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Palm, Lars
Publications (10 of 11) Show all publications
Nilsson, A., Alkner, B., Wetterlöv, P., Wetterstad, S., Palm, L. & Schilcher, J. (2019). Low compartment pressure and myoglobin levels in tibial fractures with suspected acute compartment syndrome.. BMC Musculoskeletal Disorders, 20(1), Article ID 15.
Open this publication in new window or tab >>Low compartment pressure and myoglobin levels in tibial fractures with suspected acute compartment syndrome.
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2019 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 20, no 1, article id 15Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The intense ischemic pain of acute compartment syndrome can be difficult to discriminate from the pain related to an associated fracture. Lacking objective measures, the decision to perform fasciotomy is often only based on clinical findings and performed at a low threshold. Biomarkers of muscle cell damage might help to identify and monitor patients at risk. In patients with fractures, however, markers of muscle cell damage could be elevated because of other reasons associated with the trauma, which would make interpretation difficult. In a review of all patients who underwent emergency fasciotomy in our health care district we aimed to investigate the decision-making process and specifically the use of biomarkers in patients with and without fractures.

METHODS: In the southeast health care region of Sweden 79 patients (60 men) with fractures (median age 26 years) and 42 patients (34 men) without associated fractures (median age 44 years) were treated with emergency fasciotomy of the lower leg between 2007 and 2016. Differences in clinical findings, p-myoglobin and p-creatine phosphokinase as well as pressure measurements were investigated.

RESULTS: P-myoglobin was analyzed preoperatively in 20% of all cases and p-creatine phosphokinase in 8%. Preoperative levels of p-myoglobin were lower in patients with fractures (median 1065 μg/L, range 200-3700 μg/L) compared with those without fractures (median 7450 μg/L, range 29-31,000 μg/L), p < 0.05. Preoperative intracompartmental pressure was lower in the fracture group (median 45 mmHg, range 25-90 mmHg) compared with those without fractures (median 83 mmHg, range 18-130 mmHg), p < 0.05.

CONCLUSIONS: Biomarkers are seldom used in the context of acute fasciotomy of the lower leg. Contrary to our expectations, preoperative levels of p-myoglobin and intracompartmental pressures were lower in fracture patients. These findings support differences in the underlying pathomechanism between the groups and indicate that biomarkers of muscle cell necrosis might play a more important role in the diagnosis of acute compartment syndrome than previously thought.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Acute compartment syndrome;Creatine phosphokinase;Fasciotomy;Myoglobin;Tibial fracture
National Category
Orthopaedics
Identifiers
urn:nbn:se:liu:diva-153783 (URN)10.1186/s12891-018-2394-y (DOI)000454957500014 ()30611244 (PubMedID)
Note

Funding agencies: Linkoping University; Region Ostergotland; Medical Research Council of Southeast Sweden

Available from: 2019-01-10 Created: 2019-01-10 Last updated: 2019-05-27
Schilcher, J., Palm, L., Ivarsson, I. & Aspenberg, P. (2017). Local bisphosphonate reduces migration and formation of radiolucent lines adjacent to cemented acetabular components. The Bone & Joint Journal, 99B(3), 317-324
Open this publication in new window or tab >>Local bisphosphonate reduces migration and formation of radiolucent lines adjacent to cemented acetabular components
2017 (English)In: The Bone & Joint Journal, ISSN 2049-4394, E-ISSN 2049-4408, Vol. 99B, no 3, p. 317-324Article in journal (Refereed) Published
Abstract [en]

Aims Post-operative migration of cemented acetabular components as measured by radiostereometric analysis (RSA) has a strong predictive power for late, aseptic loosening. Also, radiolucent lines predict late loosening. Migration has been reduced by systemic bisphosphonate treatment in randomised trials of hip and knee arthroplasty. Used as a local treatment, a higher local dose of bisphosphonate can be achieved without systemic exposure. We wished to see if this principle could be applied usefully in total hip arthroplasty (THA). Patients and Methods In this randomised placebo-controlled, double-blinded trial with 60 participants, we compressed gauze soaked in bisphosphonate solution (ibandronate) or saline against the acetabular bone bed immediately before cementing the acetabular component. RSA, classification of radiolucent lines, the Harris Hip Score (HHS) and the Western Ontario McMasters Universities Osteoarthritis Index (WOMAC) were carried out at three-, six-, 12-, and 24-month follow-up. Results Migration of the cemented acetabular component relative to the pelvis was reduced by movement almost half in the ibandronate group, when measured as maximum total point or as movement of the femoral head (p = 0.001 and 0.004, respectively). Radiolucent lines after one year were classified as absent, partial or complete, and correlated with treatment (rho 0.37; p = 0.004). Only three of 30 patients in the ibandronate group had complete lines, compared with 13 of 28 in the placebo group (p = 0.002). There were no significant effects on HHS or WOMAC score. Conclusion Considering the power of RSA to predict loosening of cemented acetabular components, and the likelihood that radiolucent lines indicate risk of loosening, these data suggest that local treatment with a bisphosphonate can reduce the risk of late aseptic loosening.

Place, publisher, year, edition, pages
BRITISH EDITORIAL SOC BONE JOINT SURGERY, 2017
National Category
Orthopaedics
Identifiers
urn:nbn:se:liu:diva-136657 (URN)10.1302/0301-620X.99B3.BJJ-2016-0531.R1 (DOI)000395691400006 ()
Available from: 2017-04-20 Created: 2017-04-20 Last updated: 2019-05-27
Schilcher, J., Ivarsson, I., Perlbach, R. & Palm, L. (2017). No Difference in Periprosthetic Bone Loss and Fixation Between a Standard-Length Stem and a Shorter Version in Cementless Total Hip Arthroplasty. A Randomized Controlled Trial. The Journal of Arthroplasty, 32(4), 1220-1226
Open this publication in new window or tab >>No Difference in Periprosthetic Bone Loss and Fixation Between a Standard-Length Stem and a Shorter Version in Cementless Total Hip Arthroplasty. A Randomized Controlled Trial
2017 (English)In: The Journal of Arthroplasty, ISSN 0883-5403, E-ISSN 1532-8406, Vol. 32, no 4, p. 1220-1226Article in journal (Refereed) Published
Abstract [en]

Background: Cementless femoral stems in total hip arthroplasty provide dependable clinical and radiographic results in the treatment of osteoarthritis. Stem length might affect the preservation of proximal bone stock and stability. We hypothesized that a shorter stem decreases proximal bone loss without affecting implant stability. Methods: We randomly assigned 60 patients aged between 50 and 70 years to either a standard cementless femoral stem or a 35-mm shorter version. Patients were followed with dual-energy X-ray absorptiometry, radiostereometric analysis, Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index score, and clinical follow-up at 3, 6, 12, and 24 months. The trial is registered on ClinicalTrials. gov/. Results: After 24 months, short stems had on average 3.8% (95% confidence interval, 1.2%-8.9%) more bone loss in zone 1 compared to standard stems (P - .14). In zone 7, the bone loss was on average 6.5% (95% confidence interval, 6.6%-19.7%) higher compared to standard stems (P - .33). After 24 months, standard stems had migrated 0.93 mm (range, 0.25-4.66 mm) and short stems 0.93 mm (range, 0.17-2.96 mm; Student t-test after log transformation, P - .3). Patient-reported outcome measures were similar in both groups. One patient in the standard stem group was diagnosed with infection, one with a posterior dislocation, and one with a deep venous thrombosis. No stems were revised. Conclusion: There were no statistically significant differences in periprosthetic bone loss or fixation between the stems at 24 months. (C) 2016 Elsevier Inc. All rights reserved.

Place, publisher, year, edition, pages
CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS, 2017
Keywords
total hip arthroplasty; short stem; radiostereometric analysis; dual-energy X-ray absorptiometry; cementless stem
National Category
Orthopaedics
Identifiers
urn:nbn:se:liu:diva-138287 (URN)10.1016/j.arth.2016.11.015 (DOI)000401125600032 ()27993496 (PubMedID)
Available from: 2017-06-13 Created: 2017-06-13 Last updated: 2019-05-27
Palm, L., Jacobsson, S.-A., Kvist, J., Lindholm, A., Öjersjö, A. & Ivarsson, I. (2007). Acetabular revision with extensive allograft impaction and uncemented hydroxyapatite-coated implants. Results after 9 (7-11) years follow-up. The Journal of Arthroplasty, 22(8), 1083-1091
Open this publication in new window or tab >>Acetabular revision with extensive allograft impaction and uncemented hydroxyapatite-coated implants. Results after 9 (7-11) years follow-up
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2007 (English)In: The Journal of Arthroplasty, ISSN 0883-5403, E-ISSN 1532-8406, Vol. 22, no 8, p. 1083-1091Article in journal (Refereed) Published
Abstract [en]

This is a clinical and radiographic review of 87 hips in 79 patients 9 (7-11) years after acetabular revision with extensive use of morselized allograft firmly impacted into localized defects as well as the entire acetabular cavity, followed by insertion of an uncemented hydroxyapatite-coated cup with supplementary screw fixation. The 9-year survival rate for the acetabular implant was 90.5% (95% CI, 83.4%-97.6%) with revision for any reason as end point and 94% (95% CI, 89%-99.1%) with revision for aseptic loosening as end point. Acetabular revision with massive allograft impaction and hydroxyapatite-coated implants show very promising results. The limited contact between implant and host bone does not seem to compromise implant survival in the 7- to 11-year perspective.

Keywords
acetabular, revision, allograft, impaction, hydroxyapatite coating, uncemented
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-12810 (URN)10.1016/j.arth.2006.11.021 (DOI)
Available from: 2007-11-28 Created: 2007-11-28 Last updated: 2017-12-14
Palm, L. & Ivarsson, I. (2007). Early radiolucent lines around cemented cups do not reliably predict increased migration as measured by radiostereometry.
Open this publication in new window or tab >>Early radiolucent lines around cemented cups do not reliably predict increased migration as measured by radiostereometry
2007 (English)Article in journal (Refereed) Submitted
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-12812 (URN)
Available from: 2007-11-28 Created: 2007-11-28 Last updated: 2010-04-23
Palm, L., Olofsson, J., Åström, S.-E. & Ivarsson, I. (2007). No difference in migration or wear between cemented low-profile cups and standard cups. A randomized radiostereographic study of 53 patients over 3 years. Acta Orthopaedica, 78(4), 479-484
Open this publication in new window or tab >>No difference in migration or wear between cemented low-profile cups and standard cups. A randomized radiostereographic study of 53 patients over 3 years
2007 (English)In: Acta Orthopaedica, ISSN 1745-3674, Vol. 78, no 4, p. 479-484Article in journal (Refereed) Published
Abstract [en]

Background: Minor design changes may cause major changes in implant performance. Thus, as part of a stepwise introduction of a new low-profile cup, we performed a randomized trial comparing it to a well-docu-mented standard cup.

Patients and methods: 60 patients, stratified according to sex, weight, and age, underwent cemented total hip arthroplasty using a Lubinus SP2 stem with ceramic head and were randomized to either the new low-profile Lubinus Flanged Anti-Luxation cup (FAL) or the Lubinus Standard Eccentric cup (Standard). 7 patients were excluded and 53 (28 FAL) were evaluated at 3, 6, 12, and 36 months postoperatively. Primary outcome variables, cup migration (MTPM), and wear (total 3-dimensional femoral head penetration) were measured with radiostereometry (RSA). Clinical outcome was evaluated with the western Ontario and McMaster osteoarthritis index (Womac) and the visual analog pain score (VAS).

Results: We found no difference in migration between the FAL and Standard cups. There was no difference in wear between the two cups and there was no correlation between wear and migration. 3 cups (2 FAL and 1 Standard) showed continuous migration of a magnitude that indicated an increased risk of early loosening. Clinical outcome was excellent, without any difference between the 2 groups.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-12811 (URN)10.1080/17453670710014112 (DOI)
Available from: 2007-11-28 Created: 2007-11-28 Last updated: 2009-08-20
Palm, L. (2007). On Fixation of Hip Prostheses. (Doctoral dissertation). Institutionen för klinisk och experimentell medicin
Open this publication in new window or tab >>On Fixation of Hip Prostheses
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis, comprising 5 separate studies, is concerned with fixation of prosthetic components in total hip arthroplasty. The results and conclusions of the studies fol-low;

The initial stability of femoral revision components, the long cementless PCA stem and the Exeter standard stem cemented in a bed of impacted bone graft, was com-pared in an experimental study. The PCA stem was more stable than the Exeter stem. However, for both stems initial stability may not be sufficient to allow bone ingrowth. Initial fixation is especially vulnerable to torsion.

Identical femoral stems with or without HA-coating were compared in a prospec-tive randomized clinical trial. The long-term stable fixation of a cementless Link RS femoral component was improved by application of hydroxyapatite coating to the femoral stem.

In a clinical study the method of extensive impaction of morsellized bone allograft and a hydroxyapatite-coated cementless Mallory-Head acetabular component was found to be advantageous for acetabular revision in the presence of contained or acetabular wall defects. The limited contact between the HA-coated implant and living host bone did not seem to compromise long-term stable fixation.

Two different cup designs were compared in a prospective randomized RSA study. At 3 years after implantation the cemented low profile Lubinus FAL cup performed as well as the cemented Lubinus Standard cup in terms of migration and polyethyl-ene wear.

In a study of the relationship between radiolucent lines and migration the Lubinus FAL cup displayed more radiolucent lines in the cement bone interface than the Lubinus Standard cup but no difference in migration was found. Early appearance of such radiolucent lines represents an unspecific finding without reliable correla-tion to 3-year migration of the acetabular component.

Place, publisher, year, edition, pages
Institutionen för klinisk och experimentell medicin, 2007
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1014
Keywords
Fixation, Hip prostheses, primary arthroplasty, revision arthroplasty, cemented, uncemented, bone grafting, Fixation, Höftprotes, primärartroplastik, revisionsartroplastik, cement, cementfri, bentransplantation
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-10351 (URN)978-91-85895-98-4 (ISBN)
Public defence
2007-10-12, Berzeliussalen, Hälsouniversitetet, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2007-11-28 Created: 2007-11-28 Last updated: 2009-08-22
Bottner, F., Zawadsky, M., Su, E., Bostrom, M., Palm, L., Ryd, L. & Sculco, T. (2005). Implant migration after early weightbearing in cementless hip replacement. Clinical Orthopaedics and Related Research (436), 132-137
Open this publication in new window or tab >>Implant migration after early weightbearing in cementless hip replacement
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2005 (English)In: Clinical Orthopaedics and Related Research, ISSN 0009-921X, E-ISSN 1528-1132, no 436, p. 132-137Article in journal (Refereed) Published
Abstract [en]

Twenty-nine patients (five women and 24 men) with an average age of 47 years (range, 24-59 years) had 37 total hip arthroplasties using a hydroxyapatite-coated double-wedge press-fit femoral component. All patients had a Type A bone quality. Patients were either mobilized with weightbearing as tolerated or toe-touch weightbearing for 6 weeks postoperatively. After 6 weeks all patients were advanced to weightbearing as tolerated. Radiostereometric analysis radiographs were taken at 3 days, 6 weeks, and 6 months postoperatively to measure migration of the femoral component. Radiostereometric analysis revealed no difference in stem migration between the two groups as defined by maximal total point migration. There was a difference in the vertical (proximal-distal) migration within the first 6 weeks between groups (0.81 mm versus 0.13 mm), but not afterwards (0.17 mm versus 0.18 mm). Continuous migration after 6 weeks was observed in three patients from each group. There was no loosening in either group within a 2-year followup. Weightbearing as tolerated is recommended for young patients with excellent bone quality after cementless total hip arthroplasty with a double-wedge press-fit femoral component. Level of Evidence: Diagnostic study, Level I (testing of previously developed diagnostic criteria in series of consecutive patients-with previously applied reference gold standard). See the Guidelines for Authors for a complete description of levels of evidence.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-46104 (URN)
Note

DOI does not work: 10.1097/01.bio.0000160380.15429.fb

Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2018-03-06
Palm, L., Jacobsson, S.-A. & Ivarsson, I. (2002). Hydroxyapatite coating improves 8- to 10-year performance of the Link RS cementless femoral stem. The Journal of Arthroplasty, 17(2), 172-175
Open this publication in new window or tab >>Hydroxyapatite coating improves 8- to 10-year performance of the Link RS cementless femoral stem
2002 (English)In: The Journal of Arthroplasty, ISSN 0883-5403, Vol. 17, no 2, p. 172-175Article in journal (Refereed) Published
Abstract [en]

In a prospective randomized clinical study, 12 hydroxyapatite (HA)-coated and 8 identical but noncoated stems were implanted in 20 patients. At 8- to 10-year follow-up, the HA-coated stems displayed excellent clinical and radiographic results in 11 out of 12 patients, whereas 7 out of 8 noncoated stems were failures and had been subject to revision. Despite the small number of patients in this series, HA coating seems to improve the long-term stable fixation of uncemented femoral implants.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-12809 (URN)10.1054/arth.2002.29395 (DOI)
Available from: 2007-11-28 Created: 2007-11-28 Last updated: 2009-08-20
Palm, L., Ivarsson, I. & Jacobsson, S.-A. (1999). Initial stability of two different hip revision concepts: A biomechanical study. Hip International, 1, 7-13
Open this publication in new window or tab >>Initial stability of two different hip revision concepts: A biomechanical study
1999 (English)In: Hip International, ISSN 1120-7000, Vol. 1, p. 7-13Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-12808 (URN)
Available from: 2007-11-28 Created: 2007-11-28 Last updated: 2009-08-20
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