Weight Loss Intervention Before Total Knee Replacement: A 12-Month Randomized Controlled Trial.

BACKGROUND AND AIMS: Obesity is an increasing problem in patients after total knee replacement. The aim of this study was to investigate whether a weight loss intervention before primary total knee replacement would improve quality of life, knee function, mobility, and body composition 1 year after surgery. MATERIAL AND METHODS: Patients scheduled for total knee replacement due to osteoarthritis of the knee and obesity were randomized to a control group receiving standard care or to an intervention group receiving 8-week low-energy diet before total knee replacement. Patient-reported quality of life, 6-Min Walk Test, and body composition by dual-energy X-ray absorptiometry were assessed before intervention for the diet group, and within 1 week preoperatively for both groups, and the changes in outcome from baseline to 1 year after total knee replacement were compared between groups. The number of participants was lower than planned, which might introduce a type-2 error and underestimate the trend for a better outcome after weight loss. RESULTS: The analyses are based on a total of 76 patients, 38 in each group. This study showed major improvement in both study groups in quality of life and knee function, though no statistically significant differences between the groups were observed 1 year after total knee replacement. The average weight loss after 8-week preoperative intervention was 10.7 kg and consisted of a 6.7 kg reduction in fat mass. One year after total knee replacement, the participants in the diet group managed to maintain the weight reduction, whereas there was no change in the control group. CONCLUSION: The results suggest that it is feasible and safe to implement an intensive weight loss program shortly before total knee replacement. The preoperative intervention resulted in a 10% body weight loss, improved body composition, lower cardiovascular risk factors, and sustained s-leptin.

Tracking of bone mass from childhood to puberty: a 7-year follow-up. The CHAMPS study DK.

Bone mass in childhood is highly influenced by puberty. At the same age, bone mass was higher for pubertal than pre-pubertal children. A high level of tracking during 7 years from childhood through puberty was shown, indicating that early levels of bone mass may be important for later bone health. INTRODUCTION: Bone mass development in childhood varies by sex and age, but also by pubertal stage. The objectives of this study were to (1) describe bone mass development in childhood as it relates to pubertal onset and to (2) determine the degree of tracking from childhood to adolescence. METHODS: A longitudinal study with 7 years of follow-up was initiated in 2008 to include 831 children (407 boys) aged 8 to 17 years. Participants underwent whole body dual-energy X-ray absorptiometry (DXA) scanning, blood collection to quantify luteinizing hormone levels, and Tanner stage self-assessment three times during the 7-year follow-up. Total body less head bone mineral content, areal bone mineral density, and bone area were used to describe development in bone accrual and to examine tracking over 7 years. RESULTS: Bone mass in pubertal children is higher than that of pre-pubertal children at the same age. Analysing tracking with quintiles of bone mass Z-scores in 2008 and 2015 showed that more than 80% of participants remained in the same or neighbouring quintile over the study period. Tracking was confirmed by correlation coefficients between Z-scores at baseline and 7-year follow-up (range, 0.80-0.84). CONCLUSIONS: Bone mass is highly influenced by pubertal onset, and pubertal stage should be considered when examining children's bone health. Because bone mass indices track from childhood into puberty, children with low bone mass may be at risk of developing osteoporosis later in life.

[Long-term results following cemented total hip alloplasty in primary hip arthrosis. What to expect?]. / Langtidsresultater efter cementeret total hoftealloplastik i behandlingen af primaer hofteartrose. Hvad må man forvente?

The aim was to investigate the age-, gender- and implant related survival up to 14 years postsurgery in patients with primary hiparthrosis in one or both hips and operated in county hospitals with cemented prosthesis designs. The subjects consisted of 1,199 patients operated in the years 1981-1990, and the cohort was followed till 31.12.1994. The 1,199 patients had a total of 1,477 cemented total hipalloplastics (THA's) inserted. Two hundred and fourty-eight patients died during follow-up. Until 1990, 278 patients had had both hips operated, and a further 58 patients had the contralateral hip operated during follow-up to 31.12.1994. Fourty-nine hips were revised between four and 14 years (median: nine years) postsurgery. The cumulative survival for all THA's was 92.5%. Respective figures for the Richard Series 2 and the Charnley-prosthesis were 91.5% and 92%, now more than 14 years from the first operations. In conclusion, cemented total hip arthroplasty is a good treatment option for patients with primary hip arthrosis. Younger patients have an increased risk of revision, and alternative fixation may be considered. With an overall prosthesis-survival more than 14 years postsurgery of 92.5%, the treatment can take place at local orthopaedic departments. Our results are comparable to figures from the Swedish national register.

One-stage bilateral total hip arthroplasty a simultaneous procedure in 79 patients.

The authors retrospectively studied 79 patients who had undergone simultaneous bilateral total hip arthroplasty during the period 1982 to 1994. Forty one patients were examined clinically and radiographically at least 5 years postsurgery. The procedure was associated with few early postoperative complications and so far excellent results at 7.5 years with regard to patient satisfaction, Hip Functional Index and survival of the prostheses. It is concluded, that in selected patients with bilateral hip disease necessitating bilateral hip replacement, the bilateral operation may be advantageously carried out in one session.

[Osteonecrosis of a knee joint in a young man with IDDM]. / Osteonekrose i et knaeled hos en ung mand med IDDM.

We report a case story where IDDM was diagnosed in a young man due to late complications such as ischaemia in a toe, retinopathy and nephropathy. Due to a prior minor knee trauma he developed osteonecrosis/Charcot joint in his knee eighteen months after diagnosis of IDDM.

Treatment of intracapsular fractures of the femoral neck in Denmark: trends in indications over the past decade.

A questionnaire survey was set up in Denmark in 1996 including 40 orthopedic departments and 20 departments of general surgery, all dealing with the treatment of intracapsular fractures of the femoral neck. The aim of the survey was to investigate whether the treatment of these complex fractures in Denmark followed the international standard, the "gold standard", recommended in the recent international literature. A shift in the treatment was noted, as compared with an earlier questionnaire survey in 1988, with more orthopedic departments performing a graduated treatment with respect to the age of the patients and fracture grade (Garden class). That is: a) nondisplaced fractures, b) displaced fractures (b.1 below 75 years and b.2 above 75 years). Cannulated screws/pins were more commonly used in Garden I and II fractures (non displaced fractures) and in Garden III and IV fractures (displaced fractures) in patients below 75 years. Hemiarthroplasty/arthroplasty were more commonly used in the older age group, above 75 years, in displaced fractures (Garden III-IV). It is concluded that a shift in the treatment of these fractures has occurred, especially in orthopedic departments. One reason for this may be an increasing number of orthopedic specialists with experience in arthroplastic surgery, making it possible to perform and/or supervise younger surgeons in this procedure. Another reason must be an increasing awareness among orthopedic specialists in Denmark that complication rates in osteosynthesis of the displaced fractures (Garden III-IV) have been too high.

The Richards Series 2 total hip prosthesis: a 13-year study and radiographic evaluation.

This retrospective long-term study analyzes the clinical function, failures, and radiographic status of 131 Richards Series 2 prostheses in total hip arthroplasties (THAs) performed during 1981 and 1982. After a minimum follow-up period of 11 years, the results were evaluated. Sixty two (54%) patients with 71 THAs were available for follow-up; 44 (38%) patients with 49 THAs had died. Three patients with three THAs were lost to follow-up, and seven patients with eight THAs were unable to participate in the examination due to causes not related to their present hip status. Ten patients underwent revision THA during the observation period. The median hip functional index (HFI) was 8.6 preoperatively and 15.8 at follow-up. Hip functional index correlated to radiographic signs of loosening. With revision as endpoint, the Kaplan-Meier survivorship for all 131 hips was 93% after 10 years and 91% after 12 years. The radiographic examination at follow-up revealed 5 (8%) definite loose cups and 12 (19%) definite loose stems. Including the number of aseptic loosened cups and stems confirmed at revision, aseptic loosening was found in 6% of all cups and 13% of all stems. This radiographic evaluation confirmed that lack of containment of the cup and varus position of the stem were factors influencing the long-term stability of the prostheses, whereas etiology, type of arthritis, and ectopic ossification did not. A fixation and stability score that was modified for cemented prostheses was developed and was of value in detecting the prostheses at risk. The long-term results of the Richards Series 2 THA are acceptable and comparable with other long-term studies on conventional prosthetic designs. Ten percent to 20% revision THAs due to aseptic loosening can be expected. In addition, patients younger than age 60 at surgery and especially men were found to belong to a high-risk group with regard to revision THA. These patients must be evaluated carefully so that revision THA can be performed before the bone bed is destroyed.

[Simultaneous bilateral rupture of the quadriceps tendon]. / Simultan bilateral quadriceps seneruptur.

Bilateral rupture of the quadriceps tendon is a rare injury. It usually occurs in obese older patients. Other predisposing factors are long-term chronic renal failure, gout, rheumatoid arthritis, diabetes mellitus, hyperparathyroidism and abuse of anabolic steroids. The most common cause of bilateral rupture is a sudden violent contraction of the quadriceps muscles with the knees semiflexed and the feet fixed. Examination reveals bilateral joint effusion, palpable or visible suprapatellar gaps, and an inability to extend both knees and lift the straight legs. Often the diagnosis is missed, and diagnostic confusion with other causes of inability to use the legs happens. We report one case of simultaneous bilateral rupture where treatment was delayed for several weeks because of diagnostic confusion.

Need for bilateral arthroplasty for coxarthrosis. 1,477 replacements in 1,199 patients followed for 0-14 years.

During the 10-year period 1981-1990, 1,199 patients in the county of South Jutland, Denmark, had 1,477 primary total hip arthroplasties (THA) performed because of primary arthrosis (OA). The patients were followed until the end of 1994, with a mean follow-up of 5.6 (0-14) years. Bilateral operations were performed on 356 patients, whereas 248 patients had died with only 1 THA. The cumulated risk of replacement of the contralateral hip was approximately 0.15 1 year after replacement of the first hip, 0.20 after 2 years, 0.29 after 5 years and 0.47 after 10 years, respectively. During the follow-up period, the demand for a THA of the contralateral hip continued to be approximately 15 times higher than in the general population.

[Single-session bilateral hip alloplasty. A simultaneous procedure in 79 patients]. / Bilateral hoftealloplastik i én seance. En simultan procedure hos 79 patienter.

The aim of the study was to evaluate the per- and postoperative complications in 79 consecutively operated selected patients with bilateral hip disease who had bilateral hip replacements performed in one session. It was carried out as a retrospective examination of the case records, a questionnaire and clinical and radiological follow-up of 41 patients after a median of 7.5 years. No serious complications were registered peroperatively, and the duration of anaesthesia was on average three and a half hours. Eight patients were treated for early postoperative complications. The average hospitalization time was 15 days. Forty-one patients were followed up at a minimum of five years postoperatively. All patients were fully satisfied with the result, and there had been no cases of dislocation or reoperation. The average hip function index had been 7.2 preoperatively, and was at follow-up found to be 16.7. Radiological examination showed signs of looseness in 12 of the 82 examined hips. It is concluded that in selected patients with bilateral hip disease necessitating bilateral hip replacement the two operations may with benefit be carried out in one session.

[Cemented hip alloplasty. 11-13-year follow-up study of the Richards' series 2 hip prostheses]. / Cementeret hoftealloplastik. 11-13 års efterundersøogelse af Richards serie 2 hofteprotese.

The study comprises a follow-up (11-13 years) of an orthopaedic department's first 131 consecutive cemented total hip arthroplasties (THA). All operations were performed with Richards' Series 2. Posterior approach, plug, lavage, cementation with cement pistol, antibiotics and low-dose heparin. At the time of follow-up 44 patients (38%) were dead (= 49 THA), and 56 patients representing 65 THA (50%) were available for the follow-up, on average 11.95 years (11-13 years) after the operation. The patients hip/hips were examined as regards a) pain b) walking ability and c) hip-mobility (M. d'Aubigné) (HFI). A frontal x-ray of the pelvis and hip/hips was taken. The examining surgeon evaluated the hip/hips based on a clinical examination and the x-ray as 1 = stable, 2 = perhaps loose, 3 = most likely loose and 4 = definitely loose both with regard to the acetabular and femoral component. Pre-operatively 78% of the patients had an ideopathic coxarthrosis. Eight patients had considerable postoperative complications. Ten patients (7.8%) were reoperated during the examination period: two due to loosening of the total prosthesis, one due to loosening of the cup, three due to loosenings of the femoral component, two because of recurring luxations, one late (deep) infection and one fracture of the femur near the prosthesis. Preoperatively the patients' HFI was at 8.6, at follow-up 15.8. The clinical and the radiographic examination showed that 86% of the acetabular cups and 63% of the femoral components were fixed solidly.(ABSTRACT TRUNCATED AT 250 WORDS)

[Continuous subcutaneous morphine to patients with terminal cancer. Analgesia at home]. / Kontinuerlig subkutan morfin til terminale cancerpatienter. Smertebehandling i hjemmet.

Since 1992 it has been possible for cancer patients in the county of Southern Jutland to receive terminal care in their own homes. An essential part of this management is effective pain relief; more than 60% of cancer patients have chronic pain. In cases where oral medication or epidural administration of morphine is insufficient or complicated by side-effects continuous subcutaneous morphine administration may be suitable. The patient may be treated in this latter manner for long periods of time. A case story is described where a cancer patient was treated with continuous subcutaneous morphine in his home for more than 257 days without complications or major side-effects.

[Femoral fractures close to the hip--an epidemiological study in the county of Southern Jutland]. / Hoftenaere femurfrakturer--en epidemiologisk undersøgelse i Sønderjyllands Amt.

During the period 1986-1991 a total of 3159 patients with diagnosis of either subcapital, intertrochanteric or subtrochanteric fracture were registered in the County of Southern Jutland in order to make a prognosis for the next twenty years. Contrary to other investigations an exponential increase in fractures was not seen, but only an increase related to the rising number of elderly people in the population.