Karl Göran Thorngren

Long-term cost and effect on quality of life of osteoporosis-related fractures in Sweden

Background and purpose Few economic or quality-of-life studies have investigated the long-term consequences of fragility fractures. This prospective observational data collection study assessed the cost and quality of life related to hip, vertebral, and wrist fracture 13–18 months after the fracture, based on 684 patients surviving 18 months after fracture. Patients and methods Data regarding resource use and quality of life related to fractures was collected using questionnaires at 7 research centers in Sweden. Information was collected using patient records, register sources, and by asking the patient. Quality of life was estimated using the EQ-5D questionnaire. Direct and indirect costs were estimated from a societal standpoint. Results The mean fracture-related cost 13–18 months after a hip, vertebral, or wrist fracture were estimated to be €2,422, €3,628, and €316, respectively. Between 12 and 18 months after hip, vertebral, and wrist fracture, utility increased by 0.03, 0.05, and 0.02, respectively. Compared to prefracture levels, the mean loss in quality of life between 13 and 18 months after fracture was estimated to be 0.05, 0.11, and 0.005 for hip, vertebral, and wrist fracture. Interpretation The sample of vertebral fracture patients was fairly small and included a high proportion of fractures leading to hospitalization, but the results indicate higher long-term costs and greater loss in quality of life related to vertebral fracture than previously believed.

Dose-dependent stimulation of bone induction by basic fibroblast growth factor in rats

Implantation of demineralized bone matrix in rodents elicits a series of cellular events leading to the formation of new bone inside and adjacent to the implant. This process is believed to be initiated by an inductive protein present in bone matrix, and local growth factors may further regulate the process. We have previously shown that local application of recombinant human basic fibroblast growth factor (bFGF) in a carboxymethyl cellulose gel to demineralized bone matrix implants increases the bone yield as measured by calcium content 3 weeks after implantation in rats. We now report that this increase was seen at 3 and 4 weeks, but not earlier or later. Further, the stimulatory effect was seen with doses from 3 to 75 ng per implant. A dose of 0.6 or 380 ng did not increase the bone yield, and 1,900 ng had a marked inhibitory effect. This narrow dosage optimum may reflect the complex actions of the growth factor.

Migration of the Tibial Component in Successful Unicompartmental Knee Arthroplasty: A Clinical, Radiographic and Roentgen Stereophotogrammetric Study

Migration of the tibial component in unicompartmental Marmor knee arthroplasty was measured by conventional radiography and roentgen stereophotogrammetry during a 2-year follow-up of six patients operated on for femoro-tibial arthrosis. The clinical course was satisfactory for all six patients. A radiolucent zone developed in all cases, the width of which was greater than 2 mm in one case. By radiography movements of two of the six prosthetic components could be detected. Roentgen stereophotogrammetry showed significant rotational and translatory movements in all six tibial components. In four cases these movements were small not exceeding 1 mm for translation and 1.5 degrees for rotation. The remaining two components showed larger migrations with maximum values of 2.7 mm for translation and 12.6 degrees for rotation. Five of the components tilted backwards about the transverse axis, four tilted away from the centre of the knee about the sagittal axis, and four rotated with the anterior part away from the centre of the knee about the vertical axis. The small movements of the four tibial components may be due to a semi-rigid fixation by connective tissue in the bone-cement interface. Since all knees were asymptomatic, neither the zones nor the minor movements seemed to have any clinical significance within the follow-up period.

Size of osteonecrosis of the knee.

In the Swedish Multicenter Study of Knee Arthroplasty, 115 knees in 110 patients with knee osteonecrosis represented all reported cases treated with knee arthroplasty in the period from 1975 to 1986. Primary medial femoral condyle osteonecrosis was the most common osteonecrosis reported (89%). Preoperative roentgenograms were staged according to the type of osteonecrosis and classified according to the grade of arthrosis. Detailed measurements of the size of the lesion were also performed. For primary medial femoral osteonecrosis, the width of the lesion averaged 45% of the condyle. The mean width of the lesion (anteroposterior size) was 21 mm and the mean length (lateral size) was 34 mm. The mean depth on lateral roentgenograms was 6 mm. There was a high correlation of results among the various methods of measurement. Using regression analysis, it was possible to approximate the volume of the lesion even from a single measurement of the width on anteroposterior view. The size of osteonecrosis of the knee can be used to plan resection and select the implant design.

Three-phase scintimetry in osteonecrosis of the knee

Three-phase scintimetry with 99mTc MDP was analyzed in 40 patients with a clinical history of spontaneous onset of knee pain and a focal static isotope uptake in the femoral condyle indicating osteonecrosis. A strong correlation was found between pool-phase ratios and the static ratios. The pool-phase study did not add to the information obtained from the flow phase and static studies. There was a characteristic change of the pattern of the early flow-phase curves with the duration since the onset of symptoms indicating hyperemia early in the disease. A persistent high flow-phase and static-uptake ratio 6-12 months after the onset of symptoms correlated positively with a poor clinical and radiographic outcome. The 10 patients with a good prognosis had, as a group, a more rapid decrease in isotope uptake after 6 months. There was a positive correlation between a high static uptake ratio and the size of the lesion, and subsequently with the clinical and radiographic outcome. 30 patients developed arthrosis and/or severe clinical symptoms. Five of the 10 patients who did not develop arthrosis never developed radiographic evidence of osteonecrosis.

3-year follow-up of 215 fracture patients from a prospective and consecutive osteoporosis screening program. Fracture patients care!

Background and purpose Fractures can be prevented if osteoporosis is identified and treated. Starting in 2002, we have been using a screening program in which patients between 50 and 75 years of age with a wrist, shoulder, vertebral, or hip fracture are assessed by DEXA of the hip and spine and if osteoporostic or osteopenic, they are encouraged to see a doctor of their own choice. The patients receive documents containing information, the results of DEXA, and a letter to present to their doctor with suggestions regarding blood tests and treatment. Here we report the 3‐year follow‐up regarding compliance to the recommended treatment. Methods A questionnaire was sent to fracture patients who participated in the initial screening study from November 2002 through November 2003. Questions included whether they had seen a doctor, whether treatment had been initiated, and their opinions about osteoporosis. Results 215 of the 236 patients answered the questionnaire, with a mean follow‐up of 39 months. 76/87 of those with osteoporosis, 70/99 of those with osteo‐penia, and 11/29 of those with normal BMD had seen a doctor. Anti‐resorptive treatment was prescribed to two‐thirds of the osteoporotic patients, to one‐sixth of the osteopenic patients, and to none of the patients with normal bone density. Calcium‐vitamin D supplementation as monotherapy was given to one‐third of the osteoporotic patients, to half of the osteopenic patients, and to half of the normal patients. Only a few osteoporotic patients, one‐third of the osteopenic patients, and half of the normal patients received no treatment. Compliance to treatment was 80% over 3 years in those treated. Most patients felt that they could influence their skeletal health. Interpretation Screening of fracture patients for osteoporosis effectively identifies patients with low bone mineral density and the patient can be trusted to seek appropriate medical advice for treatment of osteoporosis. Based on the bone scan diagnosis, the treatment that these patients received reflects current treatment guidelines well.

Using national hip fracture registries and audit databases to develop an international perspective

Hip fracture is the commonest reason for older people to need emergency anaesthesia and surgery, and leads to prolonged dependence for many of those who survive. People with this injury are usually identified very early in their hospital care, so hip fracture is an ideal marker condition with which to audit the care offered to older people by health services around the world. We have reviewed the reports of eight national audit programmes, to examine the approach used in each, and highlight differences in case mix, management and outcomes in different countries. The national audits provide a consistent picture of typical patients - an average age of 80 years, with less than a third being men, and a third of all patients having cognitive impairment - but there was surprising variation in the type of fracture, of operation and of anaesthesia and hospital length of stay in different countries. These national audits provide a unique opportunity to compare how health care systems of different countries are responding to the same clinical challenge. This review will encourage the development and reporting of a standardised dataset to support international collaboration in healthcare audit.

Hormonal effects on development of transplanted embryonic hypothalamus

Abstract Transplantation of the embryonic hypothalamus onto the choroidal pia of an adult female rat host offers unique opportunities for studies of the humoral and neural factors which regulate hypothalamic differentiation and the acquisition of neuroendocrine function. Our previous work established that the transplanted hypothalamus acquires immunoreactivity for a number of peptides (e.g., LHRH, somatostatin, neurophysin), the ability to sequestor 3 H-estradiol, and an organized median eminence-like structure with catecholamine fluorescence. This report presents initial data on three additional aspects of the hypothalamic transplants which are important to assess their ability to function: (1) Estrogen receptors are characterized and measured biochemically in transplants and their elaboration following transplantation is shown to be independent of the presence of gonadal steroids through the use of gonadectomized hosts. Estrogen-mediated induction of progestin receptor sites, a feature of the normal mature hypothalamus, is shown to occur in hypothalamic transplants in both intact and gonadectomized hosts. (2) Neurophysin immunostaining also develops in a seemingly normal manner in intact and in gonadectomized and adrenalectomized (GDX-ADX) hosts given corticosterone. However, preliminary observations on transplants into GDX-ADX hosts without corticosterone replacement suggest that glucocorticoids, which are present in the maternal and fetal blood, may increase the number and/or immunoreactivity of neurophysin-containing perikarya. (3) Initial experiments on bone growth in hypophysectomized hosts indicate that pituitary-hypothalamic cotransplants function to some extent to promote bone growth above the low level seen after total hypophysectomy of the host. It is unknown at this time the degree to which the hypothalamic cotransplant functions to drive the pituitary transplant.

Proceedings of the Swedish Orthopedic Society Helsingborg, June 1-2, 1987

The Swedish Orthopedic Society held its annual spring meeting in Helsingborg, Sweden, on June 1 and 2, 1987.Helsingborg is situated in southern Sweden on Oresund and is traditionally called the “Pearl of the Sund” because of its beautiful location on the coast. This year the orthopedic clinic in Helsingborg celebrated its centennial. In 1887, the department started with 9 patients as a combined medical and teaching center for the rehabilitation of crippled youth. These patients received occupational training and remained usually 3-4 years in the rehabilitation school. In those days, patients suffered mainly from birth defects, osteomyelitis, or polio. The unit soon expanded; and by the 1930s, it had become a famous 175-bed rehabilitation center. Now, 100 year later, Helsingborg, with its population of 145,000, has a modern 66-bed orthopedic unit that is mainly engaged in arthroplasties and fracture surgery. Since 1975, the clinic has been located in the new central block of Helsingborg Central Hospital. T...

Proceedings of the Swedish Orthopedic Society

The Swedish Orthopaedic Society held its meeting on September 10–12, 1986, in Ostersund, which is situated on a large lake in central Sweden. This year, Ostersund celebrated its bicentennial; but more than 1,000 years ago the Vikings had a center here to worship their gods, as well as a fortress on the neighboring island of Froso. Today, Ostersund is the gateway to Swedens most popular winter recreational area. Ostersund has a single hospital that serves 135,000 inhabitants living in a 50,000 square kilometer catchment area. Finally, the meeting gathered 220 Swedish orthopedic surgeons.The Ostersund Orthopedic Clinic, headed by Helge Semb, has, apart from the treatment of ski injuries, become renowned for its rheumatoid surgery. The latter topic was manifested by the invited speaker Professor Norbert Gschwend, Zurich, Switzerland, whose talk was titled ‘Surgery in rheumatoid arthritis’, and which was followed by papers on the subject. In addition, a special symposium entitled ‘Orthopedics - does it give ...