Session 4 : YODA Best Paper
13. November
11:00 - 12:00
Lokale: Sal A
Chair: Christian Bredgaard Jensen & Claus Varnum
31. The effect of Virtual Reality on pre-procedural anxiety in children – a pilot randomized controlled trial
Julie Hyldgaard Petersen1, Karen Vestergaard Andersen2, Line Kjeldgaard Pedersen1, Stine Fjendbo Galili3, Claus Sixtus Jensen3, 4, Marianne Lisby3, Bjarne Møller-Madsen1, Jan Duedal Rölfing1
1. Children’s Orthopaedics and Reconstruction, Aarhus University Hospital,
Denmark
2. The Emergency Department, Aarhus University Hospital, Aarhus
Denmark
3. Research Center for Emergency Medicine, Department of Clinical
Medicine, Aarhus University, Aarhus Denmark
4. Department of Paediatrics, Aarhus University Hospital, Denmark
Background: Virtual reality (VR) is a promising method to
reduce procedural anxiety and pain in
children without pre-procedural pain.
Aim: The primary aim of this pilot study was to
investigate the effect of VR on pre-
procedural anxiety in children experiencing
acute pain in the setting of an Emergency
Department (ED). In addition, this study
aimed to test the feasibility of the study
procedure.
Materials and Methods: In this pilot randomized controlled trial
(RCT) twenty children aged 6-14 years were
randomized to standard of care (SOC) or
VR+SOC during their visit at the ED.
Anxiety was assessed three times using
modified Yale Preoperative Anxiety Scale
(mYPAS); at baseline, after intervention
immediately before the procedure (pre-
procedure) and during the procedure. The
pain level was at the same time assessed
using Numerical Rating Scale (NRS).
Results: Twenty children, median age 11 (7-14)
years, were randomized. VR significantly
decreased the level of anxiety and pain from
baseline to the pre-procedural
measurement: -8.33 (95%CI [-15.28; -2.38])
points, p=0.0114 and -1.85 (95%CI [-2.29;
-0.78]) points, p=0.0023. A high level of
anxiety at baseline was found to be
associated with a positive effect of VR to
reduce pre-procedural anxiety, spearman’s
rho: 0.988.
Interpretation / Conclusion: The preliminary results found an effect of
VR on reducing pre-procedural anxiety and
pain in children with acute pain. An
association between anxiety at baseline and
the effect of VR was found. This study has
been profitable for structuring a large-scale
study which, due to the limitation of a pilot
study, is needed to confirm the findings.
32. The risk of dislocation in dual mobility vs. 36mm femoral heads in primary total hip arthroplasty for osteoarthritis - A propensity-matched analysis from the Danish Hip Arthroplasty Register
Yousef Hussein1, Afrim Iljazi1, Michala Sørensen1,2,4, Søren Overgaard3,4, Michael Petersen1,4
1. Musculoskeletal Tumor Section, Department of Orthopedic Surgery,
Copenhagen University Hospital Rigshospitalet
2. Department of Orthopedic Surgery, Zealand University Hospital
3. Department of Orthopedic Surgery and Traumatology, Copenhagen University
Hospital Bispebjerg-Frederiksberg
4. Department of Clinical Medicine, Faculty of Health Science, University of
Copenhagen, Denmark
Background: Dislocation is a major concern following total
hip arthroplasty (THA) for osteoarthritis (OA).
Both dual mobility cups (DMCs) and standard
cups (SC) with large femoral heads are utilized
to reduce the risk of dislocation.
Aim: We investigated whether DMCs are superior to
SCs in reducing the two-year risk of dislocation
in a propensity-matched sample from the
Danish Hip Arthroplasty Register (DHR).
Materials and Methods: This population-based cohort study utilizing
data from the DHR and the Danish National
Patient Register. We included all patients
undergoing primary THA for OA from 2010 to
2019 with either DMC or SC with metal-on-
polyethylene or metal-on-ceramic
articulations with a 36mm femoral head. The
samples were propensity-score matched on
patient and implant characteristics. The
primary outcome was the difference in the
absolute risk of dislocation within two years,
with a secondary outcome of the difference
in the absolute risk of revision surgery of any
cause within the same timeframe. The
cumulative incidence of dislocation was
calculated using the Aalen-Johansen
estimator, while the difference in absolute
risk was estimated using absolute risk
regression.
Results: We included 4,499 patients with DMC and
4,499 patients with SC after propensity score
matching. Both groups had a mean age of 75
years, included approximately 60% females,
and had a two-year survival of 95%. The DMC
group was 80% less likely to dislocate within
two years (ARR 0.20, CI 0.14-0.28, p<0.01)
with no increased risk of revision surgery (ARR
1.15, CI 0.89-1.48, p<0.01).
Interpretation / Conclusion: DMCs are associated with a lower risk of
dislocation within two years compared to SCs,
with no increased risk of revision surgery.
33. Gait Analysis in Healthy Adults: GAITRite and Xsens
Marianne Frydendal Nielsen1, Søren Ege Quist1, Rasmus Elsoe2, Peter Larsen2,3, Bjarne Møller-Madsen1, Jan Duedal Rölfing1,4
1. Children’s Orthopaedics and Reconstruction, Aarhus University Hospital, Palle Juul-
Jensens Boulevard 99, 8200 Aarhus N, Denmark
2. Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
3. Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital,
Aalborg, Denmark
4. Department of Clinical Medicine, HEALTH, Aarhus University, Aarhus, Denmark
Background: Gait analysis by technical means is more
objective than clinical observation. Highly
specialized 3D motion capture systems are the
gold standard. An instrumented walkway system
like GAITRite is a validated alternative. GAITRite
is a portable carpet for automated measurement
of spatiotemporal parameters of the footstep
pattern. Inertial measurement units (IMUs) like
Xsens are alternative options. IMUs register
movement in space. They are portable, less
expensive, and increasingly available compared
to video-based systems.
Aim: The aim of the study was to evaluate the interrater
reliability between Xsens and GAITRite assessing
spatiotemporal gait parameters in healthy adults.
Materials and Methods: 42 healthy adults volunteered to participate.
Two clinicians examined all participants within one
session using the Xsens and the GAITRite gait
analyses simultaneously.
The spatiotemporal gait parameters were compared
with interclass correlation coefficient (ICC) analysis.
ICC estimates and their 95% confident intervals
(95%-CI) were calculated in Python. We analysed
ICC (2, k) and ICC (3, k) to assess both absolute
agreement and consistency of the measurements.
Results: The strongest absolute agreements were for
cadence, step length, cycle time and stride
length. ICC (2, k) ranged from 0.97 [95%-CI:
0.22, 0.99] to 0.98 [95%-CI: 0.88, 0.99]. ICC (3,
k) ranged from 0.86 [95%-CI: 0.72, 0.93] to 1.00
[95%-CI: 0.99, 1.00], indicating good to excellent
reliability considering a systematic difference.
Swing time, stance time and single support time
measurements showed insignificant ICC (2, k)
values, but significant ICC (3, k) values with
good to excellent reliability.
There was a systematic difference between
duration and step count because of the
experimental setup.
Distance and percentage measurements (swing,
stance, and single support) were not correlated.
Neither was bilateral differences between step
time, step length or cycle time.
Interpretation / Conclusion: The interrater reliability between GAITRite and
Xsens is moderate to excellent for selected gait
parameters. For these, both systems may be used
interchangeably for gait analysis in healthy adults.
34. A comparison of manual measurements vs 3D-scans of children's foot anthropometry: An evaluation based on 496 Danish children (PANIC Feet Project)
Anne Marie Holt1, Frederik Hammer1, Thea Saabye1, Ales Jurca5,6, Andreas Balslev-Clausen1, Steen Harsted3,4, Christian Wong1,2
1. Department of Orthopedic Surgery, Copenhagen University Hospital; Rigshospitalet
2. Department of Orthopedic Surgery, Copenhagen University Hospital; Hvidovre
Hospital
3. Center for Muscle and Joint Health, Department of Sports Science and Clinical
Biomechanics, University of Southern Denmark
4. Medical Research Unit, Spine Center of Southern Denmark, University Hospital of
Southern Denmark
5. Volumental AB, Stockholm, Sweden
6. Jozef Stefan International Postgraduate School
Background: Accurate data collection on children's foot size and
shape is crucial due to potential impacts on
functionality, pain, and quality of life. The advent of
3D scanning technology offers a novel approach to
assessing foot dimensions and deformities.
Aim: This study aims to explore the correlation,
agreement, and reliability between manual
measurements and 3D scans, along with assessing
intra-rater reproducibility for each method.
Materials and Methods: In a cross-sectional design, 3D scans and manual
measurements were collected from 496 children
aged 6-16 years as part of the PANIC Feet study,
covering foot length AND width, hallux valgus angle
(HVA), and arch height. Correlations were assessed
using Pearson's correlation coefficient, reliability
through the intraclass correlation coefficient (ICC),
and agreement with limits of agreement (LoA). Intra-
rater reliability was examined using re-test data to
evaluate correlation, agreement, and reliability for
both methods, respectively.
Results: For most subjects, the 3D-scanner measures
higher values for foot length and width compared
to manual measurements. Between-method
reliability was excellent for foot length
(ICC>0,99), good for foot width (ICC>0,83), and
poor for HVA measurements (ICC>0,42). While
there was a correlation for arch height
measurements between methods (r > 0,61), a
direct comparison was not possible. Between-
session reliability was excellent for both methods
(ICC>0,97) for foot length measurements. In
general, the 3D-scan measurements had a
higher between-session reliability than the
manual measurements. The between-session
reliability for the 3D-scan measurements was
excellent (ICC>0,98) for foot width, moderate
(ICC>0,68) for HVA measurements, and good
(ICC>0,81) for arch height measurements.
However, the between-session reliability for the
manual measurements was good (ICC>0,76) for
foot width, poor (ICC>0,48) for HVA
measurements, and poor (ICC>0,28) for arch
height measurements.
Interpretation / Conclusion: 3D scanning has higher between-session reliability
than manual measurements for assessing children's
foot dimensions. However, this study does not
address the validity of 3D measurements,
highlighting the need for further research in this
area.
35. Elbow kinematics with increasing radial head arthroplasty overlengthening evaluated with dynamic radiostereometric analysis
Johanne Frost Teilmann1, Emil Toft Petersen1,2,3, Theis Muncholm Thillemann2,3, Chalotte Hemmingsen1, Josephine Olsen Kipp1,2, Thomas Falstie-Jensen3, Maiken Stilling1,2,3
1. AutoRSA Research Group, Orthopedic Research Unit, Aarhus University
Hospital.
2. Department of Clinical Medicine, Aarhus University.
3. Department of Orthopedic Surgery, Aarhus University Hospital.
Background: Radial head arthroplasty (RHA) is used in the
treatment of complex elbow fracture dislocations
with a risk of overlengthening the radius.
Overlengthening of the radius has been
associated with elbow joint stiffness and
decreased range of motion, but little is known
about the detailed kinematics of the elbow joint
with an overlengthened radius following RHA.
Aim: This experimental study aimed to evaluate the
elbow kinematics following increasing radial
head arthroplasty overlengthening by use of
dynamic radiostereometry.
Materials and Methods: Eight human donor arms were examined
with dynamic radiostereometry during a
motor-controlled elbow flexion with the
forearm in unloaded neutral position, and in
supinated- and pronated position without and
with 1kg of either varus or valgus load,
respectively. The elbows were examined
before and after RHA with stem lengths of
anatomical size, +2 mm, and +4 mm length.
The ligaments were kept intact using a step-
cut humerus osteotomy for repeated RHA
exchange. Bone models were obtained from
computed tomography and AutoRSA
software was used to match the bone
models with dynamic radiostereometric
analysis recordings. To describe elbow
kinematics, anatomic coordinate systems
were applied to the humerus, the ulna, and
the radius.
Results: The greatest kinematic changes in the elbows
were observed with the +4 mm implant
imposing:
1) Joint distraction of 2.8 mm (CI 95% 1.6;
4.0) in the radiohumeral joint and of 1.1 mm (CI
95% 0.4; 1.7) in the ulnohumeral joint.
2) Increased varus angle up to 2.4° for both
the radius (CI 95% 0.0; 4.8) and the ulna (CI
95% 0.2; 4.5).
3) Radial shift of 2 mm (CI 95% 0.2; 3.1) in
the ulnar direction and ulnar shift of 1.0 mm (CI
95% 0.3; 1.6) in the posterior direction.
Interpretation / Conclusion: The kinematics of the elbow joint deviated
increasingly from the native joint kinematics with
a +2 mm to a +4 mm radial overlengthening.
This might affect several other factors, like the
joint contact pressure, interosseus membrane
tension, and distal radioulnar joint stability and
congruency. This study supports the importance
of restoring the anatomical radial length in RHA
surgery.
36. Change of practice favoring non-surgical treatment of dorsally displaced distal radius fractures in elderly patients - complications and secondary surgeries
Dilay Kesgin Fener1, Emil Østergaard Nielsen 2, Ottilia Wyon Steenholdt1, Ali Abdel-Hadi Toma 1, Stig Brorson 3, Dennis Winge Hallager1,3
1. Department of Orthopaedic Surgery, Zealand University Hospital, Køge
2. Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-
Hvidovre
3. Center for Evidence-Based Orthopaedics, Zealand University Hospital and
Department of Clinical Medicin, University of Copenhagen.
Background: Based on randomized trials and guidelines, non-
surgical treatment is recommended for elderly
patients with dorsally displaced distal radius
fractures (DDDRF). Practice at our institution
underwent evaluation in 2020. Using the CEBO
model led to a new local guideline favoring non-
surgical treatment in patients aged 60 years or
older.
Aim: The aim of this retrospective quality assessment
study was to investigate whether there has been
an increased rate of complications or secondary
surgeries following the change in clinical
practice.
Materials and Methods: All patients aged 60 years or older treated at
our institution for a forearm fracture between
February 1, 2019, and January 31, 2020, and
between February 1, 2022, and January 31,
2023, were screened for inclusion. Patients
with DDDRFs were included. They were
stratified based on the practice change in a
before (group 1) and an after (group 2)
cohort. The diagnosis was confirmed on
radiographs. Exclusion criteria were high
energy or open fractures, neurovascular
compromise, previous fracture on the same
side, other fractures, and patients relying on a
walking aid in the injured hand or rejected use
of data for quality assessment. Data were
managed in Redcap according to a
predefined protocol. Rates of complications
and secondary surgeries within one year
were compared between groups using
Pearson’s Chi squared test.
Results: 689 patients were screened, 213 were included
for analysis. Group 1 included 98 patients with a
median age of 72 years (range 60-96), 88%
female. Group 2 included 115 patients, with a
median age of 76 years (range 60-93), 94%
female. Surgical treatment was received by 78%
in group 1 and 11% in group 2.
In group 1, 12% (12 of 98) had at least one
complication compared to 13% (15 of 115) in
group 2 (p=0.9).
In group 1, 4% (4 of 98) had secondary surgery
within one year, compared to 6% (7 of 115) in
group 2 (p=0.5). Carpal tunnel syndrome was
the predominant indication in both groups.
Interpretation / Conclusion: We found no statistically significant difference in
rates of complications and secondary surgery
within one year of treatment before and after the
practice change favoring non-surgical treatment
in elderly patients with a DDDRF.