Capio St Gorans Hospital

Stockholm, Sweden

Capio St Gorans Hospital

Stockholm, Sweden
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Background: The indications for reverse shoulder arthroplasty have grown dramatically during the past decade. In a relevant proportion of cases, there are accompanying significant glenoid bony defects. Objectives: We aimed to review and summarize the current literature on the management of glenoid defects in reverse shoulder arthroplasties and to describe our approach. Results: Currently, there are no treatment algorithms based on a specific classification system of glenoid defects in reverse shoulder arthroplasty published in the peer-reviewed literature. The authors distinguish between defects that are centric (contained), eccentric (uncontained). The literature mostly describes biological reconstruction of the defect by an autograft, with only a few allograft cases reported. Furthermore, it is unclear whether the procedure can be performed in a one- (glenoid defect reconstruction and implantation of reverse shoulder) or two-stage approach. We prefer a one-stage procedure if there is sufficient fixation of the central peg of the metaglene and good locking screw fixation in the native scapula. In advanced defects, specific glenoid base plates with a longer peg are necessary. In the literature and in our experience, the complication rate for this indication is not higher than with reverse arthroplasties without glenoid defects. Metal-augmented glenoid base plates are a possible alternative to biological reconstruction. Conclusion: Glenoid defects concomitant with reverse shoulder arthroplasties represent a significant percentage of surgically difficult-to-treat patients. It is critical to distinguish between the different types of glenoid defects and to adjust the surgical procedure to the individual defect. In the majority of cases, a one-stage procedure is possible by using specific glenoid base plate designs. © 2017, Springer Medizin Verlag GmbH.


Nordgren J.,Linköping University | Kindberg E.,Linköping University | Lindgren P.-E.,Linköping University | Lindgren P.-E.,County Hospital Ryhov | And 3 more authors.
Emerging Infectious Diseases | Year: 2010

Norovirus (NoV) is recognized as the commonest cause of acute gastroenteritis among adults. Susceptibility to disease has been associated with histo-blood group antigens and secretor status; nonsecretors are almost completely resistant to disease. We report a foodborne outbreak of GI.3 NoV gastroenteritis that affected 33/83 (40%) persons. Symptomatic disease was as likely to develop in nonsecretors as in secretors (odds ratio [OR] 1.41, 95% confidence interval [CI] 0.46-4.36 vs. OR 0.71, 95% CI 0.23-2.18, p = 0.57). Moreover, no statistical difference in susceptibility was found between persons of different Lewis or ABO phenotypes. The capsid gene of the outbreak strain shares high amino acid homology with the Kashiwa645 GI.3 strain, previously shown to recognize nonsecretor saliva, as well as synthetic Lewis a. This norovirus outbreak affected persons regardless of secretor status or Lewis or ABO phenotypes.


Barenius B.,Karolinska Institutet | Nordlander M.,Section of Physiotherapy and Occupational Therapy | Ponzer S.,Karolinska Institutet | Tidermark J.,Karolinska Institutet | And 2 more authors.
American Journal of Sports Medicine | Year: 2010

Background: Randomized controlled trials after anterior cruciate ligament reconstructions with long-term follow-up including assessment of health-related quality of life are rare. Purpose: To compare clinical outcome and health-related quality of life 8 years after anterior cruciate ligament reconstruction using 2 types of graft. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Long-term follow-up of 164 patients with anterior cruciate ligament injury randomized to arthroscopic reconstruction with a quadrupled semitendinosus graft or a boneg-patellar tendong-bone graft was undertaken. After a mean 8 years, 153 patients were available for follow-up, including instrumented laxity, 1-legged hop test, a knee-walking test, and assessment with International Knee Documentation Committee, Lysholm, Tegner, and patellofemoral pain score. Health-related quality of life was assessed with Knee Osteoarthritis Outcome Score and Short Formg-36. Results: Patients in both graft groups retained the same stability, knee function, and health-related quality of life. The patellofemoral pain score was similar for both groups; the boneg-patellar tendong-bone group had more donor site morbidity from kneeling and knee walking. In the boneg-patellar tendong-bone group, 19 patients had no kneeling problems, 23 slight problems, 31 moderate problems, and 5 unable to kneel. Corresponding figures for the semitendinosus group were 25, 32, 16, and 2 (P <.001). Patients with early reconstructions (<5 months) had a lower risk for meniscal injuries (37%) than did later reconstructed (62%, P =.008). Health-related quality of life regarding physical functioning in Short Formg-36 was better for the early-reconstructed patients than for the later reconstructed (92 vs 85; P =.014). Patients without medial meniscal surgery had higher Knee Osteoarthritis Outcome Scores for all subscales than did patients with medial meniscal surgery, with most significant difference for sport and recreation (63 vs 75, P =.008). Conclusion: In the long term, the semitendinosus graft provided similar stability, knee function, and health-related quality of life but with less kneeling morbidity than did the boneg-patellar tendong-bone graft. © 2010 The Author(s).


Inngul C.,Karolinska Institutet | Hedbeck C.-J.,Karolinska Institutet | Blomfeldt R.,Karolinska Institutet | Lapidus G.,Capio St Gorans Hospital | And 2 more authors.
International Orthopaedics | Year: 2013

Purpose: The treatment of choice for a displaced femoral neck fracture in the most elderly patients is a cemented hemiarthroplasty (HA). The optimal design, unipolar or bipolar head, remains unclear. The possible advantages of a bipolar HA are a better range of motion and less acetabular wear. The aim of this study was to evaluate hip function, health related quality of life (HRQoL), surgical outcome and acetabular erosion in a medium-term follow-up. Methods: One hundred and twenty patients aged 80 or more with a displaced fracture of the femoral neck (Garden III and IV) were randomised to treatment with a cemented Exeter HA using a unipolar or a bipolar head. All patients were able to walk independently, with or without aids, before surgery. Follow-ups were performed at four, 12, 24 and 48 months postoperatively. Assessments included HRQoL (EQ-5D index score), hip function (Harris hip score [HHS]) and radiological acetabular erosion. Results: The mean EQ-5D index score was generally higher among the patients with bipolar hemiarthroplasties at the follow-ups with a significant difference at 48 months: unipolar HAs 0.59 and bipolar HAs 0.70 (p = 0.04). There was an increased rate of acetabular erosion among the patients with unipolar hemiarthroplasties at the early follow-ups with a significant difference at 12 months (unipolar HAs 20 % and bipolar HAs 5 %, p = 0.03). At the later follow-ups the incidence of acetabular erosion accelerated in the bipolar group, and there were no significant differences between the groups at the 24- and 48-month follow-ups. There was no difference in HHS or reoperation rate between the groups at any of the follow-ups. Conclusion: The bipolar HAs seem to result in better HRQoL beyond the first two years after surgery compared to unipolar HAs. Bipolar HAs displayed a later onset of acetabular erosion compared to unipolar HAs. © 2013 Springer-Verlag Berlin Heidelberg.


Hedbeck C.J.,Karolinska Institutet | Enocson A.,Karolinska Institutet | Lapidus G.,Capio St Gorans Hospital | Blomfeldt R.,Karolinska Institutet | And 3 more authors.
Journal of Bone and Joint Surgery - Series A | Year: 2011

We performed a four-year follow-up of a randomized controlled trial involving 120 elderly patients with an acute displaced femoral neck fracture who were randomized to treatment with either a bipolar hemiarthroplasty or a total hip arthroplasty. The difference in hip function (as indicated by the Harris hip score) in favor of the total hip arthroplasty group that was previously reported at one year persisted and seemed to increase with time (mean score, 87 compared with 78 at twenty-four months [p < 0.001] and 89 compared with 75 at forty-eight months [p < 0.001]). The health-related quality of life (as indicated by the EuroQol [EQ-5Dindex] score) was better in the total hip arthroplasty group at the time of each followup, but the difference was significant only at forty-eight months (p < 0.039). These results confirm the better results in terms of hip function and quality of life after total hip arthroplasty as compared with hemiarthroplasty in elderly, lucid patients with a displaced fracture of the femoral neck. Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence. Copyright © 2011 by The Journal of Bone and Joint Surgery, Incorporated.


Olerud P.,Karolinska Institutet | Tidermark J.,Karolinska Institutet | Tidermark J.,Capio St Gorans Hospital | Ponzer S.,Karolinska Institutet | And 2 more authors.
Journal of Shoulder and Elbow Surgery | Year: 2011

Background: This study evaluated the internal and external responsiveness of the EuroQol EQ-5D (EuroQol Group, Rotterdam, The Netherlands) health status component, defined as the instrument's ability to capture clinically important changes in patients with a proximal humeral fracture within the context of a prospective study. Materials and methods: To evaluate the internal responsiveness of the EQ-5D, the observed change and the standardized response mean (SRM) in relation to the change in the EQ-5D index score were calculated. To calculate external responsiveness, an external criterion (EC) was constructed by using the Disabilities of the Arm, Shoulder and Hand (DASH) score. Receiver operating characteristic (ROC) curves and logistic regression analysis were used in the evaluation. Results: The mean change score from prefracture status to the 4-month follow-up for the EQ-5D was -20.9 and the corresponding SRM was 0.90, indicating good internal responsiveness. The clearly improved or clearly deteriorated patients according to the EC (DASH) reported change scores of approximately 12 points in the EQ-5D, corresponding to moderately strong SRMs, which, together with the results of the ROC analyses and logistic regression, indicated a good external responsiveness. Conclusion: The EQ-5D displayed good internal and external responsiveness in patients with proximal humeral fractures and can be recommended for use as a quality of life measure in patients with this particular injury. © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees.


Ekelund A.,Capio St Gorans Hospital | Nyberg R.,Capio St Gorans Hospital
Clinical Orthopaedics and Related Research | Year: 2011

Background Many patients with rheumatoid arthritis develop superior migration of the humeral head because of massive cuff tears, causing loss of active motion. Reverse shoulder arthroplasty could potentially restore biomechanical balance but a high incidence of glenoid failure has been reported. These studies do not, however, typically include many patients with rheumatoid arthritis (RA) and it is unclear whether the failure rates are similar. Questions/purposes We therefore (1) evaluated pain relief and shoulder function after reverse arthroplasty in RA; (2) compared results between primary and revision procedures; (3) determined the incidence of scapular notching; and (4) determined the complication rate. Methods We identified 29 patients with RA who had 33 reverse arthroplasties from among 412 patients having the surgery. Six patients were lost to followup. Twenty three patients (27 shoulders) were evaluated after a minimum followup of 18 months (mean, 56 months; range, 18-143 months), including 18 primary and nine revision arthroplasties. All patients were evaluated preoperatively and 23 shoulders postoperatively by an independent physiotherapist and four were assessed postoperatively by phone. Level of pain, range of motion, and Constant- Murley score were recorded and new radiographs taken. Results Visual Analog Scale score for pain decreased from 8.0 to 1.0. Constant-Murley score increased from 13 to 52. Primary procedures had higher scores compared with revisions. Three patients had revision surgery. Notching occurred in 52% of shoulders but no loosening was seen. Conclusions Reverse arthroplasty in rheumatoid arthritis improved shoulder function with a low incidence of complications. We believe it should be considered in elderly patients with rheumatoid arthritis with pain and poor active range of motion resulting from massive cuff tears. Level of Evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. © 2011 The Association of Bone and Joint Surgeons.


Olerud P.,Karolinska Institutet | Ahrengart L.,Karolinska Institutet | Ponzer S.,Karolinska Institutet | Saving J.,Karolinska Institutet | And 2 more authors.
Journal of Shoulder and Elbow Surgery | Year: 2011

Background: The aim of the study was to report the 2-year outcome after a displaced 4-part fracture of the proximal humerus in elderly patients randomized to treatment with a hemiarthroplasty (HA) or nonoperative treatment. Patients and Methods: We included 55 patients, mean age 77 (range, 58-92) years, 86% being women. Follow-up examinations were done at 4, 12, and 24 months. The main outcome measures were health-related quality of life (HRQoL) according to the EQ-5D and the DASH and Constant scores. Results: At the final 2-year follow-up the HRQoL was significantly better in the HA group compared to the nonoperative group, EQ-5D index score 0.81 compared to 0.65 (P = .02). The results for DASH and pain assessment were both in favor of the HA group, DASH score 30 versus 37 (P = .25) and pain according to VAS 15 versus 25 (P = .17). There were no significant differences regarding the Constant score or range of motion (ROM). Both groups achieved a mean flexion of approximately 90-95° and a mean abduction of 85-90°. The need for additional surgery was low: 3 patients in the HA group and 1 patient in the nonoperative group. Conclusion: The results of the study demonstrated a significant advantage in quality of life in favor of HA, as compared to nonoperative treatment in elderly patients with a displaced 4-part fracture of the proximal humerus. The main advantage of HA appeared to be less pain while there were no differences in ROM. © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees.


von Heideken J.,Karolinska University Hospital | Bostrom Windhamre H.,Capio St Gorans Hospital | Une-Larsson V.,Capio St Gorans Hospital | Ekelund A.,Capio St Gorans Hospital
Journal of Shoulder and Elbow Surgery | Year: 2013

Background: Outcomes for patients with acromioclavicular joint dislocation, Rockwood type V, treated with acute or delayed hook plate surgery were investigated. Materials and methods: Patients treated with a hook plate for acromioclavicular joint dislocation, Rockwood type V, were retrospectively evaluated 1 to 8 years after the injury. Of 41 patients, 37 were re-evaluated, 32 in person and 5 by telephone or letter. The acute surgery group comprised 22 patients operated on with a hook plate within 4 weeks after the injury. The delayed surgery group comprised 15 patients, with unacceptable pain or functional disability after a minimum of 4 months of conservative treatment, who were operated on with modified Weaver-Dunn procedure augmented with a hook plate. The evaluation was based on radiographs, registration of activity level, and shoulder function. Results: The median Constant Score was 91 for the acute surgery group and 85 for the delayed surgery group (P = .097). The acutely treated patients had better outcomes according to the median Shoulder Pain and Disability Index (SPADI; P = .006), shortened version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH; P = .002), and Subjective Shoulder Value (P = .032). The acutely treated patients had less pain in their injured shoulder during rest (P = .014) and during movement (P = .005). There was a significant difference in subluxation between the groups in favor of the acute group, shown by weighted radiographs (P = .011), but no significant relation between subluxation on the weighted radiographs and the shoulder function according to Constant Score at follow-up (rs = .122, P = .619). Conclusions: Patients treated with acute surgery had a more satisfactory outcome than those with late surgery after failed conservative treatment. © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees.


Bostrom Windhamre H.A.,Capio St Gorans Hospital | von Heideken J.P.,Karolinska Institutet | Une-Larsson V.E.,Capio St Gorans Hospital | Ekelund A.L.,Capio St Gorans Hospital
Journal of Shoulder and Elbow Surgery | Year: 2010

Background: The objective was to evaluate the Weaver-Dunn procedure (W-D) for chronic acromioclavicular joint dislocation augmented with a temporary hook plate or braided polydioxanone (PDS) loop suture. Methods: Retrospective comparative study of all patients treated for chronic acromioclavicular joint dislocation 1995-2006; 47 out of 52 included patients were re-examined. Twenty-three patients were operated with W-D augmented with PDS-braid and 24 patients with W-D and a temporary hook plate. Thirty-six were re-examined and new radiographs were taken, while 11 patients were evaluated over the phone. Results: The mean Constant score was 85 for the PDS group and 75 for the hook plate group (P = .21). There was no difference in outcome between the groups, according to the mean SPADI (P = .19), QuickDASH (P = .06), or Subjective Shoulder Value (P = .13). The patients in the hook plate group had more pain during movement (P = .003) at Visual Analogue Scale. Furthermore, there was no difference in the degree of subluxation after surgery between the PDS group and the hook plate group (P = .80). Conclusion: Reconstruction of chronic acromioclavicular joint dislocations restores good shoulder function and results in satisfied patients. Patients treated with the hook plate had more pain during movement and rest at the follow-up. The more rigid hook plate had no advantage and did not improve functional outcome. Furthermore, the extraction of the hook plate results in an additional surgical procedure. © 2010 Journal of Shoulder and Elbow Surgery Board of Trustees.

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