Posterwalk
13. November
17:00 - 18:00
Poster Walk 1: Hip and Knee Arthroplasty 1
Chair:
165. Cross-cultural validation of the Oxford Hip and Knee Scores in patients undergoing hip and knee replacement
Lina Holm Ingelsrud1, Shiraz A. Sabah2, Eric Bohm3, Karl Bang Christensen4, Anders Troelsen1,5, Andrew J. Price2, Anneke Spekenbrink-Spooren6, Anne Lubbeke7, Christoph Barea7, Jasper Most8, Conrad Harrison2, J. Mark Wilkinson9
1 Department of Orthopaedic Surgery, Copenhagen University Hospital – Hvidovre,
Denmark
2 University of Oxford, United Kingdom
3 University of Manitoba, Canada
4 Department of Public Health, University of Copenhagen, Denmark
5 Department of Clinical Medicine, University of Copenhagen, Denmark
6 Dutch Arthroplasty Register (LROI), The Netherlands
7 Geneva University Hospitals, University of Geneva, Switzerland
8 Zuyderland Medical Center, Sittard-Geleen, The Netherlands
9 University of Sheffield, United Kingdom
Background: The cross-cultural validity of the Oxford hip score
(OHS) and Oxford knee score (OKS) across
different language versions is not known.
Aim: To evaluate the cross-cultural validity of the English,
Dutch, Danish and French OHS and OKS in
patients undergoing hip and knee replacement.
Materials and Methods: Patients undergoing primary hip or knee
replacement for osteoarthritis between 2019 to
2022 answering OHS or OKS preoperatively and
at 6 or 12 months postoperatively were included
from the United Kingdom National Joint Registry
(English), the Dutch Arthroplasty Register (LROI)
(Dutch), the Copenhagen University Hospital
Hvidovre’s local arthroplasty database (Danish),
and the Swiss Geneva Arthroplasty Registry
(French). Analyses were performed separately
for each registry dataset. Unidimensionality of
the constructs was evaluated with confirmatory
factor analysis (CFA), with root mean square
error of approximation (RMSEA) <0.06,
Standardized Root Mean Square Residual
(SRMR) =0.08, Comparative Fit Index (CFI)
>0.95, and Tucker-Lewis Index (TLI) >0.95.
Monotonicity was indicated by Loevinger's H
coefficient >0.3 and item local independence with
the Yen Q3 residual correlations <0.2.
Results: The mean age ranged from 67 to 71 years,
female proportion from 54% to 63%, mean BMI
from 27 to 30, and proportions with ASA score =3
from 17% to 29%, across hip and knee cohorts
where English (n=21,108 and 28,230), Dutch
(n=36,792 and 29,651), Danish (n=815 and
1,015) and French (n=590 and 459) instruments
were utilised. Preoperative mean OHS ranged
from 18 to 23 and OKS from 19 to 24. For the
OHS, RMSEA ranged from 0.072 to 0.092. For
OKS, RMSEA ranged from 0.057 to 0.061. For
both OHS and OKS, SRMR, CFI and TLI were
acceptable in all languages. Monotonicity was
indicated for all items besides Night pain in the
Dutch and Danish OKS. Item independence was
confirmed for all items besides OHS Dressing
and Washing in the Dutch and Danish versions
and Sudden pain and Night pain in the Danish
version.
Interpretation / Conclusion: Structural validity of the English, Dutch, Danish and
French versions of the OHS and OKS was
acceptable. Further analyses will inspect
measurement invariance across languages.
191. Development and Field-Testing of In-Consult Patient Decision Aids for Hip and Knee Osteoarthritis: A Collaborative Approach
Trine Pedersen Ahlmann 1,2, Charlotte Jensen Myhre3,4, Martin Lidberg-Larsen3,4, Claus Varnum1,2, Karina Steffensen Dahl2,5
1 Department of Orthopaedic Surgery, Lillebaelt Hospital, University Hospital of Southern
Denmark, Vejle, Denmark
2 Department of Regional Health Research, University of Southern Denmark, Odense,
Denmark
3 Orthopaedic Research Unit, Clinical Institute, University of Southern Denmark,
Denmark
4 Department of Orthopaedic Surgery, Odense University Hospital, Odense, Denmark.
5 Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern
Denmark, Vejle, Denmark
Background: Severe osteoarthritis (OA) affecting the hip or
knee commonly results in joint arthroplasty, with
notable rates of dissatisfaction post-surgery (7%
for total hip arthroplasty and 11-18% for total
knee arthroplasty). This points at the importance
of well-informed decision-making in treatment
decisions, highlighting the necessity for patients
to understand various options. While shared
decision-making (SDM) and patient decision aids
(PtDA) are recognized as beneficial tools in
consultations, their use in OA consultations
remains limited.
Aim: This study aims to develop and field-test an in-
consult PtDA tailored for patients with hip or knee
OA.
Materials and Methods: Following the International Patient Decision Aid
Standards, we conducted an iterative PtDA
development process. This involved a systematic
literature search, fifteen field observations, two
focus group discussions with patients (n=11) and
relatives (n=4), and two discussions with
orthopaedic surgeons (n=12). Alpha testing was
carried out with orthopaedic surgeons (n=12) and
newly recruited patients with hip or knee OA (n=15)
to assess acceptability and usability.
Results: Field observations and focus group discussions
provided valuable insights into the consultation
process and dynamics of shared decision-
making. Patients emphasized themes such as
weighing treatment options, considering quality
of life and the pivotal role of the patient-surgeon
relationship. In contrast, surgeons expressed
scepticism and apprehensions about PtDAs,
focusing on concerns about individual practices,
information-sharing and potential imbalances in
decision-making responsibilities.
Patients and surgeons expressed a preference
for joint-specific PtDAs leading to the
development of distinct editions tailored for hip
and knee OA patients. Both patients and
surgeons found the PtDAs acceptable and useful
in the decision-making process.
Interpretation / Conclusion: Two in-consult PtDAs tailored for severe OA in the
hip or knee were successfully developed and tested.
They were found to be useful and acceptable by
both patients and surgeons, underscoring their
potential to enhance the decision-making process
for OA treatment.
151. Starting up a medial unicompartmental knee arthroplasty practice – a prospective cohort study of 200 knees.
Annika Gottholt Hansen1, Kristina Ifigenia Bunyoz1, Cecilie Henkel1, Mette Mikkelsen1, Kirill Gromov1, Anders Troelsen1
1. Clinical Orthopaedic Research Hvidovre, Department of Orthopaedic Surgery,
Copenhagen University Hospital Hvidovre, Denmark.
Background: Medial unicompartmental knee arthroplasty (mUKA)
has for many surgeons become the treatment of
choice in patients with anteromedial osteoarthritis
(AMOA) of the knee. Despite the widespread use of
mUKA, data on outcomes during the adoption
phase are scarce.
Aim: To investigate the learning curve and the clinical and
radiological outcome during the implementation of
mUKA by 2 knee arthroplasty surgeons.
Materials and Methods: The first 200 mUKA (uncemeted, mobile bearing,
microplasty instrumentation) performed by two
arthroplasty surgeons, were evaluated to
determine whether there was an association
between outcomes and the cumulative number
of cases performed. The primary outcome was
the learning curve of surgery duration. The
secondary outcomes were patient reported
outcomes (PROMs), including the Oxford Knee
Score (OKS), Forgotten Joint Score (FJS), and
Activity & Participation Questionnaire (APQ),
evaluated at 3, 12, and 24 months
postoperatively, the survival rate and implant
positioning. The learning curve was estimated
using the cumulative summation analysis
(CUSUM).
Results: The mean follow-up was 5.8 ± 1.1 years and the
mean age at the time of surgery was 64.9 ± 10.4
years. The CUSUM curve reveals a learning curve
in surgery duration, with a turning point at the 55th
patient, after which the operation duration
decreases. Postoperatively PROMs remained
consistently good with minimal fluctuation across
the initial 200 cases. The median OKS at 12- and
24-months post-surgery was 41 and 43. The implant
survival rate was 97.5% at 5 years, with 6 re-
operations (3.0%) and 8 revisions (4.0%).
Radiographic assessments in the coronal plan
revealed 86.5% of patients had tibial placement
within 5 degrees of neutral position. No patient
exhibited a tibial overhang > 2 mm.
Interpretation / Conclusion: The implementation of medial UKA appears to be
safe and efficient, with no compromise in PROM
outcomes. Surgical duration decreased after 55
cases, and surgical precision appeared high already
in the early phase of adoption.
156. Factors associated with undergoing knee arthroplasty– a two-year prospective cohort study of patients with knee osteoarthritis consulting an orthopaedic surgeon
Lina Holm Ingelsrud1, Søren T Skou2,3, Anne Møller4, Thomas Bandholm1,5,6,7, Henrik M Schrøder8,9, Simon M Bruhn1, Jakob Kjellberg10, Anders Troelsen1,7
1. Department of Orthopaedic Surgery, Copenhagen University Hospital – Hvidovre,
Denmark;
2. Research Unit for Musculoskeletal Function and Physiotherapy, Department of
Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense,
Denmark;
3. The Research and Implementation Unit PROgrez, Department of Physiotherapy
and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand,
Denmark;
4. Center for Research and Education in General Practice, Department of Public
Health, University of Copenhagen, Copenhagen, Denmark;
5. Physical Medicine & Rehabilitation Research Copenhagen (PMR-C), Department of
Physical and Occupational Therapy, Copenhagen University Hospital - Hvidovre,
Denmark,
6. Department of Clinical Research, Copenhagen University Hospital - Hvidovre,
Denmark;
7. Department of Clinical Medicine, University of Copenhagen, Copenhagen,
Denmark;
8. Department of Regional Health Research, University of Southern Denmark,
Odense, Denmark;
9. Department of Orthopaedic Surgery, Næstved-Slagelse-Ringsted Hospitals, Region
Zealand, Denmark;
10. The Danish Center for Social Science Research (VIVE), Copenhagen, Denmark
Background: Patients encounter diverse treatments for knee
osteoarthritis (OA) before undergoing knee
arthroplasty.
Aim: To describe 1) the proportions of patients with knee
OA who undergo knee arthroplasty within the first
two years after consulting an orthopaedic surgeon
and 2) which factors are associated with surgery.
Materials and Methods: Patients with primary referral to orthopaedic
surgeons for knee OA were included at two high-
volume Danish outpatient orthopaedic departments
from October 2018 to December 2020. Patients
answered questionnaires about prior treatment of
knee OA at inclusion and after 6 months and 2
years. Information about knee arthroplasty was
extracted from the Danish Knee Arthroplasty
Register. Patient characteristics were compared
descriptively among those undergoing arthroplasty
or not within 6 months and 2 years. Trial ID:
NCT03746184.
Results: We included 3,507 of 5,251 eligible patients
(67%). Within 6 months, 28% had a knee
arthroplasty, with an additional 16% within 2
years. Those operated at 6 months and 2 years
were on average 5 and 3 years older and had 3-
and 5-points lower Oxford knee scores than non-
operated patients. Proportions with Kellgren
Lawrence Score 3-4 were 58% in the non-
operated, 72% in those operated at 6 months
and 78% at 2-years. Knee problems lasting <1
year were reported by 39% of non-operated
patients, compared to 15% and 19% in patients
operated at 6 months or 2 years. Amongst those
who had surgery within 6 months and 2 years,
88% and 82%, responded preferring surgery
before the initial consultation, while 47% of non-
operated patients preferred surgery. Among
respondents at both 6-month and 2-year follow-
up (68%, n = 2385), 38% (n = 290) of those
operated within 6 months had both performed
exercise and received education before surgery,
increasing to 60% (n = 249) in those operated at
2 years, compared to 26% in non-operated
patients.
Interpretation / Conclusion: Whether undergoing knee arthroplasty or not, within
two years after the initial consultation with an
orthopedic surgeon, is associated with subtle
distinctions in patient characteristics and prior knee
OA treatments. Patients’ initial preference for
surgery may weigh more when deciding on having
surgery.
157. The association between arthroplasty center type and day-case surgery implementation and feasibility
Christian Bredgaard Jensen1,4, Oddrún Danielsen1,2, Claus Varnum1,3, Thomas Jakobsen1,5, Mikkel Rathsach Andersen1,6, Manuel Josef Bieder1,7, Søren Overgaard1,8, Christoffer Calov Jørgensen1,9, Henrik Kehlet 1,10, Martin Lindberg-Larsen1,2, Kirill Gromov1,4
1. Center for Fast-track Hip and Knee Replacement, Denmark;
2. Dept. of Orthopaedic Surgery and traumatology, Odense University Hospital
and Svendborg;
3. Dept. of Orthopaedic Surgery, Lillebaelt Hospital – Vejle;
4. Dept. of Orthopaedic Surgery, Hvidovre University Hospital;
5. Dept. of Orthopaedic Surgery, Aalborg University Hospital;
6. Dept. of Orthopaedic Surgery, Copenhagen University Hospital, Herlev-
Gentofte;
7. Dept. of Orthopaedic surgery, Næstved, Slagelse and Ringsted Hospitals;
8. Dept. of Orthopaedic Surgery and Traumatology, Copenhagen University
Hospital, Bispebjerg;
9. Dept. of Anaesthesia, Hospital of Northern Zeeland, Hillerød;
10. Section of Surgical Pathophysiology, Copenhagen University Hospital,
Rigshospitalet;
Background: Hip and knee arthroplasties as day-case
procedures can reduce bed occupancy and
enhance cost-effectiveness, which is needed to
accommodate the future demands for
arthroplasty surgeries.
Aim: We aimed to investigate the association
between different arthroplasty center setups and
the rate of day-of-surgery (DOS) discharge
before and after implementation of a day-case
setup.
Materials and Methods: We included unilateral primary hip and knee arthroplasty patients from 7 fast-track
arthroplasty centers with identical day-case eligibility and discharge criteria initiated in
September 2022 under the Center for Fast-track Hip and Knee Replacement. The
centers were categorized into three types: Satellite arthroplasty center (SAC): only
primary arthroplasties, separate logistics. Elective arthroplasty center (EAC): complex
primaries, revisions, separate logistics. Arthroplasty unit orthopedic department (AUO):
primary and revision procedures, integrated into general orthopedic department. DOS
discharge rate in the study period (September 2022-September 2023) was compared
to a control period (July 2019-December 2019) before implementation. The likelihood
of DOS discharge for day-case surgery eligible patients was compared between center
types using a logistic regression model.
Results: We included 6718 hip and knee arthroplasty
patients (1357 from SACs, 4309 from EACs,
1052 from AUOs), and 3974 patients in the
control period. The overall DOS discharge rates
increased in all three center types after
implementation of the day-case surgery setup
(SACs; control=3.9%, study=30%. EAC;
control=5.5%, study=23%. AUO; control=7.4%,
study=14%). Successful DOS discharge was
more likely in day-case eligible SAC patients
(54%, [OR: 2.3 (CI 1.7-3.1)]) and EAC patients
(60%, [OR: 3.1 (CI 2.4-4.1)]), compared to AUO
patients (36%).
Interpretation / Conclusion: After implementation of a day-case setup, the
overall DOS discharge rates were higher in
satellite arthroplasty centers and elective
arthroplasty centers, compared to arthroplasty
units at orthopedic departments. DOS discharge
was also more likely for day-case eligible
patients operated in satellite arthroplasty centers
and elective arthroplasty centers.
174. When do patients resume driving after day-case hip and knee arthroplasty
Oddrún Danielsen1, Jens Lauritsen1, Martin Lindberg-Larsen1
1. Dept. of Orthopaedic Surgery and traumatology, Odense University Hospital and
Svendborg
Background: Following surgery, patients are eager to return to
their regular activities, with the timing of resuming
driving being a significant concern. Being fully
capable of operating a vehicle involves various
factors, including anesthesia, opioids, and
immobilized joints. While doctors can offer advice,
the legal requirements are imprecise. Currently,
there is only limited data on the post-operative
driving timeline for hip and knee arthroplasty
patients.
Aim: The aim was to estimate variation in time to resume
car driving after hip and knee arthroplasty, including
the influence of patients’ and surgical factors on
resumption.
Materials and Methods: This prospective single-centre study, includes
patients undergoing primary total hip arthroplasty
(THA), total knee arthroplasty (TKA) and
unicompartmental knee arthroplasty (UKA) in a day-
case setup at Odense University hospital
Svendborg, Denmark from September 2022 to
August 2023. Eligible patients received an electronic
survey 3 to 12 months after being discharged, with
the question “How many weeks after the surgery did
you drive a car again?”
Results: A total of 427 day-case eligible patients received the
survey and 373 patients (87%) responded to the
survey.
The proportion who resumed driving at two weeks
was 13% (CI: 7-18%) for THA, 11 % (6-19%) for
TKA and 24% (16-35%) for UKA. At six weeks 76
(68-83%) for THA, 65% (55-74%) for TKA and 75%
(65-84%) for UKA.
Female patients had increased risk of delayed car
driving resumption compared to males (OR 2.8, CI:
1.6 – 4.8). TKA surgery, psychiatric disorder
medication, and clinical frailty scale (CFS) =4 where
found to have increased risk of delayed car driving,
but were not significant.
Interpretation / Conclusion: More than twice as many UKA patients resumed
driving during the first two weeks compared to THA
and TKA. Overall, 65%-76% of patients resumed
driving within 6 weeks. Female gender was a
significant predictor of delay in resuming car driving
six weeks post-surgery.
181. Translation and cross-cultural adaptation into Danish of the Oxford Arthroplasty Early Recovery Scale (OARS) and the Oxford Arthroplasty Early Chance Scale (OACS)
Mette Garval(1), Lone Ramer Mikkelsen(1), Søren Thorgaard Skou(2,3), Jeppe Lange(4,5), David Høyrup Christiansen(1,5)
1. University Clinic for Orthopaedic Pathways (UCOP), Elective Surgery Centre, Regional
Hospital Silkeborg
2. The Research and Implementation Unit PROgrez, Næstved-Slagelse-Ringsted
Hospitals
3. Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern
Denmark
4. Department of Orthopaedics, Regional Hospital Horsens
5. Department of Clinical Medicine, Aarhus University
Background: Until recently, Danish-language validated patient-
reported outcome measures (PROMs) to assess
early postoperative recovery following hip or knee
arthroplasty have been absent. The Oxford
Arthroplasty Early Recovery Scale (OARS) and the
Oxford Arthroplasty Early Chance Scale (OACS) are
PROMs designed to assess joint-related and
systemic symptoms and health status during weeks
0-6 following a knee or a hip arthroplasty in a UK
population.
Aim: To translate and cross-culturally adapt the OARS
and OACS into Danish.
Materials and Methods: The OARS and OACS comprise 14 items
measuring patient health status and changes in
the patient's health and symptoms during the first
6 post-operative weeks. The scores can be used
simultaneously but are independently
interpreted. In collaboration with Oxford
University, the OARS and OACS were translated
and cross-culturally adapted into Danish using a
forward-backward translation method in
accordance with international guidelines. The
translated versions were pilot tested through
qualitative interviews with 6 participants
conducted 2-3 weeks post-surgery at Regional
Hospital Silkeborg. Verbatim transcriptions of the
interviews were analysed to evaluate the
understanding, relevance and
comprehensiveness of the instructions, items
and response options (cognitive debriefing).
Results: All 6 participants (3 undergoing hip arthroplasty and
3 knee arthroplasty) found the OARS and OACS to
be easy to understand, and quick to complete (the
average time to complete both measures was 5
minutes and 22 seconds). All items were considered
relevant, and no important topics were reported as
missed. There were no suggestions for alternative
wording. Overall feedback on the OARS and OACS
was positive, supporting the face and content validity
of the measures.
Interpretation / Conclusion: The translated versions of OARS and OACS seem
suitable for measuring recovery in Danish patients
undergoing hip or knee arthroplasty. However,
further evaluation of measurement properties is
necessary to determine utility when evaluating or
comparing the efficacy of perioperative
interventions.
Poster Walk 2: Hip and Knee Arthroplasty 2
Chair:
185. Characteristics of eligible patients with knee osteoarthritis accepting versus declining participation in a randomized trial investigating the effect of weight loss vs. knee arthroplasty to explore generalizability: A cross sectional study.
Saber M. Saber1,2,3, Robin Christensen2,4, Marius Henriksen2,3, Henning Bliddal2,3, Troelsen Anders3,5, Boesen Mikael 3,6, Asbjørn Seenithamby Poulsen2,3, Camilla Toft Nielsen2,3,6, Kristine Ifigenia Bunyoz2,3,5, Søren Overgaard1,3
1. Department of Orthopedic Surgery and Traumatology, Copenhagen University
Hospital - Bispebjerg & Frederiksberg, Copenhagen, Denmark;
2. The Parker Institute, Copenhagen University Hospital - Bispebjerg &
Frederiksberg, Frederiksberg, Denmark;
3. Department of Clinical Medicine, Faculty of Health and Medical Sciences,
University of Copenhagen, Copenhagen Denmark;
4. Research Unit of Rheumatology, Department of Clinical Research, University of
Southern Denmark, Odense University Hospital, Odense, Denmark;
5. Department of Orthopedic Surgery, Copenhagen University Hospital – Hvidovre &
Amager, Hivdovre, Denmark;
6. Department of Radiology, Copenhagen University Hospital - Bispebjerg &
Frederiksberg, Copenhagen, Denmark .
Background: The Intensive Diet vs Knee Arthroplasty (INKA)
trial is a randomized trial assessing weight loss
as an alternative to knee arthroplasty (KA) in
obese patients with severe knee osteoarthritis
awaiting KA (NCT05172843). The external
validity of the INKA trial may be hampered if the
patients who participate differ from those who
decline participation.
Aim: To compare baseline characteristics between
patients who enroll in the INKA trial and those
who decline participation (i.e., the non-INKA
group, abbreviated as nINKA)
Materials and Methods: We applied a cross-sectional study design,
collecting and comparing baseline
characteristics among all patients eligible for
enrolment in the INKA trial from 2 clinics in
Copenhagen. Imbalance between accepting
(INKA) and declining (nINKA) groups was
assessed using standardized differences (StdD).
We prespecified that StdD values <0.20 would
indicate a clinically insignificant imbalance
between groups, whereas values >0.80 indicate
incomparability.
Results: Of 913 patients scheduled for KA, 888 were
screened for INKA trial eligibility. Of the 217
eligible patients, 92 (42%) were enrolled in the
INKA trial, while 37 (17%) participated in the
nINKA cross-sectional sample only. Patients
enrolled in INKA had on average a less severe
Oxford Knee Score of 22.0 (SD: 6.7) compared
to declining participants in nINKA with 18.6 (7.2),
corresponding to an StdD of 0.50, and an
absolute difference of 3.45 (95% Confidence
interval 0.64 to 6.26, p=0.017). A consistent
similar pattern was noted across all secondary
patient-reported outcomes applied in the INKA
trial.
Interpretation / Conclusion: We observed discrepancies in patient-reported
outcomes, with those who declined enrollment
reporting more severe symptoms.
183. The Influence of Comorbidity, Anxiety, and Depression on Postsurgical Referral to Municipal Rehabilitation: A Cross-Sectional Study of Knee Arthroplasty Patients
Ahmed Kurmasha1, Torben Hansen1,2, Jens Hansen3
1. Department of Orthopaedics, University Clinic for Hand, Hip and Knee
Surgery, Gødstrup Hospital, Herning
2. Department of Clinical Medicine, Aarhus University
3. The Faculty of Social Sciences, Department of Sociology, Environmental
and Business Economics, University of Southern Denmark
Background: Our Cross-Sectional Study follows the
completion of osteoarthritis treatment,
utilizing through either unicompartamental
or total knee prostheses. In the period from
May 2020 to December 2021, 235 patients
underwent knee arthroplasty followed by
either supervised municipal rehabilitation, or
home-based rehabilitation based on
individual assessment of the patients by the
physiotherapist.
Aim: To investigate the impact of comorbidity,
anxiety, and depression on postsurgical
referral to supervised municipal
rehabilitation of knee arthroplasty patients.
Materials and Methods: 109 (mean 71Y), (64F/45M), received
supervised municipal rehabilitation, while
126 (mean 70Y), (59F/67M), underwent
home-based rehabilitation. Data were
gathered through telephone interviews
conducted 12-24 months post-operation,
with an 83% response rate. The binary
outcome variable indicates whether patients
were referred to supervised municipal
rehabilitation or home-based rehabilitation.
Exposure variables include comorbidity,
measured by Charlson Comorbidity Index
(CCI) and anxiety and depression levels,
categorized as either "no problems" or "not
without problems."
Results: The study shows a significant association
between comorbidities and referral to
supervised municipal rehabilitation, with a
risk ratio of 1.35 (CI 1.18-1.54) in the
multivariate model, controlling for various
factors. Anxiety and depression levels also
influence referral, with a higher prevalence
(24%) in the supervised municipal
rehabilitation group compared to the home-
based group (9.5%). The risk ratio for
referral with reported anxiety and
depression issues is 1.43 (CI 1.05-1.94) in
the multivariate model.
Interpretation / Conclusion: The study suggests that patients are often
referred based on factors unrelated to knee
conditions but rather on general and mental
well-being. The implications underscore the
potential need for standardized criteria for
referral to supervised municipal
rehabilitation, recognizing the multifaceted
influences on patient outcomes.
175. Anteromedial knee osteoarthritis (AMOA) evaluated with magnetic resonance imaging (MRI): a cohort study of 100 patients
Kristine Bunyoz1, Joseph Dixon2, Jason Patel3, Anders Troelsen1, Abtin Alvand2, Will Jackson2, Andrew Price2, Nickolas Bottomly2
1Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre,
Kettegård Alle 30, 2650 Hvidovre, Copenhagen, Denmark
2Nuffield Orthopaedic Centre, Windmill Rd, Oxford, OX3 7LD, UK
3Bart’s Bone and Joint Health, Royal London Hospital, Whitechapel Rd, London E1 1FR,
UK
Background: The clinical use of MRI scans for assessing knee osteoarthritis and
aiding preoperative planning before a unicompartmental knee
arthroplasty (UKA) is increasing. Therefore, an MRI-based depiction of
AMOA holds value for both the research community and orthopaedic
surgeons. Such a description will enhance understanding of the
disease pattern, patient selection, and preoperative planning.
Aim: Describe the MRI findings in patients with AMOA,
who meet current indications for medial UKA.
Materials and Methods: We analysed MRI scans from 100 knees evaluated
for UKA between 2006-2013. Inclusion criteria
comprised full-thickness medial compartment loss
and intact lateral compartment joint space on
preoperative radiographs. The assessment included
cartilage lesions, osteophytes, meniscal damage,
and anterior-cruciate ligament (ACL) status. Final
decision to proceed with UKA relied on
intraoperative findings, independent of MRI.
Results: Complete anteromedial tibial and femoral cartilage
loss preserved posterior cartilage rims was evident
in all cases. Cartilage thinning occurred in the lateral
compartment in 34% of cases. While 62% displayed
lateral osteophytes, only 6 exhibited small areas of
full-thickness cartilage loss. ACL abnormalities
varied: 27% normal, 3% ruptured, and 70% had
intrasubstance high signal. Larger osteophytes in
the medial (p = 0.012) and lateral (p = 0.002)
intercondylar notch correlated significantly with ACL
damage. All underwent medial UKA, with no
evidence of full lateral compartment cartilage loss
intraoperatively.
Interpretation / Conclusion: Isolated ACL high signal does not consistently
indicate significant dysfunction. The presence of
lateral osteophytes or small areas of cartilage loss
shouldn't preclude UKA if full cartilage loss in the
weight-bearing area isn't evident intraoperatively.
The findings record the range of MRI scan findings
in patients who meet current indications for medial
UKA, aiding preoperative assessment, if an MRI
scan is requested to evaluate the state of the ACL.
159. The one-year trajectories of patient reported outcomes are better for medial unicompartmental knee arthroplasty compared with total knee arthroplasty – A matched cohort study
Anne Louise Elkjær Christensen1, Christian Bredgaard Jensen1, Cecilie Henkel1, Lina Holm Ingelsrud1, Kirill Gromow1, Andrew J Price2, Anders Troelsen1
1.Clinical Orthopedic Research Hvidovre, Department of Orthopeadic Surgery,
Copenhagen University Hospital Hvidovre, Denmark
2.Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science,
Nuffield Orthopaedic Centre, Oxford, UK.
Background: Whether medial unicompartmental knee arthroplasty
(mUKA) or total knee arthroplasty (TKA) is more
suitable for patients with end stage antero-medial
osteoarthritis is an ongoing debate.
Quality of life, pain relief and functional restoration
are important outcomes for these patients.
Aim: We aimed to compare the development over time in
patient reported outcome measures (PROMs)
between patients receiving medial
unicompartmental knee arthroplasty (mUKA) and
total knee arthroplasty (TKA).
Materials and Methods: We included patients receiving either TKA or
mUKA between March 2018, and February 2020.
Included TKAs were performed by surgeons
using mUKA in less than 1% of their knee
arthroplasties in the study period.
PROMs (Oxford Knee Score (OKS), Forgotten
Joint Score (FJS), and the Activity and
Participation Questionnaire (APQ)) were
completed preoperatively, 3, 6, and 12-months
postoperatively. Missing values, were handled
with multiple imputation, using predictive mean
matching.
The patients were propensity score matched in a
variable 1:2 ratio using BMI, sex, age, and
preoperative PROM-scores.
We calculated the area under the curve (AUC)
using the trapezium rule to quantify the change
from the preoperative PROM scores to scores at
3, 6 and 12 months postoperatively.
Between-group differences in AUC were
analyzed using linear regression adjusted for
pre-operative scores.
Results: A total of 536 patients (236 mUKAs and 300 TKAs)
were included.
AUC was significantly lower for TKA patients
compared to mUKA patients for all three PROM
scores; (OKS: ?AUC of -21%, CI: [-31%; -11%],
FJS: ?AUC of -24% , CI: [-35 % ; -14 %], APQ-27%,
CI: [-38 % ; -15 %]).
The median PROM scores at 3 months were 35 and
30 for OKS, 50 and 41.67 for FJS, 43.75 and 28.13
for APQ, for the mUKA and TKA groups,
respectively. At 6 months median PROM scores
increased to 39 and 35 for OKS, 60.21 and 48.96
for FJS and 50 and 37.5 for APQ.
Interpretation / Conclusion: AUC for PROMS during the first year was 21-27%
lower for TKA compared with mUKA. This contrast
in development trajectories is present especially in
the early recovery 3-6 months after surgery and
may be relevant for surgeons to consider, when
discussing surgical treatment options with patients.
170. Weight change and the risk of chronic pain following hip and knee arthroplasty: A nationwide registry-based cohort survey study
Saber M. Saber1,2,3, Jens Laigaard1,3, Martin Lindberg-Larsen4, Søren Overgaard1,3
1. Department of Orthopedic Surgery and Traumatology, Copenhagen University
Hospital - Bispebjerg & Frederiksberg, Copenhagen, Denmark;
2. The Parker Institute, Copenhagen University Hospital - Bispebjerg &
Frederiksberg, Frederiksberg, Denmark;
3. Department of Clinical Medicine, Faculty of Health and Medical Sciences,
University of Copenhagen, Copenhagen Denmark;
4. Department of Orthopaedic Surgery and Traumatology, Odense Hospital,
Odense, Denmark
Background: Few studies investigated changes in body
weight following total hip, total knee and
unicondylar knee arthroplasty (THA, TKA and
UKA) for osteoarthritis. As many surgeons may
recommend weight loss after arthroplasty, we
found it important to invistigate it's potential
effect.
Aim: To investigate whether an increase or decrease
of 5% or more in BMI is associated with a
concurrent increase or decrease in persistent
postoperative pain (PPP), defined as numeric
rating scale (NRS) [0-10]) =4 following
arthroplasty, across non-obese and obese
patients (BMI=30)
Materials and Methods: Nationwide, register-based cohort survey study.
We obtained data on BMI prior to surgery from
the Danish Hip and Knee Arthroplasty Registers
and sent surveys to patients 15-18 months
following arthroplasty, which included patient-
reported weight, height, NRS, frequency of pain,
use of analgesics, satisfaction [1-5] and pain
interference of daily activities (PIDA)
Results: Mean response rate was 71.4%. There was 10-
12% weight-gainers and 18%-20% weight losers
following all types of arthroplasties. BMI prior to
arthroplasty was 30-32 for weight-losers, 27-29
for weight-gainers, and 27-30 for the rest. For
obese weight-losers following THA, 20% had
PPP compared to 13% for those without weight
change, this gave an Odd Ratio (OR) [95%
Confidence Interval] for having PPP of 1.7
[1.0;2.8], being satisfied 0.5 [0.7;0.9], experience
frequent pain 1.7 [1.0;2.7], PIDA 2.6 [1.5;4.6],
use of analgesics 2.3 [1.00;5.4]. No such
association was found for TKA and UKA.
Interpretation / Conclusion: Weight loss was associated with increased
incidence of PPP in obese patients following
THA. Nevertheless, it is crucial to interpret this
association with caution.
153. Indications for lateral unicompartmental knee arthroplasty – a systematic review
Kristine Bunyoz1, Kirill Gromov1, Anders Troelsen1, Andrew Price2
1: Department of orthopaedic surgery, Copenhagen University Hospital Hvidovre
2: Nuffield Orthopaedic Centre
Background: While evidence-based indications are established for
medial UKA, the optimal indications for lateral UKA
have not received as much attention. Significant
differences exist between medial and lateral UKA.
The indications for the two procedures may
therefore not be identical.
Aim: This review aims to access the indications and
contraindications in published cohort studies on
lateral UKA, to assess if consensus exists.
Materials and Methods: In July 2023, a systematic review was carried out
following the Preferred Reporting Item for
Systematic Reviews and Meta-Analyses (PRISMA)
guidelines. We included cohort studies on lateral
UKA with a clear report of indications. Data on
indications and contraindications were extracted
systematically to evaluate consensus. Further,
outcomes specifically related to expanding or testing
indications for lateral UKA were also obtained.
Results: 38 studies were included. Lateral UKA was most
frequently performed for primary lateral
osteoarthritis. The most reported indications were
moderate to severe lateral osteoarthritis, with full-
thickness cartilage in the medial compartment, intact
ligaments, a correctable valgus deformity, and a
flexion contracture less than 10-15 degrees. The
most reported contraindications were inflammatory
arthritis and severe patellofemoral involvement.
Interpretation / Conclusion: While the literature suggests that some agreement
does exist regarding indications for lateral UKA, a
strong consensus was not found, indicating that
well-defined and consensus-based indications for
lateral UKA do not yet exist.
Poster Walk 3: Infection/Amputation and Experimental
Chair:
172. Does plate positioning affect fracture stability in complex tibial plateau fractures using Finite Element Analysis and Sensitivity Analysis
Simon Comtesse1, Alexander Crotta 1, Thomas Zumbrunn 2, Stephen Ferguson 1, Arvind von Keudell(2,3,4)
1. Institute for Biomechanics, ETH Zurich, Switzerland; 2. CustomSurg AG,
Switzerland; 3. Brigham and Women’s Hospital, Harvard Medical School,
Boston, USA; 4. Bispebjerg Hospital, Copenhagen, Denmark;
Background: The surgical treatment of tibial plateau
fractures is complex and subjective,
resulting in complication rates up to 28% .
Hence, an objective method for the
optimization of tibial plateau fractures by
means of Finite Element Modelling (FEM)
has been introduced. However, while
simulation parameters are chosen based on
best practice, they introduce uncertainties to
the model.
Aim: Therefore, a sensitivity analysis was
performed where the modelling parameters
were varied to quantify the influence thereof
on the simulation results.
Materials and Methods: The CT scan of a cadaveric tibial plateau
fracture was segmented, and the bone
fragments were aligned to achieve the
fracture reduction and further fixed with a
medial plate and several locking screws.
Hounsfield Units (HU) derived bone material
properties based on a phantom-less
calibration method as well as joint and
muscle forces from subject-specific
musculoskeletal gait models were
integrated.
Modelling parameters were changed
systematically and the results were
compared relative to the standard
simulation in terms of maximum
displacement of fracture fragments and von
Mises screw stresses.
Results: The following parameters had no or minimal
influence on the results (< 5 %):
Linear instead of non-linear geometry
Linear instead of quadratic elements
Frictional coefficient of plate-bone interface
Frictional coefficient of bone-bone interface
The results for the parameters determining
the material properties (hardware and bone)
are shown in figure 1.
Interpretation / Conclusion: Although the contact in-between bone
fragments and the bone and the plate
seems to be an important modelling
parameter, their actual frictional coefficient
is irrelevant.
A much larger impact on the result arises
from the parameters directly determining the
material properties of the hardware or the
bone. However, according to the
manufacturers indications, the Young’s
Modulus of the plate can be checked
precisely.
Moreover, the magnitude of applied joint
reaction forces has a direct influence on the
results in that the maximum fragment
displacement and von Mises stresses in the
screws increase proportionally to the
applied load.
180. Assessment of basic orthopaedic surgical skills in a low-cost simulation-based setting
Jacob Juul Pedersen1, Anders Bo Nielsen2, Amandus Gustafsson3, Bjarke Viberg2
1. University of southern Denmark, Odense, Denmark
2. Odense University Hospital, Odense, Denmark
3. University of Copenhagen, Copenhagen, Denmark
Background: Basic orthopaedic surgery skills (BOSS) in
drilling and handling instruments have previously
been assessed as one of the most prioritized
areas in a simulation-based residency
curriculum. Still, simulation training in BOSS has
yet to be developed and is usually very costly.
Aim: To develop a low-cost simulation-based test to
assess BOSS, gather validity evidence for the
tests, establish credible pass/fail scores, and
explore the consequences of the pass/fail score.
Materials and Methods: Five practical skill stations were developed
from a previous published work using pilot
testing and interviews:
S1) Depth of plunging
S2) 2-dimensional drilling
S3) Drilling through the center of a long bone
by feel
S4) Fracture reduction with clamps
S5) Fluoroscopy
The stations were made of standard items
from hardware- and electronic stores.
Messick's framework was used to gather
validity evidence for the test. A novice group
of doctors with no surgical experience (n=11),
an expert group of specialized
traumatologists (n=9), and a novice group for
training to pass (n=7) were included. All
scores were measured in millimeters, and
each station's test was repeated until a
plateau score, defined as no improvement in
three subsequent repetitions.
Levene’s test and students' t-test compared
performances. The pass/fail score was
established using the contrasting groups
method (CGM).
Results: The simulation setup estimated costs were
less than 8.300 DKK.
There was moderate to high internal
consistency reliability using the interclass
correlation coefficient for the 5 stations (0.40
to 0.95). The mean plateau scores when
comparing the novice and expert groups for
each station were all statistically significantly
different (p scores 0.002-0.022). This led to
pass/fail scores using CGM for S1: 12mm,
S2: 8mm, S3: 4mm, S4: 2mm, and S5: 8mm.
The average time and no. of attempts to pass
the tests were S1: 5.1 minutes, 8 attempts,
S2: 17.6 minutes, 24 attempts, S3: 3.8
minutes, 6 attempts, S4: 6.5 minutes, 5
attempts, S5: 32 minutes, 11 attempts.
Interpretation / Conclusion: We developed a low-cost, simulation-based
practical test to assess BOSS with solid validity
evidence. This enables a standardized, objective,
evidence-based approach to assessing BOSS.
192. Trends in medical healthcare complaints in 2 Danish orthopedic departments - A descriptive study
Oliver Lyndrup1, Charlotte Juhl Lorentsen1, Ane Simony1
1. Department of Orthopedic Surgery and Traumatology. Lillebaelt Hospital,
University Hospital of Southern Denmark, Kolding
Background: Medical healthcare complaints are a frequent
encounter at departments of orthopedic surgery.
Consequently, the heads of departments spend
a valuable amount of time handling the
complaints through dialogue with all parties
involved. Being in risk of receiving a complaint is
stressful to younger doctors, thus supervision
from experienced colleagues is crucial to ensure
a safe learning environment.
Aim: This study aimed to report the trends in medical
healthcare complaints at two different orthopedic
departments at Lillebaelt Hospital, both taking
care of acute and elective patients
Materials and Methods: This descriptive study included all medical
healthcare complaints at two orthopedic
departments at Lillebaelt Hospital, Region of
Southern Denmark, during 2023. Outcomes
were number of complaints for each medical
staff group, in elective/acute setting, for each
ground and distribution between the two
hospitals.
Results: 58 complaints were registered during the study
period, and 16 of these involved more than 1
staff group. In total, 39 (67%) complaints
involved a consultant and 16 (28%) involved a
resident in training. 28 (48%) complaints was in
an elective setting, 19 (32%) was in an acute
setting, and 11 (20%) had missing data. In terms
of grounds of complaint, 42 (72%) patients
complained of treatment, 5 (9%) of behavior, 1
(2%) of the examination, 6 (10%) of a
combination of these and 4 (7%) for other
reasons. The complaints were distributed
between 22 (38%) from the department in Vejle
and 36 (62%) from the department in Kolding.
Interpretation / Conclusion: Few complaints involved residents and most of
these were aimed at more than 1 group of staff,
indicating that fear of complaints amongst young
doctors should be low. The department in Vejle
had fewer complaints than Kolding, most likely
caused by the higher proportion of residents with
great responsibilities in clinical practice.
203. The Use of Digital Two-way Communication between Patients and Healthcare Professionals after Hospital Discharge: A Scoping Review
Lili Worre Høpfner Jensen1, Arash Ghaffari1, Ole Rahbek1, Birthe Dinesen2, Søren Kold1
1. Interdisciplinary Orthopaedics, Orthopaedic Surgery Department, Aalborg
University Hospital
2. Laboratory for Welfare Technologies – Digital Health & Rehabilitation,
ExerciseTech, Department of Health Science and Technology, Aalborg University
Background: Digital communication between patients and
healthcare professionals is increasingly used in
healthcare. Defined as e-mail, secure
messaging, or text messaging, studies describe
it as one of the most used features in digital
patient portals and eHealth interventions.
Enabling asynchronous interaction offers
flexibility to both patients and healthcare
professionals. Nevertheless, there remains a
paucity of literature detailing its utilization in the
post-discharge period and the factors motivating
or hindering implementation.
Aim: This scoping review aimed to identify and map
how digital two-way communication is used
between patients and healthcare professionals
after hospital discharge, as well as identify
facilitators and barriers to implementation.
Materials and Methods: Following the JBI guidance for scoping reviews,
we searched seven databases on August
29,2022. Rayyan was employed for screening
the articles, and data were extracted using a
predefined and iteratively modified data
extraction tool. Facilitators and barriers were
charted according to the domains and
constructs of the Consolidated Framework for
Implementation Science (CFIR).
Results: Forty articles were included, primarily published
between 2012 and 2022 and from the USA.
Digital two-way communication was used across
patient populations with similar and overlapping
reasons. Facilitators and barriers were identified
in 24 of 40 articles and encountered equally yet
sparsely across CFIR domains and constructs.
Interpretation / Conclusion: There is a gap in the literature between studies
that describe the use of digital two-way
communication exhaustively and reports on
facilitators and barriers to implementation. This
scoping review serves as an overview of the
current use of digital two-way communication
after hospital discharge and sheds light on
facilitators and barriers relevant to managers
and clinicians when implementing digital
communication.
186. Assessing Prosthetic Compatibility in Major Lower Limb Amputees: A Comparative Study of Pre- and Post-Amputation Prosthetic Suitability
Markus Mogensen1, Charlotte Abrahamsen1,2, Inge Hansen Bruun2,3, Ane simony1,2
1. Department of Orthopedics, Kolding, Hospital Lillebelt
2. Institute for Regional Health Services, University of Southern Denmark
3. Department for physical therapy and occupational therapy, Kolding, Hospital
Lillebelt
Background: Major lower limb amputation are performed in
patients suffering from arteriosclerosis, diabetes
and infections. Amputations are a procedure
making permanent change in a patients’
physical capability and has an impact on mental
wellbeing. A prosthesis can be a useful tool to
regain mobility and increase quality of life.
Aim: In this study we examined the change of
prosthetic suitability assessment given at time
of admission with the prosthetic suitability given
at time of discharge comparing the findings with
impactful risk factors.
Materials and Methods: Data from amputees was extracted from the
KOKO database from Orthopedic Department
Kolding, Hospital Lillebelt. Patient
demographics and variables were examined,
according to assessment of prosthetic suitability.
Data was analysed using STATA.
Results: A total of 249 patients underwent a LEA in this
study period, of which 107 did not meet the
inclusion criteria; 107 patients was excluded
due to age < 50 years, missing data, transferred
to other hospitals and mortality. A total of 142
(57%) patients were eligible to further analysis,
mean age 72 y (60-79), 62 % males. 54 % was
active or previous smokers, 43 % had diabetes
and 66% arteriosclerosis. 31 was found suitable
for prosthesis at the time of admission for
surgery, 81 patients was considered maybe and
30 was not candidates for prosthesis. 46
patients changed prosthesis evaluation during
the admission period, 3 patients improved and 3
patients declined.
Interpretation / Conclusion: This study highlights there is a difference in
prosthetic compatibility from time of
admission to time of discharge. 61% of the
patients assessed maybe prosthetic suitable
at time of admission are equally distributed
between prosthetic suitable and not
prosthetic suitable at time of discharge. 90%
of prosthetic suitable and not prosthetic
suitable remains unchanged from admission
to discharge. Age, civil status, new mobility
score, mobility aids, previous amputation,
and accommodation at time of admission
were of significance comparing the suitable
and the not suitable patients. While BAMS
and amputation level were of significance
between the maybe prosthetic suitable
patients.
190. Tell me, so I understand”? A nurse-led nutritional intervention to improve wound healing in patients with leg ulcers – A feasibility study
Christine Krogsgaard Schrøder1, 2, Vibeke Nørholm2, Ingrid Poulsen2, 3, Pia Søe Jensen1, 2, 3
1. The Research Unit of Orthopaedic Nursing, Department of Orthopaedic Surgery,
Copenhagen University Hospital, Hvidovre, Denmark;
2. Department of Clinical Research, Copenhagen University Hospital, Hvidovre,
Denmark;
3. Department of People and Technology, Health Promotion Research Center, Roskilde
University, Denmark.
Background: Integrating nutritional dialogue and education into
leg ulcer treatment in the outpatient clinic may
enhance wound healing and prevent leg ulcer
progression to amputation.
Aim: This study examines the feasibility, acceptability, and
fidelity of a nurse-led nutritional intervention
including a dialogue tool, patient information, and
protein supplement.
Materials and Methods: An observational cohort study, at Hvidovre
Hospital's wound clinic using mixed-methods.
The intervention comprises 1) a dialogue tool,
presenting the correlation between nutritional
status, the immune system, and wound healing;
2) an information brochure detailing wound
healing, treatment recommendations, and
supportive behaviours; and 3) an introduction to
protein drinks along with the distribution of a
"green" prescription. Eligible participants are
patients with first-time referrals for assessment of
ulcers or amputation wounds in the lower
extremities. Specialized wound nurses will
administer the intervention. Following inclusion,
patients will receive two follow-up calls after their
subsequent clinic visits. The first follow-up will
collect patient characteristics, wound information
using the Wound-QoL, and closed-ended
questionnaire responses assessing the feasibility
of the intervention's three components. The
second follow-up will involve interviews
evaluating the acceptability of the intervention.
Feasibility will be determined by predefined
criteria for each intervention component, with
compliance thresholds set at 80% for feasible
and below 30% for non-feasible. The overall
feasibility will be assessed through the synthesis
of these criteria and thematic analysis of the
interviews. Additionally, focus group interviews
with nurses will be conducted. The study is
registered at Clinical Trials (NCT06255288).
Patients will be recruited between 01.02.2024
and 31.05.2024.
Results: The feasibility, acceptability, and fidelity will be
reported for each component of the intervention.
Interpretation / Conclusion: This is the first project to provide a three-part
nutritional intervention engaging both patients, their
relatives, and the nurses regarding lower extremity
wound care. The study will be used to inform the
development of a subsequent RCT study.
194. Tissue concentrations of azithromycin after both systemic and local treatment: a patient case with mycobacterial tenosynovitis of the hand
Mads K. D. Mikkelsen1,2, Andrea R. Jørgensen1,2, Victor N. Dahl3, Christian M. Wejse3, Mats Bue1,2, Maiken Stilling1,2
1. Orthopedic Research Laboratory, Aarhus University Hospital;
2. Department of Orthopedics, Aarhus University Hospital;
3. Department of Infectious Diseases, Aarhus Unioversity Hospital
Background: Extrapulmonary nontuberculous
mycobacteria (NTM) infections are
notoriously hard to treat, which may partly
be due to inadequate tissue concentrations
of antimicrobials
Aim: We aimed to evaluate local tissue
concentrations of azithromycin in a patient
treated for Mycobacterium heraklionense
tenosynovitis of the flexor tendons of the
index finger.
Materials and Methods: Using microdialysis, we evaluated the local
tissue concentrations of azithromycin during
three tendon and pulley reconstructive
surgeries of the right index finger in a
patient treated with an all-oral azithromycin-
ethambutol-rifabutin regimen for 11 months.
We sampled from the brachioradial muscle,
subcutis, and flexor tendon sheaths of the
palm and forearm. To increase infection
control, we installed local antibiotics in the
surgical field of the index finger and distal
forearm during surgery 2 in the form of
STIMULAN® calcium sulfate beads
prepared with azithromycin.
Results: At submission, analysis is complete for the
first and second surgery.
Plasma concentrations ranged from 0.1-1.1
µg/mL throughout all surgeries and
resembled the tissue concentrations,
ranging from 0.5-1.8 µg/mL during surgery 1
and 0.3-1.7 µg/mL during surgery 2. Plasma
concentrations reached Cmax targets of
>0.2 ug/mL from previous studies of
pulmonary NTM.
During surgery 2, the azithromycin
concentrations in the compartments in direct
contact with the beads ranged from 56-151
µg/mL during a sampling period of 5 hours.
The beads had to be surgically removed
after 10 days due to continuous drainage
and wound infection with Enterococcus
faecalis. One month after the final
reconstructive surgery the patient has not
shown signs of relapse and is in good
recovery.
Interpretation / Conclusion: Azithromycin concentrations in the targeted
hand tissues resembled the steady-state
concentrations found in plasma following
long-term oral azithromycin treatment.
When applying azithromycin locally mixed in
calcium sulphate beads, high target site
concentrations can be achieved. However,
calcium sulfate beads should be used with
caution under thin skin flaps due to risk of
drainage and delayed wound healing. More
evidence is needed to challenge current
recommended treatment regimens of NTM
infections.
198. Patients with chronic limb-threatening ischemia, experience of their disease, treatment and care in a cross-sectorial setting..A scoping review.
Susanne Friis-Søndergaard1,2, Ane Simony3,4, Johanne Christensen 5, Marie Dahl2,6
1. Lovisenberg, University of Applied Science. Norway;
2. Vascular Research Unit, Department of Vascular Surery, Hospital Viborg;
3. Department of Orthopedic Surgery, Hospital Lillebelt;
4. Institute for Regional Health Services, University of Southern Denmark;
5. Department of Culture and Language, University of Southern Denmark;
6. Cardiac thoracic and vascular Research Unit, University of Southern Denmark.
Background: Chronic limb-threatening ischemia (CLTI) is
accompanied by high utilization of healthcare
services, with multidisciplinary professionals
providing care in primary and secondary
settings. CLTI is a progressive disease that
induces physical, emotional, and social burden
on the patients, but also requires high patient
adherence to avoid severe complications. To
our knowledge, no previous studies has focused
on the patient perspectives related to this topic.
Aim: The objective of this review was to
systematically identify, examine, and
conceptually map the existing literature on
patients who have CLTI in the context of living
with the condition, and explore their
experiences of living with CLTI and their
treatment and care within a cross-sectoral
setting.
Materials and Methods: A systematic search was conducted and
completed on September 18th, 2023, without
methodological or format restrictions. We
identified Population, Concept, and Context to
pinpoint the focus of this review process. The
JBI methodology for scoping reviews and the
PRISMA-ScR checklist were followed.
Results: Based on our search, we found ten relevant
scientific qualitative and/or quantitative and one
non-scientific sources. We identified four main
maps: 1) Dependency on others is my new life
condition; 2) I’m more than the sum of my
conditions, 3) I’m lost in chaos, be alert to all of
me, and 4) Give me more time, my body and
mind are under attack.
Interpretation / Conclusion: This scoping review describes how patients’ life
is affected by the CLTI and their perception of
both shared decision-making alongside
treatment and care, emphasizing the need for
more person-centered care. To nuance person-
centred care further, it is necessary to consider
the impact of patients’ cultural values and
preferences, about which there is a notable gap
in research.
188. Incidence of reoccurrence and risk factors following partial matrixectomy of ingrown nails
Nawfal Khalid-Rasheed Al-Attar1, Mykola Horodyskyy1, Jacob Fyhring Mortensen1, Kenneth Chukwuemeka Obionu2, Søren Overgaard2,
1. Department of Orthopaedics, Sjællands Universitets Hospital - Nykøbing Falster
2. Department of Orthopaedics, Bispebjerg Hospital
Background: Ingrown nails present a common and
debilitating issue, and while partial
matrixectomy is deemed an effective
approach for treating ingrown nails,
recurrence rates have been observed ranging
from 10-50% in the literature. While it can
manifest at any age, the most typical age
range is 15 to 40 years old, with a male-to-
female ratio of 3:1 (1), and factors
contributing to recurrence are many. Our
study identifies a significant association
between complications, including panaricium,
abscess, and claw formation, in the
postoperative periode and the recurrence of
ingrown toenails.
Aim: The aim of this study is to examine the incidence
of reoccurrence and risk factors following partial
matrixectomy of ingrown nails.
Materials and Methods: This was a retrospective cohort study, including
patients aged 18 years and above. The electronic
health records from Copenhagen university
Hospital, Bispebjerg , department of orthopaedic
surgery and traumatologywere reviewed between
2017-2020. Data was analysed using descriptive
statistics, while chi-square analysis was
performed to analyze the determinants of
recurrence.
Results: Of 159 participants, 52% (n=83) were female,
and 48% (n=76) were males. The age
distribution was: 18-28 years (43.4%), 29-40
years (22%), 41-60 years (15,7%), 61-90
years (18,2%).
Among all participants, 72.7% (n=115) were
active smokers. Age [OR 1.02, 61-90 (0%);
18-28 (29%); 51-60(38%); 41-50 (60%); 29-
40(64%)], and muscoskeletal disorders (OR
1.06) manifested slightly high recurrence,
however with a non-significant association
(Age, p=0.07, MSD, p=0.402). Although there
was a significant association of recurrences
with Smoking (OR 0.24, 95% CI, p=0.000)
and gender (OR 0.34, 95% CI, p=0.016), both
smokers and males demonstrated lower
odds. Furthermore, the incidence of
complications was remarkably higher (OR
4.35, 95% CI, p<0.000) among patients with
recurrence.
Interpretation / Conclusion: The study identified elevated complication rates
among relapsed patients, and highlighted other
factors that could lead to recurrence of ingrown
toenails.
Poster Walk 4: Upper Extremity
Chair:
169. Anatomic total shoulder arthroplasty using hybrid glenoid fixation with a porous coated titanium post. Two to ten years follow-up of 256 cases with primary glenohumeral osteoarthritis.
Adriano Axel Ceccotti1, Tøttrup Mikkel 2, Morch Anica1, Husum Hans-Chresten1, Jensen Steen Lund1
1. Department Orthopaedics, Aalborg University Hospital
2. Department Orthopaedics, Aarhus University Hospital
Background: Anatomic total shoulder arthroplasty (aTSA) is the
recommended surgical treatment for severe
glenohumeral osteoarthritis providing good pain
relief and function. Aseptic loosening of the glenoid
component, however, is a major cause for revision.
Hybrid components have been introduced
combining cemented fixation with bone ingrowth to
improve fixation.
Aim: The purpose of this study was to report our mid-
term to long-term experience using such a
component including clinical outcomes and implant
survival.
Materials and Methods: We reviewed all patients who were operated for
primary osteoarthritis during the period 2011-19
leaving a minimum of 2 years follow-up. Clinical
outcomes included WOOS index. Postoperative
radiographs were analyzed for radiolucent lines.
Patient records were studied for complications
including revisions. Kaplan-Meier estimates for
implant survival were calculated.
Results: A total of 256 arthroplasties in 224 patients were
included (mean age: 69 years ± 9 years, 149
females). Mean follow-up time was 49 months
(range 24 - 127). The response rate for patient
reported outcomes was 91%. The median
WOOS index was 94% (81%-99%), the median
EQ-5D-5L was 0.87 (0.69-0.95), and the mean
CMS was 75 (SD 17.7). 13 cases (6%) had a
WOOS index below 50%. 8.2% had
complications related to surgery. A radiolucent
line had developed around the central post in six
cases, and at the bone-cement interface in three
cases at follow-up. Six cases had been revised
(2.3%); three due to aseptic loosening of the
glenoid. The 10-year survival estimate was 95.6
% (95% CI: 87.9% - 98.5%).
Interpretation / Conclusion: Anatomic total shoulder arthroplasty with hybrid
glenoid fixation provides excellent clinical outcome
with a low complication rate in patients with primary
glenohumeral osteoarthritis. The 10-year survival
rate is high and comparable to that reported for the
best performing all-polyethylene components.
Longer observation is needed to see if hybrid
fixation will outperform standard all-cemented
components.
179. Patient-reported outcome measures for adhesive capsulitis. Recommendations based on analyses of 16 existing questionnaires
Gustav Kalle Mølbak Vangsgaard1, Michael Rindom Krogsgaard1, Christian Fugl Hansen1
1. Section for Sports Traumatology, M51, Bispebjerg and Frederiksberg
Copenhagen University Hospital
Background: Patient reported outcome measures
(PROMs) are essential to express the
patient’s subjective perspective in clinical
studies. Like any measurement instrument
PROMs should be valid, reliable, and
responsive. Inadequate PROMs induce a
high risk of type-II errors.
There is no thorough analysis of the PROMs
that have been used in the clinical research
regarding adhesive capsulitis (AC).
Aim: The aim was to evaluate the quality of these
PROMs and identify which are the most useful
for future studies on AC.
Materials and Methods: Relevant PROMs used to evaluate patients
with AC were identified through PubMed
searches and a catalogue of PROMs, and
subsequently, validity studies were identified
for selected PROMs.
Quality assessment involved evaluating
development and validation processes,
utilizing a rating system. Development
quality was assessed based on guidelines
emphasizing content validity. Validation
studies were rated based on modern test
theory models and the psychometric
assessments undertaken. Aggregated
scores considered both content and
construct validity, with the “lowest score
counts” principle.
Results: 16 different musculoskeletal PROMs that
had been used 160 times in total (range 1-
43) were identified. None of the PROMs
were developed specifically for patients with
AC. Four PROMs had some degree of
patient involvement in the developmental
process, but the patients represented
broader conditions or other diseases than
AC.
39 articles on measurement properties were
identified through PubMed, analyzed, and
assessed together with 40 articles from the
catalogue. Five PROMs have had their
psychometric properties validated with an
MTT model. However, all five possessed
inadequate content validity as none of them
had patients involved in the development
process. Hence, this study was not able to
identify any PROM with adequate content
and construct validity for patients with AC.
Interpretation / Conclusion: A new and condition-specific PROM for AC is
urgently needed. The current PROMs should be
used with significant reservations and results
obtained by them should be interpreted with
caution.
196. Variations in treatment practice of patients with scapula alata- A national survey across public hospitals in Denmark
Kirstine Lyngsøe Hvidberg1, Cecilie Rud Budtz2, Grethe Aalkjær1, Søren Riis Villumsen3, Brian Elmengaard3, David Høyrup Christiansen2, Helle Kvistgaard Østergaard1
1. Department of Orthopaedics, Viborg Regional Hospital
2. University Clinic for Orthopaedic Pathways (UCOP) Elective Surgery Centre ,
Silkeborg Regional Hospital
3. Department of Elective Surgery Centre, Silkeborg Regional Hospital
Background: Scapula alata (SA) is a condition characterized by
medial winging and decreased upward rotation of
the scapula during elevation of the arm, often
causing impairment of the shoulder function. There
is currently no evidence regarding the most optimal
treatment for this condition.
Aim: This study aimed to assess the current treatment
approaches used for SA in public hospitals in
Denmark.
Materials and Methods: A cross-sectional survey was undertaken using a
self-administered questionnaire to healthcare
professionals across departments in all public
hospitals in Denmark. The survey investigated local
treatment guidelines, as well as diagnostic practices
with referral to electroneurography(ENG), the use of
International Classification of Diseases 10th
Revision (ICD10) coding, and the annual number of
patients.
Results: In total, 20 hospital departments completed the
questionnaire. Treatment approaches included
exercise therapy in various contexts, brace
treatment, surgery, and, in some cases, a waiting
approach. Only four hospitals reported the use of
written local guidelines for SA treatment and
diagnostics practices.
Five hospitals use ENG as part of their
diagnostic practice, while five others do so
selectively based on specific indications. Seven
different ICD-10 codes were reported for SA. The
annual patient number ranged from none to 20,
with four hospitals accounting for most of the
patients. Doctors and physiotherapists are the
primary healthcare providers involved in the
diagnostic and treatment process.
Interpretation / Conclusion: This survey revealed large national variations in the
treatment of SA in Denmark. This emphasizes the
need for further research and standardized
guidelines for the treatment and diagnostics of
patients with SA.
205. Corrective osteotomy with volar plate fixation of radius malunion using 3D-modelling based on mirroring of the contralateral healthy arm: A case series of 4 patients.
Carl Christian Holkgaard Burvil1, 3, Emil Toft Petersen1, 2, 3, Janni Kjærgaard Thillemann1, 2, 3, Jan Duedal Rölfing2, 3 , Maiken Stilling1, 2, 3
1 AutoRSA Research Group, Orthopaedic Research Unit, Aarhus
University Hospital, Aarhus N, Denmark
2 Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus
N, Denmark
3 Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Background: Radius malunion is a common complication
of diaphyseal and distal radius fractures and
frequently leads to reduced forearm rotation
and ulnar wrist pain. The underlying
deformity is often multiplanar and corrective
“free hand” osteotomies are thus difficult.
Aim: To evaluate outcomes of patient-specific, 3-
dimensional (3D) surgical planning for
radius malunions.
Materials and Methods: 4 patients with symptomatic radius
malunions underwent corrective
osteotomies (3 received individually
manufactured plates) and 2 cases received
a simultaneous triangular fibrocartilage
complex (TFCC) reinsertion. Pre- and
postoperative data were collected including
1) CT scans of both forearms to plan the
osteotomies and to evaluate the achieved
correction by bone mirroring of the
contralateral forearm, 2) standard AP and
LA radiographs (ulna variation, radius
angulation and inclination), 3) bilateral
dynamic radiostereometry (dRSA) to
compare the kinematics of the distal
radioulnar joints (DRUJ) at the maximum
applied force during a press-test and a
rotation-test, 4) physical examination (range
of motion (ROM), hand grip strength), and
5) patient reported outcome measures
(qDASH, PRWE, and overall satisfaction).
Results: Postoperative bone mirroring and
radiographs showed that all 4 radial bones
were corrected towards the planned
correction. However, the planned ulnar
variance was only fully achieved in 1 of 4
cases. Kinematics of the DRUJ improved in
2 patients, were unchanged in 1 patient,
and worse in 1 patient during the press-test.
The ROM and grip strength changed
minimally, except for 1 patient with
significant improvement in ROM. The
qDASH score improved in 3 of 4 patients (1
was clinically significant) while PRWE
improved for all 4 patients (2 were clinically
significant). 2 patients reported to be “very
satisfied” and 2 reported to be neither
satisfied nor dissatisfied with surgery.
Interpretation / Conclusion: Specific 3D-planning using the contralateral
healthy arm as a template is of great value
when planning radius malunion corrective
surgery. Sufficient lengthening of the radius
to correct positive ulnar variance is
challenging to achieve, but crucial for a
good clinical outcome.
206. MR-skannings rolle i diagnosticeringen af triangulære fibrokartilaginøse kompleks (TFCC)-skader af det ulnar håndled
Ditte N. Schreiner1, Gvozdenovic Robert2, 3,
1. Medicin, Det Sundhedsvidenskabelige Fakultet, Københavns Universitet
2. Afdelingen for Led- og Knoglekirurgi, Klinik for Skulder-, Albue- og
Håndkirurgi, Københavns Universitetshospital - Herlev-Gentofte Hospital
3. Institut for Klinisk Medicin, Det Sundhedsvidenskabelige Fakultet,
Københavns Universitet
Background: Wrist arthroscopy is a gold standard in the
diagnosis of triangular fibrocartilage
complex injuries. Although minimally
invasive, this surgical procedure has the
disadvantage of being technically advanced,
needing high skills, and the interpretation of
the findings might be variable among the
observers. Even though the ulnocarpal and
distal radioulnar joints are not as large as
articular spaces of the knee or shoulder,
recent studies reveal MR scan could be an
alternative diagnostic tool.
Aim: The purpose of this literature review is to
investigate the role of Magnetic Resonance
Imaging (MRI) in diagnosing triangular
fibrocartilage complex (TFCC) injuries in the
ulnar wrist. The methodology is interpreted
using the STARD standards for diagnostic
studies. Additionally, it aims to analyze the
clinical utility of the studies.
Materials and Methods: 25 articles were selected through
systematic reading of available papers in
the databases PubMed, Embase, and
Cochrane Library, as well as reference lists
from selected articles, using a set of
exclusion criteria.
Results: The predictive values of MRI in identifying
TFCC lesions vary considerably. However,
this study highlights some advantages of
using specific sequences, field strengths,
post-processing techniques, and specific
"pathological markers" alongside MRI. It is
also concluded that magnetic resonance
arthrography (MRA) shows more promising
results than MRI, although the method is
more expensive and associated with
surgical risks. Additionally, this study
addresses the issue of the need for
extensive experience in image analysis for
both MRI and MRA in diagnosing TFCC
lesions.
Interpretation / Conclusion: Although the predictive values of MRI have
shown promising results, those are largely
based on retrospective studies where the
patient groups have been selected among
those having ulnar-sided pain, without
controls. Therefore, it is concluded that MRI
should not be relied upon as an
independent diagnostic tool for painful
TFCC lesions. There is a need for more
well-designed studies to further determine
the clinical relevance of this diagnostic
modality.
Poster Walk 5: Pediatrics
Chair:
152. Prevalence and regional differences in migrated hips in Danish children with cerebral palsy from 2008 to 2021 – a comparison of ambulant vs non-ambulant children
Muhammed Bakhtiyar, Afrim Iljazi, Michael Mørk Petersen, Anders Oddgaard, Christian Wong
Department of Orthopedic Surgery, Rigshospitalet, Copenhagen, Denmark
Background:
Aim: This study aims to assess the incidence of hip
displacement and dislocation (denominated as hip
migration) among ambulant and non-ambulant
Danish children with cerebral palsy (CP) by
estimating their cumulative incidence of migrated
hips. A secondary objective is to compare the
prevalence across different Danish regions.
Materials and Methods: Data were obtained from the Danish Cerebral
Palsy Follow-Up Program (CPOP) from the years
2008 to 2021. This population-based cohort
study included 1,388 children with CP (58%
male, 42% female) as subjects, aged 0-15 years,
with an average age of 5.4 years at their last
follow-up. The children were categorized
according to their Gross Motor Function
Classification System level (GMFCS) into
ambulators (GMFCS I-III) and non-ambulators
(GMFCS IV-V). The Kaplan-Meier estimator was
employed to calculate the cumulative incidence
of migrated hips from birth until the date of their
last radiographic follow-up. Differences between
ambulatory and non-ambulatory children and
regional differences were assessed with the Log-
rank test.
Results: Median radiological follow-up for ambulators was 51
months and 94 months for non-ambulators. The
cumulative incidence of hip dislocation was 0.3%
(95% CI: 0-0.8 %) and 22.0% (95% CI: 9.2 -34.8 %)
for ambulators and non-ambulators, respectively
(p<0.0001), whereas the incidence for hip
displacement were 21.1% (95% CI: 16.3-25.9 %)
and 76.7% (95% CI: 68.6-84.7 %) for ambulators
and non-ambulators respectively (p<0.0001). There
were no significant regional differences in the
incidence of hip dislocation among ambulators, but
there were significant differences for non-
ambulators. Moreover, significant regional
differences were detected in hip displacement for
both ambulators and non-ambulators.
Interpretation / Conclusion: The prevalence of hip migration in Danish children
with CP is significantly higher among non-
ambulators, who are at an increased risk of hip
migration compared to their ambulant counterparts.
However, the low frequency of radiographic follow-
up for ambulators might cause the incidence of hip
migration to be underestimated. This study
highlights the necessity of continued targeted
surveillance and interventions in Danish non-
ambulators.
195. Incidence of Protrusio Acetabuli Among Children Diagnosed with Osteogenesis Imperfecta at Aarhus University Hospital During the Period 2018-2023
Maria Lund Gjættermann1,2, Jan Duedal Rölfing1,2, Jannie Dahl Hald3,4, Bjarne Møller-Madsen1,2
1. Danish Paediatric Orthopaedic Research, www.dpor.dk, Aarhus University
Hospital, AUH, Denmark;
2. Department of Children's Orthopaedics and Reconstruction, Aarhus University
Hospital, AUH, Denmark;
3. Department of Endocrinology and Internal Medicine, Aarhus University Hospital,
AUH, Denmark;
4. Center for Rare Disorders, Department of Paediatrics, Aarhus University
Hospital, AUH, Denmark
Background: Osteogenesis Imperfecta (OI) is a rare genetic
connective tissue disorder characterised by
increased bone fragility, bone deformities, and
increased risk of fractures. One among other
radiographic findings in OI patients is Protrusio
Acetabuli (AP), in which the acetabulum and
femoral head migrate into the pelvic cavity.
Aim: This study aims to investigate the incidence and
severity of AP in children with OI, as well as the
OI types in which it occurs. Additionally, we aim
to investigate the clinical consequences to AP
and elucidate potential risk and protective
factors.
Materials and Methods: Medical records and pelvic radiographs of 16
children (7 F, 9 M), aged 2-18 years (mean age:
10,5 years), with OI, followed at Department of
Children’s Orthopaedics at Aarhus University
Hospital between 2018 and 2023, were
retrospectively evaluated. Demographic and
anthropometric information, along with Sillence
and Glorieux classification were registered. The
severity and presence of AP were determined
utilising the following radiographic criteria: the
appearance of the teardrop configuration, the
center-edge angle of Wiberg, and the
acetabulum’s location relative to the Kohler and
iliopectineal line.
Results: 4 of the 16 OI patients had AP. One third of the
cases had type III or IV. None of the patients
had severe AP with the acetabulum progressing
medial to the iliopectineal line. The median age
of the AP patients was 13,5 years. 3/4 were
female. 3/4 had anisomelia, and 2/4 had
scoliosis. 2/4 were dependent on mobility
devices. 2/4 experienced pain in the same hip
where AP was present, and 1/4 experienced
knee pain. Patients over 12 years of age (OR: 2,
95%-CI: 0,2-19,9), with a BMI exceeding 25
(OR: 33, 95%-CI: 1,6-698, p < 0,05), of female
gender (OR: 6, 95%-CI: 0,5-77,8), and suffering
from scoliosis/anisomelia (OR: 3, 95%-CI: 0,3-
31,6; OR: 3, 95%-CI: 0,24-37,7) had higher
odds of developing AP. None of potential
protective factors were identified.
Interpretation / Conclusion: OI patients often present with AP. Hence, it may
be beneficial to investigate the incidence of AP
in adults and its clinical consequences to offer
improved management, if not to provide advice
on how to prevent AP.
197. 10-years Patient Reported Outcome Follow-up of Children with Cerebral Palsy Treated with Tibialis Posterior Tendon Transfer
Prajahi Ketheeswaran 1,2, Line Kjeldgaard Pedersen1,2, Polina Martinkevich1,2 , Bjarne Møller-Madsen1, 2
1. Department of Children's Orthopedics, Aarhus Universitet;
2. dpor.dk, Aarhus, Denmark, Denmark
Background: Cerebral Palsy (CP) is a motor function
disorder due to damage in the immature
brain. One motor function difficulty seen
amongst patients with CP is a spastic varus
foot deformity caused by an overactivation
of the tibialis posterior muscle (TP) or a
weakening of the peroneus muscle group.
This contributes to several problems in the
daily life of these patients. The dynamic
characteristic of the disease makes it
difficult to treat. One treatment option is
tibialis posterior tendon transfer (TPT).
Aim: This study aims to investigate the life quality
of patients with CP treated with TPT for
spastic varus foot.
Materials and Methods: In this retrospective single-centre follow-up
study 24 patients were included of which 19
patients with a total of 26 operated feet
answered the patient reported outcome
measure (PROM). The mean follow-up time
was 2.6 years ± 2.14. PROMs were
collected using the validated Danish
translation of the Oxford Ankle and Foot
Questionnaire (OxAFQ-C). OxAFQ-C
investigates four main domains; Physical
activity, School and Play, Emotional
outcome, and Footwear and Clothing.
Answers given by the patient, or a proxy
were collected using REDCap or through
phone calls.
Results: OxAFQ showed that patients were most
satisfied regarding School and Play. As
seen in (Fig 1) the majority answered
‘Never’ in three out of four questions asked
in this domain, which implies that they were
not troubled regarding these events.
Patients were least satisfied concerning
some aspects of physical activity (Fig 1). In
this domain patients answered that they
were “Often” or “Always” hindered when
running or standing for a longer period.
Interpretation / Conclusion: Results indicate that TPT is valuable to
patients with CP and spastic varus foot. The
study suggests that patients who underwent
TPT experience satisfaction especially
concerning School and Play. However,
patients were generally satisfied in all four
invastigated domains. Information on patient
satisfaction of TPT for patients with CP is
still scarce. This study invites to consider
TPT as a simple soft tissue procedure in
spastic varus foot with weakening of the
peroneus muscle group or overactivation of
TP.
202. Long-term functional follow-up of pediatric orthopedic sarcoma patients treated with brachytherapy
Christian Kveller1, Thomas Baad-Hansen1
1. Department of Orthopaedic, Aarhus University Hospital
Background: Sarcomas are rare and aggressive tumors,
affecting all age groups, accounting for
approximately 1% of all adult malignancies
and over 10% of pediatric malignancies. A
majority of these tumors are treated with a
combination of surgery, chemotherapy, and
radiation therapy. Radiation near growth
zones can result in abnormal or stunted
development, as well as the risk of induction
of malignancy secondary to the radiation.
Brachytherapy allows delivery of high doses
of radiation to the tumor or tumor-bed, while
sparing surrounding tissue and treatment
duration is shortened compared to external
beam radiotherapy, while avoiding radiation-
related side effects.
Aim: To assess the functional outcome and long-term
effects on extremity function following
brachytherapy treatment in all pediatric patients
having received brachytherapy at our institution.
Materials and Methods: Pediatric patients having received
brachytherapy were identified through internal
hospital records and patients were recruited
during regular follow-up appointments, during
which they were interviewed and completed
PROMs.
Results: 3 patients were recruited. None had
experienced recurrence during follow-up.
Time since treatment ranged from 5-9 years.
66% were treated at or near a physis and
100% of these experienced limb-length
discrepancy, while only the patient with lower
extremity length discrepancy was
symptomatic. 66% had experienced
progressive functional deterioration inversely
correlated with growth due to unyielding
cicatricial tissue, more pronounced in patient
with lower extremity affection. 66% had
undergone pronounced muscle excision
during treatment and experienced decreased
endurance in the affected limb. None
reported neural deficits despite having
received surgery and radiation adjacent to
significant peripheral nerves.
Interpretation / Conclusion: Brachytherapy is a viable treatment modality for
pediatric sarcomas with good functional results.
However, the dynamic growth of the patient
poses challenges in securing the best possible
functional outcomes. Closer cooperation with
oncological late effects clinics and pediatric
orthopedic surgeons may be beneficial as the
brachytherapy patient’s post-operative
conditions mimic growth abnormalities.
Poster Walk 6: Sports orthopaedics
Chair:
160. The use of osseous risk factors and patient reported outcome measures in studies investigating treatment of patellar dislocation: a scoping review
Ebrahim Rahdi1, Catarina Anna Evelina Malmberg1, Tue Smith Jørgensen2, Rafal Yahya1, Adam Witten1, Lars Blønd2, Per Hölmich1, Kristoffer Weisskirchner Barfod1,3
1 Sports Orthopedic Research Center – Copenhagen (SORC-C),
Department of Orthopedic Surgery, Copenhagen University Hospital
Amager-Hvidovre, Denmark
2 The Zealand University Hospital of Koege
3 Unit of Sports Traumatology, Department of Orthopedic Surgery,
Copenhagen University Hospital, Bispebjerg-Frederiksberg
Background: Treatment of patellar dislocation is based on
the absence or presence of osseous risk
factors.
Aim: To map the literature regarding the use of
osseous risk factors, patient reported
outcome measures (PROM’s), and
treatment methods in studies investigating
treatment of patellar dislocation.
Materials and Methods: This was a scoping review following the
PRISMA guidelines extension for scoping
reviews (PRISMA-ScR). Studies published
between January 1, 2013, and April 3, 2023,
were eligible for inclusion if investigating the
treatment of patellar dislocation and
mentioning an osseous risk factor. Case
series with fewer than 10 patients, reviews,
and meta-analyses were excluded.
Results: A total of 8,923 records were identified,
1,007 were full text-screened, and 300
articles were included. A two-fold increase
of articles investigating the treatment of
patellar dislocation was observed from 2013
to 2022. Across the included articles, 160
osseous risk factors and 56 PROM’s were
identified. 131 (44%) of the included articles
used osseous risk factors as in- or exclusion
criteria. 26 (9%) articles used a PROM
developed for evaluation of patellar
instability (the Banff Patellar Instability
Instrument or the Norwich Patellar Instability
score) to evaluate the treatment effect. The
most frequently investigated treatment was
medial patellofemoral ligament
reconstruction (231 articles, 77%) followed
by tibial tubercle osteotomies (87 articles,
29%). A threefold increase of articles
investigating these methods was observed
from 2013 to 2022, and the same was
observed for trochleoplasties.
Interpretation / Conclusion: Since 2013, a two-fold increase in studies
investigating treatment outcome after
patellar dislocation and mentioning osseous
risk factors was seen, but less than half of
the studies defined the study population
based on the absence or presence of
osseous risk factors. Only one out of ten
studies used a PROM developed for
evaluation of patellar instability to evaluate
the treatment effect. The most frequently
investigated treatment was medial
patellofemoral ligament reconstruction.
163. Cross-cultural validity and reliability of the Danish version of the Banff Patella Instability Instrument (BPII 2.0)
Torsten Grønbech Nielsen1,2, Martin Lind1, Simon Damgaard Petersen3, Pia Kjær Kristensen2
1. Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark;
2. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark;
3. Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, Kolding,
Denmark.
Background: The Banff Patellar Instability Instrument 2.0 (BPII
2.0) is a patient reported outcome measure
designed specifically for measuring
patellofemoral instability. As only few
questionnaires evaluating patellar instability has
been developed, the BPII 2.0 might be the best
option to evaluate patients with patellar
instability. The questionnaire has shown good
psychometric properties in major countries. A
cross-cultural translated Danish version of the
BPII 2.0 was done in 2019, but the psychometric
properties have not been evaluated.
Aim: This present study aimed to assess the BPII 2.0
psychometric properties in a Danish population of
patients with patellar instability. Secondly to present
the cross-culturally translated and adapted Danish
version of the BPII 2.0.
Materials and Methods: The BPII 2.0 was cross-culturally adapted
according to international guidelines. The BPII
2.0-DK was tested for concurrent validity
(Spearman Rho), internal consistency (Cronbach
alpha), and test-rest reliability (intraclass
correlation-ICC) in a cohort of patients with
patellar instability.
The Tegner activity score, the Victorian Institute
of Sport Assessment-Patella (VISA-P), the
Anterior knee pain scale (Kujala-DK), and the
International Knee Documentation Committee
(IKDC) were used to assess convergent validity.
The test-retest reliability of the Danish version of
the BPII 2.0 was evaluated in 50 patients with
patellar instability. The patients completed the
score, 2 times with a 7-day interval between
assessments.
Results: Very strong concurrent validity was found with a
value of 0.80 for VISA-P, 0.79 for Kujala-DK and
0.87 for IKDC. Strong convergent validity was found
with the Tegner activity score (0.67). A calculated
Cronbach alpha sum score of 0.97 indicating
excellent internal consistency among items within
the BPII 2.0. Test-retest reliability shows excellent
and consistent results between the 2 assessments 7
days apart with ICC sum score of 0.94 and
individual sum scores from 0.36 to 0.96.
Interpretation / Conclusion: The BPII 2.0-DK is a valid and reliable tool for
patients with patellar disorders, showing excellent
internal consistency and excellent test-retest
reliability and is comparable to other translated
versions of the BPII 2.0.
164. Two-year outcome after Bereiter trochleoplasty for high grade trochlear dysplasia in a cohort of 374 consecutive cases over a ten-years period (2011-2022).
Christian Dippmann1, Anette Kourakis1, Simone Rechter1, Volkert Siersma2, Peter Lavard1
1 Section for Sports Traumatology M51, Department of orthopedic surgery, Copenhagen
University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark. A part of IOC
Research Center Copenhagen.
2 The Research Unit for General Practice and Section of General Practice, Department
of Public Health, University of Copenhagen, Denmark
Background: Recurrent patellar dislocation (chronic patellar
instability) is often caused by predisposing
factors, with trochlear dysplasia (TD) as the most
prominent. Untreated patellar instability leads to
impaired function and an increased risk of
patellofemoral osteoarthritis. TD can be treated
by trochleoplasty (TP) and section of sports
traumatology at Bispebjerg Frederiksberg
Hospital has performed 78% of the TPs in
Denmark between 2011 -21, following a
standardized treatment algorithm including
Bereiter TP by which all predisposing factors are
corrected.
Aim: To analyse a cohort of consecutive patients treated
2011-2021 with Bereiter TP for severe TD, including
their concomitant predisposing factors, for two-year
clinical and patient reported outcome measures.
Materials and Methods: Prospectively collected information covering 2011 to
2021 was analyzed for all patients undergoing
patella stabilizing surgery with TP +/- concomitant
procedures to correct predisposing pathology
(MPFL reconstruction, medialization/distalization of
the tibial tuberosity, de-rotating osteotomy, among
others). Data preoperatively and at follow-up after
one and two years included clinical examination
and scores from patient reported outcome
measures (Kujala, KOOS and Lysholm).
Results: From 2011 to September 2021 374 Bereiter TPs
were performed on 335 patients (102 males, 233
females, 39 bilateral surgeries). There were 92
cases (25%) who had previous patella stabilising
surgery. The mean age at surgery was 22 years
(range 12-47). All patients had TP and MPFL-
reconstruction. 94 knees (25%) also had
medialization of the tibial tuberosity, while 98
(26%) had other additional procedures. 102
knees (27%) had subsequent surgery (in 49
(12.1%) arthroscopically assisted brisement
force). Four knees (1.1%) experienced a re-
dislocation. There were significant improvements
in all PROM-scores (p<.0001), e.g. mean Kujala
(range 0-100) had improved 18.7 points (95%CI
16.5-20.9), and mean KOOS QoL 31.0 points
(95%CI 28.0-34.0) two years after surgery.
Interpretation / Conclusion: Following our algorithm there was a very low re-
dislocation rate and significant improvement of the
subjective condition one and two years after
Bereiter trochleaplasty.
167. Evaluating knee muscle strength with the ForceFrame dynamometer in patients with anterior cruciate ligament injury - a study evaluating psychometric properties
Kamilla Arp1,2, Thomas Frydendal3,4, Troels Kjeldsen3,4, Ulrik Dalgas5, Signe Timm1, Bjarke Viberg6,7, Claus Ingwersen1,8, Claus Varnum1,2
1. Department of Orthopedic Surgery, Lillebaelt Hospital - University Hospital of
Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
2. Department of Regional Health Research, University of Southern Denmark,
Campusvej 555230 Odense M, Denmark
3. Department of Orthopedic Surgery, Aarhus University Hospital, Palle Juul-
Jensens Boulevard 99, 8200 Aarhus N, Denmark
4. Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens
Boulevard 99, 8200 Aarhus N, Denmark
5. Exercise Biology, Department of Public Health, Aarhus University, Dalgas
Avenue 4, 8000 Aarhus C, Denmark
6. Orthopaedic Surgery and Traumatology, Odense University Hospital, J. B.
Winsløws Vej 4, 5000 Odense C, Denmark
7. Traumatology, Hospital Lillebaelt - University Hospital of Southern Denmark,
Sygehusvej 24, 6000 Kolding, Denmark
8. Department of Physio- and Occupational therapy, Lillebaelt Hospital -
University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle,
Denmark
Background: Restoring maximal muscle strength of knee extension and knee flexion
following anterior cruciate ligament (ACL) injury and reconstruction is of
great importance. It is therefore essential for clinicians and healthcare
providers to have dynamometers that are easy-to-use, valid and reliable.
The ForceFrame is a novel dynamometer that may be a reliable option in
comparison to the gold-standard isokinetic dynamometer.
Aim: To assess the reproducibility of the ForceFrame dynamometer and
compare to an isokinetic dynamometer in maximum voluntary isometric
contraction (MVIC) during knee extension and flexion.
Materials and Methods: Twenty-seven participants with ACL injury or reconstruction participated in
this reproducibility study. ForceFrame MVIC were tested on two separate
days: Day one including gold-standard isokinetic dynamometer,day two
assessment by a new assessors. Main outcomes were concurrent validity
and agreement (ForceFrame vs. isokinetic dynamometer), day-to-day test-
retest reliability and agreement and inter-tester reliability of ForceFrame.
Results: ForceFrame showed a fair concurrent validity compared to the isokinetic
dynamometer for extension (r=0.56), poor concurrent validity for flexion
(r=0.24), Bland-Altman plots between ForceFrame and the isokinetic
dynamometer showed a mean difference of -0.51 Nm/kg for extension and
-0.32Nm/kg for flexion. There was a good day-to-day test-retest reliability for
MVIC of extension (ICC=0.77, CI95: 0.48-0.90) and flexion (ICC=0.83,
CI95: 0.61-0.92), while there were excellent inter-tester reliability for MVIC
of extension (ICC=0.97, CI95: 0.94-0.98) and flexion (ICC=0.93, 95CI: 0.85-
0.97). Standard error of measurement was 8% and 9% while the smallest
detectable change was 22% and 27% for extension and flexion,
respectively.
Interpretation / Conclusion: ForceFrame can be used to obtain valid and reliable results to assess MVIC
of knee extension and flexion but absolute results may be considered an
underestimation of actual MVIC. The test position to assess knee flexion in
ForceFrame does not appear to be optimal, and different test-positions may
be considered.
168. Patellar Dislocation and Trochlear Dysplasia: Reference data concerning the Banff Patella Instability Instrument (BPII), the Kujala score, the Marx score and the EQ-5D in people aged 15-19 from the nationwide Faroese Knee Cohort
Niclas Højgaard Eysturoy1,5, Hans-Christen Husum2, Lina H. Ingelsrud3, Lars Blønd4, Elinborg Mortensen1, Per Holmich5, Kristoffer Barfod5
1. Department of Orthopedic Surgery, National Hospital of the Faroe Islands, Torshavn,
Faroe Island
2. Interdisciplinary Orthopedics, Aalborg University Hospital, Denmark.
3. Clinical Orthopedic Research Hvidovre, Copenhagen University Hospital Amager-
Hvidovre, Copenhagen, Denmark
4. Zealand University Hospital, Køge and Aleris Hospital, Copenhagen, Denmark.
5. Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of
Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Copenhagen,
Denmark
Background: .
Aim: To investigate patient-reported outcome
measurement (PROM) reference data on a national
cohort of patients between 15-19 years with prior
patella dislocation and trochlear dysplasia.
Materials and Methods: All inhabitants in the Faroe Islands between 15
to 19 years were invited to answer an online
survey. The survey included questions
concerning prior patellar dislocation and the
PROMs: Banff Patella Instability Instrument
(BPII), Kujala score, Marx score and the EQ-5D-
5L. Three cohorts were established: 1) The
background cohort consisting of the participants
with no prior patellar dislocation, 2) The patellar
dislocation cohort consisting of all participants
with prior patellar dislocation, 3) The trochlear
dysplasia cohort consisting of participants with
prior patellar dislocation who had trochlear
dysplasia.
Results: 3749 persons were contacted, and 1119 (30%)
completed the demographic survey and at least one
PROM. 43 persons had prior surgery to the knee
and were excluded. 102 reported prior patellar
dislocation, of whom 57 were found to have
trochlear dysplasia. All PROMs except the Marx
score reflected worse quality of life and function
after patellar dislocation than the background
population, most pronounced in the BPII. The
percentage of people experiencing problems in the
EQ-5D-5L dimensions was increased for the patellar
dislocation cohort and the trochlear dysplasia cohort
in all EQ-5D-5L domains, except for
anxiety/depression.
Interpretation / Conclusion: Young people (age 15-19) with prior patellar
dislocation report seriously affected quality of life
and function measured with the BPII, the Kujala, the
EQ-5D-5L index values, and all EQ-5D-5L domains
except anxiety/depression.
177. Seventy-four percent of patients with Anterior Cruciate Ligament injury treated non-operatively manage without Anterior Cruciate Ligament reconstruction five years after treatment
Randi Rasmussen1, Lone Frandsen2, Torsten Grønbech Nielsen2, Martin Lind 2
1. Department of Physiotherapy and Occupational Therapy
2. Department of Orthopaedics, Aarhus University Hospital
Background: Today, both operative and non-operative treatment
of Anterior Cruciate Ligament (ACL) injuries are
considered viable treatment options depending on
the individual patient's preference. The Danish Knee
Ligament Reconstruction Registry (DKRR) monitor
the outcomes of surgeries for ACL-injury. However,
no registry data exist for ACL injury patients who are
managed non-operatively
Aim: To investigate how many patients remained non-
operatively treated five years after physiotherapy-led
non-operative treatment.
Furthermore, we aimed to describe and compare the
demographics and epidemiology characteristics of
patients who managed with non-operative treatment
and patients who failed non-operative treatment and
were converted to ACLR
Materials and Methods: A retrospective analysis was performed to identify
patients with ACL injuries referred to non-operative
treatment at The Orthopaedic Rehabilitation Center
in Aarhus between 2014 and 2018. Demographic
and epidemiology data were extracted from medical
records. Furthermore, patients were encouraged to
complete a questionnaire. Finally, data from the
Danish Knee Ligament Registry was extracted to
identify the patients who underwent ACLR
Results: A total of 289 patients (290 knees), with 63.5%
females and a mean age of 37.4 years (range
18-64) were identified in medical records. Mean
time from physiotherapy-led non-operative
treatment to ACLR was nine months.
Seventy-four percent (216 patients) managed
with non-operative treatment five years after
physiotherapy-led non-operative treatment. 76%
of these were females with a mean age was 39.2
years. 161 patients had an isolated ACL injury
while 52 had ACL and medial collateral ligament
(MCL) injury.
Of the 72 patients that converted to ACL
reconstruction were 66% females with a mean
age of 32.7 years. Fourty-eight patients had an
isolated ACLR and three patients had ACLR and
MCL reconstruction while 21 patients had ACLR
and meniscal surgery
Interpretation / Conclusion: 74% of patients with ACL injury treated with
physiotherapy-led non-operative treatment managed
without conversation to ACLR five years after
treatment. More females than males were referred to
non-operative treatment. Patients converted to
ACLR within the first year after treatment
193. Limited evidence on which patients need anterior cruciate ligament reconstruction after initial treatment with rehabilitation. A scoping review
Kamilla Arp1,2, Jacob Nedermark1, Kim Ingwersen2,3, Eva Ageberg4, Claus Varnum1,2, Bjarke Viberg5,
1.Department of Orthopedic Surgery, Lillebaelt Hospital – Vejle, University
Hospital of Southern Denmark, Denmark
2. Department of Regional Health Research, University of Southern Denmark,
Odense, Denmark
3. Department of Physiotherapy, Lillebaelt Hospital – Vejle, University Hospital of
Southern Denmark, Vejle, Denmark
4. Department of Health Sciences, Faculty of Medicine, Lund University, Lund,
Sweden
5. Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense,
Denmark
Background: Some patients with anterior cruciate ligament (ACL) injury
initially treated with rehabilitation need ACL reconstruction
(ACLR), yet it is unclear what characterizes these patients.
Aim: This review aimed to describe predictors for
ACLR in patients initially treated with
rehabilitation.
Materials and Methods: A systematic literature search was performed in the Cochrane, Embase,
Medline, SportsDiscus and Web of Science databases from inception to
21st of February 2023. Articles describing characteristics in adult patients
with ACL injury undergoing ACLR after minimum of 5 weeks rehabilitation
were included. It was a priori chosen that characteristics described in at
least three articles were considered more certain and could be defined as
a predictor for ACLR. Characteristics described in less than three articles
were considered less certain and therefore defined as possible
predictors. Articles were screened by two independent reviewers. The
study was originally intended as a systematic review with meta-analysis
but in case of limited data we would convert to a scoping review, as was
the case for this review.
Results: There were 22,836 studies identified and 181 full texts were screened
of which 10 papers were finally included. Only lower age and higher
preinjury activity level were identified as predictors for ACLR. Another
12 possible predictors were identified in single studies. Through an
iterative process, potential predictors were categorized into 4 groups:
patient demographics, knee function, patient-reported outcome
measures and anatomical structures.
Interpretation / Conclusion: Lower age and higher preinjury activity level were the only predictors for
ACLR after initial treatment with rehabilitation. The evidence regarding
which patients need delayed ACL reconstruction is very limited. While
younger and highly active patients show a higher need for ACLR more
studies focusing on predictors and reasons for delayed ACLR are
warranted.
201. Low complication rate for lateral patellar instability treated with a non-anatomic functional reconstruction of the medial patellofemoral ligament
Johanna Dalsgaard1, Signe Petri1, Henrik Sjølander1, Jens Christian Pörneki2, Knud Gade Freund3, Niels Maagaard1, Bjarke Viberg1
1. Department of Orthopaedic Surgery and Traumatology, Odense University
Hospital;
2. Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt –
University Hospital of Southern Denmark;
3. Department of Orthopaedic Surgery and Traumatology, Hospital of South West
Jutland.
Background: Most hospitals in the Region of Southern
Denmark uses a lesser demanding technique
for the reconstruction of the medial
patellofemoral ligament (MPFL) but it has not
been assessed for complications. Instead of
anchoring the MPFL graft in the bone, the
graft is sutured into the top of the medial
collateral ligament (MCL) using it as a pulley
providing a functional non-anatomical
reconstruction. This procedure offers several
advantages: a simpler technical procedure
without the use of fluoroscopy, the fixation is
dynamic and not static as with an interference
screw in the femur, and the procedure can be
used for children with open physis as well.
Aim: To assess the outcome of an operative method
for non-anatomic medial patellofemoral ligament
(MPFL) reconstruction using the medial collateral
ligament (MCL) as a pulley in adults above 16
years old
Materials and Methods: Patients were retrieved using procedural
codes for MPFL reconstruction at hospitals
the region of Southern Denmark from 1st of
January 2016 to 31st of December 2020.
Health care records were reviewed for data
concerning surgical information with one- and
two-year follow-up. All patients with a primary
MPFL reconstruction (no previous surgery)
were included. Major complications were
defined as re-dislocations, infections, and
reoperations with intervention of the graft.
Minor complications were defined as
arthroscopy of the knee without graft
intervention.
Results: There were 420 knees (342 patients) with
non-anatomic MPFL reconstruction included
in the study. The median age was 22 (16-78)
years and 68.5% were female. The gracilis
tendon was used as the graft in 92.4% of the
cases and there were 76 (18.2%) patients
who had additional minor surgery to the
primary intervention such as synovectomy,
lateral release, and cartilage debridements or
reinsertions.
There were an overall of 14 (3.3%)
complications within 1 year and 26 (6.2%)
within 2 years. Within the first year, 10 (2.4%)
were major complications, and four (1%) were
minor. Within 2 years, 18 (4.8%) were major
complications and eight (1.9%) were minor.
Interpretation / Conclusion: Using the MCL as a pulley demonstrates low
rates of major complications and can safely be
used in the reconstruction of the MPFL.
154. The effectiveness of low-load Blood flow restriction Exercise in patients with an acute Achilles tendon rupture treated Non-surgically (BEAN): Protocol for a randomized controlled trial
Andreas Bentzen1,2, Per Gundtoft1, Karin Silbernagel3, Stian Jørgensen1,4,5, Inger Mechlenburg1,2,6
1. Department of Orthopaedic Surgery, Aarhus University Hospital
2. Department of Clinical Medicine, Aarhus University
3. Department of Physical Therapy, University of Delaware, USA.
4. Department of Occupational and Physical Therapy, Horsens Regional Hospital
5. H-HIP, Department of Orthopedic Surgery, Regional Horsens Regional Hospital
6. Department of Public Health, Aarhus University
Background: Blood flow restriction exercise (BFRE) has been
proposed as a viable method for preserving muscle
mass and function after an injury, particularly during
periods of load restrictions, such as after an acute
Achilles tendon rupture. However, its effectiveness
and safety in patients with an Achilles tendon rupture
have yet to be evaluated in a randomized trial.
Aim: The objective of this trial is twofold: firstly, to
investigate the effectiveness of early initiated BFRE
in patients with non-surgically treated acute Achilles
tendon rupture; secondly, to evaluate whether there
is a difference in outcome when applying BFRE in
the beginning (1-12 weeks) versus later in the
rehabilitation period (13-24 weeks).
Materials and Methods: This is an assessor-blinded, randomized,
controlled multicenter trial with patients assigned
in a 1:1 ratio to two parallel groups, that either
receive BFRE in weeks 1-12 followed by usual
care in weeks 13-24, or receive usual care in
weeks 1-12 followed by BFRE in weeks 13-24.
The BFRE program is performed three times
weekly on the injured leg at 80% of the pressure
required to restrict the arterial blood flow fully.
Post-intervention tests are conducted in week
13, comparing early BFRE with usual care, and
in week 25, comparing early BFRE with late
BFRE. At the 13-week evaluation, the primary
outcome is the Single-Leg Heel-Rise test which
assesses the patient’s ability to raise the heel of
the injured leg a minimum of 2 cm. At the 25-
week evaluation, the primary outcome is the
Achilles tendon Total Rupture Score which
assesses the patient’s self-reported symptoms
and physical ability.
Results: Results are expected in early 2027.
Interpretation / Conclusion: BFRE may enable patients with Achilles tendon
rupture to return to normal function far earlier than
with current rehabilitation practices. We expect that
positive results regarding the effectiveness of BFRE
in patients with an Achilles tendon rupture may
profoundly impact the physiotherapeutic practice
within this patient group, both locally at participating
hospitals and possibly on a national and
international scale.
Poster Walk 7: Trauma
Chair:
149. TENSION BAND VERSUS LOCKING PLATE FIXATION FOR THE TREATMENT OF PATELLA FRACTURES - a study and an analysis plan for a multicenter, Randomized Clinical Trial
Rasmus Elsoe1, Rikke Thorninger2, Rasmus Severinsen2, Jens-Christian Beuke3, Rikke Serritslev3, Steffen Skov Jensen4, Morten Kjerri Rasmussen4, Peter Szephalmi5, Juozas Petruskevicius6, Jeppe Barckman6, Nils Henrik Bruun7, Peter Larsen1,8
1 Department of Orthopedic Surgery, Aalborg University Hospital, Denmark
2 Department of Orthopedic Surgery, Randers, Denmark
3 Department of Orthopedic Surgery Kolding, Denmark
4 Department of Orthopedic Surgery Viborg, Denmark
5 Department of Orthopedic Surgery, Hjoerring Hospital, Denmark
6 Department of Orthopedic Surgery, Aarhus University Hospital Denmark
7 Research Data and Biostatistics, Aalborg University Hospital, Aalborg
Denmark
8 Department of Occupational Therapy and Physiotherapy, Aalborg
University Hospital, Aalborg, Denmark
Background: Following surgical management of patella
fractures, patients commonly report pain,
difficulties with weight-bearing tasks such as
walking, running, and climbing stairs and
restrictions in quality of life. Recently a
locking plat system for surgical
management of patella fractures have been
introduced. To date, no studies have tested
standard treatment with tension band wiring
against locking plate fixation in a
randomized study design.
Aim: We aim to compare the 1-year patient-
reported Knee Injury and Osteoarthritis
Outcome subscale Scores (KOOS5-
subscales) after standard care tension band
fixation with locking plate fixation for
patients with patella fractures.
Materials and Methods: This study is a multicenter randomized and
prospective clinical trial. A total of 122
patients will be included in the study, and
the primary outcome will be the KOOS at 12
months following surgery.
Results: This is a study protocol - no results will be
available
Interpretation / Conclusion: Findings from the present study is expected
to advance the understanding of outcome
following surgical treatment of patella
fractures.
150. The knee injury and osteoarthritis outcome score (KOOS) for lateral tibial plateau fractures – validity, reliability, responsiveness, and minimal clinically important difference
Jens Trærup1,2
1 Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
2 Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital,
Aalborg, Denmark.
Background: Evidence is lacking in psychometric properties such
as validity, reliability, responsiveness, and minimal
clinically important difference for PROMs to patients
with lateral tibial plateau fractures
Aim: This study aimed to establish validity, reliability, and
responsiveness and to estimate the minimal
clinically important difference (MICD) of the Knee
Injury Osteoarthritis outcome score (KOOS) for
patients with lateral tibial plateau fractures.
Materials and Methods: Adult patients with surgically treated lateral tibial
plateau fractures (AO 41B) were included. The
primary outcome measure was the KOOS
subscales: Pain, Symptoms, Activity of Daily
Living (ADL), Sport and Recreational Activities
(Sport/rec), and Quality of Life (QOL). The
KOOS was repeated at 14 and 15 days, six
weeks, and 6 and 12 months. Content validity
was evaluated by patients ranking the relevance
of all the items in the KOOS, test-retest reliability
by an interclass correlation coefficient, and
responsiveness by effect size end estimation of
minimal clinically important difference (MCID) by
the anchor-base method.
Results: Forty-one patients with a mean age of 54.8 years
(ranging from 21 to 81 years) were included. The
results showed an acceptable content validity of all
the KOOS subscales. The test-retest reliability was
moderate to high for all five subscales, with an
interclass-correlation coefficient ranging from 0.6-
0.9. At the 6- and 12-month follow-ups, the
responsiveness showed large effect sizes for all the
KOOS subscales, ranging from 0.9 to 2.1. The
MCIDs for the KOOS subscales were: Pain 5.6,
Symptoms 7.9, ADL 5.3, Sport/Rec 6.1, and QOL
6.1.
Interpretation / Conclusion: The KOOS appear to be a valid and useful patient-
reported outcome measure to capture patients’
perceived outcomes within one year following a
lateral tibial plateau fracture.
155. Accuracy and reliability of the AO/OTA classification for tibial shaft fractures
Rasmus Stokholm1, Peter Larsen1,2, Jan Duedal Rölfing3, Marie Arildsen1, Christian Rasmussen1, Firaz Mahdi4, Rasmus Elsoe1
1.Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg,
Denmark
2. Department of Occupational Therapy and Physiotherapy, Aalborg
University Hospital, Aalborg, Denmark.
3. Department of Orthopedics, Aarhus University Hospital, Aarhus,
Denmark.
4. Department of Radiology, Aalborg University Hospital, Aalborg,
Denmark
Background: Available literature lacks information
regarding the accuracy and reliability of the
AO/OTA classification for tibial shaft
fractures.
Aim: This study aimed to assess the inter- and
intra-observer agreement and accuracy of
the AO/OTA 42 classification (4-signs) for
adult patients with tibial shaft fractures.
Materials and Methods: The study design is an accuracy, inter- and
intra-observer agreement study. Anterior
and posterior (AP) and side X-rays of the
fracture were used in the examination. The
raters comprised two junior doctors and two
orthopedic trauma consultants. A committee
including two consultant orthopedic trauma
surgeons, one consultant orthopedic
radiologist, and one associate professor
was established to represent the “golden
standard.” Each patient was scored twice,
including a washout period between the first
and second examinations of minimum 18
days.
Results: A total of 101 patients were included. X-rays
were available for all 101 patients. Based on
the golden standard classification, AO/OTA
42-A1 (56%) was the most common fracture
type, followed by AO/OTA 42-A3 (14%). The
agreement, when comparing the four raters
and the golden standard classification was
between 75% and 86% (Choen’s kappa
0.53 to 0.79). Choen’s kappa coefficient for
intra-and inter-observer agreement was
between 0.57 and 0.74 and 0.47 and 0.59,
respectively.
Interpretation / Conclusion: This study showed substantial to moderate
accuracy of the AO/OTA 42- classification
for tibial shaft fractures. Inter- and intra-
observation agreements showed substantial
to moderate agreement. Results indicated
that using the AO/OTA 42- classification for
tibial shaft fractures may be valuable in
clinical practice.
166. AI software technology for quick Hip-fracture detection
Camilla Cronstad Jørgensen1, Kamilla Jægerum Nielsen 2, Michael Lundeman3, Jacob Fyhring Mortensen4
1: Anaestisiology department, Nykøbing Falster hospital.
2: Orthopaedics, Slagelse hospital.
3: Radiobotics ApS.
4: orthopaedic department, Nykøbing Falster Hospital.
Background: Fast diagnosis and treatment are pivotal in the
management of hip fractures and have been
shown to reduce the 1-year mortality rate and
number of complications following surgery.
Aim: The aim of this study was to investigate how the
use of an artificial intelligence (AI) decision
support tool may affect the diagnostic accuracy
of clinicians working with the diagnostic workup
of hip and pelvic fractures in an accident and
emergency (A&E) department.
Materials and Methods: Radiographic exams from 214 adult patients
referred with suspicion of hip fractures were
consecutively collected using stratified sampling
to ensure a 50% fracture prevalence. Two
radiographers, two medical interns and two
consultants evaluated fracture status on all
exams without and with support from the AI tool.
The reference standard was defined from the
radiological reports, taking additional information
from computed tomography into consideration
when relevant. The change in sensitivity and
specificity was recorded.
Results: The patient age was 78.0 (standard deviation:
11.9) and 149 were females. The sensitivity and
specificity across all clinicians changed from 0.93
(CI: 0.91;0.95) and 0.87(CI: 0.85; 0.90) to 0.96
(CI: 0.95; 0.98) and 0.86 (CI: 0.83; 0.89),
respectively. The change was equivalent to a
43% reduction in missed fractures and 8%
increase in overcalls. The improvement in
sensitivity was consistent for all six readers. The
specificity, on the other hand, decreased for the
radiographers and the seniors, but not for the
interns. Furthermore, with the help from the AI
tool, radiographers and interns found as many
fractures as the senior orthopedists, but not as
many as the AI.
Interpretation / Conclusion: The sensitivity for hip and pelvic fracture
detection among and clinicians increased
significantly when supported by the AI tool. The
change in specificity was not statistically
significant. The improvement in diagnostic
performance may lead to improvements in
patient care through better initial diagnosis and
shorter time to surgery, however, this warrants
further research in a prospective study.
171. RESTORE: a multi-national, Randomized Controlled Trial of a Local Osteo-Enhancement Procedure (LOEP) to Prevent Secondary Hip Fractures in Women Presenting with Index Fragility Hip Fracture
Jan Duedal Rölfing1,2, Rikke Thorninger1,2, Ole Brink1,2, Rehne Lessmann Hansen1,2, Ahmed Abood1,2, Per Hviid Gundtoft1,2,
1. Department of Orthopaedics, Aarhus University Hospital
2. International RESTORE collaborators
Background: Hip fractures occur predominently in as fragility
fractures in postmenopausal women. The 1-year
cumulative incidence of secondary hip fractures
has been estimated to be 2-10%, increasing up
to 20% by 5 years. Preventing a contralateral
secondary hip fractures may thus be an
important treatment goal after sustaining a hip
fracture.
Aim: RESTORE (NCT04796350) will evaluate the
safety and efficacy of AGN1 LOEP in reducing
the incidence of secondary hip fractures in
subjects presenting with an index hip fracture
and undergoing hip fracture repair surgery.
Materials and Methods: Up to 2,400 women =65 years of age will be
randomized (1:1) to receive AGN1 LOEP on the
contralateral, non-fractured hip in a single-
blinded, multi-national study. AGN1, a
proprietary calcium-based implant material is
delivered using a minimally invasive procedure
to strengthen the proximal femur. The
cumulative incidence of secondary fractures and
adverse events (primary outcomes) will be
compared to a non-treated, control arm over a
5-year study period. As an event driven study,
efficacy and safety analysis will be performed
once 56 secondary hip fractures occur across
both study arms. An interim analysis at the 28-
event mark may result in an “early-win”
termination of recruitment, subject to a
statistically significant effect. Areal bone mineral
density (aBMD) will be compared at 12, 24 and
60-months using interval DXA scans, as
secondary outcome measure.
Results: To date, 224 patients have been enrolled across
51 sites in Austria, Denmark, France, Germany,
Italy, the Netherlands, Spain, the UK and Japan.
Aiming at a total of up to 100 RESTORE sites
globally, additional sites in Canada and Europe
are currently in activation.
Interpretation / Conclusion: The first Danish site, Aarhus University Hospital,
was activated in February 2024. Other Danish
and Scandinavian sites may follow. Hopefully,
minimally invasive AGN1 LOEP will prove as
safe as well as effective in preventing secondary
fractures in at risk treated hips.
182. Healing, infection rates and clinical scores of surgically treated tibial non-unions: a single-centre cohort of 53 consecutive patients with a mean 2.8 years follow-up
Marie Arildsen1, Jan Duedal Rölfing1, 2, Mats Bue1, 2, Juozas Petruskevicius1
1. Department of Orthopaedics, Aarhus University Hospital, Denmark
2. Department of Clinical Medicine, Aarhus University, Denmark
Background: Tibial non-unions are notoriously difficult to treat due
to the high risk of infection and the need for multiple
surgical procedures. Non-union occurs after approx.
2% of all fractures and up to 17% of tibial fractures.
The treatment is costly, often demanding long
recovery with the risk of chronic pain, reduced
functional outcomes and amputation.
Aim: To report healing, infection rates and clinically
relevant non-union scores in surgically treated tibial
shaft non-union patients.
Materials and Methods: A single-centre retrospective follow-up study of a
consecutive cohort of 53 patients (18 F, median age
56 (IQR 24-64), and 35 M, median age 50 (IQR 34-
62)) treated at Aarhus University Hospital from Dec
2018 until Dec 2023. Pathological fractures, as well
as non-union after osteotomies, were excluded.
Infection status was evaluated based on the
diagnostic criteria for fracture-related infections.
NUSS was used as clinical non-union score and
RUST to evaluate radiographic healing.
Results: During a mean follow-up of 2.8.y, 49 patients
(92%) obtained healing, 2 were amputated, and
2 were lost to follow-up. 21 patients were
confirmed infected: 17 monomicrobial, 3
polymicrobial and 1 with negative growth but a
confirmatory clinical sign. 8 patients were
identified as likely infected based on biochemical
markers, presence of a persistent wound and a
single bacteria identified by culture. 24 patients
were ruled unlikely of infection.
For data analysis infected and likely infected
were pooled and tested against non-infected.
The mean number of surgical revisions for the
infected group was 2.5 (range 1-8) and for non-
infected group, 1.8 (range 1-4).
Neither the median RUST score 13.6 (IQR 13-
15) vs. 14.3 (IQR 13-15) or the median NUSS
score 34 (IQR 26-38) vs. 27 (IQR (20-38) were
significantly different between the infected and
non-infected groups. External fixation for
definitive surgical management was more often
used in the infected group (p=0.01).
Interpretation / Conclusion: Results indicate that future standardized
prospective data collection is needed in patients
with tibial non-union to optimize the diagnostic
approach and improve treatment. Treatment of
these patients is complex and should be performed
in a multidisciplinary team.
184. Fast track reconstructive surgery, a preliminary review of 22 cases
Ulrik Kähler Olesen1
Department of Orthopedics, Rigshospitalet, Copenhagen.
Background: Current focus on reducing health care cost by
increasing flow in all aspects of surgical
treatment, demands efficient solutions.
Aim: To evaluate the preliminary results of 22 cases
of fast track surgeries in reconstructive
orthopedic. Based on a new protocol aiming at
discharge on the day or the day-after surgery:
Avoiding epidurals and other motor blocks,
minimizing blood loss (blodlessness,
vasoconstrictors, compression), promoting fast
mobilisation, involving all caregivers (surgeons,
anesthesiologist, nurses, physiotherapists).
Materials and Methods: 20 patients booked for 22 elective procedures:
Intramedullary lengthenings (6), osteotomies
around the knee (7), bone transport (1) and
hardware removals (8) were evaluated for LOS
(length of stay), complications, and general
satisfaction with the setup.
Results: 7 of 10 patients planned for same-day discharge
achieved the goal. 3 patients had one extra
night in hospital.
6 of 11 patients planned for discharge on the
day after surgery achieved the goal. 5 patients
had 2-4 additional nights in the hospital. Of
these, 4 were osteotomies around the knee and
one external ring fixator. Reasons for delay
were pain (5), logistics (missing relative at
home, late start (3), bleeding (1) and/or
anticoagulant treatment issues (1).
Interpretation / Conclusion: Our protocol was relatively succesfull in
achieving the time-saving goals, given the
heterogenecity of the population. Reconstructive
nailing seems less troublesome than
osteotomies. Most patients were more than
happy to recover in their home and expressed
overall satisfaction with the setup. However,
meticulous planning of all details in the flow,
backup in case of delays, flexibility and close
follow up, involvement of all allied health care
givers, including relatives - is mandated to
ensure compliance with the protocol.
200. High-voltage injury leading to bilateral transtibial amputation in a 17-year-old boy: A case report
Charlotte Mosbak Festersen 1, Sakshi Andersen1, Rikke Holmgaard1
1. Department of Plastic Surgery and Burns Treatment, Rigshospitalet
Background: High voltage current can cause serious damage to
the skin, but also to underlying tissue. Current
passes through tissue with the lowest resistance
(e.g. nerves, vessels, muscles) where it will
generate heat, cause tissue necrosis and
subsequently edema. Muscle breakdown
(rhabdomyolysis) and edema in the muscle
compartments may lead to compartment syndrome
(CS), and if so, fasciotomy needs to be performed.
Aim: The purpose of this case report is to describe how
the body is affected by high voltage current and to
highlight possible complications.
Materials and Methods: Case report of a patient with severe injuries due to
high voltage current.
Results: A 17-year-old male was admitted to the hospital
in Greenland following a high voltage accident by
a transmission tower. Examination revealed
bilateral circumferential 3rd degree burns on the
lower extremities and 2nd degree burns on some
of the body and face. Due to the severe burns,
the patient was intubated, but prior to this
expressed severe pain from both feet. At initial
assessment, there was no pulse or capillary refill
(CR), but CS was not suspected. The patient had
dark red urine - a sign of myoglobinuria. Transfer
to Denmark was delayed 32 hours, and upon
arrival, both feet appeared vital with bleeding
from the dermis and with no obvious signs of CS.
The patient underwent necrectomy of the 3rd
degree burns 47 hours after the trauma, and
during this, bilateral CS of the lower extremities
was suspected. Bilateral fasciotomy was
performed to regain sufficient blood supply
distally however, the muscles were only partially
vital. Bilateral transtibial amputation was
performed 15 days after the trauma.
Interpretation / Conclusion: CS is a well-described complication to high
voltage injuries typically characterized by pain as
the predominant clinical symptom. In cases
where electrical current passes through the body
it is important to consider internal injuries
especially in intubated patients who are unable
to express pain. Key indicators such as the
absence of distal pulses, delayed CR and the
presence of myoglobinuria are indicators of
potential internal damage. Therefore,
fasciotomies must be performed with a low
threshold if there is any anamnestic or clinical
suspicion of CS.
173. Does single plating of complex tibial plateau fractures portend to lower infection rates?
Papa Kwadwo Morgan-Asiedu1,2, Easton Ryan1,3, Bram Verhofste1,3, Devon Brameier1, Nishant Suneja1, Derek Stenquist1, Michael Weaver1, Arvind G. Von Keudell1
1. Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's
Hospital
2. Perelman School of Medicine, University of Pennsylvania
3. Harvard Combined Orthopedics Residency Program
Background: There is scarce evidence comparing infection
rates in complex bicondylar tibial plateau
fractures treated with single versus dual plated
Open Reduction Internal Fixation (ORIF)
Aim: To identify the rate of surgical site infection (SSI)
in OTA/AO 41C tibial plateau fractures treated
with single versus dual plating
Materials and Methods: Setting: Retrospective cohort study of patients
presenting to two level 1 trauma centers with
OTA/AO 41C tibial plateau closed fractures who
received ORIF
Intervention: Single vs dual plated ORIF
Primary outcome: SSIs after index operation
Covariates: Age, sex, BMI, tobacco use, alcohol
use, compartment syndrome
Chi square comparisons: Overall SSI rates,
superficial SSIs, deep infections requiring
reoperation stratified by AO fracture subclass to
account for asymmetric distribution of higher
energy fractures
Results: We included 223 patients with mean age 53.4
years, 49.3% (n=110) males, mean BMI 28.3.
148 had single plated ORIF and 75 had dual
plated ORIF. Cohorts were similar in terms of
age, number of males, mean BMI, tobacco use,
alcohol use & compartment syndrome. The
overall rate of SSIs was 24.2% (n=54); single
plating had a lower infection rate (19.6%, n=29,
p=0.02) than dual plating (33.3%, n=25). Single
plating had lower rates of superficial SSIs
(4.7%, n=7, p=0.02) than dual plating (13.3%,
n=10). The rates of deep infection requiring
reoperation were similar for single plating
(16.9%, n=25, p=0.09) and dual plating (26.7%,
n=20). Among 41C1 fractures, single plating had
lower infection rates (3.0%, n=1, p<0.01) than
dual plating (44.4%, n=4). Among 41C2
fractures, single plating had lower infection rates
(8.6%, n=3, p<0.01) than dual plating (37.5%).
However, 41C3 fracture infection rates were
similar between single plating (34.3%, n=23,
p=0.58) and dual plating (29.3%, n=12). Finally,
among dual plated patients with infections
requiring reoperation, 60% (n=12) involved the
medial component, 20% (n=4) involved the
lateral, and 15% (n=3) involved both
components.
Interpretation / Conclusion: Per this study, single plating in fixation of
OTA/AO 41C tibial plateau closed fractures is
associated with a lower rate of SSIs as
compared to dual plating, especially for 41C1
and 41C2 fractures.
176. Current Payment Model for Geriatric Hip Fractures Underestimates the Cost to Treat
Alec Friswold, Devon Brameier, Faith Selzer, Liqin Wang, Li Zhou, Michael Weaver, Arvind von Keudell
Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
Background: Geriatric hip fractures utilize substantial hospital resources. The Center for Medicare &
Medicaid Services (CMS) reimburses hospitals by a fixed amount as determined by
patients’ Medicare Severity Diagnosis Related Group (MS-DRG), which assign
payment weights based on the average resources required to manage that condition.
Aim: In this study, we evaluate whether current CMS estimates of resource utilization for
the MS-DRG, “Hip and Femur Procedures Except Major Joint”, the most commonly
allocated MS-DRG for geriatric femur fractures, is consistent with resource
utilization of these patients at a large academic medical center.
Materials and Methods: Analysis included 198 patients over 65 years old who underwent surgical repair of
a hip fracture between 2018-2020 at a Level 1 Trauma Center and were
reimbursed under one of three MS-DRGs: “Hip and femur procedures except
major joint without complication or comorbidity (CC)”, “…with CC”, and “…with
major CC (MCC)”. Financial data was obtained for each episode. Primary
outcome was a percentage difference in total cost of care compared to the
“without CC” group. Secondary outcomes include difference in length of stay
(LOS) between the study site and CMS, profitability, and frailty within each MS-
DRG.
Results: Compared to patients without CC, treating patients with MCC on average cost 60%
more (p<0.05). The average profit per episode was negative for all three MS-
DRGs. Moreover, patients coded with MCC were 64% less profitable than patients
coded without CC. The average LOS at the study site was 1.9 days longer than the
LOS CMS cites for this condition. Moreover, severely frail patients made up 38% of
patients with a MCC compared to 7% of patients without a CC.
Interpretation / Conclusion: Negative profits across all versions of the “Hip and Femur Procedures Except
Major Joint” MS-DRG suggest current payment weights are not sufficiently
meeting the cost to treat. This may be due to CMS underestimating the average
LOS, and thus resource utilization, of these patients. Caring for patients with
major complications was associated with more negative profit, suggesting the
current payment model may disincentivize treating patients who are more likely
to have complications.
Poster Walk 8: Spine and Tumor
Chair:
158. Reconstruction surgery with custom-made 3D-printed pelvic implants due to bone tumors involving the acetabulum. A single-center retrospective cohort study with clinical follow-up
Müjgan Yilmaz1, Linda Fernandes2, Michael Mørk Petersen3
1. Department of Orthopaedics, North Zealand Hospital, Denmark
2. University College Copenhagen, Copenhagen, Denmark
3. Department of Orthopaedics, Rigshospitalet, Denmark
Background: In patients with malignant bone tumors,
metastases, or benign tumors causing
significant bone loss, limb-salvage surgery
is the recommended surgical intervention.
Aim: We evaluated the effects (surgical and
functional outcomes) of using pelvic
reconstruction using personalized, 3D-
printed pelvic implants in bone tumor
surgery.
Materials and Methods: A single-center cohort study including 12
patients (M/F=8/4, mean age 51, range:15-
76 years) reconstructed with custom-made
3D-printed pelvic prosthesis.
Pathology: Chondrosarcoma (n=4), Ewing
sarcoma (n=1), Giant cell tumor (n=1), B-
cell lymphoma (n=1), Renal cell carcinoma
(n=2), Ductal carcinoma (n=1), Planocellular
carcinoma (n=1) and Aneurismal bone cyst
(n=1).
Ten patients were available for follow-up
(not alive=1, sick=1) and were assessed
with active/passive ROM, isometric muscle
strength, MSTS, TESS, EQ-5D-5L, EORTC
QLQ-C30, 6-minute walk test, and 30-
second chair-stand test on average 4 years
postoperatively.
Results: The probability of avoiding revision due to
implant failure calculated by Kaplan-Meier
survival analysis was 85.7% (95%CI:
63.3%-100%) at 5 years. We found that
active-ROM for the surgical limb was
decreased compared to the healthy
contralateral site in hip abduction (p=0.007),
adduction (p=0.007), internal rotation
(p=0.007), and external rotation (p=0.007).
Hip flexion was decreased in passive ROM
(p=0.007). In the surgical limbs, we found
decreased hip muscle strength in flexion
(p=0.008), abduction (p=0.008), knee
extension (p=0.008), and flexion (p=0.008).
EQ-5D-5L (preoperative: 0.9 (range:0.87-
0.97) and 0.9 (postoperative range:0.84-
0.92)),
TESS (mean: 68.3, range:55-90), MSTS
(mean: 66.1, range:55-85), and EORTC
QLQ-C30 (mean: 63.3, range:55-80) 6-
minute walk test (mean: 413.6 m,
range:320-501.5) and 30-second chair-
stand test (mean: 11.2, range:7-18) was
assessed at follow-up.
Interpretation / Conclusion: Reconstruction with custom-made 3D-
printed pelvic prosthesis has overall
expected lower isometric muscle strength
and ROM compared with the healthy site.
199. Soft tissue sarcomas masquerading as hematomas - three case reports
Kasper Vestergaard Rydberg1, Flemming Secher Kromann Nielsen2, Anna Bertoli Borgognoni3, Michael Melchior Bendtsen4, Thomas Baad-Hansen5
1. Department of Orthopaedics, Aarhus University Hospital;
2. Department of Radiology, Aarhus University Hospital;
3. Department of Orthopaedics, Aarhus University Hospital;
4. Department of Orthopaedics, Aarhus University Hospital;
5.Department of Orthopaedics, Aarhus University Hospital.
Background: Misdiagnosis of soft tissue sarcomas as hematomas
can lead to treatment delays, larger tumors,
metastasis, difficult surgical removal, and poor
prognosis.
Aim: We present three cases where patients initially
diagnosed with hematoma-like soft tissue masses
were later found to have sarcomas. The aim of the
study is to identify and highlight diagnostic
characteristics of a suspected hematoma that
should arise suspicion of a soft tissue sarcoma.
Materials and Methods: The study is a retrospect case study. In the three
patients' journals we found information about patient
history, clinical examinations, imaging diagnostics,
and biopsies.
Results: The extended duration from the initial appearance of
a thigh swelling to diagnosis delays surgical
intervention, allowing tumor growth and metastasis,
reducing the chance of successful treatment. Larger
tumors are harder to remove surgically, increasing
the risk of incomplete removal and potential cancer
spillage, heightening the risk of relapse. Additionally,
tumor expansion within soft tissue and muscle
necessitates more extensive limb removal during
surgery, leading to reduced postoperative limb
function.
The patients presented with a lump accompanied by
swelling and pain. Intriguingly, none of the patients
manifested subcutaneous ecchymosis.
Consequently, the absence of ecchymosis coupled
with the presence of a lump, swelling, and pain in an
extremity signals potential suspicion of soft tissue
sarcoma, particularly in the absence of direct
trauma.
The study suggests that delayed MRI extends the
interval between clinical appearance of a tumor and
final surgical treatment, ultimately worsening
prognosis and increasing the risk of unplanned
excisions. MRI should therefore be performed
without further delay.
Core needle biopsy or open biopsy yielded
conclusive diagnoses in all three cases presented,
suggesting these methods should be prioritized for
obtaining correct diagnosis.
Interpretation / Conclusion: A soft tissue sarcoma should be suspected when a
patient presents with a lump, swelling, and pain in
the absence of a direct trauma. MRI scans and core
needle biopsies are vital in soft tissue sarcoma
diagnostics and should be performed without
unnecessary delay.
161. Health-related quality of life is unchanged at 5 years follow-up after AIS surgery - A single-center study of 164 patients
Niklas Tøndevold11, Lærke Ragborg 1, Martin Heegaard1, Martin Gehrchen1, Benny Dahl1
1. Ortopaedic department U, Copenhagen University Hospital Rigshospitalet
Background: Surgical treatment for adolescent idiopathic
scoliosis (AIS) is typically performed before the
patients embark on their work life. A few multicenter
studies have shown a decline in patient-reported
outcome when patients are followed beyond the
traditional two years after surgery. However, most of
these large studies are characterized by a low
follow-up rate and the inherent heterogeneity of
multi-center studies.
Aim: Determine health-related quality of life in patients
surgically treated for scoliosis with a minimum of 5-
year follow up.
Materials and Methods: All patients surgically treated for AIS from marts
2011 to marts 2018 were included. All patients had
multi-segmental all-pedicle screw constructs.
Patient-reported outcome; SRS-22, NRS 1-10 and
EQ-5D-3L were collected pre-operatively and at 1-
year, 2-year and final follow-up. Radiological and
clinical follow included use of daily pain medication,
work status including weekly work hours and
physical activity level.
Results: One hundred and sixty-four of 178 (92%) patients
surgically treated for AIS during the inclusion period
were available for follow-up. Mean age at surgery
was 15.6 years. Mean follow-up was 6.8(SD±1.4)
years with a mean age of 22.3(SD±2.4). Sixteen
patients (10%) had revision surgery, most
commonly due to infection (26%). We found no
change in main curve correction between 2 and 5
year follow-up (29° vs 30°, p=0.78) and no
significant difference in SRS-22 (Table 1). At 5-year
follow-up, 132 (80%) patients used over-the-counter
painkillers once a week or less and only 2 patients
(1.2%) used morphine daily. Thirteen patients (8%)
where unemployed and the rest was in either full-
time employed or studying.
Interpretation / Conclusion: In this single-center study, we found no decline in
patient reported outcomes at minimum 5-year
follow-up. With a 92% follow-up rate and use of all-
pedicle screw constructs, it is illustrative of the
advances made in surgical treatment of AIS over the
last decade.
162. Is your surgical field as sterile as you think when operating patients with adolescent idiopathic scoliosis?
Niklas Tøndevold1, Gehrchen Martin1, Benny Dahl1,
1. Orthopeadic department U, Copenhagen University Hospital, Rigshospitalet
Background: Late surgical site infection (>90 days) is seen in 1.7 to 6.9% of patients undergoing surgery for AIS. Cutibacterium acnes (C. acnes) is reported to be the most common finding in these patients. However, the same pattern is not seen ASD patients. C. acnes is known to act as an opportunistic pathogen through biofilm. Particularly shoulder arthroplasties but also breast implants and cardiovascular device-related infections are known to have high infection rates with that pathogen. However, whether inoculation is hematogenic or the result of bacterial contamination at the initial surgery is not known.
Aim: Exmine the presence of skin bacteria, especially Cutibacterium acnes, is more prevalent in the surgical field of patients treated for adolescent idiopathic scoliosis (AIS) than that of patients treated for adult spinal deformity (ASD).
Materials and Methods: We included patients at least two years after their last spine surgery (ASD group) or no prior spine surgery (AIS group) undergoing surgery at our institution from January 1 through December 31, 2020. The patients were surgically prepared according to the consensus guidelines. Three muscle tissue samples were obtained before wound closure, and two positive cultures were considered a positive test result. Furthermore, the unused rod tip was sent for sonication. All cultures were observed for 14 days.
Results: We included 161 AIS patients and 23 ASD patients. There were no statistically significant differences between the 2 groups regarding surgical time or blood loss. Cultures were positive in 112 AIS patients (68%) and in 2 ASD patients (8.6%). Of the 112 positive AIS cultures 100 had C. acnes as the only pathogen. The remaining were other skin bacteria. Bacteria were found on 92 of the rod tips (81%) all were C. acnes. WGS showed no sign of a single contaminate source.
Interpretation / Conclusion: C. acnes is present in the muscle tissue of most patients surgically treated for AIS. In the majority of cases the same bacteria were found on the unused sterile implant only handled by the surgeons, possibly by contamination from the surgical gloves. Surgeons treating these patients should therefore make sure of targeting this pathogen in their prophylactic strategy.
178. Does a Thoracolumbar Sacral Orthosis Affect Axial Rotation in Adolescent Idiopathic Scoliosis Patients?
Lærke Ragborg1,2, Amy McIntosh2, David Thornberg2, Jamie Gross2, Søren Ohrt-Nissen1, Martin Gehrchen1, Benny Dahl1, Daniel Sucato2, Megan Johnson2
1. Spine Unit, Dept. of Orthopedic Surgery, Rigshospitalet, København, Denmark
2. Scottish Rite for Children, Dallas, United States of America
Background: Modern brace design aims to correct spinal
deformity in the coronal, sagittal, and axial planes
through personalized brace construction. However,
limited data is available confirming if axial changes
actually occur when patients are treated with a
thoracolumbar sacral orthosis (TLSO).
Aim: To assess if axial changes occur in-brace.
Materials and Methods: A consecutive cohort of patients diagnosed with
AIS who underwent bi-planar, low-dose x-rays
with subsequent 3D reconstructions at both pre-
brace and inbrace was assessed retrospectively
for inclusion. All patients were prescribed a full-
time, 3D CAD/CAM, de-rotational TLSO. Axial
rotation magnitude and direction were compared
at each vertebral level between pre-brace and in-
brace images to detect where changes occurred
according to major curve location (Thoracic (T1-
T11) and Lumbar (T12-L5)). Magnitude was
calculated as the absolute value of the difference
between in-brace and pre-brace. Direction of
axial rotation was termed “amplification” or "de-
rotation" defined as an increase in magnitude
toward the initial direction or a change in the
opposite direction regardless of magnitude,
respectively.
Results: We included 126 consecutive patients, 91 (72%)
were females and 93 (74%) had main thoracic
curves. Pre-brace major Cobb angle was 32±8° and
in-brace Cobb angles reduced to 23±8°. Overall and
within groups, there was a greater proportion of de-
rotation compared to amplification at every level.
For thoracic curves, the highest frequency of de-
rotation occurred at T8-T9 with the largest changes
in magnitude occurring at T1-T4 (Figure 1). For
lumbar curves, the highest frequency of de-rotation
occurred at T7-T8, T11 and L1, with the highest
magnitude of de-rotation occurring at T12 .
Interpretation / Conclusion: A TLSO does influence axial rotation in patients with
adolescent idiopathic scoliosis while in-brace.
Although de-rotation primarily occurs around the
apical regions, changes can be observed
throughout the length of the spine regardless of
curve type.
187. Using Electric Stimulation of the Spinal Muscles and Electromyography during Motor Tasks for Evaluation of the Role in Development and Progression of Adolescent Idiopathic Scoliosis
Christian Wong1,2, Benny Dahl1,2
Department of Orthopedic Surgery, Rigshospitalet, 2100 Osterbroo, Denmark
Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
Background: The role of the spinal muscles in scoliogenesis is not
fully substantiated. Do they act scoliogenic (inducing
scoliosis) or counteract scoliosis in adolescent
idiopathic scoliosis (AIS)?
Aim: In this study, we will examine this by using
selectively placed Transcutaneous Electric
Stimulation (TES) combined with a cinematic
radiographic technique and by performing
electromyographic (EMG) evaluations during various
motor tasks
Materials and Methods: This is a cross-sectional study of subjects with
small-curve AIS. Using cinematic radiography, they
were evaluated dynamically either under electrical
stimulation or when performing motor tasks of left
and right lateral bending and rotation while
measuring the muscle activity by EMG.
Results: Five subjects volunteered for TES and six subjects
performed the motor tasks with EMG.When
analyzing the spatial positions when calibrated, we
found that the spinal muscles exert a compressive
‘response’ with a minor change in the Cobb angle
(CA) in small-curve AIS (CA = 10–20°). In larger
curves (CA > 20°), TES induced a relative four-fold
change in the CA compared to small-curve AIS with
a ratio of 0.6. When adding the absolute EMG ratios
for all four motor tasks, the subject with progression
had almost 10-fold fewer summed EMG ratios, and
the subject with regression had more than 3-fold
higher summed EMG ratios.
Interpretation / Conclusion: Based on these findings, we suggest that the
spinal muscles in small-curve AIS have a
stabilizing function, maintaining a straight spine
and keeping it in the midline. When deformities
are larger (CA > 20°), the spine muscle curve
exerts a 'scoliogenic response’. This suggests
that the role of the muscles converts from
counteracting AIS and stabilizing the spine to
being scoliogenic for a CA of more than 20°.
Moreover, we interpret higher EMG ratios as
heightened asymmetric spinal muscle activity
when the spinal muscles try to balance the spine
to maintain or correct the deformity. When
progression occurs, this is preceded or
accompanied by decreased EMG ratios. These
findings must be substantiated by larger studies.
189. The association between Hounsfield units and mechanical failure in ASD patients
Martin Heegaard1, Kristín Ingadóttir1, Lærke Ragborg1, Benny Dahl1, Lars V. Hansen1, Søren Ohrt-Nissen1, Martin Gehrchen1
1. Spine unit, Rigshospitalet, Copenhagen University Hospital, Denmark
Background: Low bone mineral density (BMD) is a known risk
factor for revision surgery in patients with adult
spinal deformity (ASD). Hounsfield units (HUs) on
CT scans have been suggested as a proxy for
assessing BMD.
Aim: This study aimed to assess HUs in the lumbar
region, including the upper instrumented vertebra
(UIV) as well as UIV+1, and the association with
mechanical failure in patients undergoing ASD
surgery.
Materials and Methods: We retrospectively included ASD patients
undergoing surgery from 2010-2020 with a minimum
of two-year follow-up. We excluded patients without
a preoperative CT scan, or a CT scan made more
than one year before surgery. Mechanical failure
was defined as proximal junctional failure,
pseudarthrosis, or implant failure requiring revision
surgery. On preoperative CT scans, HUs were
measured on three axial slices on each vertebra
from L1 to L5 and, if available, at UIV and UIV+1. A
logistic regression model was used to assess the
association between HUs and mechanical failure.
Results: We included 170 patients with a mean age of 63
(±12) years, 108 (64%) were females, and the
median instrumentation was 13 [IQR 10-16] levels.
Mechanical failure occurred in 27% (n=46) of
patients at two-year follow-up. Mean lumbar HUs
were 146 ±51 in the mechanical failure group and
135 (±52) in the no-revision group (p=0.232). The
area under the curve was 0.58 (95% CI 0.48-0.68)
corresponding to no to low discriminatory power in
predicting mechanical failure using lumbar HUs.
Univariate logistic regression analysis showed no
statistically significant difference between
mechanical failure and HUs in the lumbar region
(OR= 1.00, 95%CI 1.00-1.01, p=0.239) or at
UIV/UIV+1 (OR= 1.00, 95%CI 0.99-1.01, p=0.286).
Interpretation / Conclusion: We found no association between mechanical
failure and HUs on preoperative CT scans in ASD
patients. Thus, we cannot recommend using HUs to
predict mechanical failure in these patients.
204. Posterior migration of the mobile core in an unconstrained cervical disc replacement: A Case Report
Katerina Znacko, Anders Kruse, Dennis Winge Hallager
Background: Cervical disc replacement (CDR) offers motion
preservation compared to fusion for degenerative
disc disease. Potential harms should be weighed
against the possible advantages when patients are
counselled on the treatment choice.
Aim: To present a rare case of posterior core migration in
an unconstrained CDR device, highlighting the risk
of devastating complications and discus failure
mechanism.
Materials and Methods: A 29-year-old woman underwent arthroplasty at
C5/6 with an unconstrained device in 2016 for a disc
herniation, when conservative treatment failed. In
2024, she presented with recurrent neck and right
sided arm pain, and difficulty in neck flexion.
Imaging revealed posterior migration of the device
core, which occupied the right side of the spinal
canal. Revision surgery unveiled a loose upper
metal endplate with soft tissue metallosis and
severe wear of the migrated core. The device was
removed, and after debridement, anterior fusion
surgery was performed. Soft tissue and device
sonication cultures were obtained.
Results: Postoperatively, the symptoms had resolved, and
cultures revealed Cutibacterium acnes infection.
Antibiotic treatment was initiated, and the patient is
currently planned for follow-up at three months in
our outpatient clinic.
Interpretation / Conclusion: Discussion:
This case underscores CDR surgery complexities,
urging research into device failure mechanisms.
Loosening of the upper endplate may exacerbate
core wear, facilitating core migration.
Conclusion:
Posterior core migration in unconstrained CDR
devices poses a severe risk, which surgeons and
patients should consider when choosing this
surgical option.