonunion following surgically managed, traumatic, diaphyseal fractures: a systematic review and meta-analysis. EFORT Open Rev 2022; 7:516-525. [PMID: 35900220 PMCID: PMC9297052 DOI: 10.1530/eor-21-0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Signe Steenstrup Jensen
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, Kolding, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Niels Martin Jensen
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, Kolding, Denmark
| | - Per Hviid Gundtoft
- Department of Orthopedic Surgery and Traumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Kold
- Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Robert Zura
- Department of Orthopedic Surgery, Louisiana State University Medical Center, New Orleans, Louisiana, USA
| | - Bjarke Viberg
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, Kolding, Denmark
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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20
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Galsklint J, Kold S, Kristensen SR, Severinsen MT, Gade IL. Validation of Postsurgical Venous Thromboembolism Diagnoses of Patients Undergoing Lower Limb Orthopedic Surgery in the Danish National Patient Registry. Clin Epidemiol 2022; 14:191-199. [PMID: 35210866 PMCID: PMC8860350 DOI: 10.2147/clep.s345293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background Healthcare databases can be a valuable source of epidemiological research regarding postoperative venous thromboembolism (VTE), ie, deep vein thrombosis (DVT) and pulmonary embolism (PE), following orthopedic procedures, but only if the diagnoses are valid. We examined the validity of VTE diagnosis codes in the Danish National Patient Registry (DNPR) by calculating their positive predictive value (PPV) and negative predictive value (NPV) versus actual medical records. Methods We identified patients who had undergone lower limb surgery during the period 2009–2019 at a hospital in the North Denmark Region. Of these, 420 patients had at least one VTE diagnosis registered in the DNPR within 180 days after lower limb surgery. Each patient with a VTE diagnosis was matched with two patients on age and sex, as well as type, location and period of surgery. The entire medical record and diagnostic imaging were reviewed to confirm VTE diagnosis. Results The overall PPVs was 85.2% (95% CI: 81.5–88.5%) for first time VTE diagnosis following lower limb surgery, 82.6% (95% CI: 77.5–82.8%) for DVT, and 90.3% (95% CI: 84.3–94.6%) for PE. We found improvement in PPV during the study period when stratifying for three periods of the whole period. There were no significant differences when stratifying for sex, age, or surgery site. All negative predictive values were higher than 99%. A total of 113 additional VTE diagnoses were registered among 88 VTE patients during follow-up. Only four of the suspected recurrent VTEs were confirmed to be true recurrent VTEs. Conclusion The VTE diagnosis codes in the DNPR after lower limb orthopedic surgery were highly valid against the actual medical records, and we observed better PPV over recent years.
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Affiliation(s)
- Josephine Galsklint
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Kold
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Risom Kristensen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Marianne Tang Severinsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Hematology and Clinical Cancer Research, Aalborg University Hospital, Aalborg, Denmark
- Correspondence: Marianne Tang Severinsen, Department of Hematology, University Hospital, Aalborg, Denmark, Email
| | - Inger Lise Gade
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Hematology and Clinical Cancer Research, Aalborg University Hospital, Aalborg, Denmark
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
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21
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Husum HC, Thomsen JL, Kold S, Maimburg RD, Rahbek O. Referral criteria recognition of screeners in the Danish screening programme for hip dysplasia. Dan Med J 2022; 69:A01210098. [PMID: 35088700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The aim of this study was to review risk factors used in the current Danish screening programme for developmental dysplasia of the hip (DDH) and the self-reported recognition of these risk factors among midwives, general practitioners (GP) and GPs in training. METHODS A survey of regional DDH referral guidelines was conducted through online regional guideline databases. Furthermore, risk factors used as referral criteria for DDH were compared across regions. Using an online survey, we asked midwives, GPs and GPs in training to identify which of six risk factors for DDH were currently featured as referral criteria for specialised DDH examination in the referral guidelines of their employment region. Answers were compared with the DDH referral guidelines of the responders' employment region. RESULTS We collected 178 survey responses and 11 local and regional DDH referral guidelines. Six risk factors were identified from referral guidelines (breech presentation, oligohydramnios, family history of DDH, clubfeet, twins and premature birth). Overall, correct answer percentages for currently used risk factors for DDH as specified in the corresponding regional guidelines were: 96% (breech presentation), 90% (family history of DDH), 66% (twins), 63% (premature birth), 34% (clubfeet) and 29% (oligohydramnios). CONCLUSIONS This study found variation in the referral criteria among Danish regional DDH referral guidelines and an overall high level of recognition for two out of six referral criteria but a low level of recognition for the remaining four. FUNDING The authors received no financial support for the research conducted in preparation of this article. TRIAL REGISTRATION not relevant.
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Affiliation(s)
- Hans-Christen Husum
- Interdisciplinary Orthopaedics, Aalborg University Hospital
- Danish Paediatric Orthopaedic Research, Denmark
| | | | - Søren Kold
- Interdisciplinary Orthopaedics, Aalborg University Hospital
| | - Rikke Damkjær Maimburg
- Department of Gynaecology and Obstetrics, Aarhus University Hospital
- Danish Paediatric Orthopaedic Research, Denmark
| | - Ole Rahbek
- Interdisciplinary Orthopaedics, Aalborg University Hospital
- Danish Paediatric Orthopaedic Research, Denmark
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22
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Annadatha S, Hua Q, Fridberg M, Lindstrøm Jensen T, Liu J, Kold S, Rahbek O, Shen M. Preparing infection detection technology for hospital at home after lower limb external fixation. Digit Health 2022; 8:20552076221109502. [PMID: 35783467 PMCID: PMC9243585 DOI: 10.1177/20552076221109502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/06/2022] [Indexed: 11/15/2022] Open
Abstract
Background Patients with severe bone fractures and complex bone deformities are treated by orthopedic surgeons with external fixation for several months. During this long treatment period, there is a high risk of inflammation and infection at the superficial skin area (pin site). This can develop into a devastating, sometimes fatal, and always costly condition of deep bone infection. Objective For pin site infection surveillance, thermography technology could be the solution to build an objective and continuous home-based remote monitoring tool to avoid frequent nursing care and hospital visits. However, future studies of infection monitoring require a preliminary step to automate the process of locating and detecting the pin sites in thermal images reliably for temperature measurement, and this step is the aim of this study. Methods This study presents an automatic approach for identifying and annotating pin sites on visible images using bounding boxes and transferring them to the corresponding thermal images for temperature measurement. The pin site is detected by applying deep learning-based object detection architecture YOLOv5 with a novel loss evaluation and regression method, control distance intersection over union. Furthermore, we address detecting pin sites in a practical environment (home setting) accurately through transfer learning. Results and conclusion The proposed model offers the pin site detection in 1.8 ms with a high precision of 0.98 and enables temperature information extraction. Our work for automatic pin site annotation on thermography paves the way for future research on infection assessment on thermography.
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Affiliation(s)
- Sowmya Annadatha
- Department of Electronic Systems, Aalborg University, Aalborg, Denmark
| | - Qirui Hua
- Department of Electronic Systems, Aalborg University, Aalborg, Denmark
| | | | | | - Jianan Liu
- Vitalent Consulting, Gothenburg Sweden and Silo AI, Stockholm,
Sweden
| | - Søren Kold
- Aalborg University Hospital, Aalborg, Denmark
| | - Ole Rahbek
- Aalborg University Hospital, Aalborg, Denmark
| | - Ming Shen
- Department of Electronic Systems, Aalborg University, Aalborg, Denmark
- Ming Shen, Department of Electronic
Systems, Aalborg University, Aalborg, Denmark Ole Rahbek, Aalborg University
Hospital, Aalborg, Denmark.
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23
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Kold S, Fridberg M, Bue M, Rölfing J. Host factors and risk of pin site infection in external fixation: A systematic review examining age, body mass index, smoking, and comorbidities including diabetes. J Limb Lengthen Reconstr 2022. [DOI: 10.4103/jllr.jllr_32_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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24
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Okowinski M, Hjorth MH, Mosegaard SB, Jürgens-Lahnstein JH, Storgaard Jakobsen S, Hedevang Christensen P, Kold S, Stilling M. Ten-year comparison of two different techniques for femoral bone cavity preparation-broaching versus compaction in patients with cementless total hip arthroplasty : a randomized radiostereometric study of 30 total hip arthroplasties in 15 patients operated bilaterally. Bone Jt Open 2021; 2:1035-1042. [PMID: 34865512 PMCID: PMC8711659 DOI: 10.1302/2633-1462.212.bjo-2021-0152.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Aims Femoral bone preparation using compaction technique has been shown to preserve bone and improve implant fixation in animal models. No long-term clinical outcomes are available. There are no significant long-term differences between compaction and broaching techniques for primary total hip arthroplasty (THA) in terms of migration, clinical, and radiological outcomes. Methods A total of 28 patients received one-stage bilateral primary THA with cementless femoral stems (56 hips). They were randomized to compaction on one femur and broaching on the contralateral femur. Overall, 13 patients were lost to the ten-year follow-up leaving 30 hips to be evaluated in terms of stem migration (using radiostereometry), radiological changes, Harris Hip Score, Oxford Hip Score, and complications. Results Over a mean follow-up period of 10.6 years, the mean stem subsidence was similar between groups, with a mean of -1.20 mm (95% confidence interval (CI) -2.28 to -0.12) in the broaching group and a mean of -0.73 mm (95% CI -1.65 to 0.20) in the compaction group (p = 0.07). The long-term migration patterns of all stems were similar. The clinical and radiological outcomes were similar between groups. There were two intraoperative fractures in the compaction group that were fixed with cable wire and healed without complications. No stems were revised. Conclusion Similar stem subsidence and radiological and clinical outcomes were identified after the use of compaction and broaching techniques of the femur at long-term follow-up. Only the compaction group had intraoperative periprosthetic femur fractures, but there were no long-term consequences of these. Cite this article: Bone Jt Open 2021;2(12):1035–1042.
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Affiliation(s)
- Maciej Okowinski
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Holm Hjorth
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Sebastian Breddam Mosegaard
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
| | - Jonathan Hugo Jürgens-Lahnstein
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Stig Storgaard Jakobsen
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Søren Kold
- Department of Orthopedics, Aalborg University Hospital, Aalborg, Denmark
| | - Maiken Stilling
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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25
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Abstract
Background Intramedullary lengthening nails have shown excellent short-term results. The FITBONE and the PRECICE nail are the two most commonly used intramedullary lengthening nails. The manufacturer of each nail recommends the removal of the implant after the completion of the treatment. Despite the need for removal of each nail, the authors are not aware of any prior publications documenting the results of standard intramedullary lengthening nail removal. Therefore, the aim of this study was to examine the intraoperative and postoperative complications of elective intramedullary lengthening nail removals. Materials and methods We performed a retrospective chart review of patients operated with intramedullary lengthening nails at two limb reconstruction centres (one in the United States, and the second in Denmark). Data retrieved from the patient charts included patient demographics, nail information and any complications occurring at or after nail removal. Only lower limb lengthening with FITBONE and PRECICE or STRYDE nails that had an elective nail removal was included. Result A total of 271 elective nail removals were included in the study. Complications occurred during 3% of the nail removals and in 13% after nail removal. There were 18 reported cases with postoperative knee pain. All these patients had nail removal through the knee joint, representing 8% of the retrograde femur nail removals and 7% of the tibia nail removals. Four postoperative fractures occurred, of which two needed surgery. Eleven percent of femur removals and 26% of tibial removals sustained a complication. Conclusion and clinical significance This study emphasises the importance of adequate follow-up of the bone lengthening patient even after the nail has been removed. It also shows that the recommended removal of the intramedullary nail (IMN) lengthening nails must be included in studies reporting on the overall risks of complications using bone lengthening nails. How to cite this article Frost MW, Kold S, Rahbek O, et al. Complications in Elective Removal of 271 Bone Lengthening Nails (FITBONE, PRECICE and STRYDE). Strategies Trauma Limb Reconstr 2021;16(2):110-115.
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Affiliation(s)
- Markus W Frost
- Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Søren Kold
- Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Ole Rahbek
- Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Anirejuoritse Bafor
- Department of Orthopedic Surgery, Center for Limb Lengthening and Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, United States of America
| | - Molly Duncan
- Department of Orthopedic Surgery, Center for Limb Lengthening and Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, United States of America
| | - Christopher A Iobst
- Department of Orthopedic Surgery, Center for Limb Lengthening and Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, United States of America
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26
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Jellesen MS, Lomholt TN, Hansen RQ, Mathiesen T, Gundlach C, Kold S, Nygaard T, Mikuzis M, Olesen UK, Rölfing JD. The STRYDE limb lengthening nail is susceptible to mechanically assisted crevice corrosion: an analysis of 23 retrieved implants. Acta Orthop 2021; 92:621-627. [PMID: 34102950 PMCID: PMC8519523 DOI: 10.1080/17453674.2021.1927506] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - We noted several adverse events in patients in whom the first version of the STRYDE limb-lengthening nail (NuVasive Specialized Orthopaedics, San Diego, CA) had been implanted. Pain, osteolysis, periosteal reactions, and cortical hypertrophy at the nail junction were noted. Here, we present the analysis of 23 retrieved STRYDE implants.Materials and methods - We undertook visual inspection of the retrieved nails and screws, mechanical evaluation of the junction, micro-CT analyses, microscopic inspection of the bushing, screws, screw holes, and separated parts of the implants. Positive material identification (PMI) and energy-dispersive X-ray spectroscopy (EDS) were used to analyze the chemical composition. The hardness of the material was also investigated.Results - 20/23 retrieved nails had visible signs of corrosion, i.e., discoloration at the telescopic junction. Micro-CT verified corrosion attacks in 12/12 scanned bushings. Corrosion, predominantly mechanically assisted crevice corrosion, was observed at the locking screws and screw holes in 20/23 nails. Biological material inside the nail was observed in addition to oozing from the junction of 2 nails during hardware removal, which was experimentally reproducible. Notably, the mechanical construction of the bushing changed from PRECICE P2 to STRYDE nails.Interpretation - STRYDE nails are not hermetically sealed, and liquid can pass the bushing. Biodur 108 itself is corrosion resistant; however, mechanically assisted crevice corrosion of the bushing, locking screws, and screw holes may be aggravated due to manufacturing aiming for increased strength and hardness of the alloy.Observing several adverse events, we recently published a nationwide cross-sectional analysis of all 30 STRYDE limb- lengthening nails (NuVasive, Specialized Orthopedics, San Diego, CA) that were implanted in Denmark (Rölfing et al. 2021a). 27/30 STRYDE nails have now been removed and we present data from metallurgical analysis of 23 of the retrieved implants.
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Affiliation(s)
| | | | - Rikke Quist Hansen
- Department of Mechanical Engineering, Technical University of Denmark, Lyngby; ,Materials and Product Testing, FORCE Technology, Brøndby;
| | | | | | - Søren Kold
- Department of Orthopaedics, Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg;
| | - Tobias Nygaard
- Department of Orthopaedics, Limb Lengthening and Bone Reconstruction Unit, Rigshospitalet, Copenhagen;
| | - Mindaugas Mikuzis
- Department of Orthopaedics, Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg;
| | - Ulrik Kähler Olesen
- Department of Orthopaedics, Limb Lengthening and Bone Reconstruction Unit, Rigshospitalet, Copenhagen;
| | - Jan Duedal Rölfing
- Orthopaedic Reconstruction and Children’s Orthopaedics, Aarhus University Hospital, Aarhus, Denmark,Jan Duedal Rölfing Correspondence: Orthopaedic Reconstruction and Children’s Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
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27
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Iobst CA, Frost MW, Rölfing JD, Rahbek O, Bafor A, Duncan M, Kold S. Radiographs of 366 removed limb-lengthening nails reveal differences in bone abnormalities between different nail types. Bone Joint J 2021; 103-B:1731-1735. [PMID: 34414785 DOI: 10.1302/0301-620x.103b.bjj-2021-0549.r1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Limb-lengthening nails have largely replaced external fixation in limb-lengthening and reconstructive surgery. However, the adverse events and high prevalence of radiological changes recently noted with the STRYDE lengthening nail have raised concerns about the use of internal lengthening nails. The aim of this study was to compare the prevalence of radiological bone abnormalities between STRYDE, PRECICE, and FITBONE nails prior to nail removal. METHODS This was a retrospective case series from three centres. Patients were included if they had either of the three limb-lengthening nails (STYDE, PRECICE, or FITBONE) removed. Standard orthogonal radiographs immediately prior to nail removal were examined for bone abnormalities at the junction of the telescoping nail parts. RESULTS In total, 306 patients (168 male, 138 female) had 366 limb-lengthening nails removed. The mean time from nail insertion to radiological evaluation was 434 days (36 to 3,015). Overall, 77% of STRYDE nails (20/26) had bone abnormalities at the interface compared with only 2% of FITBONE (4/242) and 1% of PRECICE nails (1/98; p < 0.001). Focal osteolysis in conjunction with periosteal reaction at the telescoping interface was only observed in STRYDE nails. CONCLUSION Bone abnormalities at the interface of telescoping nail parts were seen in the majority of STRYDE nails, but only very rarely with FITBONE or PRECICE nails. We conclude that the low prevalence of radiological changes at the junctional interface of 242 FITBONE and 98 PRECICE nails at the time of nail removal does not warrant clinical concerns. Cite this article: Bone Joint J 2021;103-B(11):1731-1735.
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Affiliation(s)
| | | | | | - Ole Rahbek
- Aalborg University Hospital, Aalborg, Denmark
| | | | - Molly Duncan
- Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Søren Kold
- Aalborg University Hospital, Aalborg, Denmark
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28
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Mikužis M, Rahbek O, Christensen K, Kold S. Complications common in motorized intramedullary bone transport for non-infected segmental defects: a retrospective review of 15 patients. Acta Orthop 2021; 92:485-492. [PMID: 34074206 PMCID: PMC8381977 DOI: 10.1080/17453674.2021.1910777] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Since the introduction of intramedullary bone transport nails only very few cases have been reported in the literature. Thus we evaluated the results and complications in a single institution retrospective cohort.Patients and methods - 15 (median age 40 years (18-70), 8 males) consecutive patients, were included and the electronic patient records and radiographs were reviewed. Complications were severity graded and categorized as device or non-device related.Results - The segmental bone loss was due to non-union site in 8 femurs and 4 tibias, or traumatic bone loss in 2 femurs and 1 tibia. The segmental bone defect was a median of 3 cm (0.5-10). 9 of 10 femoral cases and 4 of 5 tibial cases healed with the bone transport nail. All 15 patients had a healed docking site and regenerate at the end of treatment after a median of 13 months (6-38). 24 complications (15 device related and 9 non-device related) occurred in 11/15 patients with a minimum follow-up of 6 months after nail removal. The number of unplanned surgeries due to device related complications was: 0 in 9 patients, 1 in 3 patients, 2 in 1 patient, 3 in 2 patients.Interpretation - Segmental bone defects can heal with a bone transport nail. However, the number of complications was high and 15 out of 24 complications were devicerelated. Optimizing nail design is therefore needed to reduce complications in intramedullary bone transport.
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Affiliation(s)
- Mindaugas Mikužis
- Department of Orthopaedics, Aalborg University Hospital, Aalborg,Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, Denmark,Correspondence:
| | - Ole Rahbek
- Department of Orthopaedics, Aalborg University Hospital, Aalborg,Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | - Knud Christensen
- Department of Orthopaedics, Aalborg University Hospital, Aalborg,Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Kold
- Department of Orthopaedics, Aalborg University Hospital, Aalborg,Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
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Husum H, Ghaffari A, Rytoft LA, Svendsson J, Harving S, Kold S, Rahbek O. Positive predictive values in clinical screening for developmental dysplasia of the hip. Acta Paediatr 2021; 110:2430-2434. [PMID: 33914971 DOI: 10.1111/apa.15896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/30/2021] [Accepted: 04/26/2021] [Indexed: 11/28/2022]
Abstract
AIM To establish the positive predictive value (PPV) of clinical hip examinations performed by referrers in the Danish screening programme for Developmental Dysplasia of the Hip (DDH) utilising three definitions of true positive DDH diagnosis. METHODS We retrospectively identified 290 children (169 female) referred during a 4-year period to the orthopaedic outpatient clinic at our institution with a positive clinical hip examination. Positive predictive value was calculated for clinical hip examinations across three definitions of a true positive clinical hip examination for all referrers and subgroups consisting of general practitioners, midwives and paediatricians. The PPV for clinical hip examinations was calculated for paediatric orthopaedic surgeons using one of the three definitions. RESULTS Positive predictive value of clinical hip examinations for all referrers were 5.4%, 3.6% and 1.8% with the definition of a true positive DDH diagnosis defined as clinical instability found by orthopaedic surgeon, ultrasound classification ≥Graf IIc or both definitions combined, respectively. Positive predictive value of clinical hip examinations performed by orthopaedic surgeons was 33.3% with a true positive clinical examination defined as an ultrasound classification ≥Graf IIc. CONCLUSION We conclude that the positive predictive value of clinical hip examinations made by referrers in the Danish screening programme for DDH is low.
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Affiliation(s)
| | - Arash Ghaffari
- Interdisciplinary Orthopaedics Aalborg University Hospital Aalborg Denmark
| | | | - Jens Svendsson
- Interdisciplinary Orthopaedics Aalborg University Hospital Aalborg Denmark
| | - Søren Harving
- Interdisciplinary Orthopaedics Aalborg University Hospital Aalborg Denmark
| | - Søren Kold
- Interdisciplinary Orthopaedics Aalborg University Hospital Aalborg Denmark
| | - Ole Rahbek
- Interdisciplinary Orthopaedics Aalborg University Hospital Aalborg Denmark
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Kappel A, Nielsen PT, Kold S. 1-stage total knee arthroplasty and proximal tibial non-union correction using 3-D planning and custom-made cutting guide. Acta Orthop 2021; 92:452-454. [PMID: 33683179 PMCID: PMC8381981 DOI: 10.1080/17453674.2021.1894789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Andreas Kappel
- Interdisciplinary Orthopaedics, Aalborg University Hospital;
- Department of Clinical Medicine, Aalborg University, Denmark
| | | | - Søren Kold
- Interdisciplinary Orthopaedics, Aalborg University Hospital;
- Department of Clinical Medicine, Aalborg University, Denmark
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31
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Rölfing JD, Kold S, Nygaard T, Mikuzis M, Brix M, Faergemann C, Gottliebsen M, Davidsen M, Petruskevicius J, Olesen UK. Pain, osteolysis, and periosteal reaction are associated with the STRYDE limb lengthening nail: a nationwide cross-sectional study. Acta Orthop 2021; 92:479-484. [PMID: 33757381 PMCID: PMC8428270 DOI: 10.1080/17453674.2021.1903278] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Observing serious adverse events during treatment with the Precice Stryde bone lengthening nail (NuVasive, San Diego, CA, USA), we conducted a nationwide cross-sectional study to report the prevalence of adverse events from all 30 bone segments in 27 patients treated in Denmark.Patients and methods - Radiographs of all bone segments were evaluated regarding radiographic changes in February 2021. We determined the number of bone segments with late onset of pain and/or radiographically confirmed osteolysis, periosteal reaction, or cortical hypertrophy in the junctional area of the nail.Results - In 30 bone segments of 27 patients we observed radiographic changes in 21/30 segments of 20/27 patients, i.e., 19/30 osteolysis, 12/30 periosteal reaction (most often multi-layered), and 12/30 cortical hypertrophy in the area of the junction between the telescoping nail parts. Late onset of pain was a prominent feature in 8 patients. This is likely to be a prodrome to the bony changes. Discoloration (potential corrosion) at the nail interface was observed in multiple removed nails. 15/30 nails were still at risk of developing complications, i.e., were not yet removed.Interpretation - All Stryde nails should be monitored at regular intervals until removal. Onset of pain at late stages of limb lengthening, i.e., consolidation of the regenerate, should warrant immediate radiographic examination regarding osteolysis, periosteal reaction, and cortical hypertrophy, which may be associated with discoloration (potential corrosion) of the nail. We recommend removal of Stryde implants as early as possible after consolidation of the regenerate.
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Affiliation(s)
- Jan Duedal Rölfing
- Orthopaedic Reconstruction and Children’s Orthopaedics, Aarhus University Hospital, Aarhus
- Department of Clinical Medicine, Aarhus University, Aarhus
| | - Søren Kold
- Department of Orthopaedics, Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg
| | - Tobias Nygaard
- Department of Orthopaedics, Limb Lengthening and Bone Reconstruction Unit, Rigshospitalet, Copenhagen
| | - Mindaugas Mikuzis
- Department of Orthopaedics, Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg
| | - Michael Brix
- Department of Orthopaedics, Odense University Hospital, Odense, Denmark
| | | | - Martin Gottliebsen
- Orthopaedic Reconstruction and Children’s Orthopaedics, Aarhus University Hospital, Aarhus
| | - Michael Davidsen
- Orthopaedic Reconstruction and Children’s Orthopaedics, Aarhus University Hospital, Aarhus
| | - Juozas Petruskevicius
- Orthopaedic Reconstruction and Children’s Orthopaedics, Aarhus University Hospital, Aarhus
| | - Ulrik Kähler Olesen
- Department of Orthopaedics, Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg
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Ghaffari A, Jørgensen MK, Rømer H, Sørensen MPB, Kold S, Rahbek O, Bisgaard J. Does the performance of lower limb peripheral nerve blocks differ among orthopedic sub-specialties? A single institution experience in 246 patients. Scand J Pain 2021; 21:794-803. [PMID: 34062627 DOI: 10.1515/sjpain-2021-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/27/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Continuous peripheral nerve blocks (cPNBs) have shown promising results in pain management after orthopaedic surgeries. However, they can be associated with some risks and limitations. The purpose of this study is to describe our experience with the cPNBs regarding efficacy and adverse events in patients undergoing orthopedic surgeries on the lower extremity in different subspecialties. METHODS This is a prospective cohort study on collected data from perineural catheters for pain management after orthopedic surgeries in lower limbs. Catheters were placed by experienced anesthesiologists using sterile technique. After an initial bolus dose of 10-20 mL ropivacaine 0.5% (weight adjusted), the catheters were secured and connected to disposable mechanical infusion pumps with ropivacaine 0.2% (basal infusion rate = 6 mL/h; weight adjusted (0.2 mL/kg/h)). After catheterization, the patients were examined daily, by specially educated acute pain service nurses. Pro re nata (PRN) or fixed boluses (10 mL bupivacaine 0.25%; weight adjusted) with an upper limit of 4 times/day, were administered if indicated. Patients' demographic data, physiological status, and pre-op intake of opioids and other analgesics were registered. The severity of post-operative pain was assessed with 'Numeric Rating Scale' (NRS) and 'Face, legs, Activity, Cry, Consolability' (FLACC) scale for adults and children, respectively. The need for additional opioids and possible complications were registered. RESULTS We included 547 catheters of 246 patients (Range 1-10 catheters per patient). Overall, 115 (21%) femoral, 162 (30%) saphenous, 66 (12%) sciatic, and 204 (37%) popliteal sciatic nerve catheter were used. 452 (83%) catheters were inserted by a primary procedure, 61(11%) catheters employed as a replacement, and 34 catheters (6.2%) used as a supplement. For guiding the catheterization, ultrasound was applied in 451 catheters (82%), nerve stimulator in 90 catheters (16%), and both methods in 6 catheters (1.1%). The median duration a catheter remained in place was 3 days (IQR = 2-5). The proportion of catheters with a duration of two days was 81, 79, 73, and 71% for femoral, sciatic, saphenous, and popliteal nerve, respectively. In different subspecialties, 91% of catheters in wound and amputations, 89% in pediatric surgery, 76% in trauma, 64% in foot and ankle surgery, and 59% in limb reconstructive surgery remained more than two days. During first 10 days after catheterization, the proportion of pain-free patients were 77-95% at rest and 63-88% during mobilization, 79-92% of the patients did not require increased opioid doses, and 50-67% did not require opioid PRN doses. In addition to 416 catheters (76%), which were removed as planned, the reason for catheter removal was leaving the hospital in 27 (4.9%), loss of efficacy in 69 (13%), dislodgement in 23 (4.2%), leakage in 8 (1.5%), and erythema in 4 catheters (0.73%). No major complication occurred. CONCLUSIONS After orthopaedic procedures, cPNBs can be considered as an efficient method for improving pain control and minimizing the use of additional opioids. However, the catheters sometimes might need to be replaced to achieve the desired efficacy.
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Affiliation(s)
- Arash Ghaffari
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | | | - Helle Rømer
- Orthopedic Anaestesia Department, Aalborg University Hospital, Aalborg, Denmark
| | | | - Søren Kold
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | - Ole Rahbek
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | - Jannie Bisgaard
- Orthopedic Anaestesia Department, Aalborg University Hospital, Aalborg, Denmark
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Frost MW, Rahbek O, Traerup J, Ceccotti AA, Kold S. Systematic review of complications with externally controlled motorized intramedullary bone lengthening nails (FITBONE and PRECICE) in 983 segments. Acta Orthop 2021; 92:120-127. [PMID: 33106069 PMCID: PMC7919879 DOI: 10.1080/17453674.2020.1835321] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - In recent years motorized intramedullary lengthening nails have become increasingly popular. Complications are heterogeneously reported in small case series and therefore we made a systematic review of complications occurring in lower limb lengthening with externally controlled motorized intramedullary bone lengthening nails.Methods - We performed a systematic search in PubMed, EMBASE, and the Cochrane Library with medical subject headings: Bone Nails, Bone Lengthening, and PRECICE and FITBONE nails. Complications were graded on severity and origin.Results - The search identified 952 articles; 116 were full text screened, and 41 were included in the final analysis. 983 segments were lengthened in 782 patients (age 8-74 years). The distribution of nails was: 214 FITBONE, 747 PRECICE, 22 either FITBONE or PRECICE. Indications for lengthening were: 208 congenital shortening, 305 acquired limb shortening, 111 short stature, 158 with unidentified etiology. We identified 332 complications (34% of segments): Type I (minimal intervention) in 11% of segments; Type II (substantial change in treatment plan) in 15% of segments; Type IIIA (failure to achieve goal) in 5% of segments; and Type IIIB (new pathology or permanent sequelae) in 3% of segments. Device and bone complications were the most frequent.Interpretation - The overall risk of complications was 1 complication for every 3 segments lengthened. In 1 of every 4 segments, complications had a major impact leading to substantial change in treatment, failure to achieve lengthening goal, introduction of a new pathology, or permanent sequelae. However, as no standardized reporting method for complications exists, the true complication rates might be different.
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Affiliation(s)
- Markus W Frost
- Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg; ,Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark,Correspondence:
| | - Ole Rahbek
- Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg; ,Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Jens Traerup
- Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg;
| | | | - Søren Kold
- Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg; ,Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Gade IL, Kold S, Severinsen MT, Kragholm KH, Torp‐Pedersen C, Kristensen SR, Riddersholm SJ. Venous thromboembolism after lower extremity orthopedic surgery: A population-based nationwide cohort study. Res Pract Thromb Haemost 2021; 5:148-158. [PMID: 33537539 PMCID: PMC7845063 DOI: 10.1002/rth2.12449] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/07/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) causes morbidity and mortality in the general population. Several events occur after lower limb orthopedic surgery, but the contribution from various types of lower limb surgery is not well known. OBJECTIVE To investigate the postoperative incidence of VTE for all types of lower extremity orthopedic surgery compared with the background population. METHODS Individual-level linkage of Danish nationwide register data for all Danish residents with first-time orthopedic surgery of the lower limb (1996-2017) and, for each of these, four controls from the general population matched on age, sex, and history of VTE. Adjusted hazard ratios (HR) compared the postoperative risk of VTE to the matched controls. RESULTS In total 7203 of the 1 012 823 patients with a first orthopedic procedure had a VTE within 180 days after surgery, corresponding to a postoperative cumulative incidence of 0.71% (95% confidence interval [CI], 0.70-0.73). The cumulative incidence of VTE among controls was 0.11% (95% CI, 0.11-0.12). The HR of VTE within the first 30 days after surgery below knee level was 20.5 (95% CI, 17.9-23.5) compared with matched controls. The HRs of VTE after minor distal procedures (eg, meniscectomy and arthroscopies) were 2.9 (95% CI, 1.9-4.4) to 7.1 (95% CI, 6.4-8.0). CONCLUSION All types of lower limb orthopedic surgery including minor distal procedures were associated with higher rates of VTE compared with matched controls, in particular within the first 30 days after surgery.
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Affiliation(s)
- Inger Lise Gade
- Department of Hematology and Clinical Cancer Research CenterAalborg University HospitalAalborgDenmark
- Department of Clinical BiochemistryAalborg University HospitalAalborgDenmark
| | - Søren Kold
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
- Department of Orthopedic SurgeryAalborg University HospitalAalborgDenmark
| | - Marianne T. Severinsen
- Department of Hematology and Clinical Cancer Research CenterAalborg University HospitalAalborgDenmark
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
| | - Kristian H. Kragholm
- Department of CardiologyNorth Denmark Regional HospitalHjørringDenmark
- Unit of Clinical BiostatisticsAalborg University HospitalAalborgDenmark
| | - Christian Torp‐Pedersen
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
- Unit of Clinical BiostatisticsAalborg University HospitalAalborgDenmark
- Department of Cardiology and Clinical InvestigationNorth Zealand HospitalHillerødDenmark
| | - Søren R. Kristensen
- Department of Clinical BiochemistryAalborg University HospitalAalborgDenmark
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
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Abood AA, Rahbek O, Olesen ML, Christensen BB, Møller-Madsen B, Kold S. Does Retrograde Femoral Nailing through a Normal Physis Impair Growth? An Experimental Porcine Model. Strategies Trauma Limb Reconstr 2021; 16:8-13. [PMID: 34326896 PMCID: PMC8311745 DOI: 10.5005/jp-journals-10080-1515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Materials and methods The study was carried out using an experimental porcine model. Eleven juvenile female porcines were randomized for insertion of a retrograde femoral nail in one limb. The other limb acted as a control. The animals were housed for 8 weeks before the nail was removed and housed for 8 additional weeks, that is, 16 weeks in total. Growth was assessed by interphyseal distance on 3D magnetic resonance imaging (MRI) after 16 weeks and the operated limb was compared to the non-operated limb. Histomorphometric analysis of the physeal canal was performed. Results No difference in longitudinal growth was observed when comparing the operated femur to the non-operated femur using MRI after 16 weeks. No osseous tissue crossing the physis was observed on MRI or histology. The empty canal in the physis after nail removal was filled with fibrous tissue 16 weeks after primary surgery. Conclusion Growth was not impaired and no bone bridges were seen on MRI or histology 16 weeks after insertion and later removal of the retrograde femoral nail. Clinical significance The insertion of a retrograde intramedullary femoral nail centrally through the physis and later removal might be safe, however, long-term follow-up is needed. Aim and objective The insertion of an intramedullary nail may be beneficial in certain cases of leg length discrepancy (LLD) in children. However, it is unknown if the physeal injury due to the surgery may cause bone bridge formation and thereby growth arrest after removal. This study aimed to assess longitudinal interphyseal growth 16 weeks after insertion and later removal of a retrograde femoral nail passing through the physis. Moreover, to analyse the tissue forming in the empty physeal canal after removal of the nail. How to cite this article Abood AA, Rahbek O, Olesen ML, et al. Does Retrograde Femoral Nailing through a Normal Physis Impair Growth? An Experimental Porcine Model. Strategies Trauma Limb Reconstr 2021;16(1):8–13.
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Affiliation(s)
- Ahmed A Abood
- Department of Orthopaedics and Reconstruction, Aalborg University Hospital, Aalborg, Denmark
| | - Ole Rahbek
- Department of Orthopaedics and Reconstruction, Aalborg University Hospital, Aalborg, Denmark
| | - Morten L Olesen
- Department of Orthopaedics and Reconstruction, Aarhus University Hospital, Aarhus, Denmark
| | - Bjørn B Christensen
- Department of Orthopaedics and Reconstruction, Aarhus University Hospital, Aarhus, Denmark
| | - Bjarne Møller-Madsen
- Department of Orthopaedics and Reconstruction, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Kold
- Department of Orthopaedics and Reconstruction, Aalborg University Hospital, Aalborg, Denmark
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Abstract
Aim and objective The purpose of this study was to explore the capability and Intrarater reliability of thermography in detecting pin site infection. Materials and methods This is an explorative proof of concept study. Clinical assessment of pin sites was performed by one examiner with the Modified Gordon Pin Infection Classification from grade 0 to 6. Thermography of the pin sites was performed with a FLIR C3 camera. The analysis of the thermographic images was done in the software FLIR Tools. The maximum skin temperature around the pin site and the maximum temperature for the whole thermographic picture were measured. An Intrarater agreement was established and test-retests were performed with different camera angles. Results Thirteen (four females, nine males) patients (age 9–72 years) were included. Indications for frames: Fracture (n=4), two deformity correction, one lengthening and six bone transport. Days from surgery to thermography ranged from 27 to 385 days. Overall, 231 pin sites were included. Eleven pin sites were diagnosed with early signs of infection: five grade 1, five grade 2 and one grade 3. Mean pin site temperature for each patient was calculated, varied between patients from 29.0°C to 35.4°C (mean 33.9°C). With 34°C as cut-off value for infection, sensitivity was 73%; specificity, 67%; positive predictive value, 10%; and negative predictive value, 98%. Intrarater agreement for thermography was ICC 0.85 (0.77–0.92). The temperature measured was influenced by the camera positioning in relation to the pin site with a variance of 0.2. Conclusions Measurements of pin site temperature using the hand-held FLIR C3 infrared camera was a reliable method and the temperature was related to infection grading. Clinical significance This study demonstrated that digital thermography with a hand-held camera might be used for monitoring the pin sites after operations to detect early infection. How to cite this article Rahbek O, Husum HC, Fridberg M, et al. Intrarater Reliability of Digital Thermography in Detecting Pin Site Infection: A Proof of Concept Study. Strategies Trauma Limb Reconstr 2021;16(1):1–7.
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Affiliation(s)
- Ole Rahbek
- Department of Orthopaedics, Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | - Hans-Christen Husum
- Department of Orthopaedics, Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | - Marie Fridberg
- Department of Orthopaedics, Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | - Arash Ghaffari
- Department of Orthopaedics, Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Kold
- Department of Orthopaedics, Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
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Abstract
INTRODUCTION Undisplaced femoral neck fractures (FNFs) are usually treated by internal fixation (IF) but two randomised controlled trials (RCTs) have demonstrated advantages of treatment with arthroplasty. The complication rate was lowered but there were no clinically improved patient-reported outcome measures (PROM), which could be due to underpowering or choice of selected PROM as the studies do appear to report a better functional outcome. We will conduct an RCT comparing IF with arthroplasties in patients aged over 65 years with an undisplaced FNF. METHODS AND ANALYSIS All hospitals in Denmark treating patients with hip fracture can provide patients for this study; therefore, the study can be considered a national RCT. Patients over 65 years old with an undisplaced FNF will be screened for eligibility and patients will only be excluded if they are unable to understand the study information (due to dementia or language), if they have a posterior tilt >20°, a pathological fracture or they cannot walk. Participants will be electronically randomised (in alternating blocks of 4 or 6) into either IF or arthroplasty. Postoperative care will follow the department standards.Primary and secondary outcomes and measuring points have been established in collaboration with patients with hip fracture by focus group interviews. The primary outcome measure is the New Mobility Score assessed after 1 year. Secondary outcomes are the Oxford Hip Score, EuroQol 5 domain (EQ-5D-5L), degree of posterior tilt, pain Verbal Rating Scale, reoperation and mortality. ETHICS AND DISSEMINATION The study is approved by the Danish Data Protection Agency (19/7429) and the scientific ethics committee (S-20180036). All participants will sign an informed consent before entering the trial. Because this is a national trial, all relevant healthcare professionals in Denmark will automatically receive the trial results that will be published in international peer-reviewed journals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04075461).
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Affiliation(s)
- Bjarke Viberg
- Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
- Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Søren Kold
- Orthopaedic Surgery and Traumatology, Aalborg University Hospital, Aalborg, Denmark
| | - Ole Brink
- Orthopaedic Surgery and Traumatology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Kristoffer Borbjerg Hare
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Orthopaedics, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Henrik Palm
- Orthopaedic Surgery and Traumatology, Bispebjerg Hospital, Kobenhavn, Denmark
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Ghaffari A, Kold S, Rahbek O. A review of outcomes associated with femoral neck lengthening osteotomy in patients with coxa brevis. J Child Orthop 2020; 14:379-386. [PMID: 33204345 PMCID: PMC7666796 DOI: 10.1302/1863-2548.14.200163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Double and triple femoral neck lengthening osteotomies have been described to correct coxa brevis deformity. Only small studies reported the results. Our aim was to provide an overview of the outcomes of double and triple femoral neck lengthening. METHODS After an extensive search of different online databases, we included studies reporting the results of double and triple femoral neck osteotomies. Clinical and radiological outcomes, and reported complications were extracted. The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS After evaluating 456 articles, we included 11 articles reporting 149 osteotomies in 143 patients (31% male, 64% female, 5% unspecified). Mean age of the patients was 20 years (range 7 years to 52 years). Indications were developmental hip dysplasia (51%), Perthes disease (27%), infection (6%), post-trauma (4%), congenital disorders (2%), slipped capital femoral epiphysis (1%), idiopathic (3%) and unknown (6%). The mean limb length discrepancy reduced by 12 mm (0 mm to 40 mm). In total, 65% of 101 positive Trendelenburg sign hips experienced improvement of abductor muscle strength. An 18% (9% to 36%) increase could be found in functional hip scores. Mean increase in articulo-trochanteric distance was 24 mm (10 mm to 34 mm). Five patients older than 30 years at the time of osteotomy and two younger patients with prior hip incongruency had disappointing results and required arthroplasty. In all, 12 complications occurred in 128 osteotomies, in which complications were reported. CONCLUSIONS Double and triple femoral neck lengthening osteotomies in coxa brevis show good results with few complications in the literature, especially in young patients with non-arthritic hips. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Arash Ghaffari
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Kold
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | - Ole Rahbek
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, Denmark,Correspondence should be sent to Ole Rahbek, Interdisciplinary Orthopaedics, Aalborg University Hospital, Hobrovej 18-22, 9100 Aalborg, Denmark. E-mail:
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Schmal H, Brix M, Bue M, Ekman A, Ferreira N, Gottlieb H, Kold S, Taylor A, Toft Tengberg P, Ban I. Nonunion - consensus from the 4th annual meeting of the Danish Orthopaedic Trauma Society. EFORT Open Rev 2020; 5:46-57. [PMID: 32071773 PMCID: PMC7017598 DOI: 10.1302/2058-5241.5.190037] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Nonunions are a relevant economic burden affecting about 1.9% of all fractures. Rather than specifying a certain time frame, a nonunion is better defined as a fracture that will not heal without further intervention. Successful fracture healing depends on local biology, biomechanics and a variety of systemic factors. All components can principally be decisive and determine the classification of atrophic, oligotrophic or hypertrophic nonunions. Treatment prioritizes mechanics before biology. The degree of motion between fracture parts is the key for healing and is described by strain theory. If the change of length at a given load is > 10%, fibrous tissue and not bone is formed. Therefore, simple fractures require absolute and complex fractures relative stability. The main characteristics of a nonunion are pain while weight bearing, and persistent fracture lines on X-ray. Treatment concepts such as ‘mechanobiology’ or the ‘diamond concept’ determine the applied osteosynthesis considering soft tissue, local biology and stability. Fine wire circular external fixation is considered the only form of true biologic fixation due to its ability to eliminate parasitic motions while maintaining load-dependent axial stiffness. Nailing provides intramedullary stability and biology via reaming. Plates are successful when complex fractures turn into simple nonunions demanding absolute stability. Despite available alternatives, autograft is the gold standard for providing osteoinductive and osteoconductive stimuli. The infected nonunion remains a challenge. Bacteria, especially staphylococcus species, have developed mechanisms to survive such as biofilm formation, inactive forms and internalization. Therefore, radical debridement and specific antibiotics are necessary prior to reconstruction.
Cite this article: EFORT Open Rev 2020;5:46-57. DOI: 10.1302/2058-5241.5.190037
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Affiliation(s)
- Hagen Schmal
- Department of Orthopaedics and Traumatology, Odense University Hospital, Odense, Denmark.,Department of Orthopaedics and Traumatology, Freiburg University Hospital, Freiburg, Germany
| | - Michael Brix
- Department of Orthopaedics and Traumatology, Odense University Hospital, Odense, Denmark
| | - Mats Bue
- Department of Orthopaedic Surgery, Horsens Regional Hospital, Horsens, Denmark
| | - Anna Ekman
- Orthopaedic Department, Södersjukhuset, Stockholm, Sweden
| | - Nando Ferreira
- Division of Orthopaedics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Hans Gottlieb
- Department of Orthopaedic Surgery, Herlev Hospital, Herlev, Denmark
| | - Søren Kold
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Andrew Taylor
- Department of Orthopaedic Surgery, Nottingham University Hospitals, UK
| | - Peter Toft Tengberg
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Ilija Ban
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
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Jakobsen T, Kold S, Shiguetomi-Medina J, Baas J, Soballe K, Rahbek O. Topical zoledronic acid decreases micromotion induced bone resorption in a sheep arthroplasty model. BMC Musculoskelet Disord 2017; 18:441. [PMID: 29132335 PMCID: PMC5683542 DOI: 10.1186/s12891-017-1802-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/03/2017] [Indexed: 12/28/2022] Open
Abstract
Background Initial micromotion of a total hip replacement is associated with aseptic loosening. The use of bisphosphonates could be one way to reduce peri-implant bone resorption induced by micromotion. Bisphosphonates compounds are inhibitors of bone resorption. The aim of this study was to investigate whether local treatment with bisphosphonate would reduce bone resorption and fibrous tissue around an experimental implant subjected to micromotion. Methods One micromotion implant were inserted into each medial femoral condyle in ten sheep. During each gait cycle the implant axially piston 0.5 mm. During surgery one of the femoral condyles were locally treated with 0.8 mg zoledronate. The other condyle served as control. Observation period was 12 weeks. Results Histological evaluation showed a fibrous capsule around both the control and bisphosphonate implants. Histomorphometrical analysis showed that 97% of the surface on both control and bisphosphonate implants were covered by fibrous tissue. However, the bisphosphonate was able to preserve bone in a 1 mm zone around the implants. Conclusion This study indicates that local treatment with bisphosphonate cannot prevent the formation of a fibrous capsule around an implant subjected to micromotion, but bisphosphonate is able to reduce resorption of peri-prosthetic bone.
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Affiliation(s)
- Thomas Jakobsen
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000, Aarhus, Denmark. .,Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark.
| | - Søren Kold
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000, Aarhus, Denmark.,Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | - Juan Shiguetomi-Medina
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000, Aarhus, Denmark
| | - Jorgen Baas
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000, Aarhus, Denmark
| | - Kjeld Soballe
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000, Aarhus, Denmark
| | - Ole Rahbek
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000, Aarhus, Denmark
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Hjorth MH, Kold S, Søballe K, Langdahl BL, Nielsen PT, Christensen PH, Stilling M. Preparation of the Femoral Bone Cavity for Cementless Stems: Broaching vs Compaction. A Five-Year Randomized Radiostereometric Analysis and Dual Energy X-Ray Absorption Study. J Arthroplasty 2017; 32:1894-1901. [PMID: 28111123 DOI: 10.1016/j.arth.2016.12.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/24/2016] [Accepted: 12/17/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Short-term experimental and animal studies have confirmed superior fixation of cementless implants inserted with compaction compared to broaching of the cancellous bone. METHODS Forty-four hips in 42 patients (19 men) were randomly operated using cementless hydroxyapatite-coated Bi-Metric stems. Patients were followed with radiostereometric analysis at baseline, 6 and 12 weeks, 1, 2, and 5 years, and measurements of periprosthetic bone mineral density at baseline, 1, 2, and 5 years. Complications during the study period and clinical outcome measures of Harris Hip Score were recorded at mean 7 years (5-8.8) after surgery. RESULTS Absolute migrations of medio/lateral translations between the broaching group and the compaction group of mean 0.14 mm (standard deviation [SD] 0.10) vs mean 0.30 mm (SD 0.27) (P = .01) at 1 year, and of mean 0.13 mm (SD 0.10) vs 0.34 mm (0.31) (P = .01) at 5 years were different. Absolute valgus/varus rotations of mean 0.12° (SD 0.13°) in the broaching group were less than mean 0.35° (0.45°) in the compaction group (P < .01) at 1 year, but at 5 years no difference was observed (P = .19). Subsidence and retroversion were similar between groups at all follow-ups (P > .13). The compaction group had significantly less bone loss than the broaching group in Gruen zone 3 (distal-lateral to the stem) at 1 and 5 years. No further differences in bone mineral density changes were found between groups up to 5 years after surgery. Complications throughout the period and clinical outcome measures of Harris Hip Score were similar at 7 years (5-8.8) after surgery. CONCLUSION We found increased migration when preparing the bone with compaction compared with broaching in cementless femoral stems.
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Affiliation(s)
- Mette H Hjorth
- Department of Orthopaedics, THG, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Kold
- Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | - Kjeld Søballe
- Department of Orthopaedics, THG, Aarhus University Hospital, Aarhus, Denmark
| | - Bente L Langdahl
- Department of Endocrinology and Internal Medicine, THG, Aarhus University Hospital, Aarhus, Denmark
| | - Poul T Nielsen
- Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | - Poul H Christensen
- Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | - Maiken Stilling
- Department of Orthopaedics, THG, Aarhus University Hospital, Aarhus, Denmark
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Affiliation(s)
- Søren Kold
- grid.154185.cAarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark
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Abstract
Background and purpose - Short-term experimental studies have confirmed that there is superior fixation of cementless implants inserted with compaction compared to broaching of the cancellous bone. Patients and methods - 1-stage, bilateral primary THA was performed in 28 patients between May 2001 and September 2007. The patients were randomized to femoral bone preparation with broaching on 1 side and compaction on the other side. 8 patients declined to attend the postoperative follow-up, leaving 20 patients (13 male) with a mean age of 58 (36-70) years for evaluation. The patients were followed with radiostereometric analysis (RSA) at baseline, at 6 and 12 weeks, and at 1, 2, and 5 years, and measurements of periprosthetic bone mineral density (BMD) at baseline and at 1, 2, and 5 years. The subjective part of the Harris hip score (HHS) and details of complications throughout the observation period were obtained at a mean interval of 6.3 (3.0-9.5) years after surgery. Results - Femoral stems in the compaction group had a higher degree of medio-lateral migration (0.21 mm, 95% CI: 0.03-0.40) than femoral stems in the broaching group at 5 years (p = 0.02). No other significant differences in translations or rotations were found between the 2 surgical techniques at 2 years (p > 0.4) and 5 years (p > 0.7) postoperatively. There were no individual stems with continuous migration. Periprosthetic BMD in the 7 Gruen zones was similar at 2 years and at 5 years. Intraoperative femoral fractures occurred in 2 of 20 compacted hips, but there were none in the 20 broached hips. The HHS and dislocations were similar in the 2 groups at 6.3 (3.0-9.5) years after surgery. Interpretation - Bone compaction as a surgical technique with the Bi-Metric stem did not show the superior outcomes expected compared to conventional broaching. Furthermore, 2 periprosthetic fractures occurred using the compaction technique, so we cannot recommend compaction for insertion of the cementless Bi-Metric stem.
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Affiliation(s)
- Mette H Hjorth
- Department of Orthopaedics, Aarhus University Hospital, Aarhus;,Correspondence:
| | - Maiken Stilling
- Department of Orthopaedics, Aarhus University Hospital, Aarhus
| | - Kjeld Søballe
- Department of Orthopaedics, Aarhus University Hospital, Aarhus
| | | | - Poul H Christensen
- Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Kold
- Department of Orthopaedics, Aarhus University Hospital, Aarhus
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Foldager CB, Bendtsen M, Berg LC, Brinchmann JE, Brittberg M, Bunger C, Canseco J, Chen L, Christensen BB, Colombier P, Deleuran BW, Edwards J, Elmengaard B, Farr J, Gatenholm B, Gomoll AH, Hui JH, Jakobsen RB, Joergensen NL, Kassem M, Koch T, Kold S, Krogsgaard MR, Lauridsen H, Le D, Le Visage C, Lind M, Nygaard JV, Olesen ML, Pedersen M, Rathcke M, Richardson JB, Roberts S, Rölfing JHD, Sakai D, Toh WS, Urban J, Spector M. Aarhus Regenerative Orthopaedics Symposium (AROS). Acta Orthop 2016; 87:1-5. [PMID: 28271925 PMCID: PMC5389427 DOI: 10.1080/17453674.2017.1297918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The combination of modern interventional and preventive medicine has led to an epidemic of ageing. While this phenomenon is a positive consequence of an improved lifestyle and achievements in a society, the longer life expectancy is often accompanied by decline in quality of life due to musculoskeletal pain and disability. The Aarhus Regenerative Orthopaedics Symposium (AROS) 2015 was motivated by the need to address regenerative challenges in an ageing population by engaging clinicians, basic scientists, and engineers. In this position paper, we review our contemporary understanding of societal, patient-related, and basic science-related challenges in order to provide a reasoned roadmap for the future to deal with this compelling and urgent healthcare problem.
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Affiliation(s)
- Casper B Foldager
- Orthopaedic Research Laboratory, Aarhus University Hospital, Denmark,Department of Orthopaedics, Aarhus University Hospital, Denmark,Correspondence:
| | | | - Lise C Berg
- Department of Large Animal Science, University of Copenhagen, Denmark
| | - Jan E Brinchmann
- Division of Biochemistry, Faculty of Medicine, University of Oslo, Norway
| | - Mats Brittberg
- Department of Orthopaedics, Sahlgrenska University Hospital, University of Gothenburg, Sweden
| | - Cody Bunger
- Orthopaedic Research Laboratory, Aarhus University Hospital, Denmark,Department of Orthopaedics, Aarhus University Hospital, Denmark
| | - Jose Canseco
- Department of Orthopaedics, University of Pennsylvania, PN, USA
| | - Li Chen
- Molecular Endocrinology and Stem Cell Research Unit (KMEB), University of Southern Denmark, Denmark
| | | | | | - Bent W Deleuran
- Department of Biomedicine, Aarhus University and Department of Rheumatology, Aarhus University Hospital, Denmark
| | - James Edwards
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, UK
| | | | - Jack Farr
- Cartilage Restoration Center of Indiana, OrthoIndy, IN, USA
| | - Birgitta Gatenholm
- Department of Orthopaedics, Sahlgrenska University Hospital, University of Gothenburg, Sweden
| | - Andreas H Gomoll
- Cartilage Repair Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - James H Hui
- Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Rune B Jakobsen
- Department of Orthopaedics, Akershus University Hospital and Institute of Health and Society, University of Oslo, Norway
| | | | - Moustapha Kassem
- Molecular Endocrinology and Stem Cell Research Unit (KMEB), University of Southern Denmark, Denmark
| | - Thomas Koch
- Department of Biomedical Sciences, University of Guelph, ON, Canada
| | - Søren Kold
- Department of Orthopaedics, Aarhus University Hospital, Denmark
| | | | | | - Dang Le
- Orthopaedic Research Laboratory, Aarhus University Hospital, Denmark
| | | | - Martin Lind
- Department of Orthopaedics, Aarhus University Hospital, Denmark
| | | | - Morten L Olesen
- Orthopaedic Research Laboratory, Aarhus University Hospital, Denmark
| | | | - Martin Rathcke
- Department of Orthopaedics, Copenhagen University Hospital, Bispebjerg, Denmark
| | - James B Richardson
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Keele University, Oswestry, UK
| | - Sally Roberts
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Keele University, Oswestry, UK
| | - Jan H D Rölfing
- Department of Orthopaedics, Aarhus University Hospital, Denmark
| | - Daisuke Sakai
- Department of Orthopaedics, Tokai University Hospital, Japan
| | - Wei Seong Toh
- Faculty of Dentistry, National University of Singapore, Singapore
| | - Jill Urban
- Department of Physiology, Anatomy and Genetics, University of Oxford, UK
| | - Myron Spector
- Department of Orthopaedics, Brigham and Women’s Hospital, Harvard Medical School and Tissue Engineering Labs, VA Boston Healthcare System, Boston, MA, USA
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Kold S. CORR Insights(®): Is there an Increase in Valgus Deviation in Tibial Distraction Using the Lengthening Over Nail Technique? Clin Orthop Relat Res 2016; 474:1292-3. [PMID: 26883657 PMCID: PMC4814431 DOI: 10.1007/s11999-016-4751-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/10/2016] [Indexed: 01/31/2023]
Affiliation(s)
- Søren Kold
- Head of Orthopaedic Reconstructive Section, Aarhus University Hospital, Nørrebrogade, 8000 Aarhus, Denmark
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Jakobsen T, Kold S, Baas J, Søballe K, Rahbek O. Sheep Hip Arthroplasty Model of Failed Implant Osseointegration. Open Orthop J 2015; 9:525-9. [PMID: 26664497 PMCID: PMC4671224 DOI: 10.2174/1874325001509010525] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 08/26/2015] [Accepted: 09/03/2015] [Indexed: 12/13/2022] Open
Abstract
Early secure stability of an implant is important for long-term survival. We examined whether micromotion of implants consistently would induce bone resorption and formation of a fibrous membrane and thereby prevent osseointegration. One micromotion implant was inserted into one of the medial femoral condyles in ten sheep. The micromotion device consists of an anchor bearing a PMMA implant and a PE plug. During each gait cycle the PE plug will make the PMMA implant axially piston 0.5 mm. After 12 weeks of observation the bone specimens were harvested and a post-mortem control implant was inserted into the contra-lateral medial femoral condyle. Histomorphometrical evaluation showed that the surface on the implant observed for 12 weeks was covered by fibrous tissue. The control implants were covered by lamellar bone. No difference was found with respect to the volume fraction of lamellar bone in a 1 mm zone around the implants. This study indicates that implant micromotion is sufficient to induce bone resorption and formation of a fibrous membrane.
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Affiliation(s)
- Thomas Jakobsen
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Kold
- Aalborg University Hospital, Department of Orthopaedics, Aalborg, Denmark
| | - Jørgen Baas
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
| | - Kjeld Søballe
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
| | - Ole Rahbek
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
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Christensen M, Troelsen A, Kold S, Brix M, Ban I. [Treatment of distal radius fractures in the elderly]. Ugeskr Laeger 2015; 177:V11140614. [PMID: 26320591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Evidence on the treatment of distal radius fractures (DRF) in the elderly is lacking. Over the last decade new volar locking plates have increased in popularity as other means of treating DRF are pushed aside. No definitive evidence exists to support the use of volar locking plates especially among the elderly. There is some evidence that Disabilities of the Arm, Shoulder and Hand-scores improve the first 3-6 months after treatment with volar locking plates only to become insignificant after 12 months. This article examines the evidence of the different modes of treatment.
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Kold S, Christensen KS. Bone transport of the tibia with a motorized intramedullary lengthening nail--a case report. Acta Orthop 2014; 85:333. [PMID: 25061655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Affiliation(s)
- Søren Kold
- Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark.
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Stilling M, Kold S, de Raedt S, Andersen NT, Rahbek O, Søballe K. Superior accuracy of model-based radiostereometric analysis for measurement of polyethylene wear: A phantom study. Bone Joint Res 2012; 1:180-91. [PMID: 23610688 PMCID: PMC3626226 DOI: 10.1302/2046-3758.18.2000041] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 06/29/2012] [Indexed: 12/17/2022] Open
Abstract
Objectives The accuracy and precision of two new methods of model-based
radiostereometric analysis (RSA) were hypothesised to be superior
to a plain radiograph method in the assessment of polyethylene (PE)
wear. Methods A phantom device was constructed to simulate three-dimensional
(3D) PE wear. Images were obtained consecutively for each simulated
wear position for each modality. Three commercially available packages
were evaluated: model-based RSA using laser-scanned cup models (MB-RSA),
model-based RSA using computer-generated elementary geometrical
shape models (EGS-RSA), and PolyWare. Precision (95% repeatability
limits) and accuracy (Root Mean Square Errors) for two-dimensional
(2D) and 3D wear measurements were assessed. Results The precision for 2D wear measures was 0.078 mm, 0.102 mm, and
0.076 mm for EGS-RSA, MB-RSA, and PolyWare, respectively. For the
3D wear measures the precision was 0.185 mm, 0.189 mm, and 0.244
mm for EGS-RSA, MB-RSA, and PolyWare respectively. Repeatability
was similar for all methods within the same dimension, when compared between
2D and 3D (all p > 0.28). For the 2D RSA methods, accuracy was below
0.055 mm and at least 0.335 mm for PolyWare. For 3D measurements,
accuracy was 0.1 mm, 0.2 mm, and 0.3 mm for EGS-RSA, MB-RSA and
PolyWare respectively. PolyWare was less accurate compared with
RSA methods (p = 0.036). No difference was observed between the
RSA methods (p = 0.10). Conclusions For all methods, precision and accuracy were better in 2D, with
RSA methods being superior in accuracy. Although less accurate and
precise, 3D RSA defines the clinically relevant wear pattern (multidirectional).
PolyWare is a good and low-cost alternative to RSA, despite being
less accurate and requiring a larger sample size.
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Affiliation(s)
- M Stilling
- Aarhus University Hospital, Department of Orthopaedics, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
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