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1.  Results of 189 wrist replacements 
Acta Orthopaedica  2011;82(4):405-409.
Background and purpose
There is very little literature on the long-term outcome of wrist replacements. The Norwegian Arthroplasty Register has registered wrist replacements since 1994. We report on the total wrist replacements and their revision rates over a 16-year period.
Material and methods
189 patients with 189 primary wrist replacements (90 Biax prostheses (80 of which were cementless), 23 cementless Elos prostheses, and 76 cementless Gibbon prostheses), operated during the period 1994–2009 were identified in the Norwegian Arthroplasty Register. Prosthesis survival was analyzed using Cox regression analyses. The 3 implant designs were compared and time trends were analyzed.
The 5-year survival was 78% (95% CI: 70–85) and the 10-year survival was 71% (CI: 59–80). Prosthesis survival was 85% (CI: 78–93) at 5 years for the Biax prosthesis, 77% (CI: 30–90) at 4 years for the Gibbon prosthesis, and 57% (CI: 33–81) at 5 years for the Elos prosthesis. There was no statistically significant influence of age, diagnosis, or year of operation on the risk of revision, but females had a higher revision rate than males (RR = 3, CI: 1–7). The number of wrist replacements performed due to osteoarthritis increased with time, but no such change was apparent for inflammatory arthritis.
The survival of the total wrist arthroplasties studied was similar to that in other studies of wrist arthroplasties, but it was still not as good as that for most total knee and hip arthroplasties. However, a failed wrist arthroplasty still leaves the option of a well-functioning arthrodesis.
PMCID: PMC3237028  PMID: 21657971
2.  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.
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.
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.
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.
PMCID: PMC3216073  PMID: 21110699
3.  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.
PMCID: PMC2823234  PMID: 19297791
4.  External fixation of fractures of the distal radius 
Acta Orthopaedica  2009;80(1):104-108.
Background and purpose External fixators allowing movement during fracture healing are commonly used for treatment of unstable distal radius fractures. The dynamic Dynawrist fixator with the distal pins in metacarpal bone may avoid fixation problems in comminuted fractures and may reduce the risk of nerve injury. We compared anatomical and functional outcome for the well-established Hoffmann compact II non-bridging fixator and for the Dynawrist fixator.
Patients and methods 75 patients with unstable distal radius fractures were randomized to treatment with either the Hoffman compact II fixator (the H-group) or the Dynawrist fixator (the D-group). Anatomical and functional variables were recorded preoperatively, postoperatively, and at 6, 12, 24, and 52 weeks. Pain was assessed using the VAS score and function was assessed using DASH score.
Results Postoperatively, radial tilt, inclination, and radial length all improved statistically significantly in both groups. At time of removal of the fixators, the H group had superior volar radial tilt. At the 52-week follow-up, there were no statistically significant differences between the groups regarding anatomical variables. At 6 weeks, flexion was greater in the D group but at 12, 24, and 52 weeks flexion was similar in the two groups, as were the other wrist and forearm movements. There were no statistically significant differences between the groups according to VAS and DASH scores. 3 nerve injuries occurred in the H group and 1 in the D group (p = 0.4), all of which were transient.
Interpretation The Dynawrist bridging but dynamic fixator gives radiographic and functional outcome similar to that of the Hoffman II compact non-bridging fixator.
PMCID: PMC2823232  PMID: 19234890

Results 1-4 (4)