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1.  Pelvic irradiation does not increase the risk of hip replacement in patients with gynecological cancer 
Acta Orthopaedica  2014;85(6):652-656.
Background and purpose —
Long-term survivors of cancer can develop adverse effects of the treatment. 60% of cancer patients survive for at least 5 years after diagnosis. Pelvic irradiation can cause bone damage in these long-term survivors, with increased risk of fracture and degeneration of the hip.
Patients and methods —
Analyses were based on linkage between the Cancer Registry of Norway (CRN) and the Norwegian Arthroplasty Register (NAR). All women who had been exposed to radiation for curative radiotherapy of gynecological cancer (40–60 Gy for at least 28 days) were identified in the CRN. Radiotherapy had been given between 1998 and 2006 and only patients who were irradiated within 6 months of diagnosis were included. The control group contained women with breast cancer who had also undergone radiotherapy, but not to the pelvic area. Fine and Gray competing-risk analysis was used to calculate subhazard-rate ratios (subHRRs) and cumulative incidence functions (CIFs) for the risk of having a prosthesis accounting for differences in mortality.
Results —
Of 962 eligible patients with gynecological cancer, 26 (3%) had received a total hip replacement. In the control group without exposure, 253 (3%) of 7,545 patients with breast cancer had undergone total hip replacement. The 8-year CIF for receiving a total hip replacement was 2.7% (95% CI: 2.6–2.8) for gynecological cancer patients and 3.0% (95% CI: 2.95–3.03) for breast cancer patients; subHRR was 0.80 (95% CI: 0.53–1.22; p = 0.3). In both groups, the most common reason for hip replacement was idiopathic osteoarthritis.
Interpretation —
We did not find any statistically significantly higher risk of undergoing total hip replacement in patients with gynecological cancer who had had pelvic radiotherapy than in women with breast cancer who had not had pelvic radiotherapy.
doi:10.3109/17453674.2014.963784
PMCID: PMC4259020  PMID: 25238432
2.  Total hip arthroplasty in young adults, with focus on Perthes' disease and slipped capital femoral epiphysis 
Acta Orthopaedica  2012;83(2):159-164.
Background and purpose
Pediatric hip diseases account for 9% of all primary hip arthroplasties in the Norwegian Arthroplasty Register. We wanted to validate the diagnosis as reported to the register and to assess the quality of life of these patients after hip replacement.
Patients and methods
540 patients accepted to participate in this follow-up study (634 hips). All were less than 40 years of age and had been reported to the Norwegian Arthroplasty Register as having undergone a primary total hip arthroplasty (THA) between 1987 and 2007. The underlying diagnosis, age at diagnosis, and type of treatment given prior to the hip replacement were recorded from the original hospital notes.
Results
The diagnoses reported to the Norwegian Arthroplasty Register were confirmed to be correct in 91% of all cases (538/592). For the 94 hips that had been treated due to Perthes' disease or slipped capital femoral epiphysis (SCFE), the diagnosis was verified in 95% of cases (89/94). The corresponding proportion for inflammatory hip disease was 98% (137/140) and it was only 61% for primary osteoarthritis (19/31). The self reported quality of life (EQ-5D) was poorer for these young patients with THA than for persons in age-matched cohorts from Great Britain and Sweden, except for those with an underlying SCFE.
Interpretation
The diagnoses reported to the Norwegian Arthroplasty Register as the underlying cause of THA were correct in 91% of cases. Individuals who undergo THA before the age of 40 have a reduced quality of life, except for those requiring a hip replacement because of SCFE.
doi:10.3109/17453674.2011.641105
PMCID: PMC3339530  PMID: 22112152
3.  Low infection rates after 34,361 intramedullary nail operations in 55 low- and middle-income countries 
Acta Orthopaedica  2011;82(6):737-743.
Background
The Surgical Implant Generation Network (SIGN) supplies intramedullary (IM) nails for the treatment of long bone fractures free of charge to hospitals in low- and middle-income countries (LMICs). Most operations are reported to the SIGN Online Surgical Database (SOSD). Follow-up has been reported to be low, however. We wanted to examine the pattern of follow-up and to assess whether infection rates could be trusted.
Patients and methods
The SOSD contained 36,454 IM nail surgeries in 55 LMICs. We excluded humerus and hip fractures, and fractures without a registered surgical approach. This left 34,361 IM nails for analysis. A generalized additive regression model (gam) was used to explore the association between follow-up rates and infection rates.
Results
The overall follow-up rate in the SOSD was 18.1% (95% CI: 17.7–18.5) and national follow-up rates ranged from 0% to 74.2%. The overall infection rate was 0.7% (CI: 0.6–0.8) for femoral fractures and 1.2% (CI: 1.0–1.4) for tibial fractures. If only nails with a registered follow-up visit were included (n = 6,224), infection rates were 3.5% (CI: 3.0–4.1) for femoral fractures and 7.3% (CI: 6.2–8.4) for tibial fractures. We found an increase in infection rates with increasing follow-up rates up to a level of 5%. Follow-up above 5% did not result in increased infection rates.
Interpretation
Reported infection rates after IM nailing in the SOSD appear to be reliable and could be used for further research. The low infection rates suggest that IM nailing is a safe procedure also in low- and middle-income countries.
doi:10.3109/17453674.2011.636680
PMCID: PMC3247895  PMID: 22066554
4.  Surgical procedures in the treatment of 784 infected THAs reported to the Norwegian Arthroplasty Register 
Acta Orthopaedica  2011;82(5):530-537.
Background and purpose
Controversies still exist regarding the best surgical procedure in the treatment of periprosthetic infection after total hip arthroplasty (THA). Based on data in the Norwegian Arthroplasty Register (NAR), we have compared the risk of re-revision after 4 different surgical procedures: 2-stage with exchange of the whole prosthesis, 1-stage with exchange of the whole prosthesis, major partial 1-stage with exchange of stem or cup, and minor partial 1-stage with exchange of femoral head and/or acetabular liner.
Methods
Between 1987 and 2009, 124,759 primary THAs were reported to the NAR, of which 906 (0.7%) were revised due to infection. Included in this study were the 784 revisions that had been performed by 1 of the 4 different surgical procedures. Cox-estimated survival and relative revision risks are presented with adjustment for differences among groups regarding gender, type of fixation, type of prosthesis, and age at revision.
Results
2-stage procedures were used in 283 revisions (36%), 1-stage in 192 revisions (25%), major partial in 129 revisions (17%), and minor partial in 180 revisions (23%). 2-year Kaplan-Meier survival for all revisions was 83%; it was 92% for those re-revised by 2-stage exchange procedure, 88% for those re-revised by 1-stage exchange procedure, 66% for those re-revised by major partial exchange procedure, and it was 76% for those re-revised by minor partial exchange. Compared to the 2-stage procedure and with any reason for revision as endpoint (180 re-revisions), the risk of re-revision increased 1.4 times for 1-stage (p = 0.2), 4.1 times for major partial exchange (p < 0.001), and 1.5 times for minor partial exchange (p = 0.1). With infection as the endpoint (108 re-revisions), the risk of re-revision increased 2.0 times for 1-stage exchange (p = 0.04), 6.0 times for major partial exchange (p < 0.001), and 2.3 times for minor partial exchange (p = 0.02). Similar results were found when the analyses were restricted to the period 2002–2009.
Interpretation
In the Norwegian Arthroplasty Register, the survival after revision of infected primary THA with 2-stage implant exchange was slightly superior to that for 1-stage exchange of the whole prosthesis. This result is noteworthy, since 2-stage procedures are often used with the most severe infections. However, debridement with exchange of head and/or liner but with retention of the fixed implant (minor revision) meant that there was a 76% chance of not being re-revised within 2 years.
doi:10.3109/17453674.2011.623572
PMCID: PMC3242948  PMID: 21992085
5.  In situ fixation of slipped capital femoral epiphysis with Steinmann pins 
Acta Orthopaedica  2011;82(3):333-338.
Background and purpose
Slipped capital femoral epiphysis (SCFE) is often treated by surgical fixation; however, no agreement exists regarding technique. We analyzed the outcome of in situ fixation with Steinmann pins.
Patients and methods
All 67 subjects operated for slipped capital femoral epiphysis at Haukeland University Hospital during the period 1990–2007 were included. All were treated by in situ fixation with 2 or 3 parallel Steinmann pins (8 mm threads at the medial end). The follow-up evaluation consisted of clinical examination and hip radiographs. Radiographic outcome was based on measurements of slip progression, growth of the femoral neck, leg length discrepancy, and signs of avascular necrosis and chondrolysis.
Results
67 subjects (41 males) were operated due to unilateral slips (n = 47) or bilateral slips (n = 20). Mean age at time of diagnosis was 13 (7.2–16) years. Mean age at follow-up was 19 (14–30) years, with a mean postoperative interval of 6.0 (2–16) years. The operated femoral neck was 9% longer at skeletal maturity than at surgery, indicating continued growth of the femoral neck. At skeletal maturity, 12 subjects had radiographic features suggestive of a previous asymptomatic slip of the contralateral hip. The total number of bilateral cases of SCFE was 32, i.e half of the children had bilateral SCFE. 3 subjects required additional surgery and mild avascular necrosis of the femoral head was seen in 1 patient. None had slip progression or chondrolysis.
Interpretation
In situ pinning of SCFE with partly threaded Steinmann pins appears to be a feasible and safe method, with few complications. The technique allows further growth of the femoral neck.
doi:10.3109/17453674.2011.579520
PMCID: PMC3235312  PMID: 21504367
6.  Total hip replacement in young adults with hip dysplasia 
Acta Orthopaedica  2011;82(2):149-154.
Background and purpose
Dysplasia of the hip increases the risk of secondary degenerative change and subsequent total hip replacement. Here we report on age at diagnosis of dysplasia, previous treatment, and quality of life for patients born after 1967 and registered with a total hip replacement due to dysplasia in the Norwegian Arthroplasty Register. We also used the medical records to validate the diagnosis reported by the orthopedic surgeon to the register.
Methods
Subjects born after January 1, 1967 and registered with a primary total hip replacement in the Norwegian Arthroplasty Register during the period 1987–2007 (n = 713) were included in the study. Data on hip symptoms and quality of life (EQ-5D) were collected through questionnaires. Elaborating information was retrieved from the medical records.
Results
540 of 713 patients (76%) (corresponding to 634 hips) returned the questionnaires and consented for additional information to be retrieved from their medical records. Hip dysplasia accounted for 163 of 634 hip replacements (26%), 134 of which were in females (82%). Median age at time of diagnosis was 7.8 (0–39) years: 4.4 years for females and 22 years for males. After reviewing accessible medical records, the diagnosis of hip dysplasia was confirmed in 132 of 150 hips (88%).
Interpretation
One quarter of hip replacements performed in patients aged 40 or younger were due to an underlying hip dysplasia, which, in most cases, was diagnosed during late childhood. The dysplasia diagnosis reported to the register was correct for 88% of the hips.
doi:10.3109/17453674.2011.566146
PMCID: PMC3235283  PMID: 21434808

Results 1-6 (6)