Tommy Frøseth Aae

Background/Objectives: Osteopenia is common in postmenopausal women and predisposes to osteoporosis and fracture, representing a population at risk of bone loss but without indication for pharmacologic therapy. Conventional calcium salts offer modest, often transient gains in bone mineral density (BMD). We evaluated whether CalGo^®, a salmon bone complex containing microcrystalline hydroxyapatite within a collagen-rich matrix, preserves BMD versus placebo in post-menopausal women with osteopenia. Methods: In a 24-month, randomized, double-blind, placebo-controlled trial, 80 women (50–80 years) with dual-energy X-ray absorptiometry (DXA)-confirmed femoral-neck osteopenia were assigned to CalGo^® (2 g/day) or placebo. The prespecified primary endpoint was 24-month change in femoral-neck BMD (g/cm²) analyzed by linear regression (unadjusted and baseline-adjusted). Secondary endpoints included lumbar spine and distal radius BMD, serum P1NP and β-CTX-I, health-related quality of life, and safety. Results: The primary analysis included participants with 24-month DXA (CalGo^® n = 29; placebo n = 30). Femoral-neck BMD was maintained with CalGo^® (+0.003 g/cm²; +0.4%) but declined with placebo (−0.017 g/cm²; −2.4%), yielding a significant baseline-adjusted between-group difference of +0.019 g/cm² (95% confidence interval (CI) 0.001–0.038; p = 0.044). Lumbar-spine loss was attenuated with CalGo^® (−0.005 g/cm²; −0.3%) versus placebo (−0.028 g/cm²; −3.4%); the adjusted difference favored CalGo^® (+0.026 g/cm²; p = 0.058). In exploratory responder analysis, ≥1% lumbar-spine gain was more likely with CalGo^® (32.5% vs. 11.4%; OR 3.61; p = 0.043). No treatment effects were observed at the distal radius, in P1NP or β-CTX-I, or in EQ-5D-3L/EQ-VAS. CalGo^® was well tolerated with no hepatic or renal safety signals. Conclusions: CalGo^® maintained femoral-neck bone mineral density and reduced lumbar-spine loss over 24 months in osteopenic women, with good tolerability. These findings support its potential role as a nutritional approach for maintaining bone health.

Background/Objectives: Osteopenia predisposes to osteoporosis and fracture, especially at the femoral neck and spine. Conventional calcium supplements offer modest benefit with tolerability limits. CalGo®, a salmon bone complex (calcium hydroxyapatite, colla-gen, trace minerals), may support skeletal health. We evaluated its efficacy and safety in postmenopausal women with osteopenia. Methods: In a 24-month, randomized, dou-ble-blind, placebo-controlled trial, 80 women aged 50–80 years with DXA-confirmed fem-oral-neck osteopenia were assigned to daily CalGo® (n=40) or placebo (n=40). The prima-ry endpoint was 24-month change in femoral-neck BMD (g/cm²) analyzed by base-line-adjusted linear regression; secondary outcomes were lumbar spine and distal radius BMD, serum bone turnover markers (β-CTX-I, P1NP), health-related quality of life, and safety. Results: The primary analysis included participants with 24-month DXA (CalGo® n=29; placebo n=30). Femoral-neck BMD was maintained with CalGo® (+0.003 g/cm²; +0.4%) but declined with placebo (–0.017 g/cm²; –2.4%), yielding a significant base-line-adjusted between-group difference of +0.019 g/cm² (95% CI 0.001–0.038; p=0.044). Lumbar-spine loss was attenuated with CalGo® (–0.005 g/cm²; –0.3%) versus placebo (–0.028 g/cm²; –3.4%); the adjusted difference favored CalGo® (+0.026 g/cm²; p=0.058), and ≥1% spine gain was more likely with CalGo® (32.5% vs 11.4%; OR 3.61; p=0.043). No treatment effects were seen at the distal radius, in bone turnover markers, or in EQ-5D/EQ-VAS. CalGo® was well tolerated, with low adverse-event rates and no hepatic or renal safety signals. Conclusions: Over 24 months, CalGo® preserved femoral-neck BMD and attenuated lumbar-spine loss in osteopenic postmenopausal women, with a favorable safety profile.

Background: Knee cartilage injuries can lead to significant functional limitations, pain, and diminished quality of life. Microfracture (MF) is the most common surgical procedure for smaller (2 ) cartilage lesions of the knee. However, there is no established gold-standard surgical intervention. Purpose: To compare functional and patient-reported outcomes after MF and arthroscopic debridement (AD) for symptomatic, isolated femoral cartilage injuries 2 in patients aged 18 to 50 years. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 65 patients were included, randomized to undergo either MF (n = 31) or AD (n = 34), and followed for 2 years. The primary outcome was the change in the Knee injury and Osteoarthritis Outcome Score (KOOS) Quality of Life subscore. Secondary outcomes included scores for the other KOOS subscales, Tegner activity scale, Lysholm score, and visual analog scale for pain. Results: The mean age at the time of inclusion was 33.2 ± 9.7 years. There were 44 (68%) male patients. The mean size of the lesion was 1.2 ± 0.6 cm ² . There was no statistically significant difference between the groups in the change in the KOOS Quality of Life subscore from baseline to 2 years (3.5 [95% CI, –10.0 to 16.9]; P = .61). There were 10 complications in 5 patients in the MF group and 2 complications in 2 patients in the AD group. According to a linear mixed model, there were no statistically significant differences between the groups for any of the secondary outcomes at any time point during the 2-year follow-up period. Conclusion: MF was not superior to AD when treating femoral cartilage lesions of the knee 2 .

Background and purpose: The optimal approach to the hip joint in patients with displaced femoral neck fractures (dFNF) receiving a total hip arthroplasty (THA) remains controversial. We compared the direct lateral approach (DLA) with the direct anterior approach (DAA) primarily on Timed Up and Go (TUG), and secondarily on the Forgotten Joint Score (FJS), the Oxford Hip Score (OHS), EQ5D-5L, and the EQ5D-VAS.Methods: Between 2018 and 2023, we conducted a randomized controlled trial including elderly patients with dFNFs treated with THA. The primary outcome was the difference in TUG at 6 weeks postoperatively. Key secondary outcomes were TUG at 2, 12, and at 52 weeks postoperatively, and FJS, OHS, EQ5D-5L, and EQ5D-VAS at 2, 6, 12, and at 52 weeks postoperatively.Results: 130 patients with a mean age of 78.6 (standard deviation 1.2) were allocated to DAA (n = 64) or DLA (n = 66). There was no statistically significant difference in TUG times at 6 weeks postoperatively between the DAA and the DLA, 16.0 s (95% confidence interval [CI] 13.2–18.7) vs 17.8 s (CI 15.1–20.4), estimated mean difference –1.8 s (CI –5.7 to 2.0). However, patients who underwent DAA had a significantly higher FJS at 2, 6, and 12 weeks.Conclusion: Among elderly patients with dFNF we found no difference between DAA or DLA regarding crude mobility as demonstrated with the TUG test, but patients treated with DAA showed better outcomes in the FJS in the early post-fracture period though not at 52 weeks.

Purpose: Meniscal injuries in the knee are usually treated surgically with arthroscopic partial resection (APR) or arthroscopic repair (AR). APR has been shown to increase the risk of osteoarthritis and the focus has shifted to repairing the meniscus with AR. The extent of this shift is yet to be established and an analysis of incidence rates (IR) of APR and AR for meniscal injuries could highlight this.Methods: Data from the Norwegian Patient Registry (NPR) and Statistics Norway (SN) from 2010 to 2020 were collected. The number of procedures, demographics and facilities providing meniscal surgery were obtained from NPR, while population size and catchment area were collected from SN. IR of APR and AR and APR/AR rate ratios were estimated and compared.Results: A total of 119,528 knee arthroscopies were performed, 89.6% of which were APR. The number of APR performed nationally decreased by 72%, while AR procedures increased by 178%. The national IR of APR decreased from 298 to 82/100,000 inhabitants (p < 0.001). For AR, the national IR increased annually from 13/100,000 inhabitants to a peak in 2019 of 32/100,000 inhabitants (p < 0.001). The APR/AR rate ratio decreased from 22 to below five and the APR/AR trend curves showed a statistically significant decrease (p < 0.001).Conclusion: Surgical treatment of meniscal injuries has changed, with a substantial reduction in APR and a strong increase in AR. The reduction in APR, especially in older patients, suggests that meniscal surgery in Norway has undergone a paradigmatic shift, in line with recent literature.Level of Evidence: Level IV.

Purpose: The aim of the study is to identify the most common avoidable patient injuries related to hallux valgus surgery. Methods: We assessed the claims reported to the Norwegian System of Patient Injury Compensation (NPE) following surgery for hallux valgus in light of hospital volume. Data from NPE was categorized according to age, sex, reason for claim, and reason for accepted/rejected claim. The institutions were grouped by catchment population into low volume (300,000) institutions. The effect of hospital volume on the likelihood of an accepted claim was estimated. Results: NPE received 369 claims of which 173 (46.9%) were accepted. The main reason for accepted claims was recurrence of the deformity, wrong level osteotomy or insufficient fixation. A quarter of the claims were accepted because of lack of indication and one in 5 accepted claims was due to a postoperative infection. Patient treated at low-volume institutions had a higher fraction of accepted claims (P < 0.01). The odds ratio for an accepted claim in the low volume hospitals was 5.8 (95% confidence interval 4.1–8.3) compared with the middle- and high-volume institutions. Conclusions: The likelihood of a treatment error that leads to compensation was higher in low-volume institutions. Level of Evidence: Level II Prospective cohort study

Background and purpose: It is still debatable which is the least invasive approach to the hip joint in arthroplasty for a femoral neck fracture (FNF). We compared the traditional direct lateral approach (DLA) with the direct anterior approach (DAA) regarding creatine kinase (CK), C-reactive protein (CRP), and hemoglobin (Hb).Methods: In a randomized controlled trial, 130 elderly patients with dislocated FNFs treated with total hip arthroplasty (THA) were included. CK, CRP, and Hb were measured preoperatively and on postoperative days 1 to 4 and were compared between the DAA and DLA groups using repeated measures mixed-effect models.Results: The CK level was significantly higher on the 1st postoperative day in the DLA group, 597 U/L (95% confidence interval [CI] 529–666) vs 461 U/L (CI 389–532), estimated mean difference (MD) 136 U/L (CI 38–235). The CRP levels were significantly higher on postoperative days 3 and 4 in the DLA group, 207 mg/L (CI 189–226) vs 161 mg/L (CI 143–180), estimated MD 46 mg/L (CI 19–72) and 162 mg/L (CI 144–181) vs 121 (CI 102–140), estimated MD 41 mg/L (CI 15–68). Blood loss, expressed as difference in Hb, did not differ between the groups.Conclusion: In an elderly population with FNFs, we found that the DAA, compared with the DLA, results in less CK and CRP increase, but no change in Hb.

Systematic analysis of compensation claims following patient injuries is helpful in improving patient safety. The objective of the current study was to assess compensation claims after arthroscopic treatment of rotator cuff ruptures, impingement, and acromioclavicular joint osteoarthritis reported to the Norwegian System of Patient Injury Compensation and evaluate if there was regional variation on the risk of patient injuries leading to an accepted compensation claim. Data from the Norwegian System of Patient Injury Compensation and the Norwegian Patient Registry (NPR) from 2008 to 2018 were collected. Demographics (age and sex) and type of claim and reasons for accepted claims were obtained from the Norwegian System of Patient Injury Compensation, while the number of arthroscopic procedures was collected from NPR. The treating institutions were grouped on geography according to Norway’s four regional Health Trusts and private institutions and the effect of geography on the probability of an accepted claim was estimated. NPR registered 69,097 shoulder arthroscopies during the study period, of which 216 (0.3%) compensation claims were filed for patient injury. A total of 38% of the claims were accepted, representing 0.1% of the arthroscopic procedures. Infection (37.8%) was the most common reason for accepted claim, followed by no surgical indication (15.9%) and wrong surgical technique (12.2%). We found a statistically significantly increased odds ratio for a claim being accepted in both the smallest and largest regional Health Trusts compared to the other regional Health Trusts and private institutions. Compensation claims due to patient injury following shoulder arthroscopy are rare (0.3% of patients file a claim, of which a third is accepted (0.1% of all shoulder arthroscopy patients)). The most common reason for accepted claim was infection followed by lack of indication.

Background: Surgical complications contribute to the significant mortality following hip fractures in the elderly. The purpose of this study was to increase our knowledge of surgical complications by evaluating compensation claims following hip fracture surgery in Norway. Further, we investigated whether the size and location of performing institutions would influence surgical complications. Methods: We collected data from the Norwegian System of Patient Injury Compensation (NPE) and the Norwegian Hip Fracture Register (NHFR) from 2008 to 2018. We classified institutions into 4 categories based on annual procedure volume and geographical location. Results: 90,601 hip fractures were registered in NHFR. NPE received 616 (.7%) claims. Of these, 221 (36%) were accepted, which accounts for .2% of all hip fractures. Men had nearly a doubled risk of ending with a compensation claim compared to women (OR: 1.8, CI, 1.4-2.4, P < .001). Hospital-acquired infection was the most frequent reason for accepted claims (27%). However, claims were rejected if patients had underlying conditions predisposing to infection. Institutions treating fewer than 152 hip fractures (first quartile) annually, had a statistically significant increased risk (OR: 1.9, CI, 1.3-2.8, P = .005) for accepted claims compared to higher volume facilities. Discussion: The fewer registered claims in our study could be due to the relatively high early mortality and frailty in this patient group, which may decrease the likelihood of filing a complaint. Men could have undetected underlying predisposing conditions that lead to increased risk of complications. Hospital-acquired infection may be the most significant complication following hip fracture surgery in Norway. Lastly, the number of procedures performed annually in an institution influences compensation claims. Conclusions: Our findings indicate that hospital acquired infections need greater focus following hip fracture surgery, especially in men. Lower volume hospitals may be a risk factor.