Long-term results after weight loss intervention in knee arthroplasty patients with obesity.

INTRODUCTION: Obesity is a well-known problem in patients undergoing total knee arthroplasty (TKA). We have previously shown that it is feasible and safe to implement an intensive weight loss programme shortly before TKA. Preoperatively, the programme produced an average weight loss of 10.7 kg while also improving body composition and reducing cardiovascular risk factors. One year after TKA, the patients in the weight loss programme managed to maintain their weight loss, whereas no change was observed in the control group. Both groups showed major improvements in health-related quality of life (QoL) and knee function. The aim of this study was to investigate the long-term effect of a weight loss intervention in patients with obesity undergoing TKA. METHODS: This was a seven-year follow-up study from a randomized controlled trial. Body weight, blood pressure and waist circumference were measured. Additionally, data on patient-reported outcome, range of knee motion (ROM), hypertension and diabetes status were collected. RESULTS: Forty-nine patients were examined at the follow-up. No differences were found between the intervention and the control group on body weight, hypertension, diabetes, waist circumference or knee ROM. The intervention group had increased their mean weight significantly more than the control group (difference = 3.1, 95% confidence interval: 1.3-4.8). 66% had hypertension and 38% had Type 2 diabetes. Pain, function and QoL were improved for both groups. CONCLUSION: The patients in the intervention group were unable to maintain their preoperative weight loss when measured seven year after TKA. FUNDING: none. TRAIL REGISTRATION. not relevant.

Eighty Percent Survival of Resurfacing Implants in the Knee After 10 Years: A Nationwide Cohort Study on 379 Procedures from the Danish Knee Arthroplasty Registry.

OBJECTIVE: Focal cartilage injuries are debilitating and difficult to treat. Biological cartilage repair procedures are used for patients younger than 40 years, and knee arthroplasties are generally reserved for patients older than 60 years. Resurfacing implants are well suited for patients in this treatment gap. The objective was to investigate the 10-year survival of resurfacing implants in the Danish Knee Arthroplasty Registry. DESIGN: In this retrospective cohort study, patients treated with resurfacing implants were followed longitudinally in the Danish Knee Arthroplasty Registry from 1997 to 2020. The primary endpoint was revision surgery. The survival of the resurfacing implants was analyzed by Kaplan-Meier method. RESULTS: A total of 379 resurfacing implant procedures were retrieved from the Danish Knee Arthroplasty Registry. The mean age and weight of patients were 50 years (SD = 11) and 84 kg (SD = 17), respectively. The indications for surgery were as follows: secondary osteoarthritis (42%), primary osteoarthritis (32%), and osteochondral lesions (20%). Within the follow-up period, 70 (19%) of the implants were revised to arthroplasties. The 1-, 5-, and 10-year revision-free survival estimation was 0.95 (95% CI 0.93-0.97), 0.84 (95% CI 0.80-0.88), and 0.80 (95% CI 0.75-0.84), respectively. The median time to revision was 2 years. CONCLUSION: The 10-year revision-free survival rate for resurfacing implants was 80%. Based on the revision rates, this treatment offers a viable alternative to biological cartilage repair methods in patients aged 40 to 60 years with focal cartilage pathology. Improved patient selection could further improve the implant survival rate. Further studies are needed to investigate this treatment method.

HemiCAP Knee Implants: Mid- to Long-Term Results.

PURPOSE: The aim of the study was to investigate the long-term outcomes of the Focal Femoral Condyle Resurfacing Prosthesis (HemiCAP) using clinical and radiographic assessments, and to evaluate the revision and survival rates. METHODS: Clinical evaluation was performed in those not revised and was able to participate. This was a prospective single-center cohort study of HemiCAP patients with 7 to 10 years of clinical and radiographic follow-up. The clinical examination included the Knee Society Score (KSS) and visual analogue scale (VAS) score. The radiographic examination included the Kellgren-Lawrence (KL) grade. Survival was estimated by Kaplan-Meier survival analysis, and potential risk factors for revision was evaluated by a regression analysis. RESULTS: Of the 62 patients with 64 HemiCAP prostheses, 37 were HemiCAP condyle, 11 HemiCAP PF, and 16 HemiCAP Wave; 27 (42%) were revised-HemiCAP condyle 17 (42%), HemiCAP PF 4 (36%), HemiCAP Wave 6 (37%), and 1 died. Examinations were performed on 31 patients (86%). When compared with the preoperative data, there were significant increases in the KSS objective (mean = 51.5, standard deviation [SD] = 5.9 vs. mean =94.2, SD = 5.0) and function (mean = 51.0, SD = 6.2 vs. mean = 93.7, SD = 4.8) scores, a decrease in the VAS score (mean = 7.1, SD = 0.7 vs. mean = 2.7, SD = 1.7) and a decrease in the KL lateral score (mean = 1.1, SD = 0.3 vs. mean = 0.6, SD = 0.6). The mean follow-up was 7.3 years (SD 1.4) with minimum 4.2 years and maximum 10.2 years. No failures occurred in the series beyond 5 years. CONCLUSIONS: As hypothesized, we found good clinical and radiographic outcomes, and for those patients who did not require revisions, there were long-term improvements in disability and function. This suggests that patient selection is a key element to successfully applying these devices in clinical practice.

A longterm prospective follow-up study of resurfacing miniprosthesis suitable for patients above sixtyfive years with localized cartilage lesions or early osteoarthritis in the knee.

PURPOSE: The aim of the study was to investigate the long-term outcomes of the Focal Femoral Condyle Resurfacing Prosthesis for treatment of localized cartilage lesion in patients > 65 years. METHODS: This was a prospective case series study. Non-reopererated patients initially treated with resurfacing condylar miniprothesis (HemiCAP/UniCAP) were evaluated clinically and radiographically at 7-10 years follow-up (mean 9 years). The clinical examination included the Knee Society Score (KSS) and Visual Analogue Scale (VAS) pain score and EQ5D. The radiographic examination included the Kellgren-Lawrence (KL) grade for investigate of OA progression. A comparison analysis of the preoperative and follow-up subjective outcome data and a Kaplan-Meier implant survival analysis were performed. RESULTS: Twenty-three patients were included in the study (9 HemiCAP and 14 UniCAP). There were seven revisions (one HemiCap and six UniCap respectively) (30%) and three patients had died. Follow-up examinations were performed on 10 patients. When comparing follow-up with the preoperative state, there were significant increases in the KSS objective (50.0 ± 8.3) vs. 90.0 ± 6.3)) and KSS function (45.0 ± 11.7) vs. 85.0 ± 4.7)) scores, a decrease in the pain VAS score (7.0 ± 0.9) vs. (4.0 ± 1.9)). Radiographic evaluation demonstrated increase in osteoarthritis development with a KL medial score (2.0 ± 0.6) and KL lateral score (1.4 ± 0.6) vs. (2.0 ± 0.9)).The EQ5D-score was 86 ± 8.4 and patients Health-score was 85 ± 18). CONCLUSIONS: Resurfacing implant treatment for early OA in patients above 65 years can require revision to knee arthroplasty in 30% of patients. But in patients that are not revised long-term improvements in subjective clinical outcome was demonstrated. This suggests that even elderly patients with isolated cartilage lesions or early OA might benefit from the limited invasive resurfacing implant treatment. LEVEL OF EVIDENCE: IV.

[Severely dislocated distal physeal femur fracture in a 13-year-old girl].

In this case report, a 13-year-old girl with a distal Salter-Harris type II physeal fracture was treated by open reduction and internal fixation. She had to undergo a CT scan to establish the extent of injury prior to treatment. Distal physeal fractures of the femur are rare fractures, which often present various difficulties in the post-operative regimen. The classification and dislocation of the fracture have therapeutical and prognostic values in terms of treatment planning and growth disturbances. Follow-up after these fractures is recommended in order to detect malunion or anisomelia.

Is high body mass index a potential risk factor for poor outcome after hip arthroplasty? A cohort study of 98 patients 1 year after surgery.

The association between obesity and outcome after hip arthroplasty is controversial. We investigated whether there was an association between the preoperative body mass index in primary total hip arthroplasty patients and their quality of life and physical function 1 year after surgery. 98 patients were included in the study. The results were adjusted for age, sex, and comorbidities. The obese group had an increased risk of obtaining a worse physical score and a lower activity in daily living score at the 1-year follow-up than compared with the normal-weight group. In addition, the obese patients' hospitalization was 1 day longer than that of the normal-weight patients. However, the overweight patients accomplished the largest improvement of general health and hip-related health compared with the normal-weight group.

UniCAP offers a long term treatment for middle-aged patients, who are not revised within the first 9 years.

PURPOSE: The aim of this study was to investigate the long-term outcome of the unicompartmental knee resurfacing prosthesis (UniCAP) using clinical and radiographic assessments, and to evaluate the revision and survival rates. METHODS: This was a prospective cohort study of patients with UniCAP prostheses with 6-9 years of follow-up. The clinical examination included the Knee Society Score (KSS) and Visual Analogue Scale (VAS) score. The radiographic examination included the Kellgren-Lawrence (KL) grading scale. A comparison analysis of the clinical preoperative and follow-up data and a Kaplan-Meier survival analysis were performed. RESULTS: Of the 64 UniCAP patients, 36 (56%) were revised and one died. Examinations were performed on 23 (85%) of them. When compared with the preoperative data, the examinations showed a significant increase in the KSS objective [mean = 47.4, standard deviation (SD) = 5.8 vs. mean = 90.0, SD = 6.9] and function (mean = 46.7, SD = 6.8 vs. mean = 91.1, SD = 6.9) scores, a decrease in the VAS-score (mean = 7.3, SD = 0.5 vs. mean = 3.4, SD = 1.4) and a significant increase in the KL medial score (mean = 1.7, SD = 0.6 vs. mean = 2.1, SD = 0.5). The Kaplan-Meier survival rate after 5 years indicated good long-term outcomes. CONCLUSIONS: There was a survival rate of approximately 40% after 9 years of follow-up, but in the group of patients (35-65 years old) not eligible for a final total arthroplasty. These patients were often left with pain and disability. This implant can be a temporary or even long-term treatment because it improved the disability and function over the long-term without a major progression in the osteoarthritis, function or pain. Long term results of this mini-prosthesis have not been previously reported. LEVEL OF EVIDENCE: IV.

Bone mass development is sensitive to insulin resistance in adolescent boys.

PURPOSE: Insulin resistance may exert a negative influence on bone mass in childhood and adolescence. The objective was to assess the association between insulin resistance and total body less head (TBLH) bone mineral content (BMC) and to investigate whether body composition, physical activity or osteocalcin levels may influence this association. METHODS: A longitudinal study with follow-up over more than 6 years was performed and included 562 apparently healthy participants with a mean age of 9.6 years at baseline. Participants underwent DXA scanning at baseline. At the two follow-ups, participants had performed another DXA scanning, had blood samples taken for fasting insulin, glucose and osteocalcin and had physical activity measured with an accelerometer. HOMA-IR was calculated as an index of insulin resistance. RESULTS: HOMA-IR was negatively associated with TBLH BMC in boys at follow-ups (ß = -31.4, p < 0.001) after adjustment for maturity, height, bone area, and baseline level of TBLH BMC. The negative association remained almost unchanged after further adjustments for body composition and physical activity. No association between HOMA-IR and TBLH BMC was found in girls. CONCLUSION: Insulin resistance may be detrimental for bone development through puberty in boys independent of body composition and the level of physical activity.

Bone Mass Development in Childhood and Its Association with Physical Activity and Vitamin D Levels. The CHAMPS-Study DK.

This longitudinal study examined associations of bone mass with physical activity and vitamin D level over more than 6 years through puberty. A total of 663 participants (320 boys) with mean age 9.6 years at baseline (10-17 years at follow-up), underwent dual energy X-ray absorptiometry, anthropometry and blood samples for vitamin D at least twice during the study period (with three possible time-points). Physical activity was assessed using accelerometers at follow-up. A positive association was found between percent time spent at vigorous physical activity and total-body less head bone mineral content (ß = 5.8, p = 0.002). The magnitude of this association increased with maturational development; thus physical activity may have a greater influence on bone mass in the more mature participants. The vitamin D levels were also positively associated with bone mass. A high degree of tracking was observed with changes in anthropometric Z scores predictive of deviation from tracking. No environmental factor predicted deviation from tracking.

Treatment of full-thickness femoral cartilage lesions using condyle resurfacing prosthesis.

PURPOSE: The HemiCAP® implant for femoral resurfacing treatment of cartilage lesions was introduced in 2003. We present outcome from a prospective cohort study of 61 patients with both trochleal and condylar lesions treated with the HemiCAP® implant. METHODS: From 2007 to 2012, 61 patients were treated with femoral resurfacing using the HemiCAP implant. There were 36 femoral condyle implants and 25 trochleal implants. Indication for treatment with HemiCAP implant was symptomatic cartilage lesion at the femoral condyle demonstrated by MRI or arthroscopy, which was ICRS grade 3-4 and size less than 4 cm2. There were 24 males and 37 females with a median age of 49 (range 35-65) years. Patients were followed for 2 years with Knee Society subjective outcome scores (KSS), pain scores and radiographic evaluations and for 7 years with complications and reoperations. RESULTS: At 2-year follow-up, mean KSS was improved from 52 (6.2) to 90 (7.9), mean KSS function score was improved from 45 (7.5) to 92 (8.3), and mean Pain score improved from 7.1 (0.7) to 1.8 (1.7). Twenty-three per cent of implants were revised within 7 years to arthroplasty due to progression of cartilage lesions, progression of osteoarthritis, or increased knee pain. No difference between females and males was found for reoperation rate. CONCLUSION: The present study demonstrated improved subjective outcome and reduced pain after femoral resurfacing using the HemiCAP implant in a relatively large cohort of patients with symptomatic cartilage lesions. A concerning 23 % reoperation rate with conversion to arthroplasty was found. Femoral resurfacing implantation treatment can be a temporary treatment for cartilage lesions expected to develop into osteoarthritis and for younger patients not eligible for arthroplasty treatment. LEVEL OF EVIDENCE: IV.

High mid-term revision rate after treatment of large, full-thickness cartilage lesions and OA in the patellofemoral joint using a large inlay resurfacing prosthesis: HemiCAP-Wave®.

PURPOSE: The HemiCAP-Wave® implant for the patellofemoral resurfacing treatment of large cartilage lesions and osteoarthritis (OA) was introduced in 2009. The outcome of a prospective cohort study of 18 patients with large trochlea lesions or isolated OA treated with the HemiCAP-Wave® implant is presented with up to a 6-year survival rate, and hypothesised short-to mid-term reduced pain and improved function. METHODS: Indication for treatment with the HemiCAP-Wave® implant was a symptomatic, large cartilage lesion in trochlea demonstrated by MRI or arthroscopy, which was ICRS grades 3-4 and larger than 4 cm2. Patients were followed for 2 years with American Knee Society Subjective outcome Scores (AKSS), pain scores and radiographic evaluations and for up to 6 years with complications and reoperations. RESULTS: At the 1- and 2-year follow-up mean AKSS clinical score, the mean AKSS function score and mean pain score improved significantly. Within 6 years, 28 % of the implants were revised to arthroplasty due to the progression of cartilage lesions, osteoarthritis or increased knee pain. CONCLUSION: The present study demonstrated an improved short- to mid-term clinical outcome and reduced pain but high mid-term revision rate after patellofemoral inlay resurfacing using the HemiCAP-Wave® implant. Patellofemoral resurfacing implantation treatment with a large inlay prosthesis can offer temporary treatment for large isolated patellofemoral cartilage lesions or OA in younger patients with almost healthy cartilage in the other compartments who are not yet eligible for arthroplasty treatment. LEVEL OF EVIDENCE: IV.

Treatment of full-thickness cartilage lesions and early OA using large condyle resurfacing prosthesis: UniCAP(®).

PURPOSE: The UniCAP (®) implant for femoral resurfacing treatment of large cartilage lesions and early OA was introduced in 2006. The outcome of the present study is from a prospective cohort study of 64 patients, followed 2 years clinically and 7 years for revisions. METHODS: From 2009 to 2013, 64 patients were treated with femoral resurfacing using the UniCAP implant. Indication for treatment with UniCAP implant was symptomatic huge cartilage lesion or early OA at the femoral condyle demonstrated by MRI or arthroscopy, which was ICRS grades 3-4 and more than 4 cm(2). There were 28 males and 36 females with a median age of 51 (range 35-65) years. Patients were followed for 2 years clinically with Knee Society subjective outcome scores (KSS), pain scores and radiographic evaluations and for 7 years with complications and reoperations. RESULTS: At 2 years, the follow-up mean KSS improved from 49 (6.9) to 88 (17.1), the mean KSS function score improved from 46 (8.0) to 90 (17.1), and the mean Pain score improved from 7.4 (0.5) to 2.3 (1.4). 47 % of the implants were revised within 7 years to arthroplasty due to the progression of cartilage lesions, progressing of osteoarthritis or increased knee pain. The reoperation rate did not show any significant difference between females and males. The Kaplan-Meier survival rate was 50 % at 7 years, no difference among females and males. CONCLUSION: The present study demonstrated an improved subjective outcome and reduced pain after femoral resurfacing using the UniCAP (®) implant in a relatively large cohort of patients with symptomatic large cartilage lesions or early OA. A 47 % reoperation rate with conversion to arthroplasty was found. The femoral resurfacing implantation can be a temporary treatment for large cartilage lesions or early OA that is expected to develop into osteoarthritis. For younger patients who are ineligible for arthroplasty treatment, this implant can offer a temporary solution. LEVEL OF EVIDENCE: IV.

[Risk of nerve damage by surgery of the lateral malleolus].

Fracture of the lateral malleolus is a common injury, which often requires surgery. The lateral approach is often used with a "cut straight to bone" method. In this 59-year-old woman with an ankle fracture we found a variant of the superficial peroneal nerve (SPN) crossing the operative field with great danger of laceration. A review of the literature reveals that in more than 10% of the cases significant nerve branches may be found in the operative field. This report emphasises the need for neurological exam and recommends that great care for nerve variants should be taken during surgery on and around the lateral malleolus.

[Spontaneous bilateral quadriceps tendon rupture in obese patient medicated with statin].

Bilateral quadriceps tendon rupture (BQTR) is a rare diagnosis only reported in about 100 cases in international literature, and is often associated with medical diseases, trauma or certain medications. We present a 64-year-old man with spontaneous BQTR, diagnosed and treated at our hospital. His risk factors were obesity (BMI = 30.95 kg/m2), statin use, and recreational tennis at time of injury. The diagnosis of BQTR is difficult and is often missed initially. There is also emerging thoughts that the use of statins may be a risk factor for BQTR. The evidence, however, is scarce.

[Treatment of intracapsular femoral fractures in Denmark from 1996 to 2007]. / Udviklingen i behandlingen af intrakapsulaere femurfrakturer i Danmark 1996-2007.

INTRODUCTION: The treatment of medial collum femoris fractures (MCFF) is a topic for discussion. Recommendations favour internal fixation at all four levels of displacement (Garden type I-IV) for patients younger than 75 years. Older patients with undisplaced fractures (Garden type I-II) are being offered internal fixation, while arthroplasty is offered to patients with displaced fractures (Garden type III-IV). The aim of the present survey is to map the extent and the development in the use of the above mentioned methods in Denmark. METHODS: A questionnaire was distributed to all 39 emergency wards in Denmark. The results were compared with those of a similar survey from 1996. RESULTS: In the period 1996-2007, the number of wards treating MCFF was reduced by 50%. In 2007 only a single mixed surgery ward remained compared with 14 in 1996. Garden type I fractures were treated with internal fixation in 77% of the wards and conservatively in 8%. In 1996, 60% were offered surgery. Garden type II fractures were treated with internal fixation in all wards in 2007 as well as in 1996. Garden type III fractures were treated with internal fixation in 12% of the wards, while 81% of the wards offered age-graduated treatment. Garden type IV fractures were treated with internal fixation in one among 26 wards, 81% performs treatment according to the above standards. The period 1996 to 2007 has seen a 12-13% decrease in the number of patients with displaced MCFF who are offered age-graduated treatment. CONCLUSION: International recommendations seem to have been accepted widely in Danish orthopaedic wards. Nearly all wards currently offer age-graduated treatment.

[Long-term reflex dystrophy leading to bilateral knee exarticulation]. / Langvarig refleksdystrofi førende til bilateral knaeeksartikulation.

CRPS 1 is a chronic pain disorder with an as yet not fully understood pathophysiology. The diagnosis is clinical, and the disorder is characterised primarily by pain and skin changes. We present a patient with an aggressively spreading CRPS 1 due to a minor trauma to the right foot, which led to bilateral knee ex-articulation 11 years later. This case report demonstrates the potentially devastating effects of this disorder and the difficulties in treating it.