Tranexamic acid (TA) in total knee replacement surgery (TKR) has shown marked reduction in bleeding and blood transfusion. There are little data on TA in revision TKR. From February 2008 all patients having primary or revision TKR received TA 10mg/kg × 2. We whished to evaluate the effect and possible complications of TA. 49 patients had revision TKR from January to August 2010. 21 patients (group I) operated before the regular use of TA were compared to 28 patients (group II) receiving TA. The groups were compared according to bleeding, blood transfusion, postoperative complication and type of revision. Revision TKR was compared to 157 primary TKR (94 operated without TA (group III) and 63 who received TA (group IV).Background
Patients and Methods
There are few studies of total knee replacements with cemented tibia and uncemented femur (hybrid). Previous studies have not shown any difference in revision rate between different fixation methods, but these studies had few hybrid prostheses. This study evaluates the results of hybrid knee replacements based on data from the Norwegian Arthroplasty Register (NAR). Primary total knee replacements without patella resurfacing, reported to the NAR during the years 1999–2009, were evaluated. Hinged-, posterior stabilized- and tumor prostheses were excluded. LCS- and Profix prostheses with conforming plus bearing were included. With the risk for revision at any cause as the primary end-point, 2945 hybrid knee replacements (HKR) were evaluated against 20838 cemented knee replacements (CKR). Kaplan-Meier survival analysis and Cox regression analysis with adjustment for age, sex and preoperative diagnosis were used.Background
Patients and Methods
The treatment of trochanteric and subtrochanteric fractures remains controversial, and new implants are constantly being developed trying to improve outcome and minimize the number of complications in these fractures. In Norway the Sliding Hip Screw(SHS), with or without a Trochanteric Stabilizing Plate (TSP), is still the most commonly used implant, but worldwide nailing of these fractures is increasing. This trend, however, has not been supported by documentation of better clinical results compared to the SHS in well designed studies. Therefore, in the present study we compared the recently launched Trigen Intertan nail (Smith and Nephew) with the SHS in the treatment of trochanteric and subtrochanteric fractures. In a prospective, randomized multicenter study with 697 patients, we compared the Trigen Intertan nail with the SHS regarding postoperative pain, functional mobility, complications, and reoperation rates. Patients older than 60 years with trochanteric and subtrochanteric fractures were included in 5 hospitals. At day 5, and 3 and 12 months postoperatively, pain was measured using a Visual Analogue Scale (VAS), and the Timed Up and Go-test (TUG-test) was performed to evaluate functional mobility. Complications and reoperations were recorded at discharge, and after 3 and 12 months.Introduction
Patients and Methods
Using data from the Norwegian Hip Fracture Register,
8639 cemented and 2477 uncemented primary hemiarthroplasties for
displaced fractures of the femoral neck in patients aged > 70 years
were included in a prospective observational study. A total of 218
re-operations were performed after cemented and 128 after uncemented
procedures. Survival of the hemiarthroplasties was calculated using
the Kaplan-Meier method and hazard rate ratios (HRR) for revision
were calculated using Cox regression analyses. At five years the
implant survival was 97% (95% confidence interval (CI) 97 to 97)
for cemented and 91% (95% CI 87 to 94) for uncemented hemiarthroplasties.
Uncemented hemiarthroplasties had a 2.1 times increased risk of
revision compared with cemented prostheses (95% confidence interval
1.7 to 2.6, p < 0.001). The increased risk was mainly caused
by revisions for peri-prosthetic fracture (HRR = 17), aseptic loosening
(HRR = 17), haematoma formation (HRR = 5.3), superficial infection
(HRR = 4.6) and dislocation (HRR = 1.8). More intra-operative complications,
including intra-operative death, were reported for the cemented
hemiarthroplasties. However, in a time-dependent analysis, the HRR
for re-operation in both groups increased as follow-up increased. This study showed that the risk for revision was higher for uncemented
than for cemented hemiarthroplasties.
In this prospective study we studied the effect
of the inclination angle of the acetabular component on polyethylene wear
and component migration in cemented acetabular sockets using radiostereometric
analysis. A total of 120 patients received either a cemented Reflection
All-Poly ultra-high-molecular-weight polyethylene or a cemented
Reflection All-Poly highly cross-linked polyethylene acetabular
component, combined with either cobalt–chrome or Oxinium femoral
heads. Femoral head penetration and migration of the acetabular
component were assessed with repeated radiostereometric analysis
for two years. The inclination angle was measured on a standard
post-operative anteroposterior pelvic radiograph. Linear regression
analysis was used to determine the relationship between the inclination
angle and femoral head penetration and migration of the acetabular component. We found no relationship between the inclination angle and penetration
of the femoral head at two years’ follow-up (p = 0.9). Similarly,
our data failed to reveal any statistically significant correlation
between inclination angle and migration of these cemented acetabular
components (p = 0.07 to p = 0.9).
194 of the THAs had articulations with an Alumina liner and a femoral head made of a composite of Alumina and Zirconium oxide ceramic (Biolox delta). This group had a median follow-up of only 1.1 years, and the group was therefore not included in the survival analyses. 2312 of the THAs were uncemented prostheses with Alumina-on-Alumina articulations, with a follow-up of 0–11 years (median 4.3 years). For further analyses we included only patients under the age of 80 years (n = 2209). We compared the two most common C-on-C cup/stem combinations: Igloo/Filler (n=1402) and Trilogy/SCP (n=363), and a group of others (n= 547). Further we compared the C-on-C prostheses with cemented Charnley prostheses in patients under the age of 80 years, operated during the same time-period. We also compared the C-on-C prostheses with Charnley prostheses in a group limited to patients under the age of 60 years. Prosthesis survival was estimated by Kaplan-Meier and Cox regression analyses adjusted for age and gender.
We wanted to investigate any differences in pain and function between the new Intertan nail and the Sliding Hip Screw in the early postoperative phase.
9,596 of the 280,201 primary THRs, had been revised. Ten-years survival was 91.9% (95% CI: 91.5 – 92.3) in Denmark, 93.9% (95% CI: 93.6–94.1) in Sweden, and 92.6% (95% CI: 92.3–93.0) in Norway. In Sweden and Norway 23% of revisions were due to dislocation, compared to 34% in Denmark. Replacement of only cup or liner constituted 29% of the revisions in Sweden, 33% in Norway, and 44% in Denmark.
The Norwegian Arthroplasty Register has shown that several designs of uncemented femoral stems give good or excellent survivorship. The overall findings for uncemented total hip replacement however, have been disappointing because of poor results with the use of metal-backed acetabular components. In this study, we exclusively investigated the medium-to long-term performance of primary uncemented metal-backed acetabular components. A total of 9113 primary uncemented acetabular components were implanted in 7937 patients between 1987 and 2007. These were included in a prospective, population-based observational study. All the implants were modular and metal-backed with ultra-high-molecular-weight polyethylene liners. The femoral heads were made of stainless steel, cobalt-chrome (CoCr) alloy or alumina ceramic. In all, seven different designs of acetabular component were evaluated by the Kaplan-Meier survivorship method and Cox regression analysis. Most acetabular components performed well up to seven years. When the endpoint was revision of the acetabular component because of aseptic loosening, the survival ranged between 87% and 100% at ten years. However, when the endpoint was revision for any reason, the survival estimates were 81% to 92% for the same implants at ten years. Aseptic loosening, wear, osteolysis and dislocation were the main reasons for the relatively poor overall performance of the acetabular components. Prostheses with alumina heads performed slightly better than those with stainless steel or CoCr alloy in subgroups. Whereas most acetabular components performed well at seven years, the survivorship declined with longer follow-up. Fixation was generally good. None of the metal-backed uncemented acetabular components with ultra-high-molecular-weight polyethylene liners in our study had satisfactory long-term results because of high rates of wear, osteolysis, aseptic loosening and dislocation.
There is an increased early postoperative mortality (operation risk) after joint replacement surgery. This mortality is normally associated with cardiovascular events, such as deep venous thrombosis, pulmonary embolism, and ischemic heart diseases. Our objective was to quantify the magnitude of the increased mortality and how long the mortality after an operation persists. We focused on the early postoperative mortality after surgery for total knee and total hip replacements from the national registries in Australia and Norway, which cover more than 95% of all operations in the two nations. Only osteoarthritis patients between 50 and 80 years of age were included. A total of 244.275 patients remained for analyses. Smoothed intensity curves were calculated for the early postoperative period. Effects of risk factors were studied using a non-parametric proportional hazards model. The mortality was highest immediately after the operation (~1 deaths per 10.000 patients per day), and it decreased until the 3rd postoperative week. The mortality was virtually the same for both nations and both joints. Mortality increased with age and was higher for males than for females. A possible reduction of early postoperative mortality is plausible for the immediate postoperative period, and no longer than the 3rd postoperative week.