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Biomedical subjects

M Flören

Publications and source records attributed to M Flören.

4 recordsLinked to original sources
PubMed2006

Indications for total hip replacement: comparison of assessments of orthopaedic surgeons and referring physicians.

OBJECTIVES: To analyse differences of opinions on indications for primary total hip replacements (THRs) within and between groups of orthopaedic surgeons and the physicians who refer patients to them. METHODS: 22 orthopaedic centres in 12 European countries took part, resulting in a postal survey of 304 orthopaedic surgeons and 314 referring physicians. Each participant was asked to state what importance different domains (pain, functional impairment, physical examination and radiographs) have on their decision to recommend THR and to select the most appropriate level of severity of each symptom or sign for recommending THR. In addition, the participants were asked to prioritise other personal or environmental factors that affect their decision to undertake a THR. RESULTS: Rest pain, pain with activity and functional limitations were the most important criteria for THR, although range of motion and radiographic changes were of least importance. Both similarities and differences were observed within and between groups of surgeons and referring physicians in the overall approach to indications and the most appropriate level of severity of disease for recommending THR. Most surgeons agreed on severity levels in only 4 of 11 items and most referring physicians in only one. Between the groups, major differences occurred with regard to the importance of activities of daily living and the appropriate level of symptoms for THR. In general, compared with surgeons, referring physicians reported that the disease needed to be more advanced to warrant surgery. CONCLUSION: Currently, no consensus exists on objective indication criteria for THR. The observed differences between the gatekeepers (referring physicians) and surgeons can lead to variations and perhaps inequities in the provision of care.

Arthroplasty, Replacement, Hip↗
PubMed2000

Interdependence of clinical and isokinetic results after bicondylar knee prostheses with special emphasis on quality of life results.

Nineteen patients were examined at an average follow-up of 2 years after total knee joint replacement without patella resurfacing. They were compared with 22 healthy subjects of the same age. Using the Hospital for Special Surgery (HSS) score the operated knee joints scored an average of 77 points, the contralateral side scored 87 points and the control group 97 points. In the SF-36 health questionnaire the patients showed highly significant deviations. Isokinetic measurements revealed a clear loss of isokinetic strength of more than 50% on average in flexion as in extension when compared to the control group and there were considerable asymmetries between the operated and the contralateral legs.

Aged↗
PubMed1998

[Shoulder joint instability after primary arthroplasty].

Instability is one of the most common complications after shoulder arthroplasty. The literature cites subluxation or luxation to occur between 0% and 38% in various studies. Instabilities may present either as subluxation or frank dislocation, and may be directed in an anterior, posterior, inferior or, depending on the state of the rotator cuff, cranial direction. The stability of any shoulder joint is given by the balance of the muscles directing the forces around the shoulder joint in association with the passive stabilizers of the shoulder joint capsule as well as the bony contours between glenoid and humeral head. Any disturbance of this delicate balance will lead the shoulder into instability, particular so if bony erosion patterns such as posterior glenoid wear in osteoarthritics will develop subluxation early on. Therefore implantation of any prosthesis is required to be done in the appropriate version as to avoid secondary instability through the prosthetic components. In the study undertaken here instability was found to be the most common complication in 44 shoulder revision surgeries. The result with an average Score of 41.9 recorded after Constant demonstrates that the excellent and good results obtained with primary arthroplasties can not be expected in revision surgery. Posterior instability may be present just as well as the more easily observed anterior instability. Separate to frank luxation or instability is the late cranialisation of the rotator cuff deficient shoulder which, although resulting in many cases in superior anterior subluxation, will mostly be seen as a late complication after arthroplasty.

Arthroplasty, Replacement↗