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Johansson, Torsten
Publications (10 of 18) Show all publications
Johansson, T. (2016). PTH 1-34 (teriparatide) may not improve healing in proximal humerus fractures A randomized, controlled study of 40 patients. Acta Orthopaedica, 87(1), 79-82
Open this publication in new window or tab >>PTH 1-34 (teriparatide) may not improve healing in proximal humerus fractures A randomized, controlled study of 40 patients
2016 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 87, no 1, p. 79-82Article in journal (Refereed) Published
Abstract [en]

Background and purpose - There is solid evidence from animal experiments that parathyroid hormone (PTH) improves fracture healing. So far, only 3 papers on PTH and fracture repair in humans have been published. They suggest that PTH may enhance fracture healing, but the results do not appear to justify specific clinical recommendations. This study was carried out to determine whether teriparatide enhances fracture healing of proximal humerus fractures. Patients and methods - 40 post-menopausal women with a proximal humerus fracture were randomized to either daily injections with 20 mu g teriparatide (PTH 1-34 (Forteo)) for 4 weeks or control treatment. At randomization, the patients were asked to assess how their pain at rest and during activity (visual analog scale (VAS)) and also function (DASH score) had been prior to the fracture. At 7 weeks and again at 3 months, their current state was assessed and the tests were repeated, including radiographs. 2 radiologists performed a blind qualitative scoring of the callus at 7 weeks. Callus formation was arbitrarily classified as normal or better. Results - 39 patients completed the follow-up. The radiographic assessment showed a correct correlation, better in the teriparatide group and normal in the control group, in 21 of the 39 cases. There were no statistically significant differences in pain, in use of strong analgesics, or in function between the groups at the follow-up examinations. Interpretation - There were no radiographic signs of enhanced healing or improved clinical results in the group treated with teriparatide

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2016
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-124467 (URN)10.3109/17453674.2015.1073050 (DOI)000367530700015 ()26179771 (PubMedID)
Available from: 2016-02-02 Created: 2016-02-01 Last updated: 2017-11-30
Johansson, T. (2014). Internal fixation compared with total hip replacement for displaced femoral neck fractures: A minimum fifteen-year follow-up study of a previously reported randomized trial. Journal of Bone and Joint Surgery. American volume, 96(6), e46.1-e46.6
Open this publication in new window or tab >>Internal fixation compared with total hip replacement for displaced femoral neck fractures: A minimum fifteen-year follow-up study of a previously reported randomized trial
2014 (English)In: Journal of Bone and Joint Surgery. American volume, ISSN 0021-9355, E-ISSN 1535-1386, Vol. 96, no 6, p. e46.1-e46.6Article in journal (Refereed) Published
Abstract [en]

Background: Prospective randomized studies comparing internal fixation and a cemented hip replacement in the treatment of displaced femoral neck fractures have shown favorable short-term results for prosthetic replacement. The present report compares the results after a minimum of fifteen years. Methods: From 1994 to 1998, 143 patients (146 hips) were randomized to closed reduction and internal fixation with two screws (n = 78) or a cemented total hip replacement (n = 68). The average age of the patients was eighty-four years (range, seventy-five to 101 years), and 38% were classified as mentally impaired. Failure after internal fixation was defined as early redisplacement, nonunion, symptomatic segmental collapse, or deep infection. In the arthroplasty group, failure was defined as two dislocations or more, implant loosening, deep infection, or a periprosthetic fracture. Results: For the lucid patients, the failure rate was 55% after internal fixation compared with 5% after total hip replacement. For patients with mental impairment, it was 16% in both groups. Conclusions: Total hip replacement is superior to internal fixation in the treatment of a displaced femoral neck fracture. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Place, publisher, year, edition, pages
Journal of Bone and Joint Surgery, Inc, 2014
National Category
Orthopaedics
Identifiers
urn:nbn:se:liu:diva-110520 (URN)10.2106/JBJS.K.00244 (DOI)000352322000003 ()24647513 (PubMedID)2-s2.0-84896958225 (Scopus ID)
Available from: 2014-09-18 Created: 2014-09-12 Last updated: 2018-01-11
Lundin, E. S., Johansson, T., Zachrisson, H., Leandersson, U., Backman, F., Falknas, L. & Kjölhede, P. (2014). Single-dose tranexamic acid in advanced ovarian cancer surgery reduces blood loss and transfusions: double-blind placebo-controlled randomized multicenter study. Acta Obstetricia et Gynecologica Scandinavica, 93(4), 335-344
Open this publication in new window or tab >>Single-dose tranexamic acid in advanced ovarian cancer surgery reduces blood loss and transfusions: double-blind placebo-controlled randomized multicenter study
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2014 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 93, no 4, p. 335-344Article in journal (Refereed) Published
Abstract [en]

ObjectiveTo determine whether single-dose tranexamic acid given intravenously immediately before surgery for presumed advanced ovarian cancer reduces perioperative blood loss and blood transfusions. DesignA randomized double-blind, placebo-controlled multicenter study. SettingTwo university hospitals and two central hospitals in the southeast health region of Sweden. PopulationOne hundred women with presumed advanced ovarian cancer scheduled for radical debulking surgery between March 2008 and May 2012 who complied with inclusion/exclusion criteria were randomized; 50 were allocated to receive tranexamic acid and 50 to receive placebo. Analysis was performed according to intention-to-treat principles. MethodsThe volume of tranexamic acid (15mg/kg body weight, 100mg/mL tranexamic acid) or the same volume of placebo (0.9% NaCl) was added to a 100-mL saline solution plastic bag. The study medication was given immediately before the start of surgery. Data were analyzed by means of non-parametric statistics and multivariate models adjusted for confounding factors. Main outcome measuresBlood loss and red blood cell transfusions. ResultsThe total blood loss volume and transfusion rate were significantly lower in the tranexamic acid group compared with the placebo group. Median total blood loss was 520 and 730mL, respectively (p=0.03). Fifteen (30%) and 22 (44%), respectively received transfusions (odds ratio 0.44; upper 95% CI 0.97; p=0.02). ConclusionA single dose of tranexamic acid given immediately before surgery reduces blood loss and transfusion rates significantly in advanced ovarian cancer surgery. Tranexamic acid may be recommended as standard prophylactic treatment in advanced ovarian cancer surgery.

Place, publisher, year, edition, pages
Informa Healthcare / Wiley, 2014
Keywords
Blood loss; ovarian cancer; randomized trial; surgery; tranexamic acid; transfusion
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-106118 (URN)10.1111/aogs.12333 (DOI)000333150700003 ()
Available from: 2014-04-25 Created: 2014-04-24 Last updated: 2019-12-10
Aspenberg, P., Genant, H. K., Johansson, T., See, K., Krohn, K., Garcia-Hernandez, P. A., . . . Lakshmanan, M. C. (2010). Teriparatide for Acceleration of Fracture Repair in Humans: A Prospective, Randomized, Double-Blind Study of 102 Postmenopausal Women With Distal Radial Fractures. JOURNAL OF BONE AND MINERAL RESEARCH, 25(2), 404-414
Open this publication in new window or tab >>Teriparatide for Acceleration of Fracture Repair in Humans: A Prospective, Randomized, Double-Blind Study of 102 Postmenopausal Women With Distal Radial Fractures
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2010 (English)In: JOURNAL OF BONE AND MINERAL RESEARCH, ISSN 0884-0431, Vol. 25, no 2, p. 404-414Article in journal (Refereed) Published
Abstract [en]

Animal experiments show a dramatic improvement in skeletal repair by teriparatide. We tested the hypothesis that recombinant teriparatide, at the 20 mu g dose normally used for osteoporosis treatment or higher, would accelerate fracture repair in humans. Postmenopausal women (45 to 85 years of age) who had sustained a dorsally angulated distal radial fracture in need of closed reduction but no surgery were randomly assigned to 8 weeks of once-daily injections of placebo (n = 34) or teriparatide 20 mu g (n = 34) or teriparatide 40 mu g (n = 34) within 10 days of fracture. Hypotheses were tested sequentially, beginning with the teriparaticle 40 mu g versus placebo comparison, using a gatekeeping strategy. The estimated median time from fracture to first radiographic evidence of complete cortical bridging in three of four cortices was 9.1, 7.4, and 8.8 weeks for placebo and teriparaticle 20 1 and 40 mu g, respectively (overall p = .015). There was no significant difference between the teriparaticle 40 mu g versus placebo groups (p = .523). In post hoc analyses, there was no significant difference between teriparaticle 40 1 versus 20 mu g (p = .053); however, the time to healing was shorter in teriparaticle 20 mu g than placebo (p = .006). The primary hypothesis that teriparatide 40 jug would shorten the time to cortical bridging was not supported. The shortened time to healing for teriparaticle 20 mu g compared with placebo still may suggest that fracture repair can be accelerated by teriparaticle, but this result should be interpreted with caution and warrants further study.

Keywords
COLLES FRACTURE, CORTICAL BRIDGING, DISTAL RADIAL FRACTURE, FRACTURE HEALING, TERIPARATIDE
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-54502 (URN)10.1359/jbmr.090731 (DOI)000275215500025 ()
Available from: 2010-03-19 Created: 2010-03-19 Last updated: 2011-08-18
Aspenberg, P. & Johansson, T. (2010). Teriparatide improves early callus formation in distal radial fractures. ACTA ORTHOPAEDICA, 81(2), 236-238
Open this publication in new window or tab >>Teriparatide improves early callus formation in distal radial fractures
2010 (English)In: ACTA ORTHOPAEDICA, ISSN 1745-3674, Vol. 81, no 2, p. 236-238Article in journal (Refereed) Published
Abstract [en]

Methods One third of the patients of the international trial were treated at Linkoping University Hospital. The multicenter trial did not evaluate early callus formation. We therefore made a blinded qualitative scoring of the callus at 5 weeks in our 27 patients. Callus formation was arbitrarily classified as rich, intermediate, or poor. Results 9 patients were classified as rich (none had received placebo, 3 low-dose teriparatide, and 6 high-dose teriparatide). 9 patients were classified as intermediate (1 had received placebo, 5 low-dose, and 3 high-dose). 9 patients were classified as poor (7 had received placebo, 1 low-dose, and 1 high-dose) (p andlt; 0.001). Interpretation This is a post hoc subgroup analysis of an outcome variable, which was not in the official protocol. The results must therefore be interpreted with caution. However, in combination with the results of the larger trial, the data suggest that radiographic quality at an early time point might be a sensitive variable, perhaps better than time to cortical continuity. Moreover, teriparatide appeared to improve early callus formation in distal radial fractures.

Place, publisher, year, edition, pages
Taylor and Francis / Informa Healthcare, 2010
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-55062 (URN)10.3109/17453671003761946 (DOI)000276361700014 ()
Available from: 2010-04-28 Created: 2010-04-28 Last updated: 2010-04-28
Johansson, T. (2009). Letter: Pneumatic wound compression after hip fracture surgery [Letter to the editor]. Acta Orthopaedica, 80(5), 628-628
Open this publication in new window or tab >>Letter: Pneumatic wound compression after hip fracture surgery
2009 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 80, no 5, p. 628-628Article in journal, Letter (Other academic) Published
Abstract [en]

n/a

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-52915 (URN)
Available from: 2010-01-12 Created: 2010-01-12 Last updated: 2017-12-12Bibliographically approved
Bachrach-Lindström, M., Karlsson, S., Pettersson, L.-G. & Johansson, T. (2008). Patients on the waiting list for total hip replacement: a 1-year follow-up study. Scandinavian Journal of Caring Sciences, 22(4), 536-542
Open this publication in new window or tab >>Patients on the waiting list for total hip replacement: a 1-year follow-up study
2008 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 22, no 4, p. 536-542Article in journal (Refereed) Published
Abstract [en]

Patients on the waiting list for total hip replacement: a 1-year follow-up study

Untreated osteoarthritis (OA) in the hip causes pain and reduced physical and social functioning. The aim of this study was to evaluate the effect of waiting time on health-related quality of life (HRQOL), functional condition and dependence on help at the time of surgery and during follow-up 1 year after surgery. A further aim was to elucidate possible differences between men and women. Two hundred and twenty-nine consecutively included patients with OA in the hip were interviewed when assigned to the waiting list, again 1 week prior to surgery with unilateral total hip replacement (THR), and 1 year after surgery. Health-related quality of life and function were measured using the Nottingham Health Profile, EuroQoL and the Western Ontario and McMaster Universities Osteoarthritis Index. The result showed that the average waiting time was 239 days, that 15% of the patients were operated on within 3 months, and that 21% had to wait more than 6 months. At the time of surgery, HRQOL had deteriorated significantly (p < 0.05) and the number of patients receiving support from relatives had increased from 31% to 58% during the wait. At the 1-year follow-up, both HRQOL and functional condition had improved significantly despite the wait, and the need for support from relatives had decreased to 11% (p < 0.001). In conclusion, long waiting time for THR is detrimental to patients HRQOL causing reduced functional condition, pain and increased need for support from relatives, which limit the independence in daily life.

Keywords
health-related quality of life, osteoarthritis, total hip replacement, Western Ontario and McMaster Universities Osteoarthritis Index, Nottingham Health Profile
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16142 (URN)10.1111/j.1471-6712.2007.00567.x (DOI)
Available from: 2009-01-08 Created: 2009-01-07 Last updated: 2017-12-14
Olofsson, C., Ahl, T., Johansson, T., Larsson, S., Nellgard, P., Ponzer, S., . . . Winslow, R. (2006). A multicenter clinical study of the safety and activity of maleimide-polyethylene glycol-modified hemoglobin (Hemospan®) in patients undergoing major orthopedic surgery. Anesthesiology, 105(6), 1153-1163
Open this publication in new window or tab >>A multicenter clinical study of the safety and activity of maleimide-polyethylene glycol-modified hemoglobin (Hemospan®) in patients undergoing major orthopedic surgery
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2006 (English)In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 105, no 6, p. 1153-1163Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Hemospan® (Sangart Inc., San Diego, CA), a polyethylene glycol-modified hemoglobin with unique oxygen transport properties, has successfully completed a phase I trial in healthy volunteers. Because adverse events are expected to increase with age, the authors conducted a phase II safety study of Hemospan in elderly patients undergoing elective hip arthroplasty during spinal anesthesia. METHODS: Ninety male and female patients, American Society of Anesthesiologists physical status I-III, aged 50-89 yr, in six Swedish academic hospitals were randomly assigned to receive either 250 or 500 ml Hemospan or Ringer's acetate (30 patients/group) before induction of spinal anesthesia. Safety assessment included vital signs and Holter monitoring from infusion to 24 h, evaluation of laboratory values, and fluid balance. The hypothesis to be tested was that the incidence of adverse events would be no more frequent in patients who received Hemospan compared with standard of care (Ringer's acetate). RESULTS: Three serious adverse events were noted, none of which was deemed related to study treatment. Liver enzymes, amylase, and lipase increased transiently in patients in all three groups. There were no significant differences in electrocardiogram or Holter parameters, but there was a suggestion of more bradycardic events in the treated groups. Hypotension was less frequent in the treated patients compared with controls. CONCLUSIONS: In comparison with Ringer's acetate, Hemospan mildly elevates hepatic enzymes and lipase and is associated with less hypotension and more bradycardic events. The absence of a high frequency of serious adverse events suggests that further clinical trials should be undertaken. © 2006 American Society of Anesthesiologists, Inc.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-37801 (URN)10.1097/00000542-200612000-00015 (DOI)38745 (Local ID)38745 (Archive number)38745 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
Johansson, T., Bachrach-Lindström, M., Aspenberg, P., Jonsson, D. & Wahlström, O. (2006). The total costs of a displaced femoral neck fracture: comparison of internal fixation and total hip replacement. A randomised study of 146 hips. International Orthopaedics, 30(1), 1-6
Open this publication in new window or tab >>The total costs of a displaced femoral neck fracture: comparison of internal fixation and total hip replacement. A randomised study of 146 hips
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2006 (English)In: International Orthopaedics, ISSN 0341-2695, Vol. 30, no 1, p. 1-6Article in journal (Refereed) Published
Abstract [en]

We randomised 143 patients –age 75 years or older–with displaced femoral neck fracture to either internal fixation or total hip replacement (THR) and compared the socio-economic consequences. In the internal fixation group, 34 of 78 hips underwent secondary surgery. In the THR group, 12 of 68 hips dislocated, the majority in mentally impaired patients. We calculated the total hospital costs for two years after operation. When secondary surgery was included, there was no difference in costs between the internal fixation and THR groups, or between the mentally impaired and lucid subgroups. The costs to the community were calculated comparing the baseline cost before surgery with the average cost per month during the first postoperative year. No difference was found between the treatment groups. The Harris hip scores were higher in the THR group, and pain was more common in the internal fixation group. In lucid patients, THR gives a better clinical result at the same cost.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13731 (URN)10.1007/s00264-005-0037-z (DOI)
Available from: 2002-05-12 Created: 2002-05-12
Johansson, T. (2006). Untitled - Reply. The Journal of Arthroplasty, 21(5)
Open this publication in new window or tab >>Untitled - Reply
2006 (English)In: The Journal of Arthroplasty, ISSN 0883-5403, E-ISSN 1532-8406, Vol. 21, no 5, p. 775-775Other (Other academic)
Publisher
p. 775-775
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-46003 (URN)10.1016/j.arth.2006.04.003 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13
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