Posterudstilling
Fra onsdag den 21. oktober
10:30 –
lokale: Capital Foyer
Postere med foredrag er listet under Session 14, Session 15, Session 16
173. Functional outcome and patient satisfaction following implant removal in patients treated for a clavicle fracture.
Andreas Saine Granlund, Ilija Ban, Anders Troelsen
Dept. of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre
Background: Implant related discomfort (soft-tissue irritation, pain
and cosmetics) are often seen in patients with a
clavicle fracture treated surgical. Even the newer
low profile and precontoured plates are associated
with a high discomfort rate as close to 30% of these
plates are removed. Whether implant removal
results in improved functionality and patient
satisfaction is unknown.
Purpose / Aim of Study: Primary aim was to investigate whether plate
removal following clavicle fracture treatment had a
desired effect and satisfaction according to the
patient. Secondary aim was to assess functionality
and complications following implant removal.
Materials and Methods: 97 patients, (73 males, mean age 43 years) had
between 2007 and 2014 a clavicle plate removed at
our institute. A purpose made questionnaire was
used to assess self-perception of cause of implant
removal, remission, complications and overall
satisfaction. Functionality was assessed using the
short version of Disabilities of the Arm, Shoulder
and Hand score (QuickDASH). Assessment was
primarily by phone interview.
Findings / Results: 74% of the plates that were removed were primarily
used to treat midshaft fractures, with the rest used
for lateral fractures. Pain or soft tissue irritation was
indication in 52% of all cases with another 11%
caused by cosmetic deficits. 58% of all patients
were available for phone interview with a minimum
of 1 year follow-up. 75% reported satisfaction with
plate removal. 29% had complete remission in
symptoms. Another 46% had partially remission,
14% had no remission and 11% reported
worsening. Mean QuickDASH was 8 [range 0 to 91].
67% reported no complication with 19% complaining
of larger scar tissue.
Conclusions: Clavicle plates causing nuisance to the patient can
be removed expecting satisfying results with close
to normal functionality and few complications.
174. Eighty-seven patients operated due to Herniated Disc. No correlation between the presence of Modic changes and Propionibacterium Acnes.
Anne Hansen, Laura Mathiesen, Thomas Bender, Peter Lemcke, Søren Fruensgaard, Malene Laursen
Spine , CPK, Regionshospitalet Silkeborg, HEM; Spine, CPK, Regionshospitalet Silkeborg, HEM
Background: A recent systematic review has found
moderate evidence for a correlation
between the presence of p. acnes and
back pain and/or Modic changes in
patients with disc herniation. Further
studies are needed to determine whether
these findings are results of
contamination or represent a low grade
infection.
Purpose / Aim of Study: To investigate the presence of
propionibacterium acnes in patients
operated due to disc herniation.
Further, to examine a hypothesised
association within the presence of Modic
changes and bacteria.
Materials and Methods: Eighty-seven patients undertaking an
open MIS approach due to disc
herniation. During operation, a total of
six disc-tissue samples, using separate
sterile single use instruments were
obtained. Five samples were inoculated
into thioglycolate agar tubes and
long-time incubated (14 days) and
observed for growth. Positive samples
were interpreted according to the Kamme
& Lindberg definition, the “standard”
used for discrimination between
contamination and true infection. One
sample was stored for later PCR. Modic
changes were examined on MRI scans
(preoperatively).
Findings / Results: Modic changes were seen in 51% of
patients. 5 patients (6%), had disc
tissue infected by p. acnes. 2 of the 5
patients with disc infection had no
Modic changes.
Conclusions: A low incidence of p. acnes in herniated
discs (6%) was found using an open MIS
approach combined with a tissue-handling
technique am. Kamme. No correlation was
found between the presence of Modic
changes and p. acnes.
The low incidence of infection might be
due to a low contamination-rate i.e. the
peroperative sample handling-technique
am. Kamme and/or an open surgical
technique versus scopic techniques.
175. The use of Quantitative Sensory Testing as predictive measure of surgical outcome in Lumbar Disc Herniation
Christian Støttrup, Søren O'Neill, Mikkel Andersen
Center for Spine Surgery and Research - Middelfart, Lillebaelt Hospital - University of Southern Denmark; Rygmedicinsk Afdeling - Middelfart, Lillebaelt Hospital
Background: Lumbar disc herniation (LDH) is associated
with great morbidity and significant socio-
economic impact in many parts of the world.
Patients where pain and disability is
unacceptable, surgical intervention provides
effective clinical relief in many cases.
Unfortunately, 10-20% of patients who
undergo surgery have little or no effect of the
intervention. Currently the selection of
patients suited for surgery is based on clinical
workup and surgeon experience.
Purpose / Aim of Study: The aim of this study is to evaluate if
quantitative sensory testing (QST) can be
used as a preoperative tool for identifying
patients with higher chance of favorable
outcome following surgical intervention.
Materials and Methods: Patients with first-time LDH found eligible
for surgery were included in an ongoing
study and tested using a standardized
protocol for QST preoperatively and 6
weeks post-op. Patient reported outcome
measures; EQ5D, VAS-leg and -back were
also collected. All patients followed normal
surgical and post-operative regime.
Findings / Results: Preliminary data on 16 patients were used
in these analysis. A correlation of 0.59 was
found between the preoperative result of a
cold pressor test (CPT) and the 6 weeks
post-operative change in EQ5D, with a
significance level of 0.01. A correlation of
0.43 was found for CPT and change in VAS-
leg with a significance level of 0.10. There
seems to be a correlation between pressure
pain response and surgical outcome,
however current data does not provide
significant results.
Conclusions: Preoperative cold pressor test results
seems to be correlated with post-operative
PROMs, and current data also suggest
correlation between other parameters in
quantitative sensory testing and prediction
of surgical outcome in LDH. Quantitative
sensory testing may have potential as a
preoperative predictive tool of patient
outcome.
176. Noises from total hip arthroplasty and patient-reported outcome (PRO)
Claus Varnum, Alma B. Pedersen, Per Kjærsgaard-Andersen, Søren Overgaard
Department of orthopaedic surgery, Vejle Hospital; Department of clinical epidemiology, Aarhus University Hospital; Department of orthopedic surgery and traumatology, Odense University Hospital
Background: Noises from total hip arthroplasty (THA) with
ceramic-on-ceramic (CoC) and metal-on-
metal (MoM) bearings have been described
in small series of patients – but not with
comparison to metal-on-polyethylene (MoP)
bearings.
Purpose / Aim of Study: We aimed to describe the frequency of
patient reported noises from THA with CoC,
MoM, and MoP bearings and compare PRO
scores from patients having noisy THA to
PRO scores from patients having silent MoP
THA.
Materials and Methods: We identified 3,762 patients from the
Danish Hip Arthroplasty Registry
operated from 2002 to 2009 and with no
revision, who received the following
PROs: The hip disability and
osteoarthritis outcome score (HOOS),
the EQ-5D, the UCLA activity score, and
a questionnaire about noises from the
THA. 145 patients were excluded due to
confirmed revision, and 3,082 patients
responded (response rate 85%).
Multivariate linear regression was used
to compare mean values of PRO scores
within the noisy THAs with the 3 types of
bearings to silent MoP THA.
Findings / Results: Among responders, 1,393 (45%) had
CoC, 512 (17%) MoM, and 1,177 (38%)
MoP THA. 27% of patients with CoC,
29% of patients with MoM, and 12% of
patients with MoP bearings had
experienced noises from the THA.
Significantly lower mean scores of all
HOOS subscales, EQ-5D index, and
EQ-5D VAS were shown for patients
experiencing noises from the CoC, MoM
or MoP THA compared to patients having
silent MoP THA. Only for the ULCA
activity score, no difference was found
for noisy CoC THA compared to silent
MoP THA, but patients having noisy MoM
and MoP THA had significantly lower
mean UCLA activity scores when
compared to patients having silent MoP
THA.
Conclusions: The frequency of noises was high and even
present in MoP THA. Patients with noises
from CoC, MoM, and MoP THA had lower
PRO scores than patients without noises
from their MoP THA.
177. Malformation is a risk factor for osteoarthritis in young THA patients - a prospective multicenter cohort study
Dennis Karimi, Anders Troelsen, Jakob Klit
Orthopedic Surgery, Copenhagen University Hospital of Hvidovre
Background: In Denmark, 120.988 total hip arthroplasties
(THA) has been registered from 1995 to
2012. Twenty % are younger than 60 years.
The indication is in 79.2% primary idiopathic
osteoarthritis (OA). OA is a multifactorial
disease correlated to age and hip
malformations like CAM-deformity. In
population studies this deformity has been
identified in 17–24% of men and in 4% of
women. Still it is uncertain why young adults
develop primary idiopathic OA.
Purpose / Aim of Study: Our aim was to assess the correlation
between hip malformations and OA in a
cohort of younger patients undergoing THA
by analyzing distribution and type of hip
malformations.
Materials and Methods: In this consecutive multi-center cohort
study, 96 consecutive patients (107 hips)
met the inclusion criteria. One observer
performed radiographic measurements for
malformations and radiographic OA defined
by Tönnis-grade on a dichotomous scale.
Inter- and intraobserver variability was
measured. Data is presented as prevalence
and OR.
Findings / Results: Male/female prevalences of hip
malformations were; CAM-deformity
60.4%/28.3%, coxa profunda 34.9%/26.4%,
acetabula dysplasia 11.3%/3.8%, acetabular
retroversion 34%/27.4%. Concomitant hip
malformation was 100%. The Tönnis grade
was 22.2% and 77.4%. No association were
found, all OR<1 for malformations and the
Tönnis grade.
Conclusions: All patients showed malformations. CAM-
deformity was more than three times as
frequent as in population studies. Acetabular
deformities were coxa profunda and
acetabular retroversion. Hip dysplasia was
less typical. In conclusion, our observations
showed a high prevalence of hip
malformations in young OA patients,
supporting the emerging consensus that hip
malformations lead to OA in a young age.
Focus on hip malformations for correct
registration and referral to joint-preserving
surgery is essential.
178. The association between preoperative symptoms of obesity in knee and hip joints and the change in quality of life after laparoscopic Roux-en-Y gastric bypass
Ida Birn, M.Sc, Inger Mechlenburg, M.Sc, PhD, Anette Liljensøe, M.Sc, PhD, Kjeld Soballe, MD, DMSc, Professor, Jens Fromholt Larsen, M.D, PhD
(1) Department of Orthopaedic Surgery , (2) Department of Physiotherapy and Occupational Therapy, (1) Aarhus University Hospital, Denmark, (2) Aarhus University Hospital, Denmark ; (1) Department of Orthopaedic Surgery, (2) Centre of Research in Rehabilitation (CORIR), Department , (1) Aarhus University Hospital, Denmark, (2) Hospital and Aarhus University, Denmark); Department of Orthopaedic Surgery , Aarhus University Hospital, Denmark; Department of Orthopaedic Surgery, Aarhus University Hospital, Denmark; Department of Bariatric Surgery , Mølholm Private Hospital, Denmark
Background: Weight loss after bariatric surgery is
shown to reduce knee and hip pain in
the majority of the severely obese.
Studies indicate that with a reduction in
musculoskeletal symptoms quality of
life (QoL) will improve. The group of
severely obese with knee and hip
symptoms might, therefore have
potential for a large improvement in
QoL after a bariatric surgery.
Purpose / Aim of Study: to assess the association between the
degree of knee and hip symptoms
before a laparoscopic Roux-en-Y
gastric bypass (LRYGB) and the
improvement of QoL, one year after
the surgery, in severely obese.
Materials and Methods: This study is a historical cohort study
based on data collected consecutively
at the private hospital Mølholm,
Denmark. Before LRYGB surgery
4,548 severely obese completed a
questionnaire on knee and hip
symptoms of obesity and QoL. One
year after surgery, 2,862 (62.9%) of
the participants answered the same
questionnaire again.
Findings / Results: 81.6% of the participants with knee
symptoms and 74.5% of participants
with hip symptoms experienced a
reduction of these after the LRYGB
surgery. Participants with moderate or
severe knee or hip symptoms, before
the surgery, experienced a statistically
significantly larger improvement of
their QoL, compared to participants
without symptoms before the surgery.
Furthermore, an association between
the reduction of knee and hip
symptoms and the improvement in
QoL was found.
Conclusions: Severely obese with moderate or
severe preoperative knee and hip
symptoms experienced a larger
improvement of their QoL after a
LRYGB compared to participants
without symptoms before the
operation.
179. Clinical and radiological improvement after trochleoplasty in patients with patellar dislocation secondary to trochlea dysplasia. A pilot study.
Isabel Maria Nyring, Philip Hansen, Mikael Boesen, Peter Lavard, Anette Holm Kourakis, Michael Rindom Krogsgaard
Department of Orthopaedic Surgery, Bispebjerg Hospital; Department of Radiology, Frederiksberg Hospital
Background: Trochlear dysplasia is an important risk
factor for patellar instability. Trochleoplasty
is a surgical procedure which reshapes the
trochlea groove. Previous studies in smaller
series shows encouraging results after
trochleoplasty.
Purpose / Aim of Study: To evaluate the quantitative changes in
radiological measures and clinical outcome
after trochleoplasty as a pilot study.
Materials and Methods: Since August 2009, 54 patients (59 knees)
with recurrent patellar instability underwent
a Bereiter-type trochleoplasty. Except for
three knees, the procedure was combined
with an additional procedure according to
the underlying etiological cause of patellar
dislocations. Based on availability of pre-
and postoperative MRI we selected 9 knees
for evaluation of the patella-femoral joint.
Clinical condition was evaluated
preoperatively and one year postoperatively
with the Kujala score. We compared the
sulcus angle, patellar tilt, tibial tuberosity-
trochlea groove distance (TTTG), patellar-
trochlear index (PTTI) and modified Insall-
Salvati index in pre- and postoperative MRI
scans.
Findings / Results: Postoperatively, mean Kujala score
increased (Mean Difference (MD): 16.11,
Confidence Interval (CI): 6.6-25.62;
P=0.005). The sulcus angle (MD: 11.43°, CI:
4.02-18.85°; P=0.007) and the patellar tilt
(MD: 12.19°, CI: 7.60-16.77°; P<0.001)
decreased postoperatively. No difference
was found between TTTG (MD: 4.39 mm,
CI: -2.57-11.35 mm; P=0.184), PTTI (MD:
0.05, CI: -0.14-0.24, P=0.542) or modified
Insall-Salvati index (MD: 0.12, CI: -0.02-
0.26; P=0.075) postoperatively.
Conclusions: After trochleoplasty the Kujala score
demonstrated clinical improvement. There
was a marked change in some radiological
measures demonstrating improvement of
trochlear morphology and patellar tracking
after trochleoplasty. We await the analysis
of the complete cohort.
180. MCL as a pulley in MPFL reconstruction
Jens-Christian Beuke, Jens Christian Pörneki , Kristine Bollerup Arndt , Bjarke Viberg
Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital Kolding
Background: Treatment of lateral patellar instability is complex,
usually requiring a surgical reconstruction of the
medial patellofemoral ligament (MPFL).
Purpose / Aim of Study: The study aims to describe the postoperative
outcomes and patient reported outcome measures
(PROMs) when using a new type of MPFL
reconstruction with the knee’s medial collateral
ligament (MCL) as a pulley.
Materials and Methods: From 2011 to 2015, 44 knees (38 patients; 24
females/14 males) underwent an MPFL
reconstruction with the MCL as a pulley due to
serious patellar instability. Patient records were
reviewed for minor and major complications. 32
patients (38 knees) responded to the following
PROMs: Kujala and Tegner-Lysholm knee scoring
scales, and EuroQol EQ-5D-3L.
Findings / Results: The data collected showed that 38 knee operations
(86.4%) had a postoperative course without
complications. 4 knees (9.1%) were registered with
minor complications (2 superficial infections and 2
suture problems). Major complications (e.g. re-
dislocation) resulted in re-treatment for 3 knees
(6.8%).
The mean Kujala score was estimated to 82.4 ±
10.4 SD, whilst the Tegner-Lysholm score was 84.7
± 15.6 SD. The EQ-5D-3L showed to be 0.87 ± 0.15
SD. 24 patients (75.0%) described the result of their
operation as “splendid or very good”. Only 2 patients
(6.3%) communicated their disappointment at the
result of the reconstruction. Furthermore, 28
patients (87.5%) stated that they would choose the
applied MPFL surgery again. 30 of the patients
(93.8%) no longer used analgesic due to their knee.
Conclusions: Using the MCL as a pulley in MPFL reconstruction is
very promising in the treatment of patellar instability.
However, despite reporting successful
reconstruction in 93.2% of cases, further studies
and especially a long-term analysis is
recommended.
181. Two case reports on the use of negative pressure wound therapy with instillation ( NPWTi ) as adjuvant treatment of infected total hip replacements.
Jörg Dominik Adam, Jens Jørgen Elmer Christensen, Rene´ Kirchhoff-Jensen, Xiaohui Chen Nielsen
Department of Orthopaedics, , Køge Hospital; Department of Clinical Microbiology, Slagelse Hospital; Department of Orthopaedics, Køge Hospital
Background: Negative pressure treatment has been
combined with instillation of cleansing
solutions (NPWTi ) in cases of
complicated infected wounds with
promising results. Two patients having
infected total hip replacements treated
with this new technique are reported,
which to our knowledge is the first
Scandinavian report describing the use
of this technique.
Purpose / Aim of Study: we want to describe first results in
treating infected total hipreolacements
with this new technique .
Materials and Methods: we are describing 2 cases where
NPWTii was applied to treat deep
infection in total hipreplacements.
Findings / Results: . It was our hope that this supplementing
treatment could help us in retaining the
hip replacement in the case of early
chronically infected arthroplasties and
improve our chances for success in
treating acutely infected hip
replacements.
In both cases macroscopically healthy
looking wounds were seen after few
days of NPWTi treatment. After wound
closure, however, both patients were
suffering from wound healing problems
with defects, secretion and elevated
infection parameters. In case 1 it seems
that a deep E. coli infection was
successfully eradicated; however, a
secondary infection made regular 2
stage revision necessary.
Conclusions: Treatment results seemed non-inferior to
standard regimens. Optimization of
technique and selection of patients that
may benefit from this treatment have to
be elucidated.
182. Persistent pain following surgically treated distal radius and malleolar fractures
Kristian Christensen, Kirill Gromov, Lone Knudsen, Michael Brix, Anders Troelsen, Lone Nikolajsen
Department of Anesthesiology, Aarhus University Hospital; Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre; Danish Pain Research Center, Aarhus University; Department of Orthopedic Surgery, Odense University Hospital
Background: Persistent pain is a well-recognized problem after
various types of surgery, such as amputation,
thoracotomy, and inguinal hernia repair. Less is
known about persistent pain after fracture-related
surgery
Purpose / Aim of Study: We investigated the prevalence, characteristics of,
and risk factors for persistent pain one year after
following surgically treated distal radius and
malleolar fractures
Materials and Methods: Between June 2014 and March 2015, a postal
questionnaire was sent to 599 patients who had
undergone surgery one year previously at Hvidovre
and Odense University Hospitals, Denmark, and
whose surgical data were registered in the Danish
Fracture Database. The questionnaire contained
questions about 1) pain in the operated wrist or
ankle (intensity (numeric rating scale (NRS, 0-10)),
impact of pain on daily activities), 2) signs of
Complex Regional Pain Syndrome (CRPS), 3)
quality of life (EQ-5D), and 4) psychological aspects
(PCS)
Findings / Results: 328 patients returned the questionnaire (response
rate: 54.7 %). 193 patients were operated at
Hvidovre University Hospital (ankle fracture, n=87;
wrist fracture, n=104) and 137 were operated at
Odense University Hospital (ankle fracture, n=65;
wrist fracture, n=72). Overall, 62 patients (18.9%)
experienced persistent pain in the operated
extremity one year+/-6 weeks after surgery [NRS 6
(5-8)]. Patients with ankle fracture were more likely
to report persistent pain compared with patients with
wrist fracture [23.7% (CI 16.8-30.5) vs. 14.8% (CI
9.5-20.1) P=0.04]. 12 patients (3.6%) fulfilled the
diagnostic patient-reported research symptoms for
CRPS
Conclusions: A substantial number of patients reported pain in the
operated extremity. Patients should be informed of
the high risk of persistent pain
183. Evidence for performance of implants used for proximal femoral fractures in Denmark
Anne Marie Nyholm, Henrik Palm, Henrik Malchau, Anders Troelsen, Kirill Gromov
Orthopedic Department, Hvidovre Hosptial
Background: So far trauma implants has been evaluated by
sporadic publications on limited study populations.
Currently no registry exist that continuously monitors
performance of trauma related implants.
Purpose / Aim of Study: To present the evidence of survival of the implants
currently used for proximal femoral fractures in
Denmark.
Materials and Methods: PubMed was searched for clinical studies on primary
proximal femoral fractures (AO 31A and 31B) with
follow up of ≥12 months, reporting implant related
failure and evaluating one of following sliding hip
screws (SHS) or nails: DHS, CHS, HipLoc,
Gamma3, IMHS, InterTan, PFN, PFNA or PTN.
Limits were English language and publication date
after 1st of January 1990.
Findings / Results: All studies were evidence level II or III.
30 publications for SHS were found: 13 of CHS,
15 of DHS and 2 of HipLoc. Only two included
>200 patients, both retrospective studies of DHS.
In total CHS was evaluated in 1110 patients (900
prospectively), DHS in 2486 patients (567
prospectively) and HipLoc in 251 patients (all
prospectively).
54 publications for nails were found: 13 of
Gamma3, 7 of IMHS, 5 of InterTan, 10 of PFN, 24
of PFNA and 0 of PTN. One study of each
InterTan, IMHS and PFNA included >200
patients. In total Gamma3 was evaluated in 1088
patients (829 prospectively), IMHS in 1543
patients (210 prospectively), InterTan in 595
patients (585 prospectively), PFN in 716 patients
(557 prospectively), PFNA in 1762 patients (1018
prospectively) and PTN in 0 patients.
Conclusions: The clinical evidence behind the current implants for
proximal femoral fractures is weak considering the
number of implants used worldwide. Sporadic
evaluation is not sufficient to identify long term
problems. A systematic post market surveillance of
implants used for fracture treatment, preferable by a
national register, is necessary in the future.
184. Patient-reported quality of life and hip function after revision of total hip arthroplasty due to chronic periprosthetic infection: An analysis of one-stage revision and a comparison of one-stage and two-stage revision
Ninna Rysholt Poulsen, Kjeld Søballe, Inger Mechlenburg, Jeppe Lange
Orthopaedic Research and on behalf of the CORIHA Research group, Aarhus University Hospital, Denmark; Orthopaedic Research, Aarhus University Hospital, Denmark
Background: Two-stage revision is currently regarded the
gold standard treatment in chronic hip
periprosthetic joint infections (PJI).
However, one-stage revision is assumed to
benefit the patient. There are currently no
studies comparing patient-reported outcome
measures of cementless one-stage versus
two-stage revision, and little is known on
how the patients perceive either treatment
strategy.
Purpose / Aim of Study: To investigate the health-related quality of
life (HRQOL) and patient reported hip
function after cementless one-stage
revision. Further, to compare HRQOL and
patient-reported hip function for patients
treated with either one-stage or two-stage
revision of a chronic hip PJI.
Materials and Methods: The patients in the one-stage revision group
had a prospective two-year follow-up on an
outpatient basis, where they completed
three questionnaires; EQ-5D, SF-36 and
OHS. The patients in the two-stage group
were identified retrospectively in the
National Patient Register and were
contacted by mail with the questionnaires
EQ-5D and OHS.
Findings / Results: In the one-stage group the improvement in
HRQOL appeared in the first six months
after surgery, reached a plateau, and for
most parameters decreased slightly again.
The largest improvements over two years
were OHS with effect size (ES) on 1.3 and
SF-36’s physical role limitation as well as
bodily pain with ES on 1.1. The mean
scores (CI 95%) for one-stage revision were
significantly higher compared to the two-
stage revision group on EQ-5D VAS 12.9
(2.4;23.3 p=0.02) and OHS 5.9 (0.5;11.2
p=0.03).
Conclusions: Two years after one-stage revision, HRQOL
and hip function increased significantly.
Patients receiving one-stage revision obtain
higher HRQOL and hip function compared
to two-stage revision. However the
comparison of the two groups can be
questioned, due to difference in follow-up.
185. Metacarpophalangeal Joint Silicone Artroplasty – A Review Of Sugery Performed At Aarhus University Hospital In The Period 2007-2012
Peter Birk
Ortopedic Department T, HEM, Regional Hospital Viborg
Background: Rheumatoid arthritis (RA) is a chronic inflammatory
disease. RA leads to the destruction of the joints. In
particular, peripheral joints and tissue are affected
resulting in bone erosion and destruction of the
articular cartilage. This is seen in particularly severe
degree in the metacarpophalangeal (MCP) joints
resulting in loss of joint integrity and disability in
everyday life for the RA patient.
Purpose / Aim of Study: The aim of this study is to describe if there has been
a change in the number of MCP-joint artroplasty
(MCP-JA). Our a´priori theory is that the new array
of non-surgical treatment modalities introduced over
the last decades, including DMARD and biological
medication, have contributed to improved disease
control. Subsequent reduced joint destruction and
therefore less demand for surgery.
Materials and Methods: Descriptive study based on a review of surgery
carried out by the Devison of Hand Surgery,
Ortopedic Department, AUH in the period 2007-2012.
Inclusion criteria was primary silicone MCP-JA on
basis of joint destruction caused by RA.
Findings / Results: In the period 49 patients were offered surgical
treatment with MCP-JA of the affected joints.
Demographics: 42 female: Mean age 59 years
(range 36Y- 85Y). 7 male: Mean age 60 years (range
45Y- 78Y). By exponential regression analysis, we
found no significant change in surgery over time (R2
≈ 0,007)
Conclusions: In regard to patient characteristics we found that 85
% of the patients were femal, with a peak age for
surgery from 50 Y - 70 Y accounting for 57% of the
overall surgery for the females. In the period 2007-
2012 we have found no significant decrease in the
number of MCP-JA surgery. Further studies with a
longer timespan would be needed to determine the
changes in MCP-JA sugery on the basis of RA.
186. Clinical outcome of posterior tibial support brace treatment of isolated or combined posterior cruciate ligament rupture with the PTS Jack bandage
Torsten Grønbech Nielsen, Birgitte Blaabjerg, Randi Gram Rasmussen, Martin Lind
Division of Sports Trauma, Department of Orthopedic Surgery, Aarhus University Hospital ; Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital
Background: Non-operative treatment is the first
choice in patients with isolated grade 1
and 2 ruptures of the posterior cruciate
ligament (PCL), while grade 3 ruptures
are often treated operatively.
Purpose / Aim of Study: To evaluate the clinical outcome of non-
operative treatment of PCL using the
posterior tibial support brace in
combination with physiotherapist
supervised rehabilitation.
Materials and Methods: Between January 2013 and January
2015, 34 patients (21 males; mean age
32.6 years; (range 14-65)) were treated
conservatively with a posterior tibial
support Jack Brace (JB). Patients were
diagnosed by MRI and objective PCL
instability. Ten patients had isolated PCL
injury and 24 had multi-ligament (11 knee
luxations) injuries. Mechanism of injury:
Sports 59%, traffic accidents 23% and
falls 18%. Rehabilitation: Range of
motion 0-90 degrees and JB usage for 8-
12 weeks including weekly training
sessions. Patients started JB treatment
(range 2-52 days), JB treatment period
was mean 62 days (range 43-97).
Outcome was evaluated using the
posterior step off PCL laxity grading
system and conversion to PCL
reconstruction treatment.
Findings / Results: At baseline, 62% had a PCL laxity ¡Ý
grade 2. After brace treatment (8-12
weeks) laxity ¡Ý2 was 36%; 55% of the
patients were clinically graded ¡Ý1 at
follow up. Five patients (15 %) were
converted to operative PCL treatment;
four of these had multi-ligament injury
after knee luxation.
Conclusions: A total of 85% of patients with PCL
injury starting treatment with posterior
tibial support brace within 60 days after
injury avoided PCL reconstruction
surgery. Knee dislocation injury
increased the risk of undergoing PCL
reconstruction surgery.
187. Ulnar Head Arthroplasty – short term results
Robert Gvozdenovic, Michel Boeckstyns
Department of Orthopedic Surgery, Hand Surgery Unit, Gentofte Hospital
Background: Arthritic changes at the distal
radioulnar joint (DRUJ) can lead to
pain, worsening of grip strength, and
disability. Ulnar head resection may
result in destabilizing the wrist as well
as forearm. To restore stability and
resist the pressure loads, ulna head
replacement has been introduced.
Purpose / Aim of Study: To report our experience using distal
ulnar head prosthesis in treatment of
painful disorders of the DRUJ.
Materials and Methods: 20 ulnar head arthroplasties have been
implanted from March 2005 to June
2015. Of these, 13 had a follow-up of
at least 6 months, mean 37.8 months.
SBI Ulnar Head was used in 10 cases,
Eclipse in 3. 7 were combined with
total wrist arthroplasty (TWA). There
were 5 men, 8 women with mean age
of 57, 6 years. The diagnosis was
rheumatoid arthritis in 4 cases,
degenerative arthritis in 6,
posttraumatic arthritis in 2, Kienboeck
in 1.
Findings / Results: No intraoperative complications have
been recorded. None of the implants
have been revised. Mean VAS-score
for pain was 66 before operation and
26 at follow-up. Median QuickDASH
was 58 before operation and 34 at
follow-up. The mean grip strength
improved from 15 to 25 kgF. There
were no statistically or clinically
significant changes in wrist motion or
forearm rotation. 10 of the 13 patients
were very satisfied or satisfied at follow-
up.
Conclusions: Ulnar Head Arthroplasty yielded
improvement of pain, grip strength and
function at short time follow-up. Longer
follow-up studies are desirable.
188. The odds of receiving a knee arthroplasty is higher in patients with a high Pain Catastrophizing score
Sara Birch, Inger Mechlenburg, Stilling Maiken, Bæk Hansen Torben
Department of Physiotherapy and Occupational therapy, Holstebro Regional Hospital, Denmark; Orthopaedic Department, Aarhus University Hospital, Denmark; University clinic for Hand, Hip and Knee surgery, Holstebro Regional Hospital, Aarhus University, Denmark
Background: Psychological factors such as pain
catastrophizing is associated with low
physical function and pain after knee
arthroplasty (KA), but only few studies
have described self-reported function
and pain catastrophizing in patients
referred to the orthopedic outpatient
clinic with symptoms of knee
osteoarthritis (OA).
Purpose / Aim of Study: To describe self-reported function and
pain catastrophizing in Danish patients
with symptoms of knee OA and test the
hypothesis, that low self-reported
function with severe symptoms is
associated with receiving KA whereas
pain catastrophizing is not.
Materials and Methods: All patients referred with clinical
symptoms of knee OA from March -
October 2013 completed a set of
questionnaires: EuroQol (EQ-5D), Short
Form (SF-36 (PF)), Oxford Knee Score
(OKS), Pain Catastrophizing Scale (PCS)
and expectations to the consultation. In
total 431 patients (234 women) mean
age 64.6 years were included. Of those,
193 were scheduled for KA directly and
additionally 15 within 12 months after the
consultation. 48 were scheduled for a
knee arthroscopy and 175 were treated
conservatively.
Findings / Results: The odds of getting a KA is 2.72 (p=
0.001) if a patient has a high PCS score
(>24) compared with patients with low
PCS score (<12). 59% of the patients
with high PCS score received KA and
only 37% of the patients with low score.
Low OKS and low SF-36 (PF) score is
also associated with getting a KA (OR:
1.98, p= 0.02; OR: 2.20, p=0.006).
Furthermore, patients expecting KA as
treatment has higher odds for KA
compared with patients expecting
conservative treatment (OR: 6.81,
p<0.001).
Conclusions: Patients selected for KA have lower self-
reported physical function but also
higher PCS score than patients treated
conservatively. Thus, some patients
offered KA are at high risk of having
postoperative pain and low physical
function.
189. DVR® Anatomic volar plating system vs. VA2 Variable Angle LCP Two Column Volar Distal Radius Plate. A comparison of two volar locking plates for treatment of distal radius fractures.
Tord Salomonsen, Bjarke Viberg
Orthopedic surgery, Odense University Hospital, Svendborg Hospital
Background: Fracture of the distal radius (DRF) can require open
reduction and internal fixation (ORIF) and there are
many different volar locking plates on the marked,
but no studies have compared the plates in terms of
complications and clinical outcome.
Purpose / Aim of Study: To compare complications and functional outcome
after ORIF of dorsally displaced distal radius
fractures with the DVR® Anatomic Plate (DePuy) vs.
2.4 mm Variable Angle LCP Distal Radius Plate (VA2)
(Synthes) in adults above 50 years.
Materials and Methods: 50 patients were in 2009 treated with the DVR® and
in 2013 41 patients were treated with the VA2, and
their patient health records were reviewed for
complications that required additional surgery within
1 year after primary surgery. In total 67 patients
were seen at six months evaluating range of motion
(ROM), relative grip strength (fractured wrist
compared with un-fractured wrist) and DASH score.
Findings / Results: The median (interquartile range – IQR) age were
70,7 (IQR: 63,7-81,8) and 70,6 (IQR: 65,2-80,1)
in the DVR® and VA2 group. There were 8 (16%)
complications in the DVR® group and 6 (15%) in the
VA2 group. The median (IQR) score for DVR® and
VA2 were respectively 9,6 (IQR: 4,3-28,3) and 14,0
(IQR: 6,0–29,0) for the DASH score (p<0.395).
There were a statistical better ROM for flexion,
extension, supination, pronation, ulnar and radial
deviation in the VA2 group (p<0.0012 for all) but this
was probably due to interrater measurement bias.
Conclusions: The DVR® and VA2 systems had similar results
regarding complications and functional outcome in
our setting.
190. The induced membrane technique for healing of bone defects. A review of 9 cases.
Ulrik Kähler Olesen, Anders Wallin Paulsen, Per Bosemark, Henrik Eckardt
Trauma and reconstruction, orthopedic surgery, Rigshospitalet; Orthopedic Surgery, University hospital Lund, Sweden; Orthopedic surgery, University Hospital Basel, Switzerland
Background: Segmental defects of long bones are notoriously
demanding to treat.
We evaluate nine cases where the Masquelet
induced membrane technique to substitute bone
loss has been used.
Purpose / Aim of Study: We discuss the method compared to other types of
bone reconstruction and share our tips and tricks to
reduce treatment time and improve patient comfort.
Materials and Methods: Eight patients (nine injuries) operated between 2011
and 2014 were included. Four were infected.
Outcome was time-to weight-bearing, consolidation,
complications, bone grafting.
Findings / Results: All patients were weight bearing fully after 270 days.
Mean time to weight bearing was 225 days. Time to
full weight bearing was shorter in patients where
nails were used to stabilize the construct: median
115 (range 0-268) compared to plates: median 244
(range 219-271).Two cases are not fully
consolidation at present. Three cases needed
grafting, one was misaligned. There were no
amputations, no persistent infections, and no
implant failures
Conclusions: The induced membrane technique is a relevant
alternative to traditional bone substitution in select
cases, yet somewhat unpredictable in its course and
prolonged immobilisation is often required.
Nailing seems to improve the outcome by reducing
treatment time and volume of bone graft needed
and should be considered when feasible.
191. Analysis of drain fluid particle content after implantation of an antibiotic eluting bone graft substitute close to a partial pelvic replacement
Hettwer Werner
Orthopaedic Department, Rigshospitalet
Background: Endoprosthetic reconstruction for
pathologic acetabular fractures is
associated with a high risk of
periprosthetic joint infection. In this
setting, bone defect reconstruction
utilising co-delivery of a synthetic bone
substitute with an antibiotic, is an
attractive treatment option from a
prophylactic perspective.
Purpose / Aim of Study: We wished to investigate the possible
presence of potentially wear inducing
HA particles in the periprosthetic
haematoma.
Materials and Methods: We analysed a drain fluid sample from
an endoprosthetic reconstruction of a
pathologic acetabular fracture with
implantation of a gentamicin eluting,
biphasic bone graft substitute,
consisting of 40% hydroxyapatite (HA)
and 60% calcium sulphate
(CERAMENTTMG), into the residual
peri-acetabular bone defect. This
sample was divided into two 1.5ml
subsamples, to one of which 100mg
HA particles were added as control
before burning off all organic
substance at very high temperature.
These heat treated samples were then
examined with scanning electron
microscopy (SEM) and energy
dispersive x-ray analysis (EDAX) and
compared to a reference sample
consisting of HA particles only.
Findings / Results: On SEM, hydroxyapatite particles were
readily recognisable in the control and
reference samples, whereas only very
few particles over 2ìm were apparent
in the ”pure” drain sample. EDAX
revealed that very large amounts of
salts were present in both drainage
samples. The pure drainage sample
contained markedly lower amounts of
calcium and phosphate compared to
reference and control samples. No HA
particles as such, were seen in the
pure sample.
Conclusions: We could not find clear evidence that
the drain fluid really contained HA
particles. More thorough investigations
are needed and future analyses with
prior removal of the high salt content
would likely yield more conclusive
results.
192. Utility of the Ganz Trochanteric Flip Osteotomy and Surgical Dislocation of the Hip for Benign Tumors of the Hip.
Hettwer Werner
Orthopaedic Department, Rigshospitalet
Background: Adequate access is critical for complete and
thorough intralesional removal of benign
bone lesions in order to ensure a low local
recurrence rate. This can be a challenge for
some tumors located in the femoral neck or
the hip joint.
Purpose / Aim of Study: The surgical technique for operative
dislocation of the hip described by Ganz
affords excellent exposure of the femoral
head, neck and acetabulum. We present 2
cases to illustrate the utility of this approach
in the musculoskeletal oncology setting.
Materials and Methods: The technique consists of a posterior
approach with a ‘trochanteric flip’ osteotomy,
followed by a z-shaped capsulotomy,
designed to preserve the blood supply to
the femoral head, which allows surgical
dislocation in an anterior direction. To
illustrate the utility of each of the steps of
this approach, two different case examples
are described: Firstly, defect reconstruction
of a large enchondroma of the proximal
femur through a trochanteric flip osteotomy
and secondly, complete removal of
extensive synovial chondromatosis through
a formal surgical dislocation
Findings / Results: In both cases, generous access could be
achieved comfortably, allowing controlled
removal of the lesion under direct vision,
while affording ample space for throrough
and safe application of adjuvants such as
burring, and/or surgical reconsruction of the
defect, if required. Wound closure including
transosseous refixation of the trochanter
fragment, as well as immediate post
operative course were straight forward and
without complication. Both patients maintain
complete restoration of function at 1-year
follow up.
Conclusions: This approach can be useful to the
musculoskeletal tumor surgeon in portions
or its entirety, to approach various benign
intra-articular, as well as intra-osseous bone
and soft tissue tumors of the hip and the
proximal femur.
193. Surgical treatment of severe scoliosis in young children using magnetically controlled growing rods – initial experience in a prospective cohort
Benny Dahl, Thomas Borbjerg Andersen, Martin Gehrchen
Spine Unit, Department of Orthopaedic Surgery
Background: The surgical treatment of scoliosis in young children
often requires multiple surgical procedures in
general anesthesia to distract the spinal implant
corresponding the growth of the spine. Recently,
magnetically controlled growing rods have been
introduced allowing non-invasive, outpatient
distraction.
Purpose / Aim of Study: The purpose of the present study was to assess the
efficacy and safety of magnetically controlled growing
rods in a Danish patient population.
Materials and Methods: Eight patients have been operated; four girls and four
boys. The median age at the time of surgery was 10
years (range 6 – 13). Three patients had idiopathic
scoliosis and the remaining patients had
neuromuscular or syndromic curves. Anchoring points
were constructed caudally and cranially with pedicle
screws or hooks, with intramuscular placement of the
rods. Patients underwent rod distraction with 3-months
intervals as outpatient procedures using a magnetic
external remote controller.
Findings / Results: The median pre-operative Cobb angle was 66 degrees
(range 54-95) and the immediate post-operative Cobb
angle was 27 degrees (20-50)(p = 0.01). No
intraoperative complications occurred. One patient
underwent revision surgery 19 months after the primary
procedure due to screw loosening. The average
lengthening per distraction procedure was between 2.4
and 3.8 mm. All the lengthening procedures were carried
out in the outpatient clinic not requiring general
anesthesia or any type of analgesics.
Conclusions: The use of magnetically controlled growing rods in this
cohort with severe scoliosis showed no intraoperative
complications. A satisfactory correction at index
operation was obtained and distraction of the rods was
possible in the outpatient clinic every 3 months. The
method seems promising in the growing child.
194. Early Clinical Experience with Local Bisphosphonate Delivery for Bone Defect Reconstruction in Aggressive Benign Bone Tumors
Werner Hettwer, Peter Horstmann, Michael Mørk Petersen
Orthopaedic Department, Rigshospitalet
Background: Bisphosphonates inhibit osteolysis
associated with benign bone tumors
mediated by osteoclasts. They also induce
apoptosis of tumor cells and have shown
promising reduction of local recurrence
rates in small case series. We have
developed a surgical method for
reconstruction of cavitary bone defects with
a combination of cancellous allograft and a
synthetic bone graft substitute, able to
deliver and elute antibiotics as well as
zoledronic acid locally.
Purpose / Aim of Study: To report our early clinical experience with
local delivery of zoledronic acid for bone
defect reconstruction in benign,
aggressively behaving bone tumors.
Materials and Methods: We prospectively followed 11 patients (9f,
2m, mean age 35 (range 18-62)) with
aggressively behaving benign bone tumors
(5 GCT, 4 ABC, 2 UBC) who underwent
tumor resection with curettage, high speed
burring and subsequent bone defect
reconstruction utilising a combination of a
gentamycin eluting bone graft substitute
(Cerament™|G, BONESUPPORT, Lund,
Sweden) and cancellous allograft with serial
imaging (X-ray/CT) for a mean of 11 months
(range 7-17).
Findings / Results: Radiographic evidence of local bone
formation and remodeling by far exceeded
rates and amounts usually observed with
either single component alone. Rapid and
homogeneous remodeling typically started
in areas with cancellous bone contact in the
periphery of the defects but was not limited
to the cavities only. Substantial periosteal
bone formation was also observed in areas
of ungrafted surrounding cortical bone.
Conclusions: Effective local delivery and elution of
zoledronic acid appears to substantially
enhance and accelerate local bone
formation/remodeling in our patients.
Further studies to confirm this hypothesis
are needed.
195. Complications following distal radius fracture osteosynthesis using two different volar locking plates.
Julie Ladeby Erichsen, Roland Knudsen, Zafar Bahadirov, Frank Damborg
Ortopædkirurgisk afd. , Kolding SLB; Ortopædkirurgisk afd., Kolding SLB
Background: Open Reduction and Internal Fixation
(ORIF) of distal radius fractures using a
volar locking plate, has become one of the
most common operations performed.
However, to date there is a limited amount
of literature describing the complications
following this procedure
Purpose / Aim of Study: We wanted to investigate the complications
after ORIF of distal radius fractures using
two different volar locking plates, and how
often these complications occurred.
Materials and Methods: We included 241 patients with a distal
radius fracture which had been operated on
with ORIF using one of the two volar locking
plates at Kolding Hospital in the period
January 1. 2013 to july 1. 2014. We did a
retrospective cohorte study using the patient
journal and X-rays, and we registered any
complications which indicated a second
operative intervention.The patients were
operated on using either a “Variable angle
two column plate” (VA2, Synthes) or a
“Distal Volar Radius plate” (DVR, Depuy).
Findings / Results: 28/241 (11,6%) patients experienced a
complication which needed a second
operative intervention. There were no
differences in incidents of complications
when operated on using either VA2 or DVR
(p-value: 0.671). Patients suffering from
more complex fractures (ie. AO 23-C
fractures) had a tendency towards more
complications than patients suffering from
simple fractures when operated on using
either VA2 or DVR, but this was not
significant and there were no statistically
significant differences between the two
groups.
Conclusions: We registered 11.6% complications, which
needed interventions. There was no
difference in complications when using
either a VA2 or DVR, although there was a
tendency towards more frequent
complications after more complex fractures.
Other studies have shown similar results
regarding the frequency of incidents of
complications.