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Mahmood, Sarwar
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Publications (10 of 10) Show all publications
Al-Amiry, B., Pantelakis, G., Mahmood, S., Kadum, B., Brismar, T. B. & Sayed-Noor, A. S. (2019). Does body mass index affect restoration of femoral offset, leg length and cup positioning after total hip arthroplasty?: A prospective cohort study. BMC Musculoskeletal Disorders, 20, Article ID 422.
Open this publication in new window or tab >>Does body mass index affect restoration of femoral offset, leg length and cup positioning after total hip arthroplasty?: A prospective cohort study
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2019 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 20, article id 422Article in journal (Refereed) Published
Abstract [en]

Background: In obese patients, total hip arthroplasty (THA) can be technically demanding with increased perioperative risks. The aim of this prospective cohort study is to evaluate the effect of body mass index (BMI) on radiological restoration of femoral offset (FO) and leg length as well as acetabular cup positioning.

Methods: In this prospective study, patients with unilateral primary osteoarthritis (OA) treated with THA between September 2010 and December 2013 were considered for inclusion. The perioperative plain radiographs were standardised and used to measure the preoperative degree of hip osteoarthritis, postoperative FO, leg length discrepancy (LLD), acetabular component inclination and anteversion.

Results: We included 213 patients (74.5% of those considered for inclusion) with a mean BMI of 27.7 (SD 4.5) in the final analysis. The postoperative FO was improper in 55% and the LLD in 15%, while the cup inclination and anteversion were improper in 13 and 23% of patients respectively. A multivariable logistic regression model identified BMI as the only factor that affected LLD. Increased BMI increased the risk of LLD (OR 1.14, 95% CI 1.04 to 1.25). No other factors included in the model affected any of the primary or secondary outcomes.

Conclusion: Increased BMI showed a negative effect on restoration of post-THA leg length but not on restoration of FO or positioning of the acetabular cup. Age, gender, OA duration or radiological severity and surgeon’s experience showed no relation to post-THA restoration of FO, leg length or cup positioning.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
BMI, Hip arthroplasty, Femoral offset, Leg length discrepancy, Cup positioning
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-151712 (URN)10.1186/s12891-019-2790-y (DOI)000485277400001 ()31510993 (PubMedID)2-s2.0-85072113263 (Scopus ID)
Available from: 2018-09-10 Created: 2018-09-10 Last updated: 2019-11-13Bibliographically approved
Al-Amiry, B., Mahmood, S., Krupic, F. & Sayed-Noor, A. (2017). Leg lengthening and femoral-offset reduction after total hip arthroplasty: where is the problem - stem or cup positioning?. Acta Radiologica, 58(9), 1125-1131, Article ID UNSP 0284185116684676.
Open this publication in new window or tab >>Leg lengthening and femoral-offset reduction after total hip arthroplasty: where is the problem - stem or cup positioning?
2017 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 58, no 9, p. 1125-1131, article id UNSP 0284185116684676Article in journal (Refereed) Published
Abstract [en]

Background: Restoration of femoral offset (FO) and leg length is an important goal in total hip arthroplasty (THA) as it improves functional outcome. Purpose: To analyze whether the problem of postoperative leg lengthening and FO reduction is related to the femoral stem or acetabular cup positioning or both. Material and Methods: Between September 2010 and April 2013, 172 patients with unilateral primary osteoarthritis treated with THA were included. Postoperative leg-length discrepancy (LLD) and global FO (summation of cup and FO) were measured by two observers using a standardized protocol for evaluation of antero-posterior plain hip radiographs. Patients with postoperative leg lengthening >= 10mm (n = 41) or with reduced global FO >5mm (n = 58) were further studied by comparing the stem and cup length of the operated side with the contralateral side in the lengthening group, and by comparing the stem and cup offset of the operated side with the contralateral side in the FO reduction group. We evaluated also the inter-observer and intra-observer reliability of the radiological measurements. Results: Both observers found that leg lengthening was related to the stem positioning while FO reduction was related to the positioning of both the femoral stem and acetabular cup. Both inter-observer reliability and intra-observer reproducibility were moderate to excellent (intra-class correlation co-efficient, ICC >= 0.69). Conclusion: Post THA leg lengthening was mainly caused by improper femoral stem positioning while global FO reduction resulted from improper positioning of both the femoral stem and the acetabular cup.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD, 2017
Keywords
Hip arthroplasty, leg length discrepancy, femoral offset, plain radiographs, reliability
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-138202 (URN)10.1177/0284185116684676 (DOI)000405779200013 ()
Note

Originally included in thesis in manuscript form with title Leg lengthening and femoral offset reduction after total hip arthroplasty: where is the problem located – stem or cup?

Available from: 2017-08-21 Created: 2017-08-21 Last updated: 2018-11-08Bibliographically approved
Mahmood, S. S., Mukka, S. S., Crnalic, S., Wretenberg, P. & Sayed-Noor, A. S. (2016). Association between changes in global femoral offset after total hip arthroplasty and function, quality of life, and abductor muscle strength: A prospective cohort study of 222 patients. Acta Orthopaedica, 87(1), 36-41
Open this publication in new window or tab >>Association between changes in global femoral offset after total hip arthroplasty and function, quality of life, and abductor muscle strength: A prospective cohort study of 222 patients
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2016 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 87, no 1, p. 36-41Article in journal (Refereed) Published
Abstract [en]

Background and purpose - There is no consensus on the association between global femoral offset (FO) and outcome after total hip arthroplasty (THA). We assessed the association between FO and patients? reported hip function, quality of life, and abductor muscle strength.

Patients and methods - We included 250 patients with unilateral hip osteoarthritis who underwent a THA. Before the operation, the patient?s reported hip function was evaluated with the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and quality of life was evaluated with EQ-5D. At 1-year follow-up, the same scores and also hip abductor muscle strength were measured. 222 patients were available for follow-up. These patients were divided into 3 groups according to the postoperative global FO of the operated hip compared to the contralateral hip, as measured on plain radiographs: the decreased FO group (more than 5 mm reduction), the restored FO group (within 5 mm restoration), and the increased FO group (more than 5 mm increment).

Results - All 3 groups improved (p < 0.001). The crude results showed that the decreased FO group had a worse WOMAC index, less abductor muscle strength, and more use of walking aids. When we adjusted these results with possible confounding factors, only global FO reduction was statistically significantly associated with reduced abductor muscle strength. The incidence of residual hip pain and analgesics use was similar in the 3 groups.

Interpretation - A reduction in global FO of more than 5 mm after THA appears to have a negative association with abductor muscle strength of the operated hip, and should therefore be avoided.

Place, publisher, year, edition, pages
Taylor & Francis, 2016
National Category
Surgery Orthopaedics
Identifiers
urn:nbn:se:umu:diva-112199 (URN)10.3109/17453674.2015.1091955 (DOI)000367530700008 ()26471772 (PubMedID)
Available from: 2015-12-03 Created: 2015-12-03 Last updated: 2018-06-07Bibliographically approved
Mukka, S., Mahmood, S., Kadum, B., Sköldenberg, O. & Sayed-Noor, A. (2016). Direct lateral vs posterolateral approach to hemiarthroplasty for femoral neck fractures. Orthopaedics & Traumatology: Surgery & Research, 102(8), 1049-1054
Open this publication in new window or tab >>Direct lateral vs posterolateral approach to hemiarthroplasty for femoral neck fractures
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2016 (English)In: Orthopaedics & Traumatology: Surgery & Research, ISSN 1877-0568, E-ISSN 1877-0568, Vol. 102, no 8, p. 1049-1054Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Adopting the direct lateral (DL) instead of the posterolateral (PL) approach in hip arthroplasty for femoral neck fracture (FNF) patients could lower the rate of prosthetic dislocation. However, little is known about how the approach influences the functional outcome.

HYPOTHESIS: We hypothesized that both approaches would give comparable results.

MATERIAL AND METHODS: In a prospective cohort study, we enrolled 185 hips (183 patients, 128 women, median age 84 years) with a displaced FNF. Subjects were assigned to treatment using DL (n=102) or PL approach (n=83) with a hemiarthroplasty (HA). Functional outcome was assessed by Harris Hip Score (HHS), Western Ontario and McMaster Universities Arthritis (WOMAC) index, pain numeric rating scale (PNRS) for pain, mortality and hip complications. Patients were followed-up after 1 year.

RESULTS: The HHS was 71 (SD 18) in the DL group and 72 (SD 17) in the PL group (P=0.59). We found no difference in WOMAC, PNRS and mortality. Seven patients (6.9%) in the DL group and 11 patients (13.3%) in the PL group had undergone a major reoperation (adjusted OR 0.51; 95% CI, 0.18-2.07; P=0.23).

DISCUSSION: In this prospective cohort study, patients treated with HA for FNF using either the DL or PL approaches had comparable functional outcome after 1 year. The PL approach had a tendency towards a higher reoperation rate.

TYPE OF STUDY: Prospective cohort study.

LEVEL OF PROOF: Level 2.

Place, publisher, year, edition, pages
Elsevier, 2016
Keywords
Femoral neck fracture, Surgical approach, Direct lateral, Posterolateral, Function, Complications
National Category
Orthopaedics Surgery
Identifiers
urn:nbn:se:umu:diva-129430 (URN)10.1016/j.otsr.2016.08.017 (DOI)000389540700016 ()27863919 (PubMedID)
Available from: 2016-12-28 Created: 2016-12-28 Last updated: 2018-06-09Bibliographically approved
Mahmood, S. (2016). Leg length discrepancy and femoral offset after total hip arthroplasty: clinical and radiological studies. (Doctoral dissertation). Umeå: Umeå Universitet
Open this publication in new window or tab >>Leg length discrepancy and femoral offset after total hip arthroplasty: clinical and radiological studies
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Every year, about 1 million patients worldwide and 16000 patients in Sweden undergo total hip arthroplasty (THA). This surgical intervention is considered a successful, safe and cost-effective procedure to regain pain-free mobility and restore hip joint function in patients suffering from severe hip joint disease or trauma. Besides relieving the pain, restoration of biomechanical forces around the hip with appropriate femoral offset (FO), leg length and proper component position and orientation are important goals. The radiographic preoperative planning and postoperative evaluation of these parameters require good validity, interobserver reliability and intraobserver reproducibility. It remains controversial as to how much postoperative leg length discrepancy (LLD) and FO change are acceptable. Generally, lengthening of the operated leg ≥ 10mm and FO reduction of the operated hip > 5mm should be avoided by using preoperative radiological templating and intraoperative measurement methods. There is no consensus on the association between LLD and FO and outcome after THA.

The aims of this thesis were to:

1. To determine the influence of non-corrected LLD after THA on patients’ reported hip function and quality of life (QoL).

2. To study the association of global FO changes after THA with patients’ reported hip function, QoL and abductor muscle strength.

3. To evaluate the concurrent validity of the Sundsvall method of measuring postoperative global FO by comparing it to a standard method and to evaluate the interobserver reliability and intraobserver reproducibility of measurement of postoperative global FO, LLD and acetabular cup inclination and anteversion.

4. To analyse the postoperative radiographs of THA patients with leg lengthening and FO reduction to determine whether the problem is located in the stem, cup or both.

Study I: A prospective cohort study of 174 patients with unilateral osteoarthritis (OA), comparing patients with lengthening ≥ 10mm, restoration (between 9 mm lengthening and 5 mm shortening) or shortening > 5 mm of the operated leg after THA. Follow up was 12–15 months. We found that a LLD of up to 20 mm did not influence the functional outcome (WOMAC) or QoL (EQ-5D). However, the lengthening group showed less improvement in WOMAC and more use of a shoe lift.

Study II: A prospective cohort study of 222 patients with unilateral hip OA, comparing patients with decreased global FO (> 5 mm reduction), restored FO (within 5 mm restoration), and increased FO (> 5 mm increment) after THA. Follow up was was 12–15 months. The unadjusted results showed that the decreased FO group had a worse WOMAC index, less abductor muscle strength, and more use of walking aids. When these results were adjusted for possible confounding factors, only global FO reduction was statistically significantly associated with reduced abductor muscle strength. The incidence of residual hip pain and analgesics use was similar in the 3 groups.

Study III: A prospective cohort study of 90 patients with primary unilateral OA treated with THA. Global FO using the Sundsvall method, global FO (standard method), LLD, acetabular cup inclination and anteversion were measured on postoperative radiographs. The interobserver reliability and intraobserver reproducibility were tested using three independent observers. We found that the Sundsvall method is as reliable as the standard method and the evaluated radiographic measurement methods have the required validity and reliability to be used in clinical practice.

Study IV: A prospective cohort study of 174 patients with unilateral primary OA treated with THA. LLD and global FO were measured on postoperative radiographs. Patients with lengthening of the operated leg ≥ 10mm (n=41) and patients with reduction of global FO > 5mm (n=58) were further studied to investigate the amount of lengthening and global FO reduction that took place in the stem and in the cup compared with the contralateral side. The interobserver reliability and intraobserver reproducibility were tested using two independent observers. We found that post-THA lengthening of the operated leg ≥ 10mm was mainly caused by improper placement of the femoral stem, whereas a decrease of global FO > 5 was caused by improper placement of both acetabular and femoral components. The radiological measurement methods used showed substantial to excellent interobserver reliability and intraobserver reproducibility and are therefore clinically useful.

The main conclusions of this thesis are:

LLD up to 20 mm and reduced global FO more than 5 mm did not influence the functional outcome or quality of life at 12–15 months postoperatively.

Lengthening ≥ 10mm was associated with increased use of a shoe lift. A reduction of global FO more than 5 mm compared to the contralateral hip was associated with weaker hip abductor muscles and more use of walking aids. Therefore both should be avoided.

The radiographic measurement methods of LLD, global FO, cup inclination and anteversion have the required validity and reliability to be used in clinical practice.

Lengthening of the operated leg is mainly caused by improper femoral stem positioning while global FO reduction results from improper positioning of both acetabular and femoral components. Surgeons should be aware of these operative pitfalls in order to minimize component malpositioning.

Abstract [sv]

Varje år opereras ungefär 1 miljon patienter runt om i världen och 16000 patienter i Sverige med en total höftledsprotes (THA). Operation med höftledsprotes anses vara enav de mest framgångsrika, säkra och kostnadseffektiva kirurgiska åtgärderna med syfte att för att återställa livskvalité. Målet är att smärtlindra och återställa rörligheten i dendestruerade höftleden vid artros, reumatisk destruktion eller men efter exempelvis Perthes sjukdom. Vid operation med THA är det viktigt att återställa de biomekaniskakrafterna runt höftleden med en adekvat så kallad femoral offset (FO), postoperativ benlängdsskillnad (BLS) och ett tillfredsställande komponentläge. Den preoperativaplaneringen och den postoperativa bedömning av dessa parametrar kräver god tillförlitlighet, det vill säga validitet och reproducerbarhet både mellan olika bedömareoch vid upprepade mätningar av samma bedömare. Det är fortfarande inte klarlagt hur mycket postoperativ förändring i FO och BLS som är acceptabla. I dagsläget är detacceptabelt om den postoperativa benförlängningen understiger 1 cm och förändringen i FO är under 5 mm. Det finns ingen konsensus huruvida det föreligger ett sambandmellan BLS, FO och den patientrapporterade höftfunktionen och livskvalitén efter THA.

Syftet med denna avhandling var:

1. Att studera effekten av icke-korrigerad BLS efter THA på den patientrapporterade höftfunktionen och livskvalitén.

2. Att studera effekten av förändringen i FO efter THA på den patientrapporterade höftfunktion, livskvalitén och muskelstyrka i abduktion.

3. Att utvärdera validitet och reliabilitet av en så kallad global FO genom att jämföra den med den gällande standard metoden samt studera tillförlitlighet av de radiologiskamätningar av postoperativa BLS, FO, cup inklination och anteversion efter THA.

4. Att radiologiskt undersöka i vilken av komponenterna (stam eller cup) somförändringen i FO och BLS verkar vara förlagd.

Studie I: En prospektiv kohortstudie med 174 patienter som behandlats med THA för en primär unilateral koxartros. Patienterna delades in i tre grupper; de som fått en BLSförlängning över 10mm, återställning (mellan 9mm förlängning och 5mm förkortning) eller förkortning >5mm av det opererande benet efter THA. Uppföljning gjordes 12-15månader postoperativt. Vi fann att BLS upp till 20mm påverkade inte höftfunktion (WOMAC) och livskvalité (EQ-5D), men den förlängda gruppen visade en mindreförbättring i WOMAC och rapporterade en mer frekvent användning av skoinlägg.

Studie II: En prospektiv kohortstudie med 222 patienter som behandlats med THA för en primär unilateral koxartros. Patienterna delades in i tre grupper; de patienter medförminskad FO (> 5mm minskning), återställd FO (inom 5mm) eller ökad FO (>5mm ökning). Uppföljning genomfördes efter 1 år med WOMAC, styrkemätning av höftensabduktorer och en frågeformulär. En minskad FO var associerade med en minskad styrka i höftens abduktorer. Det var ingen skillnad mellan grupperna gällandekvarstående höftsmärta och användning av analgetika.

Studie III: En prospektiv kohortstudie med 90 patienter som behandlats med THA på grund av primär unilateral koxartros. På de postoperativa röntgenbilderna uppmättesglobala FO (Sundsvalls metodologi), globala FO (standard metod), BLS, cup inklination och anteversion. Reliabilitet och reproducerbarhet bedömdes mellan treoberoende observatörer. Vi fann att global FO (enligt Sundsvalls metodologi) är lika tillförlitlig som den nuvarande standardmetoden och de utvärderade radiologiskamätmetoderna har hög validitet och reliabilitet och kan således användas i klinisk praxis.

Studie IV: En prospektiv kohortstudie med 174 patienter som behandlats med en THA för en primär unilateral koxartros. På de postoperativa röntgenbilderna uppmättes BLSoch globala FO. Patienter med förlängning ≥ 10mm (n=41) och patienter med minskning av globala FO >5mm (n=58) studerades for att mäta förlängning ochglobala FO minskning som sitter i stammen eller i cup jämfört med kontralaterala sidan. Reliabilitet och reproducerbarhet bedömdes av två oberoende observatörer. Vifann att en BLS över 10mm sitter framför allt i stamkomponenten i lårbenet medan en minskning i FO över 5 mm sitter i båda stam och cup. De radiologiska mätmetodernahar hög reliabilitet och reproducerbarhet och kan således användas i klinisk praxis.

De viktigaste slutsatserna i denna avhandling är:

1. BLS med en förlängning upp till 20 mm och en minskning av globala FO mer än 5 mm påverkar inte patientrapporterad höftfunktion eller livskvalitet 1 år postoperativt.

2. BLS med en förlängning mer än 9 mm var associerad med mer användning av skoinlägg. En minskad FO med mer än 5 mm jämfört med den icke opererade höftenvar associerad med en sämre muskelstyrka i abduktion och ökat användning av gånghjälpmedel.

3. De radiologiska mätmetoderna av BLS, FO, acetabulära komponentens inklination och anteversion har hög validitet och reliabilitet, vilket kan användas i klinisk praxis.

4. En förlängning av det opererade benet orsakas främst av en positioneringen av stamkomponenten i lårbenet medan förlust av FO beror på otillfredsställande placeringav både stam och den acetabulära komponenten. Kirurger bör vara medveten om dessa operativa fallgropar för att optimera det kirurgiska resultatet.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2016. p. 84
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1775
Keywords
Total hip arthroplasty, leg flength discrepancy, femoral offset, WOMAC, quality of life, complication, radiographic measurements, acetabular cup, inclination, anteversion
National Category
Clinical Medicine
Research subject
Orthopaedics
Identifiers
urn:nbn:se:umu:diva-114415 (URN)978-91-7601-394-6 (ISBN)
Public defence
2016-02-12, Aulan, Länssjukhuset Sundsvall-Härnösand, Länssjukhuset Sundsvall-Härnösand, Sundsvall, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2016-01-22 Created: 2016-01-18 Last updated: 2018-09-10Bibliographically approved
Mukka, S., Lindqvist, J., Peyda, S., Broden, C., Mahmood, S., Hassany, H. & Sayed-Noor, A. (2015). Dislocation of bipolar hip hemiarthroplasty through a postero-lateral approach for femoral neck fractures: A cohort study. International Orthopaedics, 39(7), 1277-1282
Open this publication in new window or tab >>Dislocation of bipolar hip hemiarthroplasty through a postero-lateral approach for femoral neck fractures: A cohort study
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2015 (English)In: International Orthopaedics, ISSN 0341-2695, E-ISSN 1432-5195, Vol. 39, no 7, p. 1277-1282Article in journal (Refereed) Published
Abstract [en]

Purpose To analyze postoperative global femoral offset (FO), leg length discrepancy (LLD) and Wiberg angle as risk factors for prosthetic dislocation after treatment with bipolar hemiarthoplasty (HA) through a postero-lateral approach for femoral neck fracture (FNF). Methods Three hundred and seventy three patients treated with a cemented bipolar HA through a postero-lateral approach between January 2006 and December 2013 were included in a cohort study with a follow-up time ranging from 6 months to 7 years. Radiographs and all surgical records were reviewed regarding Global FO, LLD and Wiberg angle. We compared stable hips without dislocation to those with either a single dislocation and those with recurrent instability. Results Three hundred and twenty eight hips fulfilled the inclusion criteria and were analyzed in the study. The incidence of prosthetic dislocation was 10.7 % (36/373). The mean time from surgery to first dislocation was 3.9 months (0-47) and 62.5 % had recurrent dislocations. Patients with dislocation had a statistically significantly decreased postoperative global FO (-6.4 mm vs. -2.8 mm, p = 0.04), LLD (-2 vs. 1.5 mm, p = 0.03) and smaller Wiberg angle (40A degrees vs. 46A degrees, p = 0.01) on the operated side compared with the rest of cohort. In comparison to age and sex-matched control groups from the cohort, the difference in the radiographic parameters were significant in patients with recurrent dislocations but not in patients with a single dislocation. Conclusion Patients with recurrent dislocations had a decreased postoperative global FO, shorter leg and shallower acetabulum on the operated side compared with their controls. These factors might decrease the soft-tissue tension around the operated hip and predispose to dislocation.

Keywords
Femoral neck fracture, Hemiarthroplasty, Femoral offset, Leg length, Discripancy, Dislocation
National Category
Orthopaedics
Identifiers
urn:nbn:se:umu:diva-106562 (URN)10.1007/s00264-014-2642-1 (DOI)000356809900004 ()25557759 (PubMedID)
Available from: 2015-07-20 Created: 2015-07-20 Last updated: 2018-06-07Bibliographically approved
Mahmood, S., Mukka, S. S., Crnalic, S. & Sayed-Noor, A. S. (2015). The Influence of Leg Length Discrepancy after Total Hip Arthroplasty on Function and Quality of Life: a Prospective Cohort Study. The Journal of Arthroplasty, 30(9), 1638-1642
Open this publication in new window or tab >>The Influence of Leg Length Discrepancy after Total Hip Arthroplasty on Function and Quality of Life: a Prospective Cohort Study
2015 (English)In: The Journal of Arthroplasty, ISSN 0883-5403, E-ISSN 1532-8406, Vol. 30, no 9, p. 1638-1642Article in journal (Refereed) Published
Abstract [en]

We investigated whether patients with lengthening (> 9 mm), restoration (between 9 mm lengthening and 5 mm shortening) or shortening (> 5 mm) of the operated leg after total hip arthroplasty (THA) had different function (WOMAC score), quality of life (EQ-5D), residual hip pain, use of shoe lift and walking aid and leg length discrepancy (LLD) awareness, 12-15 months postoperatively. All patients had a significant postoperative improvement in WOMAC and EQ-5D regardless the LLD. However, the lengthening group showed less improvement in WOMAC, more use of shoe lift, residual hip pain and LLD awareness compared with the other two groups. No differences in EQ-5D were found. In spite of the improvement in function and quality of life, lengthening had adverse effects and should therefore be avoided.

Place, publisher, year, edition, pages
Elsevier, 2015
Keywords
total hip arthroplasty, leg length discrepancy, WOMAC, quality of life, complication
National Category
Orthopaedics
Identifiers
urn:nbn:se:umu:diva-112016 (URN)10.1016/j.arth.2015.04.012 (DOI)000363948900031 ()25922312 (PubMedID)
Available from: 2015-11-30 Created: 2015-11-30 Last updated: 2018-06-07Bibliographically approved
Mahmood, S. S., Al-Amiry, B., Mukka, S. S., Baea, S. & Sayed-Noor, A. S. (2015). Validity, reliability and reproducibility of plain radiographic measurements after total hip arthroplasty. Skeletal Radiology, 44(3), 345-351
Open this publication in new window or tab >>Validity, reliability and reproducibility of plain radiographic measurements after total hip arthroplasty
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2015 (English)In: Skeletal Radiology, ISSN 0364-2348, E-ISSN 1432-2161, Vol. 44, no 3, p. 345-351Article in journal (Refereed) Published
Abstract [en]

In total hip arthroplasty (THA), radiographic preoperative planning and postoperative evaluation of acetabular component, femoral offset (FO) and leg length discrepancy (LLD) require good validity, interobserver reliability and intraobserver reproducibility. In this study, we evaluated the validity of the Sundsvall method of FO measurement and the interobserver reliability and intraobserver reproducibility of measurement of FO, LLD, acetabular cup inclination and anteversion. Ninety patients with primary unilateral osteoarthritis (OA) were included in this prospective study. On postoperative radiographs FO by the Sundsvall method (femoral axis-pelvic midline), FO by a standard method (femoral axis-hip rotational centre-teardrop point), LLD (inter-teardrop line-lesser trochanter), acetabular cup inclination (on AP view the angle between the cup rim and transischial line) and anteversion (on lateral view the angle between the face of acetabulum and a line perpendicular to the horizontal plane) were measured. The interobserver reliability and intraobserver reproducibility were calculated for three independent observers. The concurrent validity and degree of prediction of the Sundsvall method are measured by comparing its results with the standard method. The interobserver reliability of all measurements was excellent (ICC > 0.80), except for LLD, which was substantial (ICC = 0.79). The intraobserver reproducibility of all measurements was excellent (ICC > 0.80). The concurrent validity of the Sundsvall method compared to the standard method was good with a positive correlation. The Sundsvall method is as reliable as the standard method. The evaluated radiographic measurement methods have the required validity and reliability to be used in clinical practice.

Place, publisher, year, edition, pages
Springer, 2015
Keywords
Radiographic measurements, Total hip arthroplasty, Leg length discrepancy, Femoral offset, etabular cup, Inclination, Anteversion
National Category
Surgery Orthopaedics Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-100945 (URN)10.1007/s00256-014-2055-7 (DOI)000348925400005 ()25403426 (PubMedID)
Available from: 2015-03-20 Created: 2015-03-16 Last updated: 2018-11-08Bibliographically approved
Mukka, S., Mahmood, S., Sjödén, G. & Sayed-Noor, A. (2013). Dual mobility cups for preventing early hip arthroplasty dislocation in patients at risk: experience in a county hospital. Orthopedic Reviews, 5(10), 48-51
Open this publication in new window or tab >>Dual mobility cups for preventing early hip arthroplasty dislocation in patients at risk: experience in a county hospital
2013 (English)In: Orthopedic Reviews, ISSN 2035-8237, E-ISSN 2035-8164, Vol. 5, no 10, p. 48-51Article in journal (Refereed) Published
Abstract [en]

Dislocation remains a major concern after hip arthroplasty. We asked whether dual mobility cups (DMC) would improve early hip stability in patients with high risk of dislocation. We followed 34 patients (21 females, 13 males) treated between 2009 and 2012 with cemented DMC for hip revisions caused recurrent hip prosthetic dislocation or as a primary procedure in patients with high risk of instability. Functional outcome and quality of life were evaluated using Harris Hip Score and EQ-5D respectively. We found that the cemented DMC gave stability in 94%. Seven patients (20%) were re-operated due to infection. One patient sustained a periprosthetic fracture. At follow-up (6 to 36 months, mean 18), the mean Harris hip score was 67 (standard deviation: 14) and mean EQ-5D was 0.76 (standard deviation: 0.12). We concluded that treating patients with high risk of dislocation with DMC can give good stability. However, complications such as postoperative infection can be frequent and should be managed carefully.

Place, publisher, year, edition, pages
PAGEPress, 2013
Keywords
dual mobility cup, hip arthroplasty, dislocation, stability, outcome, complications
National Category
Orthopaedics
Identifiers
urn:nbn:se:umu:diva-79177 (URN)10.4081/or.2013.e10 (DOI)
Available from: 2013-08-12 Created: 2013-08-12 Last updated: 2018-06-08Bibliographically approved
Mukka, S., Mahmood, S., Kadum, B., Sköldenberg, O. & Sayed-Noor, A. Direct lateral versus posterolateral approach to hip hemiarthroplasty for femoral neck fractures: a prospective cohort study.
Open this publication in new window or tab >>Direct lateral versus posterolateral approach to hip hemiarthroplasty for femoral neck fractures: a prospective cohort study
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(English)Article in journal (Refereed) Submitted
Abstract [en]

Background: Adopting the direct lateral (DL) instead of the posterolateral (PL) approach to thehip for femoral neck fractures (FNF) results in a lower rate of prosthetic dislocation. The aim ofthis study was to compare hip function and complications after hemiarthroplasty (HA) by eitherthe DL or the PL approach for a FNF.

Methods: In a prospective cohort study, we enrolled 185 hips (183 patients, 128 women, medianage 84 years) with a displaced FNF. Subjects were, by the surgeons’ preference, assigned totreatment using DL (n=102) or PL approach (n=83) with a HA. Outcomes were Harris hip score(HHS), WOMAC, pain numeric rating scale (PNRS) for pain, limp, mortality and hipcomplications. Patients were followed-up after 1 year.

Results: The HHS was 71 (SD 18) in the DL group and 72 (±17) in the PL group (p=0.59). Wefound no difference in HHS, WOMAC, PNRS and mortality. Seven patients (6.9%) in the DLgroup and 11 patients (13.3%) in the PL group had undergone a major re-operation (adjusted OR0.51; 95% CI, 0.18-2.07; p=0.23). The DL approach was associated with an increased frequencyof patient reported limp (adjusted OR 2.97,1,32-6.67;p=0.008).

Interpretation: In this prospective cohort study, patients treated with HA for FNF using either theDL or PL approaches had comparable functional outcome after 1 year. The PL approach had ahigher re-operation rate while the DL approach had a higher incidence of limp.

National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-108606 (URN)
Available from: 2015-09-14 Created: 2015-09-14 Last updated: 2018-06-07
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