Thromboprophylaxis in primary shoulder arthroplasty does not seem to prevent death: a report from the Norwegian Arthroplasty Register 2005-2018.

Background and purpose - There is still no consensus on whether to use thromboprophylaxis as a standard treatment in shoulder replacement surgery. We investigated the use of thromboprophylaxis reported to the Norwegian Arthroplasty Register (NAR). The primary endpoint was early mortality after primary shoulder arthroplasty with and without thromboprophylaxis. Secondary endpoints included revisions within 1 year and intraoperative complications.Patients and methods - This observational study included 6,123 primary shoulder arthroplasties in 5,624 patients reported to the NAR from 2005 to 2018. Cox regression analyses including robust variance analysis were performed with adjustments for age, sex, ASA score, diagnosis, type of implant, fixation, duration of surgery, and year of primary surgery. An instrumental variable Cox regression was performed to estimate the causal effect of thromboprophylaxis.Results - Thromboprophylaxis was used in 4,089 out of 6,123 shoulder arthroplasties. 90-day mortality was similar between the thromboprophylaxis and no thromboprophylaxis groups (hazard ratio (HR) = 1.1, 95% CI 0.6-2.4). High age (> 75), high ASA class (≥ 3), and fracture diagnosis increased postoperative mortality. No statistically significant difference in the risk of revision within 1 year could be found (HR = 0.6, CI 0.3-1.2). The proportion of intraoperative bleeding was similar in the 2 groups (0.2%, 0.3%).Interpretation - We had no information on cause of death and relation to thromboembolic events. However, no association of reduced mortality with use of thromboprophylaxis was found. Based on our findings routine use of thromboprophylaxis in shoulder arthroplasty can be questioned.

Bisphenol A in human saliva and urine before and after treatment with dental polymer-based restorative materials.

The aim of this study was to quantify bisphenol A (BPA) concentrations in saliva and urine before and after treatment with dental polymer-based restorative materials to assess if placement of this material is associated with increased BPA levels in saliva and urine. Twenty individuals in need of at least one dental restoration with polymer-based restorative material were included in this study. The participants were instructed to abstain from eating, drinking, and brushing their teeth for at least 10 h prior to sampling. Saliva and urine were collected before and 10 min (saliva only), 1 h, 24 h, and 1 wk after treatment. Samples were stored at -80°C before analyses. BPA in saliva and urine was determined with liquid chromatography/mass spectrometry. Linear mixed effects regression models were used for statistical analyses. There was a statistically significant increase of salivary BPA concentration directly after placement of the dental polymer-based restorations. Following placement, the concentration of BPA decreased exponentially with time. One week after treatment the BPA level in saliva was only marginally higher than before treatment. In urine, no statistically significant change of the BPA concentration was detected after treatment.

Self-reported dry mouth among ageing people: a longitudinal, cross-national study.

Focusing on Swedish and Norwegian cohorts of community-dwelling older adults between age 65 and 70, this study aimed to identify predictors of the prevalence and incident cases of daytime and night-time xerostomia. It was hypothesized that the prevalence increases with increasing age and is higher in women than in men and that the prevalence of persistent xerostomia and the 5-yr-incident cases are higher in people with consistent use of medication and need for health care. Of the Norwegian participants who completed the 2007 survey (age 65 yr), 70% (n = 2,947) participated in 2012. Individuals participating in both 2007 and 2012 constituted the Swedish panel (80%, n = 4,862). The prevalence of xerostomia was higher in women than in men and increased from age 65 to age 70, most markedly in the Swedish cohort. The risk of persistent xerostomia was greatest for participants with consistent use of medication (OR = 1.3) and contact with a physician (OR = 2.3). The risk of incident cases of xerostomia during daytime was greatest for participants with recent and consistent use of medication and recent contact with a physician. Dental professionals should identify patients with xerostomia, emphasize early prevention, and alleviate oral symptoms in collaboration with physicians.

A survivorship study of 838 total elbow replacements: a report from the Norwegian Arthroplasty Register 1994-2016.

BACKGROUND: The aim of this study was to present the long-term survivorship (20 years) of total elbow arthroplasty (TEA) for a relatively large population and to compare different prosthesis brands and patient subgroups. METHODS: Between 1994 and 2017, a total of 838 primary TEAs were reported to the Norwegian Arthroplasty Register. Implant survival was calculated using the Kaplan-Meier method. Risk differences were examined using Cox regression analyses and exact Cox regression for rare events. We compared the survivorship of the 8 most frequently used implant brands, the different diagnoses leading to TEA, and the influence of the fixation technique. RESULTS: The overall 5-, 10-, 15-, and 20-year survival rates for all elbow arthroplasties were 92%, 81%, 71%, and 61%, respectively. Risk factors for revision were a diagnosis of sequelae after trauma and cementless fixation of the ulna component. There were some differences between the implant brands. The Norway prostheses had higher survival compared with the Kudo after 15 years of follow-up (78% and 66%, respectively; P < .001). Among the implants with shorter follow-up, the IBP and NES had inferior survivorship compared with the Norway. The frequently used Discovery had promising survivorship up to 5 years. The most frequent reason for revision surgery was aseptic loosening, followed by defective polyethylene, infection, and dislocation. The revision causes were to some degree implant specific. CONCLUSION: Fairly good results in terms of prosthesis survival were obtained with TEA, although results were poorer than for knee and hip arthroplasties.

Nano-TiO2 penetration of oral mucosa: in vitro analysis using 3D organotypic human buccal mucosa models.

BACKGROUND: Oral cavity is a doorway for a variety of products containing titanium dioxide (TiO2 ) nanoparticles (NPs) (nano-TiO2 ) such as food additives, oral healthcare products and dental materials. Their potential to penetrate and affect normal human oral mucosa is not yet determined. OBJECTIVES: To evaluate the ability of nano-TiO2 to penetrate the in vitro reconstructed normal human buccal mucosa (RNHBM). METHODS: RNHBM was generated from primary normal human oral keratinocytes and fibroblasts isolated from buccal oral mucosa of healthy patients (n = 6). The reconstructed tissues were exposed after 10 days to clinically relevant concentrations of spherical or spindle rutile nano-TiO2 in suspension for short (20 min) and longer time (24 h). Ultrahigh-resolution imaging (URI) microscopy (CytoViva™ , Auburn, AL, USA) was used to assess the depth of penetration into reconstructed tissues. RESULTS: Ultrahigh-resolution imaging microscopy demonstrated the presence of nano-TiO2 mostly in the epithelium of RNHBM at both 20 min and 24-h exposure, and this was shape and doze dependent at 24 h of exposure. The depth of penetration diminished in time at higher concentrations. The exposed epithelium showed increased desquamation but preserved thickness. CONCLUSION: Nano-TiO2 is able to penetrate RNHBM and to activate its barrier function in a doze- and time-dependent manner.

Dental hygienist attendance and its covariates in an ageing Swedish cohort.

Delegation of tasks between professional groups is important to make health-care services accessible and effective for ageing people. Focussing on a Swedish 1942 birth cohort and guided by Andersen's Behavioral Model, this study assessed dental hygienist attendance from age 50 to age 70 and identified covariates at the population-averaged and person-specific levels. In 1992, a census of 50-yr-old subjects was invited to participate in a questionnaire survey. Of the 6,346 respondents, 3,585 completed follow-ups in 1997, 2002, 2007, and 2012. Multiple logistic regression analysis was conducted using a marginal model and a random intercept model. Cochran's Q test revealed that significantly more respondents confirmed dental hygienist attendance in 2012 than in 1992 (57.2% in 2012 vs. 26.0% in 1992). Population-averaged ORs for dental hygienist attendance across time were 3.5 at age 70 yr compared with age 50 yr (baseline); 2.0 if being a regular rather than an irregular dental attendee; and 0.7 if being of non-native origin compared with native origin. The corresponding person-specific ORs were 8.9, 3.2, and 0.5. Consistent with Andersen's Behavioral Model, predisposing, enabling, and need-related factors were associated with dental hygienist attendance at population-averaged and person-specific levels. This has implications for promoting dental hygienist attendance among ageing people.

Do self-efficacy and depression predict oral impacts on daily performances across time? A 2-yr follow-up of students in Tanzania.

This study aimed to assess the longitudinal validity of the oral impacts on daily performance (OIDP) and to identify psychosocial determinants, in terms of self-efficacy and depressive symptoms, of the OIDP across time. Following conceptual frameworks of oral health, it was hypothesized that sociodemographic, clinical, and psychosocial factors predict oral impacts across time at both population- averaged and person-specific levels. Whether the effects of sociodemographic and clinical factors were accounted for, totally or in part, by psychosocial factors were also investigated. Self administered questionnaires and oral clinical examinations at baseline (2009) and follow-up (2011) were completed by 1,714 and 727 secondary school students, respectively. Generalized equalized equations and a random intercept model were used to account for the dependency in repeated observations. Mean OIDP change scores were negative (worsened) among those who reported worsened self-reported oral health. Psychosocial, clinical, and sociodemographic factors were independently associated with oral impacts at the population-averaged and person-specific levels. Mediation of sociodemographic and clinical variables according to psychosocial variables was not observed. Satisfactory longitudinal evaluative properties of the OIDP, and independent effects of psychosocial factors on oral impacts across time, were confirmed among secondary school students in Tanzania.

Life-course social influences on tooth loss and oral attitudes among older people: evidence from a prospective cohort study.

This study examined the relationship of trajectories in social condition with oral attitudes and major tooth loss, using the social mobility and accumulation life-course models in a cohort. Whether social-condition inequalities remained stable or changed from 65 yr of age to 70 yr of age was investigated. In 1992, 6,346 inhabitants born in 1942 and residing in two Swedish counties agreed to participate in a prospective survey. Of the participants in 1992, 3,585 (47.6% men) completed questionnaires in 1997, 2002, 2007, and 2012. In line with the social-mobility model, the prevalence of negative oral attitudes and major tooth loss in participants at 65 and 70 yr of age showed a consistent gradient according to social-condition trajectory, whereby it was lowest among those who were persistently high and highest among those who were persistently low, with the upwardly and downwardly mobile categories being intermediate. A linear graded association between the number of periods with disadvantaged social condition and oral health supported the accumulation model. Both the social mobility and accumulation life-course models were supported. Social-condition differentials in negative oral attitudes and tooth loss seem to remain stable or to narrow weakly after the usual age of retirement.

Equivalent mortality after operation with sliding hip screw or intramedullary nail for trochanteric AO/OTA A1 and A2 fractures reported in the Norwegian Hip Fracture Register 2008 to 2020.

Aims: This study aimed to compare mortality in trochanteric AO/OTA A1 and A2 fractures treated with an intramedullary nail (IMN) or sliding hip screw (SHS). The primary endpoint was 30-day mortality, with secondary endpoints at 0 to 1, 2 to 7, 8 to 30, 90, and 365 days. Methods: We analyzed data from 26,393 patients with trochanteric AO/OTA A1 and A2 fractures treated with IMNs (n = 9,095) or SHSs (n = 17,298) in the Norwegian Hip Fracture Register (January 2008 to December 2020). Exclusions were made for patients aged < 60 years, pathological fractures, pre-2008 operations, contralateral hip fractures, fractures other than trochanteric A1/A2, and treatments other than IMNs or SHSs. Kaplan-Meier and Cox regression analyses adjusted for type of fracture, age, sex, cognitive impairment, American Society of Anesthesiologists (ASA) grade, and time period were conducted, along with calculations for number needed to harm (NNH). Results: In unadjusted analyses, there was no significant difference between IMN and SHS patient survival at 30 days (91.8% vs 91.1%; p = 0.083) or 90 days (85.4% vs 84.5%; p = 0.065), but higher one-year survival for IMNs (74.5% vs 73.3%; p = 0.031) compared with SHSs. After adjustments, no significant difference in 30-day mortality was found (hazard rate ratio (HRR) 0.94 (95% confidence interval (CI) 0.86 to 1.02(; p = 0.146). IMNs exhibited higher mortality at 0 to 1 days (HRR 1.63 (95% CI 1.13 to 2.34); p = 0.009) compared with SHSs, with a NNH of 556, but lower mortality at 8 to 30 days (HRR 0.89 (95% CI 0.80 to 1.00); p = 0.043). No differences were observed in mortality at 2 to 7 days (HRR 0.94 (95% CI 0.79 to 1.11); p = 0.434), 90 days (HRR 0.95 (95% CI 0.89 to 1.02); p = 0.177), or 365 days (HRR 0.97 (95% CI 0.92 to 1.02); p = 0.192). Conclusion: This study found no difference in 30-day mortality between IMNs and SHSs. However, IMNs were associated with a higher mortality at 0 to 1 days and a marginally lower mortality at 8 to 30 days compared with SHSs. The observed differences in mortality were small and should probably not guide choice of treatment.

Effect of peer-based low back pain information and reassurance at the workplace on sick leave: a cluster randomized trial.

PURPOSE: To evaluate whether information and reassurance about low back pain (LBP) given to employees at the workplace could reduce sick leave. METHODS: A Cluster randomized controlled trial with 135 work units of about 3,500 public sector employees in two Norwegian municipalities, randomized into two intervention groups; Education and peer support (EPS) (n = 45 units), education and "peer support and access to an outpatient clinic" (EPSOC) (n = 48 units), and a control group (n = 42 units). Both interventions consisted of educational meetings based on a "non-injury model" and a "peer adviser" appointed by colleagues. Employees in the EPSOC group had access to an outpatient clinic for medical examination and further education. The control group received no intervention. The main outcome was sick leave based on municipal records. Secondary outcomes were self-reported pain, pain related fear of movement, coping, and beliefs about LBP from survey data of 1,746 employees (response rate about 50 %). RESULTS: EPS reduced sick leave by 7 % and EPSOC reduced sick leave by 4 % during the intervention year, while sick leave in the control group was increased by 7 % during the same period. Overall, Rate Ratios (RR) were statistically significant for EPSOC (RR = .84 (C.I = 0.71-.99) but not EPS (RR = .92 (C.I = 0.78-1.09)) in a mixed Poisson regression analysis. Faulty beliefs about LBP were reduced in both intervention groups. CONCLUSIONS: Educational meetings, combined with peer support and access to an outpatient clinic, were effective in reducing sick leave in public sector employees.

Long-term survival of 2997 finger metacarpophalanageal joint arthroplasties from the Norwegian Arthroplasty Register.

We present the long-time survival of 2997 primary metacarpophalangeal (MCP) joint implants from the Norwegian Arthroplasty Register from 1994 to 2019. Six different implants were compared in terms of survival and risk of revision. The majority of implants were inserted in patients diagnosed with inflammatory diseases and in women. The overall survival was found to be 94%, 89%, 85% and 84% after 5, 10, 15 and 20 years. The most prevalent reason for revision was a fractured prosthetic component, and the second was pain. Implants inserted in the right hand and in younger patients had a higher risk for revision. Sex, type of implant, finger treated, one- or two-component prosthesis, and inflammatory or non-inflammatory conditions did not influence the survival. The frequency of MCP joint implantations decreased during the observation period. Our data show satisfactory long-term survival of the MCP implants, with no difference found between implant types or concepts.Level of evidence: II.

Dental implant surface morphology, chemical composition, and topography following double wavelength (2780/940 nm) laser irradiation. An in vitro study.

OBJECTIVE: The aim of this in vitro study was to evaluate morphology alterations, chemical composition, and topography of moderately rough dental implants following double-wavelength laser irradiation. MATERIAL AND METHODS: Commercial-grade titanium dental implants representing different surface characteristics (Osseospeed [OS], TiUnite [TiU], and Roxolid SLActive [RS]) were used. Laser irradiation was performed using a computer-controlled robotic device with calibrated energy/power settings and deionized water spray. Micro-, nano-morphology surface alterations, chemical composition, and surface topography (Sa , Sds , Sdr ) in the test group (laser plus water), control group A (water only), and control group B (no treatment) were analyzed using scanning electron microscopy (SEM), energy-dispersive X-ray analysis (EDX), and white light laser profilometer (Interferometry). RESULTS: SEM-evaluation revealed minor between-group differences in micro- and nano-morphology within each implant system. Significant overall differences in surface element content were observed between the test and control group B for all implant systems (p < .05). For the test compared with control group B, statistically significantly higher oxygen content was detected for OS and RS (p < .05), a corresponding significant difference was detected for carbon for TiU (p < .05). For RS, a significantly lower content of titanium and zirconium was detected within the test group (p < .05). A significant difference in topography between test and control group B was observed for OS (Sa : p = .039 and Sdr : p = .041) with the highest roughness value for control group B. CONCLUSIONS: Altered chemical composition and surface topography were observed for all implant surfaces compared with untreated control following double wavelength laser irradiation. A clinical evaluation of the impact of the altered surface composition following double wavelength laser irradiation on the ability to reosseointegrate appears warranted.

Long-term survival from adenocarcinoma of the esophagus after transthoracic and transhiatal esophagectomy.

BACKGROUND: The effects of transthoracic or transhiatal esophagectomy on the long-term survival of patients who had adenocarcinoma of the esophagus were compared, as were factors applicable in preoperative stratification of patient treatment. METHODS: A cohort of 147 consecutive patients with adenocarcinoma of the esophagus was evaluated for esophagectomy between 1984 and 2000. The patients were followed prospectively and observed survival rates of patients with a transthoracic or transhiatal approach to esophagectomy were compared by standardized mortality ratio (SMR) and relative mortality ratio (RMR) using the expected survival of a matched Norwegian population. RESULTS: A R0 resection was performed by transthoracic (n = 33) or a transhiatal (n = 55) esophagectomy in 88 (60%) patients with a median age of 61 (range: 35-77) and 70 (42-88) years, respectively (P <0.001). Tumor stages and other possible risk factors were similar in the two groups. Transthoracic or transhiatal esophagectomy resulted in a median survival time of 20.5 (95% confidence interval (CI): 10.4-57.6) and 16.4 (10.6-28.7) months, respectively. The respective survival rates were 31.2% and 27.8% by 5 years, and 21.3% and 16.6% by 10 years with an overall RMR of 1.14 (P = 0.63). Median survival time in the absence or presence of lymph node metastases was 74.0 (95% CI: 17.5-166.4) and 10.7 (7.9-14.9) months. The corresponding survival rates by 10 years with non-involved or involved nodes were 48.9% and 3.8% respectively (RMR 2.22, P = 0.007). Patients with a pT1-tumor were few and the survival rate was not very different from that of the general population (SMR = 1.7, 95% CI: 0.7-4.1). The median survival time of patients with a pT2-tumor was 30.4 (95% CI: 9.0-142) months and with a pT3-tumor 14 (9.2-16.4) months. The survival rates by 10 years among patients with a pT1 tumor were 57.0% (95% CI: 14.9-78.9), pT2 33.3% (11.8-52.2), and pT3 7.1% (1.9-15.5). The relative mortality for T3 stages compared to T1 stages was statistically significant (RMR = 3.22, P = 0.024). CONCLUSION: Transthoracic and transhiatal esophagectomy are both effective approaches for treatment of adenocarcinoma of the esophagus and survival of more than 10 years can be expected without adjuvant chemotherapy. However, increasing depth of tumor invasion and lymph node metastases reduce life expectancy.

Results of 189 wrist replacements. A report from the Norwegian Arthroplasty Register.

BACKGROUND AND PURPOSE: There is very little literature on the long-term outcome of wrist replacements. The Norwegian Arthroplasty Register has registered wrist replacements since 1994. We report on the total wrist replacements and their revision rates over a 16-year period. MATERIAL AND METHODS: 189 patients with 189 primary wrist replacements (90 Biax prostheses (80 of which were cementless), 23 cementless Elos prostheses, and 76 cementless Gibbon prostheses), operated during the period 1994-2009 were identified in the Norwegian Arthroplasty Register. Prosthesis survival was analyzed using Cox regression analyses. The 3 implant designs were compared and time trends were analyzed. RESULTS: The 5-year survival was 78% (95% CI: 70-85) and the 10-year survival was 71% (CI: 59-80). Prosthesis survival was 85% (CI: 78-93) at 5 years for the Biax prosthesis, 77% (CI: 30-90) at 4 years for the Gibbon prosthesis, and 57% (CI: 33-81) at 5 years for the Elos prosthesis. There was no statistically significant influence of age, diagnosis, or year of operation on the risk of revision, but females had a higher revision rate than males (RR = 3, CI: 1-7). The number of wrist replacements performed due to osteoarthritis increased with time, but no such change was apparent for inflammatory arthritis. INTERPRETATION: The survival of the total wrist arthroplasties studied was similar to that in other studies of wrist arthroplasties, but it was still not as good as that for most total knee and hip arthroplasties. However, a failed wrist arthroplasty still leaves the option of a well-functioning arthrodesis.

Improved results of primary total hip replacement.

BACKGROUND AND PURPOSE: Over the past 20 years, several changes in treatment policy and treatment options have taken place regarding hip replacement. For this reason, we wanted to investigate the results after hip replacement in terms of revision rate, during a 21-year period among hip replacements reported to the Norwegian Arthroplasty Register. METHODS: 110,882 primary total hip replacements were reported to the Norwegian Arthroplasty Register from 1987 through 2007. Risk of revision during the time periods 1993-1997, 1998-2002, and 2003-2007 was compared to that of the reference period 1987-1992. Adjusted Cox regression analyses were performed to compare the risk of revision in different time periods and extended analyses were done to investigate revision within the first postoperative year and after the first year. RESULTS: There was an overall reduced risk of revision in the time periods 1993-1997, 1998-2002, and 2003-2007 compared to the reference period: RR = 0.81 (95% CI 0.77-0.86), 0.51 (CI 0.47-0.55), and 0.77 (CI 0.68-0.85), respectively. The improved results were due to a marked reduction in aseptic loosening of the femoral and acetabular components in all time periods and in all subgroups of prostheses. A change in the timing of revision took place, with more early revisions and fewer late revisions in the later time periods. Revision due to dislocation and infection increased over time. INTERPRETATION: The risk of revision decreased during the study period, due to fewer cases of aseptic loosening of prosthetic components. The best results were obtained with the use of cemented prostheses. Prevention of dislocation and infection should be a major goal in the future, as revision due to these causes increased during the study period.

Sequential bortezomib and temozolomide treatment promotes immunological responses in glioblastoma patients with positive clinical outcomes: A phase 1B study.

BACKGROUND: Glioblastoma (GBM) is an aggressive malignant brain tumor where median survival is approximately 15 months after best available multimodal treatment. Recurrence is inevitable, largely due to O6 methylguanine DNA methyltransferase (MGMT) that renders the tumors resistant to temozolomide (TMZ). We hypothesized that pretreatment with bortezomib (BTZ) 48 hours prior to TMZ to deplete MGMT levels would be safe and tolerated by patients with recurrent GBM harboring unmethylated MGMT promoter. The secondary objective was to investigate whether 26S proteasome blockade may enhance differentiation of cytotoxic immune subsets to impact treatment responses measured by radiological criteria and clinical outcomes. METHODS: Ten patients received intravenous BTZ 1.3 mg/m2 on days 1, 4, and 7 during each 4th weekly TMZ-chemotherapy starting on day 3 and escalated from 150 mg/m2 per oral 5 days/wk via 175 to 200 mg/m2 in cycles 1, 2, and 3, respectively. Adverse events and quality of life were evaluated by CTCAE and EQ-5D-5L questionnaire, and immunological biomarkers evaluated by flow cytometry and Luminex enzyme-linked immunosorbent assay. RESULTS: Sequential BTZ + TMZ therapy was safe and well tolerated. Pain and performance of daily activities had greatest impact on patients' self-reported quality of life and were inversely correlated with Karnofsky performance status. Patients segregated a priori into three groups, where group 1 displayed stable clinical symptoms and/or slower magnetic resonance imaging radiological progression, expanded CD4+ effector T-cells that attenuated cytotoxic T-lymphocyte associated protein-4 and PD-1 expression and secreted interferon γ and tumor necrosis factor α in situ and ex vivo upon stimulation with PMA/ionomycin. In contrast, rapidly progressing group 2 patients exhibited tolerised T-cell phenotypes characterized by fourfold to sixfold higher interleukin 4 (IL-4) and IL-10 Th-2 cytokines after BTZ + TMZ treatment, where group 3 patients exhibited intermediate clinical/radiological responses. CONCLUSION: Sequential BTZ + TMZ treatment is safe and promotes Th1-driven immunological responses in selected patients with improved clinical outcomes (Clinicaltrial.gov (NCT03643549)).

A dimensional versus a categorical approach to diagnosis: anxiety and depression in the HUNT 2 study.

The aim of this study was to compare a dimensional and a categorical approach to diagnosis, using as an illustration co-occurring symptoms of anxiety and depression concerning description, associations and predictive power. We analysed data from 60 869 individuals with valid ratings on the Hospital Anxiety and Depression Scale (HADS) and on mental impairment in the age range of 20 to 89 years of the cross-sectional Nord-Trøndelag Health Study 1995-1997. There was a wide variation of the dimensional symptom level (subscale scores) within both diagnostic categories (cut-offs > > or = 8 on both subscales), as is usually true with categorical and dimensional diagnosis. The dimensional (Spearman) correlation coefficients between anxiety and depression was 0.51 compared to 0.38 for the categorical. The power to predict impairment was weaker with the categorical than with the dimensional approach of the HADS, showing fewer statistically significant coefficients in the logistic regression models and lower area under curve (0.82 versus 0.87). This is an example illustrating the impact use of dimensional diagnoses would have on research and clinical practice.

Results after 562 total elbow replacements: a report from the Norwegian Arthroplasty Register.

BACKGROUND: The aim of this study was to give results of elbow arthroplasty for a relatively large population and compare different prosthesis brands and different patient subgroups. METHODS: Between 1994 and 2006, 562 total elbow replacement operations were reported to the Norwegian Arthroplasty Register. Revisions of prostheses were shown using Kaplan-Meier failure curves, and risk of revision was calculated using Cox regression analysis. RESULTS: The overall 5- and 10-year failure rates were 8% and 15%, respectively. There were only minor differences between the different implants. Patients who developed traumatic arthritis after fracture had the worst prognosis compared with inflammatory arthritis (P = .005). Risk of revision was also increased when the ulnar component was inserted without cement (P = .02.) CONCLUSIONS: Good results in terms of prosthesis survival were obtained with total elbow arthroplasty, although results were worse than for knee- and hip arthroplasties. The best results were achieved in patients with inflammatory arthritis.

External fixation of fractures of the distal radius: a randomized comparison of the Hoffman compact II non-bridging fixator and the Dynawrist fixator in 75 patients followed for 1 year.

BACKGROUND AND PURPOSE: External fixators allowing movement during fracture healing are commonly used for treatment of unstable distal radius fractures. The dynamic Dynawrist fixator with the distal pins in metacarpal bone may avoid fixation problems in comminuted fractures and may reduce the risk of nerve injury. We compared anatomical and functional outcome for the well-established Hoffmann compact II non-bridging fixator and for the Dynawrist fixator. PATIENTS AND METHODS: 75 patients with unstable distal radius fractures were randomized to treatment with either the Hoffman compact II fixator (the H-group) or the Dynawrist fixator (the D-group). Anatomical and functional variables were recorded preoperatively, postoperatively, and at 6, 12, 24, and 52 weeks. Pain was assessed using the VAS score and function was assessed using DASH score. RESULTS: Postoperatively, radial tilt, inclination, and radial length all improved statistically significantly in both groups. At time of removal of the fixators, the H group had superior volar radial tilt. At the 52-week follow-up, there were no statistically significant differences between the groups regarding anatomical variables. At 6 weeks, flexion was greater in the D group but at 12, 24, and 52 weeks flexion was similar in the two groups, as were the other wrist and forearm movements. There were no statistically significant differences between the groups according to VAS and DASH scores. 3 nerve injuries occurred in the H group and 1 in the D group (p = 0.4), all of which were transient. INTERPRETATION: The Dynawrist bridging but dynamic fixator gives radiographic and functional outcome similar to that of the Hoffman II compact non-bridging fixator.

Risk factors for revision after shoulder arthroplasty: 1,825 shoulder arthroplasties from the Norwegian Arthroplasty Register.

BACKGROUND AND PURPOSE: Previous studies on shoulder arthroplasty have usually described small patient populations, and few articles have addressed the survival of shoulder implants. We describe the results of shoulder replacement in the Norwegian population (of 4.7 million) during a 12-year period. Trends in the use of shoulder arthroplasty during the study period were also investigated. PATIENTS AND METHODS: 1,531 hemiprostheses (HPs), 69 total shoulder replacements (Neer type TSR), and 225 reversed total shoulder replacement (reversed TSR) operations were reported to the Norwegian Arthroplasty Register between 1994 and 2005. Kaplan-Meier failure curves were drawn up for particular subgroups of patients, and revision rates were calculated using Cox regression analysis. RESULTS: The 5- and 10-year failure rates of hemiprostheses were 6% (95% CI: 5-7) and 8% (95% CI: 6-10), and for reversed total shoulder replacements they were 10% (95% CI: 5-15) and 22% (95% CI: 10-33), respectively. For hemiprostheses, the risk of revision for patients who were 70 years or older was half that of those who were younger (RR = 0.47, CI: 0.28-0.77), while the risk of revision was highest for patients with sequelae after fracture compared to those with acute fractures (RR = 3.3, CI: 1.5-7.2). No differences in prosthesis survival were found between the different hemiprosthesis brands. The main reasons for revision of hemiprostheses were pain and luxation. For reversed total prostheses, the risk of revision was less for women than for men (RR = 0.26, CI: 0.11-0.63), and the main cause of revision was aseptic loosening of the glenoid component. During the study period, the incidence of shoulder arthroplasty increased for all diagnostic groups except inflammatory arthritis, for which a decrease was seen. INTERPRETATION: We found good results in terms of 5-year prosthesis failure rate, with the use of hemiarthroplasty for patients with inflammatory arthritis, osteoarthritis, and acute fractures. Reversed total shoulder replacement was associated with a rather poor prognosis.