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1.  Pain and function in eight hundred and fifty nine patients comparing shoulder hemiprostheses, resurfacing prostheses, reversed total and conventional total prostheses 
International Orthopaedics  2012;37(1):59-66.
Purpose
Functional results of reversed total prostheses (RTP) have—to a very limited degree—been compared with those of other shoulder prosthesis types. The aim of our study was to compare results of four different types of shoulder prostheses in terms of function, pain, and quality of life (QoL).
Methods
Questionnaires were completed by 859 patients with shoulder prostheses registered in the Norwegian Arthroplasty Register. Patients with osteoarthritis (OA), rheumatoid arthritis (RA), or fracture sequela (FS) were included. Symptoms and function were assessed using the Oxford Shoulder Score (OSS, scale 0–48), and the EuroQoL-5D (EQ-5D) was used to assess QoL.
Results
Best functional results were obtained using conventional total prostheses (TPs) and RTPs —mean OSS improvement 18 and 16 units, respectively, vs 11 with hemiprostheses (HPs). For patients with OA, TPs performed best; for those with RA and FS, RTPs performed best; and those with HPs had the worst results in all diagnostic groups. The greatest improvement in QoL was seen in patients with TPs and RTPs.
Conclusions
Conventional TPs provide the best improvement in pain, function and QoL in OA patients; RTPs are superior in patients with RA and FS.
doi:10.1007/s00264-012-1722-3
PMCID: PMC3532636  PMID: 23229798
2.  Good function after shoulder arthroplasty 
Acta Orthopaedica  2012;83(5):467-473.
Background and purpose
Different results after shoulder arthroplasty have been found for different diagnostic groups. We evaluated function, pain, and quality of life after shoulder arthroplasty in 4 diagnostic groups.
Patients and methods
Patients with shoulder arthroplasties registered in the Norwegian Arthroplasty Register from 1994 through 2008 were posted a questionnaire in 2010. 1,107 patients with rheumatoid arthritis (RA), osteoarthritis (OA), acute fracture (AF), or fracture sequela (FS) returned completed forms (65% response rate). The primary outcome measure was the Oxford shoulder score (OSS), which assesses symptoms and function experienced by the patient on a scale from 0 to 48. A secondary outcome measure was the EQ-5D, which assesses life quality. The patients completed a questionnaire concerning symptoms 1 month before surgery, and another concerning the month before they received the questionnaire.
Results
Patients with RA and OA had the best results with a mean improvement in OSS of 16 units, as opposed to 11 for FS patients. Both shoulder pain and function had improved substantially. The change in OSS for patients with AF was negative (–11), but similar end results were obtained for AF patients as for RA and OA patients. Quality of life had improved in patients with RA, OA, and FS.
Interpretation
Good results in terms of pain relief and improved level of function were obtained after shoulder arthroplasty for patients with RA, OA, and—to a lesser degree—FS. A shoulder arthropathy had a major effect on quality of life, and treatment with shoulder replacement substantially improved it.
doi:10.3109/17453674.2012.720118
PMCID: PMC3488172  PMID: 22950481
3.  Improved results of primary total hip replacement 
Acta Orthopaedica  2010;81(6):649-659.
Background and purpose
Over the past 20 years, several changes in treatment policy and treatment options have taken place regarding hip replacement. For this reason, we wanted to investigate the results after hip replacement in terms of revision rate, during a 21-year period among hip replacements reported to the Norwegian Arthroplasty Register.
Methods
110,882 primary total hip replacements were reported to the Norwegian Arthroplasty Register from 1987 through 2007. Risk of revision during the time periods 1993–1997, 1998–2002, and 2003–2007 was compared to that of the reference period 1987–1992. Adjusted Cox regression analyses were performed to compare the risk of revision in different time periods and extended analyses were done to investigate revision within the first postoperative year and after the first year.
Results
There was an overall reduced risk of revision in the time periods 1993–1997, 1998–2002, and 2003–2007 compared to the reference period: RR = 0.81 (95% CI 0.77–0.86), 0.51 (CI 0.47–0.55), and 0.77 (CI 0.68–0.85), respectively. The improved results were due to a marked reduction in aseptic loosening of the femoral and acetabular components in all time periods and in all subgroups of prostheses. A change in the timing of revision took place, with more early revisions and fewer late revisions in the later time periods. Revision due to dislocation and infection increased over time.
Interpretation
The risk of revision decreased during the study period, due to fewer cases of aseptic loosening of prosthetic components. The best results were obtained with the use of cemented prostheses. Prevention of dislocation and infection should be a major goal in the future, as revision due to these causes increased during the study period.
doi:10.3109/17453674.2010.537807
PMCID: PMC3216073  PMID: 21110699
4.  Risk factors for revision after shoulder arthroplasty 
Acta Orthopaedica  2009;80(1):83-91.
Background and purpose Previous studies on shoulder arthroplasty have usually described small patient populations, and few articles have addressed the survival of shoulder implants. We describe the results of shoulder replacement in the Norwegian population (of 4.7 million) during a 12-year period. Trends in the use of shoulder arthroplasty during the study period were also investigated.
Patients and methods 1,531 hemiprostheses (HPs), 69 total shoulder replacements (Neer type TSR), and 225 reversed total shoulder replacement (reversed TSR) operations were reported to the Norwegian Arthroplasty Register between 1994 and 2005. Kaplan-Meier failure curves were drawn up for particular subgroups of patients, and revision rates were calculated using Cox regression analysis.
Results The 5- and 10-year failure rates of hemiprostheses were 6% (95% CI: 5–7) and 8% (95% CI: 6–10), and for reversed total shoulder replacements they were 10% (95% CI: 5–15) and 22% (95% CI: 10–33), respectively. For hemiprostheses, the risk of revision for patients who were 70 years or older was half that of those who were younger (RR = 0.47, CI: 0.28–0.77), while the risk of revision was highest for patients with sequelae after fracture compared to those with acute fractures (RR = 3.3, CI: 1.5–7.2). No differences in prosthesis survival were found between the different hemiprosthesis brands. The main reasons for revision of hemiprostheses were pain and luxation. For reversed total prostheses, the risk of revision was less for women than for men (RR = 0.26, CI: 0.11–0.63), and the main cause of revision was aseptic loosening of the glenoid component. During the study period, the incidence of shoulder arthroplasty increased for all diagnostic groups except inflammatory arthritis, for which a decrease was seen.
Interpretation We found good results in terms of 5-year prosthesis failure rate, with the use of hemiarthroplasty for patients with inflammatory arthritis, osteoarthritis, and acute fractures. Reversed total shoulder replacement was associated with a rather poor prognosis.
doi:10.1080/17453670902805098
PMCID: PMC2823234  PMID: 19297791

Results 1-4 (4)