Fredag den 23. oktober
13:30 – 15:00
Chairmen: Anders Troelsen / Martin Lind
Anders Odgaard, Frank Madsen, Per Wagner Kristensen, Andreas Kappel, Jesper Fabrin
Dept. of Orthopaedics, Copenhagen University Hospital Gentofte
Background: Controversy exists over surgical
treatment of patellofemoral
osteoarthritis (PF-OA). Registers
consistently show poor results of
patellofemoral arthroplasty (PFA)
compared to total knee arthroplasty
(TKA), but case series show good results
Purpose / Aim of Study: This study aims to compare the clinical
and patient-reported outcomes of
treatment with PFA and TKA.
Materials and Methods: A double-blinded (for the first year),
multi-centre trial with intraoperative
randomization between TKA and PFA was
performed. Participating hospitals
included 205 patients from 2007 until
2014. The inclusion criterion was
bone-on-bone on the skyline view. Of the
inclusions, 67 patients rejected
participation, and a further 38 patients
were excluded intraoperatively due to
tibiofemoral lesions. The remaining 100
patients were operated in one of five
hospitals, 50 received a PFA and 50 a
TKA. Clinical, radiological and
patient-reported data was collected.
This paper reports the 1-7 year results.
Findings / Results: There were 76 females and 24 men. The
OKS was 23.8/ 23.1 for the PFA/TKA
groups at inclusion. For the PFA group,
the OKS was 39.6, 39.0, 40.2 and 39.5 at
9 months, 1, 3 and 5 years,
respectively, and for the TKA group, the
OKS was 34.6, 36.3, 36.0 and 35.7
(p<0.01 for all time points before one
year, n.s. thereafter). Similar results
were found for other PROMs. The flexion
range at two years was 130 degrees for
the PFA group and 123 for the TKA group
Conclusions: Patient-reported outcomes were
significantly better for PFA compared to
TKA for the first year. This difference
between PFA and TKA results are also in
favour of PFA for all later time points,
although non-significant. Patients
receiving a PFA had significantly better
range of movement. There were more
reoperations in the PFA group, but the
number of implant revisions was identical.
Andreas Qvist, Carsten Moss, Michael Toft Væsel, Steen Lund Jensen
Orthopedics, Aalborg University Hospital
Background: Newer studies have questioned traditional
nonoperative treatment of midshaft clavicular
fractures, indicating superior results following
operative treatment, including higher healing rates.
Purpose / Aim of Study: To compare the efficacy of osteosynthesis with that
of nonoperative treatment regarding shoulder
function, non-union rates, and sick leave in patients
with a displaced midshaft clavicular fracture.
Materials and Methods: In a multicenter, prospective trial, 147 adult patients
with an acute displaced fracture of the middle third
clavicula were randomized to either osteosynthesis
with a precontoured plate and locking screws (75) or
nonoperative treatment with a sling (72). Outcome
parameters included Disabilities of the Arm,
Shoulder and Hand (DASH) Score, Constant Score,
duration of sick leave, and radiographic union.
Patients were followed for 1 year.
Findings / Results: At three months follow-up both DASH (median 1,7
vs. 8,3) and Constant Scores (97 vs. 90) were
significant better in the operated group (p<0.05).
After one year there was no difference in DASH
(0.83 in both groups) or Constant Scores (98 vs.
97). The non-union rate was lower in the operated
group (2 of 65 vs. 11 of 64 patients, p<0.02). Nine
patients in the non-operated group were surgically
treated for non-union. Plate removal was performed
in sixteen patients after primary osteosynthesis.
Ninety percent of surgically treated patients had
returned to work after three months compared with
seventy-four percent of conservatively treated
Conclusions: Osteosynthesis of displaced midshaft clavicle
fractures with precontoured plates and locking
screws results in higher union rate and quicker
return to work. There is, however, no difference in
functional outcome after one year.
Bjørn Borsøe Christensen, Casper Bindzus Foldager, Morten Lykke Olesen, Hede Kris Chadwick, Martin Lind
Department of orthopedic surgery, Orthopedic research laboratory, Aarhus University hospital; Orthopedic research laboratory, Aarhus University hospital; Department of orthopedic surgery, Aarhus University hospital
Background: Osteochondral injuries in the knee have a poor
endogenous healing potential and no gold standard
treatment has been established. Recently, the use
of cartilage chips has been emerging in the
literature with promising short-term clinical results.
Purpose / Aim of Study: The aim of this study was to investigate the repair
response of cartilage chips in a Göttingen minipig
(GMP) osteochondral defect model. The hypothesis
was that the presence of cartilage chips would
improve the quality of the cartilage repair tissue in
Materials and Methods: Twelve GMP’s received two 6 mm deep
osteochondral defects in each knee. The defects
were randomized to autologous bone graft
combined with autologous cartilage chips
(Autologous dual-tissue transplantation, ADTT) or
autologous bone graft alone (ABG). Six GMP’s were
euthanized at six months and six GMP’s at 12
months. Evaluation of repair was performed by
Findings / Results: The presence of cartilage chips in the defects
resulted in significantly more hyaline cartilage in the
ADTT group compared with the ABG group at both
six months (25.8% vs. 12.8%) and at 12 months
(20.1% vs. 4.8%). There was significantly more
fibrocartilage in the ADTT group compared with
ABG alone at both time-points (44% vs. 27.5% and
60.8% vs. 41%, respectively) and there was
significantly less fibrous tissue in the ADTT group
compared with the ABG group at both time-points
(27.6% vs. 57.7% and 16% vs. 48.3% respectively).
Conclusions: The presence of cartilage chips in an osteochondral
defect facilitated the formation of fibrocartilage as
opposed to fibrous tissue at both six- and 12-
months follow-up. This study confirms the
chondrogenic effect of cartilage chips on cartilage
repair tissue in osteochondral defects.
Christian Skovgaard Nielsen, Oejvind Jans, Nicolai Bang Foss, Tue Ørsnes, Anders Troelsen, Henrik Husted
Department of Orthopaedic Surgery , Hvidovre University Hospital, Denmark; Lundbeck Foundation Centre for Fast-track Hip and Knee Arthroplasty, Rigshospitalet, Copenhagen, Denmark; Department of Anaesthesia, Hvidovre University Hospital, Denmark
Background: In total knee arthroplasty (TKA) both systemic and
topical administration of tranexamic acid (TXA) has
been proven to reduce blood loss in several RCT´s
though routine use of systemic TXA is considerably
more common. However, additional benefit of topical
TXA in addition to systemic TXA has not previously
Purpose / Aim of Study: The aim was to evaluate if combined topical and
systemic TXA administration reduced total blood loss
compared to systemic TXA alone.
Materials and Methods: In this randomized, double-blind, placebo-
controlled, trial 60 patients scheduled for TKA
were assigned to receive either 1) combined TXA
administration 1 g intravenously (IV)
preoperatively + intra-articular (3 g TXA diluted in
100 ml saline) prior to wound closure (TXA IA +
IV) or 2) 1 g TXA IV alone + 100 mL saline intra-
articular (TXA IV + placebo). IA TXA was
administrated through a puncture needle. Primary
outcome was 24 h calculated blood loss.
Secondary outcomes were blood loss on 2nd
postoperative day, thromboembolic complications
and transfusion rate. Blood loss was calculated
by hemoglobin differences.
Findings / Results: Data on primary outcome was available for all 60
included patients. 24 h blood loss was 466 (SD±313)
mL in the TXA IV + IA vs. 743 (SD±358) mL in the
TXA IV + placebo group, treatment effect 277 (95%
CI 103 – 451; p = 0.002) mL. 2nd day blood loss was
644 (SD±382) mL in the TXA IV + IA vs. 1017 (±519)
mL in the TXA IV + placebo group, treatment effect
373 (95% CI 132 – 614; p = 0.003) mL. No thrombo-
embolic complications were observed within 90 days
Conclusions: The combined administration of systemic and intra-
articular TXA resulted in a clinically relevant
reduction in blood loss of 37% both 24 h and 2nd day
after surgery compared to intravenous TXA alone.
No thromboembolic events were observed.
Janni Kjærgaard Thillemann, Theis Muncholm Thillemann, Anders Ditlev Foldager-Jensen, Bo Munk
Department of Handsurgery, Aarhus Universitetshospital; , Aarhus Universitetshospital
Background: Treatment of mallet finger fractures with a bony
fragment of more than one third of the articulating
surface is controversial. Surgery is commonly
recommended, but conservative treatment has been
proposed regardless the size of the bony fragment.
Purpose / Aim of Study: This study aimed to compare the outcomes after
conservative treatment with splinting and surgical
extension block pinning (EBP) of mallet finger
Materials and Methods: Based on sample size calculation we included thirty
patients in this study. The inclusion criteria’s were
acute mallet finger fracture with a bony fragment of
at least one third of the articulating surface and no
subluxation. Patients were randomized to a 6 weeks
of splinting or surgical EBP. Patients were followed
up at 3 and 6 months.
The primary outcome was degrees of extension lag.
Secondary outcomes were range of motion and
finger pulp-distal crease distance. At final follow up
patients reported pain intensity on a Numeric Rating
Scale (0-10), DASH score was filled in and
complications were recorded.
Findings / Results: At 3 months follow up the extension lag was 10°
(95% CI; 6-15) in the splinting group and 9° (95%
CI; 4-15) in the surgical EBP group (p=0.84). Range
of motion was 54° (95% CI; 48-59) in the splinting
group and 35° (CI; 25-46) in the surgical EBP group
(p<0.05). The finger pulp-distal crease distance
were 0 centimeter (range 0-1) and 1.5 (range 0-5) in
the splinting and surgical EBP group, respectively
(p< 0.05). The complete six months results will be
ready for presentation at the DOS conference 2015.
Conclusions: To our knowledge this is the first randomized
controlled trial comparing splinting and surgical
treatment with EBP in mallet finger fractures. Based
on results from this study we recommend splinting in
the treatment of mallet finger fractures without
Mikkel Rathsach Andersen, Nikolaj Winther, Thomas Lind, Henrik Schrøder, Gunnar Flivik, Michael Mørk Petersen
Orthopaedic Department, Gentofte Hospital, University of Copenhagen, Denmark; Orthopaedic, Skåne University Hospital, Lund, Sweden
Background: Previous studies have shown very low migration rate of the uncemented Zimmer Nexgen Trabecular Metal Monoblock tibial component (A), but there are no data regarding the modular version (B) of the implant exists.
Purpose / Aim of Study: To investigate the effects of the 2 different uncemented tibia component designs on the migration of the implants and the changes in bone mineral density (BMD) of the proximal tibia.
Materials and Methods: 67 patients scheduled for an uncemented TKA (Zimmer NexGen Trabecular metal) were included in the study and block randomized to 2 groups of either monoblock (A) or modular (B) polyethylene design. We performed 2 year follow-up of 53 patients (mean age 62 (38-70) years, F/M=27/26, BMI 29.5) using radiostereometric analysis (RSA) and dual energy X-ray absorptiometry (DEXA). Statistics: Nonparametric tests (Wilcoxon signed rank-sum test and Mann–Whitney U-test).
Findings / Results: We found no significant difference in maximum total point migration (MTPM) between the groups at 3 months (p=0.16) or 6 months (p=0.10), but at 12 and 24 months of follow-up a difference in MTPM between groups of 0.36 mm (p=0.021) and 0.42 mm (p=0.017) was found with the highest total migration of 1.01 mm in group B. In group A We found a decrease in BMD of 15% and 13% in respectively the medial and lateral tibia condyle, whereas in group B BMD at 2 years was almost unchanged compared to the preoperative level. The differences in BMD change were statistically significant between the groups in both the medial (p=0.034) and lateral (p=0.016) ROI. In the distal ROI we found no significant change in BMD in either group.
Conclusions: We found a higher MTPM in group B, but a beneficial migration pattern was seen in both groups. A higher degree of bone loss was seen in group A.
Troels Haxholdt Lunn, Henrik Husted, Mogens Berg Laursen, Lars Tambour Hansen, Henrik Kehlet
Department of Orthopedic Surgery and Department of Anesthesiology, Copenhagen University Hospital, Hvidovre and and The Lundbeck Centre for Fast-track Hip and Knee Art; Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre and and The Lundbeck Centre for Fast-track Hip and Knee Art; Section of Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet and The Lundbeck Centre for Fast-track Hip and Knee A
Background: The acute postoperative pain
intensity is pronounced after TKA.
Gabapentin has shown promising
analgesic effects, but the optimal
dose and procedure-specific
benefits vs. harm have not been
Purpose / Aim of Study: We aimed to investigate the dose-
related effect of gabapentin in
patients undergoing TKA by
conducting the largest, randomized,
Materials and Methods: The study was approved by relevant
health authorities and followed GCP-
standards. It was conducted at 3 high
volume knee arthroplasty centers;
Hvidovre, Farsø and Grindsted. 300
patients scheduled for unilateral TKA
were randomized (1:1:1) to
gabapentin 1300 mg/day (group A),
gabapentin 900mg/day (group B) or
placebo (group C) daily from 2 hours
preoperatively to postoperative day
6. In addition, all patients received a
standardized multimodal analgesic
regime. The primary outcome was
pain upon ambulation (walking 5
meters) 24 hours after surgery; the
secondary outcome sedation 6 hours
after surgery. Further, we evaluated
pain, morphine use, side-effects and
adverse reactions in detail during the
entire study period.
Findings / Results: Pain upon ambulation [VAS, mean
(95% CI)] 24 hours after surgery in
group A vs. B vs. C was: 41 (37-46)
vs. 41 (36-45) vs. 42 (37-47),
p=0.93. Sedation [NRS, median
(range)] 6 hours after surgery was:
3.2 (0-10) vs. 2.6 (0-9) vs. 2.3 (0-9),
the mean difference A vs. C being
0.9 (0.2–1.7), p=0.046. Sleep quality
was better during the first 2 nights in
group A and B vs. C, but dizziness
was more pronounced from day 2-6
in A vs. C. More severe adverse
reactions were observed in group A
vs. B and C. No other between-group
differences were observed.
Conclusions: Gabapentin has limited if any role in
acute postoperative pain
management of TKA patients and
should not be recommended as
standard of care.