Session 14:
Poster med foredrag A
Onsdag 21. oktober
11:00 – 12:00
Lokale: Reykjavik
Chairmen: Micheal Bentsen / Theis Thillemann
140. Preoperative treatment of Giant-Cell Tumors of Bone with Denosumab
Anna Lynge Sørensen, Rehne Lessmann Hansen, Inger Krog-Mikkelsen, Peter Holmberg Jørgensen
Orthopaedic Surgery Research, University Hospital of Aarhus; Orthopaedic Surgery, Tumor Section, University Hospital of Aarhus
Background: Giant cell tumor of bone(GCT) is a locally aggressive
tumor classified as borderline malignant. GCT
consists of multinucleated giant cells(osteoclast-like-
cells) and stromal cells which lead to destruction of
the bone. Treatment has so far been surgical
resection. Denosumab(Dmab) is a RANKL-inhibitor
which inhibits osteoclasts and impairs the growth of
GCT
Purpose / Aim of Study: To describe the clinical, radiographic and
pathological effects on the first 5 GCT-patients in
Denmark treated with Dmab
Materials and Methods: 5 patients(15-30 years) with GCT considered
operable only by amputation or with a high risk of
functional impairment were treated preoperatively
with Dmab, 120mgx1s.c. at day 1, 8 and 15 and
every 4 week. Treatment was continued until the
patients were considered operable (3-8 months)
Patients were surgically treated with curettage
and cement (3), bone graft (1) and wide resection
(1). Tumor-size was evaluated on MRI and X-ray
until surgical treatment. Local tumor bone mineral
density(BMD) and bone turnover
markers(osteocalcin and CTX) was followed in 3
patients. GCT was evaluated histologically before
and after treatment with Dmab
Findings / Results: Dmab treatment resulted in reduction in tumor size in
3 patients. BMD increased by 37-44% and bone
formation increased. The GCT tissue almost
disappeared and was replaced by benign fibrous
histiocytoma tissue. All patients experienced pain
reduction after 5 weeks of treatment. No adverse
events were reported. Two patients had a
recurrence of which 1 was amputated and 1 had a
wide resection of the tumor
Conclusions: Dmab has a deleterious effect on GCT tissue
resulting in increased bone deposition. Recurrence
may occur probably due to presence of stroma cells
not affected by Dmab. It is questioned whether Dmab
treatment should be continued after surgery in this
selected group of patients
141. Danish Hip Arthroscopy Registry: The first outcome description of patients with femoroacetabular impingement (FAI).
Bent Lund, Bjarne Mygind-Klavsen, Torsten Grønbech Nielsen, Per Hölmich, Otto Kraemer, Martin Lind
Department of Orthopedics, Horsens Regional Hospital; Department of Sportstraumatology, Aarhus University Hospital; Arthroscopic Center, Department of Orthopedics , Copenhagen University Hospital, Amager-Hvidovre; Arthroscopic Center, Department of Orthopedics, Copenhagen University Hospital, Amager-Hvidovre
Background: The Danish Hip Arthroscopy Registry
(DHAR) was initiated in January 2012 as a
web-based prospective registry.
Purpose / Aim of Study: The purpose of this study was to evaluate
and report the outcome data of a Danish
population with radiological and clinical FAI
undergoing hip arthroscopy. Our primary
hypothesis was that patients undergoing hip
arthroscopy would improve significantly in
both pain, quality of life and in sports related
outcome measurements in Patient Related
Outcome Measures (PROM).
Materials and Methods: Perioperative data and PROM data from
DHAR between January 2012 and May
2015 was extracted. Radiological pincer-
type FAI was defined as LCE > 35 degrees
and CAM-type FAI as Alfa angle > 55
degrees. These data was combined with
FAI surgical data such as osteoplasty and
labral repair or resection. PROMs consisting
of iHOT12, HAGOS, EQ-5D and VAS pain
scores were submitted online by the
patients preoperatively and at 1, 2 and 5
years follow-up.
Findings / Results: We extracted data from 1480 FAI patients in
DHAR. HAGOS demonstrated significant
improvement in all subscales at follow up.
EQ-5D demonstrated improvement after 1
and 2 years from 0,66 pre-op to 0,78 at 2
years. Mean iHOT12 was respectively 47
(pre-op), 49 (1 year FU) and 43 (2 year FU).
At 1 year follow up iHOT12 shows
improvement in 5 subscales, deteriorating in
3 subscales and no change in 4 subscales.
At 2 year follow up there was a worsening in
6 subscales including pain in hip, getting up
from floor, sexual activity, carrying children,
walking distances, pushing and lifting. The
pain score data demonstrated improvement
in VAS 55 to 33 at follow up.
Conclusions: We conclude that patients with
femoroacetabular impingement undergoing
hip arthroscopy experience improvement in
pain and quality of life but only in some
aspects of function and sports.
142. Danish Hip Arthroscopy Registry: An epidemiologic and perioperative description of the first two thousand patients.
Bjarne Mygind-Klavsen, Torsten Grønbech Nielsen, Otto Kraemer, Per Hölmich, Bent Lund, Martin Lind
Department of Sportstraumatology, Aarhus University Hospital; Arthroscopic Center, Department of Orthopedics , Copenhagen University Hospital, Amager-Hvidovre; Department of Orthopedics, Horsens Regional Hospital
Background: The Danish Hip Arthroscopy Registry
(DHAR) was initiated in January 2012 as a
web-based prospective registry.
Purpose / Aim of Study: The purpose of this study was to evaluate
and report the epidemiologic and
perioperative data of the first two thousand
patients in the DHAR and to describe the
registry. We hypothesized that patients
undergoing hip arthroscopy have
considerable hip and/or groin pain, loss of
function and reduced quality of life
measured and that the majority of patients
were treated for femoroacetabular
impingement (FAI).
Materials and Methods: Surgeons report operative and radiographic
data on-line to the database. Patients
submit on-line preoperatively and at follow-
up several patient reported outcome
measures (PROM). These PROMs are all
validated scores suitable for Danish patients
undergoing hip arthroscopy. Perioperative
data and PROM data from the DHAR
between January 2012 and May 2015 was
extracted.
Findings / Results: The 2000 patients consisted of 56%
females and 44% males. Mean age 37,5
years. Mean surgical time was 86 minutes
and mean traction time 49.7 minutes. The
most frequent procedure was CAM and
Pincer resection in 86% and labral refixation
in 70% of the cases. Acetabular chondral
damage Grade III and IV changes were
seen in 41 % of the cases. The preoperative
iHOT12 PROM was mean 45 based on all
12 items. EQ-5D was 0.65 and HAGOS sub
scores were 51 (pain), 49 (symptoms),
(ADL), 35 (sport), 20 (physical activity) and
29 (QoL) respectively.
Conclusions: We conclude that patients undergoing hip
arthroscopy report considerable pain, loss
of function, reduced activity level and
reduced quality of life prior to surgery. The
majority of patients undergo procedures for
FAI treatment. We consider the
development of a national clinical registry
for hip arthroscopy successful as both a
clinical and scientific tool.
143. Healthy patients with colonized implants - a ticking bomb for the future of orthopedics?
Charlotte Stenqvist, Steffen Eickhardt, Thomas Bjarnsholt, Jesper Hvolris
Department of Orthopedic Surgery , Bispebjerg Hospital; Department of Immunology & Microbiology , University of Copenhagen; Department of Orthopedic Surgery, Bispebjerg Hospital
Background: Many chronic infections are caused by
aggregates of bacteria called biofilm.
The biofilms are small, heterogeneously
spread within the infected area and have a
low metabolism. Because of this, the
bacteria are hard to eradicate with standard
antibiotic treatment, but they are also hard
to diagnose. Not much is known about the
early stages of infection.
Purpose / Aim of Study: The purpose of this study was to identify
and describe whether healthy implants are
colonized with microbiological agents.
Materials and Methods: Over a two-month period 20 implants were
collected from adult patients, using a
standard aseptic surgical procedure.
Inclusion criteria were no clinical sign of
infection. Implants were placed into sterile
containers with physiological saline
adequate for sonication. Implants were
vortexed and sonicated followed by
centrifugation. The pellet was re-
suspended, plated on agar-plates and DNA
was purified. Colonies were analysed by
MALDI-TOF (Matrix Assisted Laser
Desorption/Ionization - Time of Flight Mass
Spectrometry), DNA was analysed with RT-
PCR and sequenced to identify bacterial
and fungal agents.
Findings / Results: The median time for an implant in our 20
patients was 10 months with a range from
0.3-432 months. 14 patients had implants
removed after fracture surgery; five implants
came from arthroplasty surgery and one
from ligament reconstruction.
We found 12 positive at agar-plates and
MALDI-TOF. PCR found 8 positive for
bacterial agents and 6 for fungal agents.
Only one set of seven Kamme-Lindberg
cultures were found to be positive.
Conclusions: Clinically non-infected implants may be
colonized by bacterial and fungal agents.
This study indicates that bacteria can
prosper on implants without causing
pathology. Further research should examine
a greater cohort of patients.
144. Patient reported effect of arthroscopic subacromial decompression after failure of conservative treatment.
Jón Rói Jacobsen, Søren Rasmussen Deutch, Carsten Moss Jensen
Departement of Orthopedics (Stud.med. Århus universitet), Randers Regionshospital; Departement of Orthopedics, Randers Regionshospital
Background: Impingement of the shoulder is the most common
shoulder complaint. Though previously
investigated, an international consensus in
treatment of impingement is inconclusive.
Several studies have provided good evidence of
the effects of an Arthroscopic Subacromial
Decompression(ASD), but recent studies have
cast doubt if surgery is beneficial in treating
impingement.
However, few studies have investigated which
patients would benefit the most from an ASD,
after conservative treatment has failed.
Purpose / Aim of Study: To decide the effect of ASD in patients suffering from
impingement after conservative treatment has failed.
Furthermore, an investigation of which patients
benefit the most from ASD.
Materials and Methods: 235 patients with no limitations of age were
prospectively included in the study. All patients were
treated with an ASD at the department of
Orthopedics at Randers Regionshospital, Denmark.
Patients submitted two questionnaires before
surgery and at 6 months follow-up. The
questionnaires included The Oxford Shoulder Score
(OSS), EQ-5D and VAS of arm function.
Findings / Results: Patients were divided into 3 subgroups according to
low/moderate/high Pre-OSS.
The Low Pre-OSS group had a mean difference in
OSS of 18.8 [12.9 ; 24.7]p=0.0001.
The Moderate Pre-OSS group had a mean difference
in OSS of 11.9 [6.6 ; 17.3]p=0.0001
The high Pre-OSS had a mean difference in OSS of
4.1 [-1 ; 9.3]p=0.11.
The EQ-5D and VAS of arm function also concluded
a significant shift in the low/moderate Pre-OSS
group, and also pointed out that quality of life was
compatible for all groups postoperatively.
Conclusions: ASD is an effective treatment for patients suffering
from impingement after conservative treatment has
failed. Furthermore our study provides evidence that
patients with lower/moderate Pre-OSS benefit the
most from surgical intervention.
145. Does an accelerated hip fracture pathway in a non-orthogeriatric unit reduce hospitalization without changes in 30 day mortality?
Martin Peter Nielsen, Jon Jacobsen, Peter Revald
Orthopedic Surgery, Randers Regional Hospital
Background: Hip fractures pose a socio-economical challenge and
often result in long-term hospitalization. This is
hazardous for weakened elderly patients who risk
infections, deterioration and thereby increased
mortality. Accelerated hip fracture pathways in
orthogeriatric units have shown to have a positive
effect on hospital Length Of Stay and mortality.
Purpose / Aim of Study: To evaluate if implementation of an accelerated hip
fracture pathway in a non-orthogeriatic unit reduces
LOS while not increasing mortality or readmission
rates.
Materials and Methods: A multidisciplinary hip fracture study-group
involving doctors, other health professionals and
the community care was created. An optimized
accelerated hip fracture program was designed.
Early contact to community care, early surgery,
mobilization and accelerated rehabilitation after
discharge was intended. The program was
enrolled on the 1/9/2014. A consecutive group of
patients with ICD (S72.0/1/2) proximal femoral
fracture admitted through the Emergency
Department from the 1/9/2014 to 31/12/2014 was
compared with a consecutive group of patients
admitted 1/9/2011 to 31/12/2011 with the same
ICD codes.
Findings / Results: Demographic data, ASA-score and fracture types
were comparable. LOS decreased significantly from
a mean at 133 hours (5.5 days) 95%CI [124;142] to
97 hours (4.0 days) [89;107], p < 0.0001. Thirty-day
mortality of 9 % was seen in both cohorts which
compares to that of similar studies. The readmission
rate did not change significantly. Data showed an
unforeseen increase in proximal femoral fractures of
36,2% admitted to the hospital in the observation
period from 2011 to 2014.
Conclusions: Implementation of an accelerated hip fracture
pathway in a non-orthogeriatric unit decreased LOS
without increasing mortality or readmission.
146. Comparison of Clinical Results with Bone Allograft or PMMA after Intralesional Curettage for Giant Cell Tumors of Bone
Peter Frederik Horstmann, Peter Holmberg Jørgensen, Werner Hettwer, Bjarne Hauge Hansen, Michael Mørk Petersen
Muskuloskeletal Tumor Section, Copenhagen University Hospital; ) Department of Orthopedic Surgery, Sarcoma Center , University Hospital of Aarhus
Background: PMMA is a popular option for
reconstruction after curettage of giant
cell tumors (GCT). However, bone
remodeling is precluded by the
presence of PMMA, which is why
cancellous allograft remains the
preferred material for bone defect
reconstruction in some centers. Wide
resection is usually only considered
when the joint is deemed
unsalvageable.
Purpose / Aim of Study: To determine local recurrence rates
after wide resection of GCT compared
to intralesional treatment.
Materials and Methods: A retrospective review of all
consecutive patients (n=104, M/F:
60/44, mean age 35 (11-84 years)
treated for GCT in the appendicular
skeleton at two orthopedic oncology
centers between 1998 and 2013.
Choice of treatment and local
recurrence rates was recorded and
evaluated with statistical methods
including Kaplan-Meier survival
analysis and log rank test.
Findings / Results: Wide resection (16 arthroplasties, 15
local bone resections and 4
amputations) was performed in 35
patients. The remaining 69 patients
underwent curettage and bone defect
reconstruction with cancellous allograft
(n=37) or PMMA (n=32). Local
recurrence occurred in only 1 case of
patients treated with wide resection,
whereas it occurred in 23 cases of
patients treated by intralesional
curettage. This difference between
wide and intralesional treatment was
statistically highly significant
(P<0,001). When comparing local
recurrence rates of reconstruction
methods for intralesional treatment, we
found no statistical difference (p=0.75)
between bone cement (n=10) and
bone graft (n=13).
Conclusions: Wide resection of GCT’s is associated
with very low recurrence rates
compared to intralesional treatment.
We were unable to detect a statistical
difference in recurrence rates when
using PMMA for bone defect
reconstruction compared to bone
allograft without further adjuvant
therapy.
147. Clinical Results after Intralesional Curettage in Benign and Borderline Bone Tumors
Peter Frederik Horstmann, Werner Hettwer, Michael Mørk Petersen
Muskuloskeletal Tumor Section, Copenhagen University Hospital
Background: Intralesional curettage is a common
surgical treatment for benign bone
tumors. Although, in principle, the
tumor recurrence rate is higher with
intralesional surgery, the functional
outcome is often better than in wide
resections.
Purpose / Aim of Study: To determine the clinical results
following curettage and bone grafting.
Materials and Methods: We performed a retrospective review
of all consecutive patients (n=166,
F/M: 86/80, mean age 31 (2-72 years))
who underwent intralesional curettage
for benign or borderline bone tumors in
the appendicular skeleton at our
orthopedic oncology center, between
2009 and 2013. We recorded histology
and anatomic region of the bone
tumors, choice of treatment and biopsy
verified local recurrence rates.
Findings / Results: The most common lesions treated
were enchondromas (n=57), simple
cysts (n=31), aneurysmal bone cysts
(n=16), fibrous dysplasia (n=14) and
GCT’s (n=13). Cancellous allograft
was used for bone defect
reconstruction in the majority of the
cases (n=141). Autograft was used in 3
cases and a bone graft substitute in 5
cases. In 17 cases, the bone defect
was left empty. The most commonly
affected long bones were femur
(n=47), tibia (n=26) and humerus
(n=10), and the most commonly
affected region was the knee (n=47).
We recorded 10 complications, with
postoperative infection (n=3),
postoperative fracture (n=2) and nerve
palsy (n=2) being the most common.
Local recurrence occurred in 13 cases
(8%), with simple cysts in children
(n=3) surprisingly being the most
common.
Conclusions: In this 5-year review of 166 patients,
treated for a benign or borderline bone
tumor in a single orthopedic oncology
center, we found that intralesional
curettage and bone defect
reconstruction with cancelleous bone
allograft is a reliable treatment with
acceptable recurrence and
complication rates.
148. Reoperation factors in malleolus fracture surgery
Peter Sass Jensen
Department of Orthopedic Surgery, Odense University Hospital, Odense Denmark
Background: Malleolus fractures often require operation.
They have a high reoperation rate – the
second highest in Denmark only surpassed
by proximal femoral fractures. Reoperation
is followed by longer rehabilitation time and
is uneconomical.
Purpose / Aim of Study: The reason for the high reoperation rate has
yet to be determined. The purpose of the
study was to provide a descriptive analysis
of malleolus fracture operation cases that
were followed by reoperation and to
determine factors in primary operations that
led to increases in reoperations.
Materials and Methods: This study included patients with operations
registered in the Danish Fracture Database
(DFDB) from November 2008 to May 2014
who were reoperated. The factors leading to
reoperation were found.
Findings / Results: 111 of 281 reoperations had a primary
operation registered in the DFDB: 43
underwent hardware removal due to
irritation or pain from material; 26,
postoperative infection; 22, suboptimal
osteosynthesis, and 13, osteosynthesis
failure.
A resident or intern performed 79 of the 111
primary operations; 25 of the 111 were
supervised by an attending surgeon or
traumatologist
AO fracture classification 44C was higher in
reoperated patients with suboptimal
osteosynthesis and osteosynthesis failure
than in any primary operations.
Conclusions: Operations by unsupervised residents
tended to have a higher reoperation rate
than attending surgeons or supervised
residents. More complex malleolus fractures
seem to have a higher risk of suboptimal
osteosynthesis or failure.
149. Bone shortening of clavicular fractures: comparison of measurement methods.
Anders Thorsmark Høj, Peter Udby, Ilija Ban, Lars Henrik Frich
orthopedic and traumatologic Holbæk, Odense university hospital research unit/ Holbæk sygehus; Orthopedic and traumatologic Køge, Køge; orthopedic and traumatologicHvidovre, Hvidovre; orthopedic and traumatologicOdense, Odense university hospital
Background: A relative indication for operative treatment of the
fresh clavicular fracture is bone shortening over 2
cm; nonetheless this is controversial within the
scandinavian countries were such a connection has
not been found. A review of the literature shows
different measurement methods for shortening are
used scientifically.
Purpose / Aim of Study: We wanted to investigate if the scientifically used
measurement methods were interchangeable to
each other by comparing intraclass correlation,
standard error of measurement and minimal
detectable change as well as using Bland-Altman
plots.
Materials and Methods: Two raters measured clavicle shortening on 65
patients using conventional radiographs on two
separate sessions. The two methods described by
Hill et al and Silva et al were used on unilateral
pictures. Side comparison were done on panoramic
radiographs.
Findings / Results: We found that none of the methods were directly
interchangeable. We found fewer patients patients
with bone shortening over 2 cm when using side
comparison.
Conclusions: Our results cautions for the interpretation of scientific
results on clavicular bone shortening. In a clinical
context the measurement method used for clavicular
bone shortening could be an explanatory factor in
differences of operative care rates between
countries.
150. Positiv cultures in primary cuff surgery
Thomas Falstie-Jensen, Theis Thillemann, Brian Elmengaard, Hans Viggo S. Johannesen, Janne Ovesen
orthopedic, Aarhus University Hospital; Orthopedic, Aarhus University Hospital
Background: High rate of positive tissue cultures
are reported from primary shoulder
arthroplasty but it is unclear whether
open cuff surgery have similar rates.
Purpose / Aim of Study: To characterize and investigate the
rates of positive cultures in patients
undergoing open shoulder surgery
Materials and Methods: The study was designed as a prospective
cohort study enrolling consecutive
patients scheduled for open shoulder
surgery between May 2014 and May 2015.
Previously ipsilateral shoulder-operated
patients were excluded.
During surgery five tissue biopsies were
obtained ad modum Kamme Lindberg and
cultured for aerob and anaerob growth on
three different plates, and in Serum
broth and Semi-solid agar. All cultures
were checked daily the first four days
to identify growth. Serum broth and
Semi-solid agar was furthermore observed
after 14 days. Infection was defined as
three or more positive cultures with the
same bacteria and contamination as less
than three.
Results are presented with counts or
percentage including 95% confidence
interval (95% CI).
Findings / Results: Until February, 2015, 39 cases were
included with an average age of 67 years
(range: 47-79) and 15 were male (38.46%).
Preliminary results showed seven
infected cases 17.95% (95%CI 5.35-30.55)
and two cases as contaminated (7.69%).
All infected cases were
proprionibacterium acne, all diagnosed
after the extended growth period.
The cases showed no clinical signs of
infection postoperatively, although they
later were diagnosed as infected or
contaminated.
Conclusions: High rate of positive biopsies were
found in assumable sterile shoulders.
The clinical implication is unclear and
raises the question of the need for
prolonged prophylactic treatment after
open shoulder surgery.