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Kuiper J.W.P.,Center for Orthopaedic Research Alkmaar | Van Den Bekerom M.P.J.,Onze Lieve Vrouwe Gasthuis | Van Der Stappen J.,University Hospitals Leuven | Nolte P.A.,Spaarne Hospital | Colen S.,University Hospitals Leuven
Acta Orthopaedica | Year: 2013

Background and purpose Fungal prosthetic joint infections are rare and difficult to treat. This systematic review was conducted to determine outcome and to give treatment recommendations. Patients and methods After an extensive search of the literature, 164 patients treated for fungal hip or knee prosthetic joint infection (PJI) were reviewed. This included 8 patients from our own institutions. Results Most patients presented with pain (78%) and swelling (65%). In 68% of the patients, 1 or more risk factors for fungal PJI were found. In 51% of the patients, radiographs showed signs of loosening of the arthroplasty. Candida species were cultured from most patients (88%). In 21% of all patients, fungal culture results were first considered to be contamination. There was co-infection with bacteria in 33% of the patients. For outcome analysis, 119 patients had an adequate follow-up of at least 2 years. Staged revision was the treatment performed most often, with the highest success rate (85%). Interpretation Fungal PJI resembles chronic bacterial PJI. For diagnosis, multiple samples and prolonged culturing are essential. Fungal species should be considered to be pathogens. Co-infection with bacteria should be treated with additional antibacterial agents. We found no evidence that 1-stage revision, debridement, antibiotics, irrigation, and retention (DAIR) or antifungal therapy without surgical treatment adequately controls fungal PJI. Thus, staged revision should be the standard treatment for fungal PJI. After resection of the prosthesis, we recommend systemic antifungal treatment for at least 6 weeks-and until there are no clinical signs of infection and blood infection markers have normalized. Then reimplantation can be performed. © Nordic Orthopaedic Federation.


Kievit A.J.,University of Amsterdam | Van Duijvenbode D.C.,Center for Orthopaedic Research Alkmaar | Stavenuiter M.H.J.,Center for Orthopaedic Research Alkmaar
Journal of Pediatric Orthopaedics Part B | Year: 2013

We report a case of genu recurvatum following eight-Plate epiphysiodesis and the successful treatment of this complication. A 10-year-old patient underwent epiphysiodesis of the knee with eight-Plates. She was followed up and genu recurvatum developed as a complication. At the 12-month follow-up after epiphysiodesis, the treated knee showed a flexion of 135 and an extension of 35 . Lateral radiograph evaluation showed an extension change of the femur. During reoperation, the eight-Plates were repositioned more posterior, which resulted in successful treatment of the hyperextension. Eight-Plates can lead to (treatable) articular surface angle changes in the sagittal plane. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Fransen B.L.,Center for Orthopaedic Research Alkmaar | Hoozemans M.J.M.,Center for Orthopaedic Research Alkmaar | Hoozemans M.J.M.,VU University Amsterdam | Keijser L.C.M.,Center for Orthopaedic Research Alkmaar | And 3 more authors.
Journal of Arthroplasty | Year: 2015

New insert types have been developed to improve clinical and functional outcome in mobile bearing (MB-TKA) and fixed bearing total knee arthroplasty (FB-TKA). A prospective single blinded randomised controlled clinical trial was performed to evaluate 2 types of MB-TKA inserts and 2 types of FB-TKA inserts of the Genesis II prosthesis (Smith & Nephew) in 146 patients with 5-years follow-up. A significant difference (P= .042) between the MB-TKA inserts was found in KSS function scores, but clinical significance is expected to be limited. Goniometry, temporal gait parameters and QoL were similar in all groups. Survival was significantly better (P= .047) for FB-TKA. The comparable outcome and higher revision rate in MB-TKA indicate that FB-TKA may be preferential for the Genesis II implant system. © 2015 Elsevier Inc..


Hoozemans M.J.M.,VU University Amsterdam | Hoozemans M.J.M.,Center for Orthopaedic Research Alkmaar | Knelange E.B.,VU University Amsterdam | Frings-Dresen M.H.W.,University of Amsterdam | And 3 more authors.
Occupational and Environmental Medicine | Year: 2014

Systematically review observational studies concerning the question whether workers that perform pushing/pulling activities have an increased risk for upper extremity symptoms as compared to workers that perform no pushing/pulling activities. A search in MEDLINE via PubMed and EMBASE was performed with work-related search terms combined with push/pushing/pull/pulling. Studies had to examine exposure to pushing/pulling in relation to upper extremity symptoms. Two authors performed the literature selection and assessment of the risk of bias in the studies independently. A best evidence synthesis was used to draw conclusions in terms of strong, moderate or conflicting/insufficient evidence. The search resulted in 4764 studies. Seven studies were included, with three of them of low risk of bias, in total including 8279 participants. A positive significant relationship with upper extremity symptoms was observed in all four prospective cohort studies with effect sizes varying between 1.5 and 4.9. Two out of the three remaining studies also reported a positive association with upper extremity symptoms. In addition, significant positive associations with neck/shoulder symptoms were found in two prospective cohort studies with effect sizes of 1.5 and 1.6, and with shoulder symptoms in one of two cross-sectional studies with an effect size of 2.1. There is strong evidence that pushing/pulling is related to upper extremity symptoms, specifically for shoulder symptoms. There is insufficient or conflicting evidence that pushing/pulling is related to (combinations of ) upper arm, elbow, forearm, wrist or hand symptoms. © 2014, BMJ Publishing Group. All rights reserved.


Hoozemans M.J.M.,VU University Amsterdam | Hoozemans M.J.M.,Center for Orthopaedic Research Alkmaar | Koppes L.L.J.,TNO | Twisk J.W.R.,VU University Amsterdam | Van Dieen J.H.,VU University Amsterdam
Spine | Year: 2012

STUDY DESIGN.: Longitudinal study of lumbar bone mass as predictor of low back pain (LBP). OBJECTIVE.: To investigate whether low bone mineral content (BMC) and bone mineral density (BMD) values at the age of 36 years are associated with the prevalence of LBP at the age of 42 years among the study population of the Amsterdam Growth and Health Longitudinal Study. SUMMARY OF BACKGROUND DATA.: Results of epidemiological, clinical, and in vitro studies indicate that spinal injuries, caused by mechanical loading, might be a cause of LBP. BMC and BMD are determinants of spinal strength. We therefore hypothesized that BMC and BMD are associated with LBP. METHODS.: At the age of 36 years, the lumbar BMC and BMD were determined by dual-energy x-ray absorptiometry in 140 men and 152 women. At the age of 42 years, the participants were asked whether they had experienced LBP in the previous 12 months. Logistic regression analyses were performed to determine odds ratios (ORs)-adjusted for stature, body weight, physical activity, and smoking-for the relationship of BMC and BMD with LBP. RESULTS.: BMC and BMD at the age of 36 years were significantly associated with the reported 12-month prevalence of LBP at the age of 42 years. This association, however, was observed only for men and not for women. Men within the quartile with the lowest BMC or BMD values had higher odds for LBP with ORs of 4.78 (95% confidence interval, 1.52-15.00) and 3.48 (95% confidence interval, 1.23-9.85), respectively. CONCLUSION.: For a male population that is not characterized by osteoporosis or old age, lower lumbar BMC and BMD values at the age of 36 years are associated with an increased risk of reporting to have had LBP in the previous 12 months at the age of 42 years. Copyright © 2012 Lippincott Williams & Wilkins.


Willigenburg N.W.,VU University Amsterdam | Kingma I.,VU University Amsterdam | Hoozemans M.J.M.,VU University Amsterdam | Hoozemans M.J.M.,Center for Orthopaedic Research Alkmaar | van Dieen J.H.,VU University Amsterdam
Human Movement Science | Year: 2013

Motor control is challenged in tasks with high precision demands. In such tasks, signal-dependent neuromuscular noise causes errors and proprioceptive feedback is required for optimal performance. Pain may affect proprioception, muscle activation patterns and resulting kinematics. Therefore, we investigated precision control of trunk movement in 18 low back pain (LBP) patients and 13 healthy control subjects. The subjects performed a spiral-tracking task requiring precise trunk movements, in conditions with and without disturbance of proprioception by lumbar muscle vibration. Tracking task performance and trunk muscle electromyography were recorded. In conditions without lumbar muscle vibration, tracking errors were 27.1% larger in LBP patients compared to healthy controls. Vibration caused tracking errors to increase by 10.5% in healthy controls, but not in LBP patients. These results suggest that reduced precision in LBP patients might be explained by proprioceptive deficits. Ratios of antagonistic over agonistic muscle activation were similar between groups. Tracking errors increased trunk inclination, but no significant relation between tracking error and agonistic muscle activation was found. Tracking errors did not decrease when antagonistic muscle activation increased, so, neither healthy subjects nor LBP patients appear to counteract trunk movement errors by increasing co-contraction. © 2013 Elsevier B.V.


Kievit A.J.,University of Amsterdam | Jonkers F.J.,Center for Orthopaedic Research Alkmaar | Barentsz J.H.,Orthopedium Orthopedische Kliniek Delft | Blankevoort L.,University of Amsterdam
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2013

Purpose: The purpose of this study was to assess the degree of osteoarthritis, degree of laxity, and quality-of-life (QOL) scores in primary and revision anterior cruciate ligament (ACL) reconstruction. Methods: This was a cross-sectional study; 25 patients who had undergone revision ACL reconstruction with allografts were identified and compared with 27 randomly selected primary ACL reconstruction patients operated on in the same hospital in the same period with the same technique. The main outcome measure was the International Knee Documentation Committee (IKDC) radiographic osteoarthritis sum score, and secondary outcome measures were Knee injury and Osteoarthritis Outcome Score, IKDC functional outcome measures, anterior laxity, and QOL at follow-up. Results: The median follow-up was 5.3 years for revision reconstruction patients and 5.1 years for primary reconstruction patients. Radiographic IKDC sum scores for osteoarthritis were found to be significantly worse in revision patients, with a median of 4, compared with primary patients, with a median of 1 (P =.016). Differences were found in meniscal injury (P =.02) and cartilage status (P <.001) before or at the index operation. Significantly worse outcomes were found in the following subscores of the Knee injury and Osteoarthritis Outcome Score: pain (median, 92 v 97; P =.032), symptom (median, 86 v 96; P =.015), activities of daily living (median, 94 v 100; P =.020), sport (median, 50 v 85; P =.006), and QOL (median, 56 v 81; P =.001). IKDC functional outcome measures were the same in both groups except for the pivot-shift test (P =.007). No differences were found in anterior drawer, Lachman, or KT-1000 arthrometer (MEDmetric, San Diego, CA) testing. Present-day health scores on the EQ-5D were worse for revision reconstruction patients (median, 70 v 80; P =.009). Conclusions: Revision reconstruction patients have more signs of osteoarthritis and worse QOL than primary reconstruction patients, even though they have comparable IKDC success rates and KT-1000 arthrometer laxity test results. Level of Evidence: Level III, retrospective comparative study. © 2013 by the Arthroscopy Association of North America.


Fransen B.,Center for Orthopaedic Research Alkmaar | Hoozemans M.,VU University Amsterdam | Vos S.,Center for Orthopaedic Research Alkmaar
Acta Orthopaedica Belgica | Year: 2016

Early research shows several advantages of the Direct Anterior Approach (DAA) in total hip arthroplasty (THA), although no studies evaluated the DAA on a regular operating table without using fluoroscopy. We performed a retrospective cohort study on the outcome of this variation of the DAA compared with the posterolateral approach (PLA) with one year follow-up. All procedures were uncemented THA performed in 2012 by a single surgeon. Patients in the DAA group (N = 45) had a lower Body Mass Index (p <.001) than the PLA group (N = 38). Functional outcome, pain scores and complications were comparable between the two approaches. Compared with PLA, the DAA was associated with longer operation time (p < 0.001), more blood loss (p < 0.001), shorter length of stay (p =.009), and more adequate acetabular cup inclination (p =.004). This study shows that the DAA on a regular operating table without using fluoroscopy has several advantages compared to the PLA. © 2016, Acta Orthopædica Belgica.


PubMed | University Hospitals Leuven and Center for Orthopaedic Research Alkmaar
Type: Journal Article | Journal: Hip international : the journal of clinical and experimental research on hip pathology and therapy | Year: 2016

The aim of this review was to assess (health-related) quality of life ([HR]Qol) after 1-stage or 2-stage revision for prosthetic joint infection of the hip (PJI). Additionally, we compared (HR)QoL scores with normative population scores to assess whether QoL is reduced after revision for PJI.A systematic search was performed in Embase, Cochrane and Pubmed. We included articles that reported (HR)QoL questionnaires after staged revision for hip PJI with a minimum follow-up of 24 months. Methodological quality was assessed using the MINORS score.The search produced 11,195 results. We selected 12 papers describing 2-stage revisions. The mean MINORS score was 9.8. Average WOMAC scores of 185 patients with a mean follow-up of 69.8 months were 73.Average Short Form 36 (SF-36) scores of 159 patients with a mean follow-up of 40.7 months were 40.4 for the physical component score (PCS) and 51.6 for the mental component score (MCS). Average Short Form 12 (SF-12) scores of 154 patients with a mean follow-up of 73.4 months were: a PCS of 35.4 and a MCS of 49.1. The WOMAC, SF-12 (PCS) and SF-36 (PCS) were respectively 12%, 26.7% and 14.8% lower, compared to normative values.Patients who underwent 2-stage revision for hip PJI had substantially lower (physical component) (HR)QoL scores, but mental scores were comparable to the general population.


PubMed | University of Amsterdam, Center for Orthopaedic Research Alkmaar and Onze Lieve Vrouwe Gasthuis
Type: | Journal: Archives of orthopaedic and trauma surgery | Year: 2016

Evidence-based advice for return to work (RTW) after anterior cruciate ligament (ACL) reconstruction is not available. Therefore, the objectives of this study were to determine when patients achieve full RTW, and to explore the beneficial and limiting factors for fully RTW after ACL reconstruction.A retrospective cohort study was performed after ACL reconstruction among 185 patients in one hospital. Data from patient files and a questionnaire were used to explore whether patient-, injury-, surgery-, sports-, work- and rehabilitation-related factors are beneficial or limiting for fully RTW after ACL reconstruction, using a backward stepwise logistic regression analysis.Of the 125 (68%) patients that returned the questionnaire, 36 were not part of the working population. Of the remaining 89 patients, 82 patients (92%) had returned fully to work at follow-up. The median time to fully RTW was 78days. In the final regression model, which explained 29% of the variance, a significant OR of 5.4 (90% CI 2.2-13.1) for RTW>78days was observed for patients performing heavy knee-demanding work compared to patients performing light knee-demanding work. In addition, a significant and positive OR (1.6, 90% CI 1.2-1.9) for the number of weeks walking with the aid of crutches for RTW>78days was observed in the final model.After ACL reconstruction, 92% of the patients fully return to work at a median time of 78days. The significant predictors for fully RTW>78days are performing heavy knee-demanding work and a longer period of walking aided with crutches after ACL reconstruction.

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