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  • 1. Afif, Haitham
    et al.
    Mukka, Sebastian
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics. Sundsvall Hospital.
    Sjödén, Göran
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics. Sundsvall Hospital.
    Sayed-Noor, Arkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics. Sundsvall Hospital.
    Do bisphosphonate-related atypical femoral fractures and osteonecrosis of the jaw affect the same group of patients?: a pilot study2014In: Orthopedic Reviews, ISSN 2035-8237, E-ISSN 2035-8164, Vol. 6, 5067Article in journal (Refereed)
    Abstract [en]

    Bisphosphonates (BPs) are commonly used drugs in clinical practice. In this pilot study, we investigated whether bisphosphonate-related atypical femoral fractures (AFF) and osteonecrosis of the jaw (ONJ) occurred simultaneously in the same group of patients. Six ONJ patients were examined by an orthopedic surgeon and 5 AFF patients were examined by a dentist to look for manifestations of simultaneous occurrence of AFF in ONJ patients and vice versa. The required radiological investigations and previous medical and dental records were available. No simultaneous occurrence of AFF and ONJ was found in the examined patients. In this pilot study with limited sample size, no manifestations of simultaneous occurrence of AFF and ONJ were found. This could be an indication that these complications have different pathophysiologies and affect different subgroups of patients on long-term BP treatment.

  • 2. Agren, Per-Henrik
    et al.
    Tullberg, Tycho
    Mukka, Sebastian
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Wretenberg, Per
    Sayed-Noor, Arkan S.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Post-traumatic in situ fusion after calcaneal fractures: A retrospective study with 7-28 years follow-up2015In: Foot and Ankle Surgery, ISSN 1268-7731, E-ISSN 1460-9584, Vol. 21, no 1, 56-59 p.Article in journal (Refereed)
    Abstract [en]

    Background: In situ fusion as salvage operation after calcaneal fractures has been used. In this retrospective investigation, a group of in situ fused patients is analyzed with long-term follow-up.

    Methods: Twenty-nine patients with in situ single or multiple fusions performed between 1970 and 1990 were included. In 1998 these patients were examined with plain radiographs and computerized tomography (CT) scan of the affected foot. Also, a visual analogue score (VAS) for calcaneal fractures, short form health survey (SF-36), Olerud Molander score and American Orthopaedic Foot and Ankle society (AOFAS) hindfoot score were evaluated.

    Results: The plain radiographs and CT scan showed severe remaining deformities in these patients. The outcome parameters were generally poor and correlated to the degree of remaining deformity.

    Conclusions: Simple in situ fusion, without consideration of the deformity at hand, after a calcaneal fracture is not an adequate treatment and generally associated with poor outcome. (C) 2014 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  • 3.
    Al-Amiry, Bariq
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Karolinska Univ Hosp, Dept Radiol, Stockholm, Sweden.
    Mahmood, Sarwar
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Krupic, Ferid
    Sayed-Noor, Arkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Leg lengthening and femoral-offset reduction after total hip arthroplasty: where is the problem - stem or cup positioning?2017In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 58, no 9, 1125-1131 p., UNSP 0284185116684676Article in journal (Refereed)
    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.

  • 4. Bergkvist, Magnus
    et al.
    Mukka, Sebastian S.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Johansson, Lars
    Ahl, Torbjorn E.
    Sayed-Noor, Arkan S.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Skoldenberg, Olof G.
    Eisler, Thomas
    Debridement, antibiotics and implant retention in early periprosthetic joint infection2016In: HIP International, ISSN 1120-7000, E-ISSN 1724-6067, Vol. 26, no 2, 138-143 p.Article in journal (Refereed)
    Abstract [en]

    Introduction: Periprosthetic joint infection (PJI) is a devastating complication in hip arthroplasty surgery. Debridement, antibiotics (AB) and implant retention (DAIR) is recommended in early PJI in association with stable implants. The aim of this study was to evaluate the success rate of DAIR in early PJI (<4 weeks) and to identify factors predicting the outcome. Methods: This cohort study included a consecutive series of 35 patients (median age 74 years, 25 women, 26 primary arthroplasties) treated with DAIR for an early PJI in a regional hospital. Results: 28 patients (80%) had their infection eradicated. DAIR-only eradicated the PJI in 22 (63%) patients with a median follow-up of 50 (24-84) months. In 17 (49%) patients, oral AB had been given prior to intraoperative cultures, which delayed first debridement with average 6 days and delayed hospital stay. Primary surgery for a hip fracture increased the risk of DAIR-failure. Surgical experience did not affect the outcome. 17% (n = 6) of the patients sustained a secondary infection during their hospital stay; the majority was beta-lactam resistant coagulase negative Staphylococcus aureus. Conclusions: The success rate of DAIR was inferior to pervious controls from experienced revision centers. Hip fracture patients should be informed about the increased risk of DAIR treatment failure. In order not to delay surgery, empirically based oral AB should not be administered prior to deep cultures.

  • 5.
    Hashem, Ali
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Al-Azzawi, Ammar
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Riyadh, Hasan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Mukka, Sebastian
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Sayed-Noor, Arkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Cementless, modular, distally fixed stem in hip revision arthroplasty: a single-center study of 132 consecutive hips2017In: European Journal of Orthopaedic Surgery & Traumatology, ISSN 1633-8065, E-ISSN 1432-1068Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The use of cementless, modular, distally fixed stem in hip revision arthroplasty has increased during the last decades. We aimed to analyze the early and late postoperative complications, re-operation rate, and survival rate of the MP stem operated at our county hospital with relatively limited caseload.

    METHODS: In this retrospective study, we included 132 hips operated with MP stem between January 2007-2014. An independent observer reviewed patients' medical records in July 2015 (18-102 months postoperatively, median 52.5) to collect the following data: age, sex, American Society of Anesthesiologists (ASA) class, body mass index, indication of revision, type of operation, early and late complications, re-operation rate, and mortality during study period.

    RESULTS: The commonest indication for MP stem operation was aseptic loosening (72%). We found early and late postoperative complications in 29% of cases. The most common complication was prosthetic dislocation (8%), followed by intra-operative peri-prosthetic fracture (5%). The commonest indication for MP re-operation was soft tissue revision for infection (7%) followed by closed reduction for prosthetic dislocation (6%). We found no correlation between the age, sex, ASA class, and type of operation and the re-operation risk. Only one prosthesis was extracted giving a survival rate for 99% for the study period.

    CONCLUSION: This study showed good results of the MP prosthesis with reasonable complication and re-operation rates and negligible extraction rate, indicating the good performance of this implant even when used in the setting of a county hospital with limited caseload.

  • 6.
    Kadum, Bakir
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Hassany, Hamid
    Wadsten, Mats
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Sayed-Noor, Arkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Göran, Sjödén
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Geometrical analysis of stemless shoulder arthroplasty: a radiological study of seventy TESS total shoulder prostheses2016In: International Orthopaedics, ISSN 0341-2695, E-ISSN 1432-5195, Vol. 40, no 4, 751-758 p.Article in journal (Refereed)
    Abstract [en]

    Purpose The aim of this study was to investigate the ability of a stemless shoulder prosthesis to restore shoulder anatomy in relation to premorbid anatomy. Methods This prospective study was performed between May 2007 and December 2013. The inclusion criteria were patients with primary osteoarthritis (OA) who had undergone stemless total anatomic shoulder arthroplasty. Radiographic measurements were done on anteroposterior X-ray views of the glenohumeral joint. Results Sixty-nine patients (70 shoulders) were included in the study. The mean difference between premorbid centre of rotation (COR) and post-operative COR was 1 ± 2 mm (range −3 to 5.8 mm). The mean difference between premorbid humeral head height (HH) and post-operative HH was −1 ± 3 mm (range −9.7 to 8.5 mm). The mean difference between premorbid neck-shaft angle (NSA) and post-operative NSA was −3 ± 12° (range −26 to 20°). Conclusions Stemless implants could be of help to reconstruct the shoulder anatomy. This study shows that there are some challenges to be addressed when attempting to ensure optimal implant positioning. The critical step is to determine the correct level of bone cut to avoid varus or valgus humeral head inclination and ensure correct head size.

  • 7.
    Kadum, Bakir
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics. Sundsvall Teaching Hosp, Dept Orthopaed, Sundsvall, Sweden.
    Mukka, Sebastian
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics. Sundsvall Teaching Hosp, Dept Orthopaed, Sundsvall, Sweden.
    Englund, Erling
    Sayed-Noor, Arkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics. Sundsvall Teaching Hosp, Dept Orthopaed, Sundsvall, Sweden.
    Sjöden, Göran
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics. Sundsvall Teaching Hosp, Dept Orthopaed, Sundsvall, Sweden.
    Clinical and radiological outcome of the Total Evolutive Shoulder System (TESSA (R)) reverse shoulder arthroplasty: a prospective comparative non-randomised study2014In: International Orthopaedics, ISSN 0341-2695, E-ISSN 1432-5195, Vol. 38, no 5, 1001-1006 p.Article in journal (Refereed)
    Abstract [en]

    Purpose The aims of this study were to assess the function and quality of life after the Total Evolutive Shoulder System (TESS) reverse shoulder arthroplasty (RSA), to evaluate the radiological stability of the stemless version and to address the effect of arm lengthening and scapular notching (SN) on the outcome. Methods This was a prospective comparative non-randomised study. A total of 37 consecutive patients (40 shoulders) underwent TESS RSA between October 2007 and January 2012; 16 were stemless and 26 were stemmed. At a mean follow-up of 39 months (15-66), we evaluated range of motion (ROM), pain and functional outcome with QuickDASH and quality of life with EQ-5D score. Radiologically, component positioning, signs of loosening, SN and arm length difference were documented. Results We found a significant improvement in functional outcome and reduction of pain in both stemmed and stemless groups. No humeral loosening was evident, but there were four glenoid loosenings. In 12 shoulders that developed SN, seven already had scapular bone impression (SBI) evident on initial post-operative radiographs. Glenoid overhang seemed to decrease the risk of SN. Arm lengthening was associated with better EQ-5D but did not influence ROM or functional outcome. Conclusions Reverse shoulder arthroplasty markedly improved shoulder function. SN is of concern in RSA, but proper positioning of the glenoid component may prevent its development.

  • 8.
    Kadum, Bakir
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Sayed-Noor, Arkan S.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Perisynakis, Nikolaos
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Baea, Saida
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Sjödén, Göran
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Radiologic assessment of glenohumeral relationship: reliability and reproducibility of lateral humeral offset2015In: Surgical and Radiologic Anatomy, ISSN 0930-1038, E-ISSN 1279-8517, Vol. 37, no 4, 363-368 p.Article in journal (Refereed)
    Abstract [en]

    It has been shown that anatomical reconstruction is an important step in achieving good function after shoulder arthroplasty. It is essential to reconstruct the distance between the coracoid process and greater tubercle as this relates to the moment arm of the deltoid and rotator cuff muscles. This study evaluated the reliability of measurement of the lateral humeral offset (LHO) on plain radiographs and on computed tomography (CT). Four independent observers performed measurements of LHO on radiographs and CT from 26 patients awaiting shoulder reconstruction. The interobserver reliability and intraobserver reproducibility were assessed. Interobserver reliability and intraobserver reproducibility of LHO in axial CT scans were excellent. Plain radiography showed fair to excellent interobserver reliability and variable intraobserver reproducibility. CT is a reliable tool to measure LHO supporting its use in preoperative planning. When AP radiography is used for preoperative planning the examiner should be aware of its limitations and standardisation protocols should be considered.

  • 9.
    Kadum, Bakir
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Wahlström, Per
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Hand Surgery.
    Khoschnau, Shwan
    Sjödén, Göran
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Sayed-Noor, Arkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Association of lateral humeral offset with functional outcome and geometric restoration in stemless total shoulder arthroplasty2016In: Journal of shoulder and elbow surgery, ISSN 1058-2746, E-ISSN 1532-6500, Vol. 25, no 10, E285-E294 p.Article in journal (Other academic)
    Abstract [en]

    Background: Restoration of shoulder geometry is desirable in total shoulder arthroplasty (TSA) and thought to influence the postoperative clinical outcome. We aimed to study the association of postoperative lateral humeral offset (LHO) changes and clinical outcome, as well as to investigate the ability of stemless anatomic TSA to restore shoulder geometry. Methods: In patients with primary shoulder osteoarthritis who underwent stemless anatomic TSA, the preoperative and postoperative clinical outcome was measured. Shoulder geometry was measured on preoperative computed tomography for the osteoarthritic shoulder and contralateral healthy shoulder and on postoperative computed tomography for the operated shoulder. Results: Forty-four patients with a minimum follow-up of 12 months (range, 12-50 months) were available for the study. Postoperatively, the clinical outcome measures improved. The postoperative difference in LHO between the operated shoulder and contralateral healthy shoulder was 1.3 +/- 4.6 mm and was correlated with scores on the short version of the Disabilities of the Arm, Shoulder and Hand questionnaire at 3 months (Pearson correlation = 0.36, P =.01) and visual analog scale for pain at rest (Pearson correlation = 0.30, P =.03) and with exertion (Pearson correlation = 0.34, P =.01) at 3 months. Lengthening of LHO was associated with worsening shoulder function at 3 months but not at 12 months. The postoperative shoulder geometric parameters were restored postoperatively to acceptable ranges. Conclusion: The stemless anatomic TSA could restore shoulder geometry in an acceptable manner. At 3 months but not at 12 months, increased LHO had a negative effect on shoulder function and resulted in more shoulder pain at rest and with exertion but did not affect quality of life, health status, or range of motion.

  • 10.
    Kjellberg, Martin
    et al.
    Department of Orthopaedics, Sundsvall Hospital, Sundsvall,l Sweden.
    Al-Amiry, Bariq
    Department of Radiology, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
    Englund, Erling
    Department of Research and Development, Västernorrland County, Sundsvall, Sweden.
    Sjöden, Göran O
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Sayed-Noor, Arkan S
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Measurement of leg length discrepancy after total hip arthroplasty: The reliability of a plain radiographic method compared to CT-scanogram2012In: Skeletal Radiology, ISSN 0364-2348, E-ISSN 1432-2161, Vol. 41, no 2, 187-191 p.Article in journal (Refereed)
    Abstract [en]

    To measure the interobserver reliability and intraobserver reproducibility of post total hip arthroplasty (THA) leg length discrepancy (LLD) measurement on radiographs as well as to evaluate its accuracy by comparing it with LLD measurement on computed tomographic scanogram (CT-scanogram). In this prospective study, postoperative LLD measurements in ten THA patients were made by four observers on anteroposterior radiographs of the pelvis (inter-teardrop line to the tip of lesser trochanter) and compared to LLD measurements made on CT-scanogram scout views of the lower limb. Two observers repeated the LLD measurements on radiographs 8 weeks after the first measurements. The interobserver reliability of the LLD measurement on plain radiographs was evaluated by comparing the measurements of the four observers and the intraobserver reproducibility by comparing the two repeated measurements made by the two observers. We found excellent interobserver reliability (mean ICC 0.83) and intraobserver reproducibility (ICC 0.90 and 0.88) of the LLD measurements on plain radiographs. There was a moderate to excellent agreement, but with wide variation of measurements among the four observers, when plain radiographic measurement was compared with CT-scanogram (ICC 0.58, 0.60, 0.71, and 0.82). Despite the excellent interobserver reliability and intraobserver reproducibility of LLD measurement on radiographs, clinicians should be aware of its limited accuracy when compared to CT-scanogram.

  • 11.
    Mahmood, Sarwar
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Al-Amiry, Bariq
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Karolinska University Hospital - Department of Radiology.
    Mukka, Sebastian S
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Sundsvall and Norrland University Hospitals.
    Sayed-Noor, Arkan S
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Sundsvall and Norrland University Hospitals.
    Leg lengthening and femoral offset reduction after total hip arthroplasty: where is the problem located – stem or cup?Manuscript (preprint) (Other academic)
    Abstract [en]

    Background and aims:

    Restoration of the biomechanical forces around the hip with appropriate femoral offset (FO) and leg length is an important goal in total hip arthroplasty (THA). It is still controversial as to how much postoperative leg length discrepancy (LLD) and FO change are acceptable. The aim of this prospective study is to analyse whether the problem of postoperative leg lengthening and FO reduction is located in the stem or cup or both.

    Material and methods:

    Between September 2010 and April 2013, 174 patients with unilateral primary OA treated with THA were included. Postoperative LLD and global FO were measured using a standardized protocol of the antero-posterior hip radiograph. Patients whose operated leg became ≥ 10mm longer compared with the contralateral side (n=41) or reduction of the global FO > 5mm (n=58) were further studied to investigate the amount of leg lengthening and global FO reduction that took place in the stem and in the cup compared with the contralateral side. We compared the measurements made by an orthopaedic surgeon with the measurements made by a radiologist.

    Results:

    The leg lengthening was located in the stem while the FO reduction was located in both the stem and cup, for the two observers. For observer 1, the mean stem length of the operated side was 57.7 mm vs. 50.9 mm, p=0.003, while the mean cup length of the operated side was 19.0 mm vs. 18.9, p=0.95. For observer 2, the mean stem length of the operated side was 59.5 mm vs. 50.9 mm, p=0.001, while the mean cup length of the operated side was 18.2 mm vs. 18.8, p=0.90. The global FO reduction was located both in the stem and cup for the two observers. For observer 1, the mean stem offset of the operated side was 49.2 mm vs. 57.1 mm, p<0.001, while the mean cup offset of the operated side was 35.1 mm vs. 39.9, p<0.001. For observer 2, the mean stem offset of the operated side was 48.9 mm vs. 55.1mm, p<0.001, while the mean cup offset of the operated side was 35.5mm vs. 40.4mm, p<0.001. Both interobserver reliability and intraobserver reproducibility were substantial to excellent (ICC ≥ 0.79).

    Conclusion:

    Post THA 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 observations in order to avoid them.

  • 12.
    Mahmood, Sarwar
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Sundsvall and Norrland University Hospitals.
    Mukka, Sebastian S
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Sundsvall and Norrland University Hospitals.
    Crnalic, Sead
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Sundsvall and Norrland University Hospitals.
    Sayed-Noor, Arkan S
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Sundsvall and Norrland University Hospitals.
    The Influence of Leg Length Discrepancy after Total Hip Arthroplasty on Function and Quality of Life: A Prospective Cohort Study2015In: The Journal of Arthroplasty, ISSN 0883-5403, E-ISSN 1532-8406, Vol. 30, no 9, 1638-1642 p.Article in journal (Refereed)
    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.

  • 13.
    Mahmood, Sarwar S
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Al-Amiry, Bariq
    Department of Radiology, Karolinska University Hospital-Huddinge, Stockholm, Sweden.
    Mukka, Sebastian S
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Sundsvall and Norrland University Hospitals.
    Baea, Saida
    Department of Radiology, Sundsvall Teaching Hospital, Sundsvall, Sweden.
    Sayed-Noor, Arkan S
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Department of Orthopaedics, Sundsvall Teaching Hospital, Sundsvall, Sweden .
    Validity, reliability and reproducibility of plain radiographic measurements after total hip arthroplasty2015In: Skeletal Radiology, ISSN 0364-2348, E-ISSN 1432-2161, Vol. 44, no 3, 345-351 p.Article in journal (Refereed)
    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.

  • 14.
    Mahmood, Sarwar S.
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Mukka, Sebastian S.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics. Sundsvall and Norrland University Hospitals.
    Crnalic, Sead
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Wretenberg, Per
    Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
    Sayed-Noor, Arkan S.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics. Sundsvall and Norrland University Hospitals.
    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 patients2016In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 87, no 1, 36-41 p.Article in journal (Refereed)
    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.

  • 15.
    Mukka, Sebastian
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Berg, Gustaf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Hassany, Hamid R. Haj
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Koye, Alan K.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Sjödén, Göran
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Sayed-Noor, Arkan S.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Semiconstrained total elbow arthroplasty for rheumatoid arthritis patients: clinical and radiological results of 1-8 years follow-up2015In: Archives of Orthopaedic and Trauma Surgery, ISSN 0936-8051, E-ISSN 1434-3916, Vol. 135, no 5, 595-600 p.Article in journal (Refereed)
    Abstract [en]

    We investigated whether the Discovery total elbow arthroplasty (TEA) system had good results and survival in rheumatoid arthritis (RA) patients. In a prospective cohort study, one elbow surgeon performed TEA on 25 consecutive RA patients (31 elbows) between December 2004 and November 2012 using the Discovery system. We evaluated the preoperative elbow range of motion (ROM), functional outcome with QuickDash and quality of life with EQ-5D. An independent colleague evaluated the same parameters 1-8 years (mean 4.5) postoperatively. The medical records of the follow-up visits for the study period were available for review. A complete set of results was available for 19 patients (25 elbows). The mean ROM improved in flexion/extension from 88A degrees (SD 27) to 113A degrees (SD 19) and in pronation/supination from 55A degrees (SD 28) to 68A degrees (SD 22) (p < 0.05). The mean QuickDash also improved from 66.5 (SD 25.7) to 40.2 (SD 24) (p < 0.01). The mean EQ-5D improved from 0.68 (SD 0.2) to 0.75 (SD 0.13) but was not statistically significant (p = 0.09). Three patients were revised because of loosening, 2 more patients were re-operated. This resulted in a Kaplan-Meier survival of 90 % (CI 72-97) for the study period. The Discovery system has shown satisfactory results in RA patients even if the rate of complication remained relatively high. Further follow-up is required to investigate the radiological changes observed in some of our patients.

  • 16.
    Mukka, Sebastian
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Chammout, Ghazi
    Sayed-Noor, Arkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Sköldenberg, Olof
    External validity of a randomized controlled trial in patients with femoral neck fractureManuscript (preprint) (Other academic)
    Abstract [en]

    Background: Randomized clinical trials (RCT) are the most reliable way to evaluate theeffect of treatments by comparing them to previously accepted treatment regimes. The resultsobtained from a RCT are extrapolated from the study environment to the general health caresystem. This parameter is called external validity. The present study we sought to evaluatethe external validity of an RCT comparing the results of total hip arthroplasty tohemiarthroplasty in displaced femoral neck fracture in patients 80 years of age and above.

    Methods: In a prospective cohort study, 267 patients (76% females, mean age 87 [SD] 4.7years) were included in the cohort study. All were screened according to the inclusion andexclusion criteria to be included in a RCT comparing total hip arthroplasty andhemiarthoplasty. Those who gave their informed consent and were randomized (RCT group,92 patients), those that were asked to participate in the RCT but would not give theirinformed consent (Non-consenters group, 54 patients) and all patients missed in the screeningprocess (Missed screening group, 121 patients). The primary end point was hip functionevaluated with Harris hip score at 1 year. Secondary end points included quality-of-lifeevaluated with EQ-5D mortality and hip re-operations. Follow up was performed at 1 yearpostoperatively by a mailed survey including patient reported outcome.

    Results: We did not find any difference between the groups regarding HHS and EQ-5D, alsowhen adjusting for confounders. There was a statistically significant difference between thethree groups (p=0.047) as the Non-consenter group had a higher risk of death than thoseincluded (HR 2.06, 95% Cl 1.13 to 3.75). The rate of reoperation was lower in the MS groupcompared to the RCT and NC groups (4.1% vs 7.6% vs 9.3%). This difference did not reachstatistical significance when adjusting for confounders

    Interpretation: This cohort study indicates a higher mortality rate but comparable hip functionand quality-of-life among eligible non-consenters compared to eligible consenters whenevaluating the external validity of a RCT patients with femoral neck fracture age 80 andabove.

  • 17.
    Mukka, Sebastian
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Hassany, Hamid H.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Sayed-Noor, Arkan S.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Geometrical restoration and component positioning after hip arthroplasty for femoral neck fracture2016In: Acta Orthopaedica Belgica, ISSN 0001-6462, Vol. 82, no 3, 557-562 p.Article in journal (Refereed)
    Abstract [en]

    In this study, the restoration of leg length and global femoral offset and positioning of the femoral stem and acetabular cup of hemiartroplasty (HA) and total hip arthroplasty (THA) after femoral neck fracture (FNF) were compared at the postoperative radiographs between 181 hips operated using the direct lateral (DL) approach and 127 hips operated using the posterolateral (PL) approach. Regarding HA, the DL approach was associated with lengthening of the operated leg (5.7 mm vs. 2.1 mm), p = 0.001. The PL approach had more varus stem position (23% vs. 12%, p = 0.03) and the DL approach had more stems with C-position (58% vs. 32%, p = 0.001). Regarding THA, the DL approach showed increased cup anteversion (28 degrees vs. 21 degrees), p = 0.016, and a decrease in FO (-5.9 mm vs. -2.0 mm, p = 0.04). Surgeons caring for FNF patients are to be aware of the differences in geometrical restroration and component positioning between the two approaches.

  • 18.
    Mukka, Sebastian
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Hand Surgery.
    Knutsson, Björn
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Krupic, Ferid
    Sayed-Noor, Arkan S.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    The influence of cognitive status on outcome and walking ability after hemiarthroplasty for femoral neck fracture: a prospective cohort study2017In: European Journal of Orthopaedic Surgery & Traumatology, ISSN 1633-8065, E-ISSN 1432-1068, Vol. 27, no 5, 653-658 p.Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Femoral neck fracture (FNF) is a devastating injury with serious medical and social consequences. One-third of these patients have some degree of impaired cognitive status. Despite this, a high proportion of hip fracture trials exclude patients with cognitive impairment (CI). We aimed to evaluate whether moderate to severe CI could predict walking ability, quality of life, functional outcome, reoperations and mortality in elderly patients with displaced FNF treated with hemiarthroplasty (HA).

    METHODS: This cohort study included a consecutive series of 188 patients treated with HA for a displaced FNF. Patients were assessed for estimated preoperative and 1 year postoperatively with regard to walking ability, cognitive status, quality of life with EQ-5D and hip function with Harris hip score.

    RESULTS: There were 188 patients who met the inclusion criteria. A total of 130 patients were in the control group, and 58 were in the CI group. At 1-year follow-up, 31 patients (24%) had died in the control group and 22 patients (38%) had died in the cognitive impaired group. This difference in reoperation and mortality rate was statistically significant (log-rank test, p = 0.016). The CI had a significantly higher incidence of being non-walker (28 vs. 4%, OR 9.2, p = 0.001). The EQ-5D was higher in the control group, while the Harris hip score was comparable in the two groups.

    CONCLUSIONS: Moderate to severe CI was associated with a high incidence of non-walking ability, worse quality of life, high mortality and re-operation rate after femoral neck fractures treated with HA.

  • 19.
    Mukka, Sebastian
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Knutsson, Björn
    Majeed, Ammar
    Sayed-Noor, Arkan S
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Reduced revision rate and maintained function after hip arthroplasty for femoral neck fractures after transition from posterolateral to direct lateral approach.2017In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, 1-7 p.Article in journal (Refereed)
    Abstract [en]

    Background and purpose - The direct lateral (DL) approach to the hip for femoral neck fractures (FNF) has been shown to reduce the rate of dislocation and reoperations. We evaluate the effect of transition from the posterolateral (PL) to DL approach on reoperation and dislocation rates and patients' reported outcome. Patients and methods - In a prospective cohort study between 2012 and 2015, we enrolled 362 patients (median age 83 years, 70% women, mean follow-up 25 months) with a displaced FNF. The first group of 146 patients were operated using the PL and the second group of 216 patients with a DL approach, after change of our routines. A multivariable Cox regression analysis was used to evaluate factors associated with dislocation and reoperation. A generalized linear model was used to evaluate the functional outcome by comparing WOMAC and Harris hip scores between the 2 groups. Results - The reoperation rate was reduced from 13% in the PL to 6% in the DL group and the dislocation rate from 13% to 4%. Cox proportional hazard analysis identified the PL approach as the only factor associated with an increased risk of reoperation (hazard ratio =2.5, 95% CI 1.2-5.2). Age, sex, ASA classification, type of arthroplasty, cognitive dysfunction, or the experience of the surgeon had no effect on the risk of reoperation. Patient-reported outcome was similar between the 2 groups. Interpretation - In patients with FNF we have reduced the reoperation and dislocation rates by changing the surgical approach used for hip arthroplasty without affecting the patient-reported functional outcome.

  • 20.
    Mukka, Sebastian
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Lindqvist, Jenny
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Peyda, Sara
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Broden, Cyrus
    Mahmood, Sarwar
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Hassany, Hamid
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Sayed-Noor, Arkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Dislocation of bipolar hip hemiarthroplasty through a postero-lateral approach for femoral neck fractures: A cohort study2015In: International Orthopaedics, ISSN 0341-2695, E-ISSN 1432-5195, Vol. 39, no 7, 1277-1282 p.Article in journal (Refereed)
    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.

  • 21.
    Mukka, Sebastian
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Mahmood, Sarwar
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Kadum, Bakir
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Sköldenberg, O
    Sayed-Noor, Arkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Direct lateral vs posterolateral approach to hemiarthroplasty for femoral neck fractures2016In: Orthopaedics & Traumatology: Surgery & Research, ISSN 1877-0568, E-ISSN 1877-0568, Vol. 102, no 8, 1049-1054 p.Article in journal (Refereed)
    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.

  • 22.
    Mukka, Sebastian
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Mahmood, Sarwar
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Kadum, Bakir
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Sköldenberg, Olof
    Sayed-Noor, Arkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Direct lateral versus posterolateral approach to hip hemiarthroplasty for femoral neck fractures: a prospective cohort studyArticle in journal (Refereed)
    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.

  • 23.
    Mukka, Sebastian
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Mahmood, Sarwar
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Sjödén, Göran
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Sayed-Noor, Arkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Dual mobility cups for preventing early hip arthroplasty dislocation in patients at risk: experience in a county hospital2013In: Orthopedic Reviews, ISSN 2035-8237, E-ISSN 2035-8164, Vol. 5, no 10, 48-51 p.Article in journal (Refereed)
    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.

  • 24.
    Mukka, Sebastian
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Mellner, Carl
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Knutsson, Bjorn
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Sayed-Noor, Arkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Skoldenberg, Olof
    Substantially higher prevalence of postoperative periprosthetic fractures in octogenarians with hip fractures operated with a cemented, polished tapered stem rather than an anatomic stem A prospective cohort study involving 979 hips2016In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 87, no 3, 257-261 p.Article in journal (Refereed)
    Abstract [en]

    Background and purpose - Recent studies have demonstrated a high incidence of postoperative periprosthetic femoral fracture (PPF) in elderly patients treated with 2 commonly used cemented, polished tapered stems. We compared the prevalence and incidence rate of PPF in a consecutive cohort of octagenerians with femoral neck fractures (FNFs) treated with either a collarless, polished tapered (CPT) stem or an anatomic matte stem (Lubinus SP2). Patients and methods - In a multicenter, prospective cohort study, we included 979 hips in patients aged 80 years and above (72% females, median age 86 (80-102) years) with a femoral neck fracture as indication for surgery. 69% of the patients were classified as ASA class 3 or 4. Hip-related complications and repeat surgery were assessed at a median follow-up of 20 (0-24) months postoperatively. Results - 22 hips (2.2%) sustained a PPF at a median of 7 (0-22) months postoperatively; 14 (64%) were Vancouver B2 fractures. 7 of the 22 surgically treated fractures required revision surgery, mainly due to deep infection. The cumulative incidence of PPFs was 3.8% in the CPT group, as compared with 0.2% in the SP2 group (p < 0.001). The risk ratio (RR) was 16 (95% CI: 2-120) using the SP2 group as denominator. Interpretation - The CPT stem was associated with a higher risk of PPF than the SP2 stem. We suggest that the tapered CPT stem should not be used for the treatment of femoral neck fractures in patients over 80 years.

  • 25.
    Mukka, Sebastian S
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Sayed-Noor, Arkan S
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    An update on surgical approaches in hip arthoplasty: lateral versus posterior approach2014In: HIP International, ISSN 1120-7000, E-ISSN 1724-6067, Vol. 24, no Supplement 10, S7-S11 p.Article, review/survey (Refereed)
    Abstract [en]

    In this update we searched the literature about the outcome of the lateral versus posterior approach in hip arthoplasty for osteoarthritis (OA) and femoral neck fracture (FNF) patients. The available evidence shows that the use of posterior approach in OA patients is associated with lower mortality and better functional outcome while the use of lateral approach in FNF patients gives lower dislocation rate. We recommend therefore the use of posterior approach in OA patients and lateral approach in FNF patients.

  • 26. Per-Henrik, Ågren
    et al.
    Mukka, Sebastian
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics. Orthopaedics Sundsvall.
    Tullberg, Tycho
    Wretenberg, Per
    Sayed-Noor, Arkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics. Orthopaedics Sundsvall.
    Factors affecting long-term treatment results of displaced intraarticular calcaneal fractures: a post hoc analysis of a prospective, randomized, controlled multicenter trial2014In: Journal of Orthopaedic Trauma, ISSN 0890-5339, E-ISSN 1531-2291, Vol. 28, no 10, 564-568 p.Article in journal (Refereed)
    Abstract [en]

    Objectives: To study the factors affecting long-term treatment results of displaced intraarticular calcaneal fractures (DIACFs). Design: A post hoc analysis. Settings: Tertiary care teaching hospitals. Patients: Eight to twelve years of results from a randomized controlled multicenter trial of operative versus nonoperative treatment (n = 56) were divided into 2 groups: the superior 50% results (n = 28) and the inferior 50% results (n = 28), regardless of the treatment given. The determinant of this division was a visual analog score for pain and function. Interventions: The operative treatment consists of open reduction and internal fixation, whereas the nonoperative treatment consists of nonweight bearing and early range of motion exercise. Main Outcome Measurements: A visual analog score for pain and function, the short-form 36 (SF-36) general health outcome questionnaire, the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scale, and Olerud-Molander score. We compared age, sex, fracture type (Sanders classification), treatment given, Böhler angle, residual articular surface step-off at healing, type of occupation, and injury insurance between the 2 groups. Results: Patients of the superior group had higher physical SF-36, AOFAS, and Olerud-Molander score than in the inferior group. Operative treatment, better Böhler angle and articular surface restoration, light labor/retirement, and absence of injury insurance were more common in the superior group. Age, sex, pretreatment Böhler angle, and fracture type were comparable in the superior and inferior groups. Conclusions: The decision making for definitive treatment of intraarticular calcaneal fractures is multifactorial with a spectrum of results and trends such as patient demographic features that should be considered in choosing the best treatment option.

  • 27.
    Sayed-Noor, Arkan S.
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Hanas, Aleksandra
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Sköldenberg, Olof G.
    Mukka, Sebastian S.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Abductor Muscle Function and Trochanteric Tenderness After Hemiarthroplasty for Femoral Neck Fracture2016In: Journal of Orthopaedic Trauma, ISSN 0890-5339, E-ISSN 1531-2291, Vol. 30, no 6, e194-e200 p.Article in journal (Refereed)
    Abstract [en]

    Objectives: To compare the abductor muscle function and trochanteric tenderness in patients operated with hemiarthroplasty using the direct lateral (DL) or posterolateral (PL) approach for displaced femoral neck fracture.Design:Prospective cohort study. Setting: A secondary teaching hospital.Participants:We enrolled 183 hips operated with hemiarthroplasty for displaced femoral neck fracture using the DL or PL approach. Interventions: Preoperatively, we evaluated the Harris hip score (HHS) and European Quality of Life-5 Dimensions (EQ-5D). At 1 year postoperatively, lucid patients were clinically examined to evaluate the Trendelenburg sign, abductor muscle strength with a dynamometer, and trochanteric tenderness with an electronic algometer. The 1-year HHS and EQ-5D were documented. Main Outcome Measures: The primary outcome was the incidence of postoperative Trendelenburg sign, whereas the secondary outcomes included patients' reported limp, abductor muscle strength, trochanteric tenderness, HHS, and EQ-5D. Results: There were 48 patients (24 in the DL group and 24 in the PL group) who attended the 1-year clinical follow-up. The 2 groups were comparable (P > 0.05). The DL group showed a higher incidence of the Trendelenburg sign (9/24 vs. 1/24, P = 0.02) and limp (12/24 vs. 2/24, P = 0.004). Further analysis with logistic regression showed the surgical approach to be the only factor that resulted in the increment. No differences regarding HHS, EQ-5D, abductor muscle strength, algometer pressure pain threshold, and radiologic measurements were found (P > 0.05). Conclusions: The incidence of the Trendelenburg sign and limp were significantly higher in the DL approach although this seemed not to influence abductor muscle strength or the incidence of trochanteric tenderness or compromise the clinical outcome. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

  • 28.
    Wadsten, Mats A
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Sayed-Noor, Arkan S
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Englund, E
    Department of Research and development. Sundsvall Hospital.
    Buttazzoni, GG
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Sjödén, Göran O
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Cortical comminution in distal radial fractures can predict the radiological outcome2014In: The Bone & Joint Journal, ISSN 2049-4394, E-ISSN 2049-4408, Vol. 96B, no 7, 978-983 p.Article in journal (Refereed)
    Abstract [en]

    This paper investigates whether cortical comminution and intra-articular involvement can predict displacement in distal radius fractures by using a classification that includes volar comminution as a separate parameter. A prospective multicentre study involving non-operative treatment of distal radius fractures in 387 patients aged between 15 and 74 years (398 fractures) was conducted. The presence of cortical comminution and intra-articular involvement according to the Buttazzoni classification is described. Minimally displaced fractures were treated with immobilisation in a cast while displaced fractures underwent closed reduction with subsequent immobilisation. Radiographs were obtained after reduction, at 10 to 14 days and after union. The outcome measure was re-displacement or union. In fractures with volar comminution (Buttazzoni type 4), 96% (53 of 55) displaced. In intra-articular fractures without volar comminution (Buttazzoni 3), 72% (84 of 117) displaced. In extra-articular fractures with isolated dorsal comminution (Buttazzoni 2), 73% (106 of 145) displaced while in non-comminuted fractures (Buttazzoni 1), 16 % (13 of 81) displaced. A total of 32% (53 of 165) of initially minimally displaced fractures later displaced. All of the initially displaced volarly comminuted fractures re-displaced. Displacement occurred in 31% (63 of 205) of fractures that were still in good alignment after 10 to 14 days. Regression analysis showed that volar and dorsal comminution predicted later displacement, while intra-articular involvement did not predict displacement. Volar comminution was the strongest predictor of displacement.

  • 29.
    Wadsten, Mats Å
    et al.
    Department of Orthopaedic Surgery. Sundsvall Hospital.
    Sayed-Noor, Arkan S
    Department of Orthopaedic Surgery. Sundsvall Hospital.
    Sjödén, Göran O
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Svensson, Olle
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Buttazzoni, Gunnar G
    Department of Orthopaedic Surgery. Östersund Hospital.
    The Buttazzoni Classification of Distal Radial Fractures in Adults: interobserver and Intraobserver Reliability2009In: Hand, ISSN 1558-9447, Vol. 4, no 3, 283-288 p.Article in journal (Refereed)
    Abstract [en]

    Despite the fact that distal radial fracture is the commonest fracture, there is a little evidence-based knowledge about the value of its classification to guide management and predict prognosis. The available classification systems are either complicated or weakly applicable in clinical practice. Older's classification is the most reliable, but does not cover all radial fracture types. We evaluated the interobserver and intraobserver reliability of a new classification system which is a modification of Older's classification covering all radial fracture types. Two hundred and thirty-two consecutive adult patients with acute distal radial fractures were blindly evaluated according to the new classification by three orthopedic surgeons twice with 1-year interval. The interobserver reliability was measured using the Fleiss kappa coefficient, and the intraobserver reliability was measured using the Cohen's kappa coefficient. The new classification showed fair to substantial interobserver and intraobserver reliability, i.e., results comparable to the reliability of commonly used classification systems. The reliability was better for younger patients and when evaluation was carried out by hand-surgery-interested orthopedic surgeons. The new classification system is simple, covers all radial fracture types, and has an acceptable reliability. Further studies are needed to judge its ability to direct management and predict prognosis.

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