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共1399条结果
  • 1.

    【2hr】An international comparison of THA patients, implants, techniques, and survivorship in Sweden, Australia, and the United States

    包量

    机译 瑞典，澳大利亚和美国的THA患者，植入物，技术和存活率的国际比较
    摘要：Background and purpose — International comparisons of total hip arthroplasty (THA) practices and outcomes provide an opportunity to enhance the quality of care worldwide. We compared THA patients, implants, techniques, and survivorship in Sweden, Australia, and the United States.Patients and methods — Primary THAs due to osteoarthritis were identified using Swedish (n = 159,695), Australian (n = 279,693), and US registries (n = 69,641) (2003–2015). We compared patients, practices, and implant usage across the countries using descriptive statistics. We evaluated time to all-cause revision using Kaplan–Meier survival curves. We assessed differences in countries’ THA survival using chi-square tests of survival probabilities.Results — Sweden had fewer comorbidities than the United States and Australia. Cement fixation was used predominantly in Sweden and cementless in the United States and Australia. The direct anterior approach was used more frequently in the United States and Australia. Smaller head sizes (≤ 32 mm vs. ≥ 36 mm) were used more often in Sweden than the United States and Australia. Metal-on-highly cross-linked polyethylene was used more frequently in the United States and Australia than in Sweden. Sweden’s 5- (97.8%) and 10-year THA survival (95.8%) was higher than the United States’ (5-year: 97.0%; 10-year: 95.2%) and Australia (5-year: 96.3%; 10-year: 93.5%).Interpretation — Patient characteristics, surgical techniques, and implants differed across the 3 countries, emphasizing the need to adjust for demographics, surgical techniques, and implants and the need for global standardized definitions to compare THA survivorship internationally.
  • 2.

    【2hr】High annual surgeon volume reduces the risk of adverse events following primary total hip arthroplasty: a registry-based study of 12,100 cases in Western Sweden

    包量

    机译 每年高的手术量可减少原发性全髋关节置换术后不良事件的风险：一项基于注册表的瑞典西部12,100例病例研究
    摘要：Background and purpose — Most earlier publications investigating whether annual surgeon volume is associated with lower levels of adverse events (AE), reoperations, and mortality are based on patient cohorts from North America. There is also a lack of adjustment for important confounders in these studies. Therefore, we investigated whether higher annual surgeon volume is associated with a lower risk of adverse events and mortality within 90 days following primary total hip arthroplasty (THA).Patients and methods — We collected information on primary total hip arthroplasties (THA) performed between 2007 and 2016 from 10 hospitals in Western Sweden. These data were linked with the Swedish Hip Arthroplasty Register and a regional patient register. We used logistic regression (simple and multiple) adjusted for age, sex, comorbidities, BMI, fiation technique, diagnosis, surgical approach, time in practice as orthopedic specialist and annual volume. Annual surgeon volume was calculated as the number of primary THAs the operating surgeon had performed 365 days prior to the index THA.Results — 12,100 primary THAs, performed due to both primary and secondary osteoarthritis by 268 different surgeons, were identified. The median annual surgeon volume was 23 primary THAs (range 0–82) 365 days prior to the THA of interest and the mean risk of AE within 90 days was 7%. If the annual volume increased by 10 primary THAs in the simple logistic regression the risk of AE decreased by 10% and in the adjusted multiple regression the corresponding number was 8%. The mortality rate in the study was low (0.2%) and we could not find any association between 90-day mortality and annual surgeon volume.Interpretation — High annual surgical activity is associated with a reduced risk of adverse events within 90 days. Based on these findings healthcare providers should consider planning for increased surgeon volume.
  • 3.

    【2hr】Estonian hip fracture data from 2009 to 2017: high rates of non­operative management and high 1-year mortality

    包量

    机译 爱沙尼亚2009年至2017年的髋部骨折数据：非手术治疗率高和1年死亡率高
    摘要：Background and purpose — There are no national guidelines for treatment of hip fractures in Estonia and no studies on management. We assessed treatment methods and mortality rates for hip fracture patients in Estonia.Patients and methods — We studied a population-based retrospective cohort using validated data from the Estonian Health Insurance Fund’s database. The cohort included patients aged 50 and over with an index hip fracture diagnosis between January 1, 2009 and September 30, 2017. The study generated descriptive statistics of hip fracture management methods and calculated in-hospital, 1-, 3, 6-, and 12-month unadjusted all-cause mortality rates. [CrossRef]Results — 91% (number of hips: 11,628/12,731) of the original data were included after data validation. Median patient age was 81 years, 83 years for women and 74 years for men. 28% were men. Treatment methods were: total hip arthroplasty 7%; hemiarthroplasty 25%; screws 6%; sliding hip screw 25%; intramedullary nail 27%; and nonoperative management 10%. Unadjusted all-cause mortality rates for in-hospital, 1, 3, 6, and 12 months were: 3%, 9%, 18%, 24%, and 31% respectively. The 12-month mortality rate for nonoperative management was 58%. [CrossRef]Interpretation — High rates of nonoperative management and overall high 1-year mortality rates after an index hip fracture indicate the need to review exclusion criteria for surgery and subacute care in Estonia.
  • 4.

    【2hr】Superior fixation and less periprosthetic stress-shielding of tibial components with a finned stem versus an I-beam block stem: a randomized RSA and DXA study with minimum 5 years’ follow-up

    包量

    机译 鳍状茎与I型钢块茎相比，胫骨组件固定效果好，假体周围的应力屏蔽较小：随机RSA和DXA研究，至少随访5年
    摘要：Background and purpose — The stem on the tibial component of total knee arthroplasty provides mechanical resistance to lift-off, shear forces, and torque. We compared tibial components with finned stems (FS) and I-beam block stems (IS) to assess differences in implant migration.Patients and methods — In a patient-blinded RCT, 54 patients/knees (15 men) with knee osteoarthritis at a mean age of 77 years (70–90) were randomly allocated to receive tibial components with either a FS (n = 27) or an IS (n = 27). Through 5 to 7 years’ follow-up, implant migration was measured with RSA, periprosthetic bone mineral density (BMD) was measured with DXA, and surgeons reported American Knee Society Score (AKSS).Results — At minimum 5 years’ follow-up, maximum total point motion (MTPM) was higher (p = 0.04) for IS (1.48 mm, 95% CI 0.81–2.16) than for FS (0.85 mm, CI 0.38–1.32) tibial components. Likewise, total rotation (TR) was higher (p = 0.03) for IS (1.51˚, CI 0.78–2.24) than for FS (0.81˚, CI 0.36–1.27). Tibial components with IS externally rotated 0.50° (CI –0.06 to 1.06) while FS internally rotated 0.09° (CI –0.20 to 0.38) (p = 0.03). Periprosthetic bone stress-shielding was higher (p < 0.01) up to 2 years’ follow-up for IS compared with FS in the regions medial to the stem (–13% vs. –2%) and posterior to the stem (–13% vs. –2%). Below the stem bone loss was also higher (p = 0.01) for IS compared with FS (–6% vs. +1%) up to 1-year follow-up. Knee score improved similarly in both groups up to 5 years’ follow-up.Interpretation — Periprosthetic bone stress-shielding medial and posterior to the stem until 2 years, and tibial component migration at 5 years, was less for a finned compared with an I-shaped block stem design.
  • 5.

    【2hr】Equivalent 2-year stabilization of uncemented tibial component migration despite higher early migration compared with cemented fixation: an RSA study on 360 total knee arthroplasties

    包量

    机译 尽管早期骨水泥固定比早期骨水泥固定要高，但非骨水泥胫骨组件的平均等效稳定期为2年：RSA对360例全膝关节置换术的研究
    摘要：Background and purpose — Thresholds of implant migration for predicting long-term successful fixation of tibial components in total knee arthroplasty have not separated cemented and uncemented fixation. We compared implant migration of cemented and uncemented components at 1 year and as the change in migration from 1 to 2 years.Patients and methods — Implant migration of 360 tibial components measured using radiostereometric analysis was compared at 1 year and as the change in migration from 1 to 2 years in 222 cemented components (3 implant designs) and 138 uncemented components (5 implant designs).Results — 1-year maximum total point motion was lower for the cemented tibial components compared with the uncemented components (median = 0.31 mm [0.03–2.98] versus 0.63 mm [0.11–5.19] respectively, p < 0.001, mixed model). The change in migration from 1 to 2 years, however, was equivalent for cemented and uncemented components (mean [SD] 0.06 mm [0.19] and 0.07 mm [0.27] mm respectively, p = 0.6, mixed model).Interpretation — These findings suggest that current thresholds of acceptable migration at 1 year may be better optimized by considering cemented and uncemented tibial components separately as higher early migration of uncemented components was not associated with decreased stability from 1 to 2 years.
  • 6.

    【2hr】Predicting individual knee range of motion, knee pain, and walking limitation outcomes following total knee arthroplasty

    包量

    机译 预测全膝关节置换术后单个膝盖的运动范围，膝盖疼痛和行走受限结果
    摘要：Background and purpose — Up to 20% of patients are dissatisfied after total knee arthroplasty (TKA), mainly because of pain and restricted physical function. We developed a prediction model for 6-month knee range of motion, knee pain, and walking limitations in patients undergoing TKA surgery.Patients and methods — We performed a prospective cohort study of 4,026 patients who underwent elective, primary TKA between July 2013 and July 2017. Candidate predictors included demographic, clinical, psychosocial, and preoperative outcome measures. The outcomes of interest were (i) knee extension and flexion range of motion, (ii) knee pain rated on a 5-point ordinal scale, and (iii) self-reported maximum walk time at 6 months post TKA. For each outcome, we fitted a multivariable proportional odds regression model with bootstrap internal validation.Results — At 6 months post TKA, around 5% to 20% of patients had a flexion contracture ³ 10°, range of motion < 90°, moderate to severe knee pain, or a maximum walk time £ 15 minutes. The model c-indices (the probabilities to correctly discriminate between 2 patients with different levels of follow-up TKA outcomes) when evaluating these patients were 0.71, 0.79, 0.65, and 0.76, respectively. Each postoperative outcome was strongly influenced by the same outcome measure obtained preoperatively (all p-values < 0.001). Additional statistically significant predictors were age, sex, race, education level, diabetes mellitus, preoperative use of gait aids, contralateral knee pain, and psychological distress (all p-values < 0.001).Interpretation — We have developed models to predict, for individual patients, their likely post-TKA levels of knee extension and flexion range of motion, knee pain, and walking limitations. After external validation, they can potentially be used preoperatively to identify at-risk patients and to help patients set more realistic expectations about surgical outcomes.
  • 7.

    【2hr】Custom-made asymmetric polyethylene liner to correct tibial component malposition in total knee arthroplasty — a case report

    包量

    机译 定制的不对称聚乙烯衬垫可纠正全膝关节置换术中胫骨组件的位置不正确–病例报告
    摘要：
  • 8.

    【2hr】Early recovery trajectories after fast-track primary total hip arthroplasty: the role of patient characteristics

    包量

    机译 快速全髋关节置换术后的早期康复轨迹：患者特征的作用
    • 作者：
    • 刊名：Acta Orthopaedica
    • 2019年第2期
    摘要：
  • 9.

    【2hr】Time to restrict the use of p-values in Acta Orthopaedica

    包量

    机译 是时候限制在Acta Orthopaedica中使用p值了
    • 作者：Jonas Ranstam
    • 刊名：Acta Orthopaedica
    • 2019年第1期
    摘要：
  • 10.

    【2hr】Fast-track hip and knee arthroplasty – have we reached the goal?

    包量

    机译 快速髋关节和膝关节置换术–我们达到目标了吗？
    摘要：
  • 11.

    【2hr】Early postoperative mortality similar between cemented and uncemented hip arthroplasty: a register study based on Finnish national data

    包量

    机译 骨水泥型和非骨水泥型髋关节置换术后早期死亡率相似：基于芬兰国家数据的登记研究
    摘要：Background and purpose — Implant survival of cemented total hip arthroplasty (THA) in elderly patients is higher than that of uncemented THA. However, a higher mortality rate in patients undergoing cemented THA compared with uncemented or hybrid THA has been reported. We assessed whether cemented fixation increases peri- or early postoperative mortality compared with uncemented and hybrid THA.Patients and methods — Patients with osteoarthritis who received a primary THA in Finland between 1998 and 2013 were identified from the PERFECT database of the National Institute for Health and Welfare in Finland. Definitive data on fixation method and comorbidities were available for 62,221 THAs. Mortality adjusted for fixation method, sex, age group, and comorbidities among the cemented, uncemented, and hybrid THA was examined using logistic regression analysis. Reasons for cardiovascular death within 90 days since the index procedure were extracted from the national Causes of Death Statistics and assessed separately.Results — 1- to 2-day adjusted mortality after cemented THA was comparable to that of the uncemented THA group (OR 1.2; 95% CI 0.24–6.5). 3- to 10-day mortality in the cemented THA group was comparable to that in the uncemented THA group (OR 0.54; CI 0.26–1.1), and in the hybrid THA group (OR 0.64, CI 0.25–1.6). Pulmonary embolism or cardiovascular reasons as a cause of death were not over-represented in the cemented THA group.Interpretation — Early peri- and postoperative mortality in the cemented THA group was similar compared with that of the hybrid and uncemented groups.
  • 12.

    【2hr】Dual mobility cups in primary total hip arthroplasties: trend over time in use, patient characteristics, and mid-term revision in 3,038 cases in the Dutch Arthroplasty Register (2007–2016)

    包量

    机译 初次全髋关节置换术中的双活动杯：使用时间，患者特征和中期翻修的趋势在荷兰人工关节置换登记册中有3,038例（2007-2016年）
    摘要：Background and purpose — We noticed an increased use of dual mobility cups (DMC) in primary total hip arthroplasty (THA) despite limited knowledge of implant longevity. Therefore, we determined the trend over time and mid-term cup revision rates of DMC compared with unipolar cups (UC) in primary THA.Patients and methods — All primary THA registered in the Dutch Arthroplasty Register (LROI) during 2007–2016 were included (n = 215,953) and divided into 2 groups — DMC THA (n = 3,038) and UC THA (n = 212,915). Crude competing risk and multivariable Cox regression analyses were performed with cup revision for any reason as primary endpoint. Adjustments were made for sex, age, diagnosis at primary THA, previous operation, ASA score, type of fixation, surgical approach, and femoral head size.Results — The proportion of primary DMC THA increased from 0.8% (n = 184) in 2010 to 2.6% (n = 740) in 2016. Patients who underwent DMC THA more often had a previous operation on the affected hip, a higher ASA score, and the diagnosis acute fracture or late posttraumatic status compared with the UC THA group. Overall 5-year cup revision rate was 1.5% (95% CI 1.0–2.3) for DMC and 1.4% (CI 1.3–1.4) for UC THA. Stratified analyses for patient characteristics showed no differences in cup revision rates between the 2 groups. Multivariable regression analyses showed no statistically significantly increased risk for revision for DMC THA (HR 0.9 [0.6–1.2]).Interpretation — The use of primary DMC THA increased with differences in patient characteristics. The 5-year cup revision rates for DMC THA and UC THA were comparable.
  • 13.

    【2hr】Measurement properties of the OARSI core set of performance-based measures for hip osteoarthritis: a prospective cohort study on reliability, construct validity and responsiveness in 90 hip osteo­arthritis patients

    包量

    机译 OARSI基于性能的核心指标对髋骨关节炎的测量特性：一项针对90名髋骨关节炎患者的信度，结构效度和反应性的前瞻性队列研究
    摘要：Background and purpose — Improvement of physical function is one of the main treatment goals in severe hip osteoarthritis (OA) patients. The Osteoarthritis Research Society International (OARSI) has identified a core set of performance-based tests to assess the construct physical function: 30-s chair stand test (30-s CST), 4x10-meter fast-paced walk test (40 m FPWT), and a stair-climb test. Despite this recommendation, available evidence on the measurement properties is limited. We evaluated the reliability, validity, and responsiveness of these performance-based measures in patients with hip OA scheduled for total hip arthroplasty (THA).Patients and methods — Baseline and 12-month follow-up measurements were prospectively obtained in 90 end-stage hip OA patients who underwent THA. As there is no gold standard for comparison, the hypothesis testing method was used for construct validity and responsiveness analysis. A test can be assumed valid if ≥75% of predefined hypotheses are confirmed. A subgroup (n = 30) underwent test–retest measurements for reliability analysis. The Oxford Hip Score, Hip injury and Osteoarthritis Outcome Score—Physical Function Short Form, pain during activity score, and muscle strength were used as comparator instruments.Results — Test–retest reliability was appropriate; intraclass correlation coefficient values exceeded 0.70 for all 3 tests. None of the performance-based measures reached 75% hypothesis confirmation for the construct validity or responsiveness analysis.Interpretation — The performance-based tests have good reliability in the assessment of physical function. Construct validity and responsiveness, using patient-reported measures and muscle strength as comparator instruments, could not be confirmed. Therefore, our findings do not justify their use for clinical practice.
  • 14.

    【2hr】High rate of reoperation and conversion to total hip arthroplasty after internal fixation of young femoral neck fractures: a population-based study of 796 patients

    包量

    机译 青年股骨颈骨折内固定术后再次手术和全髋关节置换术的高发生率：一项基于人群的796例患者的研究
    摘要：Background and purpose — Most often, the goal of non-geriatric femoral neck fracture surgery is to preserve the native hip joint. However, reoperations for painful implants, osteonecrosis, and nonunion are common. We determined the reoperation rate and time-to-reoperation following internal fixation of these fractures in a large population cohort.Patients and methods — This retrospective cohort study included patients between the ages of 18 and 50 years old who underwent internal fixation for a femoral neck fracture during 1997–2013. Patients were followed until December 2013. Primary outcomes were reoperation rate and time-to-reoperation. Time-to-event analysis was performed to estimate the rate of any reoperation and for THA specifically, while testing the dependency of time-to-reoperation on secondary variables.Results — 796 young femoral neck fracture patients were treated with internal fixation during the study period (median age 43 years, 39% women). Median follow-up was 8 years (IQR 4–13). One-third underwent at least 1 reoperation at a median 16 months after the index surgery (IQR 8–31). Half of reoperations were for implant removal, followed by conversion to total hip arthroplasty. 14% of the cohort were converted to THA. The median time to conversion was 2 years (IQR 1–4). Neither female sex nor older age had a statistically significant effect on time-to-reoperation or time-to-THA conversion.Interpretation — Following internal fixation of young femoral neck fracture, 1 in 3 patients required a reoperation, and 1 in 7 were converted to THA. These data should be considered by patients and surgeons during treatment decision-making.
  • 15.

    【2hr】The volume–outcome relationship for hip fractures: a systematic review and meta-analysis of 2,023,469 patients

    包量

    机译 髋部骨折的体积与结果的关系：对2,023,469位患者的系统评价和荟萃分析
    摘要：Background and purpose — It has been hypothesized that hospitals and surgeons with high caseloads of hip fracture patients have better outcomes, but empirical studies have reported contradictory results. This systematic review and meta-analysis evaluates the volume–outcome relationship among patients with hip fracture patients.Methods — A search of different databases was performed up to February 2018. Selection of relevant studies, data extraction, and critical appraisal of the methodological quality was performed by 2 independent reviewers. A random-effects meta-analysis using studies with comparative cut-offs was performed to estimate the effect of hospital and surgeon volume on outcome, defined as in-hospital mortality and postoperative complications.Results — 24 studies comprising 2,023,469 patients were included. Overall, the quality was reasonable. 11 studies reported better health outcomes in high-volume centers and 2 studies reported better health outcomes in low-volume centers. In the meta-analysis of 11 studies there was a statistically non-significant association between higher hospital volume and both lower in-hospital mortality (adjusted odds ratio (aOR) 0.87, 95% confidence interval (CI) 0.73–1.04) and fewer postoperative complications (aOR 0.87, CI 0.75–1.02). Four studies on surgeon volume were included in the meta-analysis and showed a minor association between higher surgeon volume and in-hospital mortality (aOR 0.92, CI 0.76–1.12).Interpretation — This systematic review and meta-analysis did not find an evident effect of hospital or surgeon volume on health outcomes. Future research without volume cut-offs is needed to examine whether a true volume–outcome relationship exists.
  • 16.

    【2hr】Selective serotonin reuptake inhibitor use in hip fracture patients: a Danish nationwide prevalence study

    包量

    机译 选择性5-羟色胺再摄取抑制剂在髋部骨折患者中的使用：丹麦一项全国性的流行研究
    摘要：Background and purpose — Selective serotonin reuptake inhibitors (SSRIs) are often used in the elderly and are associated with adverse effects. Therefore, it is important to ascertain the prevalence of SSRI use in fragile and surgery-treated hip fracture patients.Methods — This population-based prevalence study included Danish hip fracture patients aged ≥ 65 years operated in 2006–2016 (n = 68,607) and matched individuals from the background population (n = 343,020). Using Poisson regression, prevalence risk ratios (PRRs) with 95% confidence intervals (CIs) were estimated to compare hip fracture patients with the general population, and to estimate the association between hip fracture patient characteristics and SSRI prescriptions.Results — The prevalence of SSRI use among hip fracture patients was 23% compared with 12% in the general population. During 2006–2016, the prevalence decreased from 26% to 18% among hip fracture patients and from 13% to 10% in the general population. Factors associated with SSRI use in hip fracture patients were age 75–84 years (PRR 1.18, CI 1.13–1.23), age ≥ 85 years (PRR 1.17, CI 1.11–1.22), female sex (PRR 1.13, CI 1.09–1.17), unmarried status (PRR 1.15, CI 1.11–1.19), living in a residential institution (PRR 2.30, CI 2.19–2.40), Charlson comorbidity index (CCI) score 1–2 (PRR 1.50, CI 1.45–1.55), CCI score 3+ (PRR 1.62, CI 1.55–1.69), and several medications.Interpretation — The prevalence of SSRI use was high among hip fracture patients compared with the general population. Our data stress the importance of continued clinical awareness of frailty, comorbidity, and polypharmacy of hip fracture patients and the potentially adverse drug effects of SSRI treatment.
  • 17.

    【2hr】Patient-reported outcome and muscle–tendon pain after periacetabular osteotomy are related: 1-year follow-up in 82 patients with hip dysplasia

    包量

    机译 患者报告的结局和髋臼周围截骨术后的肌腱疼痛相关：82例髋关节发育不良患者的1年随访
    摘要：Background and purpose — Larger prospective studies investigating periacetabular osteotomy (PAO) with patient-reported outcome measures developed for young patients are lacking. We investigated changes in patient-reported outcome (PRO), changes in muscle–tendon pain, and any associations between them from before to 1 year after PAO.Patients and methods — Outcome after PAO was investigated in 82 patients. PRO was investigated with the Copenhagen Hip and Groin Outcome Score (HAGOS). Muscle–tendon pain in the hip and groin region was identified with standardized clinical tests, and any associations between them were analyzed with multivariable linear regressions.Results — HAGOS subscales improved statistically significantly from before to 1 year after PAO with effect sizes ranging from medium to very large (0.66–1.37). Muscle–tendon pain in the hip and groin region showed a large decrease in prevalence from 74% (95% CI 64–83) before PAO to 35% (95% CI 25–47) 1 year after PAO. Statistically significant associations were observed between changes in HAGOS and change in the sum of muscle–tendon pain, ranging from –4.7 (95% CI –8.4 to –1.0) to –8.2 (95% CI –13 to –3.3) HAGOS points per extra painful entity across all subscales from before to 1 year after PAO.Interpretation — Patients with hip dysplasia experience medium to very large improvements in PRO 1 year after PAO, associated with decreased muscle–tendon pain. The understanding of hip dysplasia as solely a joint disease should be reconsidered since muscle–tendon pain seems to play an important role in relation to the outcome after PAO.
  • 18.

    【2hr】Relationship between outcome scores and knee laxity following total knee arthroplasty: a systematic review

    包量

    机译 全膝关节置换术后结局评分与膝关节松弛之间的关系：系统评价
    摘要：Background and purpose — Instability following primary total knee arthroplasty (TKA) is, according to all national registries, one of the major failure mechanisms leading to revision surgery. However, the range of soft-tissue laxity that favors both pain relief and optimal knee function following TKA remains unclear. We reviewed current evidence on the relationship between instrumented knee laxity measured postoperatively and outcome scores following primary TKA.Patients and methods — We conducted a systematic search of PubMed, Embase, and Cochrane databases to identify relevant studies, which were cross-referenced using Web of Science.Results — 14 eligible studies were identified; all were methodologically similar. Both sagittal and coronal laxity measurement were reported; 6 studies reported on measurement in both extension and flexion. In knee extension from 0° to 30° none of 11 studies could establish statistically significant association between laxity and outcome scores. In flexion from 60° to 90° 6 of 9 studies found statistically significant association. Favorable results were reported for posterior cruciate retaining (CR) knees with sagittal laxity between 5 and 10 mm at 75–80° and for knees with medial coronal laxity below 4° in 80–90° of flexion.Interpretation — In order to improve outcome following TKA careful measuring and adjusting of ligament laxity intraoperatively seems important. Future studies using newer outcome scores supplemented by performance-based scores may complement current evidence.
  • 19.

    【2hr】Nonagenarians qualify for total knee arthroplasty: a report on 329 patients from the Swedish Knee Arthroplasty Register 2000–2016

    包量

    机译 Nonagenarians有资格进行全膝关节置换术：来自瑞典膝关节置换术注册2000-2016年的329名患者的报告
    摘要：Background and purpose — The nonagenarian (those aged 90 years and older) population is expected to double in the next 20 years. This demographic age quake may have a significant impact on the incidence of total knee arthroplasty (TKA), although current literature provides limited data. We examined death and revision rates, patient-reported outcomes (PROs) and bias on patient selection of nonagenarian patients operated on with TKA for osteoarthritis (OA) between 2000 and 2016.Patients and methods — The Swedish national knee arthroplasty register was used to identify 329 nonagenarians (mean age, 92 years). Each patient was followed-up until death or the end of 2017. PRO data of 22 of these patients were compared with 65- to 74-year-old patients operated in 2015, from the same register.Results — 5 patients (1.5%) died within 90 days and 23 (7%) patients died within 365 days after TKA. 8 patients (2.4%) developed knee complications that needed revision. For patients followed for 5 and 10 years, more than 50% and 10%, respectively, lived without being revised. The patients had statistically significant improvements in PROs, not significantly different from the younger SKAR cohort. However, the material is small and this statistical finding does not preclude that there may be clinically relevant differences. TKA incidence was different amongst the 21 counties in the country (range, 0–5.1/10,000).Interpretation — Our study suggests that nonagenarians with knee OA qualify for TKA, having similar outcomes to younger patients. The data presented may help surgeons and patients assessing the risks and outcome associated with the procedure.
  • 20.

    【2hr】Weight affects survival of primary total knee arthroplasty: study based on the Danish Knee Arthroplasty Register with 67,810 patients and a median follow-up time of 5 years

    包量

    机译 体重影响原发性全膝关节置换术的生存：根据丹麦膝关节置换术注册研究，研究对象为67,810名患者，平均随访时间为5年
    摘要：Background and purpose — Obesity is a rising issue worldwide and growing evidence supports poor outcome amongst obese patients following total knee arthroplasty (TKA). Using nationwide registries we investigated the association between bodyweight and risk of revision of primary TKA.Patients and methods — All primary TKA performed during 1997–2015, weight at time of primary TKA and subsequent TKA revisions were identified in the Danish Knee Arthroplasty Register (DKR). Data on comorbidities and a priori selected confounding variables were collected from nationwide registries. The association between weight and 1st time TKA revision was calculated as both crude and adjusted hazard ratios (aHR) with 95% confidence intervals (CI) using Cox regression.Results — Of 67,810 identified primary TKAs, 4.8% were revised within a median follow-up time of 5.4 years. No association between weight and risk of any revision in patients aged 18–54 and 55–70 years was found. Increased risk of any revision was seen in patients >70 years, 80–89 kg (aHR =1.5, CI 1.2–1.8), 90–99 kg (aHR =1.7, CI 1.3–2.1) and patients >99 kg (aHR =1.6, CI 1.3–2.1), as well as those weighing 45–60 kg (aHR =1.4, CI 1.1–1.9) compared with same aged patients weighing 70–79 kg.Interpretation — We found a complex association between weight and knee arthroplasty survival. There was an increased risk of any revision in patients older than 70 years of age weighing <60 kg and >80 kg. Patients aged 18–55 years weighing 60–69 kg had a lower risk of revision compared with all other weight groups, whereas weight was not found to affect risk of any revision in patients aged 55–70 years.
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