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  • 151. Kurmis, Andrew P
    et al.
    Kurmis, Timothy P
    O'Brien, Justin X
    Dalén, Tore
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    The effect of nonsteroidal anti-inflammatory drug administration on acute phase fracture-healing: a review2012Ingår i: Journal of Bone and Joint Surgery. American volume, ISSN 0021-9355, E-ISSN 1535-1386, Vol. 94, nr 9, s. 815-823Artikel i tidskrift (Refereegranskat)
  • 152.
    Larsson, Hans-Olov
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi. Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Quantitative morphological studies of the parathyroid gland1983Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    This work is based upon a series of quantitative morphological studies of the parathyroid glands of Mongolian gerbils and rats. Standard stereological methods were used on light and electron microscopical levels.

    Subclassification of the chief cells based on the staining affinity and electron density of the cytoplasm was not correlated with contents (volume and surface densities) of organelles.

    Compared to fixation by immersion, fixation by perfusion caused a remarkable reduction in the number of light chief cells and atrophic cells, indicating that the occurrence of those kind of cells is dependent on factors of artifactual nature.

    The early response of the parathyroid gland to altered concentrations of extracellular calcium was studied in vitro. At six hours of "incubation, enlargement of the Golgi zone (Golgi complex and presecretory granules), but unaltered endoplasmic reticulum, was seen in glands incubated in low (0,5 mM) compared to those incubated in high (3,0 mM) calcium concentrations.

    Prolonged hypocalcemia induced in vivo by intraperitoneal injections of ethylenediaminetetraacetate and calcium deficient diet for eight days, did not give rise to any major quantitative morphological changes in the individual parathyroid cell, and furthermore, the quantitative morphology of the parathyroid cell was unchanged in experimentally induced hyperparathyroidism (calcium deficient diet for 16 weeks).

    The morphological data do not support the opinion of a functional cycle in the parathyroid chief cell, but suggest that the early response of this cell to altered extracellular calcium may be funtional activities associated with the Golgi zone.

  • 153.
    Larsson, Johanna
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Biological age of growing individuals with patellar dislocation: A study of the growth plate examined with MRI of patients aged 10 – 20 years2017Självständigt arbete på grundnivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 154.
    Larusson, Ida
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Wound complications after primary arthroplasty of the hip: Incidence and results of treatment2016Självständigt arbete på grundnivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 155.
    Lendau, Carl
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Dokumentation till döds. Överdokumentation inom vården.2015Självständigt arbete på avancerad nivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 156.
    Li, Ming G
    et al.
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Ortopedi.
    Nilsson, Kjell G
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Ortopedi.
    Nivbrant, Bo
    Decreased precision for BMD measurements in the prosthetic knee using a non-knee-specific software.2004Ingår i: Journal of Clinical Densitometry, ISSN 1094-6950, Vol. 7, nr 3, s. 319-25Artikel i tidskrift (Refereegranskat)
  • 157.
    Li, Ming G
    et al.
    University of Western Australia.
    Rohrl, Stephan M
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap. Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Ortopedi.
    Periprosthetic changes in bone mineral density in 5 stem designs 5 years after cemented total hip arhtroplasty. No relation to stem migration.2007Artikel i tidskrift (Refereegranskat)
  • 158.
    Li, Ming G
    et al.
    Umeå universitet, Medicinsk fakultet, Integrativ medicinsk biologi. Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Ortopedi.
    Thorsen, Kim
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Nilsson, Kjell G
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Ortopedi.
    Increased bone turnover as reflected by biochemical markers in patients with potentially unstable fixation of the tibial component.2004Ingår i: Arch Orthop Trauma Surg, ISSN 0936-8051, Vol. 124, nr 6, s. 404-9Artikel i tidskrift (Refereegranskat)
  • 159.
    Lorentzon, Ronny
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Alfredson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Hildingsson, Christer
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Treatment of deep cartilage defects of the patella with periosteal transplantation1998Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 6, nr 4, s. 202-208Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Twenty-six consecutive patients (19 men and 7 women) with a mean age of 31.5 years (range 19-52 years) who suffered from an isolated full-thickness cartilage defect of the patella (area ranged from 0.75 to 20.0 cm2) and disabling knee pain were treated with autologous periosteal transplantation (without any chondrocytes). The duration of symptoms was 59 months (range 11-144 months). During the first 5 postoperative days all patients were treated with continuous passive motion (CPM). This was followed by active motion, slowly progressive strength training, and slowly progressive weight-bearing. After a mean follow-up of 42 months (range 24-76 months), 17 patients (65%) were graded as excellent (were painfree), 8 patients (31%) as good (had pain with strenuous knee-loading activities), and 1 patient as poor (had pain at rest). Twenty-two patients (85%) had returned to their previous occupation. Twelve patients (46%) had resumed sports or recreational activities at their former level. Repeated magnetic resonance imaging (MRI) investigations showed progressive, and finally complete, filling of the articular defects. Biopsies taken in five randomly selected cases showed hyaline-like cartilage. Patients with full-thickness cartilage defects of the patella and disabling knee pain can be treated with autologous periosteal transplantation (without any chondrocytes), followed by CPM, and slowly progressive strength training and weight-bearing. We believe this is a good method to accomplish regeneration of articular cartilage and satisfactory clinical results.

  • 160.
    Lundqvist, Rickard
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    The frequency of post hip surgery infections2019Självständigt arbete på grundnivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 161.
    Lundström, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Olofsson, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Stenvall, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Karlsson, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Nyberg, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Fysiologi.
    Englund, Undis
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Borssén, Bengt
    Svensson, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Postoperative delirium in old patients with femoral neck fracture: a randomized intervention study.2007Ingår i: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 19, nr 3, s. 178-186Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND AND AIMS: Delirium is a common postoperative complication in elderly patients which has a serious impact on outcome in terms of morbidity and costs. We examined whether a postoperative multi-factorial intervention program can reduce delirium and improve outcome in patients with femoral neck fractures.

    METHODS: One hundred and ninety-nine patients, aged 70 years and over (mean age+/-SD, 82+/-6, 74% women), were randomly assigned to postoperative care in a specialized geriatric ward or a conventional orthopedic ward. The intervention consisted of staff education focusing on the assessment, prevention and treatment of delirium and associated complications. The staff worked as a team, applying comprehensive geriatric assessment, management and rehabilitation. Patients were assessed using the Mini Mental State Examination and the Organic Brain Syndrome Scale, and delirium was diagnosed according to DSM-IV criteria.

    RESULTS: The number of days of postoperative delirium among intervention patients was fewer (5.0+/-7.1 days vs 10.2+/-13.3 days, p=0.009) compared with controls. A lower proportion of intervention patients were delirious postoperatively than controls (56/102, 54.9% vs 73/97, 75.3%, p=0.003). Eighteen percent in the intervention ward and 52% of controls were delirious after the seventh postoperative day (p<0.001). Intervention patients suffered from fewer complications, such as decubitus ulcers, urinary tract infections, nutritional complications, sleeping problems and falls, than controls. Total postoperative hospitalization was shorter in the intervention ward (28.0+/-17.9 days vs 38.0+/-40.6 days, p=0.028).

    CONCLUSIONS: Patients with postoperative delirium can be successfully treated, resulting in fewer days of delirium, fewer other complications, and shorter length of hospitalization.

  • 162.
    Lysholm, Jack
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Henriksson, Marketta
    Tegner, Yelverton
    In memoriam Jan Gillquist 1934-20162016Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 24, nr 9, s. 2719-2720Artikel i tidskrift (Övrigt vetenskapligt)
  • 163.
    Lysholm, Jack
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Yelverton, Tegner
    Department of Health Sciences, University of Technology, Luleå.
    Knee injury rating scales2008Ingår i: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 78, nr 4, s. 445-453Artikel i tidskrift (Refereegranskat)
  • 164.
    Löfvenberg, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Chronic lateral instability of the ankle joint: natural course, pathophysiology and steroradiographic evaluation of conservative and surgical treatment1994Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Chronic lateral instability of the ankle (CLI), defined as frequent sprains and recurrent giving way, difficulty in walking and running on uneven surface, is often connected with pain and swollen ankles. It occurs in 10 to 20 percent after acute ankle injuries. Mechanical instability of the talocrural and subtalar joint, peroneal weakness and impaired proprioception has been suggested as etiological factors.

    Aim.

    To investigate the natural course in conservatively treated patients with CLI.

    To assess the mechanical stability in patients with CLI by measuring the three dimensional motions in the talus, the fibula and the calcaneus in relation to the tibia during different testing procedures pre- and postoperatively.

    To determine if CLI is associated with proprioceptive deficiency.

    Patients and Methods.

    This Thesis includes 127 ankles in 78 patients (30 women, 48 men) with CLI.

    Thirty-seven patients were followed up 20 years after their first contact with the orthopaedic department because of CLI. Forty-six ankles were evaluated radiographically and the result was compared with a gender- and age - matched control-material.

    The neuromuscular response to a sudden angular displacement of the ankles was studied in 15 ankles in 13 patients using EMG.

    Thirty-six patients entered a prospective study using roentgen stereophotogrammetric analysis (RSA) in which the ankles were tested at manual adduction, adduction with predetermined torque, with and without external support and at drawer tests (40 N and 160N). Twenty-seven patients were followed five years postoperatively.

    Result.

    After 20 years 22 patients, conservatively treated still suffered from instability of the ankle and ten had recurrent giving way symptoms even on plane surface. Six ankles in the patient group and four in the control group displayed osteoarthritic changes

    Prolonged ipsilateral reaction time (m. per. long, and m. tib. ant.) was found in patients with CLI indicating proprioceptive insufficiency.

    Increased talar adduction and a tendency toward increased total translation of the talar center was found in ankles with CLI. Concomitant fibular rotations and translations were found but with no conclusive deviation in the ankles with symptoms. The talo-calcaneal adduction reached the same level in the patient and control groups regardless of symptoms. External support (ankle brace) increased the talar stability. The use of predetermined torque and constrained testing procedure did not add information compared with the manual test

    Twenty-five patients graded the result as excellent or good five years after lateral ligament reconstruction. Talar stability (decreased adduction and translation) was increased two years postoperatively and was improved or remained the same at five years without comprising the range of motion.

    Conclusion.

    In more than half the cases symptoms of CLI did not resolve spontaneously. Minor degenerative changes was found after twenty years, but not to a greater extent than in a control group. CLI was associated with proprioceptive insufficiency and talocrural but not subtalar instability. Increased ankle stability can be obtained by the use of an ankle brace and by an anatomical ligament reconstruction.

  • 165. Made, Curt
    et al.
    Elmqvist, Lars-Gunnar
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Ortopedi.
    A 10-year study of snowboard injuries in Lapland Sweden2004Ingår i: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 14, nr 2, s. 128-133Artikel i tidskrift (Refereegranskat)
  • 166.
    Mahmood, Sarwar S.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Mukka, Sebastian S.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi. Sundsvall and Norrland University Hospitals.
    Crnalic, Sead
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Wretenberg, Per
    Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
    Sayed-Noor, Arkan S.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi. 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 patients2016Ingår i: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 87, nr 1, s. 36-41Artikel i tidskrift (Refereegranskat)
    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.

  • 167.
    Mathillas, Johan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Olofsson, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Lövheim, Hugo
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Thirty-day prevalence of delirium among very old people: a population-based study of very old people living at home and in institutions2013Ingår i: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 57, nr 3, s. 298-304Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Delirium has mainly been studied in various patient samples and in people living in institutions. The present study investigates the 30-day prevalence of delirium in a population-based sample of very old people in northern Sweden and Finland. Seven hundred and eight persons aged 85 years and older from the GErontological Regional DAtabase (GERDA) were assessed. Information was also collected from relatives, carers and medical records. Assessments performed were among others the Organic Brain Syndrome (OBS) scale, the Mini Mental State Examination (MMSE), and the Geriatric Depression Scale-15 (GDS-15). Delirium, depression and dementia diagnoses were based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria. The prevalence of delirium was 17% among 85 year-olds, 21% among 90 year-olds and 39% among participants aged 95 years and older (p < 0.001). Delirium prevalence among individuals without dementia was lower than among those with dementia (5% vs. 52%, p < 0.001). Factors independently associated with delirium superimposed on dementia in a multivariate logistic regression model were depression (Odds Ratio (OR) = 2.0, 95% Confidence Interval (CI) = 1.2–3.3), heart failure (OR = 2.1, 95% CI = 1.2–3.7), institutional living (OR 4.4, 95% CI = 2.4–8.2) and prescribed antipsychotics (OR = 3.0, 95% CI = 1.5–6.0).

    Delirium is highly prevalent among very old people with dementia. Depression, heart failure, institutional living and prescribed antipsychotic medication seem to be associated with delirium.

  • 168.
    Mellner, Carl
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Handkirurgi.
    Eisler, Thomas
    Börsbo, Johannes
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Brodén, Cyrus
    Morberg, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Mukka, Sebastian
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    The Sernbo score predicts 1-year mortality after displaced femoral neck fractures treated with a hip arthroplasty2017Ingår i: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 88, nr 4, s. 402-406Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and purpose - Displaced femoral neck fractures (FNFs) are associated with high rates of mortality during the first postoperative year. The Sernbo score (based on age, habitat, mobility, and mental state) can be used to stratify patients into groups with different 1-year mortality. We assessed this predictive ability in patients with a displaced FNF treated with a hemiarthroplasty or a total hip arthroplasty. Patients and methods - 292 patients (median age 83 (65-99) years, 68% female) with a displaced FNF were included in this prospective cohort study. To predict 1-year mortality, we used a multivariate logistic regression analysis including comorbidities and perioperative management. A receiver operating characteristic (ROC) analysis was used to evaluate the predictive ability of the Sernbo score, which was subsequently divided in a new manner into a low, intermediate, or high risk of death during the first year. Results - At 1-year follow-up, the overall mortality rate was 24%, and in Sernbo's low-, intermediate-, and high-risk groups it was 5%, 22%, and 51%, respectively. The Sernbo score was the only statistically significant predictor of 1-year mortality: odds ratio for the intermediate-risk group was 4.2 (95% Cl: 1.5-12) and for the high-risk group it was 15 (95% CI: 5-40). The ROC analysis showed a fair predictive ability of the Sernbo score, with an area under the curve (AUC) of 0.79 (95% CI: 0.73-0.83). Using a cutoff of less than 11 points on the score gave a sensitivity of 61% and a specificity of 83%. Interpretation - The Sernbo score identifies patients who are at high risk of dying in the first postoperative year. This scoring system could be used to better tailor perioperative care and treatment in patients with displaced FNF.

  • 169.
    Mellner, Carl
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Eisler, Thomas
    Knutsson, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Mukka, Sebastian
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Early periprosthetic joint infection and debridement, antibiotics and implant retention in arthroplasty for femoral neck fracture2017Ingår i: HIP International, ISSN 1120-7000, E-ISSN 1724-6067, Vol. 27, nr 4, s. 349-353Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Periprosthetic joint infection (PJI) is a severe complication of hip arthroplasty for femoral neck fractures (FNF). Debridement, antibiotics and implant retention (DAIR) is recommended in early PJI in association with stable implants. Few studies have evaluated the outcome of DAIR in this fragile population.The purpose of this study was to analyse risk factors for PJI and the short-term outcome of DAIR in FNF patients treated with a hip arthroplasty.

    METHODS: A consecutive series of 736 patients (median age 81 years, 490 women, 246 men) had been treated with either a total hip arthroplasty or a hemi hip arthroplasty for a displaced FNF at our institution. 33 (4.5%) of the hips developed an early (&lt;6 weeks post operatively) PJI and 28 (3.8%) of these patients were treated according to the DAIR-protocol. Regression analyses were performed to assess risk factors for developing a PJI.

    RESULTS: DAIR eradicated the PJI in 82% (23/28) of patients at a median follow-up of 31 (SD 29.8) months of the infected hips.The logistic regression analysis indicated that 2 or more changes of the primary dressing due to wound bleeding was associated with an increased risk for developing PJI (OR 4.9, 95% 1.5 to 16.1, p = 0.01).

    CONCLUSIONS: The short-term success-rate of DAIR was unexpectedly favourable in this fragile patient population; the results being on par with that after PJI in osteoarthritis patients. The need for repeated bandage changes postoperatively indicates an increased risk for PJI and should prompt early surgical intervention.

  • 170.
    Mellner, Carl
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Mohammed, Jabbar
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Larsson, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Esberg, Sandra
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Szymanski, Maciej
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Hellström, Nils
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Chang, Cecilia
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Berg, Hans E
    Sköldenberg, Olof
    Knutsson, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Morberg, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Mukka, Sebastian
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap. Ortopedkliniken, Region västerbotten.
    Increased risk for postoperative periprosthetic fracture in hip fracture patients with the Exeter stem than the anatomic SP2 Lubinus stem.2019Ingår i: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The purpose of this study was to compare the cumulative incidence of postoperative periprosthetic fracture (PPF) in a cohort of femoral neck fracture (FNF) patients treated with two commonly used cemented stems: either a collarless, polished, tapered Exeter stem or the anatomic Lubinus SP2 stem.

    METHODS: In this retrospective multicenter cohort study of a consecutive series of patients, we included 2528 patients of age 60 years and above with an FNF who were treated with either hemiarthroplasty or total hip arthroplasty using either a polished tapered Exeter stem or an anatomic Lubinus SP2 stem. The incidence of PPF was assessed at a minimum of 2 years postoperatively.

    RESULTS: The incidence of PPF was assessed at a median follow-up of 47 months postoperatively. Thirty nine patients (1.5%) sustained a PPF at a median of 27 months (range 0-96 months) postoperatively. Two of the operatively treated fractures were Vancouver A (5%), 7 were Vancouver B1 (18%), 10 were Vancouver B2 (26%), 7 were Vancouver B3 (18%), and 13 were Vancouver C (32%). The cumulative incidence of PPF was 2.3% in the Exeter group compared with 0.7% in the SP2 group (p < 0.001). The HR was 5.4 (95% CI 2.4-12.5, p < 0.001), using the SP2 group as the denominator.

    CONCLUSIONS: The Exeter stem was associated with a higher risk for PPF than the Lubinus SP2 stem. We suggest that the tapered Exeter stem should be used with caution in the treatment of FNF.

    TRIAL REGISTRATION: The study was registered at clinicaltrials.gov (identifier: NCT03326271).

  • 171.
    Mertens, Carl
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Performance of highly cross-linked polyethylene cup in total hip arthroplasty.Evaluation of wear and fixation using radiostereometric analysis.2016Självständigt arbete på grundnivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 172. Mikaelsson, K.
    et al.
    Lysholm, Jack
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Nyberg, L.
    Michaelson, P.
    Relationship between physical capacity and physical activity in adolescents2012Ingår i: Gazzetta Medica Italiana, ISSN 0393-3660, E-ISSN 1827-1812, Vol. 171, nr 5, s. 639-651Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim. Physical activity and physical capacity are important health related parameters for all age-groups. Yet, little is known about the relationship between physical activity and physical capacity amongst adolescents about to leave compulsory education. The aim of the study was to investigate how physical capacities are related to self-reported energy expenditure on physical activities at different levels of physical activity and amount of time spent sitting among graduates of upper secondary school. Methods. In total, 99 third grade students participated from upper secondary school. Levels of physical activity and the amount of time spent sitting were assessed using the International Physical Activity Questionnaire (IPAQ). The energy expenditure was calculated based on the activity determined by the IPAQ. The participants' physical capacity was tested using VO2max, muscle strength and balance measures. The relationship between physical activity and physical capacity was addressed using linear regression models. Results. There was significant relationship between Total METs and aerobic capacity (R2 = 0.15), push-ups (R2 = 0.08) and sit-ups (R2 = 0.07). A stronger significant relationship was revealed for activity performed on Vigorous activity METs for aerobic capacity (R2 = 0.23), push-ups (R2 = 0.18) and sit-ups (R2 = 0.10). The regression analyses for Moderate activity METs, Walking activity METs and time spent Sitting showed no significant relationship to any measures of physical capacity. Conclusion. For adolescents, the intensity of physical activity is of importance for achieving high aerobic capacity, and the amount of time spent sitting does not influence physical capacity.

  • 173.
    Minde, Jan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Alterations in dermal innervations associated with congenital insensitivity to pain in patients with a novel mutation in the gene encoding nerve growth factor-βManuskript (preprint) (Övrig (populärvetenskap, debatt, mm))
  • 174.
    Minde, Jan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Effects of a human nerve growth factor beta (NGFB) mutation on cerebral structure and function in pain.Manuskript (preprint) (Övrig (populärvetenskap, debatt, mm))
  • 175.
    Minde, Jan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Andersson, T
    Department of Clinical Neuroscience Section of Neurophysiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden .
    Fulford, M
    Department of Internal Medicine, Gällivare Hospital, Gällivare, Sweden.
    Aguirre, M
    Department of Clinical Neuroscience Section of Neurophysiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden .
    Nennesmo, I
    Department of Pathology, Karolinska University Hospital, Stockholm, Sweden.
    Remahl, I Nilsson
    Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.
    Svensson, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Holmberg, Monica
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Medicinsk och klinisk genetik.
    Toolanen, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Solders, G
    Department of Clinical Neuroscience Section of Neurophysiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden .
    A novel NGFB point mutation: a phenotype study of heterozygous patients2009Ingår i: Journal of Neurology, Neurosurgery and Psychiatry, ISSN 0022-3050, E-ISSN 1468-330X, Vol. 80, nr 2, s. 188-195Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: A family with neurological findings similar to hereditary sensory and autonomic neuropathy type V having a point mutation in the nerve growth factor beta (NGFB) gene was recently described. The homozygous genotype gives disabling symptoms. The purpose of the present study was to evaluate the symptoms in heterozygous patients. METHODS: 26 patients heterozygous for the NGFB mutation (12 men, mean age 50 (13-90) years) were examined clinically and answered a health status questionnaire, including the Michigan Neuropathy Screening Instrument (MNSI). 28 relatives (15 men, mean age 44 (15-86) years) without the mutation served as controls in the clinical examination part. 23 of the heterozygotes were examined neurophysiologically and six heterozygous patients underwent a sural nerve biopsy. RESULTS: The heterozygous phenotype ranged from eight patients with Charcot arthropathy starting in adult age and associated with variable symptoms of neuropathy but without complete insensitivity to pain, anhidrosis or mental retardation, to 10 symptom free patients. There was no difference in MNSI between the young heterozygous cases (<55 years old) and the controls. Six of 23 heterozygous patients had impaired cutaneous thermal perception and 11 of 23 had signs of carpal tunnel syndrome. Sural nerve biopsies showed a moderate reduction of both small myelinated (Adelta) and unmyelinated (C) fibres. No apparent correlation of small fibre reduction to symptoms was found. CONCLUSIONS: The NGFB mutation in its heterozygous form results in a milder disease than in homozygotes, with a variable clinical picture, ranging from asymptomatic cases to those with Charcot arthropathy appearing in adult age. Particularly age, but perhaps lifestyle factors also, may influence the development of clinical polyneuropathy.

  • 176.
    Minde, Jan
    et al.
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Ortopedi.
    Svensson, Olle
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Ortopedi.
    Holmberg, Monica
    Umeå universitet, Medicinsk fakultet, Medicinsk biovetenskap, Medicinsk och klinisk genetik.
    Solders, Göran
    Toolanen, Göran
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Ortopedi.
    Orthopedic aspects of familial insensitivity to pain due to a novel nerve growth factor beta mutation.2006Ingår i: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 77, nr 2, s. 198-202Artikel i tidskrift (Refereegranskat)
  • 177.
    Minde, Jan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi. Gällivare lasarett.
    Toolanen, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Transient receptor potential vanilloid 1, vanilloid 2 and melastatin 8 immunoreactive nerve fibers in hyman skin from individuals with and without Norrbottnian congenital insensitivity to pain2009Ingår i: Neurosciences, ISSN 0094-4866, Vol. 162, nr 4, s. 1322-1332Artikel i tidskrift (Refereegranskat)
  • 178.
    Minde, Jan
    et al.
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Ortopedi.
    Toolanen, Göran
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Ortopedi.
    Andersson, Thomas
    Nennesmo, Inger
    Remahl, Ingela Nilsson
    Svensson, Olle
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Ortopedi.
    Solders, Göran
    Familial insensitivity to pain (HSAN V) and a mutation in the NGFB gene. A neurophysiological and pathological study.2004Ingår i: Muscle and Nerve, ISSN 0148-639X, E-ISSN 1097-4598, Vol. 30, nr 6, s. 752-760Artikel i tidskrift (Refereegranskat)
  • 179.
    Moberg, Ivan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Clinical and radiological outcomes of metal-on-metal total hip arthroplasty, a six to nine year follow-up2016Självständigt arbete på grundnivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 180.
    Monsen, Tor
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Klinisk bakteriologi.
    Lövgren, Elisabeth
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Klinisk bakteriologi.
    Widerström, Micael
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Infektionssjukdomar.
    Wallinder, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    In vitro effect of ultrasound on bacteria and suggested protocol for sonication and diagnosis of prosthetic infections2009Ingår i: Journal of Clinical Microbiology, ISSN 0095-1137, E-ISSN 1098-660X, Vol. 47, nr 8, s. 2496-2501Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Sonication of implants has been shown to be a promising method for diagnosis of prosthetic infections due to its improved sensitivity, simplicity, and low cost. The aim of the present study was to evaluate the effects of ultrasound performed under different conditions regarding temperature, duration, and composition of sonication tubes on bacterial species often associated with prosthetic infections. We found that ultrasound had an inhibitory effect on bacteria, of which gram-negative bacteria, in particular Escherichia coli, were almost eradicated after 5 min of sonication at 35 degrees C. Gram-positive bacteria were found to be resistant to the effect of ultrasound. Four factors were important for the inhibitory effect of sonication: the type of microorganism, the temperature of the sonication buffer, the duration of exposure to ultrasound (minutes), and the material and composition of the sonication tube in which sonication is performed. On the basis of the results from the present study, we propose a protocol for sonication and recovery of bacteria associated with biofilm on infected implants prior to conventional culture. From the present protocol, we recommend sonication for 7 min at 22 degrees C at the maximum effect which permits survival of gram-negative bacteria.

  • 181.
    Mukka, Sebastian
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Aspects on treatment of femoral neck fractures: studies on treatment methods, surgical approach and external validity2015Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [sv]

    Lårbenshalsfrakturer (FNF) är en utmaning för dagens sjukvård och förknippad med hög mortalitet i den äldre befolkningen. FNF orsakas främst av lågenergitrauma efter fall i samma plan hos patienter med benskörhet. Total höftledsprotes (THA) har visat sig ge en bättre höftfunktion, livskvalitet med färre omoperationer hos äldre patienter än sluten reposition samt fixering med skruvar (IF) under de första två-fyra åren efter operation. Få studier har publicerats med långtidsuppföljning av THA jämfört med IF.

    Vid behandling av felställd FNF med halv höftledsplastik (HA) eller THA finns olika kirurgiska metoder (snittföring) för implantation av protesen. Majoriteten av ortopedkliniker i Sverige använder direkt lateral (DL) eller posteriolateral (PL) snittföring. PL har kopplats till en ökad risk för luxation av protesen (urledsvridning), vilket i sin tur genererat en högre risk för omoperation jämfört med DL. Få studier har utvärderat höftfunktion med avseende på snittföring. Detsamma gäller vilka radiologiska faktorer som påverkar risken förprotesluxation. Det finns olika typer av studiedesigner för utvärdering av medicinska och kirurgiska behandlingsmetoder. Studiedesignen med högst bevisvärde anses vara den randomiserade kontrollerade studien (RCT). För att en RCT skall hålla hög kvalitet krävs intern och extern validitet. Intern validitet syftar på ett korrekt studieupplägg som mäter det som avses och undviker påverkan av icke önskvärda faktorer. Extern validitet (EV) innebär att erhållna resultat från studien är generaliserbara och kan extrapoleras till andra grupper än den studerade. Det inga rapporter i ortopediska litteraturen med fokus på EV med patienter som drabbats av FNF.

    Studie I: Prospektiv randomiserad studie av 100 patienter med en felställd FNF jämförs THA med IF med avseende på höftfunktion och reoperationer. Uppföljning gjordes efter tre månader samt 1, 2, 4, 11 och 17 år. HHS som mått på höftfunktion var högre och andelen reoperationer lägre för patienter som behandlades med THA.

    Studie II: Prospektiv kohortstudie med 183 patienter med felställd FNF behandlade med HA och antingen DL eller PL. Vi fann ingen skillnad i patientrapporterad höftfunktion utvärderat med HHS och WOMAC efter 1 år men en ökad förekomst av hälta vid DL.

    Studie III: Retrospektiv kohortstudie av 373 patienter opererade med en cementerad bipolär HA och PL. Postoperativa röntgenbilder granskades avseende femoral offset (FO), postoperativ benlägdsskillnad (LLD) samt acetabulär Wibergvinkel och relaterades till återkommande protesluxationer. Detta relaterades till återkommande luxationer. Uppföljningstiden varierade mellan 6 månader och 7 år. Patienter med återkommande luxationer hade en minskad postoperativ global FO, förkortad LLD och grundare acetabulum på den opererade sidan jämfört med kontroller.

    Studie IV: Prospektiv kohortstudie av 840 patienter med felställd FNF där patienter som ingick i en RCT jämförs med de som inte gav sitt samtycke för deltagande eller ej inkluderats i screeningprocessen. De patienterna som inte gav sitt samtycke hade ökad dödlighet, men ingen skillnad i höftfunktion jämfört med deltagare.

    Slutsatser

    • Friska och kognitivt vitala äldre patienter med god höftfunktion innan en felställd lårbenshalsfraktur bör behandlas med total höftledsprotes.

    • DLsnittföring ger ett lika bra patientrapporterad höftfunktion men en ökad förekomst av hälta jämfört med PL snitt vid behandling med halvprotes på grund av en felställd lårbenshalsfraktur.

    • Ansträngning bör göras för att återställa benlängdsskillnad samtfemoral offset och därigenom minska risken för återkommande luxation.

    • Våra resultat tyder på att patienter som deltar i en randomiserad studie har lägre dödlighet än patienter som avböjt att delta samt de som missats i screeningprocessen. Det är viktigt att ta hänsyn till när extrapolerar studieresultat till ett hälso-och sjukvårdssystem. Detta bör vägas in i värderingen av studieresultatens externa validitet.

  • 182.
    Mukka, Sebastian
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Hassany, Hamid H.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Sayed-Noor, Arkan S.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Geometrical restoration and component positioning after hip arthroplasty for femoral neck fracture2016Ingår i: Acta Orthopaedica Belgica, ISSN 0001-6462, Vol. 82, nr 3, s. 557-562Artikel i tidskrift (Refereegranskat)
    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.

  • 183.
    Mukka, Sebastian
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Handkirurgi.
    Knutsson, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Krupic, Ferid
    Sayed-Noor, Arkan S.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    The influence of cognitive status on outcome and walking ability after hemiarthroplasty for femoral neck fracture: a prospective cohort study2017Ingår i: European Journal of Orthopaedic Surgery & Traumatology, ISSN 1633-8065, E-ISSN 1432-1068, Vol. 27, nr 5, s. 653-658Artikel i tidskrift (Refereegranskat)
    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.

  • 184.
    Mukka, Sebastian
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Lindqvist, Jenny
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Peyda, Sara
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Broden, Cyrus
    Mahmood, Sarwar
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Hassany, Hamid
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Sayed-Noor, Arkan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Dislocation of bipolar hip hemiarthroplasty through a postero-lateral approach for femoral neck fractures: A cohort study2015Ingår i: International Orthopaedics, ISSN 0341-2695, E-ISSN 1432-5195, Vol. 39, nr 7, s. 1277-1282Artikel i tidskrift (Refereegranskat)
    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.

  • 185.
    Mukka, Sebastian
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Mahmood, Sarwar
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Kadum, Bakir
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Sköldenberg, O
    Sayed-Noor, Arkan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Direct lateral vs posterolateral approach to hemiarthroplasty for femoral neck fractures2016Ingår i: Orthopaedics & Traumatology: Surgery & Research, ISSN 1877-0568, E-ISSN 1877-0568, Vol. 102, nr 8, s. 1049-1054Artikel i tidskrift (Refereegranskat)
    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.

  • 186.
    Mukka, Sebastian
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Mahmood, Sarwar
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Sjödén, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Sayed-Noor, Arkan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Dual mobility cups for preventing early hip arthroplasty dislocation in patients at risk: experience in a county hospital2013Ingår i: Orthopedic Reviews, ISSN 2035-8237, E-ISSN 2035-8164, Vol. 5, nr 10, s. 48-51Artikel i tidskrift (Refereegranskat)
    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.

  • 187.
    Mukka, Sebastian S.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Andersson, Göran N.
    Hultenby, Kjell R.
    Sköldenberg, Olof G.
    Nordahl, Joakim P.
    Eisler, Thomas M.
    Osteoclasts in periprosthetic osteolysis: the charnley arthroplasty revisited2017Ingår i: The Journal of Arthroplasty, ISSN 0883-5403, E-ISSN 1532-8406, Vol. 32, nr 10, s. 3219-3227Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Periprosthetic osteolysis by polyethylene wear debris-triggered osteoclasts is viewed as the main pathophysiological pathway in aseptic loosening in total hip arthroplasty. The present aim was to study osteoclast occurrence in osteolytic lesions in early and late revisions of the Charnley low-friction torque arthroplasty (CLFA).

    METHODS: Biopsies of the soft interface membrane and the adjacent bone were taken from osteolytic lesions during revision of 16 loose CLFA, early (2-6 years) or late (>10 years) after primary surgery. By light microscopy (LM), cell-dense regions with signs of osteoclast-mediated bone resorption were selected for transmission electron microscopy. Three additional patients were studied in LM for osteoclast markers (tartrate-resistant acid phosphatase and Cathepsin K).

    RESULTS: LM disclosed a low-grade chronic inflammation and birefringent particles in most sections. Multiple conglomerates of tartrate-resistant acid phosphatase positive and Cathepsin K positive mononuclear and multinucleated cells were found deep in the fibrous interface membrane. Transmission electron microscopy showed traces of polyethylene-like particles in 67%-100% of the cells. Osteoclast-like cells exhibiting resorptive activity were few (mean, 0.7%; standard deviation, 0.2%), and multinucleated cells, possibly osteoclast precursor cells, located immediately on the bone were also scarce (mean, 2.7%; standard deviation, 5.3%). Multinucleated (odds ratio, 3.0; 95% confidence interval, 1.7-5.5) and macrophage-like cells (odds ratio, 3.6; 95% confidence interval, 2.2-5.6) were typically located deeper in the inflammatory interface membrane with a pathologic appearance with distension and abundance of phagocytic vacuoles. There were no systematic differences in cell populations between early or late revisions.

    CONCLUSION: Despite probable ongoing osteoclastogenesis in the osteolytic lesions, there were few sites of osteoclast-mediated bone resorption. These findings attach a contributing biological explanation to the longevity of the CLFA.

  • 188.
    Mukka, Sebastian S
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Sayed-Noor, Arkan S
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    An update on surgical approaches in hip arthoplasty: lateral versus posterior approach2014Ingår i: HIP International, ISSN 1120-7000, E-ISSN 1724-6067, Vol. 24, nr Supplement 10, s. S7-S11Artikel, forskningsöversikt (Refereegranskat)
    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.

  • 189. Nagi, Saad S.
    et al.
    Marshall, Andrew G.
    Makdani, Adarsh
    Jarocka, Ewa
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Fysiologi.
    Liljencrantz, Jaquette
    Ridderstrom, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Shaikh, Sumaiya
    O'Neill, Francis
    Saade, Dimah
    Donkervoort, Sandra
    Foley, A. Reghan
    Minde, Jan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Trulsson, Mats
    Cole, Jonathan
    Bonnemann, Carsten G.
    Chesler, Alexander T.
    Bushnell, M. Catherine
    McGlone, Francis
    Olausson, Hakan
    An ultrafast system for signaling mechanical pain in human skin2019Ingår i: Science Advances, E-ISSN 2375-2548, Vol. 5, nr 7, artikel-id eaaw1297Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The canonical view is that touch is signaled by fast-conducting, thickly myelinated afferents, whereas pain is signaled by slow-conducting, thinly myelinated (“fast” pain) or unmyelinated (“slow” pain) afferents. While other mammals have thickly myelinated afferents signaling pain (ultrafast nociceptors), these have not been demonstrated in humans. Here, we performed single-unit axonal recordings (microneurography) from cutaneous mechanoreceptive afferents in healthy participants. We identified A-fiber high-threshold mechanoreceptors (A-HTMRs) that were insensitive to gentle touch, encoded noxious skin indentations, and displayed conduction velocities similar to A-fiber low-threshold mechanoreceptors. Intraneural electrical stimulation of single ultrafast A-HTMRs evoked painful percepts. Testing in patients with selective deafferentation revealed impaired pain judgments to graded mechanical stimuli only when thickly myelinated fibers were absent. This function was preserved in patients with a loss-of-function mutation in mechanotransduction channel PIEZO2. These findings demonstrate that human mechanical pain does not require PIEZO2 and can be signaled by fast-conducting, thickly myelinated afferents.

  • 190.
    Nilsson, Helena
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Klassificering av fotledsfrakturer. Förekomst och klassificering av fotledsfrakturer i Norrbotten med avseende på kön och ålder.2014Självständigt arbete på avancerad nivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 191.
    Nilsson, Kjell G.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Kinematics and fixation of total knee arthroplasties: a clinical, radiographic, scintimetric, and roentgen stereophotogrammetric evaluation1992Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Aseptic loosening of the tibial component is an important cause of failure after total knee arthroplasty. Bone destruction often claimed to be caused by the cement makes the revision difficult. In order to treat younger patients, uncemented fixation has been introduced, but the etiology to loosening is multifactorial and only partly known. Early detection of implant migration facilitates research in this field but is difficult using conventional techniques. In this study modified versions of roentgen stereophotogrammetric analysis (RSA) were developed to obtain accurate and standardized evaluations facilitating comparison between prosthetic designs. The method was used to record the efficacy of cemented and uncemented fixation of different designs of the tibial component, to determine the accuracy of scintimetry in the detection of early aseptic loosening, and to analyse the in vivo kinematics of knee arthroplasties with different design and stability between the joint surfaces.

    Forty-three arthroplasties with comparatively high inherent stability of the joint surfaces were randomized to cemented or uncemented fixation of the tibial component. In all groups micromovements were rather large, but with no differences between the cemented and uncemented components. The preoperative diagnosis (arthrosis OA, n=25; rheumatoid arthritis RA, n=18) did not influence the magnitude of micromotion.

    20 arthroplasties with the same design as above but equipped with an intramedullary stem, were randomized to cemented or uncemented fixation in patients with RA. Cement improved the fixation. Uncemented stemmed components displayed micromovements seemingly larger than unstemmed ones.

    34 arthroplasties with an unconstrained design of the joint area and fixed to the tibia with four pegs were randomized to cemented or uncemented fixation in patients with OA. When used uncemented 4 screws were added. Compared with previously investigated designs small micromotions were recorded, and especially in the cemented cases. Uncemented components with thin polyethylene inserts displayed larger initial micromotions. The preoperative deformity influenced the direction of the micromotion.

    33 knees were followed prospectively with RSA and scintimetry to evaluate any correlation between these methods. Low activity under the tibial component at 2 years implied prosthetic stability, whereas high activity indicated instability or high bone remodelling caused by the preoperative malalignment.

    The in vivo kinematics in three different designs of knee arthroplasties were analyzed during active flexion and extension without weight-bearing. Each type of prosthesis displayed design-specific abnormalities when compared with a normal material. Pronounced posterior tibial translations were recorded during flexion regardless whether the posterior cruciate ligament had been sacrificed or not. Data from the kinematic and the fixation studies suggest that movements restricted by the design of the joint area are transmitted to the bony interface with design-specific micromotions as the result.

    Analysis of knee joint kinematics during extension and weight-bearing revealed small alterations compared with non-weight-bearing. Evaluation of the three-dimensional movements in terms of helical axis rotations and translations confirmed the constrained or unconstrained in vivo behaviour of the designs under study. This analysis also facilitated the interpretation of the kinematic behaviour of the prosthetic knees and may be of value in the evaluation of new designs.

  • 192.
    Nilsson, Kjell G
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Henricson, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Norgren, Bo
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Dalén, Tore
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Uncemented HA-coated implant is the optimum for the TKA in the young patient2006Ingår i: Clinical Orthopaedics and Related Research, ISSN 0009-921X, E-ISSN 1528-1132, Vol. 448, s. 129-139Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Fixation of the tibial component in total knee arthroplasty in younger patients remains controversial. We evaluate the results of three different types of fixation of the Profix total knee arthroplasty in a randomized controlled trial of 97 consecutive knees (85 patients) with osteoarthrosis or inflammatory arthritis with 2-year followup of all patients. We randomized patients to three different types of fixation of the tibial component: cemented, uncemented (HA coated) with screws, or uncemented (HA coated) without screws. We performed clinical evaluations and radiostereometric analysis at 6 weeks, and 3, 6, 12 and 24 months postoperatively. The knees in the uncemented groups migrated more than those in the cemented group during the first 3 months, but at 2 years we observed no differences. The uncemented implants displayed all migration within the first 3 months. The cemented implants did not stabilize but had continuously increasing migration during the followup. Cementless implants without screws did not migrate more than implants with screws and displayed similar pattern of migration, indicating screws do not improve fixation. Uncemented fixation using hydroxyapatite-coated implants without screws seems to be the best solution for the younger patient.

  • 193.
    Nilsson, Kjell G
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Lundholm, Rolf
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi.
    Friberg, Sven
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Assessment of horizontal laminar air flow instrument table for additional ultraclean space during surgery2010Ingår i: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 76, nr 3, s. 243-246Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The area in a vertical ultraclean laminar air flow (LAF) theatre is usually too small to accommodate all the equipment needed for major surgery. We investigated the addition of an instrument table supplied with fixed ultraclean LAF and placed alongside the existing main LAF unit, to determine its physical and bacteriological effect on the main unit. In phase 1, with two investigators but without a patient, smoke tests showed no intrusion of air from the table into the main unit and particle counts did not show any adverse effect on the main LAF unit. In phase 2, during patients undergoing two total knee replacements, the LAF table and a table without LAF were placed alongside the main LAF unit. The tables were subjected to the activity of an extra operating room (OR) nurse working from inside the main LAF vigorously simulating handling of instruments. During this activity, the >5 μm particle counts were 275/m3 at the instrument table with LAF and 8550/m3 at the table without LAF (P < 0.0001). Also, without the OR nurse activity, the particle counts, just inside the main unit and adjacent to the LAF table, were significantly reduced (P < 0.03–0.003). Sedimentation plates on the LAF table and in the main unit registered 22 and 25 cfu/m2/h respectively compared with 45 cfu/m2/h at the instrument table without LAF. In conclusion, the results from the smoke tests, particle counts and bacteriological evaluation showed that the additional instrument table supplied with LAF is efficient and can be safely used as an extension additional to a main OR LAF unit.

  • 194.
    Nilsson, Kjell G.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi. Umeå University Hospital, S-901 85 Umeå, Sweden.
    Theodoulou, Annika
    Mercer, Graham
    Quinn, Stephen J.
    Krishnan, Jeganath
    Mid-term migration of a cementless, porous acetabular cup: A 5 year Radiostereometric analysis2017Ingår i: Journal of Orthopaedics, ISSN 0972-978X, E-ISSN 0972-978X, Vol. 14, nr 4, s. 454-460Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: The aim of the study was to determine the 5 year migratory and wear patterns, adverse events and clinical outcomes of a cementless, porous acetabular cup. Methods: RSA imaging of a cohort of 11 patients was retrospective analysed at 5 years post Total Hip Arthroplasty (THA). Changes in pain, function and symptoms of the hip at 5 years post-THA were compared to preoperative and 2 year postoperative assessments on the Harris Hip Score (HHS) and Hip dysfunction and Osteoarthritis Outcome Score (HOOS). Results: The majority of cup migration occurred up to 6 months and stabilised thereafter (6 months to 5 years, p = 0.091-0.866, Wilcoxon Signed Rank test). The direction of rotation around the 3 axes was evenly distributed among the cups between anterior-posterior rotation, internal-external rotation and increased-decreased inclination. The majority of the cups translated proximally, at an average migration of 0.36 mm (+/- 95% CI 0.17) at 5-years post-THA. Following initial bedding in, up to 6 months, there was no detectable polyethylene wear between 6 months and 5 years. At 5 years postoperatively, a statistically significant difference was observed across all HOOS subscales in comparison to preoperative values, with higher means reported at 5 years (p < 0.001). The total mean HHS displayed a statistically significant improvement, increasing from 'poor' preoperatively to 'good' at 5 years post-THA. Conclusion: Following initial migration between discharge and 6 months, the cementless porous acetabular cup demonstrated a tendency for stabilisation from 6 months up to 5 years post-THA, suggesting good mid-term fixation. Additionally, improvements in clinical outcome measures of pain, function and quality-of-life remained high following THA at 5 years post-surgery. 

  • 195.
    Nilsson Sommar, Johan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Pettersson-Kymmer, Ulrika
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Farmakologi.
    Lundh, Thomas
    Svensson, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Hallmans, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning. Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning.
    Bergdahl, Ingvar A.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning.
    Hip Fracture Risk and Cadmium in Erythrocytes: A Nested Case-Control Study with Prospectively Collected Samples2014Ingår i: Calcified Tissue International, ISSN 0171-967X, E-ISSN 1432-0827, Vol. 94, nr 2, s. 183-190Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Several studies have investigated the relation between bone mass density and cadmium exposure, but only few studies have been performed on fractures and biomarkers of cadmium. This study analyzed the association between hip fracture risk and cadmium in erythrocytes (Ery-Cd). Prospective samples from the Northern Sweden Health and Disease Study's biobank were used for 109 individuals who later in life had sustained a low-trauma hip fracture, matched with two controls of the same age and gender. The mean concentration of Ery-Cd (±SD) in case samples was 1.3 ± 1.4 versus 0.9 ± 1.0 μg/L in controls. The odds ratio (OR) was 1.63 [95 % confidence interval (CI) 1.10-2.42] for suffering a hip fracture for each microgram per liter increase in Ery-Cd. However, when taking smoking into consideration (never, former, or current), neither Ery-Cd nor smoking showed a statistically significant increase in fracture risk. Using multiple conditional logistic regression with BMI, height, and smoking, the estimated OR for a 1-μg/L increase in Ery-Cd was 1.52 (95 % CI 0.77-2.97). Subgroup analysis showed an increased fracture risk among women (OR = 1.94, 95 % CI 1.18-3.20, for a 1 μg/L increase), which also remained in the multiple analysis (OR = 3.33, 95 % CI 1.29-8.56). This study shows that fracture risk is associated with Ery-Cd. It is, however, not possible to draw firm conclusions on whether cadmium is the causal factor or whether other smoking-related factors cause this association. Subgroup analysis shows that cadmium is a risk factor for hip fracture among women.

  • 196.
    Nordstrand, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Bovinder Ylitalo, Erik
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Thysell, Elin
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Jernberg, Emma
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Crnalic, Sead
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Widmark, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Bergh, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Lerner, Ulf H.
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi. Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition at Institute for Medicine, Sahlgrenska Academy at University of Gothenburg.
    Wikström, Pernilla
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Bone Cell Activity in Clinical Prostate Cancer Bone Metastasis and Its Inverse Relation to Tumor Cell Androgen Receptor Activity2018Ingår i: International Journal of Molecular Sciences, ISSN 1422-0067, E-ISSN 1422-0067, Vol. 19, nr 4, artikel-id 1223Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Advanced prostate cancer frequently metastasizes to bone and induces a mixed osteoblastic/osteolytic bone response. Standard treatment for metastatic prostate cancer is androgen-deprivation therapy (ADT) that also affects bone biology. Treatment options for patients relapsing after ADT are limited, particularly in cases where castration-resistance does not depend on androgen receptor (AR) activity. Patients with non-AR driven metastases may, however, benefit from therapies targeting the tumor microenvironment. Therefore, the current study specifically investigated bone cell activity in clinical bone metastases in relation to tumor cell AR activity, in order to gain novel insight into biological heterogeneities of possible importance for patient stratification into bone-targeting therapies. Metastasis tissue obtained from treatment-naïve (n = 11) and castration-resistant (n = 28) patients was characterized using whole-genome expression analysis followed by multivariate modeling, functional enrichment analysis, and histological evaluation. Bone cell activity was analyzed by measuring expression levels of predefined marker genes representing osteoclasts (ACP5, CTSK, MMP9), osteoblasts (ALPL, BGLAP, RUNX2) and osteocytes (SOST). Principal component analysis indicated a positive correlation between osteoblast and osteoclast activity and a high variability in bone cell activity between different metastases. Immunohistochemistry verified a positive correlation between runt-related transcription factor 2 (RUNX2) positive osteoblasts and tartrate-resistant acid phosphatase (TRAP, encoded by ACP5) positive osteoclasts lining the metastatic bone surface. No difference in bone cell activity was seen between treatment-naïve and castration-resistant patients. Importantly, bone cell activity was inversely correlated to tumor cell AR activity (measured as AR, FOXA1, HOXB13, KLK2, KLK3, NKX3-1, STEAP2, and TMPRSS2 expression) and to patient serum prostate-specific antigen (PSA) levels. Functional enrichment analysis indicated high bone morphogenetic protein (BMP) signaling in metastases with high bone cell activity and low tumor cell AR activity. This was confirmed by BMP4 immunoreactivity in tumor cells of metastases with ongoing bone formation, as determined by histological evaluation of van Gieson-stained sections. In conclusion, the inverse relation observed between bone cell activity and tumor cell AR activity in prostate cancer bone metastasis may be of importance for patient response to AR and/or bone targeting therapies, but needs to be evaluated in clinical settings in relation to serum markers for bone remodeling, radiography and patient response to therapy. The importance of BMP signaling in the development of sclerotic metastasis lesions deserves further exploration.

  • 197.
    Nordstrand, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Bovinder-Ylitalo, Erik
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Thysell, Elin
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Jernberg, Emma
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Crnalic, Sead
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Widmark, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Bergh, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Lerner, Ulf H
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    Wikström, Pernilla
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Bone remodeling in relation to androgen receptor activity in prostate cancer bone metastasesManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Prostate cancer often metastasizes to bone and the metastases are generally classified as osteoblastic, although a mixed osteoblastic/osteolytic bone response may exist. The present study aimed to characterize the bone remodeling activity in clinical bone metastasis samples, with the overall hypothesis that diversities exist that may be of importance for clinical response to current therapies. Specifically, we aimed to study bone remodeling activity in relation to tumor cell androgen receptor (AR) activity. Metastasis tissue obtained from treatment-naïve (n=11) and castration-resistant (n=28) patients during surgery for spinal cord compression was characterized using whole-genome expression analysis followed by multivariate modeling and functional enrichment analysis as well as by histological evaluation. By analyzing expression levels of a predefined set of markers representing osteoclasts (ACP5, CTSK, MMP9), osteoblasts (ALPL, BGLAP, RUNX2) and osteocytes (SOST), we found high osteoblast activity to be coupled to a high osteoclast activity. Immunohistochemistry verified a significant correlation between RUNX2 positive osteoblasts and TRAP (ACP5) positive osteoclasts lining metastatic bone surfaces in close contact to tumor cells. No difference in bone remodeling activity was seen between treatment naïve and castration-resistant patients, while the bone remodeling activity was inversely correlated to AR activity within the tissue (measured as expression of the AR, FOXA1, HOXB13, KLK2, KLK3, NKX3-1, STEAP2, and TMPRSS2) and patient serum PSA levels. Ontology analysis suggested enriched BMP signaling in metastases with high bone remodeling activity and, accordingly, BMP4 mRNA expression was significantly higher in bone metastases with than without ongoing bone formation, as determined from histological evaluation of van Gieson-stained sections. In conclusion, we have observed diversities in bone remodeling activity among clinical samples of prostate cancer bone metastases that may be of importance when selecting therapy for patients with bone metastatic cancer, especially when bone-targeting therapies are considered. The importance of the BMP signaling system for the development of sclerotic metastasis lesion deserve further exploration.

  • 198.
    Nordström, Robin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Postoperative infection after surgical treatment of hip fracture An observational, retrospective cohort study of 1,273 patients treated between the years 2003 and 2008 followed for an average of 57 months at Umeå University Hospital, Sweden2018Självständigt arbete på grundnivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 199.
    Nordvall, Helena
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Sjukgymnastik. Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Ortopedi.
    Factors in secondary prevention subsequent to distal radius fracture: Focus on physical function, co-morbidity, bone mineral density and health-related quality of life2009Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    In Sweden approximately 25000 distal radius fractures occur annually, which is 37 % of all fractures related to osteoporosis. In this thesis, risk factors for osteoporosis, bone mineral density (BMD) and health-related quality of life (the SF-36) were compared in patients who suffered a distal radius fracture after low energy trauma with a control group matched on the basis of age, gender, and municipality of residence. The aim was also to analyse, among these patients, whether a risk factor questionnaire, tests on dynamic and static balance and a one-leg rise test could identify those, who have osteopenia or osteoporosis, and run a risk of new falls. Moreover, in a three-year follow-up, mortality, the need for in- and outpatient care, and health-related quality of life after radius fracture were investigated and compared between the patients and matched controls. Finally, the effect of a preventive intervention program including patient education and self-training was evaluated. Falls were reported in a risk factor questionnaire and in a fall diary.

    The patients aged 45-64 years showed lower, although not statistically significant, BMD, compared with the controls of the same age, but there was no difference concerning their history of falls. In contrast, the patients aged 64 years or older had a history of falling more often than the corresponding controls, but no difference in BMD was found. For all other risk factors, except falls, no differences were found between the patients and the controls. The results of the one-leg rise test were associated with those of dynamic and static balance, but none of the functional tests were associated with the number of falls. Decreased height and cigarette smoking were the only risk factors, which predicted osteopenia and osteoporosis.

    Five patients, although none of the controls, died during the study time. The patients needed statistically significantly more episodes as inpatients than the controls. The patients also had lower SF-36, Role Physical scores, than the controls at three months. This difference disappeared by the time of the follow-up.

    Both the patients, who participated in a four-week intervention program, “the osteoporosis school” followed by a one-year home-based exercise program, and the controls showed statistically significantly improved dynamic and static balance, ability to walk backwards and to stand on one leg with eyes open and closed at the end of the study. However, no significant differences were found between the patients and the controls in any of the tests, in BMD or in the number of the falls.

    The thesis shows that, except for the falls in patients aged over 64 years, there were no significant differences between patients and controls with respect to BMD and other risk factors related to osteoporosis. Consequently, in patients aged 45-64 years and older, the underlying cause of a distal radius fracture is more related to falls than to osteoporosis. Furthermore, the thesis shows that the functional tests and the risk factor questionnaire seem to be of limited value for identifying 8 people with a radius fracture, who are at risk of falling or have osteopenia or osteoporosis. If, in spite of this, functional tests on musculoskeletal function are considered for testing of functional ability in patients with a recent radius fracture, the one leg-rise test may be sufficient. There seems to be an increased mortality and morbidity necessitating inpatient care among patients with a recent radius fracture. The osteoporosis school had no significant effect on BMD, balance, muscle strength or falls in this thesis. Therefore, the lack of proven efficacy of the osteoporosis school for the secondary prevention of distal radius fractures highlights the need for more and long-term randomised controlled follow-up studies in this specific population.

  • 200.
    Nordvall, Helena
    et al.
    Department of Physiotherapy, Sunderby Hospital, Department of Orthopaedics, Sunderby Hospital, Luleå.
    Glanberg-Persson, Gunhild
    Department of Orthopaedics, Sunderby Hospital, Luleå.
    Lysholm, Jack
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Ortopedi.
    Are distal radius fractures due to fragility or to falls?: a consecutive case-control study of bone mineral density, tendency to fall, risk factors for osteoporosis, and health-related quality of life2007Ingår i: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 78, nr 2, s. 271-277Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: A fracture of the distal radius is considered to indicate an increased risk of future fractures, especially a hip fracture. The main causes may be osteoporosis or a tendency to fall, separately or in combination.

    METHODS: 93 women and 5 men with a recent radius fracture and the same number of controls were measured with a heel-DXL and asked to complete one questionnaire on their quality of life (SF-36), and one on risk factors.

    RESULTS: The mean T-score of the patients was -2.1, and for the controls it was -1.9 (p = 0.3). The patients aged over 64 years had a history of falling more often than the corresponding controls (p = 0.01), but there was no difference in T-score. By contrast, patients 45-64 years of age showed a non-significant, lower T-score (p = 0.09), but there was no difference concerning their history of falling. For all other risk factors, no differences were found between the patients and the controls. There were significant differences between the patients and the controls in some of the functions in the SF-36, due to the radius fracture.

    INTERPRETATION: This study indicates that the underlying cause of a distal radius fracture may be different in patients aged 45-64 years and those who are more than 64 years old.

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