Publications
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Sundet, Mads; Martinsen, Mette; Sexton, Joseph; Sundin, Ulf Gunnar & Lillegraven, Siri
(2026).
Waiting time and mortality after hip fracture: findings from a large single-center cohort study.
European Journal of Trauma and Emergency Surgery.
ISSN 1863-9933.
52(1).
doi:
10.1007/s00068-026-03351-w.
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Sundet, Mads; Eriksen, Marianne Lund ; Storrønning, Inger; Jevnaker, Anders; Husby, Ivar Ervik & Østerhus, Ingvild Bjåland
[Show all 8 contributors for this article]
(2026).
Preoperative Anxiety and/or Depression as a Predictor of Patient‑Reported Outcomes After Total Ankle Arthroplasty.
Foot & ankle international.
ISSN 1071-1007.
doi:
10.1177/10711007261473923.
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Background: Psychological distress has been associated with inferior outcomes after major joint arthroplasty, but its impact on outcomes after total ankle arthroplasty (TAA) remains unclear. The main aim of this study was to investigate whether patients reporting anxiety or depression before TAA surgery had inferior outcomes 1 year after surgery. Methods: Retrospective analysis of prospectively collected data from a single-centre ankle arthroplasty registry. The exposure was preoperative anxiety/depression, defined from EuroQol–5 Dimensions–3 Level (EQ-5D-3L) item 5, and dichotomized, reflecting self-reported symptoms rather than a clinical diagnosis. The primary outcome was the adjusted difference between the exposure groups in the Manchester-Oxford Foot and Ankle Questionnaire (MOxFQ) score at 12 months postoperatively. Multivariable linear regression with multiple imputation of missing baseline MOxFQ was used to assess the association between preoperative anxiety/depression and 12-month MOxFQ, adjusting for baseline MOxFQ, age, sex, and diagnosis. Results: Three hundred patients were included, of whom 90 (30%) reported preoperative anxiety and/or depression. These patients were younger and reported worse baseline pain and function. Although patients with preoperative anxiety/depression had worse absolute MOxFQ scores at 12 months (mean 30.2 vs 20.1; P < .001), their improvement from baseline was comparable to patients without anxiety/depression (ΔMOxFQ 41.3 vs 43.9; P = .40). In multivariable regression analyses including baseline values, preoperative anxiety/depression was not independently associated with worse 12-month MOxFQ (β = 4.3; 95% CI −0.9 to 9.5). Among patients with baseline anxiety/depression, approximately two-thirds no longer reported anxiety/depression at 12 months. Conclusion: Preoperative self-reported anxiety or depression was common among patients undergoing TAA and was associated with worse symptoms before surgery. However, the reporting of such symptoms did not appear to limit postoperative improvement in patient-reported outcomes at 12 months. Among patients reporting anxiety/depression preoperatively, approximately two-thirds no longer reported anxiety/depression at 12 months. Level of Evidence: Level III, retrospective cohort study using prospectively collected registry data.
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Gyllensten, Karen Sandvik; Sundin, Ulf Gunnar; Storrønning, Inger; Husby, Ivar Ervik; Haavardsholm, Erik & Hammer, Hilde Berner
[Show all 9 contributors for this article]
(2025).
Short-Term Clinical and Radiological Results of the Infinity Ankle Arthroplasty: A Prospective Study.
Foot & ankle specialist..
ISSN 1938-6400.
doi:
10.1177/19386400251330086.
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Background
Ankle joint arthroplasty is increasingly used in primary or secondary end-stage osteoarthritis. Initial reports on the fourth-generation Infinity total ankle system showed a high failure rate due to component loosening. The objective of this study was to assess complications, reoperations, patient reported outcome measures (PROMs) and radiographic findings after 1 year.
Methods
Data were prospectively collected in a local ankle surgery registry between January 2018 and March 2023. All cases of primary ankle arthroplasty using the Infinity system with a 1-year follow-up were included (106 ankles in 101 patients). Complications, revisions, and reoperations were described after 1 and 2 years, and the 1-year postoperative PROMs (AOFAS Ankle-Hindfoot score, MOxFQ, EQ5D, and EQ5D-VAS) were compared to preoperative values. One-year postoperative radiographs were assessed for signs of loosening.
Results
The mean age was 65 years (SD 11.7), 55% were female, and the mean BMI was 27 kg/m2 (SD 4.2). Main indications for arthroplasty were chronic instability (27%), inflammatory joint disease (25%) and posttraumatic osteoarthritis (22%). After 1 year, there were 6 (5.5%) reoperations, of which 3 (2.7%) were prosthesis revisions, and 3 (2.7%) were outside the primary operative site. One (0.9%) reoperation was due to aseptic loosening of the tibia component. After 2 years, there was 1 additional reoperation with a tibial osteotomy and exchange of polyethylene insert. All PROMs improved significantly between the preoperative and the 1-year follow-up assessment, with mean change in AOFAS 35.9 (P < .01), MOxFQ 46.9 (P < .01), EQ5D 0.36 (P < .01), and EQ5D-VAS 13.2 (P < .01). There were findings of radiolucent lines and/or cysts on 1-year postoperative radiographs in 9 cases (9%).
Conclusions
We found an acceptable rate of early aseptic loosening. All PROMs demonstrated a significant improvement from preoperative to 1-year postoperative assessment.
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Sundet, Mads; Sundin, Ulf Gunnar; Godø, Aasmund; Sydnes, Kristian; Valland, Haldor & Sexton, Joseph
[Show all 10 contributors for this article]
(2024).
Use of direct-acting anticoagulants (DOACs) delays surgery and is associated with increased mortality in hip fracture patients.
European Journal of Trauma and Emergency Surgery.
ISSN 1863-9933.
doi:
10.1007/s00068-024-02532-9.
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Purpose Treatment with direct-acting oral anticoagulants (DOACs) is increasing among hip-fracture patients, with accompanying safety concerns regarding spinal anesthesia (SA). The aim of this study was to investigate if DOAC use is associated with increased waiting time before surgery, increased mortality, or other adverse events. Methods Registry data on surgically treated hip-fracture cases at a single hospital between 2015 and 2021 were analyzed. Multivariable regression analyses were performed with DOAC-status and choice of anesthesia as exposures, and waiting time, length of stay, transfusion, and mortality as outcomes. Results 2885 cases were included, 467 patients (16%) were using DOACs. DOAC users were older (86.3 vs. 82.2 years, p < 0.001), had a higher Charlson Comorbidity Index (2.1 vs. 1.5, p < 0.001) and had longer median time to surgery than non-DOAC cases (36 h vs 17 h, p < 0.001). General anesthesia (GA) was used in 19.3% of DOAC patients and in 3.0% of non-DOAC patients. DOAC-patients had an increased risk of one-month mortality (Adjusted Odds Ratio (AOR) 1.6 (1.1–2.3)) and one-year mortality (AOR 1.4 (1.1–1.8)). There were no differences in risk of blood transfusion. Patients on DOAC operated under GA had a lower risk of one-year mortality (AOR 0.5 (0.3–0.9)), but a similar one-month mortality to DOAC-patients operated under SA. Conclusion DOAC users had a longer waiting time to surgery, indicating postponement of surgery due to concerns of the safety of SA. The clinical practice should be changed to allow earlier surgery for DOAC patients.
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Sundlisæter, Nina Beate Paulshus; Sundin, Ulf Gunnar; Aga, Anna-Birgitte; Sexton, Joseph; Hammer, Hilde Berner & Uhlig, Till
[Show all 9 contributors for this article]
(2022).
Inflammation and biologic therapy in patients with rheumatoid arthritis achieving versus not achieving ACR/EULAR Boolean remission in a treat-to-target study.
RMD Open.
8(1),
p. 1–6.
doi:
10.1136/rmdopen-2021-002013.
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Objective To investigate limiting factors of American College of Rheumatology (ACR)/EULAR Boolean remission in rheumatoid arthritis (RA), and compare patients who fulfil the criteria to patients who only partly fulfil the criteria, with respect to imaging inflammation and biologic disease modifying anti-rheumatic drug (DMARD) usage.
Methods Patients with DMARD-naïve RA were treated according to current recommendations in the the ARCTIC trial (Aiming for Remission in rheumatoid arthritis: a randomised trial examining the benefit of ultrasound in a Clinical TIght Control regimen). Limiting factors of reaching ACR/EULAR Boolean remission at 2 years were assessed. Imaging inflammation (ultrasound and MRI) in patients in remission was compared with patients failing to fulfil different components of the criteria. The OR of biologic therapy was calculated using logistic regression.
Results Of 203 patients, 112 (55%) reached ACR/EULAR Boolean remission; 49 (24%) fulfilled three of four criteria. The main limiting factors were patient global assessment (PGA) (59%) and tender joints (22%). Imaging inflammation was not significantly different for patients in remission and patients not fulfilling the criteria due to elevated PGA and/or tender joints, but higher odds of using biologics (OR 3.63, 95% CI 1.73 to 7.61) were observed.
Conclusions PGA and tender joints were the factors most often limiting achievement of ACR/EULAR Boolean remission. The level of imaging inflammation was not elevated in these patients compared with patients in remission, but the odds of using biologic DMARDs were higher.
http://creativecommons.org/licenses/by-nc/4.0/
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Sundin, Ulf Gunnar; Sundlisæter, Nina Beate Paulshus; Aga, Anna-Birgitte; Sexton, Joseph; Nordberg, Lena Kristine Bugge & Hammer, Hilde Berner
[Show all 10 contributors for this article]
(2021).
Value of MRI and ultrasound for prediction of therapeutic response and erosive progression in patients with early rheumatoid arthritis managed by an aggressive treat-To-Target strategy.
RMD Open.
7:e001525(1),
p. 1–11.
doi:
10.1136/rmdopen-2020-001525.
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Objectives To investigate if inflammation detected by MRI or ultrasound at rheumatoid arthritis (RA) onset is predictive of erosive progression or poor response to methotrexate monotherapy, and to investigate if subclinical inflammation in remission is predictive of future treatment escalation or erosive progression. Methods In a 2-year study, 218 patients with disease-modifying antirheumatic drug-naïve early RA were treated by a tight-control treat-to-target strategy corresponding to current recommendations. MRI and ultrasound were performed at regular intervals. Baseline imaging-based inflammation measures were analysed as predictors for early methotrexate failure and erosive progression using univariate and multivariate regression adjusted for clinical, laboratory and radiographic measures. In patients in remission after 1 year, imaging measures were analysed as predictors of treatment escalation and erosive progression during the second year. The added value of imaging in prediction models was assessed using receiver operating characteristic analyses. Results Baseline MRI inflammation was associated with MRI erosive progression and ultrasound with radiographic erosive progression. No imaging inflammation measure was associated with early methotrexate failure. Imaging inflammation was present in a majority of patients in clinical remission. Tenosynovitis was associated with treatment escalation, and synovitis and tenosynovitis with MRI/radiographic erosive progression during the second year. Imaging information did not improve prediction models for any of the outcomes. Conclusions Imaging-detected inflammation, both at diagnosis and in remission, is associated with elements of future disease development. However, the lack of a significant effect on prediction models indicates limited value of systematic MRI and ultrasound in management of early RA.
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Sundin, Ulf Gunnar; Aga, Anna-Birgitte; Skare, Øivind; Nordberg, Lena Kristine Bugge; Uhlig, Till & Hammer, Hilde Berner
[Show all 10 contributors for this article]
(2020).
Conventional versus ultrasound treat to target: No difference in magnetic resonance imaging inflammation or joint damage over 2 years in early rheumatoid arthritis.
Rheumatology.
ISSN 1462-0324.
59(9),
p. 2550–2555.
doi:
10.1093/rheumatology/kez674.
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Abstract Objective To investigate whether an ultrasound-guided treat-to-target strategy for early RA would lead to reduced MRI inflammation or less structural damage progression compared with a conventional treat-to-target strategy. Methods A total of 230 DMARD-naïve early RA patients were randomized to an ultrasound tight control strategy targeting DAS &lt;1.6, no swollen joints and no power Doppler signal in any joint or a conventional strategy targeting DAS &lt;1.6 and no swollen joints. Patients in both arms were treated according to the same DMARD escalation strategy. MRI of the dominant hand was performed at six time points over 2 years and scored according to the OMERACT RA MRI scoring system. A total of 218 patients had baseline and one or more follow-up MRIs and were included in the analysis. The mean MRI score change from baseline to each follow-up and the 2 year risk for erosive progression were compared between arms. Results MRI bone marrow oedema, synovitis and tenosynovitis improved over the first year and was sustained during the second year of follow-up, with no statistically significant differences between the ultrasound and the conventional arms at any time point. The 2 year risk for progression of MRI erosions was similar in both treatment arms: ultrasound arm 39%, conventional arm 33% [relative risk 1.16 (95% CI 0.81, 1.66), P = 0.40]. Conclusion Incorporating ultrasound information in treatment decisions did not lead to reduced MRI inflammation or less structural damage compared with a conventional treatment strategy. The findings support that systematic use of ultrasound does not provide a benefit in the follow-up of patients with early RA. Trial registration number Clinicaltrials.gov, http://clinicaltrials.gov, NCT01205854.
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Sunde, Sylvia; Ranhoff, Anette Hylen; Sundet, Mads; Sundin, Ulf Gunnar; Lillegraven, Siri & Paus, Maren
[Show all 8 contributors for this article]
(2024).
Predictors for physical function three months after hip fracture surgery in older adults.
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Aims: Many patients have a substantial reduction in physical function after suffering a hip fracture. This study aimed to identify baseline factors associated with decreased physical function three months after hip fracture surgery in older adults.
Methods: Data was retrieved from a quality database including patients admitted to a general hospital in Oslo, Norway due to a hip fracture between 2014 and 2023. All patients 65 years or older who attended the three-month physiotherapy follow-up were included. Physical function was assessed by the Short Physical Performance Battery (SPPB). A multivariate linear regression analysis was performed with SPPB as outcome variable, and age, sex, Charlson Comorbidity Index (CCI), American Society of Anesthesiologists score (ASA), pre-fracture New Mobility Score (NMS), and osteosynthesis vs arthroplasty as predictor variables.
Results: 1661 cases were included in the analyses. The mean age of the patients was 81.8 (SD 8.1) years; 1196 (72%) were female. The mean score on the SPPB 3 months after surgery was 6.3 (SD 3.5) points. 832 (50%) were treated with hemiarthroplasty or total hip arthroplasty, whereas 829 (50%) were treated with osteosynthesis. Multiple regression analysis showed positive associations between pre-fracture NMS and SPPB, β 0.82 (95% CI 0.74 to 0.89). In the same model, we observed negative associations between SPPB and the other explanatory variables, age [β -0.09 (95% CI -0.11 to -0.07)], ASA score [β -0.59 (95% CI -0.88 to -0.30)], and CCI [β -0.21 (95% CI -0.36 to -0.06)]. Furthermore, being treated with osteosynthesis was negatively associated with SPPB, β -0.60 (95% CI -0.89 to -0.31). There was a trend towards worse physical function in men compared to women, β -0.32 (95% CI -0.65 to 0.01).
Conclusion: Patients with higher age, lower pre-fracture physical function measured by NMS, higher ASA score, higher Charlson Comorbidity score, or who are treated with osteosynthesis are at higher risk of worse physical function three months after hip fracture. This frail group should be offered extensive rehabilitation services while hospitalized and in the first months after discharge. The results can help healthcare providers optimize treatment for patients with a higher risk of low physical function following hip fractures.
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Hesseberg, Karin; Ranhoff, Anette Hylen; Sundet, Mads; Sundin, Ulf Gunnar; Lillegraven, Siri & Martinsen, Mette
[Show all 8 contributors for this article]
(2024).
Two out of three do not regain mobility the first three months after hip fracture: A longitudianl study.
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Aim: Hip fracture is a risk factor for functional impairment, loss of independence, and death. Significant costs are associated with the treatment of older individuals with hip fractures. Increased knowledge entailing functional impairment is valuable in the development and initiation of healthcare services for this group of frail older adults. The aim of this study was to investigate to what degree hip fracture patients regained their mobility 3 months after injury.
Method: Data were retrieved from a quality database containing information regarding all patients treated for a hip fracture at a hospital in Oslo, Norway between 2014 and 2023. The study included patients who were 65 years or older when admitted, with data available on the New Mobility Score (NMS) from the pre-fracture status (collected at the initial hospital stay) and three-months post-operatively. Pre- and three-month post injury NMS scores were compared using t-tests of differences of means. Logistic regression analysis was used to explore factors associated with the probability of regaining mobility (NMS three-months post injury).
Results: 1309 patients, 935 (71%) women and 374 (29%) men with a mean age of 81.6 (SD 8.2) years were included. The mean NMS before the fracture was 7.2 (SD 2.2) points, and the mean score three months after the surgery was 5.4 (SD 2.4) points. The mean decrease in NMS scores was 1.8 points (95% CI 1.7 to 1.9), (p < 0.001). 341 (26%) patients had the same score at follow-up as before the fracture, 109 (8%) patients improved their score by at least one point, and 859 (66%) patients had a score at least one point lower as before the fracture. The results from the logistic regression analysis showed statistically significant associations between mobility and the factors age, American Society of Anaesthesiologists score (ASA) at baseline, type of operation and pre-fracture mobility. Patients with higher age, higher ASA score at baseline, and lower pre-fracture mobility had lower odds of regaining mobility; OR 0.94 (95% CI 0.93 to 0.96), 0.73 (95% CI 0.57 to 0.93), and 0.73 (95% CI 0.69 to 0.78), respectively. In addition, those who were treated with osteosynthesis had lower odds of regaining mobility compared with those who were treated with arthroplasty 2.02 (95% CI 1.57 to 2.59). Ninety percent (1180/1305) of the patients reported that they had been seen by a physiotherapist after discharge.
Conclusion: The results show a reduction in mobility three months after the hip fracture, compared to status pre-fracture. Although 90% of the patients had been seen by a physiotherapist after discharge, only one-third of the patients had regained their pre-fracture level of mobility three months after treatment. The results indicate a potential for improved rehabilitation interventions in the first three months after a hip fracture. Patients at risk of not regaining their mobility should get a special focus.
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Published
Nov. 7, 2023 4:07 PM
- Last modified
Nov. 7, 2023 4:07 PM
