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Article ; Online: Manipulation under anesthesia: to do or not to do, that is the question.

W-Dahl, Annette

2022 Volume 93, Page(s) 682–683

MeSH term(s)	Anesthesia ; Humans ; Manipulation, Orthopedic ; Range of Motion, Articular
Language	English
Publishing date	2022-07-15
Publishing country	Sweden
Document type	Editorial ; Comment
ZDB-ID	2180677-9
ISSN	1745-3682 ; 1745-3674
ISSN (online)	1745-3682
ISSN	1745-3674
DOI	10.2340/17453674.2022.4344
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Article ; Online: Patient-Reported Anxiety or Depression Increased the Risk of Dissatisfaction Despite Improvement in Pain or Function Following Total Knee Arthroplasty: A Swedish Register-Based Observational Study of 8,745 Patients.

Heijbel, Siri / W-Dahl, Annette / E-Naili, Josefine / Hedström, Margareta

The Journal of arthroplasty

2024

Abstract: Background: Remaining pain and functional limitations may cause dissatisfaction in patients after total knee arthroplasty (TKA). Furthermore, anxiety and depression are associated with remaining postoperative symptoms and dissatisfaction. We ... ...

Abstract	Background: Remaining pain and functional limitations may cause dissatisfaction in patients after total knee arthroplasty (TKA). Furthermore, anxiety and depression are associated with remaining postoperative symptoms and dissatisfaction. We investigated if patient-reported anxiety or depression increased the risk of dissatisfaction 1 year after TKA in patients who improved in pain or function. Methods: Data on primary TKAs due to osteoarthritis between 2017 and 2019 was obtained from the Swedish Knee Arthroplasty Register. Out of 14,120 patients 9,911 completed the Knee injury and Osteoarthritis Outcome Score and satisfaction rate with the result of the surgery. According to the Outcome Measures in Rheumatology - Osteoarthritis Research Society International (OMERACT-OARSI) criteria patients were classified as responders (improved in pain or function) or non-responders. Anxiety and depression were assessed through EuroQol-5 Dimension 3 levels. Log-linear regression models estimated the risk ratios (RR) for dissatisfaction in all patients and stratified by age groups (< 65, 65 to 74, and > 74 years). There were 8,745 patients who were classified as responders whereas 11% were defined as dissatisfied. The proportion of patients who reported anxiety or depression was 35% preoperatively and 17% postoperatively. Results: Anxiety/depression increased the risk of dissatisfaction preoperatively (RR 1.23, 95% CI [confidence interval] = 1.09 to 1.40) and postoperatively (RR 2.65, CI 2.33 to 3.00). Patients younger than 65 years reported preoperative anxiety or depression to a greater extent but did not have an increased risk of dissatisfaction. Conclusion: Patient-reported anxiety or depression preoperatively and postoperatively are important and potentially treatable factors to consider, as they were found to increase the risk of dissatisfaction after TKA despite improvements in pain or function.
Language	English
Publishing date	2024-04-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	632770-9
ISSN	1532-8406 ; 0883-5403
ISSN (online)	1532-8406
ISSN	0883-5403
DOI	10.1016/j.arth.2024.04.071
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Article ; Online: Regional skillnad i incidensen av skador efter ledprotesoperation.

Rahmanian, Sabina / Aggeryd, Cecilia / Gustafson, Pelle / Heijbel, Siri / W-Dahl, Annette / Hedström, Margareta

Lakartidningen

2024 Volume 121

Abstract: Hip and knee arthroplasties are mostly successful procedures; however, patient injuries may occur and should be reported to Löf, the Swedish patient insurance. This study investigated the incidence of patient injuries after primary total hip and knee ... ...

Title translation	Considerable regional differences in patient injuries after primary hip and knee arthroplasty and between orthopedic departments depending on surgical volume.
Abstract	Hip and knee arthroplasties are mostly successful procedures; however, patient injuries may occur and should be reported to Löf, the Swedish patient insurance. This study investigated the incidence of patient injuries after primary total hip and knee arthroplasty in the Swedish regions, differences in incidence depending on annual surgical volume, and types of approved injuries. Approved patient injuries were related to the total number of hip and knee arthroplasties registered in the Swedish Arthroplasty Register 2012-2021. The national incidence was 11.4 and 8.1 per 1,000 hip and knee arthroplasties respectively and varied in the regions from 30.4 to 4.9 and 15.4 to 5.4 per 1,000 hip and knee arthroplasties respectively. Orthopedic departments with higher annual volumes of performed arthroplasties had a lower proportion of patient injuries. Infection was the most common patient injury, followed by nerve lesions and mechanical complications. The differences may be due to underreporting and varying quality of care in the regions. A centralization of hip and knee arthroplasties may be beneficial.
MeSH term(s)	Humans ; Arthroplasty, Replacement, Knee/statistics & numerical data ; Arthroplasty, Replacement, Knee/adverse effects ; Arthroplasty, Replacement, Hip/adverse effects ; Arthroplasty, Replacement, Hip/statistics & numerical data ; Sweden/epidemiology ; Incidence ; Registries ; Postoperative Complications/epidemiology ; Female ; Male ; Orthopedics ; Aged
Language	Swedish
Publishing date	2024-05-08
Publishing country	Sweden
Document type	English Abstract ; Journal Article
ZDB-ID	391010-6
ISSN	1652-7518 ; 0023-7205
ISSN (online)	1652-7518
ISSN	0023-7205
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Book ; Thesis: Hemicallotasis in tibial osteotomy using external fixation

W-Dahl, Annette

patients, pin site infection and pin site care

2005

Author's details	Annette, W-Dahl
Language	English
Size	Getr. Zählung : Ill., graph. Darst.
Publishing country	Sweden
Document type	Book ; Thesis
Thesis / German Habilitation thesis	Lund, Univ., Diss., 2005
Note	Zsfassung in schwed. Sprache
HBZ-ID	HT014568422
ISBN	91-85439-02-9 ; 978-91-85439-02-7
Database	Catalogue ZB MED Medicine, Health

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Article ; Online: Increased short- and long-term mortality amongst patients with early periprosthetic knee joint infection.

Thompson, Olof / W-Dahl, Annette / Stefánsdóttir, Anna

BMC musculoskeletal disorders

2022 Volume 23, Issue 1, Page(s) 1069

Abstract: Background: Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) is a severe complication in terms of disability, morbidity, and cost. We performed a study to investigate whether early PJI (within 90 days of primary TKA) is ... ...

Abstract	Background: Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) is a severe complication in terms of disability, morbidity, and cost. We performed a study to investigate whether early PJI (within 90 days of primary TKA) is associated with increased mortality. Secondary aims were to compare mortality rates over time and between surgical treatment methods. Methods: Patients with suspected PJI were identified by linkage of the Swedish Knee Arthroplasty Register (SKAR) and the Swedish Prescribed Drug Register (SPDR) in 2007-2008 and 2012-2013. Medical records of patients receiving more than 4 weeks of continuous antibiotic therapy were subsequently reviewed to verify the PJI diagnosis. Information on mortality was obtained through the SKAR which is updated daily from the tax agency and patients with PJI were compared to patients without PJI. Results: Four hundred sixty-six patients were diagnosed with PJI within 90 days and compared to 40,362 patients without PJI. Mortality rates were significantly higher for PJI patients in both short- and long term: 2.6% vs. 0.8% at 1 year, 4.9% vs. 1.9% at 2 years, 15.7% vs. 7.1% at 5 years, and 38% vs. 21.4% at 10 years. The difference in mortality rate remained after adjusting for sex, age, diagnosis, and time period for surgery with Hazard Ratio 1.8 (95% CI:1.6-2.1). Mortality rates did not differ between time periods, and we found no correlation to surgical treatment. Conclusion: Patients with early PJI after primary TKA have an increased mortality rate compared to TKA patients without PJI. Improvements in surgical treatment strategy has not resulted in better survival. Long term difference in mortality rates indicates that PJI is not the sole reason for mortality suggesting a general frailty in PJI patients.
MeSH term(s)	Humans ; Knee Joint
Language	English
Publishing date	2022-12-06
Publishing country	England
Document type	Journal Article
ZDB-ID	2041355-5
ISSN	1471-2474 ; 1471-2474
ISSN (online)	1471-2474
ISSN	1471-2474
DOI	10.1186/s12891-022-06024-y
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Article ; Online: Substantial clinical benefit and patient acceptable symptom states of the Forgotten Joint Score 12 after primary knee arthroplasty.

Heijbel, Siri / W-Dahl, Annette / Nilsson, Kjell G / Hedström, Margareta

Acta orthopaedica

2022 Volume 93, Page(s) 158–163

Abstract: Background and purpose - Knowing how to interpret values obtained with patient reported outcome measures (PROMs) is essential. We estimated the substantial clinical benefit (SCB) and patient acceptable symptom state (PASS) for Forgotten Joint Score 12 ( ... ...

Abstract	Background and purpose - Knowing how to interpret values obtained with patient reported outcome measures (PROMs) is essential. We estimated the substantial clinical benefit (SCB) and patient acceptable symptom state (PASS) for Forgotten Joint Score 12 (FJS) and explored differences depending on methods used for the estimates. Patients and methods - The study was based on 195 knee arthroplasties (KA) performed at a university hospital. We used 1 item from the Knee injury and Osteoarthritis Outcome Score domain quality of life and satisfaction with surgery, obtained 1-year postoperatively, to assess SCB and PASS thresholds of the FJS with anchor-based methods. We used different combinations of anchor questions for SCB and PASS (satisfied, satisfied with no or mild knee difficulties, and satisfied with no knee difficulties). A novel predictive approach and receiver-operating characteristics curve were applied for the estimates. Results - 70 and 113 KAs were available for the SCB and PASS estimates, respectively. Depending on method, SCB of the FJS (range 0-100) was 28 (95% CI 21-35) and 22 (12-45) respectively. PASS was 31 (2-39) and 20 (10-29) for satisfied patients, 40 (31-47) and 38 (32-43) for satisfied patients with no/mild difficulties, and 76 (39-80) and 64 (55-74) for satisfied patients with no difficulties. The areas under the curve ranged from 0.82 to 0.88. Interpretation - Both the SCB and PASS thresholds varied depending on methodology. This may indicate a problem using meaningful values from other studies defining outcomes after KA. This study supports the premise of the FJS as a PROM with good discriminatory ability in patients undergoing KA.
MeSH term(s)	Arthroplasty, Replacement, Knee/adverse effects ; Humans ; Knee Injuries/surgery ; Knee Joint/surgery ; Patient Reported Outcome Measures ; Quality of Life ; Treatment Outcome
Language	English
Publishing date	2022-01-03
Publishing country	Sweden
Document type	Journal Article
ZDB-ID	2180677-9
ISSN	1745-3682 ; 1745-3674
ISSN (online)	1745-3682
ISSN	1745-3674
DOI	10.2340/17453674.2021.887
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Article ; Online: Pain, Function, and Satisfaction After Total Knee Arthroplasty, with or Without Bariatric Surgery.

Ighani Arani, Perna / Wretenberg, Per / Ottosson, Johan / W-Dahl, Annette

Obesity surgery

2022 Volume 32, Issue 4, Page(s) 1164–1169

Abstract: Background: The impact of obesity on patient-reported outcome (PRO) after total knee arthroplasty (TKA) surgery has demonstrated varying results. We evaluated knee pain, Activity in Daily Life function (ADL), and satisfaction after TKA surgery in ... ...

Abstract	Background: The impact of obesity on patient-reported outcome (PRO) after total knee arthroplasty (TKA) surgery has demonstrated varying results. We evaluated knee pain, Activity in Daily Life function (ADL), and satisfaction after TKA surgery in patients with and without prior bariatric surgery (BS). Methods: Scandinavian Obesity Surgery Registry (SOReg) and the Swedish Knee Arthroplasty Register (SKAR) were used to identify patients operated on with primary TKA for osteoarthritis (OA) between 2009 and 2019 that had a BS within 2 years before the TKA (BS group). These patients were compared to patients with TKA without prior BS (no BS group). The patients filled in the Knee injury and Osteoarthritis Outcome Score (KOOS) preoperatively and one year postoperatively as well as satisfaction with the surgery one year postoperatively. Multiple linear regression analysis was used to evaluate 1-year postoperative KOOS pain and ADL function between the 2 groups. Adjustments were made for sex, age, and preoperative KOOS pain and ADL function respectively. Results: Forty-four patients were included in the BS group and 3,525 patients in the no BS group. We found no statistically or clinically significant difference in one-year postoperative KOOS pain and ADL function between the BS group and the no BS group. The majority of the patients in both groups were classified as satisfied or very satisfied one year postoperatively to the TKA. Conclusions: Our results indicate that patients without BS prior to the TKA gain similar 1-year outcome in pain, ADL function and satisfaction as patients with prior BS.
MeSH term(s)	Arthroplasty, Replacement, Knee/adverse effects ; Bariatric Surgery ; Humans ; Knee Joint/surgery ; Obesity, Morbid/surgery ; Osteoarthritis, Knee/surgery ; Pain, Postoperative/etiology ; Patient Satisfaction ; Personal Satisfaction ; Treatment Outcome
Language	English
Publishing date	2022-01-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	1070827-3
ISSN	1708-0428 ; 0960-8923
ISSN (online)	1708-0428
ISSN	0960-8923
DOI	10.1007/s11695-022-05912-5
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Article ; Online: Total knee arthroplasty and bariatric surgery: change in BMI and risk of revision depending on sequence of surgery.

Ighani Arani, Perna / Wretenberg, Per / Stenberg, Erik / Ottosson, Johan / W-Dahl, Annette

BMC surgery

2023 Volume 23, Issue 1, Page(s) 53

Abstract: Background: Patients with obesity have a higher risk of complications after total knee arthroplasty (TKA). We investigated the change in weight 1 and 2 years post-Bariatric Surgery (BS) in patients that had undergone both TKA and BS as well as the risk ... ...

Abstract	Background: Patients with obesity have a higher risk of complications after total knee arthroplasty (TKA). We investigated the change in weight 1 and 2 years post-Bariatric Surgery (BS) in patients that had undergone both TKA and BS as well as the risk of revision after TKA based on if BS was performed before or after the TKA. Methods: Patients who had undergone BS within 2 years before or after TKA were identified from the Scandinavian Obesity Surgery Register (SOReg) and the Swedish Knee Arthroplasty Register (SKAR) between 2007 and 2019 and 2009 and 2020, respectively. The cohort was divided into two groups; patients who underwent TKA before BS (TKA-BS) and patients who underwent BS before TKA (BS-TKA). Multilinear regression analysis and a Cox proportional hazards model were used to analyze weight change after BS and the risk of revision after TKA. Results: Of the 584 patients included in the study, 119 patients underwent TKA before BS and 465 underwent BS before TKA. No association was detected between the sequence of surgery and total weight loss 1 and 2 years post-BS, - 0.1 (95% confidence interval (CI), - 1.7 to 1.5) and - 1.2 (95% CI, - 5.2 to 2.9), or the risk of revision after TKA [hazard ratio 1.54 (95% CI 0.5-4.5)]. Conclusion: The sequence of surgery in patients undergoing both BS and TKA does not appear to be associated with weight loss after BS or the risk of revision after TKA.
MeSH term(s)	Humans ; Arthroplasty, Replacement, Knee ; Body Mass Index ; Reoperation ; Obesity/surgery ; Bariatric Surgery/adverse effects ; Weight Loss ; Retrospective Studies
Language	English
Publishing date	2023-03-10
Publishing country	England
Document type	Journal Article
ZDB-ID	2050442-1
ISSN	1471-2482 ; 1471-2482
ISSN (online)	1471-2482
ISSN	1471-2482
DOI	10.1186/s12893-023-01951-6
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Article ; Online: Impact of patient and prosthesis characteristics on common reasons for total knee replacement revision: a registry study of 36,626 revision cases from Australia, Sweden, and USA.

Lewis, Peter L / W-Dahl, Annette / Robertsson, Otto / Prentice, Heather A / Graves, Stephen E

Acta orthopaedica

2022 Volume 93, Page(s) 623–633

Abstract: Background and purpose: Total knee replacement (TKR) studies usually analyze all-cause revision when considering relationships with patient and prosthesis factors. We studied how these factors impact different revision diagnoses.: Patients and methods! ...

Abstract	Background and purpose: Total knee replacement (TKR) studies usually analyze all-cause revision when considering relationships with patient and prosthesis factors. We studied how these factors impact different revision diagnoses. Patients and methods: We used data from 2003 to 2019 of TKR for osteoarthritis from the arthroplasty registries of Sweden, Australia, and Kaiser Permanente, USA to study patient and prosthesis characteristics for specific revision diagnoses. There were 1,072,924 primary TKR included and 36,626 were revised. Factors studied included age, sex, prosthesis constraint, fixation method, bearing mobility, polyethylene type, and patellar component use. Revision diagnoses were arthrofibrosis, fracture, infection, instability, loosening, pain, patellar reasons, and wear. Odds ratios (ORs) for revision were estimated and summary effects were calculated using a meta-analytic approach. Results: We found between-registry consistency in 15 factor/reason analyses. Risk factors for revision for arthrofibrosis were age < 65 years (OR 2.0; 95% CI 1.4-2.7) and mobile bearing designs (MB) (OR 1.7; CI 1.1-2.5), for fracture were female sex (OR 3.2; CI 2.2-4.8), age ≥ 65 years (OR 2.8; CI 1.9-4) and posterior stabilized prostheses (PS) (OR 2.1; CI 1.3-3.5), for infection were male sex (OR 1.9; CI 1.7-2.0) and PS (OR 1.5; CI 1.2-1.8), for instability were age < 65 years (OR 1.5; CI 1.3-1.8) and MB (OR 1.5; CI 1.1-2.2), for loosening were PS (OR 1.5; CI 1.4-1.6), MB (OR 2.2; CI 1.6-3.0) and use of ultra-high molecular weight polyethylene (OR 2.3; CI 1.8-2.9), for patellar reasons were not resurfacing the patella (OR 13.6; CI 2.1-87.2) and MB (OR 2.0; CI 1.2-3.3) and for wear was cementless fixation (OR 4.9; CI 4.3-5.5). Interpretation: Patients could be counselled regarding specific age and sex risks. Use of minimally stabilized, fixed bearing, cemented prostheses, and patellar components is encouraged to minimize revision risk.
MeSH term(s)	Aged ; Arthroplasty, Replacement, Knee/adverse effects ; Female ; Fractures, Bone ; Humans ; Knee Prosthesis ; Male ; Polyethylene ; Registries ; Sweden/epidemiology
Chemical Substances	Polyethylene (9002-88-4)
Language	English
Publishing date	2022-07-05
Publishing country	Sweden
Document type	Journal Article
ZDB-ID	2180677-9
ISSN	1745-3682 ; 1745-3674
ISSN (online)	1745-3682
ISSN	1745-3674
DOI	10.2340/17453674.2022.3512
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Article ; Online: Similar periprosthetic joint infection rates after and before a national infection control program: a study of 45,438 primary total knee arthroplasties.

Thompson, Olof / W-Dahl, Annette / Lindgren, Viktor / Gordon, Max / Robertsson, Otto / Stefánsdóttir, Anna

Acta orthopaedica

2022 Volume 93, Page(s) 3–10

Abstract: Background and purpose - Strenuous efforts to minimize postoperative infection rates have been made, including the Swedish nationwide initiative Prosthesis Related Infections Shall be Stopped (PRISS). This study calculated the incidence rate of ... ...

Abstract	Background and purpose - Strenuous efforts to minimize postoperative infection rates have been made, including the Swedish nationwide initiative Prosthesis Related Infections Shall be Stopped (PRISS). This study calculated the incidence rate of periprosthetic joint infection (PJI) following primary total knee arthroplasty (TKA) before and after PRISS. Patients and methods - All 45,438 primary TKAs registered in the Swedish Knee Arthroplasty Register (SKAR) during 2007-2008 and 2012-2013 were included. Matched data on antibiotic prescriptions were obtained from the Swedish Prescribed Drug Register (SPDR). All patients with ≥ 28 days of continuous antibiotic treatment within 2 years of primary surgery had their medical charts reviewed to identify cases of PJI. The incidence rate was calculated by dividing the number of PJIs by the total time at risk during each time period and presented as percentages with 95% confidence interval (CI). Results - 644 PJIs were identified, equaling a 2-year incidence rate of 1.45% (CI 1.34-1.57). The incidence rate was 1.44% (CI 1.27-1.61) before PRISS and 1.46% (CI 1.31-1.61) after. Diagnosis was made within 30 days of primary TKA in 52%, and within 90 days in 73% of cases. 603 cases were reoperated on or revised. Median time from operation to diagnosis was 29 days (1-716), for both time periods. Debridement with exchange of the insert was performed in 32% and 63% of cases before and after PRISS, respectively. Interpretation - We found similar incidence rates before and after the PRISS initiative without any statistically significant difference. Time to diagnosis was similar during both time periods. The project may have contributed to increased compliance with treatment protocols.
MeSH term(s)	Aged ; Anti-Bacterial Agents/therapeutic use ; Arthroplasty, Replacement, Knee/methods ; Female ; Humans ; Incidence ; Infection Control/methods ; Male ; Middle Aged ; Prosthesis-Related Infections/drug therapy ; Prosthesis-Related Infections/epidemiology ; Sweden/epidemiology
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2022-01-03
Publishing country	Sweden
Document type	Journal Article
ZDB-ID	2180677-9
ISSN	1745-3682 ; 1745-3674
ISSN (online)	1745-3682
ISSN	1745-3674
DOI	10.1080/17453674.2021.1977532
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