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Makela K.T.,University of Turku | Eskelinen A.,COXA Hospital for Joint Replacement | Pulkkinen P.,University of Helsinki | Paavolainen P.,ORTON Orthopaedic Hospital | Remes V.,University of Helsinki
Acta Orthopaedica | Year: 2011

Background and purpose: In a previous study based on the Finnish Arthroplasty Register, the survival of cementless stems was better than that of cemented stems in younger patients. However, the survival of cementless cups was poor due to osteolysis. In the present study, we analyzed population-based survival rates of the cemented and cementless total hip replacements in patients under the age of 55 years with primary osteoarthritis in Finland. Patients and methods: 3,668 implants fulfilled our inclusion criteria. The previous data included years 19802001, whereas the current study includes years 19872006. The implants were classified in 3 groups: (1) implants with a cementless, straight, proximally circumferentially porous-coated stem and a porous-coated press-fit cup (cementless group 1); (2) implants with a cementless, anatomic, proximally circumferentially porous-coated stem, with or without hydroxyapatite, and a porous-coated press-fit cup with or without hydroxyapatite (cementless group 2); and (3) a cemented stem combined with a cemented all-polyethylene cup (the cemented group). Analyses were performed separately for 2 time periods: those operated 19871996 and those operated 19972006. Results: The 15-year survival for any reason of cementless total hip replacement (THR) group 1 operated on 19871996 (62%; 95% CI: 5767) and cementless group 2 (58%; CI: 5266) operated on during the same time period was worse than that of cemented THRs (71%; CI: 6280), although the difference was not statistically significant. The revision risk for aseptic loosening of cementless stem group 1 operated on 19871996 (0.49; CI: 0.320.74) was lower than that for aseptic loosening of cemented stems (p = 0.001). Interpretation: Excessive wear of the polyethylene liner resulted in numerous revisions of modular cementless cups. The outcomes of total hip arthroplasty appear to have been relatively unsatisfactory for younger patients in Finland. © 2011 Nordic Orthopaedic Federation.

Leskinen J.,Peijas Hospital | Leskinen J.,University of Helsinki | Eskelinen A.,COXA Hospital for Joint Replacement | Huhtala H.,University of Tampere | And 2 more authors.
Arthritis and Rheumatism | Year: 2012

Objective Total knee arthroplasty (TKA) is a commonly used treatment for severe primary knee osteoarthritis (OA) that is refractory to conservative treatment. Despite the presumed increase in the use of this treatment modality in younger patients, there are few published data concerning this. The aim of our study was to examine the changes in the age- and sex-standardized incidence of TKA and unicondylar knee arthroplasty (UKA) in Finland during 1980-2006 and to identify factors that might affect the incidence during this period. Methods We obtained data on UKAs and TKAs from the Finnish Arthroplasty Registry and population data from Statistics Finland to analyze the incidence of UKAs and TKAs in Finland for the period 1980-2006. The effects of sex, age group, and hospital volume on the incidence of these procedures were also evaluated. Results The annual cumulative incidence of UKAs and TKAs has increased rapidly from 1980 to 2006 among 30-59-year-old inhabitants of Finland. For UKAs, the incidence increased from 0.2 per 100,000 inhabitants to 10 per 100,000, and for TKAs, the incidence increased from 0.5 per 100,000 to 65 per 100,000. The incidence remained higher among women during the entire study period. Most of the increase occurred among patients ages 50-59 years. The incidence grew more rapidly in low-volume and intermediate-volume hospitals. Conclusion We demonstrated a rapid increase in the incidence of arthroplasty among patients with primary knee OA in Finland, especially in those ages 50-59 years. There was no single explanatory factor behind this finding, although some of the growth might be due to the increased incidence noted in low- and intermediate-volume hospitals. © 2012 American College of Rheumatology.

Skytta E.T.,COXA Hospital for Joint Replacement | Skytta E.T.,University of Tampere | Eskelinen A.,COXA Hospital for Joint Replacement | Paavolainen P.O.,ORTON Orthopaedic Hospital | Remes V.M.,University of Helsinki
Journal of Arthroplasty | Year: 2011

We evaluated the survival of 827 acetabular revisions with Trabecular Metal Revision Shell using data from a nationwide arthroplasty register. The mean age of the patients was 69.1 years. The 3-year overall survivorship was 92% (95% confidence interval, 88-95), which coincides with earlier reports. Revision rate for aseptic loosening was only 2%. The most common reason for revision was dislocation of the prosthesis with or without malposition of the socket (60%). Age was found to have significant effect on cup survivorship: each additional year in age decreased the risk of revision by 2.4% (95 % confidence interval, 0.1-4.7; P = .044). We found no differences in survival rates between aseptic and septic revisions. Furthermore, sex, diagnosis, and hospital volume did not affect the survival. © 2011 Elsevier Inc.

Niemelainen M.,COXA Hospital for Joint Replacement | Kalliovalkama J.,COXA Hospital for Joint Replacement | Aho A.J.,COXA Hospital for Joint Replacement | Moilanen T.,COXA Hospital for Joint Replacement | Eskelinen A.,COXA Hospital for Joint Replacement
Acta Orthopaedica | Year: 2014

Background - Randomized trials evaluating efficacy of local infiltration analgesia (LIA) have been published but many of these lack standardized analgesics. There is a paucity of reports on the effects of LIA on functional capability and quality of life. Methods - 56 patients undergoing unilateral total knee arthroplasty (TKA) were randomized into 2 groups in this placebo-controlled study with 12-month follow-up. In the LIA group, a mixture of levobupivacaine (150 mg), ketorolac (30 mg), and adrenaline (0.5 mg) was infiltrated periarticularly. In the placebo group, infiltration contained saline. 4 different patient-reported outcome measures (PROMs) were used for evaluation of functional outcome and quality of life. Results - During the first 48 hours postoperatively, patients in the LIA group used less oxycodone than patients in the placebo group in both cumulative and time-interval follow-up. The effect was most significant during the first 6 postoperative hours. The PROMs were similar between the groups during the 1-year follow-up. Interpretation - Single periarticular infiltration reduced the amount of oxycodone used and enabled adequate pain management in conjunction with standardized peroral medication without adverse effects. No clinically marked effects on the functional outcome after TKA were detected. © 2014, Informa Healthcare. All rights reserved.

Reito A.,COXA Hospital for Joint Replacement | Moilanen T.,COXA Hospital for Joint Replacement | Puolakka T.,COXA Hospital for Joint Replacement | Pajamaki J.,COXA Hospital for Joint Replacement | Eskelinen A.,COXA Hospital for Joint Replacement
International Orthopaedics | Year: 2014

Purpose: Conventional follow-up methods are not sufficient to identify adverse soft tissue reactions in patients with metal-on-metal hip replacements. The national guidelines regarding metal ion measurements are debatable. The aims of our study were to investigate (1) if there is a clinically significant change in whole blood (WB) cobalt (Co) or chrome (Cr) levels in repeated WB assessment in patients operated on with ASR hip replacements, and (2) what proportion of patients has WB Co or Cr level below the previously established safe upper limits (SUL) in the repeated WB metal ion assessment. Methods: We identified all patients (n=254) with unilateral ASR implants who had second blood sample taken eight to 16 months after the first. Results: WB Co and Cr levels remained below SUL and within their initial values during a mean one-year measurement interval in the majority of patients with a high risk HR device. In contrast to this, 50 % of patients with THRs had metal ion levels exceeding the SUL in the first measurement. WB Co values significantly increased over the measurement interval in the THR group. Conclusion: In patients with a high risk HR, repeated metal ion measurement did not provide useful information for clinical decision-making. In patients with a LD MoM THR repeated measurements revealed a large number of patients with metal ion levels exceeding SUL and might thus be clinically beneficial. © 2014 Springer-Verlag.

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