Digital Public Defence: Terje Ugland

MD Terje Ugland at Institute of Clinical Medicine will be defending the thesis "Direct Lateral or Minimally Invasive Surgical Approach for Hemiarthroplasty in Hip Fracture" for the degree of PhD (Philosophiae Doctor). 

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The public defence will be held as a video conference over Zoom.

The defence will follow regular procedure as far as possible, hence it will be open to the public and the audience can ask ex auditorio questions when invited to do so.

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Due to copyright reasons, an electronic copy of the thesis must be ordered from the faculty. In order for the faculty to have time to process the order, it must be received by the faculty no later than 2 days prior to the public defence. Orders received later than 2 days before the defence will not be processed. Inquiries regarding the thesis after the public defence must be addressed to the candidate.

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Adjudication committee

  • First opponent: Associate Professor Cecilia Rogmark, Lund University, Sweden
  • Second opponent: Professor Heikki Kröger, University of Eastern Finland 
  • Third member and chair of the evaluation committee: Professor II Espen Haavardsholm, Institute of Clinical Medicine, University of Oslo

Chair of defence

Professor II John Anker Zwart, Institute of Clinical Medicine, University of Oslo

Principal Supervisor

Professor II Lars Nordsletten, Institute of Clinical Medicine, University of Oslo


Hemiarthroplasty is in many cases the treatment of choice for elderly people sustaining a hip fracture. It is not quite clear which surgical approach to the hip is preferable when inserting hemiarthroplasties in patients with femoral neck fracture. The direct lateral approach and the posterior approach are the two most common used approaches. Both have pros and cons. The direct lateral approach is associated with weakening of the hip abductors causing limping and pain. The posterior approach is associated with the risk of implant dislocation. A third option are the anterior approaches also referred to as the muscle sparing approaches.  

This thesis is about the role of the surgical approach when inserting a hemiarthroplasty for femoral neck fracture. One hundred and fifty patients with femoral neck fracture were included in this RCT and randomized to a direct lateral approach or a muscle sparing approach. 

In paper I, we performed a bone scan on fifty-one patients included in the study. The scan was performed in the immediate post-operative period, at 3 and 12 months. We found a statistical significant bone loss around the femoral stem in the direct lateral approach compared to the muscle sparing one at three months. Based on these results we do believe that the surgical approach may influence the process of bone remodeling around the hemiarthroplasty. 

In paper II, we gathered blood samples from all patients included in the study. Our focus was on the enzyme Creatine Kinase (CK). CK is a biomarker of muscle damage. CK was monitored after insertion of a hemiarthroplasty in the two mentioned surgical approaches. We found higher levels of CK in the immediate post-operative period in the muscle sparing approach. We could not find a correlation between levels of serum CK and functional outcomes. 

In paper III, we compared patient reported outcome and functional outcomes assessed by physiotherapists and doctors when inserting a hemiarthroplasty in two different surgical approaches to the hip. The number of patients who suffered from a hip abductor deficiency post-operatively were higher in the direct lateral group. Patients with an abductor deficiency reported clinical outcome scores inferior to those who were not.

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Published June 2, 2021 11:40 AM - Last modified June 16, 2021 10:13 AM