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Steffen Jacobsen

Publications and source records attributed to Steffen Jacobsen.

At least 19 recordsLinked to original sources
PubMed2007

Degenerative lumbar spondylolisthesis: an epidemiological perspective: the Copenhagen Osteoarthritis Study.

STUDY DESIGN: A cross-sectional epidemiological survey of 4151 participants of the Copenhagen Osteoarthritis Study. OBJECTIVE: To identify prevalences and individual risk factors for degenerative lumbar spondylolisthesis. SUMMARY OF BACKGROUND DATA: The Copenhagen Osteoarthritis Study has registered health parameters since 1976. In 1993, standardized, lateral radiographs of the lumbar spine were recorded. There were 1533 men and 2618 women. METHODS: Statistical correlations were made between degenerative spondylolisthesis, and physical, occupational, and general epidemiological data. RESULTS: A total of 254 cases of lumbar slip were found (males 2.7%, females 8.4%). In females, no significant relationship between age at menopause or childbirths and the presence of degenerative spondylolisthesis were found. In women, relationships between body mass index (BMI) in 1976 and L4 olisthesis (P = 0.001), and between BMI in 1993 and both L4 and L5 olisthesis were found (L4: P = 0.003; L5: P = 0.006). Lumbar lordosis was associated with degenerative spondylolisthesis in women. Occupational exposures to daily lifting or smoking were not associated with degenerative spondylolisthesis. Degenerative spondylolisthesis was associated with increased age in both sexes (L4: P < 0.001; L5: P < 0.001). CONCLUSIONS: BMI longitudinally and at index evaluations, age, and angle of lordosis were significantly associated with degenerative spondylolisthesis in women. In men, no individual risk factors for degenerative spondylolisthesis were found, save increased age.

Adult↗
PubMed2006

Lumbar spondylolysis: a life long dynamic condition? A cross sectional survey of 4.151 adults.

Lumbar spondylolysis (LS) has been the subject of several studies focusing on adolescent athletes. Few, if any, studies have examined LS in the general population. Lysis of the pars interarticularis of the vertebra may be associated with slipping (olisthesis), or it may be stable. In the present survey of lumbar radiographs and general epidemiological data recorded from the Copenhagen Osteoarthritis Study cohort of 4.151 subjects (age range, 22-93 years), we identified the distribution and individual risk factors for LS-development. Men were significantly more at risk of L5 spondylolysis (P = 0.002). There were no sex-specific significant differences regarding LS-incidence at the L4 level. We found no significant differences of risk of LS between nulliparous or multiparous women (L4 P = 0.54/L5 P = 0.35). Furthermore, we found no significant relationship between age at menopause and LS-development. Increased lumbar lordosis was associated to L4/L5 spondylolysis in men (L4 P < 0.001/L5 P = 0.008). In women increased lumbar lordosis had a significant association with L5 spondylolysis (P < 0.001). Increased pelvic inclination was associated with L5 spondylolysis in both men and women (P < 0.001). There were no sex-specific differences regarding the occurrence of simultaneous slips/non-slips. In men, no individual risk factors for L4 slips with concomitant LS were found. In women slipped LS of L4 were significantly associated to aging (P < 0.001) and with decreased pelvic inclination (P = 0.001). In men slipped LS of L5 was significantly associated to increased BMI (P = 0.002), but not to aging (P = 0.10). In women, slips of L5 LS were significantly correlated to aging (P = 0.005), to BMI recorded at the time of radiographic examination (P = 0.006), and BMI measured 17 years before radiographic index examination (P = 0.004). The present study contrasts with commonly held views regarding lumbar spondylolysis. The prevalence of LS increases throughout life and is apparently not a condition restricted to adolescence. Although the cross-sectional nature of the present study prevents an exact estimate of the age at onset; future, sequential studies of the cohort may provide us with some important answers on this topic. Apart from aging-obesity, lordotic angle and pelvic inclination were found to be individual risk factors for LS.

Adult↗
PubMed2006

Influence of surgeon's experience and supervision on re-operation rate after hip fracture surgery.

OBJECTIVE: To investigate the influence of the performing surgeon's experience and degree of supervision on re-operation rate among patients admitted with a proximal femoral fracture (PFF). METHODS: Prospective study of 600 consecutive patients with proximal femoral fracture in our multimodal rehabilitation programme, between 2002 and 2004. Re-operation rate was assessed 6 months postoperatively. Surgeons were grouped as unsupervised junior registrars versus experienced surgeons operating or supervising. Fractures were stratified as technically undemanding or demanding. RESULTS: Unsupervised junior registrars operated on 23% (137/600) of all and 15% (56/365) of technically demanding proximal femoral fractures. The latter had a higher re-operation rate within 6 months, compared with the rate when more experienced surgeons were present. In logistic regression analysis combining age, gender, American Society of Anaesthesiologists score, New Mobility Score, time to surgery and type of implant, surgery by unsupervised junior registrars was still a significant independent risk factor for re-operation in technically demanding proximal femoral fractures. CONCLUSION: Unsupervised junior registrars should not operate on technically demanding proximal femoral fractures.

Adult↗
PubMed2006

[Surgical treatment of proximal femoral fracture].

In Denmark, 11,000 patients with proximal femoral fractures are admitted to hospital each year, using 2.2% of the national hospitalisation capacity. The patients are generally old and have a high degree of co-morbidities. In Denmark, the 30-day mortality rate is 10%, and on an international level, reoperation rates of 10-20% are reported. This article reports on current treatment stategies, classifications and surgical techniques and presents possible guidelines. The use of specialized centres and accelerated clinical programmes in Denmark is recommended.

Aged↗
PubMed2006

[Low back degeneration and radiology].

Low back pain (LBP) is one of the most common conditions, and at the same time one of the most complex nosological entities. The lifetime prevalence is approximately 80%, and radiological features of lumbar degeneration are almost universal in adults. The individual risk factors for LBP and significant relationships between radiological findings and subjective symptoms have both been notoriously difficult to identify. The lack of consensus on clinical criteria and radiological definitions has hampered the undertaking of properly executed epidemiological studies. The natural history of LBP is cyclic: exacerbations relieved by asymptomatic periods. New imaging modalities, including the combination of MR imaging and multiplanar 3-D CT scans, have broadened our awareness of possible pain-generating degenerative processes of the lumbar spine other than disc degeneration.

Adult↗
PubMed2006

[Osteoarthritis and obesity].

Epidemiological studies show an increased prevalence of osteoarthritis of the knee and hand with increased body mass index [BMI]. Osteoarthritis of the hip joint is not related to BMI. The connection between obesity and osteoarthritis cannot exclusively be explained by genetic factors or by the accumulation of tear and wear. Overweight occurs prior to knee joint degeneration, not as a result of diminished activity due to joint degeneration. Weight control seems to be an influential tool in the prophylaxis of overweight-specific joint degeneration.

Body Fat Distribution↗
PubMed2006

The GSB III elbow prosthesis in rheumatoid arthritis: a 2- to 9-year follow-up.

BACKGROUND: The optimal design of an elbow prosthesis for badly damaged elbows is unkown. We evaluated 23 GSB III semi-constrained (sloppy-hinged) total elbow arthroplasties in 16 consecutive patients with rheumatoid arthritis. PATIENTS AND METHODS: After a mean follow-up period of 5 (2-9) years, we assessed quality of the cementing technique, signs of aseptic loosening, patient satisfaction, range of movement, and determined the Hospital for Special Surgery (HSS) elbow score. 3 patients had died before follow-up; thus, 20 replacements in 16 patients were available for clinical and radiographic study. All patients had endstage rheumatoid arthritis (RA) of the elbow joint. RESULTS: In 2 patients, humeral components were revised due to malorientation. 1 arthroplasty was revised due to aseptic loosening of the humeral component. There were 4 cases of intraoperative fracture which healed uneventfully. The total rate of complications was thus one-third. In 17 of 40 components, the cementing technique was rated as marginal or inadequate. We found no association between cementing technique and loosening. The arc of extension/flexion increased by 19 degrees (0-80), and the range of pronation/supination increased by 31 degrees (0-130). There were no cases of infection or ulnar nerve dysfunction. At the latest follow-up, the HSS elbow score was 84 (40-100) points. 11 of 20 elbows were rated as excellent, 4 elbows were rated as good, 2 elbows were rated as fair, and 3 elbows were rated as poor. 14 of 16 patients were satisfied with the result and the 2 patients who were not satisfied had persistent pain. INTERPRETATION: Despite the inherent problems of cementing in small-calibre medullary cavities, the clinical outcome of the GSB III arthroplasty was encouraging for patients with-end stage RA. The rate of overall complications compared favorably with other studies of semiconstrained elbow arthroplasty for end-stage RA. Most complications of the series were minor and did not necessitate revision.

Adult↗
PubMed2006

The other hip in unilateral hip dysplasia.

UNLABELLED: We reviewed transverse pelvic computed tomography scans of 197 consecutively referred adult patients with hip pain thought to be secondary to developmental dysplasia. A center-edge angle of 20 degrees or less was considered the upper normal value. Four groups were identified: 69 patients with apparently unilateral right developmental dysplasia (left hip center-edge angles greater than 20 degrees), 26 patients with apparently unilateral left developmental dysplasia (right hip center-edge angles greater than 20 degrees), 68 patients with bilateral developmental dysplasia, and 34 patients with bilateral borderline developmental dysplasia (bilateral center-edge angles less than or equal to 25 degrees). The pelvic computed tomography scans were compared with computed tomography scans of 41 control subjects with healthy hips. The joint anatomy of patients with developmental dysplasia differed from that of control subjects in almost all aspects. Acetabular anteversion was larger in control subjects compared with patients with developmental dysplasia. We found inverse relationships between femoral anteversion and the anterior acetabular sector angle and coronal and sagittal center-edge angles in dysplastic hips, and also between femoral neck-shaft angles and the anterior acetabular sector angle. There was an inverse relationship between reduced anterior support developmental dysplasia in which plain radiographs suggested unilateral dysplastic abnormality only, computed tomography scans revealed both hips to be abnormal. The data suggest that patients referred with seemingly unilateral developmental dysplasia also are at risk of having contralateral dysplastic malformation. LEVEL OF EVIDENCE: Diagnostic study, Level II (development of diagnostic criteria on consecutive patients [with universally applied reference "gold" standard]). See the Guidelines for Authors for a complete description of levels of evidence.

Acetabulum↗
PubMed2005

Degeneration in dysplastic hips. A computer tomography study.

BACKGROUND: Hip dysplasia is considered pre-osteoarthritic, causing degeneration in young individuals. OBJECTIVE: To determine the pattern of degenerative change in moderate to severely dysplastic hips in young patients. DESIGN AND PATIENTS: One hundred and ninety-three consecutively-referred younger patients with hip pain believed to be caused by hip dysplasia constituted the study cohort. The average age was 35.5 years (range, 15-61 years). They were examined by close-cut transverse pelvic and knee computed tomography and antero-posterior radiographs (CT). We identified 197 hips with moderate to severe dysplasia, and 78 hips with normal morphology in the study cohort, whilst 111 hip joints were borderline dysplastic according to preset definitions. Comparative analyses of anatomy and distribution of degeneration between dysplastic and normal hips in the study cohort were performed. RESULTS: In dysplastic hips the anterior acetabular sector angle was significantly and inversely associated to femoral anteversion (p < 0.001). The center-edge (CE) angle, the acetabular angle (AA), and the acetabular depth ratio (ADR) were significantly interrelated (p < 0.001; correlation coefficients ranging from -0.8 to 0.7). Fifty-one hips were subluxated (24R/27L). There were no cases of complete dislocation. The formation of subchondral cysts or osteophytes in dysplastic hips was significantly associated with reduced minimum joint space width (p ranging from 0.005 to 0.02). However, in 67 hips with acetabular cysts, only 6 hips had minimum joint space widths = 2.0 mm (8.9%) in the coronal plane. In 96 cases with acetabular cysts found in the sagittal plane, 43 cases had minimum joint space widths = 2.0 mm (44.7%). Bony rim detachment at the site of labral insertion was recorded in 30 hips. Twenty-three of these were dysplastic (p = 0.01). CONCLUSIONS: Degeneration was most often found in the anterolateral part of the dysplastic hip joints. Most cysts were located above the transition zone between the bony and the fibrocartilaginous acetabulum, and we found a significantly- increased number of cases with avulsed bony fragments at the antero-lateral labral insertion in dysplastic hips compared to normal hips. It seems likely that the early degenerative process in dysplastic hips originates at the watershed zone between the acetabular labrum and the acetabular cartilage in response to subluxation and femoroacetabular impingement.

Adolescent↗
PubMed2005

[Risk factors for osteoarthritis of the knee: current status].

The development of arthrosis is best understood paradigmatically as the result of an interaction between individual and systemic risk factors. This review of the current literature on the subject identifies overweight, occupational exposure to repeated daily lifting and the postmenopausal decline in gonadal steroids in women as significant risk factors for the development of symptomatic and radiologic osteoarthritis of the knee.

Age Factors↗
PubMed2005

Increased body mass index is a predisposition for treatment by total hip replacement.

We investigated the radiological and epidemiological data of 4,151 subjects followed up from 1976 to 2003 to determine individual risk factors for hip osteoarthritis (OA), hip pain and/or treatment by total hip replacement (THR). Pelvic radiographs recorded in 1992 were assessed for evidence of hip-joint degeneration and dysplasia. Sequential body mass index (BMI) measurements from 1976 to 1992, age, exposure to daily lifting and hip dysplasia were entered into logistic regression analyses. The prevalence of hip dysplasia ranged from 5.4% to 12.8% depending on the radiographical index used. Radiological hip OA prevalence was 1.0--2.5% in subjects <60 years of age and 4.4--5.3% in subjects >or=60 years of age. While radiological OA was significantly influenced by hip dysplasia in men and hip dysplasia and age in women, the risk of THR being performed was only influenced by BMI assessed in 1976. Hip-joint degeneration and treatment by THR do not necessarily share the same risk factors, and caution should be exercised in epidemiological studies in attributing one or the other as the end point of coxarthrosis.

Adult↗
PubMed2005

Hip dysplasia and osteoarthrosis: a survey of 4151 subjects from the Osteoarthrosis Substudy of the Copenhagen City Heart Study.

INTRODUCTION: Hip dysplasia (HD) is assumed to be an etiological factor in the development of premature hip osteoarthrosis (OA). We established the prevalences of HD and OA in adults according to qualified radiographic discriminators, and investigated the relationship between HD and OA. METHODS: Wiberg's CE angle (CE), Sharp's angle, the femoral head extrusion index, the acetabular depth ratio (ADR), the radiographic OA discriminators of Croft, and of Kellgren and Lawrence, and also minimum joint space width (JSW) < or = 2 mm were applied to the standing, standardized pelvic radiographs of 1429 men (22-93 years), and 2430 women (22-92 years). RESULTS: The 4 HD discriminators were interrelated. A negligible sex-related difference in acetabular morphology was found, male acetabulae being slightly more dysplastic than female acetabulae. However, differences between the sexes for right and left CE angles were within 1.0 degree, and within 1.4 degrees for right and left Sharp's angles. There were no cases of hip subluxation (breakage of Shenton's line > or = 5 mm). Average CE angle was 34 degrees in men (SD 7.3 degrees), and 35 degrees in women (SD 7.6 degrees). Applying a CE cut-off value of 20 degrees for designation of definite hip dysplasia, we found a prevalence of hip dysplasia of 3.4%. Approximately 2% of cases were unilateral and 1.4% of cases were bilateral. We found significant relationships between radiographic OA discriminators and the CE angle, femoral head extrusion index and ADR. Odds ratios ranged from 1.0 to 6.2. Compared to subjects with OA in morphologically normal hips, a trend towards younger age in subjects with HD and OA was noted, but this was not strictly significant. INTERPRETATION: We found that HD is not uncommon in the general population. The assumption that HD is an etiological factor in the development of hip OA was confirmed.

Adult↗
PubMed2004

The distribution and inter-relationships of radiologic features of osteoarthrosis of the hip. A survey of 4151 subjects of the Copenhagen City Heart Study: the Osteoarthrosis Substudy.

OBJECTIVE: The aims of this study were to investigate the influence of sex, age and individual physical and occupational factors on the distribution of radiographic features of hip joint osteoarthritis (OA), and to determine the inter-relationships between the primary radiographic OA discriminator of reduced joint space width (JSW), and secondary radiographic OA features. METHOD: The study was a cross-sectional survey. Radiologic features of hip OA were recorded from standardized, standing pelvic radiographs of 3686 subjects (1397M/2289F). OA features were investigated for inter-relationships and correlations to age, sex, body mass index (BMI) and occupational exposure to repeated lifting. RESULTS: Overall, subchondral sclerosis, cysts and osteophytes were more frequently recorded in male hip joints compared to female hip joints, while a decrease in minimum JSW by age was more pronounced and progressive in women after the fifth decade compared to men. Applying logistic regression analyses, only age was found to be significantly associated to pathologically reduced minimum JSW (cut off value set at < or =2.0 mm), and the presence of osteophytes and subchondral cysts in both sexes (P ranging from 0.00 to 0.03). Minimum JSW < or =2.0 mm was recorded in 105 male hip joints, and in 167 female hip joints. In these joints, subchondral cysts, osteophytes and sclerosis were found to be significantly inter-related to minimum JSW < or =2.0 mm according to logistic regression analysis. The presence of subchondral cysts had the highest predictive sensitivity in regard to pathologically reduced minimum JSW compared to subchondral sclerosis and osteophytes. CONCLUSIONS: We believe that an accurate radiologic case definition of hip OA will rest on a combination of features. Only studies of the distribution of features, singularly and in combination, applied to clinically evaluated large cohorts may provide the optimum answer to the best possible clinical case definition of hip OA.

Adult↗
PubMed2004

The relationship of hip joint space to self reported hip pain. A survey of 4.151 subjects of the Copenhagen City Heart Study: the Osteoarthritis Substudy.

OBJECTIVES: (1) To evaluate the effect of pelvic orientation on measurements of hip joint space widths (JSW) in cadaver pelvic radiographs, thereby validating the pelvic radiographs of the Copenhagen City Heart Study: The Osteoarthritis Substudy (CCHS III) cohort of 4.152 subjects, and (2) to investigate the relationship between minimal JSW and self reported hip pain of the cohort. METHODS: (1) Cadaver pelves and proximal femora of one male and one female donor were mounted in holding devices permitting independent rotation (total arc of 42 degrees), and inclination/reclination (total arc of 24 degrees). At each 3 degrees increment an anteroposterior radiograph was recorded. Measurements of JSW were performed. (2) Self reported recurrent pain in or around the hip joint during 12 months prior to baseline examinations, and minimum JSW in pelvic radiographs of the cohort were registered. Relationships between minimum JSW and self reported pain were investigated. RESULTS: (1) Measurements of hip JSW in cadaver radiographs were not influenced significantly by rotation. Measurements of JSW were inconclusively influenced by varying inclination/reclination. (2) Minimum JSW< or =2.0 mm was significantly associated to self reported pain in or around the hip joint in both sexes. CONCLUSION: Measurements of minimum hip JSW did not seem to be significantly influenced by varying spatial orientation of the pelvis during X-ray recordings. An inclusion criteria of minimum JSW< or =2.0 mm designating definite degenerative pathology in hips will be used by the current authors in future studies.

Adult↗
PubMed2004

Radiographic case definitions and prevalence of osteoarthrosis of the hip: a survey of 4 151 subjects in the Osteoarthritis Substudy of the Copenhagen City Heart Study.

BACKGROUND: The diagnosis of osteoarthrosis (OA) is founded on radiographic evidence of joint degeneration and characteristic subjective symptoms. Due to the lack of consensus radiographic case definitions, the prevalence and incidence of OA reported in the literature varies. The aims of the current study were to establish an accurate and workable radiographic definition of OA in hip joints and to examine the association of OA (thus defined) with self-reported pain. METHODS: Radiographic features of hip OA were classified in pelvic radiographs of 3 807 subjects (1448 males and 2 359 females) according to the OA classifications of Kellgren and Lawrence (1957) and Croft (1990), and according to minimum joint space width (JSW) of 2.0 mm regardless of other radiographic features of OA. The relationships between these radiographic discriminators and self-reported hip pain were investigated. RESULTS: Formation of cysts, osteophytes and subchondral sclerosis was significantly more frequent in men. Average minimum JSW was narrower in women than in men (p < 0.001). In both sexes, minimum JSW decreased after the fourth decade of life, but progressively more so in women. Women reported hip pain more frequently than men (p < 0.001). When the cut-off JSW value of 2.0 mm was applied regardless of other radiographic features of OA, prevalences of hip OA ranged from 4.4% to 5.3% in subjects > or = 60 years of age. The radiographic discriminator with the strongest association with self-reported hip pain in men and women > or = 60 years of age was minimum JSW < or = 2.0 mm; OR = 3.3 (95% CI 1.9-5.7) for men, and OR = 3.2 (95% CI 1.9-5.2) for women. INTERPRETATION: We found that minimum JSW < or = 2.0 mm was the radiographic criterion having the closest association with self-reported hip pain. Using composite OA scores emphasizing the relatively inconsequential formation of cysts, osteophytes and subchondral sclerosis runs the risk of over-inflating the prevalence of hip OA in men and of underestimating hip OA prevalence in women.

Adult↗
PubMed2004

Pelvic orientation and assessment of hip dysplasia in adults.

BACKGROUND: The study was performed to qualify the source material of 4151 pelvic radiographs for the research into the relationship between unrecognised childhood hip disorders and the development of hip osteoarthrosis, and to investigate the effect of varying degrees of pelvic tilt and rotation on the measurements of radiographic indices of hip dysplasia. MATERIAL AND METHODS: We investigated the effect of varying pelvic orientation on radiographic measurements of acetabular dysplasia using a cadaver model. Results from the cadaver study were used to validate the radiographic assessments of acetabular dysplasia in the longitudinal survey cohort of the Copenhagen City Heart Study (CCHS; Osteoarthrosis Sub-study). 1) Cadaver pelvises and proximal femurs from a male and a female donor were mounted anatomically in holding devices allowing independent inclination/reclination and rotation. An AP pelvic radiograph was recorded at each 3 degrees increment. The most widely used radiographic parameters of hip dysplasia were assessed. 2) Critical limits of acceptable rotation and inclination/reclination of pelvises were determined on 4151 standing, standardised pelvic radiographs of the CCHS cohort. RESULTS: Wiberg's CE angle, Sharp's angle, the x-coordinate of Goodman's Cartesian coordinate system, and the acetabular depth ratio were significantly affected by varying rotation and inclination/reclination of the cadaver pelvises. Femoral head extrusion index was not significantly affected within the applied rotation and inclination/reclination of the cadaver study. Application of the corresponding critical limits of Tönnis' foramen obturator index of 0.7-1.8 meant that 188 of 4151 (4.5%) of the CCHS-III pelvic radiographs had to be omitted from further studies. INTERPRETATION: To ensure a neutral starting point and reproducible readings, especially in epidemiological and clinical studies, and when performing preoperative planning and follow-up of patients undergoing redirectional pelvic osteotomies, it is important that all aspects of the radiographic examination are controlled and reproducible. Furthermore, we found that studies of acetabular dysplasia based on supine urograms or colon radiographs without information about pelvic orientation, centering of the X-ray beam and tube to film distance, run a serious risk of erroneous measurements.

Acetabulum↗