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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, article id 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.

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  • 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, p. 56-59Article 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, p. 1125-1131, article id 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.
    Al-Amiry, Bariq
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Pantelakis, Georgios
    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
    Brismar, Torkel B.
    Sayed-Noor, Arkan S.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Does body mass index affect restoration of femoral offset, leg length and cup positioning after total hip arthroplasty?: a prospective cohort study2019In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 20, article id 422Article in journal (Refereed)
    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.

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  • 5.
    Al-Amiry, Bariq
    et al.
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Sweden.
    Rahim, Andreas
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Sweden.
    Knutsson, Björn
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Mattisson, Leif
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Sweden.
    Sayed-Noor, Arkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Kinesiophobia and its association with functional outcome and quality of life 6-8 years after total hip arthroplasty2022In: Acta Orthopaedica et Traumatologica Turcica, ISSN 1017-995X, Vol. 56, no 4, p. 252-255Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to assess the incidence and severity of kinesiophobia, and to determine the relationship between Tampa Scale of Kinesiophobia (TSK) scores, functional outcome and quality of life (QoL) 6-8 years after Total Hip Arthroplasty (THA).

    Methods: 161 patients (78 male and 83 female) with unilateral primary osteoarthritis (OA) treated with THA between September 2010 and December 2013 were included in this study. Western Ontario and McMaster Universities Osteoarthritis (WOMAC) and EQ-5D scores were measured preoperatively. At 6-8 years follow-up, these scores were repeated and TSK scores were also measured. According to the TSK, patients were divided into two groups for further comparisons and analysis: without kinesiophobia (TSK-score ≤ 36) and with kinesiophobia (TSK-score >36).

    Results: There were 99 patients (61.5%) with no kinesiophobia (TSK score ≤ 36, TSK mean 28.4, SD 4.7) and 62 patients (38.5%) with kinesiophobia (TSK score > 36, TSK mean 42.8, SD 5.3). Patients with and without kinesiophobia were not statistically different regarding age, sex or body mass index. (P = 0.20, P = 0.99, P = 0.22, respectively). In the group with no kinesiophobia, the mean 6-8 years WOMAC was 12.4 (SD 15.6), while the absolute delta (Δ) value between preoperative and 6-8 years WOMAC was 46.2 (SD 20.4), compared to the group with kinesiophobia where the mean 6-8 years WOMAC was 32.2 (SD 23.4), while the absolute delta (Δ) value between preoperative and 6-8 years WOMAC was 32.3 (SD 25.5): both P < 0.001. The group with no kinesiophobia had a mean 6-8 years EQ-5D of 0.81 (SD 0.22), while the absolute delta (Δ) value between preoperative and 6-8 years EQ-5D was 0.44 (SD 0.26), compared to the group with kinesiopho-bia where the mean 6-8 years EQ-5D was 0.57 (SD 0.23), while the absolute delta (Δ) value between preoperative and 6-8 years EQ-5D was 0.33 (SD 0.26): P < 0.001 and P = 0.03, respectively. TSK scores were associated with worse WOMAC and EQ-5D scores, higher proportion of dependence on walking aids and increased THArelated adverse events (all P < 0.05).

    Conclusion: This study has shown us that there is a high incidence of kinesiophobia 6-8 years after surgery and treating kinesiophobia early after THA might improve the outcome.

    Level of Evidence: Level IV, Therapeutic Study.

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  • 6.
    Al-Amiry, Bariq Sh.
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Gaber, John F.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Kadum, Bakir K.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Brismar, Torkel B.
    Sayed-Noor, Arkan S.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    The Influence of Radiological Severity and Symptom Duration of Osteoarthritis on Postoperative Outcome After Total Hip Arthroplasty: A Prospective Cohort Study2018In: The Journal of Arthroplasty, ISSN 0883-5403, E-ISSN 1532-8406, Vol. 33, no 2, p. 436-440Article in journal (Refereed)
    Abstract [en]

    Background: We aimed to investigate the influence of preoperative radiological severity and symptom duration of hip osteoarthritis (OA) on the postoperative functional outcome, quality of life, as well as abductor muscle strength after total hip arthroplasty (THA). Methods: In this prospective cohort study, we studied 250 patients. Preoperatively, we evaluated the function with the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and quality of life with euroqol-5D (EQ-5D). At 1 year after THA, the same scores and also hip abductor muscle strength were measured in 222 patients. We divided the cohort twice, first according to the radiological OA severity [Kellgren-Lawrence classification (KL)] and then according to the OA symptom duration. We investigated whether the preoperative KL class and symptom duration influenced the 1-year WOMAC (primary outcome measure) or EQ-5D and abductor muscle strength (secondary outcome measures). Results: The crude results showed that KL class and symptom duration had no influence (P = .90 and P = .20, respectively) on the 1-yearWOMAC. Younger age, male gender, and lower body mass index were associated with a better function. Regarding 1-year EQ-5D, the crude results showed that body mass index and KL class had no influence (P = .83 and P = .39, respectively). The adjusted results showed that only age and gender influenced the postoperative EQ-5D. No influence of the tested factors was found on the 1-year abductor muscle strength. Conclusion: Preoperative radiological OA severity and symptom duration had no influence on the outcome of THA and should probably not affect the decision about timing the operative intervention. 

  • 7.
    Aldin, Z.
    et al.
    Radiology Department, Princess Alexandra NHS Trust, Hamstel Road, Harlow, Essex, United Kingdom.
    Diss, J.K.
    Radiology Department, Princess Alexandra NHS Trust, Hamstel Road, Harlow, Essex, United Kingdom.
    Mahmood, H.
    Imaging Department, Chelsea and Westminster Hospital NHS Foundation Trust, Chelsea and Westminster Hospital, Chelsea, London, United Kingdom.
    Sadik, T.
    Orthopaedic/Spinal Surgery Department, Princess Alexandra NHS Trust, Hamstel Road, Harlow, Essex, United Kingdom.
    Basra, H.
    Radiology Department, Princess Alexandra NHS Trust, Hamstel Road, Harlow, Essex, United Kingdom.
    Ahmed, M.
    Orthopaedic/Spinal Surgery Department, Princess Alexandra NHS Trust, Hamstel Road, Harlow, Essex, United Kingdom.
    Danawi, Z.
    Department of Trauma and Orthopaedics, Southend University Hospital, Southend, Essex, United Kingdom.
    Gul, A.
    Orthopaedic/Spinal Surgery Department, Princess Alexandra NHS Trust, Hamstel Road, Harlow, Essex, United Kingdom.
    Sayed-Noor, A.S
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics. Clinical Sciences Department, College of Medicine, University of Sharjah, United Arab Emirates.
    Long-term effectiveness of transforaminal anterolateral approach CT-guided cervical epidural steroid injections for cervical radiculopathy treatment2024In: Clinical Radiology, ISSN 0009-9260, E-ISSN 1365-229XArticle in journal (Refereed)
    Abstract [en]

    Aim: To evaluate the long-term clinical effectiveness of computed tomography (CT)-guided transforaminal cervical epidural steroid injection using an anterolateral approach for the treatment of cervical radiculopathy (CR) using well-established robust clinical scoring systems for neck pain and neck disability. Despite its widespread use, evidence to support the long-term benefit of routine cervical epidural steroid injection is currently very limited.

    Materials and methods: This study included 113 patients with magnetic resonance imaging (MRI)-confirmed CR who underwent a steroid injection at a single cervical level via a unilateral transforaminal anterolateral approach. Pain was assessed quantitatively at pre-injection, 15 minutes post-injection, 1 month, 3 months, and at 1 year. Neck disability was assessed using the Oswestry Neck Disability Index (NDI) at pre-injection, 1 month, 3 months, and 1 year time points.

    Results: Eighty patients completed the study. Sixty per cent reported reduced neck pain (mean pain reduction, 55%), which was clinically significant in 45% cases. Furthermore, 66% reported an improvement in neck disability (mean improvement, 51%), which was clinically significant for 56% patients. Clinically significant good outcomes in both neck pain and neck disability were evident from as early as 1-month, and importantly, were independent both of pre-treatment CR characteristics (including severity of pre-injection neck pain or disability) and of findings on pre-injection MRI imaging.

    Conclusion: Transforaminal anterolateral approach CT-guided epidural steroid injection resulted in a clinically significant long-term improvement in both neck pain and disability for half of the present cohort of patients with unilateral single-level CR. This improvement was independent of the severity of the initial symptoms and pre-injection MRI findings.

  • 8. 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, p. 138-143Article 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.

  • 9.
    Farhang, Mehdy
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Mukka, Sebastian
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Bergström, Ulrica
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Svensson, Olle
    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.
    The trend of radiological severity of hip fractures over a 30 years period: a cohort study2019In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 20, no 1, article id 358Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Despite advances in operative techniques and preoperative care, proximal femur fractures (PFF) still represent a great public health problem. Displacement and fracture stability have been assumed as important determinants of treatment modality and outcome in such fractures. Purpose of this study was to determine whether the radiological severity of PFF fractures has increased over time.

    METHODS: In a cohort study, the plain radiographs of all patients with PFF aged over 50 years who were admitted to Umeå University Hospital in 1981/82, 2002 and 2012 were recruited to examine the types of fractures.

    RESULTS: The ratio of undisplaced to displaced femoral neck (FN) fractures was 30 to 70% in 1981/82, 28 to 72% in 2002 and 25 to 75% in 2012. The ratio of stable to unstable intertrochanteric (IT) fractures was 64 to 36% in 1981/82, 68 to 32% in 2002 and 75 to 25% in 2012. The ratio of simple to comminute subtrochanteric fractures was 35 to 65% in 1981/82, 16 to 84% in 2002 and 12 to 88% in 2012. In both FN and IT fractures we found no statistical difference among these 3 study periods, p = 0.67 and p = 0.40. In subtrochanteric fractures we saw a tendency towards more comminute subtrochanteric fractures (1981/82 to 2012), p = 0.09.

    CONCLUSIONS: We found no significant increment in the radiological severity of FN and IT over a 30 years' period. However, there was tendency towards an increase in comminute subtrochanteric fractures.

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  • 10.
    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 hips2018In: European Journal of Orthopaedic Surgery & Traumatology, ISSN 1633-8065, E-ISSN 1432-1068, Vol. 28, no 1, p. 45-50Article 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.

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  • 11. Kadum, B.
    et al.
    Inngul, C.
    Ihrman, R.
    Sjödén, Göran O.
    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.
    Higher preoperative sensitivity to pain and pain at rest are associated with worse functional outcome after stemless total shoulder arthroplasty: a prospective cohort study2018In: The Bone & Joint Journal, ISSN 2049-4394, E-ISSN 2049-4408, Vol. 100B, no 4, p. 480-484Article in journal (Refereed)
    Abstract [en]

    Aims: The aims of this study were to investigate any possible relationship between a preoperative sensitivity to pain and the degree of pain at rest and on exertion with postoperative function in patients who underwent stemless total shoulder arthroplasty (TSA). Patients and Methods: In this prospective study, we included 63 patients who underwent stemless TSA and were available for evaluation one year postoperatively. There were 31 women and 32 men; their mean age was 71 years (53 to 89). The pain threshold, which was measured using a Pain Matcher (PM) unit, the degree of pain (visual analogue scale at rest and on exertion, and function using the short version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), were recorded preoperatively, as well as three and 12 months postoperatively. Results: We found an inverse relationship between both the preoperative PM threshold and pain (VAS) at rest and the 12-month postoperative QuickDASH score (Pearson correlation coefficient (r) >= 0.4, p < 0.05). A linear regression analysis showed that the preoperative PM threshold on the affected side and preoperative pain (VAS) at rest were the only factors associated with the QuickDASH score at 12 months. Conclusion: These findings indicate the importance of central sensitization in the restoration of function after TSA. Further studies are required to investigate whether extra analgesia and rehabilitation could influence the outcome in at risk patients.

  • 12.
    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, p. 751-758Article 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.

  • 13.
    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, p. 1001-1006Article 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.

  • 14.
    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, p. 363-368Article 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.

  • 15.
    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, p. E285-E294Article 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.

  • 16.
    Kenanidis, Eustathios
    et al.
    Academic Orthopaedic Unit, Aristotle University Medical School, Thessaloniki, Greece.
    Kakoulidis, Panagiotis
    Academic Orthopaedic Unit, Aristotle University Medical School, Thessaloniki, Greece.
    Tsiridis, Eleftherios
    Academic Orthopaedic Unit, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, Greece.
    Atilla, Bülent
    Faculty of Medicine, Hacettepe University, Ankara, Turkey.
    Bicanic, Goran
    Al Zahra Hospital Dubai, Dubai, United Arab Emirates.
    Sulje, Zoran
    Department of Orthopaedic Surgery and Traumatology, University Hospital Centre Zagreb, Zagreb, Croatia.
    Delimar, Domagoj
    University of Zagreb, School of Medicine, Zagreb, Croatia; Department of Orthopaedic Surgery, University Hospital Centre Zagreb, Zagreb, Croatia.
    Bondarenko, Stanislav
    Department of Joint Pathology, Sytenko Institute of Spine and Joint Pathology, Kharkiv, Ukraine.
    Filippenko, Volodymyr
    Department of Joint Pathology, Sytenko Institute of Spine and Joint Pathology, Kharkiv, Ukraine.
    Akonjom, Mandus
    Department of Joint Pathology, Sytenko Institute of Spine and Joint Pathology, Kharkiv, Ukraine.
    Csernátony, Zoltán
    Department of Orthopaedic Surgery, University of Debrecen, Debrecen, Hungary.
    Huszanyik, Gergely
    Department of Traumatology, University of Debrecen, Debrecen, Hungary.
    Kiss, László
    Department of Orthopaedic Surgery, University of Debrecen, Debrecen, Hungary.
    Purcell, Richard L.
    Anderson Orthopaedic Research Institute, VA, Alexandria, United States; Walter Reed Military, Medical Center, MD, Bethesda, United States.
    Engh, Charles A.
    Anderson Orthopaedic Research Institute, VA, Alexandria, United States; Inova Mount Vernon Joint Replacement Center, VA, Alexandria, United States.
    Fujita, Hiroshi
    Department of Orthopaedic Surgery, Institute of Joint Replacement, Kyoto Katsuta Hospital, Kyoto, Japan.
    Meding, John B.
    The Center for Hip and Knee Surgery, St. Francis Hospital, IN, Mooresville, United States.
    Michael Keating, E.
    The Center for Hip and Knee Surgery, St. Francis Hospital, IN, Mooresville, United States.
    Sueyoshi, Tatsuya
    Kobe City Medical Center General Hospital, Kobe, Japan.
    Wretenberg, Per
    University Hospital Örebro, Örebro, Sweden.
    Mukka, Sebastian
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Khaled, Ahmad S.
    University College London Hospital, London, United Kingdom.
    Konan, Sujith
    Department of Trauma and Orthopaedics, University College Hospital, London, United Kingdom.
    Haddad, Fares S.
    University College London Hospital, London, United Kingdom.
    Gyorfi, Gyula
    Department of Orthopaedic Surgery, University of Debrecen, Debrecen, Hungary.
    Zhang, Lei
    Department of Orthopaedic Surgery, University of Debrecen, Debrecen, Hungary.
    Ranawat, Chitranjan S.
    Hospital for Special Surgery, NY, New York, United States.
    Gaudiani, Michael
    Department of Orthopedic Surgery, Hospital for Special Surgery, NY, New York, United States.
    Azboy, Ibrahim
    Department of Orthopaedic and Traumatology, Koşuyolu Medipol Hospital, Istanbul Medipol University, Istanbul, Turkey.
    Chen, Antonia F.
    Department of Orthopaedics, Harvard Medical School, MA, Boston, United States; Brigham and Women's Hospital, MA, Boston, United States.
    Rothman, Richard
    Rothman Institute, PA, Philadelphia, United States.
    Otten, Volker T C
    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.
    Carli, Alberto V.
    Hospital for Special Surgery, NY, New York, United States.
    Poultsides, Lazaros
    New York University School of Medicine, NY, New York, United States; Department of Orthopaedic Surgery, Division of Adult Reconstruction, New York Langone Orthopaedic Hospital, New York Langone Medical Center, NY, New York, United States.
    Jerabek, Seth A.
    Hospital for Special Surgery, NY, New York, United States; Weill Cornell Medical College, NY, New York, United States.
    Lampropoulou-Adamidou, Kalliopi
    Laboratory for the Research of Musculoskeletal System Th. Garofalidis, Medical School, University of Athens, General Hospital of Athens KAT, Athens, Greece.
    Hartofilakidis, George
    Laboratory for the Research of Musculoskeletal System Th. Garofalidis, Medical School, University of Athens, General Hospital of Athens KAT, Athens, Greece.
    Acetabular dysplasia2018In: The adult hip - master case series and techniques, Springer, 2018, p. 107-213Chapter in book (Refereed)
  • 17.
    Kenanidis, Eustathios
    et al.
    Academic Orthopaedic Unit, Aristotle University Medical School, Thessaloniki, Greece.
    Tzavellas, Anastasios Nektarios
    Academic Orthopaedic Unit, Aristotle University Medical School, Thessaloniki, Greece.
    Leonidou, Andreas
    Reading Shoulder Unit, Reading, United Kingdom.
    Tsiridis, Eleftherios
    Academic Orthopaedic Unit, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, Greece.
    Sayed-Noor, Arkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Kadum, Bakir
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Brabants, Karl
    ZNA Middelheim, Antwerp, Belgium.
    Mertens, Peter
    ZNA Middelheim, Antwerp, Belgium.
    Deleanu, Bogdan Nikolae
    Pius Branzeu Emergency Clinical County Hospital, Timisoara, Romania; Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
    Osteonecrosis2018In: The adult hip - master case series and techniques / [ed] Eleftherios Tsiridis, Springer, 2018, p. 303-326Chapter in book (Refereed)
  • 18.
    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.
    Sjödén, 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, p. 187-191Article 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.

  • 19.
    Knutsson, Björn
    et al.
    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.
    Wahlström, Jens
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Sayed-Noor, Arkan S.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    The association between tobacco smoking and surgical intervention for lumbar spinal stenosis: cohort study of 331,941 workers2018In: The spine journal, ISSN 1529-9430, E-ISSN 1878-1632, Vol. 18, no 8, p. 1313-1317Article in journal (Refereed)
    Abstract [en]

    BACKGROUND CONTEXT: Tobacco smoking is an injurious habit associated with a number of chronic disorders. Its influence on disc metabolism and degeneration including lumbar spinal stenosis (LSS) has been investigated in the literature.

    PURPOSE: We aimed to investigate whether tobacco smoking is an independent risk factor for undergoing surgical intervention for LSS.

    STUDY DESIGN/SETTING: This is a prospective cohort study.

    PATIENT SAMPLE: The patient sample of 331,941 workers was derived from a Swedish nationwide occupational surveillance program for construction workers.

    OUTCOME MEASURE: The outcome measure included the incidence of undergoing surgical intervention for LSS in tobacco smokers versus no smokers.

    MATERIALS AND METHODS: At inclusion, age, sex, body mass index (BMI), workers' job title, and self-reported smoking habits were registered. The workers were divided into four categories: never smoked, former smoker, moderate current (1-14 cigarettes/day), and heavy current (≥15 cigarettes/day). Patients who underwent a surgically treated LSS were defined using the relevant International Classification of Diseases (ICD) disease code derived from the Swedish National Patient Register.

    RESULTS: A total of 331,941 participants were included in the analysis. Forty-four percent of the participants were non-smokers, 16% were former smokers, 26% were moderate smokers, and 14% were heavy smokers. The vast majority of construction workers were males (95%). During the average follow-up of 30.7 years, 1,623 participants were surgically treated for LSS. The incidence rate ratio (IRRs) of LSS varied across smoking categories, with the highest values found in heavy smokers. Compared with non-smokers, all smoking categories show an increased incidence of surgically treated LSS. The findings were consistent even when the comparison was performed for participants with BMIs between 18.5 and 25 and for participants aged between 40 and 74 years.

    CONCLUSIONS: Tobacco smoking is associated with an increased incidence of surgically treated LSS. The effect seems to be dose related, whereby heavy smokers have a higher risk than moderate or former smokers.

  • 20.
    Krupic, Ferid
    et al.
    Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Samuelsson, Kristian
    Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Fatahi, Nabi
    Institute of health and care sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Skoldenberg, Olof
    Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Sayed-Noor, Arkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Migrant general practitioners' experiences of using interpreters in health-care: a qualitative explorative study2017In: Medicinski arhiv, ISSN 0350-199X, E-ISSN 1986-5961, Vol. 71, no 1, p. 42-47Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: According to the UNHCR, 250 million people currently live outside their country of birth. The growing multicultural population poses a major challenge to healthcare professionals who aim to provide individualized, holistic care, which respects the individual's autonomy. To ensure basic rights, healthcare interventions should be guided by the value of benefiting others; individuals should be treated honestly, equally, and impartially.

    OBJECTIVE: To investigate immigrant doctors' experiences of using interpreters in the Swedish health-care system.

    MATERIAL AND METHODS: Twenty-eight doctors, 12 men and 16 women from Bosnia and Herzegovina, Croatia, Macedonia and Serbia participated in four focus group interviews (FGI). The interviews were audio recorded, transcribed and analyzed using content analysis method.

    RESULTS: The best results in the present study were achieved in situations where a professional interpreter was involved. In some cases, the doctors were forced to use relatives or a colleague to interpret, which in many cases proved to be a mistake. The consequences of poor interpretation routines included payment by mistake, a patient paying an interpreter who refused to interpret, time spent waiting for another interpreter, as well as disturbances to the daily work schedule. Finding someone who could replace an interpreter who did not show up caused time shortage and increased stress.

    CONCLUSIONS: Improved routines and more effective cooperation between interpreting services and health-care centers are needed in order to ensure that using professional interpreters guarantees appropriate, high quality care. Improvements are needed to provide satisfactory health-care to people with limited language skills. In order to achieve this, better education of interpreters is needed, especially regarding cultural diversity and medical terminology. These improvements present complex challenges, deserving empirical and critical reflection in order to improve the work situation for doctors.

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  • 21. Krupic, Ferid
    et al.
    Sayed-Noor, Arkan S.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Fatahi, Nabi
    The impact of knowledge and religion on organ donation as seen by immigrants in Sweden2017In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 4, p. 687-694Article in journal (Refereed)
    Abstract [en]

    Background: Transplantation of organs is one of the most successful medical advances of the past 60 years and transplantation is the treatment of choice for severe organ failure worldwide. Despite this situation, and the general acknowledgement of organ donation as a global priority, demand for organs outstrips supply in virtually every country in the world. Aim: The aim of the study was to elucidate factors that influence immigrant's decisions regarding organ donation. Methods: Data were collected through three group interviews using open-ended questions and qualitative content analysis. 32 participants, 16 men and 16 women from Bosnia and Herzegovina, Somalia, Lebanon and Kosovo participated in focus group interviews (FGI). Results: Analysis of the collected data resulted in two main categories: Information about organ donation' and Religious aspects of organ donation and a number of subcategories'. Some of the influencing factors concerning organ donation were mainly related to limited information from society as well as limited information from healthcare professionals. Religious aspects, fear and prejudices about organ donation were other factors that mentioned by participants as hamper regarding organ donation. Conclusion: In order to improve immigrants' attitude towards organ donation, information about this issue and identification of the hampering factors, particularly culturally related factors such as the religious aspect, is essential. In this context, different intervention studies are needed to increase monitories groups' attitude towards organ donations.

  • 22.
    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, p. 1638-1642Article 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.

  • 23.
    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, p. 345-351Article 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.

  • 24.
    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, p. 36-41Article 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.

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  • 25.
    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, p. 595-600Article 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.

  • 26.
    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.

  • 27.
    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, p. 557-562Article 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.

  • 28.
    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, p. 653-658Article 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.

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  • 29.
    Mukka, Sebastian
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Knutsson, Björn
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Majeed, Ammar
    Sayed-Noor, Arkan S
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Reduced revision rate and maintained function after hip arthroplasty for femoral neck fractures after transition from posterolateral to direct lateral approach2017In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 88, no 6, p. 627-633Article 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.

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  • 30.
    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, p. 1277-1282Article 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.

  • 31.
    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, p. 1049-1054Article 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.

  • 32.
    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.
    Department of Orthopaedics at Danderyd Hospital and Karolinska Institute, Department of Clinical Sciences at Danderyd Hospital (KIDS), Stockholm, Sweden.
    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 fractures: [Voies d'abord directe latérale versus postéro-latérale dans les hémi-arthrosplasties pour fracture du col fémoral]2016In: Revue de Chirurgie Orthopedique et Traumatologique, ISSN 1877-0517, Vol. 102, no 8, p. 741-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 re-operation (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 re-operation rate.

    Type of study: Prospective cohort study.

    Level of proof: Level 2.

  • 33.
    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 vs posterolateral approach to hemiarthroplasty for femoral neck fractures2016In: Orthopaedics & Traumatology: Surgery & Research, ISSN 1877-0568, E-ISSN 1877-0568, Vol. 102, no 8, p. 1049-1054Article 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.

  • 34.
    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, p. 48-51Article 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.

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  • 35.
    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, p. 257-261Article 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.

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  • 36.
    Mukka, Sebastian
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Rolfson, Ola
    Mohaddes, Maziar
    Sayed-Noor, Arkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    The Effect of Body Mass Index Class on Patient-Reported Health-Related Quality of Life Before and After Total Hip Arthroplasty for Osteoarthritis: Registry-Based Cohort Study of 64,055 Patients2020In: JBJS Open Access, Vol. 5, no 4, article id e20.00100Article in journal (Refereed)
    Abstract [en]

    Background: Overweight status and obesity represent a global epidemic, with serious consequences at the individual and community levels. The number of total hip arthroplasties (THAs) among overweight and obese patients is expected to rise. Increasing body mass index (BMI) has been associated with a higher risk of mortality and reoperation and lower implant survival. The evaluation of perioperative health-related quality of life (HRQoL) has recently gained importance because of its direct relation to, and impact on, patients' physical, mental, and social well-being as well as health-service utilization. We sought to evaluate the influence of BMI class on HRQoL preoperatively and at 1 year following THA in a register-based cohort study.

    Methods: This observational cohort study was designed and conducted on the basis of registry data derived from the Swedish Hip Arthroplasty Register (SHAR) and included 64,055 primary THAs registered between January 1, 2008, and December 31, 2015. Patients' baseline preoperative and 1-year postoperative EuroQol-5 Dimension-3 Level (EQ-5D-3L) responses were documented by the treating department and reported to the SHAR through the patient-reported outcome measures program. The EQ-5D-3L includes a visual analogue scale (EQ VAS), which measures the patient's overall health status.

    Results: At 1 year of follow-up, all BMI classes showed significant and clinically relevant improvements in all HRQoL measures compared with preoperative assessment (p < 0.05). Patients reported improved perception of current overall health status for the EQ VAS. Underweight, overweight, and all obesity classes showed increasingly worse 1-year HRQoL compared with normal weight, both with unadjusted and adjusted calculations.

    Conclusions: In this study, we found that all BMI classes had significant improvement in HRQoL at 1 year following THA. Patients who were underweight, overweight, or obese (classes I to III), compared with those of normal weight, reported worse hip pain and EQ-5D-3L and EQ VAS responses prior to THA and at 1 year postoperatively. These results can assist both health-care providers and patients in establishing reasonable expectations about THA outcomes.

    Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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  • 37.
    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, p. S7-S11Article, 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.

  • 38.
    Mukka, Sebastian
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Sjöholm, Pontus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Aziz, Athir
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Eisler, Thomas
    Kadum, Bakir
    Krupic, Ferid
    Morberg, Per
    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.
    A cohort study comparing internal fixation for undisplaced versus hip arthroplasty for displaced femoral neck fracture in the elderly: a pilot study for a clinical trial2020In: Pilot and Feasibility Studies, E-ISSN 2055-5784, Vol. 6, article id 98Article in journal (Refereed)
    Abstract [en]

    Introduction: The literature regarding undisplaced femoral neck fractures (FNF) is sparse. The aim of this prospective feasibility study is to compare the clinical outcome after undisplaced FNF treated with internal fixation (IF) and displaced FNF treated with hip arthroplasty. We hypothesized that hip arthroplasty would give a lower incidence of reoperations.

    Methods: A total of 235 patients were included with a median age of 84 years (range 65-99). A consecutive series of 65 patients with undisplaced FNF were treated with IF, and 170 patients with displaced FNF were treated with either a total hip arthroplasty or a hemiarthroplasty. Follow-up interviews were conducted at 1 year using the Harris Hip Score (HHS), WOMAC, and pain numeric rating scale (PNRS). The minimum follow-up time was 22 months. There was no difference in baseline data between the groups.

    Results: Nineteen (8%) hips required reoperation at least once at a mean of 6 months (range 0-35). The rate of reoperation was higher in the IF group compared to the hip arthroplasty group (13.8% vs. 5.9%, 95% CI 0.9-6.4). The overall 1-year and 2-year mortality was 28% and 40%, respectively, with no difference between the groups. The most common reasons for reoperations in the IF group were non-union and avascular necrosis, and 6 patients were treated with hip or excision arthroplasty. In the arthroplasty group, the most common indications were deep infection and dislocation. We did not find any differences between the groups in terms of HHS, WOMAC, and PNRS.

    Conclusions: In this feasibility study, we found no differences in patient-reported outcomes between the groups although IF required a higher rate of reoperations. Further randomized trials are needed to establish the optimal treatment of undisplaced FNF in the elderly.

    Trial registration: ClinicalTrial.org, NCT03392285. Retrospectively registered on 5 February 2018.

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  • 39.
    Mukka, Sebastian
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Sjöholm, Pontus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Chammout, Ghazi
    Kelly-Pettersson, Paula
    Sayed-Noor, Arkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Sköldenberg, Olof
    External Validity of the HOPE-Trial Hemiarthroplasty Compared with Total Hip Arthroplasty for Displaced Femoral Neck Fractures in Octogenarians2019In: JBJS Open Access, ISSN 2472-7245, Vol. 4, no 2, p. 1-7, article id e0061Article in journal (Refereed)
    Abstract [en]

    Background: Randomized controlled trials (RCTs) are the most reliable way of evaluating the effect of new treatments by comparing them with previously accepted treatment regimens. The results obtained from an RCT are extrapolated from the study environment to the general health care system. The ability to do so is called external validity. We sought to evaluate the external validity of an RCT comparing the results of total hip arthroplasty with those of hemiarthroplasty for the treatment of displaced femoral neck fractures in patients ≥80 years of age.

    Methods: This prospective, single-center cohort study included 183 patients ≥80 years of age who had a displaced femoral neck fracture. All patients were screened according to the inclusion and exclusion criteria for an RCT comparing total hip arthroplasty and hemiarthroplasty. The population for this study consisted of patients who gave their informed consent and were randomized into the RCT (consenting group, 120 patients) as well as those who declined to give their consent to participate (non-consenting group, 63 patients). The outcome measurements were mortality, complications, and patient-reported outcome measures. Follow-up was carried out postoperatively with use of a mailed survey that included patient-reported outcome questionnaires.

    Results: We found a statistically significant and clinically relevant difference between the groups, with the non-consenting group having a higher risk of death compared with the consenting group. (hazard ratio, 4.6; 95% confidence interval, 1.9 to 11.1). No differences were found between the groups in terms of patient-reported outcome measures or surgical complications.

    Conclusions: This cohort study indicates a higher mortality rate but comparable hip function and quality of life among eligible non-consenters as compared with eligible consenters when evaluating the external validity of an RCT in patients ≥80 years of age with femoral neck fracture.

    Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

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  • 40. 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, p. 564-568Article 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.

  • 41.
    Pollock, Raymond
    et al.
    Spinal Unit, University Hospital of North Tees, Stockton on Tees, United Kingdom.
    Sayed-Noor, Arkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    How to review a scientific manuscript2014In: Classic papers in orthopaedics / [ed] Paul A. Banaszkiewicz; Deiary F. Kader, London: Springer, 2014, 1, p. 595-607Chapter in book (Refereed)
    Abstract [en]

    Critical appraisal is a systematic process used to identify the strengths and weaknesses of a research article. The process enables the reader to determine the study's validity. It is important to keep a degree of skepticism when reading an article. Reasonable skepticism means being open-minded and willing to be convinced but only if authors can adequately back up their claims. The critical reader is not put off by the limitations of a study but will expect authors to interpret their results in a way that takes account of the limitations.

  • 42.
    Sayed-Noor, Arkan
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Mukka, Sebastian
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Mohaddes, Maziar
    Kärrholm, Johan
    Rolfson, Ola
    Body mass index is associated with risk of reoperation and revision after primary total hip arthroplasty: a study of the Swedish Hip Arthroplasty Register including 83,146 patients2019In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 90, no 3, p. 220-225Article in journal (Refereed)
    Abstract [en]

    Background and purpose: The prevalence of obesity is on the rise, becoming a worldwide epidemic. The main purpose of this register-based observational study was to investigate whether different BMI classes are associated with increased risk of reoperation within 2 years, risk of revision within 5 years, and the risk of dying within 90 days after primary total hip arthroplasty (THA). We hypothesized that increasing BMI would increase these risks.

    Patients and methods: We analyzed a cohort of 83,146 patients who had undergone an elective THA for primary osteoarthritis between 2008 and 2015 from the Swedish Hip Arthroplasty Register (SHAR). BMI was classified according to the World Health Organization (WHO) into 6 classes: < 18.5 as underweight, 18.5-24.9 as normal weight, 25-29.9 as overweight, 30-34.9 as class I obesity, 35-39.9 as class II obesity, and ≥ 40 as class III obesity.

    Results: Both unadjusted and adjusted parameter estimates showed increasing risk of reoperation at 2 years and revision at 5 years with each overweight and obesity class, mainly due to increased risk of infection. Uncemented and reversed hybrid fixations and surgical approaches other than the posterior were all associated with increased risk. Obesity class III (≥ 40), male sex, and increasing ASA class were associated with increased 90-day mortality.

    Interpretation: Increasing BMI was associated with 2-year reoperation and 5-year revision risks after primary THA where obese patients have a higher risk than overweight or normal weight patients. As infection seems to be the main cause, customizing preoperative optimization and prophylactic measures for obese patients may help reduce risk.

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  • 43.
    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, p. e194-e200Article 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.

  • 44.
    Sayed-Noor, Arkan S.
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Pollock, Raymond
    Elhassan, Bassem T.
    Kadum, Bakir
    Fatty infiltration and muscle atrophy of the rotator cuff in stemless total shoulder arthroplasty: a prospective cohort study2018In: Journal of shoulder and elbow surgery, ISSN 1058-2746, E-ISSN 1532-6500, Vol. 27, no 6, p. 976-982Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The influence of preoperative rotator cuff fatty infiltration (FI) and muscle atrophy (MA) on the postoperative outcome of total shoulder arthroplasty (TSA) has only rarely been investigated and reported in the literature. We hypothesized that more FI and MA would be associated with a worse postoperative functional outcome.

    METHODS: This prospective cohort study included 63 patients (31 female and 32 male patients; mean age, 71 years [range, 53-89 years; standard deviation, 7 years]) with primary osteoarthritis of the shoulder operated on with anatomic stemless TSA. Preoperatively and at 3 months and 1 year after the operation, the functional outcome (QuickDASH [short version of Disabilities of the Arm, Shoulder and Hand questionnaire] score) and range of motion (ROM) (goniometer) and strength (dynamometer) for abduction at the scapular plane and for external rotation were measured. The degree of preoperative FI and MA was evaluated using computed tomography scans according to the Goutallier classification and Warner classification, respectively, for the supraspinatus and infraspinatus.

    RESULTS: We found clinically and statistically significant improvements in functional outcome, strength, and ROM at both 3 months and 1 year of follow-up compared with those preoperatively. The Pearson correlation coefficient (r) showed significant correlations between preoperative supraspinatus and infraspinatus FI and MA and preoperative and 1-year postoperative shoulder abduction and external rotation strength but not ROM. However, we found no influence of the rotator cuff FI and MA on the functional outcome after TSA.

    CONCLUSION: We demonstrated a significant correlation between rotator cuff FI and MA and strength but not ROM of the shoulder joint.

  • 45.
    Sayed-Noor, Arkan
    et al.
    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.
    Pollock, Raymond
    Spinal Unit, University Hospital of North Tees, Stockton on Tees, United Kingdom.
    How to get published and impact factors2014In: Classic papers in orthopaedics / [ed] Paul A. Banaszkiewicz; Deiary F. Kader, London: Springer, 2014, 1, p. 609-613Chapter in book (Refereed)
    Abstract [en]

    Publication of scientific work is an integral part of every researcher's professional life. Science progression, dissemination of research findings, health care improvement and self-promotion are some of the motivations why researchers have to write and publish their work. Unfortunately, the task of proper scientific writing and publication is not an easy one and can only be improved with regular practice. For the beginners, writing in a scientific style can be a daunting process. In addition picking the right journal is a crucial part of getting the work accepted for publication. This may require a wide knowledge of the technical requirements of each scientific journal. The aim of this chapter is to provide the reader with some fundamental guidelines to assist authors in acquiring the necessary skills to write a scientific paper and getting it published.

  • 46.
    Schmidt, Viktor
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Gordon, Max
    Petterson, Anna
    Buttazzoni, Christian
    Seimersson, Amelia
    Sayed-Noor, Arkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Mukka, Sebastian
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Wadsten, Mats
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Functional outcomes are restored a decade after a distal radius fracture: a prospective long-term follow-up study2023In: Journal of Hand Surgery, European Volume, ISSN 1753-1934, E-ISSN 2043-6289, article id 17531934231194682Article in journal (Refereed)
    Abstract [en]

    We performed an 11-13-year prospective follow-up of patients after a distal radial fracture (DRF) to investigate the association between fracture malunion, radiocarpal osteoarthritis and clinical outcome. In total, 292 patients responded to patient-reported outcome measures; of them, 242 underwent clinical examination. Clinical outcomes improved with time. A decade after fracture, median Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score was 5, EuroQol Five-dimensions score was 1.0, and range of motion and grip strength were 96% of the contralateral side. Neither osteoarthritis (6%) nor pseudoarthrosis of the ulnar styloid (30%) affected the outcomes. Dorsal tilt, radial inclination, ulnar variance and intra-articular extension did not affect long-term clinical outcomes or the risk of osteoarthritis. Recovery after a DRF is an ongoing process that lasts years. A decade after the injury event, range of motion, grip strength and QuickDASH were recovered to population normal, regardless of radiological outcomes.

    Level of evidence: II.

  • 47.
    Schmidt, Viktor
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Mellstrand Navarro, Cecilia
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden, Department of Hand Surgery, Södersjukhuset, Stockholm, Sweden.
    Ottosson, Markus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Tägil, Magnus
    Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden.
    Christersson, Albert
    Department of Orthopedics, Institution of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Engquist, Markus
    Department of Orthopedics, Ryhov Hospital, Jönköping, Sweden.
    Sayed-Noor, Arkan
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Mukka, Sebastian
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Wadsten, Mats
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Forecasting effects of "fast-tracks" for surgery in the Swedish national guidelines for distal radius fractures2022In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, no 2, article id e0260296Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: National guidelines for treatment of distal radius fractures (DRFs) were presented in Sweden in 2021. In the guidelines, a fast-track is recommended for 4 subgroups of highly unstable DRFs. Regardless of the results of the closed reduction these are recommended for surgery within 1 week of injury. This study aims to evaluate the potential consequences of the newly presented national guidelines on incidence of surgical interventions.

    PATIENTS AND METHODS: In all, 1,609 patients (1,635 DRFs) with primary radiographs after a DRF between 2014 and 2017 at two Swedish hospitals were included in a retrospective cohort study. An estimation was made of the percentage of patients in the historical pre-guidelines cohort, that would have been recommended early primary surgery according to the new national guidelines compared to treatment implemented without the support of these guidelines.

    RESULTS: On a strict radiological basis, 32% (516 out of 1635) of DRFs were classified into one of the 4 defined subgroups. At 9-13 days follow-up, cast treatment was converted into delayed primary surgery in 201 cases. Out of these, 56% (112 out of 201) fulfilled the fast-track criteria and would with the new guidelines have been subject to early primary surgery.

    INTERPRETATION: The fast-track regimen in the new guidelines, has a high likelihood of identifying the unstable fractures benefitting from early primary surgery. If the proposed Swedish national guidelines for DRF treatment are implemented, a greater proportion of fractures would be treated with early primary surgery, and a delayed surgery avoided in the majority of cases. The potential benefits in relation to possible costs when using the fast-track criteria in every day practice are still unknown.

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  • 48.
    Torstensson, Thomas
    et al.
    Department of Public Health and Caring Science, Uppsala university, Uppsala, Sweden.
    Sayed-Noor, Arkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Knutsson, Björn
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Physical inactivity before surgery for lumbar spinal stenosis is associated with inferior outcomes at 1-year follow-up: a cohort study2022In: International Journal of Spine Surgery, E-ISSN 2211-4599, Vol. 16, no 5, p. 916-920Article in journal (Refereed)
    Abstract [en]

    Background: Lumbar spinal stenosis (LSS) is a common disorder in older people. Inactivity secondary to the disease state can further increase LSS symptoms. Initial care includes physiotherapy to relieve symptoms and optimize patient function and quality of life. It is currently unclear whether inactivity before surgery for LSS is associated with postoperative outcomes. Our aim was to investigate associations between self-reported exercise before LSS surgery and self-reported outcomes at 1-year follow-up.

    Methods: Using a retrospective cohort study design, prospective data were collected from the National Swedish Register for Spine Surgery (Swespine) between September 2006 and December 2012: 11,956 patients diagnosed with LSS completed the 1-year follow-up. The primary outcome measure was the Oswestry Disability Index (ODI). Secondary outcome measures were back and leg pain reported on a visual analog scale (VAS). The independent variable was dichotomized into no regular exercise (NRE) and regular exercise (RE). Adjusted analysis of covariance models were used to analyze differences in outcome improvement between the NRE and RE groups.

    Results: The mean improvement in the ODI was 15.9 (95% CI, 15.5–16.3) in the NRE group and 19.2 (95% CI, 18.5–19.8) in the RE group (P < 0.001). Improvement in back pain (P < 0.001) and leg pain (P < 0.001) were also inferior in the NRE group compared to the RE group. The NRE group improved 21.8 (95% CI, 21.2–22.5) units in back pain and 28.8 (95% CI, 28.1–29.5) in leg pain on the VAS compared to 25.2 (95% CI, 24.2–26.3) units in back pain and 32.5 (95% CI, 31.3–33.6) in leg pain in the RE group.

    Conclusions: Inactivity defined as self-reported NRE before surgery for LSS is associated with worse outcomes 1-year postsurgery compared to patients reporting RE. Clinical Relevance: This study is relevant to currently practicing spinal surgeons and spine physiotherapists.

  • 49.
    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, G.G.
    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 outcome: a cohort multicentre study2014In: The Bone & Joint Journal, ISSN 2049-4394, E-ISSN 2049-4408, Vol. 96B, no 7, p. 978-983Article 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.

  • 50.
    Wadsten, Mats Å.
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Buttazzoni, Gunnar G.
    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.
    Kadum, Bakir
    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.
    Influence of Cortical Comminution and Intra-articular Involvement in Distal Radius Fractures on Clinical Outcome: A Prospective Multicenter Study2017In: Journal of wrist surgery, ISSN 2163-3916, E-ISSN 2163-3924, Vol. 6, no 4, p. 285-293Article in journal (Refereed)
    Abstract [en]

    Aim The purpose of this prospective multicenter study was to test the predictive value of cortical comminution and intra-articular involvement on function and quality of life in distal radius fractures (DRFs) using the Buttazzoni's classification system. Patients and Method We studied 406 patients between skeletal maturity and 74 years of age with DRF. Fractures with acceptable radiographic alignment were immobilized with a cast. Fractures with nonacceptable radiographic alignment underwent closed reduction and 4 to 6 weeks cast immobilization. Radiographs were obtained after reduction and at 10 to 14 days. Redisplaced fractures were offered surgical treatment. One-year follow-up included grip strength, range of motion (ROM), quickDASH, EQ-5D (including visual analog scale [VAS] for health status), and VAS pain. Results We found no statistically significant differences in QuickDASH, EQ-5D questionnaire, EQ-5D health status VAS, and VAS pain among the Buttazzoni classes. However, initial displacement was associated with worse quickDASH score, worse EQ-5D score, reduced grip strength, and reduced ROM. Dorsal comminution was associated with worse quickDASH score, reduced flexion, and reduced pronation-supination ability. Volar comminution predicted loss of extension, while intra-articular involvement was associated with reduced flexion-extension arc and worse EQ-5D score. There was a significant difference in ROM between noncomminuted and comminuted fracture classes. Conclusion Initial fracture position, type of comminution, and intra-articular involvement influenced the clinical outcome in DRF.

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