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1.
Scand J Rheumatol ; 47(4): 282-290, 2018 07.
Artículo en Inglés | MEDLINE | ID: mdl-29447542

RESUMEN

OBJECTIVES: To investigate how patient characteristics, time of diagnosis, and treatment affect the need for orthopaedic surgery in patients with rheumatoid arthritis (RA). METHOD: We reviewed the medical history of 1544 patients diagnosed with RA at Haukeland University Hospital in Bergen, Norway, from 1972 to 2009, of whom 1010 (mean age 57 years, 69% women) were included in the present study. Relevant orthopaedic procedures were obtained from the Norwegian Arthoplasty Register and the hospital's administrative patient records. In total, 693 procedures (joint synovectomies 22%, arthrodeses 21%, prostheses 41%, and forefoot procedures 12%) were performed in 315 patients. Survival analyses were completed to evaluate the impact of different factors such as age, gender, radiographic changes, and year of diagnosis, on the risk of undergoing surgery. RESULTS: Patients diagnosed in 1972-1985 and 1986-1998 had a relative risk of undergoing surgery of 2.4 and 2.2 (p < 0.001), respectively, compared to patients diagnosed in 1999-2009. Radiographic changes at diagnosis and female gender were also significant risk factors. Anti-rheumatic medication was significantly different in the three time periods. CONCLUSION: Patients with a diagnosis in the early years had a greatly increased risk of having orthopaedic surgery performed. This is probably due to the year of diagnosis being a proxy for the type and intensity of medical treatment.


Asunto(s)
Artritis Reumatoide/cirugía , Artrodesis/estadística & datos numéricos , Artroplastia de Reemplazo/estadística & datos numéricos , Antepié Humano/cirugía , Sinovectomía/estadística & datos numéricos , Adulto , Anciano , Antirreumáticos/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Artritis Reumatoide/inmunología , Artrodesis/tendencias , Artroplastia de Reemplazo/tendencias , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Análisis Multivariante , Noruega , Procedimientos Ortopédicos/estadística & datos numéricos , Procedimientos Ortopédicos/tendencias , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factor Reumatoide/inmunología , Factores de Riesgo , Sinovectomía/tendencias , Factores de Tiempo
2.
Osteoarthritis Cartilage ; 25(6): 878-884, 2017 06.
Artículo en Inglés | MEDLINE | ID: mdl-27986619

RESUMEN

OBJECTIVE: To explore and quantify the relative strengths of the genetic contribution vs the contribution of modifiable environmental factors to severe osteoarthritis (OA) having progressed to total joint arthroplasty. DESIGN: Incident data from the Norwegian Arthroplasty Registry were linked with the Norwegian Twin Registry on the National ID-number in 2014 in a population-based prospective cohort study of same-sex twins born 1915-60 (53.4% females). Education level and height/weight were self-reported and Body Mass Index (BMI) calculated. The total follow-up time was 27 years for hip arthroplasty (1987-2014, 424,914 person-years) and 20 years for knee arthroplasty (1994-2014, 306,207 person-years). We estimated concordances and the genetic contribution to arthroplasty due to OA in separate analyses for the hip and knee joint. RESULTS: The population comprised N = 9058 twin pairs (N = 3803 monozygotic (MZ), N = 5226 dizygotic (DZ)). In total, 73% (95% confidence intervals (CI) = 66-78%) and 45% (95% CI = 30-58%) of the respective variation in hip and knee arthroplasty could be explained by genetic factors. Zygosity (as a proxy for genetic factors) was associated with hip arthroplasty concordance over time when adjusted for sex, age, education and BMI (HR = 2.98, 95% CI = 1.90-4.67 for MZ compared to DZ twins). Knee arthroplasty was to a greater extent dependent on BMI when adjusted for zygosity and the other covariates (HR = 1.15, 95% CI = 1.02-1.29). CONCLUSION: Hip arthroplasty was strongly influenced by genetic factors whereas knee arthroplasty to a greater extent depended on a high BMI. The study may imply there is a greater potential for preventing progression of knee OA to arthroplasty in comparison with hip OA.


Asunto(s)
Enfermedades en Gemelos/cirugía , Osteoartritis de la Cadera/cirugía , Osteoartritis de la Rodilla/cirugía , Sistema de Registros , Adulto , Cuidados Posteriores , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Artroplastia de Reemplazo de Rodilla/estadística & datos numéricos , Estudios de Cohortes , Enfermedades en Gemelos/genética , Femenino , Humanos , Almacenamiento y Recuperación de la Información , Masculino , Persona de Mediana Edad , Noruega , Osteoartritis de la Cadera/genética , Osteoartritis de la Rodilla/genética , Estudios Prospectivos , Gemelos Dicigóticos , Gemelos Monocigóticos
3.
Osteoarthritis Cartilage ; 25(10): 1654-1662, 2017 10.
Artículo en Inglés | MEDLINE | ID: mdl-28705605

RESUMEN

OBJECTIVE: To investigate whether parity, age at menarche, menopausal status, age at menopause, use of oral contraceptives (OC) or use of hormone replacement therapy (HRT) were associated with total knee replacement (TKR) or total hip replacement (THR) due to primary osteoarthritis. METHOD: In a prospective cohort study of 30,289 women from the second and third surveys of the Nord-Trøndelag Health Study, data were linked to the Norwegian Arthroplasty Register (NAR) in order to identify TKR or THR due to primary osteoarthritis. Cox proportional hazards models were used to estimate the hazard ratios (HRs). RESULTS: We observed 430 TKRs and 675 THRs during a mean follow-up time of 8.3 years. Increasing age at menarche was inversely associated with the risk of TKR (P-trend < 0.001). Past users and users of systemic HRT were at higher risk of TKR compared to never users (HR 1.42 (95% confidence interval (CI) 1.06-1.90) and HR 1.40 (95% CI 1.03-1.90), respectively). No association was found between parity, age at menarche, menopausal status, age at menopause, oral contraceptive use or HRT use and THR. CONCLUSION: We found that increasing age at menarche reduced the risk of TKR. Past users and users of systemic HRT were at higher risk of TKR compared to never users. Parity did not increase the risk of THR or TKR.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/estadística & datos numéricos , Menarquia , Osteoartritis de la Rodilla/cirugía , Factores de Edad , Artroplastia de Reemplazo de Cadera , Anticonceptivos Orales/administración & dosificación , Utilización de Medicamentos/estadística & datos numéricos , Terapia de Reemplazo de Estrógeno/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Humanos , Menopausia , Persona de Mediana Edad , Noruega , Osteoartritis de la Cadera/cirugía , Paridad , Estudios Prospectivos , Sistema de Registros , Historia Reproductiva , Factores de Riesgo
4.
Osteoarthritis Cartilage ; 25(4): 455-461, 2017 04.
Artículo en Inglés | MEDLINE | ID: mdl-27856293

RESUMEN

OBJECTIVE: To estimate and compare the lifetime risk of total knee replacement surgery (TKR) for osteoarthritis (OA) between countries, and over time. METHOD: Data on primary TKR procedures performed for OA in 2003 and 2013 were extracted from national arthroplasty registries in Australia, Denmark, Finland, Norway and Sweden. Life tables and population data were also obtained for each country. Lifetime risk of TKR was calculated for 2003 and 2013 using registry, life table and population data. RESULTS: Marked international variation in lifetime risk of TKR was evident, with females consistently demonstrating the greatest risk. In 2013, Finland had the highest lifetime risk for females (22.8%, 95%CI 22.5-23.1%) and Australia had the highest risk for males (15.4%, 95%CI 15.1-15.6%). Norway had the lowest lifetime risk for females (9.7%, 95%CI 9.5-9.9%) and males (5.8%, 95%CI 5.6-5.9%) in 2013. All countries showed a significant rise in lifetime risk of TKR for both sexes over the 10-year study period, with the largest increases observed in Australia (females: from 13.6% to 21.1%; males: from 9.8% to 15.4%). CONCLUSIONS: Using population-based data, this study identified significant increases in the lifetime risk of TKR in all five countries from 2003 to 2013. Lifetime risk of TKR was as high as 1 in 5 women in Finland, and 1 in 7 males in Australia. These risk estimates quantify the healthcare resource burden of knee OA at the population level, providing an important resource for public health policy development and healthcare planning.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/tendencias , Osteoartritis de la Rodilla/cirugía , Adulto , Anciano , Australia , Dinamarca , Femenino , Finlandia , Humanos , Masculino , Persona de Mediana Edad , Noruega , Estudios Retrospectivos , Riesgo , Factores Sexuales , Suecia
5.
Osteoarthritis Cartilage ; 25(6): 817-823, 2017 06.
Artículo en Inglés | MEDLINE | ID: mdl-28049019

RESUMEN

OBJECTIVE: Smoking has been associated with a reduced risk of hip and knee osteoarthritis (OA) and subsequent joint replacement. The aim of the present study was to assess whether the observed association is likely to be causal. METHOD: 55,745 participants of a population-based cohort were genotyped for the rs1051730 C > T single-nucleotide polymorphism (SNP), a proxy for smoking quantity among smokers. A Mendelian randomization analysis was performed using rs1051730 as an instrument to evaluate the causal role of smoking on the risk of hip or knee replacement (combined as total joint replacement (TJR)). Association between rs1051730 T alleles and TJR was estimated by hazard ratios (HRs) and 95% confidence intervals (CIs). All analyses were adjusted for age and sex. RESULTS: Smoking quantity (no. of cigarettes) was inversely associated with TJR (HR 0.97, 95% CI 0.97-0.98). In the Mendelian randomization analysis, rs1051730 T alleles were associated with reduced risk of TJR among current smokers (HR 0.84, 95% CI 0.76-0.98, per T allele), however we found no evidence of association among former (HR 0.97, 95% CI 0.88-1.07) and never smokers (HR 0.97, 95% CI 0.89-1.06). Neither adjusting for body mass index (BMI), cardiovascular disease (CVD) nor accounting for the competing risk of mortality substantially changed the results. CONCLUSION: This study suggests that smoking may be causally associated with the reduced risk of TJR. Our findings add support to the inverse association found in previous observational studies. More research is needed to further elucidate the underlying mechanisms of this causal association.


Asunto(s)
Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Artroplastia de Reemplazo de Rodilla/estadística & datos numéricos , Osteoartritis de la Cadera/cirugía , Osteoartritis de la Rodilla/cirugía , Fumar/epidemiología , Causalidad , Femenino , Humanos , Modelos Logísticos , Masculino , Análisis de la Aleatorización Mendeliana , Persona de Mediana Edad , Familia de Multigenes , Proteínas del Tejido Nervioso/genética , Oportunidad Relativa , Polimorfismo de Nucleótido Simple , Modelos de Riesgos Proporcionales , Receptores Nicotínicos/genética , Riesgo , Fumar/genética
6.
Osteoarthritis Cartilage ; 24(3): 419-26, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26432511

RESUMEN

OBJECTIVE: Outcome after total hip arthroplasty (THA) depends on several factors related to the patient, the surgeon and the implant. It has been suggested that the annual number of procedures per hospital affects the prognosis. We aimed to examine if hospital procedure volume was associated with the risk of revision after primary THA in the Nordic countries from 1995 to 2011. DESIGN: The Nordic Arthroplasty Register Association database provided information about primary THA, revision and annual hospital volume. Hospitals were divided into five volume groups (1-50, 51-100, 101-200, 201-300, >300). The outcome of interest was risk of revision 1, 2, 5, 10 and 15 years after primary THA. Multivariable regression was used to assess the relative risk (RR) of revision. RESULTS: 417,687 THAs were included. For the 263,176 cemented THAs no differences were seen 1 year after primary procedure. At 2, 5, 10 and 15 years the four largest hospital volume groups had a reduced risk of revision compared to group 1-50. After 10 years RR was for volume group 51-100 0.79 (CI 0.65-0.95), group 101-200 0.76 (CI 0.61-0.95), group 201-300 0.74 (CI 0.57-0.96) and group >300 0.57 (CI 0.46-0.71). For the uncemented THAs an association between hospital volume and risk of revision were only present for hospitals producing 201-300 THAs per year, beginning at years 2 through 5 and in all subsequent time intervals to 15 years. CONCLUSION: Hospital procedure volume was associated with a long term risk of revision after primary cemented THA. Hospitals operating 50 procedures or less per year had an increased risk of revision after 2, 5, 10 and 15 years follow up.


Asunto(s)
Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Reoperación/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Cementación , Niño , Bases de Datos Factuales , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/cirugía , Falla de Prótesis , Sistema de Registros , Factores de Riesgo , Países Escandinavos y Nórdicos , Carga de Trabajo/estadística & datos numéricos , Adulto Joven
7.
Scand J Rheumatol ; 45(1): 1-7, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26303149

RESUMEN

OBJECTIVES: The disease course of patients with rheumatoid arthritis (RA) has become milder in recent years. In this study we investigated the incidence of orthopaedic surgery in patients with RA. METHOD: From the Norwegian Arthroplasty Register we selected joint replacement procedures conducted during the years 1994-2012 (n = 11 337), and from the Norwegian Patient Register we obtained data on synovectomies (n = 4782) and arthrodeses (n = 6022) during 1997-2012. Using Poisson regression we analysed the time trends in the incidence of procedures performed. RESULTS: There was a significant decrease in the incidence of arthroplasty surgery (coefficient of -0.050 per year) and synovectomies (coefficient of -0.10) and a declining trend of arthrodeses in patients with RA in the study periods. The greatest reduction was found in procedures involving the wrist and hand. CONCLUSIONS: We found a decrease in orthopaedic surgery in patients with RA that continued into the biologic era and throughout the study period. The general increasing trend in the use of synthetic and biological disease-modifying anti-rheumatic drugs (DMARDs) thus coincides with less joint destruction and an improved long-term prognosis of patients with RA.

8.
Osteoarthritis Cartilage ; 22(5): 652-8, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-24632294

RESUMEN

OBJECTIVE: To study the association between weight gain and the risk of knee replacement (KR) due to primary osteoarthritis (OA), and to evaluate whether the association differs by age. DESIGN: 225,908 individuals from national health screenings with repeated measurements of height and weight were followed prospectively with respect to KR identified by linkage to the Norwegian Arthroplasty Register. Cox proportional hazard regression was used to calculate sex-specific relative risks (RR) of KR according to change in Body Mass Index (BMI) and weight, corresponding analyses were done for age categories at first screening. RESULTS: During 12 years of follow up, 1591 participants received a KR due to primary OA. Men in the highest quarter of yearly change in BMI had a RR of 1.5 (95% confidence interval (CI) 1.1-1.9) of having a KR compared to those in the lowest quarter. For women the corresponding RR was 2.4 (95% CI 2.1-2.7). Men under the age of 20 at the first screening had a 26% increased risk for KR per 5 kg weight gain, for women the corresponding increase was 43%. At older age the association became weaker, and in the oldest it was lost. CONCLUSIONS: Weight gain increases the risk for later KR both in men and women. The impact of weight gain is strongest in the young, at older age the association is weak or absent. Our study suggests that future OA may be prevented by weight control and that preventive measures should start at an early age.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/estadística & datos numéricos , Obesidad/complicaciones , Osteoartritis de la Rodilla/etiología , Osteoartritis de la Rodilla/cirugía , Aumento de Peso/fisiología , Adolescente , Adulto , Factores de Edad , Índice de Masa Corporal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Noruega/epidemiología , Obesidad/epidemiología , Obesidad/fisiopatología , Osteoartritis de la Rodilla/epidemiología , Osteoartritis de la Rodilla/fisiopatología , Estudios Prospectivos , Medición de Riesgo/métodos , Factores Sexuales , Adulto Joven
9.
Osteoarthritis Cartilage ; 22(5): 659-67, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-24631923

RESUMEN

OBJECTIVES: To evaluate implant survival following primary total hip replacement (THR) in younger patients. To describe the diversity in use of cup-stem implant combinations. DESIGN: 29,558 primary THRs osteoarthritis (OA) patients younger than 55 years of age performed from 1995 through 2011 were identified using the Nordic Arthroplasty Registry Association database. We estimated adjusted relative risk (aRR) of revision with 95% confidence interval (CI) using Cox regression. RESULTS: In general, no difference was observed between uncemented and cemented implants in terms of risk of any revision. Hybrid implants were associated with higher risk of any revision (aRR = 1.3, CI: 1.1-1.5). Uncemented implants led to a reduced risk of revision due to aseptic loosening (aRR = 0.5, CI: 0.5-0.6), whereas the risk was similar for hybrid and cemented implants. Compared with cemented implants, both uncemented and hybrid implants led to elevated risk of revision due to other causes, as well as elevated risk of revision due to any reason within 2 years. 183 different uncemented cup-stem implant combinations were registered in Denmark, of these, 172 were used in less than 100 operations which is similar to Norway, Sweden and Finland. CONCLUSIONS: Uncemented implants perform better in relation to long-term risk of aseptic loosening, whereas both uncemented and hybrid rather than cemented implants in patients younger than 55 years had more short-term revisions because problems due to dislocation, periprosthetic fracture and infection has not yet been completely solved. The vast majority of cup-stem combinations were used in very few operations.


Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Prótesis de Cadera , Osteoartritis de la Cadera/cirugía , Falla de Prótesis/etiología , Adulto , Factores de Edad , Artroplastia de Reemplazo de Cadera/instrumentación , Cementación , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Sistema de Registros , Reoperación/estadística & datos numéricos , Factores de Riesgo , Países Escandinavos y Nórdicos
10.
Osteoarthritis Cartilage ; 21(3): 405-12, 2013 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-23274101

RESUMEN

OBJECTIVE: The incidence of joint replacements is considered an indicator of symptomatic end-stage osteoarthritis (OA). We analysed data from two national joint replacement registries in order to investigate whether evidence of a pattern of progression of end-stage hip and knee OA could be found in data from large unselected populations. DESIGN: We obtained data on 78,634 hip and 122,096 knee arthroplasties from the Australian Orthopaedic Association National Joint Replacement Registry and 19,786 hip and 12,082 knee arthroplasties from the Norwegian Arthroplasty Register. A multi-state model was developed where individuals were followed from their first recorded hip or knee arthroplasty for OA to receiving subsequent hip and/or knee arthroplasties. We used this model to estimate relative hazard rates and probabilities for each registry separately. RESULTS: The hazard rates of receiving subsequent arthroplasties in non-cognate joints were higher on the contralateral side than on the ipsilateral side to the index arthroplasty, especially if the index was a hip arthroplasty. After 5 years, the estimated probabilities of having received a knee contralateral to the index hip were more than 1.7 times the probabilities of having received a knee ipsilateral to the index hip. CONCLUSION: The results indicate that there is an association between the side of the first hip arthroplasty and side of subsequent knee arthroplasties. Further studies are needed to investigate whether increased risk of receiving an arthroplasty in the contralateral knee is related to having a hip arthroplasty and/or preoperative factors such as pain and altered gait associated with hip OA.


Asunto(s)
Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Artroplastia de Reemplazo de Rodilla/estadística & datos numéricos , Modelos Estadísticos , Osteoartritis de la Cadera/epidemiología , Osteoartritis de la Rodilla/epidemiología , Anciano , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Australia/epidemiología , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Noruega/epidemiología , Osteoartritis de la Cadera/complicaciones , Osteoartritis de la Cadera/cirugía , Osteoartritis de la Rodilla/complicaciones , Osteoartritis de la Rodilla/cirugía , Sistema de Registros
12.
J Hosp Infect ; 105(2): 216-224, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32289383

RESUMEN

BACKGROUND: The air in the operating room is considered a risk factor for surgical site infection (SSI) due to airborne bacteria shed from the surgical staff or from patients themselves. AIM: To assess the influence of validated operating room (OR) ventilation data on the risk of revision surgery due to deep infection after primary total hip arthroplasty (THA) reported to the Norwegian Arthroplasty Register (NAR). METHODS: Forty orthopaedic units reporting THAs to the NAR during the period 2005-2015 were included. The true type of OR ventilation in all hospitals at the time of primary THA was confirmed in a previous study. Unidirectional airflow (UDF) systems were subdivided into: small, low-volume, unidirectional vertical flow (lvUDVF) systems; large, high-volume, unidirectional vertical flow (hvUDVF) systems; and unidirectional horizontal flow (UDHF) systems. These three ventilation groups were compared with conventional, turbulent, mixing ventilation (CV). The association between the end-point, time to revision due to infection, and OR ventilation was estimated by calculating relative risks (RRs) in a multivariate Cox regression model, with adjustments for several patient- and surgery-related covariates. FINDINGS: A total of 51,292 primary THAs were eligible for assessment. Of these, 575 had been revised due to infection. A similar risk of revision due to infection after THA performed was found in ORs with lvUDVF and UDHF compared to CV. THAs performed in ORs with hvUDVF had lower risk of revision due to infection compared to CV (RR = 0.8; 95% CI: 0.6-0.9; P = 0.01). CONCLUSION: THAs performed in ORs with hvUDVF systems had lower risk of revision due to infection compared to THAs performed in ORs with CV systems. The perception that all UDF systems are similar and possibly harmful seems erroneous.


Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Quirófanos/normas , Reoperación/efectos adversos , Infección de la Herida Quirúrgica/etiología , Ventilación/normas , Adulto , Anciano , Anciano de 80 o más Años , Microbiología del Aire , Femenino , Humanos , Masculino , Persona de Mediana Edad , Noruega , Infecciones Relacionadas con Prótesis/etiología , Infecciones Relacionadas con Prótesis/prevención & control , Sistema de Registros , Factores de Riesgo
13.
Bone Joint J ; 100-B(12): 1565-1571, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30499310

RESUMEN

AIMS: The aim of this large registry-based study was to compare mid-term survival rates of cemented femoral stems of different designs used in hemiarthroplasty for a fracture of the femoral neck. PATIENTS AND METHODS: From the Norwegian Hip Fracture Register (NHFR), 20 532 primary cemented bipolar hemiarthroplasties, which were undertaken in patients aged > 70 years with a femoral neck fracture between 2005 and 2016, were included. Polished tapered stems (n = 12 065) (Exeter and CPT), straight stems (n = 5545) (Charnley, Charnley Modular, and Spectron EF), and anatomical stems (n = 2922) (Lubinus SP2) were included. The survival of the implant with any reoperation as the endpoint was calculated using the Kaplan-Meier method and hazard ratios (HRs), and the different indications for reoperation were calculated using Cox regression analysis. RESULTS: The one-year survival was 96.0% (95% confidence interval (CI) 95.6 to 96.4) for the Exeter stem, 97.0% (95% CI 96.4 to 97.6) for the Lubinus SP2 stem, 97.6% (95% CI 97.0 to 98.2) for the Charnley stem, 98.1% (95% CI 97.3 to 98.9) for the Spectron EF stem, and 96.4% (95% CI 95.6 to 97.2) for the Charnley Modular stem, respectively. The hazard ratio for reoperation after one year was lower for Lubinus SP2 (HR 0.77, 95% CI 0.60 to 0.97), Charnley (HR 0.64, 95% CI 0.48 to 0.86), and Spectron EF stems (HR 0.44, 95% CI 0.29 to 0.67) compared with the Exeter stem. Reoperation for periprosthetic fracture occurred almost exclusively after the use of polished tapered stems. CONCLUSION: We were able to confirm that implant survival after cemented hemiarthroplasty for a hip fracture is high. Differences in rates of reoperation seem to favour anatomical and straight stems compared with polished tapered stems, which had a higher risk of periprosthetic fracture.


Asunto(s)
Cementos para Huesos , Hemiartroplastia/efectos adversos , Fracturas de Cadera/cirugía , Fracturas Periprotésicas/cirugía , Complicaciones Posoperatorias/cirugía , Sistema de Registros , Reoperación/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Fracturas de Cadera/diagnóstico , Prótesis de Cadera , Humanos , Incidencia , Masculino , Noruega/epidemiología , Fracturas Periprotésicas/epidemiología , Fracturas Periprotésicas/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Diseño de Prótesis , Factores de Riesgo , Resultado del Tratamiento
14.
J Bone Joint Surg Am ; 89(3): 519-25, 2007 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-17332100

RESUMEN

BACKGROUND: Concern exists regarding the durability of unicompartmental knee replacements. The purpose of the present study was to compare the early failure rates and failure mechanisms of primary cemented unicompartmental knee replacements with those of primary cemented tricompartmental total knee replacements. METHODS: The rates of failure of primary cemented unicompartmental knee replacements (n = 2288) and tricompartmental total knee replacements (n = 3032) as reported to the Norwegian Arthroplasty Register from January 1994 through December 2004 were compared with use of Kaplan-Meier estimated survival rates and Cox multiple regression. RESULTS: The ten-year survival probability was 80.1% (95% confidence interval, 76.0% to 84.2%) for unicompartmental knee replacements, compared with 92.0% (95% confidence interval, 90.4 to 93.6%) for total knee replacements, with a relative risk of revision of 2.0 (95% confidence interval, 1.6 to 2.5) (p < 0.001). This increased risk of revision following unicompartmental knee replacement was seen in all age-categories. Unicompartmental knee replacement was associated with an increased risk of revision due to pain (relative risk, 11.3 [95% confidence interval, 4.8 to 26.8]; p < 0.001), aseptic loosening of the tibial component (relative risk, 1.9 [95% confidence interval, 1.2 to 3.0]; p = 0.01) and of the femoral component (relative risk, 4.8 [95% confidence interval, 2.3 to 10.3]; p < 0.001), and periprosthetic fracture (relative risk, 3.2 [95% confidence interval, 1.2 to 8.9]; p = 0.02) as compared with total knee replacement. Unicompartmental knee replacement was associated with a lower risk of infection compared with total knee replacement (relative risk, 0.28 [95% confidence interval, 0.10 to 0.74]; p = 0.01). CONCLUSIONS: The survival of cemented unicompartmental knee replacements is inferior to that of cemented tricompartmental total knee replacements in all age-categories.


Asunto(s)
Cementos para Huesos , Prótesis de la Rodilla , Falla de Prótesis , Reoperación/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Rodilla/métodos , Artroplastia de Reemplazo de Rodilla/estadística & datos numéricos , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Persona de Mediana Edad , Noruega , Complicaciones Posoperatorias/epidemiología , Modelos de Riesgos Proporcionales , Diseño de Prótesis , Insuficiencia del Tratamiento
15.
J Bone Joint Surg Br ; 89(12): 1574-80, 2007 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-18057355

RESUMEN

Primary uncemented femoral stems reported to the Norwegian arthroplasty register between 1987 and 2005 were included in this prospective observational study. There were 11 516 hips (9679 patients) and 14 different designs of stem. Kaplan-Meier survival probabilities and Cox regression were used to analyse the data. With aseptic loosening as the end-point, all currently used designs performed excellently with survival of 96% to 100% at ten years. With the end-point as stem revision for any cause, the long-term results of the different designs varied from poor to excellent, with survival at 15 years ranging between 29% and 97%. Follow-up for longer than seven years was needed to identify some of the poorly-performing designs. There were differences between the stems; the Corail, used in 5456 hips, was the most frequently used stem with a survival of 97% at 15 years. Male gender was associated with an increased risk of revision of x 1.3 (95% confidence interval 1.05 to 1.52), but age and diagnosis had no influence on the results. Overall, modern uncemented femoral stems performed well. Moderate differences in survival between well-performing stems should be interpreted with caution since the differences may be caused by factors other than the stem itself.


Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Prótesis de Cadera , Cementos para Huesos , Cementación , Femenino , Fémur/cirugía , Humanos , Masculino , Persona de Mediana Edad , Noruega , Estudios Prospectivos , Diseño de Prótesis , Falla de Prótesis , Sistema de Registros , Factores Sexuales , Análisis de Supervivencia , Resultado del Tratamiento
16.
J Bone Joint Surg Br ; 89(5): 591-4, 2007 May.
Artículo en Inglés | MEDLINE | ID: mdl-17540741

RESUMEN

We analysed the results of different strategies in the revision of primary uncemented acetabular components reported to the Norwegian Arthroplasty Register. The aim was to compare the risk of further acetabular revision after isolated liner exchange and complete component revision. The results of exchanging well-fixed components were also compared with those of exchanging loose acetabular components. The period studied was between September 1987 and April 2005. The following groups were compared: group 1, exchange of liner only in 318 hips; group 2, exchange of well-fixed components in 398; and group 3, exchange of loose components in 933. We found that the risk of a further cup revision was lower after revision of well-fixed components (relative risk from a Cox model (RR) = 0.56, 95% confidence interval 0.37% to 0.87%) and loose components (RR = 0.56, 95% confidence interval 0.39% to 0.80%), compared with exchange of the liner in isolation. The most frequent reason for a further acetabular revision was dislocation, accounting for 61 (28%) of the re-revisions. Other reasons for further revision included pain in 27 (12%), loosening in 24 (11%) and infection in 20 (9%). Re-revisions because of pain were less frequent when complete component (fixed or loose) revision was undertaken compared with isolated exchange of the liner (RR = 0.20 (95% confidence interval 0.06% to 0.65%) and RR = 0.10 (95% confidence interval 0.03% to 0.30%), respectively). The risk of further acetabular revision for infection, however, did not differ between the groups. In this study, exchange of the liner only had a higher risk of further cup revision than revision of the complete acetabular component. Our results suggest that the threshold for revising well-fixed components in the case of liner wear and osteolysis should be lowered.


Asunto(s)
Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Luxación de la Cadera/cirugía , Humanos , Masculino , Persona de Mediana Edad , Falla de Prótesis , Infecciones Relacionadas con Prótesis/cirugía , Sistema de Registros , Reoperación/métodos , Análisis de Supervivencia , Factores de Tiempo
17.
J Bone Joint Surg Br ; 88(9): 1143-8, 2006 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-16943462

RESUMEN

We performed a randomised, radiostereometric study comparing two different bone cements, one of which has been sparsely clinically documented. Randomisation of 60 total hip replacements (57 patients) into two groups of 30 was undertaken. All the patients were operated on using a cemented Charnley total hip replacement, the only difference between groups being the bone cement used to secure the femoral component. The two cements used were Palamed G and Palacos R with gentamicin. The patients were followed up with repeated clinical and radiostereometric examinations for two years to assess the micromovement of the femoral component and the clinical outcome. The mean subsidence was 0.18 mm and 0.21 mm, and the mean internal rotation was 1.7 degrees and 2.0 degrees at two years for the Palamed G and Palacos R with gentamicin bone cements, respectively. We found no statistically significant differences between the groups. Micromovement occurred between the femoral component and the cement, while the cement mantle was stable inside the bone. The Harris hip score improved from a mean of 38 points (14 to 54) and 36 (10 to 57) pre-operatively to a mean of 92 (77 to 100) and 91 (63 to 100) at two years in the Palamed G and Palacos R groups, respectively. No differences were found between the groups. Both bone cements provided good initial fixation of the femoral component and good clinical results at two years.


Asunto(s)
Antibacterianos/uso terapéutico , Artroplastia de Reemplazo de Cadera/métodos , Cementos para Huesos/uso terapéutico , Gentamicinas/uso terapéutico , Polimetil Metacrilato/uso terapéutico , Anciano , Femenino , Fémur/fisiología , Articulación de la Cadera/fisiopatología , Articulación de la Cadera/cirugía , Prótesis de Cadera , Humanos , Masculino , Persona de Mediana Edad , Movimiento , Radioisótopos , Rotación , Tantalio , Resultado del Tratamiento
18.
Bone Joint J ; 98-B(11): 1479-1488, 2016 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-27803223

RESUMEN

AIMS: The aim of this consensus was to develop a definition of post-operative fibrosis of the knee. PATIENTS AND METHODS: An international panel of experts took part in a formal consensus process composed of a discussion phase and three Delphi rounds. RESULTS: Post-operative fibrosis of the knee was defined as a limited range of movement (ROM) in flexion and/or extension, that is not attributable to an osseous or prosthetic block to movement from malaligned, malpositioned or incorrectly sized components, metal hardware, ligament reconstruction, infection (septic arthritis), pain, chronic regional pain syndrome (CRPS) or other specific causes, but due to soft-tissue fibrosis that was not present pre-operatively. Limitation of movement was graded as mild, moderate or severe according to the range of flexion (90° to 100°, 70° to 89°, < 70°) or extension deficit (5° to 10°, 11° to 20°, > 20°). Recommended investigations to support the diagnosis and a strategy for its management were also agreed. CONCLUSION: The development of standardised, accepted criteria for the diagnosis, classification and grading of the severity of post-operative fibrosis of the knee will facilitate the identification of patients for inclusion in clinical trials, the development of clinical guidelines, and eventually help to inform the management of this difficult condition. Cite this article: Bone Joint J 2016;98-B:1479-88.


Asunto(s)
Articulación de la Rodilla/patología , Articulación de la Rodilla/cirugía , Complicaciones Posoperatorias/diagnóstico , Algoritmos , Consenso , Fibrosis , Humanos , Articulación de la Rodilla/fisiopatología , Complicaciones Posoperatorias/clasificación , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/terapia , Rango del Movimiento Articular , Sistema de Registros , Índice de Severidad de la Enfermedad
19.
Bone Joint J ; 97-B(11): 1463-9, 2015 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-26530646

RESUMEN

We report the five-year outcome of a randomised controlled trial which used radiostereometric analysis (RSA) to assess the influence of surface oxidised zirconium (OxZr, Oxinium) on polyethylene wear in vivo. A total of 120 patients, 85 women and 35 men with a mean age of 70 years (59 to 80) who were scheduled for primary cemented total hip arthroplasty were randomly allocated to four study groups. Patients were blinded to their group assignment and received either a conventional polyethylene (CPE) or a highly cross-linked (HXL) acetabular component of identical design. On the femoral side patients received a 28 mm head made of either cobalt-chromium (CoCr) or OxZr. The proximal head penetration (wear) was measured with repeated RSA examinations over five years. Clinical outcome was measured using the Harris hip score. There was no difference in polyethylene wear between the two head materials when used with either of the two types of acetabular component (p = 0.3 to 0.6). When comparing the two types of polyethylene there was a significant difference in favour of HXLPE, regardless of the head material used (p < 0.001). In conclusion, we found no advantage of OxZr over CoCr in terms of polyethylene wear after five years of follow-up. Our findings do not support laboratory results which have shown a reduced rate of wear with OxZr. They do however add to the evidence on the better resistance to wear of HXLPE over CPE.


Asunto(s)
Artroplastia de Reemplazo de Cadera/instrumentación , Cabeza Femoral/cirugía , Prótesis de Cadera , Circonio , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/métodos , Cementación , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/cirugía , Estudios Prospectivos , Diseño de Prótesis , Falla de Prótesis , Análisis Radioestereométrico/métodos , Resultado del Tratamiento
20.
J Bone Joint Surg Br ; 86(4): 504-9, 2004 May.
Artículo en Inglés | MEDLINE | ID: mdl-15174543

RESUMEN

We present the results for 4762 revision total hip arthroplasties with no previous infection in the hip, which were reported to the Norwegian Arthroplasty Register between 1987 and 2003. The ten-year failure rate for revised prostheses was 26% (95% CI 25 to 26). Cox regression analyses were undertaken separately for acetabular and femoral revision components. Cemented revision components without allograft was the reference category. For acetabular components, we found a significantly reduced risk of failure for uncemented revisions both with (relative risk (RR) = 0.66; 95% CI 0.43 to 0.99) and without (RR = 0.37; 95% CI 0.22 to 0.61) allograft. For femoral components, we found a significantly reduced risk of failure for uncemented revisions, both with (RR = 0.27; 95% CI 0.16 to 0.46) and without (RR = 0.22; 95% CI 0.11 to 0.46) unimpacted allograft. This reduced risk of failure also applied to cemented revision components with allograft (RR = 0.53; 95% CI 0.33 to 0.84) and with impaction bone grafting (RR = 0.34; 95% CI 0.19 to 0.62). Revision prostheses have generally inferior results when compared with primary prostheses. Recementation without allograft, and uncemented revision with bone impaction, were associated with worse results than the other revision techniques which we studied.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Falla de Prótesis , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/métodos , Trasplante Óseo , Cementación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sistema de Registros , Reoperación , Factores de Riesgo , Análisis de Supervivencia
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