The association between metal allergy, total knee arthroplasty, and revision: study based on the Danish Knee Arthroplasty Register.

BACKGROUND AND PURPOSE: It is unclear whether delayed-type hypersensitivity reactions against implanted metals play a role in the etiopathogenesis of malfunctioning total knee arthroplasties. We therefore evaluated the association between metal allergy, defined as a positive patch test reaction to common metal allergens, and revision surgery in patients who underwent knee arthroplasty. PATIENTS AND METHODS: The nationwide Danish Knee Arthroplasty Register, including all knee-implanted patients and revisions in Denmark after 1997 (n = 46,407), was crosslinked with a contact allergy patch test database from the greater Copenhagen area (n = 27,020). RESULTS: 327 patients were registered in both databases. The prevalence of contact allergy to nickel, chromium, and cobalt was comparable in patients with and without revision surgery. However, in patients with 2 or more episodes of revision surgery, the prevalence of cobalt and chromium allergy was markedly higher. Metal allergy that was diagnosed before implant surgery appeared not to increase the risk of implant failure and revision surgery. INTERPRETATION: While we could not confirm that a positive patch test reaction to common metals is associated with complications and revision surgery after knee arthroplasty, metal allergy may be a contributor to the multifactorial pathogenesis of implant failure in some cases. In cases with multiple revisions, cobalt and chromium allergies appear to be more frequent.

The Copeland resurfacing humeral head implant does not restore humeral head anatomy. A retrospective study.

PURPOSE: Recently, there has been concern that the Copeland resurfacing humeral head implant (RHHI) leaves the shoulder joint overstuffed. The purpose of this study was in a selected cohort of patients operated with a Copeland RHHI (1) to evaluate the Length of the Gleno-Humeral Offset (LGHO), (2) to assess the patient-reported quality of life and functional outcome measured by Western Ontario Osteoarthritis of the Shoulder Index (WOOS) and (3) to determine the number of revisions in the cohort. METHODS: Pre- and postoperative radiographs were retrieved from 71 of 91 possible patients operated with a Copeland RHHI from 2005 to 2009. The cohort consisted of 30 males and 41 females at a mean age of 61 (38-89) years. One radiologist measured the LGHO and performed double measurements. The WOOS score 1 year after surgery and the number of revisions from all patients operated with a Copeland RHHI in Denmark was requested from the Danish Shoulder Arthroplasty Registry. RESULTS: The mean LGHO was 4.99 ± 0.53 cm before surgery and 5.39 ± 0.58 cm after surgery, (p < 0.001). 95 % limits of agreement for measurements of LGHO were ± 0.11 cm. One year after surgery, the WOOS score was 67 for the cohort and 64 for all patients operated with a Copeland RHHI in Denmark. 13 of 71 RHHI in the cohort were revised. CONCLUSION: The Copeland RHHI causes significantly increased LGHO and leads to overstuffing in the shoulder joint. The WOOS score in the cohort was comparable to that for all other Danish patients operated with a Copeland RHHI.

Targeting NOX2 with Bivalent Small-Molecule p47phox-p22phox Inhibitors.

Nicotinamide adenine dinucleotide phosphate oxidase isoform 2 (NOX2) is an enzymatic complex whose function is the regulated generation of reactive oxygen species (ROS). NOX2 activity is central to redox signaling events and antibacterial response, but excessive ROS production by NOX2 leads to oxidative stress and inflammation in a range of diseases. The protein-protein interaction between the NOX2 subunits p47phox and p22phox is essential for NOX2 activation, thus p47phox is a potential drug target. Previously, we identified 2-aminoquinoline as a fragment hit toward p47phoxSH3A-B and converted it to a bivalent small-molecule p47phox-p22phox inhibitor (Ki = 20 µM). Here, we systematically optimized the bivalent compounds by exploring linker types and positioning as well as substituents on the 2-aminoquinoline part and characterized the bivalent binding mode with biophysical methods. We identified several compounds with submicromolar binding affinities and cellular activity and thereby demonstrated that p47phox can be targeted by potent small molecules.

Waking Up in Pain: a prospective unselected cohort study of pain in 3702 patients immediately after surgery in the Danish Realm.

BACKGROUND: Acute and persistent pain after surgery is well described. However, no large-scale studies on immediate postoperative pain in the operating room (OR) exist, hindering potential areas of research to improve clinical outcomes. Thus, we aimed to describe the occurrence and severity of immediate postoperative pain in a large, unselected cohort. METHODS: This was a prospective cohort study, encompassing all procedures in 31 public hospitals in the Danish Realm, during a 5-day period including the weekend. Data on procedures and anesthesia were collected and the main outcome was occurrence of moderate or severe pain in the OR. Secondary outcomes included pain, sedation and nausea in the OR or during the first 15 min in the postanesthesia care unit (PACU) including relevant risk factors. Descriptive and logistic regression statistics were used. RESULTS: A total of 3675 procedures were included for analysis (87% inclusion rate). Moderate or severe pain occurred in 7.4% (95% CI 6.5% to 8.3%) of cases in the OR immediately after awakening, rising to 20.2% in the OR and/or PACU. Large intraprocedure and interprocedure variations occurred (0.0%-37.5%), and in 20% of cases with epidural-general anesthesia patients experienced moderate or severe pain. Independent risk factors were female sex, younger age, preoperative pain, daily opioid use and major surgical procedures. CONCLUSION: Moderate or severe pain in the immediate postoperative phase occurred in 20% of all cases with procedure and anesthesiological technique variations, suggesting a need for identification of relevant procedure-specific risk factors and development of preventive treatments. TRIAL REGISTRATION NUMBER: RoPR ID 43191.

[A clinical gait analysis. A survey of usefulness of a gait laboratory]. / Klinisk ganganalyse. En oversigt over anvendeligheden af et ganglaboratorium.

Advanced equipment for objective, quantitative 3-D locomotion analysis has been developed and has resulted in setting up clinical gait and locomotion laboratories connected to hospitals in USA and Europe. Before treatment of sufferings related to the locomotive system, the pathological movements can be objectified, and by repeating a gait analysis, the effect of treatment can be read. In treatment of cerebral palsy the method is used routinely, but influences of traumatic brain damage and apoplexy, as well as the effect of artificial joints in the body's locomotive patterns, can profitably be analysed.