Session 12: DOS Best Paper
16. November
16:00 - 17:00
Lokale: Auditorium
Chair: Michael M Petersen and Michala Skovlund
104. Local Cefuroxime tissue concentrations in the hand after single and repeated administration – a randomized clinical study of metacarpal bone, synovial sheath and subcutaneous tissue of patients undergoing trapeziectomy
Andrea René Jørgensen 1,2, Pelle Hanberg1, Mats Bue 1,2,3, Charlotte Hartig-Andreasen 3, Nis Pedersen Jørgensen4, Maiken Stilling1,2,3
1. Aarhus Denmark Microdialysis Research Group (ADMIRE), Orthopaedic
Research Unit, Aarhus University Hospital, Aarhus N, Denmark;
2. Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark;
3. Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus
N, Denmark;
4. Department of Infectious Diseases, Aarhus University Hospital, Aarhus
N, Denmark
Background: The role of antimicrobial prophylaxis in
shorter, clean soft tissue hand surgical
procedures is debatable, but it is standard in
hand surgeries involving bone and/or
implants. A single preoperative antimicrobial
administration may not provide sufficient
antimicrobial coverage in all tissues for the
duration of hand surgeries.
Aim: To investigate the time that the free
concentration of Cefuroxime was above
minimal inhibitory concentration (fT>MIC) of
4 µg/mL for Staphylococcus aureus in
targeted hand tissues after single and
repeated administration, enabling evaluation
of need for re-administration and optimal
time for initial administration.
Materials and Methods: In a prospective, unblinded randomized
clinical study, 16 patients (13 female, 3
male) with a mean age of 66 years (range
51 to 80 years) underwent trapeziectomy
with suspensionplasty. Before wound
closure, microdialysis catheters were placed
in the metacarpal bone, the synovial sheath
and subcutaneous tissue. After tourniquet
release, patients were randomized to
intravenous administration of a single
Cefuroxime dose (1,500 mg) (Group 1, n=8)
or repeated (2x1,500 mg) Cefuroxime
dosing with a 4-h dosing interval (Group 2,
n=8). Dialysates and venous samples were
taken over a period of 8 h.
Results: fT>MIC of 4 µg/mL was longer in all
compartments in Group 2 (range 96–100%)
than in Group 1 (range 52–75%). A mean
Cefuroxime concentration of 4 µg/mL was
reached in all compartments in both groups
within a mean time of 6 min (range 0–27
min). In Group 1, the mean concentrations
decreased below 4 µg/mL between 3 h 59
min and 5 h 38 min after administration.
Interpretation / Conclusion: A single administration of Cefuroxime 1,500
mg provided antimicrobial tissue coverage
for a minimum of 3 h 59 min. Administration
of Cefuroxime in hand surgeries should be
done a minimum of 27 min prior to incision
in order to achieve sufficient coverage in all
individuals. Re-administration of Cefuroxime
should be considered in hand surgeries
lasting longer than approximately 4 h from
the time of initial administration.
105. Poor Patient-Reported Outcomes and Satisfaction after Revisions of Medial Unicompartmental Knee Arthroplasties for unexplained pain. A cross-sectional nationwide study on patients revised for Unexplained Pain vs Aseptic Loosening
Kristine Bollerup Arndt1, Henrik Morville Schrøder2, Anders Troelsen3, Martin Lindberg-Larsen1
1. Department of Orthopaedic Surgery and Traumatology, Odense University Hospital;
Department of Clinical Research, University of Southern Denmark, Odense
2. Department of Orthopaedic Surgery. Naestved Hospital, Denmark
3. Department of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre,
Copenhagen University Hospital Hvidovre, Denmark
Background: It is uncertain if patients undergoing revision of
UKAs because of unexplained pain benefit from the
surgery.
Aim: The aim of this study was to compare patient-
reported outcome measures (PROM) and
satisfaction 1 to 3 years after revision of medial
unicompartmental knee arthroplasties (mUKA) for
unexplained pain vs aseptic loosening.
Materials and Methods: We included 104 patients undergoing revision of
mUKA's for the indications unexplained pain and
aseptic loosening in the period January 1, 2018 to
December 31, 2020 from the Danish Knee
Arthroplasty Register. 52 patients were revised for
unexplained pain and 52 for aseptic loosening.
Questionnaires including PROMs (Oxford Knee
Score (OKS), EQ-5D-5L, Forgotten Joint Score
(FJS)) and questions about satisfaction with the
surgery were sent to digitally secured mailboxes.
Results: Median OKS was 26 (IQR 22) vs 34 (IQR 12) 1 to 3
years after revisions for unexplained pain vs aseptic
loosening, p=0.033. Median EQ-5D-5L Index was
0.7 (IQR 0.6) vs 0.8 (IQR 0.1) for unexplained vs
aseptic loosening, p=0.014. Median FJS was 48
(IQR 10) vs 52 (IQR 14) for unexplained pain vs
aseptic loosening, p=0.1. Satisfaction with the
surgery (100=not satisfied; 0=very satisfied) was 55
(IQR 60) for unexplained pain vs 50 (IQR 67) for
aseptic loosening, p=0.087, and patients revised for
unexplained pain were less likely to find their knee
problem importantly improved (p=0.032).
Interpretation / Conclusion: Patients undergoing revision of mUKAs for
unexplained pain presented poor postoperative
PROM scores, and PROM scores were worse
compared to patients revised for aseptic loosening.
This study support the evidence against revisions for
unexplained pain.
106. Validity of the registration of periprosthetic joint infection after total knee arthroplasty in the Danish Knee Arthroplasty Register using microbiology data as a gold standard
Marie Anneberg1, Eskild Bendix Kristiansen1, Anders Troelsen2, Per Gundtoft3, Henrik Toft Sørensen1,4, Alma Becic Pedersen1,4
1 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus
University, Denmark;
2 Department of Orthopedic Surgery, Hvidovre Hospital, Denmark;
3 Department of Orthopedic surgery, Aarhus University Hospital, Denmark;
4 Department of Clinical Medicine, Aarhus University Denmark
Background: Periprosthetic joint infection (PJI) is a serious
complication after total knee arthroplasty (TKA).
Recent studies have revealed low validity of the
PJI diagnosis in several joint arthroplasty
registers and suggested a systematic
underestimation of the incidence of PJI
Aim: To assess the validity of recording of revision due
to PJI within the first year after primary TKA in
the Danish Knee Arthroplasty Register (DKR),
using the Danish Microbiology Database (MiBa)
as gold standard.
Materials and Methods: We included patients who underwent primary
TKA between January 1st, 2016, and
December 31st 2018, registered to both DKR
and MiBa, with matching primary operation
date and side (n= 18.454). MiBa holds
nationwide information on results of all
microbiology samples and procedure codes
via linkage to the Danish National Patient
Registry.
PJI was defined in DKR as first-time revision
due to PJI within the first year after primary
TKA, registered as “PJI suspected” or “PJI
verified by microbiology”.
PJI was defined in MiBa as first-time same-
side knee-related revision surgery within the
first year after primary TKA, accompanied by
cultures taken between 24 hours before to 48
hours after revision surgery, with a minimum
of two samples out of a minimum of three
samples positive with the same
microorganism.
We estimated the sensitivity, specificity,
positive and negative predictive value (PPV
and NPV) of PJI diagnosis in DKR.
Results: Amongst 18,454 primary TKA patients, we
identified 147 PJIs in DKR and 158 in MiBa.
Validating DKR against MiBa, 94 of PJIs in DKR
were true positive, 53 false positive, 64 false
negative, and 18243 true negative,
corresponding to a sensitivity of 59.5% (51.4 -
67.2), a specificity of 99.7% (99.6 -99.8), a PPV
of 63.9% (55.6% - 71.7), and a NPV of 99.7%
(99.6 - 99.7).
60/64 false negatives were found within the first
3 months after primary TKA.
Interpretation / Conclusion: Using microbiology samples as gold standard,
we found 40% underrecording of revision due to
PJI after TKA in DKR during 2016-2018. 36% of
PJI reported to DKR had negative cultures
according to MiBa, and likely partly represents
culture negative PJIs, as this remains a clinical
diagnosis.
107. Short-term Patient-reported outcome after stemmed versus stemless total shoulder arthroplasty for glenohumeral osteoarthritis: A patient-blinded non-inferiority randomized clinical trial.
Zaid Issa1,2, Jeppe Vejlgaard Rasmussen3, Stig Brorson1,2
1. Department of Orthopaedics, Zealand University Hospital, Køge.
2. Centre for Evidence-Based Orthopaedics (CEBO).
3. Department of Orthopaedics, Herlev Gentofte hospital.
Background: Stemmed total shoulder arthroplasty (TSA) is
the dominant implant in the treatment of
patients with primary osteoarthritis (OA) and an
intact cuff. Stemless TSA systems have been
used since 2004, but information about safety
and efficacy is sparse. The metaphyseal fixation
of the stemless TSA may be an advantage
should the need of a revision arthroplasty arise.
Aim: The purpose of the study was to compare the
short-term patient-reported outcome of stemless
and stemmed total shoulder arthroplasty.
Materials and Methods: We conducted a non-inferiority randomized
clinical trial. Patients with symptomatic OA,
computerized tomography (CT) scan-verified
adequate glenoid bone stock, and no total
rupture of rotator cuff tendons verified by a
magnetic resonance imaging (MRI) scan
were randomly allocated to a stemmed or
stemless TSA. The primary outcome was the
Western Ontario Osteoarthritis Shoulder
(WOOS) score at 12 months.
The minimal clinically important difference
(MCID) of WOOS is 12.3%. we used this
value to define the non-inferiority margin.
Results: Eighty patients were randomised, 38 in the
stemmed TSA group and 42 in the stemless
TSA group. One patient in the stemless TSA
group died after the 3 months follow-up,
otherwise no dropouts. Demographics were
comparable in both groups. At 12 months
follow-up the mean WOOS was 77.8
(SD=22.0) and median 87.1 (IQR: 66.6-94.2)
in the stemmed TSA group and 86.8
(SD=16.9) and 94.2 (IQR: 82.5-98.2) in the
stemless TSA group (p-value for non-
inferiority test =0.045).
We found a statistically significant difference
in the mean WOOS of 9.0% (95% CI 0.7-
17.0) but the lower limit of the CI (e.g., 0.7)
did not cross the margin of non-inferiority
(e.g., -12.5).
Interpretation / Conclusion: The stemless TSA is non-inferior to the
stemmed TSA in terms of patient-reported
outcome measures at short term follow-up.
Sparing the humeral shaft canal for later
revision could be an argument for using a
stemless TSA.
108. No effect of capsular closure during hip arthroscopy - one-year follow-up of a prospective randomized controlled study.
Bjarne Mygind-Klavsen1, Otto Kraemer2, Bent Lund3, Michael Krogsgaard5, Per Hölmich2, Martin Lind1, Torsten Grønbech Nielsen1, Lene Lindberg Miller1, Karen Briggs4, Marc J. Philippon4, Christian Dippmann5
1. Div. of Sports Traumatology, Dept. of Orthopedics, Aarhus University
Hospital, Palle Juul-Jensens Blvd. 99, 8200 Aarhus N, Denmark.
2. Sports Orthopedic Research Center – Copenhagen (SORC-C),
Department of Orthopedic Surgery, Copenhagen University Hospital,
Amager-Hvidovre, Kettegård Allé 30, 2650 Hvidovre Denmark.
3. Horsens Regional Hospital, Dept. of Orthopedics, 8700 Horsens,
Denmark.
4. Steadman Philippon Research Institute, Vail, CO 81657, USA.
5. Section for Sportstraumatology M51, Bispebjerg-Frederiksberg Hospital.
Part of IOC Research Center Copenhagen, Bispebjerg Bakke 23, 2400
Copenhagen, Denmark.
Background: Capsular management during hip
arthroscopic procedures has recently been
a hot topic in treatment of
Femoroacetabular impingement (FAI)
patients. Current cohort studies have
demonstrated good outcomes in favor of
capsular closure, however one randomized
controlled trial did not demonstrate any
significant differences in outcome after
capsular closure versus unrepaired
capsulotomy in FAI patients.
Aim: The aim of this controlled, randomized
multicenter trial was to evaluate the effect of
capsular closure in relation to subjective
postoperative outcomes and revision rates
in patients undergoing hip arthroscopy for
FAI.
Materials and Methods: All eligible FAI patients from four surgical
centers in Denmark, referred for hip
arthroscopy (n = 200) were randomly
assigned to either closure or no closure of
the interportal capsulotomy at termination of
the arthroscopic procedure. The capsular
closure was performed with 2-3 absorbable
sutures, using the “Quebec City Slider” knot
tying technique. The Copenhagen Hip and
Groin Outcome Score (HAGOS) was
primary outcome and scores were collected
from The Danish Hip Arthroscopy Registry
preoperatively and at one-year follow-up.
Results: Baseline epidemiological and morphological
characteristics were comparable between
the treatment groups, except for a higher
percentage of females in the capsular
closure group (66% vs. 48%). Both groups
significantly improved after surgery (p <
0.05). At one-year follow-up, there was no
difference between treatment groups in any
of the HAGOS domainscores (p > 0.05).
The revision rates after one year were
identical in both groups (n=5), however, two
patients in the non-closure group were
treated with a total hip replacement.
Interpretation / Conclusion: This controlled, randomized multicenter trial
demonstrated no evidence for improved
outcome of capsular closure after interportal
capsulotomy in hip arthroscopic treatment of
FAI-patients.
109. Effects of a progressive rehabilitation and care program across sectors for older adults following hip fracture surgery
Inge Hansen Bruun1,2, Charlotte Suetta 3,4, Jonas A. Ipsen 1,2, Lars T.Pedersen 1,2,5, Birgitte Nørgaard 6, Bjarke Viberg7,8,9
1. Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark; 2. Department of Regional Health Research, University of Southern Denmark, Odense; 3. Geriatric Research, Department of Geriatric and Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark ; 4. Institute of Clinical Medicine, University of Copenhagen, Denmark ; 5. Department of Health Education, University College South Denmark, Esbjerg,; 6. Department of Public Health, User Perspectives and Community-based Interventions, University of Southern Denmark, Odense, Denmark; 7. Department of Orthopaedic Surgery and Traumatology. Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark ; 8. Department of Orthopaedic Surgery and Traumatology. Odense University Hospital, Odense; 9. Department of Clinical Research, University of Southern Denmark, Odense, Denmark
Background: Approximately half of the home-dwelling hip fracture
patients can expect reduced functional level after
one year. One issue contributing to this may be a
lack of cooperation between the hospital and
municipality concerning rehabilitation.
Aim: To assess the effect of a continuous and progressive
rehabilitation and care program across sectors for
home-dwelling hip fracture patients above 65 years.
Materials and Methods: A cluster-randomized stepped-wedge trial was
carried out in Hospital Lillebaelt and the six
municipalities within the hospitals’ catchment
area.
The intervention group received a progressive
strength-training program initiated in the hospital
and continuing after discharge by the
municipality’s physiotherapists for 12 weeks
using an empowerment-based approach. The
intervention also included a follow-up visit by a
nurse three days after discharge. The control
group received the usual rehabilitation and care.
The primary outcome was Timed Up and Go
(TUG) measured eight weeks after surgery.
Secondary outcomes were 30-day mortality,
readmission rate, and New Mobility sum-score
(NMS).
Results: In total, 336 patients were included, 168 (116
women) in the intervention group and 171 (108
women) in the control group. The mean age was
80, the mean Hindsoe-score was 8.7, and 50%
were admitted due to a femoral neck fracture.
There were no baseline differences between the
groups regarding age, sex, comorbidity, fracture,
and mobility.
Eight weeks after surgery, TUG was significantly
higher in the intervention group (median 14.3
(IQR10-20) compared to median 13.9 (IQR 12-
22) in the control group (p=0.038). The same
applies to the NMS; for the intervention group,
the median NMS sum-score was 6 (IQR 4-7) and
5.5 (IQR 4-7) in the control group (p=0.042).
There were no significant differences in 30-day
mortality (p=0.57) and readmission rate (p=0.15)
between the groups.
Interpretation / Conclusion: A cross-sectorial strength-training program
demonstrated a significant increase in mobility in
terms of TUG and NMS compared to usual
rehabilitation and care. The program was designed
as a real-life program and will therefore be easy to
implement elsewhere.