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Article ; Online: Poor outcome after debridement and implant retention for acute hematogenous periprosthetic joint infection: a cohort study of 43 patients.

Westberg, Marianne / Fagerberg, Øystein Tyri / Snorrason, Finnur

2023 Volume 94, Page(s) 115–120

Abstract: Background and purpose: The management of acute hematogenous periprosthetic joint infection (AHI) is challenging and the optimal treatment is not clearly defined. The aim of this study was to evaluate the treatment outcome of AHI, and secondarily to ... ...

Abstract	Background and purpose: The management of acute hematogenous periprosthetic joint infection (AHI) is challenging and the optimal treatment is not clearly defined. The aim of this study was to evaluate the treatment outcome of AHI, and secondarily to investigate potential risk factors that affect outcome. Patients and methods: We retrospectively analyzed 43 consecutive AHIs in a total hip or knee arthroplasty between 2013 and 2020 at a single center. We used the Delphi international consensus criteria to define infection. Patients were treated by either debridement, antibiotics, and implant retention (DAIR) (n = 25), implant exchange/removal (n = 15), or suppressive antibiotics only (n = 3). AHI was defined as abrupt symptoms of infection ≥ 3 months after implantation in an otherwise well-functioning arthroplasty. Results: AHI was most often caused by Staphylococcus aureus (16/43) and streptococcal species (13/43), but a broad spectrum of microbes were identified. 25 of 43 were treated with DAIR, with success in 10 of 25, which was significantly lower than in patients treated with removal of the implant with success in 14 of 15. S. aureus infection, knee arthroplasty, and implant age < 2 years were associated with treatment failure. The 2-year mortality rate was 8 of 43. Conclusion: The outcome following DAIR in AHIs was poor. The majority of infections were caused by virulent microbes, and we found a high mortality rate. Removal of the implant should more often be considered.
MeSH term(s)	Humans ; Child, Preschool ; Cohort Studies ; Debridement ; Prosthesis-Related Infections/surgery ; Retrospective Studies ; Staphylococcus aureus ; Anti-Bacterial Agents/therapeutic use ; Arthroplasty, Replacement, Knee/adverse effects
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2023-03-08
Publishing country	Sweden
Document type	Journal Article
ZDB-ID	2180677-9
ISSN	1745-3682 ; 1745-3674
ISSN (online)	1745-3682
ISSN	1745-3674
DOI	10.2340/17453674.2023.10312
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Article: Late onset periprosthetic infection of the hip caused by the fish pathogen

Westberg, Marianne / Brekke, Hanne / Hermansen, Nils Olav / Flatøy, Bernhard

Journal of bone and joint infection

2020 Volume 5, Issue 3, Page(s) 106–109

Abstract: Lactococcus ... ...

Abstract	Lactococcus garvieae
Language	English
Publishing date	2020-04-06
Publishing country	Germany
Document type	Case Reports
ISSN	2206-3552
ISSN	2206-3552
DOI	10.7150/jbji.43655
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Article ; Online: Comparing two different orthogeriatric models of care for hip fracture patients: an observational prospective cross-sectional study.

Solberg, Lene Bergendal / Vesterhus, Elise Berg / Hestnes, Ingvild / Ahmed, Marc Vali / Ommundsen, Nina / Westberg, Marianne / Frihagen, Frede

BMJ open quality

2023 Volume 12, Issue Suppl 2

Abstract: Introduction: Patients with hip fractures are almost always operated with quite extensive surgery and are often frail with a high risk of complications, increased dependency, and death. Orthogeriatric interdisciplinary care has shown better results ... ...

Abstract	Introduction: Patients with hip fractures are almost always operated with quite extensive surgery and are often frail with a high risk of complications, increased dependency, and death. Orthogeriatric interdisciplinary care has shown better results compared with orthopaedic care alone. The best way of delivering orthogeriatric care, however, is still largely unknown. It is believed that a high degree of integration and shared care is better than on-demand consultative services. We aimed to evaluate two different orthogeriatric models for patients with hip fracture. Methods: A prospective hip fracture quality database was used to evaluate two coexisting models of care from 2019 to 2021 in our hospital. An 'integrated care model' (ICM) was compared with a 'geriatric consult service' (GCS). Results: 516 patients were available for analysis, 360 from ICM and 156 from GCS. Mean age was 84 years. There were 370 (72%) women. American Society of Anesthesiologists class and prefracture cognitive impairment was similar between the groups. There were more patients with femoral neck fractures in the ICM group, and more patients were living independently prefracture. A logistic regression adjusting for the variables above showed that more patients in the ICM group were given a nerve block preoperatively (OR 2.0 (95% CI 1.31 to 2.97); p<0.01), had their urinary catheter removed the first day after surgery (OR 1.9 (95% CI 1.27 to 2.89); p<0.01), were mobilised to standing or seated in a chair beside the bed the first day after surgery (OR 1.5 (95% CI 1.03 to 2.30); p=0.033) and more ICM patients were considered for treatment against osteoporosis (OR 8.58 (95% CI 4.03 to 18.28); p<0.001). There were no significant differences in time to surgery, length of stay, discharge destination or mortality. Conclusion: The ICM group performed equally good or better on all quality indicators than the GCS.
MeSH term(s)	Humans ; Female ; Aged ; Aged, 80 and over ; Male ; Cross-Sectional Studies ; Hip Fractures/surgery ; Orthopedics ; Femoral Neck Fractures ; Treatment Outcome
Language	English
Publishing date	2023-09-30
Publishing country	England
Document type	Observational Study ; Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2399-6641
ISSN (online)	2399-6641
DOI	10.1136/bmjoq-2023-002302
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Article ; Online: Postvaccination immune responses and risk of primary total hip arthroplasty-A population-based cohort study.

Rojewski, Sonia / Westberg, Marianne / Nordsletten, Lars / Meyer, Haakon E / Holvik, Kristin / Furnes, Ove / Fenstad, Anne Marie / Dahl, Jesper

Osteoarthritis and cartilage

2023 Volume 31, Issue 9, Page(s) 1249–1256

Abstract: Objective: To investigate the relationship between individual postvaccination immune responses and subsequent risk of total hip arthroplasty (THA) due to idiopathic osteoarthritis (OA) or rheumatoid arthritis (RA).: Method: Results of tuberculin skin ...

Abstract	Objective: To investigate the relationship between individual postvaccination immune responses and subsequent risk of total hip arthroplasty (THA) due to idiopathic osteoarthritis (OA) or rheumatoid arthritis (RA). Method: Results of tuberculin skin tests (TSTs) following the Bacille Calmette-Guerin (BCG) vaccination were used as a marker of individual immune responses. TST results from the mandatory mass tuberculosis screening program 1948-1975 (n = 236 770) were linked with information on subsequent THA during 1987-2020 from the Norwegian Arthroplasty Register. The multivariable Cox proportional hazard regression was performed. Results: A total of 10 698 individuals received a THA during follow-up. In men, there was no association between TST and risk of THA due to OA (Hazard ratio [HR] 1.01, 95% confidence interval [CI] 0.92-1.12 for positive versus negative TST and HR 1.06, 95% CI 0.95-1.18 for strong positive vs negative TST), while the risk estimates increased with increasingly restrictive sensitivity analyses. In women, there was no association with THA due to OA for positive versus negative TST (HR 0.98, 95% CI 0.92-1.05), while a strong positive TST was associated with reduced risk of THA (HR 0.90, 95% CI 0.84-0.97). No significant associations were observed in the sensitivity analysis for women or for THA due to RA. Conclusion: Our results suggest that an increased postvaccination immune response is associated with a nonsignificant trend of increased risk of THA among men and a decreased risk among women, although risk estimates were small.
MeSH term(s)	Male ; Humans ; Female ; Arthroplasty, Replacement, Hip/adverse effects ; Cohort Studies ; Risk Factors ; Arthritis, Rheumatoid/surgery ; Immunity ; Osteoarthritis, Hip/surgery ; Osteoarthritis, Hip/etiology
Language	English
Publishing date	2023-05-24
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1167809-4
ISSN	1522-9653 ; 1063-4584
ISSN (online)	1522-9653
ISSN	1063-4584
DOI	10.1016/j.joca.2023.05.007
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Article: Infection after Constrained Condylar Knee Arthroplasty: Incidence and microbiological findings in 100 consecutive complex primary and revision total knee arthroplasties.

Westberg, Marianne / Grøgaard, Bjarne / Snorrason, Finnur

Journal of bone and joint infection

2018 Volume 3, Issue 5, Page(s) 260–265

Abstract: Background: ...

Abstract	Background:
Language	English
Publishing date	2018-12-08
Publishing country	Germany
Document type	Journal Article
ISSN	2206-3552
ISSN	2206-3552
DOI	10.7150/jbji.28900
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Article ; Online: Results after introduction of a hip fracture care pathway: comparison with usual care.

Svenøy, Stian / Watne, Leiv Otto / Hestnes, Ingvild / Westberg, Marianne / Madsen, Jan Erik / Frihagen, Frede

Acta orthopaedica

2020 Volume 91, Issue 2, Page(s) 139–145

Abstract: Background and purpose - We established a care pathway for hip fracture patients, a "Hip Fracture Unit" (HFU), aiming to provide better in-hospital care and thus improve outcome. We compared the results after introduction of the HFU with a historical ... ...

Abstract	Background and purpose - We established a care pathway for hip fracture patients, a "Hip Fracture Unit" (HFU), aiming to provide better in-hospital care and thus improve outcome. We compared the results after introduction of the HFU with a historical control group.Patients and methods - The HFU consisted of a series of measures within the orthopedic ward, such as reducing preoperative waiting time, increased use of nerve blocks, early mobilization, and osteoporosis treatment. 276 patients admitted from May 2014 to May 2015 constituted the HFU group and 167 patients admitted from September 2009 to January 2012 constituted the historical control group. Patients were followed prospectively up to 12 months post fracture.Results - Mean preoperative waiting time was 24 hours in the HFU group and 29 hours in the control group (p = 0.003). 123 patients (47%) in the HFU were started on anti-osteoporosis treatment while in hospital. "Short Physical Performance Battery" score (SPPB) was mean 5.5 in the HFU group and 3.8 in the control group at 4 months (p < 0.001), and 5.7 vs. 3.6 at 12 months (p < 0.001). The mortality rate at 4 months was 15% in both groups. No statistically significant differences were found in readmissions, complications, new nursing home admissions, in Barthel ADL index or a mental capacity test at the follow-ups.
MeSH term(s)	Activities of Daily Living ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip/adverse effects ; Arthroplasty, Replacement, Hip/methods ; Arthroplasty, Replacement, Hip/standards ; Bone Density Conservation Agents/therapeutic use ; Critical Pathways/organization & administration ; Critical Pathways/standards ; Female ; Fracture Fixation, Internal/adverse effects ; Fracture Fixation, Internal/methods ; Fracture Fixation, Internal/standards ; Hip Fractures/rehabilitation ; Hip Fractures/surgery ; Historically Controlled Study/methods ; Hospital Units/organization & administration ; Hospitalization ; Humans ; Male ; Norway ; Osteoporotic Fractures/prevention & control ; Postoperative Complications ; Recovery of Function ; Treatment Outcome ; Waiting Lists
Chemical Substances	Bone Density Conservation Agents
Language	English
Publishing date	2020-01-13
Publishing country	England
Document type	Controlled Clinical Trial ; Journal Article
ZDB-ID	2180677-9
ISSN	1745-3682 ; 1745-3674
ISSN (online)	1745-3682
ISSN	1745-3674
DOI	10.1080/17453674.2019.1710804
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Article ; Online: Compliance with national guidelines for antibiotic prophylaxis in hip fracture patients: a quality assessment study of 13 329 patients in the Norwegian Hip Fracture Register.

Lian, Tom / Dybvik, Eva / Gjertsen, Jan-Erik / Dale, Håvard / Westberg, Marianne / Nordsletten, Lars / Figved, Wender

BMJ open

2020 Volume 10, Issue 5, Page(s) e035598

Abstract: Objective: We assessed compliance with new guidelines for prophylactic antibiotics in hip fracture surgery in Norway introduced in 2013.: Design: The data from the Norwegian Hip Fracture Register was used to assess the proportion of antibiotics given ...

Abstract	Objective: We assessed compliance with new guidelines for prophylactic antibiotics in hip fracture surgery in Norway introduced in 2013. Design: The data from the Norwegian Hip Fracture Register was used to assess the proportion of antibiotics given according to the national guidelines. Setting: All hospitals in Norway performing hip fracture surgery in the period from 2011 to 2016. Participants: We studied 13 329 hemiarthroplasties (HAs) for acute hip fracture. Main outcome measure: Type and timing between first and last dose of prophylactic antibiotics compared with the national guidelines. Results: Before the guidelines were introduced, the recommended drugs cephalotin or clindamycin was used in only 86.2% of all HAs. In 2016, one of the two recommended drugs was administered in 99.2% of HAs. However, hospitals' adaption of the recommended administration of the two drugs improved slowly, and by the end of the study period, only three out of five HAs were performed with the correct drug administered in the correct manner. We found major differences in compliance between hospitals. Conclusions: The change towards correct administration of antibiotic prophylaxis was varied both when investigating university and non-university hospitals. We suggest that both hospital leaders and the national Directorate of Health need to investigate routines for better dissemination of information and education to involved parties. Strong leadership concerning evidence-based guidelines on antibiotic prophylaxis in surgery may take away some autonomy from executing healthcare professionals, but will result in better patient care and antibiotic stewardship.
MeSH term(s)	Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Antibiotic Prophylaxis/standards ; Arthroplasty, Replacement, Hip ; Clindamycin/therapeutic use ; Female ; Guidelines as Topic/standards ; Hip Fractures/surgery ; Hospitals ; Humans ; Male ; Norway ; Qualitative Research ; Registries
Chemical Substances	Anti-Bacterial Agents ; Clindamycin (3U02EL437C)
Language	English
Publishing date	2020-05-20
Publishing country	England
Document type	Journal Article
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2019-035598
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Article ; Online: Virus transmission during orthopedic surgery on patients with COVID-19 - a brief narrative review.

Basso, Trude / Dale, Håvard / Langvatn, Håkon / Lønne, Greger / Skråmm, Inge / Westberg, Marianne / Wik, Tina S / Witsø, Eivind

Acta orthopaedica

2020 Volume 91, Issue 5, Page(s) 534–537

Abstract: Background and purpose - COVID-19 is among the most impactful pandemics that the society has experienced. Orthopedic surgery involves procedures generating droplets and aerosols and there is concern amongst surgeons that otherwise rational precautionary ... ...

Abstract	Background and purpose - COVID-19 is among the most impactful pandemics that the society has experienced. Orthopedic surgery involves procedures generating droplets and aerosols and there is concern amongst surgeons that otherwise rational precautionary principles are being set aside due to lack of scientific evidence and a shortage of personal protective equipment (PPE). This narrative review attempts to translate relevant knowledge into practical recommendations for healthcare workers involved in orthopedic surgery on patients with known or suspected COVID-19.Patients and methods - We unsystematically searched in PubMed, reference lists, and the WHO's web page for relevant publications concerning problems associated with the PPE used in perioperative practice when a patient is COVID-19 positive or suspected to be. A specific search for literature regarding COVID-19 was extended to include publications from the SARS epidemic in 2002/3.Results - Transmission of infectious viruses from patient to surgeon during surgery is possible, but does not appear to be a considerable problem in clinical practice. Seal-leakage is a problem with surgical masks. Due to the lack of studies and reports, the possibility of transmission of SARS-CoV-2 from patient to surgeon during droplet- and aerosol-generating procedures is unknown.Interpretation - Surgical masks should be used only in combination with a widely covering visor and when a respirator (N95, FFP2, P3) is not made available. Furthermore, basic measures to reduce shedding of droplets and aerosols during surgery and correct and consistent use of personal protective equipment is important.
MeSH term(s)	COVID-19/transmission ; Health Personnel ; Humans ; Infectious Disease Transmission, Patient-to-Professional/prevention & control ; Orthopedic Procedures ; Orthopedics ; Personal Protective Equipment/supply & distribution
Keywords	covid19
Language	English
Publishing date	2020-05-14
Publishing country	Sweden
Document type	Journal Article ; Review
ZDB-ID	2180677-9
ISSN	1745-3682 ; 1745-3674
ISSN (online)	1745-3682
ISSN	1745-3674
DOI	10.1080/17453674.2020.1764234
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Article ; Online: Compliance with national guidelines for antibiotic prophylaxis in hip fracture patients

Wender Figved / Lars Nordsletten / Tom Lian / Eva Dybvik / Jan-Erik Gjertsen / Håvard Dale / Marianne Westberg

BMJ Open, Vol 10, Iss

a quality assessment study of 13 329 patients in the Norwegian Hip Fracture Register

2020 Volume 5

Abstract: Objective We assessed compliance with new guidelines for prophylactic antibiotics in hip fracture surgery in Norway introduced in 2013.Design The data from the Norwegian Hip Fracture Register was used to assess the proportion of antibiotics given ... ...

Abstract	Objective We assessed compliance with new guidelines for prophylactic antibiotics in hip fracture surgery in Norway introduced in 2013.Design The data from the Norwegian Hip Fracture Register was used to assess the proportion of antibiotics given according to the national guidelines.Setting All hospitals in Norway performing hip fracture surgery in the period from 2011 to 2016.Participants We studied 13 329 hemiarthroplasties (HAs) for acute hip fracture.Main outcome measure Type and timing between first and last dose of prophylactic antibiotics compared with the national guidelines.Results Before the guidelines were introduced, the recommended drugs cephalotin or clindamycin was used in only 86.2% of all HAs. In 2016, one of the two recommended drugs was administered in 99.2% of HAs. However, hospitals’ adaption of the recommended administration of the two drugs improved slowly, and by the end of the study period, only three out of five HAs were performed with the correct drug administered in the correct manner. We found major differences in compliance between hospitals.Conclusions The change towards correct administration of antibiotic prophylaxis was varied both when investigating university and non-university hospitals. We suggest that both hospital leaders and the national Directorate of Health need to investigate routines for better dissemination of information and education to involved parties. Strong leadership concerning evidence-based guidelines on antibiotic prophylaxis in surgery may take away some autonomy from executing healthcare professionals, but will result in better patient care and antibiotic stewardship.
Keywords	Medicine ; R
Subject code	610
Language	English
Publishing date	2020-05-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Virus transmission during orthopedic surgery on patients with COVID-19 – a brief narrative review

Trude Basso / Håvard Dale / Håkon Langvatn / Greger Lønne / Inge Skråmm / Marianne Westberg / Tina S Wik / Eivind Witsø

Acta Orthopaedica , Vol 0, Iss 0, Pp 1-

2020 Volume 4

Abstract: Background and purpose — COVID-19 is among the most impactful pandemics that the society has experienced. Orthopedic surgery involves procedures generating droplets and aerosols and there is concern amongst surgeons that otherwise rational precautionary ... ...

Abstract	Background and purpose — COVID-19 is among the most impactful pandemics that the society has experienced. Orthopedic surgery involves procedures generating droplets and aerosols and there is concern amongst surgeons that otherwise rational precautionary principles are being set aside due to lack of scientific evidence and a shortage of personal protective equipment (PPE). This narrative review attempts to translate relevant knowledge into practical recommendations for healthcare workers involved in orthopedic surgery on patients with known or suspected COVID-19. Patients and methods — We unsystematically searched in PubMed, reference lists, and the WHO’s web page for relevant publications concerning problems associated with the PPE used in perioperative practice when a patient is COVID-19 positive or suspected to be. A specific search for literature regarding COVID-19 was extended to include publications from the SARS epidemic in 2002/3. Results — Transmission of infectious viruses from patient to surgeon during surgery is possible, but does not appear to be a considerable problem in clinical practice. Seal-leakage is a problem with surgical masks. Due to the lack of studies and reports, the possibility of transmission of SARS-CoV-2 from patient to surgeon during droplet- and aerosol-generating procedures is unknown. Interpretation — Surgical masks should be used only in combination with a widely covering visor and when a respirator (N95, FFP2, P3) is not made available. Furthermore, basic measures to reduce shedding of droplets and aerosols during surgery and correct and consistent use of personal protective equipment is important.
Keywords	Orthopedic surgery ; RD701-811 ; covid19
Subject code	616
Language	English
Publishing date	2020-05-01T00:00:00Z
Publisher	Taylor & Francis Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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