Return to work after lumbar disc herniation surgery : an occupational cohort study

Background and purpose - Lumbar disc herniation is a common surgically treated condition in the working-age population. We assessed health-related risk factors for return to work (RTW) after excision of lumbar disc herniation. Previous studies on the subject have had partly contradictory findings. Patients and methods - RTW of 389 (n = 111 male, n = 278 female; mean age 46 years, SD 8.9) employees who underwent excision of lumbar disc herniation was assessed based on the Finnish Public Sector Study (FPS). Baseline information on occupation, preceding health, and health-risk behaviors was derived from linkage to national health registers and FPS surveys before the operation. The likelihood of RTW was analyzed using Cox proportional hazard univariable and multivariable modelling. Results - 95% of the patients had returned to work at 12 months after surgery, after on average 78 days of sickness absence. Faster RTW in the univariable Cox model was associated with a small number of sick leave days (< 30 days) before operation (HR 1.3, 95% CI 1.1-1.6); high occupational position (HR 1.6, CI 1.2-2.1); and age under 40 years (HR 1.5, CI 1.1-1.9). RTW was not associated with sex or the health-related risk factors obesity, physical inactivity, smoking, heavy alcohol consumption, poor self-rated health, psychological distress, comorbid conditions, or purchases of pain or antidepressant medications in either the univariable or multivariable model. Interpretation - Almost all employees returned to work after excision of lumbar disc herniation. Older age, manual job, and prolonged sick leave before the excision of lumbar disc herniation were risk factors for delayed return to work after the surgery.Peer reviewe

PET/CT to detect adverse reactions to metal debris in patients with metal-on-metal hip arthroplasty: an exploratory prospective study

Metal-on-metal (MoM) bearings in total hip arthroplasties and hip resurfacing arthroplasties have recently shown a new type of complication: adverse reactions to metal debris (ARMD). ARMD is characterized by local severe inflammation and tissue necrosis leading to implant failures. The gluteal muscle region is important for the patient outcome after revision surgery. This prospective positron emission tomography/computed tomography (PET/CT) study was undertaken to evaluate the characteristics of 2-deoxy-2-[18 F]fluoro-d-glucose ([18 F]FDG) and [68 Ga]Gallium citrate ([68 Ga]Citrate) PET/CT in ARMD patients. [18 F]FDG and [68 Ga]Citrate PET/CT were performed in 18 hip arthroplasty patients: 12 ARMD patients (with 16 MoM hips) and six arthroplasty controls without ARMD. Tracer uptake was evaluated visually, and maximum standardized uptake (SUVmax ) was measured in the gluteal muscle region. ARMD severity was graded by metal artefact reduction sequence-magnetic resonance imaging (MARS-MRI). Periprosthetic [18 F]FDG uptake was observed in 15 of 16 hips, [68 Ga]Citrate uptake in three of 16 hips, respectively. The distribution of tracer uptake resembled infection in three hips. In the gluteal muscle region, the SUVmax of [18 F]FDG was significantly greater in hips with moderate and severe ARMD compared with the controls (P = 0·009 for [18 F]FDG and P = 0·217 for [68 Ga]Citrate). In patients who needed revision surgery, an intraoperative finding of gluteal muscle necrosis was associated with increased local SUVmax as detected by preoperative [18 F]FDG (P = 0·039), but not by [68 Ga]Citrate (P = 0·301). In conclusion, the inflammatory reaction to metal debris in hip arthroplasty patients is best visualized with [18 F]FDG

Implant survival of constrained acetabular device in primary total hip arthroplasty based on data from the Finnish Arthroplasty Register

Background: Constrained acetabular devices were developed to prevent dislocations after total hip arthroplasty (THA). However, the data on their success have been contradictory. In this study, we aimed to assess implant survival of the constrained acetabular device in primary THA based on the Finnish Arthroplasty Register data. Methods: A total of 373 primary THAs with constrained acetabular devices inserted from 2006 to 2017 were included. A reference group was formed on a 1:3 basis and matched for age, sex, and diagnosis, consisting of 1118 conventional THAs. Implant survival estimates using death as a competing risk were assessed with revision for any reason and for any aseptic reason as the endpoints. The Cox multiple regression models were adjusted for age, sex, and diagnosis. The mean follow-up time was 3.3 (0-12.4) years for the constrained device group and 3.8 (0-12.0) years for the reference group. Results: Overall, there were 21 revisions in the constrained device group and 49 in the reference group. The 8-year survivorship for any reason was 94% (confidence interval [CI]: 91-96) for the constrained device group and 93% (CI: 89-97) for the reference group. With revision for any aseptic reason as the endpoint, the 8-year survivorships were 97% (CI: 95-99) and 94% (CI: 90-98), respectively. During the first 1.5 years, the constrained acetabular device group had a similar revision risk (hazard ratio: 1.09 [CI: 0.57-2.07], P = .8) to that of the reference group. Conclusion: The constrained acetabular device had good survival in primary THA, and our results support its continued use even in high-risk patients. (C) 2019 The Authors. Published by Elsevier Inc.Peer reviewe

Long-term blood metal ion levels and clinical outcome after Birmingham hip arthroplasty

Background and objective: Our aim was to assess long-term metal ion level changes and clinical outcome in patients with a Birmingham hip arthroplasty. Methods: For the purpose of this study, we identified all BHR hip resurfacing arthroplasty (HRA) and total hip arthroplasty (THA) operations performed in Turku University Hospital. A random coefficient model was used to compare the change between the first and last metal ion measurement. A Kaplan-Meier estimator was used to assess the survivorship of the BHR HRA and BHR THA with metal related adverse events (pseudotumor, elevated metal ions above the safe upper limit, revision due to metallosis), or revision due to any reason as endpoints with 95% confidence intervals (CIs). Results: BHR HRA was used in 274 hips (233 patients). In addition, we identified 38 BHR-Synergy THAs (38 patients). Operations were performed between 2003 and 2010. Median follow-up time was 14 years for BHR HRA (range: 0.6-17) and 11 years for BHR THA (range: 4.7-13). In the BHR HRA group, geometric means of Cr and Co levels decreased from 2.1 to 1.6 ppb and 2.4 to 1.5 ppb, respectively, during a 3.0-year measurement interval. Metal ion levels in the BHR THA group did not show notable increase. The survivorship of BHR HRA was 66% in 16 years and 34% for BHR THA at 12 years for any metal-related adverse event. Conclusions: Patients with a Birmingham hip device do not seem to benefit from frequent repeated metal ion measurements. The amount of patients with metal-related adverse events was relatively high, but many of them did not require surgery

Repeated metal ion measurements and long-term outcome of Durom/MMC total hip arthroplasty

Background and purpose — Data regarding long-term behavior of metal ion levels in metal-on-metal total hip arthroplasty (MoM THA) patients is scarce. Therefore, we assessed whether there is any change in whole blood (WB) chromium (Cr), and cobalt (Co) ion measurements in Durom and MMC MoM THA patients over time. The secondary aim was to report the clinical outcomes using these devices in a single district.Patients and methods — Durom and MMC cups were used in 249 MoM THAs from 2005 to 2011 in our district. Median follow-up time was 12 years for Durom THA (interquartile range [IQR] = 3) and 9 years for MMC THA (IQR = 1). A random coefficient model was used to compare individual differences in repeated WB Cr and Co ion measurements. The Kaplan–Meier estimator was used to analyze implant survival with any reason for revision as the endpoint.Results — Geometric means of Cr in Durom THA and MMC THA patients decreased from 2.2 ppb (geometric standard deviation [SD] = 1.9) to 1.5 ppb (geometric SD = 2.5, pInterpretation — WB Cr levels decreased over time, and Co levels remained unchanged at long-term follow-up. Despite this we recommend continuing the follow-up of these devices due to relatively low implant survival. </p

Short-term survival of cementless Oxford unicondylar knee arthroplasty based on the Finnish Arthroplasty Register

Background: Cementless unicondylar knee arthroplasty (UKA) was introduced to secure longterm fixation and reduce the risk of revision. Experience with cementless UKA fixation is limited. Methods: The short-term survival (up to five years) of cementless Oxford UKA was assessed using data from the Finish Arthroplasty Register and was compared with that of cemented Oxford 3 UKA and total knee arthroplasty (TKA). Datawere obtained, from the Finnish Arthroplasty Register, on 1076 cementless Oxford UKAs and 2279 cemented Oxford 3 UKAs performed for primary osteoarthritis in 2005-2015. The Kaplan-Meier method, with revision for any reason as the endpoint, was used to assess the survival of these two UKA groups, and the results were compared with that of 65,563 cemented TKAs treated for primary osteoarthritis over the same period. The risk of revision of both Oxford prostheses was compared using Cox regression model, with adjustment for age and sex, with the cemented TKA group as reference. Results: The three-year survival was 93.7% for the cementless Oxford, 922% for the cemented Oxford 3, and 97.3% for the cemented TKA. The corresponding figures at five years were 92.3%, 88.9%, and 96.6%, respectively. The revision rate for both the cementless Oxford and the cemented Oxford 3 was significantly increased when compared with the cemented TKA (P <0.001). Conclusions: The survival of the cementless Oxford method was higher than that of the cemented Oxford 3 in the short term. The overall survival of Oxford UKA was poor in comparison with contemporary TKAs. (C) 2019 Elsevier B.V. All rights reserved.Peer reviewe

Return to work after lumbar disc herniation surgery: an occupational cohort study

Background and purpose - Lumbar disc herniation is a common surgically treated condition in the working-age population. We assessed health-related risk factors for return to work (RTW) after excision of lumbar disc herniation. Previous studies on the subject have had partly contradictory findings. Patients and methods - RTW of 389 (n = 111 male, n = 278 female; mean age 46 years, SD 8.9) employees who underwent excision of lumbar disc herniation was assessed based on the Finnish Public Sector Study (FPS). Baseline information on occupation, preceding health, and health-risk behaviors was derived from linkage to national health registers and FPS surveys before the operation. The likelihood of RTW was analyzed using Cox proportional hazard univariable and multivariable modelling. Results - 95% of the patients had returned to work at 12 months after surgery, after on average 78 days of sickness absence. Faster RTW in the univariable Cox model was associated with a small number of sick leave days (< 30 days) before operation (HR 1.3, 95% CI 1.1-1.6); high occupational position (HR 1.6, CI 1.2-2.1); and age under 40 years (HR 1.5, CI 1.1-1.9). RTW was not associated with sex or the health-related risk factors obesity, physical inactivity, smoking, heavy alcohol consumption, poor self-rated health, psychological distress, comorbid conditions, or purchases of pain or antidepressant medications in either the univariable or multivariable model. Interpretation - Almost all employees returned to work after excision of lumbar disc herniation. Older age, manual job, and prolonged sick leave before the excision of lumbar disc herniation were risk factors for delayed return to work after the surgery

Hydroxyapatite coating does not improve uncemented stem survival after total hip arthroplasty!: An analysis of 116,069 THAs in the Nordic Arthroplasty Register Association (NARA) database

Background and purpose — It is still being debated whether HA coating of uncemented stems used in total hip arthroplasty (THA) improves implant survival. We therefore investigated different uncemented stem brands, with and without HA coating, regarding early and long-term survival. Patients and methods — We identified 152,410 THA procedures using uncemented stems that were performed between 1995 and 2011 and registered in the Nordic Arthroplasty Register Association (NARA) database. We excluded 19,446 procedures that used stem brands less than 500 times in each country, procedures performed due to diagnoses other than osteoarthritis or pediatric hip disease, and procedures with missing information on the type of coating. 22 stem brands remained (which were used in 116,069 procedures) for analysis of revision of any component. 79,192 procedures from Denmark, Norway, and Sweden were analyzed for the endpoint stem revision. Unadjusted survival rates were calculated according to Kaplan-Meier, and Cox proportional hazards models were fitted in order to calculate hazard ratios (HRs) for the risk of revision with 95% confidence intervals (CIs). Results — Unadjusted 10-year survival with the endpoint revision of any component for any reason was 92.1% (CI: 91.8–92.4). Unadjusted 10-year survival with the endpoint stem revision due to aseptic loosening varied between the stem brands investigated and ranged from 96.7% (CI: 94.4–99.0) to 99.9% (CI: 99.6–100). Of the stem brands with the best survival, stems with and without HA coating were found. The presence of HA coating was not associated with statistically significant effects on the adjusted risk of stem revision due to aseptic loosening, with an HR of 0.8 (CI: 0.5–1.3; p = 0.4). The adjusted risk of revision due to infection was similar in the groups of THAs using HA-coated and non-HA-coated stems, with an HR of 0.9 (CI: 0.8–1.1; p = 0.6) for the presence of HA coating. The commonly used Bimetric stem (n = 25,329) was available both with and without HA coating, and the adjusted risk of stem revision due to aseptic loosening was similar for the 2 variants, with an HR of 0.9 (CI: 0.5–1.4; p = 0.5) for the HA-coated Bimetric stem. Interpretation — Uncemented HA-coated stems had similar results to those of uncemented stems with porous coating or rough sand-blasted stems. The use of HA coating on stems available both with and without this surface treatment had no clinically relevant effect on their outcome, and we thus question whether HA coating adds any value to well-functioning stem designs.publishedVersio

Preoperative Posterior Tilt Increases the Risk of Later Conversion to Arthroplasty After Osteosynthesis for Femoral Neck Fracture

BackgroundFemoral neck fractures (FNFs) are one of the most common injuries in the elderly. Treatment is either internal fixation or primary arthroplasty. The main aim of this study is to assess the risk factors associated with fixation failure leading to further arthroplasty in FNFs treated with cannulated screws.MethodsData on internal fixations of FNFs performed at Turku University Hospital between January 1, 2012 and December 31, 2017 were collected retrospectively from the patient database. Radiographical measurements were performed for preoperative displacement and posterior tilt, postoperative displacement, reduction quality, and implant shaft angle.ResultsAltogether 301 cases were included in the study. The overall reoperation rate was 25% and conversion to arthroplasty was performed in 16% of cases. In the multiple variant analysis, adjusted for age and gender, nondisplaced fractures with a 0°-20° preoperative posterior tilt had a significantly lower risk of later conversion to arthroplasty than did nondisplaced fractures with a ≤0° or ≥20° posterior tilt (odds ratio [OR] 4.0, 95% confidence interval [Cl] 1.8-8.6, P = .0005) and displaced fractures (OR 7.2, 95% CI 3.0-17.4, P P = .2).ConclusionDisplaced fractures and fractures with a preoperative posterior tilt of 20° or Keywordsinternal fixationarthroplastyreoperationfixation failureposterior tiltfemoral neck fracture</div