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Level of Evidence: Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence., Competing Interests: Disclosure: Funding for this study was received from Sophies Minde Ortopedi AS, The South-East Health Authority Norway, and The Research Council of Norway. The funding sources did not play a role in the investigation. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/I188 )., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)

Aim: To evaluate the cost-effectiveness of surgical treatment with reverse total shoulder arthroplasty (RTSA) compared with open reduction and internal fixation (ORIF) with a locking plate for patients 65-85 years old with a displaced proximal humerus fracture., Methods: A cost-utility analysis was conducted alongside a multicenter randomized controlled trial, taking a health care perspective. A total of 124 patients with displaced proximal humerus fractures were randomized to treatment with RTSA (n = 64) or ORIF (n = 60) during a 2-year period. The outcome measure was quality-adjusted life years derived from the generic questionnaire 15D in an intention to treat population. The results were expressed as incremental cost-effectiveness ratios, and a probabilistic sensitivity analysis was performed to account for uncertainty in the analysis., Results: At 2 years, 104 patients were eligible for analyses. The mean quality-adjusted life year was 1.24 (95% confidence interval: 1.21-1.28) in the RTSA group and 1.26 (95% confidence interval: 1.22-1.30) in the ORIF group. The mean cost in the RTSA group (€36.755 [€17,654-€55,855]) was higher than that in the ORIF group (€31.953 [€16,226-€47,279]). Using incremental cost-effectiveness ratio, ORIF was the dominant treatment. When using a probabilistic sensitivity analysis with 1000 replications, the plots were centered around origo. This indicates that there is no significant difference in cost or effect., Conclusion: In the cost-utility analysis of treatment of displaced proximal humeral fractures, there were no differences between RTSA and ORIF., (Copyright © 2022 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Almost one-third of patients with proximal humeral fractures are treated surgically, and the number is increasing. When surgical treatment is chosen, there is sparse evidence on the optimum method. The DelPhi (Delta prosthesis-PHILOS plate) trial is a clinical trial comparing 2 surgical treatments. Our hypothesis was that reverse total shoulder arthroplasty (TSA) yields better clinical results compared with open reduction and internal fixation (ORIF) using an angular stable plate., Methods: The DelPhi trial is a randomized controlled trial comparing reverse TSA with ORIF for displaced proximal humeral fractures (OTA/AO types 11-B2 and 11-C2) in elderly patients (65 to 85 years of age). The primary outcome measure was the Constant score at a 2-year follow-up. The secondary outcome measures included the Oxford Shoulder Score and radiographic evaluation. Results were reported as the mean difference with 95% confidence interval (CI). The intention-to-treat principle was applied for crossover patients., Results: There were 124 patients included in the study. At 2 years, the mean Constant score was 68.0 points (95% CI, 63.7 to 72.4 points) for the reverse TSA group compared with 54.6 points (95% CI, 48.5 to 60.7 points) for the ORIF group, resulting in a significant mean difference of 13.4 points (95% CI, 6.2 to 20.6 points; p < 0.001) in favor of reverse TSA. When stratified for fracture classification, the mean score was 69.3 points (95% CI, 63.9 to 74.7 points) for the reverse TSA group and 50.6 points (95% CI, 41.9 to 59.2 points) for the ORIF group for type-C2 fractures, which yielded a significant mean difference of 18.7 points (95% CI, 9.3 to 28.2 points; p < 0.001). In the type-B2 fracture group, the mean score was 66.2 points (95% CI, 58.6 to 73.8 points) for the reverse TSA group and 58.5 points (95% CI, 49.6 to 67.4 points) for the ORIF group, resulting in a nonsignificant mean difference of 7.6 points (95% CI, -3.8 to 19.1 points; p = 0.19)., Conclusions: At a 2-year follow-up, the data suggested an advantage of reverse TSA over ORIF in the treatment of displaced OTA/AO type-B2 and C2 proximal humeral fractures in elderly patients., Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Background: Osteoarthritis (OA) of the knee is a common and disabling condition. We wanted to investigate the modifiable risk factors Body Mass Index (BMI) and physical activity, using knee replacement (KR) as a marker for severely symptomatic disease, focusing on the interaction between these risk factors., Methods: 315,495 participants (mean age 43.0 years) from national health screenings were followed prospectively with respect to KR identified by linkage to the Norwegian Arthroplasty Register. Data were analysed by Cox proportional hazard regression., Results: During 12 years of follow up 1,323 individuals received KR for primary OA. There was a dose-response relationship between BMI and heavy labour, and later KR. Comparing the highest versus the lowest quarter of BMI, the relative risk was 6.2 (95% CI: 4.2-9.0) in men and 11.1 (95% CI: 7.8-15.6) in women. Men reporting intensive physical activity at work had a relative risk of 2.4 (95% CI: 1.8-3.2) versus men reporting sedentary activity at work, the corresponding figure in women being 2.3 (95% CI: 1.7-3.2). The effect of BMI and physical activity at work was additive. The heaviest men with the most strenuous work had a RR of 11.7 (95% CI: 5.9-23.1) compared to the ones with the lowest BMI and most sedentary work. For women the corresponding RR was 15.8 (95% CI: 8.2-30.3). There was no association between physical activity during leisure and KR., Conclusion: We found that a high BMI and intensive physical activity at work both contribute strongly to the risk of having a KR. As the two risk factors seem to act independently, people with strenuous physical work with a high BMI are at particularly high risk for severely disabling OA of the knee, and should be targeted with effective preventive measures.

Objective: To study the association between weight gain and the risk of knee replacement (KR) due to primary osteoarthritis (OA), and to evaluate whether the association differs by age., Design: 225,908 individuals from national health screenings with repeated measurements of height and weight were followed prospectively with respect to KR identified by linkage to the Norwegian Arthroplasty Register. Cox proportional hazard regression was used to calculate sex-specific relative risks (RR) of KR according to change in Body Mass Index (BMI) and weight, corresponding analyses were done for age categories at first screening., Results: During 12 years of follow up, 1591 participants received a KR due to primary OA. Men in the highest quarter of yearly change in BMI had a RR of 1.5 (95% confidence interval (CI) 1.1-1.9) of having a KR compared to those in the lowest quarter. For women the corresponding RR was 2.4 (95% CI 2.1-2.7). Men under the age of 20 at the first screening had a 26% increased risk for KR per 5 kg weight gain, for women the corresponding increase was 43%. At older age the association became weaker, and in the oldest it was lost., Conclusions: Weight gain increases the risk for later KR both in men and women. The impact of weight gain is strongest in the young, at older age the association is weak or absent. Our study suggests that future OA may be prevented by weight control and that preventive measures should start at an early age., (Copyright © 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.)

Objective: To study the association between change in the body mass index (BMI) at different ages and the risk of a later total hip replacement (THR) due to primary osteoarthritis (OA)., Design: A total of 265,725 individuals who had two repeated measurements of weight and height were included from national health screenings. These individuals were followed prospectively. The data were matched with the Norwegian Arthroplasty Register and 4,442 of these individuals were identified as having received a THR for primary OA. Cox proportional hazard regression was used to calculate sex-specific relative risks for having a THR according to age at screening and BMI change., Results: Men and women aged 20 years or younger at the first screening in the quartile with the greatest BMI change per year had more than twice the risk of later having a THR compared with those in the quartile with the smallest BMI change per year. For men older than 30 years at the first screening, there was no relationship between BMI gain, or weight gain, and later risk of THR. For older women, BMI gain was associated with risk of THR, but to a lesser degree than in younger women., Conclusion: There was a clear relationship between change in BMI and the risk of later THR in young men and women, whereas the association was absent in older men and weaker in older women. It is important to focus on weight control to prevent future OA, and the preventive strategy should be focused on the young population., (Copyright © 2011 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.)