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World Journal of Orthopedics 2018年第10期9卷 220-228页

作者： Madeline Therese Kudibal Thomas Kallemose anders troelsen Henrik Husted Kirill Gromov Department of Orthopedic Surgery Copenhagen University Hospital Hvidovre Clinical Research Centre Copenhagen University Hospital Hvidovre

AIM To investigate whether minority ethnicity and the duration of education influence preoperative disability and expectations in patients undergoing total knee *** We prospectively included 829 patients undergoing primary unilateral total knee arthroplasty(TKA) from April 2013 to December 2014 at a single centre. Patients filled in pre-operative questionnaires with information regarding place of birth, duration of education, expectations for outcome of surgery and baseline characteristics. Patients were stratified based on ethnicity. Majority ethnicity was defined as born inthe study country and minority ethnicity was defined as born in any other country. Similarly, patients were stratified based on duration of education in groups defined as 12 years, *** We found that 92.2% of patients were of majority ethnicity. We found that 24.5%, 44.8% and 30.8% of patients had an education of 12 years, respectively. The mean preoperative(preOP) oxford knee score(OKS) in the total population was 23.6. Patients of minority ethnicity had lower mean pre-OP OKS(18.6 vs 23.9, P 12 years education had lower mean pre-OP OKS(21.5 vs 23.8 and 24.6, P 12 years education reported higher pain compared to patients with shorter educations. However, the response-rate was low(44.6%), and therefore post-OP results were not considered to be *** Minority ethnicity and the duration of education influ-ence preoperative disability and expectation in

关键词： Socioeconomic factors Ethnicity Education Expectations to surgery Preoperative disability Total knee arthroplasty

Knee awareness and functionality after simultaneous bilateral vs unilateral total knee arthroplasty

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World Journal of Orthopedics 2016年第3期7卷 195-201页

作者： Roshan Latifi Morten Grove Thomsen Thomas Kallemose Henrik Husted anders troelsen Department of Orthopedic Surgery Copenhagen University Hospital Hvidovre Clinical Research Center Copenhagen University Hospital Hvidovre

AIM: To investigate knee awareness and functional outcomes in patients treated with simultaneous bilateral vs unilateral total knee arthroplasty(TKA).METHODS: Through a database search, we identified 210 patients who had undergone unilateral TKA(UTKA) and 65 patients who had undergone simultaneous bilateral TKA(SBTKA) at our institution between 2010 and 2012. All TKAs were cemented and cruciate retaining. The mean follow-up period was 3.2(2 to 4) years. All the patients had symptomatic and debilitating unilateral or bilateral osteoarthritis for which all conservative and non-surgical treatments were failed, thus preoperatively the patients had poor functionality. All patients were asked to complete Forgotten Joint Score(FJS) and Oxford Knee Score(OKS) questionnaires. The patients were matched according to age, gender, year of surgery, Kellgren-Lawrence score and pre- andpostoperative overall knee alignment. The FJS and OKS questionnaire results of the two groups were then compared. RESULTS: A mixed-effects model was used to analyze differences between SBTKA and UTKA. OKS: The mean difference in the OKS between the patients who had undergone SBTKA and those who had undergone UTKA was 1.5, which was not statistically significant(CI =-0.9:4.0, P-value = 0.228). The mean OKS of the SBTKA patients was 37.6(SD = 9.0), and the mean OKS of the UTKA patients was 36.1(SD = 9.9). FJS: The mean difference in the FJS between the patients who had undergone SBTKA and those who had undergone UTKA was 2.3, which was not statistically significant(CI =-6.2:10.8, P-value = 0.593). The mean FJS of the SBTKA patients was 59.9(SD = 27.5), and the mean FJS of the UTKA patients was 57.5(SD = 28.8). CONCLUSION: SBTKA and UTKA patients exhibited similar joint functionality and knee awareness. Our results support the use of SBTKA in selected patients suffering from clinically symptomatic bilateral osteoarthritis.

关键词： Unilateral total knee arthroplasty Knee awareness Patient-reported outcomes Simultaneous bilateral total knee arthroplasty Forgotten Joint Score

Early clinical outcome and learning curve following unilateral primary total knee arthroplasty after introduction of a novel total knee arthroplasty system

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World Journal of Orthopedics 2020年第10期11卷 431-441页

作者： Adam Omari anders troelsen Henrik Husted Christian Skovgaard Nielsen Kirill Gromov Department of Orthopedic Surgery Copenhagen University Hvidovre HospitalCopenhagen 2650Denmark Department of Orthopedic Surgery Copenhagen University Hospital HvidovreCopenhagen 2650Denmark

BACKGROUND New implants for total knee arthroplasty(TKA)are continuously introduced with the proposed benefit of increased performance and improved *** information exists on how the introduction of a novel arthroplasty implant affects the perioperative and surgical outcome immediately after *** To investigate how surgery-related factors and implant positioning were affected by the introduction of a novel TKA *** A novel TKA system was introduced at our institution on 30th November ***-five TKAs performed with the Persona TKA immediately following its introduction by 3 different surgeons(25 TKAs/surgeon)were identified as the Introduction ***,the latest 25 TKAs performed by each surgeon prior to introduction of the Persona TKA were identified as the Control Group.A Follow-up Group of 25 TKAs/surgeon was identified starting 1-year after the end of the introduction ***,surgery-related factors and alignment data were recorded,and intergroup differences *** Following introduction of the novel implant,Persona TKA was utilized in 69%(71%),53%(54%),and 45%(75%)of primary TKA procedures by the three surgeons,respectively(Follow-up Group).Mean surgery time was increased by 28%(P<0.0001)and mean intra-operative blood loss by 25%(P=0.002)in the Introduction Group,while only the mean surgery time was increased in the Follow-up Group by 18%(P<0.0001).Overall alignment was similar between the groups apart from femoral flexion(FF)and tibial slope(TS).The number of FF outliers was reduced in the Introduction Group with a more pronounced decrease in the Follow-up *** Introduction of the new TKA implant increased surgical time and intraoperative blood loss immediately after its *** differences diminished one year after introduction of the new *** outliers with respect to FF and TS were seen when using the novel TKA *** studies are needed to investigat

关键词： Total knee arthroplasty Early outcome Novel introduction Implant positioning Knee Component choice

Surgical apgar score predicts early complication in transfemoral amputees:Retrospective study of 170 major amputations

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World Journal of Orthopedics 2016年第12期7卷 832-838页

作者： Christian Wied Nicolai B Foss Morten T Kristensen Gitte Holm Thomas Kallemose anders troelsen Department of Orthopedic Surgery Copenhagen University Hospital Hvidovre Department of Anesthesiology and Intensive Care Copenhagen University Hospital Hvidovre Physical Medicine and Rehabilitation Research-Copenhagen Department of Physical TherapyCopenhagen University Hospital Hvidovre Clinical Research Centre Copenhagen University Hospital Hvidovre

AIM To assess whether the surgical apgar score(SAS) is a prognostic tool capable of identifying patients at risk of major complications following lower extremity amputations *** This was a single-center,retrospective observational cohort study conducted between January 2013 and April 2015. All patients who had either a primary transtibial amputation(TTA) or transfemoral amputation(TFA) conducted at our institution during the study period were assessed for inclusion. All TTA patients underwent a standardized one-stage operative procedure(ad modum Persson amputation) performed approximately 10 cm below the knee joint. All TTA procedures were performedwith sagittal flaps. TFA procedures were performed in one stage with amputation approximately 10 cm above the knee joint,performed with anterior/posterior flaps. Trained residents or senior consultants performed the surgical procedures. The SAS is based on intraoperative heart rate,blood pressure and blood loss. Intraoperative parameters of interest were collected by revising electronic health records. The first author of this study calculated the SAS. Data regarding major complications were not revealed to the author until after the calculation of SAS. The SAS results were arranged into four groups(SAS 0-4,SAS 5-6,SAS 7-8 and SAS 9-10). The cohort was then divided into two groups representing low-risk(SAS ≥ 7) and highrisk patients(SAS < 7) using a previously established threshold. The outcome of interest was the occurrence of major complications and death within 30-d of *** A logistic regression model with SAS 9-10 as a reference showed a significant linear association between lower SAS and more postoperative complications [all patients: OR = 2.00(1.33-3.03),P = 0.001]. This effect was pronounced for TFA [OR = 2.61(1.52-4.47),P < 0.001]. A significant increase was observed for the high-risk group compared to the low-risk group for all patients [OR = 2.80(1.40-5.61),P = 0.004] and for the TFA sub-

关键词： Surgical apgar score Mortality Transfemoral amputation Post-operative complication Lower extremity amputation

Tourniquets do not increase the total blood loss or reamputation risk in transtibial amputations

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World Journal of Orthopedics 2017年第1期8卷 62-67页

作者： Christian Wied Peter T Tengberg Gitte Holm Thomas Kallemose Nicolai B Foss anders troelsen Morten T Kristensen Depart-ment of Orthopedic Surgery Copenhagen University Hospital Hvidovre Clinical Research Centre Copenhagen University Hospital Hvidovre Department of Anesthesiology and Intensive Care Copenhagen University Hospital Hvidovre Physical Medicine and Rehabilita-tion Research--Copenhagen Department of Physical TherapyCopenhagen University Hospital Hvidovre

AIM To investigate the total blood loss(TBL) and the safety with respect to the re-amputation rate after transtibial amputation(TTA) conducted with and without a tourniquet. METHODS The study was a single-centre retrospective cohort study of patients with a primary TTA admitted between January 2013 and April 2015. All patients with a primary TTA were assessed for inclusion if the amputation was performed because of arteriosclerosis or diabetic complications. All patients underwent a standardized TTA procedure that was performed approximately 10 cm below the knee joint and performed with sagittalflaps. The pneumatic tourniquet, when used, was inflated around the femur to a pressure of 100 mmH g above the systolic blood pressure. The number of blood transfusions within the first four postoperative days was recorded. The intraoperative blood loss(OBL), which is defined as the volume of blood lost during surgery, was determined from the suction volume and by the weight difference of the surgical dressings. The trigger for a blood transfusion was set at a decrease in the Hgb level < 9.67 g/dL(6 mmol/L). Transfusions were performed with pooled red blood cells containing 245 m L per portion, which equals 55 g/L of haemoglobin. The TBL during the first four postoperative days was calculated based on the haemoglobin level and the estimated blood volume. The re-amputation rate was evaluated within 30 d. RESULTS Seventy-four out of 86 consecutive patients who underwent TTA within the two-year study period were included in the analysis. Of these, 38 were operated on using a tourniquet and 36 were operated on without using a tourniquet. There were no significant preoperative differences between the groups. The patients in both groups had a postoperative decrease in their Hgb level compared with preoperative baseline values. The patients operated on using a tourniquet received approximately three millilitres less blood transfusion per kilogram body weight compared with patients o

关键词： Total blood loss Intraoperative blood loss Transtibial amputation Lower extremity amputation Pneumatic tourniquet Re-amputation

髋关节畸形的发生率及其与性别、腹股沟痛和骨关节炎发病风险的关系——一项人口调查研究

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中华骨科杂志 2010年第12期30卷 I0021-I0027页

作者： Kasper Kjaerlf Gosvig Steffen Jacobsen Sfig Sonne-Holm Henrik Palm anders troelsen 付勤(译) Investigation performed at the Department of Orthopedic Surgery Copenhagen University Hospital of Hvidovre Hvidovre Denmark 中国医科大学附属盛京医院骨科沈阳110004

背景：关于股骨髋臼撞击症的临床结果已有较多阐述，但对髋关节解剖畸形在一般人群中的发生率、自然病史和骨关节炎发生风险评估的研究甚少。方法：此抽样调查资料来源于1991至1994年哥本哈根骨关节炎子研究的4151例人口调查影像学及问... 详细信息

背景：关于股骨髋臼撞击症的临床结果已有较多阐述，但对髋关节解剖畸形在一般人群中的发生率、自然病史和骨关节炎发生风险评估的研究甚少。方法：此抽样调查资料来源于1991至1994年哥本哈根骨关节炎子研究的4151例人口调查影像学及问卷调查队列研究数据。调查对象主要为丹麦哥本哈根sterbro地区的白人。符合纳入标准的男性1332名，女性2288名。根据影像学标准，髋关节被分为无畸形或有畸形，畸形中包括臼窝过深、枪柄样畸形和臼窝过深合并枪柄样畸形。髋关节骨关节炎影像学上定义为最小关节间隙宽度≤21mm。结果：3620名调查对象中髓臼发育不良的发生率为男4．3％，女3．6％：臼窝过深为男15．2％，女19．4％；枪柄样畸形为男19．6％，女5．2％；臼窝过深合并枪柄样畸形为男2．9％，女0．9％。正常髋臼顶比例为男80．7％，女77．0％。我们发现影像学上显示有髋关节畸形的调查对象其腹股沟痛的发生率无显著增加（P均〉0．13）。臼窝过深是骨关节炎发生的一个显著危险因素（风险比为2．4），枪柄样畸形亦为显著危险因素（风险比为2．2）。髋臼发育不良及性别不是髋关节骨关节炎发生的显著危险因素（P值分别为0．053和0．063）。靛关节骨关节炎发生率为男9．5％，女11．2％。髋关节骨关节炎并发畸形的发生率为男71．o％，女36．6％。结论：本组调查对象中，臼窝过深及枪柄样畸形是比较常见的影像学改变，与髋关节骨关节炎的发生风险增加相关。与髋关节畸形相关的骨关节炎高发生率提示我们应该更多地关注髋关节的早期畸形。

关键词：髋关节骨关节炎髋关节畸形人口调查腹股沟痛发生率发病风险性别影像学改变