Postersession II
Onsdag den 22. oktober
11:00 – 12:00
Lokale: Stockholm/Copenhagen
Chairmen: Thomas Jakobsen / Kjeld Søballe
154. Pain distribution in primary care patients with hip osteoarthritis – a descriptive study
Erik Poulsen, Søren Overgaard, Jacob Toft Vestergaard, Henrik Wulff Christensen, Jan Hartvigsen
Research, Nordic Institute of Chiropractic and Clinical Biomechanics; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark
Background: When adult patients present in primary
care with hip pain, the most common
diagnosis is hip osteoarthritis (OA). A
number of studies have reported pain
location and distribution in hip OA
patients but findings relate to patients
just prior to total hip arthroplasty (THA)
and include patients with rheumatoid
arthritis, osteonecrosis and severe
dysplasia. A single study has
examined pain location in primary care
patients with hip pain but 2/3 of the
patients did not have hip OA.
Purpose / Aim of Study: To describe pain location and pain
distribution in a cohort of primary care
patients with unilateral hip OA.
Materials and Methods: Primary care patients with unilateral
early to moderate clinical and
radiographic hip OA recorded
distribution of hip pain on a manikin
displaying three separate planes:
frontal, back and lateral views. Pain
drawings were analysed using a
template and drawings were
subsequently digitally processed to
produce a composite image.
Findings / Results: A total of 109 patients completed pain
drawings. The mean age was 65 (SD
9), 44% were females, the right/left hip
ratio was 66/43 respectively, the mean
pain duration was 32 months (SD 36,
range 4 – 300), and mean pain
intensity was 5.4 (SD 2.0). A minority
of patients reported pain in only one
area, most commonly the greater
trochanter area (16%). No patients
marked pain exclusively in the areas of
the knee, posterior thigh or lower leg.
Conclusions: The most common pain locations of
symptomatic hip OA presenting in
primary care are the greater
trochanter, groin, thigh and buttock
areas. When adult patients in primary
care present with pain in the greater
trochanter, groin, anterior lateral thigh
or buttock areas, the clinician as a
minimum should include a physical
examination of the hip joint.
155. The effect of periacetabular osteotomy (PAO) on the clinical outcome in patients with retroverted acetabulum - a prospective cohort study
Victoria Schmiegelow, Bjarke Løvbjerg Viberg, Ole Ovesen, Søren Overgaard
Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark
Background: A retroverted acetabulum can cause
pincer impingement with deep groin
pain, reduced quality of life and activity
level. Retroverted acetabulum is over
time to be associated with
osteoarthritis (OA). Few studies have
evaluated the effect of PAO and
reorientation of the retroverted
acetabulum and this is the first Danish
cohort.
Purpose / Aim of Study: was to investigate the effect of PAO in
patients with retroverted acetabulum
and pincer impingement on pain,
clinical outcome and quality of life.
Materials and Methods: Inclusion criterias were daily pain for at
least 6 months, positive impingement
test and verified retroverted
acetabulum on radiographs and CT-
scan. Patients had no OA. Exclusion
criterias were previous operation in the
hip for any reason. The patients were
operated from December 2004 - May
2013 with at least 1 year of follow-up.
They were scored with HHS, EQ5D-3L
and VRS (pain on verbal rating scale)
pre- and postoperatively. In addition,
they were evaluated on 3 Anchor
questions regarding their hip.
Findings / Results: 106 patients (83F) with 120 PAO with
a median age of 21.4 years (IQR
18.1-26.8) were included. The median
follow-up time was 1.1 year (IQR
1-1.6). The median HHS (IQR)
improved from 68 (61-72) to 94 (91-
96). Median (IQR) VRS improved from
8 (6-9) to 0 (0-2). Median (IQR) EQ5D-
3L improved from 0.72 (0.66-0.77) to
0.824 (0.72-1). Compared to
preoperative HHS, VRS and EQ5D-3L
all improved significantly (p< 0.0001,
Wilcoxon matched sign rank test). 78-
80 % reported good to excellent health
and result of PAO and a better hip
function than prior to surgery.
Conclusions: PAO for a patient with pincer
impingement and retroverted
acetabulum shows good postoperative
results regarding HHS, VRS, EQ5D-3L
and specific anchor questions.
156. Evaluation of bone mineral density and bone markers in femoral amputees prior to osseointegrated implant surgery
Rehne Lessmann Hansen, Peter Holmberg Jørgensen, Kjeld Søballe, Klaus Kjær Petersen, Maiken Stilling
Department of orthopaedic research, University Hospital of Aarhus; Department of orthopaedic surgery, University Hospital of Aarhus
Background: Amputees often have radiological halisteretic
bone in the residual femur. The status of
periimplant bone mineral density (BMD) and
general skeletal bone activity may offer
important information prior to osseointegration
(OI) surgery.
Purpose / Aim of Study: Evaluation of preoperative data of the first 20
patients.
Materials and Methods: 20 patients (13 male) with mean age 48 (range
30-66) years, and mean 10.5 (range 0-39)
years since amputation, were scheduled for
surgery with an OI-implant.
Preoperative assessment included AP and LA
radiographs of the femur, DXA scans with
measurement of systemic and femoral/pelvic
bone mineral density (BMD) and thigh muscle
mass, and biomarkers (BASP bone-type,
Ca2+, PTH, D2+D3, creatinine).
Findings / Results: Mean length of the residual femur was
20.3cm (range 4.7–41cm). 9 patients had
a normal systemic BMD (T>-1), 9 were
osteopenic ((T ≤ -1), and 2 patients were
osteoporotic ((T < -2.5) (male:30 yr,
male:45yr).
The BMD of the femur, hip and pelvis on the
amputated leg was decreased by 40%, 35%
and 21%, and the muscle mass in the
gluteal region and femur was decreased by
9,5% and 47,5%, compared to the healthy
leg (p<0.001). The BMD in the distal 12 cm
of the amputated femur correlated positively
with the length of the femur (spearman’s rho
0.64, p=0.002) and negatively with the
years since amputation (spearman’s rho
-0.71, p=0.0004).
7 patients had vitamin D insufficiency, 5
patients had elevated PTH-levels, 5 patients
had elevated BASP and all had normal
Ca2+ and BASP bone-type.
Conclusions: Femoral amputees have an almost 50%
reduced BMD and muscle mass in the affected
leg and the degree depends on the years
since amputation and the length of the residual
femur. Low systemic BMD and vitamin D
insufficiency with sec. hyperparathyroidism
was seen in 1/3 of patients indicating a
general need for screening.
157. Amputation after failed knee arthroplasty
Tinne B Gottfriedsen Tinne Brandt Gottfriedsen, Anders Odgaard Anders Odgaard, Henrik M Schrøder Henrik Morville Schrøder
Department of Orthopaedics, Copenhagen University Hospital Gentofte
Background: Existing data on amputation for failed
knee arthroplasty is limited. Data from
the Danish Knee Arthroplasty Register
(DKR) suggests that only 3
amputations have been performed
since 1997.
Purpose / Aim of Study: To identify the incidence and causes of
above knee amputation after failed
knee arthroplasty.
Materials and Methods: Nationwide data was extracted from
the Danish Hospital Episodes Statistics
and DKR. Relevant patient notes were
retrospectively reviewed.
Findings / Results: We identified 89,545 primary knee
arthroplasties performed in Denmark
from 1997-2013. 250 arthroplasties
were followed by amputation
corresponding to an overall crude
incidence of 0.28%. Of these, 111
were performed for causes related to
the knee arthroplasty corresponding to
an incidence of 0.12% (range among
regions, 0.07-0.16%, p=0.42). Survival
data will be presented. Mean age was
69.1 years (66.9-74.5, p=0.80). Mean
time between primary arthroplasty and
amputation was 4.1 years (1.8-5.5,
p=0.16). The patients underwent an
average of 2.7 knee surgeries prior to
amputation including arthrodesis in 23
cases (1.7-3.8, p=0.06). 54% of cases
were assessed at a highly specialised
hospital (18-90%, p=0.001). Indications
for amputation included infection in 91
cases (82%), soft tissue deficiencies in
24 cases (22%), bone loss in 20 cases
(18%), extensor mechanism disruption
in 11 cases (10%), pain in 10 cases
(9%), periprosthetic fracture in 10
cases (9%) and vascular complications
in 9 cases (8%). In 88 cases (79%)
there were at least two or more
indications for amputation.
Conclusions: We found significantly more
amputations than reported to DKR.
56% of these were performed for
causes other than failed knee
arthroplasty. The majority of
amputations related to failed knee
arthroplasty were performed for
several indications, of which infection
was present in most cases.
158. Acceptable agreement between Inertia-based Measurement Unit and Optical Motion Capture System applied in quantitative measurement of physical function in patients
Inger Mechlenburg, Peter Bo Jørgensen, Henrik Sørensen, Dennis B Nielsen, Bernd Grimm, Kjeld Søballe
Orthopaedic Research, Aarhus University Hospital; Section of Sports, Aarhus University; ATRIUM Medical Center, AHORSE Foundation, The Netherlands
Background: There is need for valid objective
measures of physical function when
outcome after orthopaedic or
rehabilitation interventions are
evaluated.
Purpose / Aim of Study: The aim of this study was to validate
an Inertia-based Measurement Units
(IMU) against an Optical Motion
Capture System (OMCS).
Materials and Methods: Ten patients (eight females), mean
age 28 (16-43) years with hip
dysplasia were tested. The test battery
included four lower extremity
performance measures: sit-stand-sit
(STS), stair climbing (SC), block
stepping test (BST) and counter
movement jump (CMJ). We applied an
IMU (Micro Strain Inertia-Link) and
recorded data at 100 Hz. Kinematic
data were recorded at 240 Hz with an
8-camera ProReflex MCU 1000
OMCS. Rotations were measured as
range between highest and lowest
value. Agreement between the two
systems was analyzed and presented
with Limits of Agreement (LOA) (mean
difference ±1.96 x SD).
Findings / Results: Overall, the agreement between the
results acquired by the IMU and the
OMCS was acceptable. LOA for
rotations in the frontal plane in degrees
for STS were 3.7±15.4 in ascending
and 3.3±11.1 in descending. For SC,
LOA for rotations in the sagittal plane
were 2.2±6.9 deg in ascending and
-3±5.8 deg in descending. LOA for
rotations in the sagittal plane at the
BST were -0.7±5.3 deg in ascending
and -1.2±5.9 deg in descending. LOA
for vertical translation for CMJ were
-0.6±5.5 cm. There were systematic
differences between the IMU and
OMCS in SC (mean diff 2.2 deg
p=0.03 and mean diff -3 deg p<0.01
respectively).
Conclusions: The IMU showed acceptable
agreement with OMCS when applied in
test of physical function in patients.
There is a clear perspective for
clinicians to apply the IMU in the
evaluation of orthopaedic or
rehabilitation interventions.
159. Intervertebral disc degenerative changes after intradiscal injection of TNF-α in a porcine model
Ran Kang, Haisheng Li, Kresten Rickers, Steffen Ringgaard, Lin Xie, Cody Bünger
Orthopaedic Research Lab, Aarhus University, Aarhus C 8000, Denmark; The MR Research Centre, Aarhus University Hospital, Skejby, Aarhus C 8000, Denmark; Department of Orthopedic Surgery, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing 210028, China
Background: While high expression of tumor
necrosis factor-α (TNF-α) is commonly
found in already degenerated discs,
whether or not exogenous TNF-α will
initiate a degeneration process in a
healthy disc in vivo has not been
studied assertively.
Purpose / Aim of Study: To investigate whether exogenous
TNF-α will initiate intervertebral disc
degeneration.
Materials and Methods: Exogenous TNF-α in dosages of 50 ng
and 100 ng in 50 ¦ÌL Dulbecco¡¯s
Modified Essential Medum (DMEM)
was injected into porcine lumbar discs;
a third disc was injected only with 50 ¦ÌL
DMEM as a control. Magnetic
resonance imaging (MRI) yielding T1-
and T2-weighted images, T2 maps, and
post-contrast T1 images was performed
and histology was studied as well.
Findings / Results: After three months, a significant
decrease in T2 value was observed in
the annulus and nucleus of both groups
injected with TNF-α along with a slight
decrease in disc height and nucleus
volumes in comparison to the control
discs. No obvious differences among
the groups were observed in the normal
T1- and T2-weighted MRI images. Post-
contrast T1 MRI showed increased
annulus enhancement in both TNF-α-
injected groups compared to the control
discs, while no enhancement difference
was observed in the nucleus.
Histological analysis showed
degenerative changes with annulus
fissure, cell cluster, nucleus matrix loss,
and vascularization in the outer
annulus of both TNF-α- injected discs,
while no degenerative changes were
observed in the control discs.
Conclusions: Intradiscal injection of exogenous TNF-
α caused disc degeneration in a
porcine model. Accordingly, such
preventive measures as anti-
inflammatory treatment might be
considered as a means of protecting
the disc when there are high TNF-α
levels in the serum.
160. A month of heavy resistance exercise increases the amount of Collagen XIV in the endomysium close to the human MTJ
Jens Rithamer Jakobsen, Abigail Mackey, Andreas Knudsen, Manuel Koch, Michael Kjaer, Michael Rindom Krogsgaard
Department of sportstraumatology M51, , Bispebjerg University Hospital; Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M, and Department of Biom, Bispebjerg University Hospital and University of Copenhagen; Institute for Dental Research and Oral Musculoskeletal Biology, and Center for Biochemistry, Medical Faculty, University of Cologne, Cologne, Germany
Background: Strain injuries are a common cause of
absence from sports. They occur most often
at the myotendinous junction (MTJ). So far
the best prevention seems to be heavy
resistance exercise (HRE), but it is unknown
which adaptions HRE induces in the human
MTJ that could explain this lowering in risk of
strain injuries.
Purpose / Aim of Study: To investigate how the MTJ and endomysium
adapts to one month of HRE training.
Materials and Methods: Ten patients scheduled for cruciate ligament
reconstruction with a hamstrings graft were
randomized into either a control group or a
training group (1 month of HRE). At the
operation, samples were collected from the
semitendinosus and gracilis MTJ and fixed in
liquid nitrogen-cooled isopentane. Samples
were sectioned and stained with
immunofluorescent antibodies against seven
collagen types. The amounts of collagen
were estimated visually using a scale from
0-2 where 2 is the highest amount.
Findings / Results: Compared with our control group, a
significantly higher collagen XIV content of
the muscle endomysium (P = 0,0132) was
found in the training group. No significant
differences for any of the investigated
collagen types where seen at the MTJ.
Conclusions: 1 month of HRE does not lead to
detectable increases in the amount of
collagen I, III, IV, VI, XII and XIV at the
MTJ. However, it leads to a significant
increase in collagen XIV content in the
endomysium of human muscle tissue
close to the MTJ. These findings suggest
that collagen XIV has a role in the
adaptation of the connective tissue
sheath to heavy loading. It is possible
that longer training periods are required
to induce measurable increases for the
other collagen types at the MTJ or
alternatively that structural changes
increasing the muscle-tendon contact
area explain the improved resistance to
strain injury at the MTJ after HRE.
161. Pharmacokinetics of vancomycin in porcine bone obtained by microdialysis
Mats Bue, Hanne Birke-Sørensen, Theis Muncholm Thillemann, Kjeld Søballe, Mikkel Tøttrup
Department of Orthopaedic Surgery, Hospital Unit Horsens; Orthopaedic Research Unit, Aarhus University Hospital
Background: Traditionally, the pharmacokinetics of
antimicrobials in bone has been
investigated using bone biopsies, which
suffers from considerable methodological
limitations. Microdialysis (MD) offers an
attractive alternative to obtain bone
concentrations of antimicrobials.
Purpose / Aim of Study: The aims of this study were to investigate
the suitability of the MD-method for
vancomycin measurement in a laboratory
setting and to apply MD for measurement of
vancomycin in subcutaneous tissue,
cancellous and cortical bone.
Materials and Methods: Laboratory studies were conducted to
determine in vitro recovery by gain and by
loss (1-25 µg/ml), appropriate flow rate,
calibration concentrations and the effect of
temperature and concentration on recovery.
In a porcine study MD-catheters were
placed in subcutaneous tissue, cancellous
and cortical bone. CMA 63 catheters were
used, and were in bone placed in drill holes,
made by use of a 2 mm drill. Blood samples
were drawn from a central venous catheter.
CMA 107 pumps produced flow rates of 0.5
µl/min. All dialysates were analysed with an
UHPLC-method, and vancomycin
concentrations in plasma were determined
with cobas (c501, Roche). Verification of
catheter locations was performed by
autopsy, and intra cortical placement of drill
holes was verified by post-mortem CT.
Findings / Results: Laboratory study: Recovery by gain
equalled recovery by loss, and was
independent of the concentration. Recovery
increased slightly with increasing
temperature.
Porcine study: For all extravascular tissue, a
heterogeneous distribution was
demonstrated.
Significant differences in AUC were found
for bone, cancellous as well as cortical,
when compared to free plasma. The lowest
AUC was found in cortical bone.
Conclusions: MD is a reliable method for assessment of
the penetration and pharmacokinetics of
vancomycin in bone and soft tissue.
162. Collagen types and distribution at the human myotendinous junction (MTJ)
Jens Rithamer Jakobsen, Abigail Mackey, Andreas Knudsen, Manuel Koch, Michael Kjaer, Michael Rindom Krogsgaard
Department of sportstraumatology M51, , Bispebjerg Hospital, University of Copenhagen, Denmark.; Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M, and Department of Biom, Bispebjerg University Hospital and University of Copenhagen; Institute for Dental Research and Oral Musculoskeletal Biology, and Center for Biochemistry, Medical Faculty, University of Cologne, Cologne, Germany
Background: The MTJ is the interface between the
muscle and tendon, through which force
produced in the muscle is transmitted.
Excessive loading of muscles can result
in strain injuries, which often occur at the
MTJ. However, very little is known about
the composition of the human MTJ. In
animals, collagen type XXII seems to be
located exclusively in the MTJ, and has
been shown to contribute to the
stabilization of MTJ and strengthening of
skeletal muscle attachments during
contraction. Similarly, a lack of Collagen
XXII results in a higher susceptibility to
ruptures of the MTJ.
Purpose / Aim of Study: The aim of this study is to investigate the
distribution of collagen type XXII in human
MTJ and the localisation of other collagen
types (I, III, VI, XII, XIV) in relation to collagen
XXII.
Materials and Methods: Samples of MTJ were collected from the
hamstring muscles of 15 patients during
ACL-reconstruction and frozen in liquid
nitrogen, cut on a cryostat and stained with
antibodies against collagen I, III, IV, VI, XII,
XIV and XXII. The sections were analysed
immunohistochemically with fluorescent
wide-field and confocal microscopes and
the amounts of stained protein were
estimated visually on a score from 0 to 2,
where 2 is highest.
Findings / Results: Collagen XXII was located only at the MTJ,
but not in all regions. It was detected
between the dystrophin-labelled myofibre
membrane and the endomysium, which was
rich in collagen types III and VI. Collagen
types XII and XIV were also observed to be
closely associated with XXII.
Conclusions: The human MTJ has a very complex
composition of different collagen types. The
possible roles of these collagens in force
transmission are discussed. Collagen type
XXII was the only type to be solely located at
the MTJ, and is therefore a valuable marker
for human MTJ even though it is not found in
all regions.
163. CAN GAIT DEVIATION INDEX BE USED EFECTIVELY FOR THE EVALUATION OF GAIT PATHOLOGY IN TOTAL HIP ARTHROPLASTY? AN EXPLORATIVE RANDOMIZED TRIAL
Carsten Jensen, Signe Rosenlund, Dennis B. Nielsen, Søren Overgaard, Anders Holsgaard-Larsen
Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hos, Institute of Clinical Research, University of Southern Denmark; Departments of Orthopedic Surgery and Traumatology, Køge and Odense Hospital; Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital
Background: Three-dimensional gait analysis
(3DGA) is widely used in the
quantitative evaluation of gait.
However, 3DGA produces a large
volume of data, and simplifying such
complex data into a single measure of
patients overall gait ‘quality’ would be
valuable in clinical practice. The
experience with GDI in osteoarthritis
(OA) patients following total hip
arthroplasty (THA) is novel.
Purpose / Aim of Study: The aim of our study was to use the
GDI to evaluate post-operative gait
quality changes in patients with hip OA
following two types of THA.
Materials and Methods: A total of 38 patients (11F:27M, age 56
± 5.6, BMI 27.8 ± 3.6) with unilateral
end-stage primary hip OA were
evaluated pre-operatively, two- and six-
months after THA, while walking at self-
selected speed. From the entire gait
cycle, rather than a small number of
discrete parameters, the GDI was
calculated for each limb (n=76 limbs).
The normative mean and standard
deviation from age-matched controls
(n=20) were used as reference.
A fixed-effects multilevel regression
model was employed to evaluate the
treatment effects.
Findings / Results: Patients had a moderate deviation
from normative gait (score = 100)
before surgical treatment (83.4 ± 10.9).
After surgery, the score improved
significantly by 4.9 [95CI: 2.1 to 7.9].
There was no difference in GDI scores
between the two treatments; 1.8 [95CI:
-2.8 to 6.4]. However, the GDI score
for the non-operated limb was higher
than the GDI score for the operated
limb; 2.5 [95CI: 0.1 to 4.8].
Conclusions: GDI increased after THA, which
indicates an overall improvement in
gait quality. No difference between
treatments was observed.
Asymmetrical gait pattern do not
disappear following THA. Further
research is required to establish the
clinical relevant difference for the GDI
score for THA patients.
164. Validation and inter-tester reliability of a tri-axial accelerometer-based classification of daily activities
Marianne Tjur, Kenneth Juul Laugesen, Kamilla Nygaard Jensen, Mads Grosmann Svendsen, Inger Mechlenburg, Signe Kierkegaard
Orthopaedic Research, Aarhus University hospital; Bachelor of Applied Science in Physiotherapy, VIA University College Aarhus
Background: Daily physical activities (PA) are often
used as outcome in the evaluation of
orthopaedic or rehabilitation
interventions. Self-reported PA suffers
from recall bias and imprecision, thus
there is a need for objective measures.
Purpose / Aim of Study: The aim was to investigate the
inter-tester reliability and precision
of the classification of PA measured
with a tri-axial accelerometer, and a
MatLab-based algorithm.
Materials and Methods: 27 healthy participants were observed
with video recordings while performing
30 min of various time intervals of the
activities; resting, standing, walking,
cycling and running. A tri-axial
accelerometer (GCDataconcepts, US) was
mounted on lateral side of right thigh
while performing the activities. Two
blinded analysers performed the
classification of activities using the
algorithm. The relative reliability was
expressed with Intraclass Correlation
Coefficient (2,1)(ICC), the absolute
reliability with Limits of Agreement
(LOA) and precision with LOA of the
proportion of analysed activity compared
to observed.
Findings / Results: ICC was high for resting 0.99, standing
0.99, walking 0.88 and running 0.99 and
acceptable for biking 0.73. LOA were
acceptable for resting [-0.34;0.42],
standing [-0.98;1.28], walking
[-449;368], running [-0.39;0.32] and
biking [-368;448]. The precision of
classifying PA was acceptable with LOA
[0.99:1.02] for resting, [0.94:1.10] for
standing and [0.98:1.07] for biking.
Walking was underestimated (mean= 0.71
(p=0.03), LOA [0.19:2.60]) while running
was overestimated (mean= 1.39 (p=0.001),
LOA [0.64:2.98]).
Conclusions: Inter-tester reliability was high while
precision of classification of resting,
standing and cycling was acceptable.
More precision is necessary in the
classification of walking and running.
The perspectives for monitoring daily PA
with accelerometer seem promising.