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Research description

Per Wretenberg is head of the arthroplasty section, department of orthopedics, Karolinska University Hospital and Karolinska Institute. He is also the head of the arthroplasty research unit. His research is related to hip and knee prosthesis surgery and also biomechanics.  Changes in function related to surgery is studied with biomechanical gait analysis as well as with clinical evaluation. In a big project complications in relation to total hip arthroplasty was studied and it was found that the infection rate for this operation national wide was 1.3 % compared to the expected 0.6 %.

Per Wretenberg and his group have also done many studies related to pain treatment after hip and knee arthroplasty surgery. Local infiltration anesthesia (LIA) has been used and the effects and side effects have been evaluated. It has been shown that the use of LIA can lead to high concentrations of anti inflammatory substances in the blood and thereby increase the risk for renal failure.  A new routine for LIA has been developed.

A big problem related to elective orthopedic surgery is that many patients are not operated on time due to so called administrative reasons. Usually this means that there is no room for the planned patients at the wards because of many patient with acute injuries. In collaboration with stress researchers a big multi center study is conducted to analyse the effects on the patients who are not operated as planned, both in relation to clinical and psychological effects.

Per Wretenberg is also involved in several other research projects, both clinical and pre clinical in collaboration with Department of Reumatology and Departmet of Microbyology, Tumor- and Cellbiology.

Per Wretenberg has been supervisor for the following PhD students

Main Supervisor

Co-Supervisor

  • Dan Ramsey: The normal and ACL deficient knee. An in-vivo thtee dimensional kinematic and electromyocraphic analysis. Dissertation 2003-01-16
  • Lollo Gröndal: The reumatic forefoot. Surgical treatment and epidemiological aspects. Dissertation 2007-02-02
  • Arkan Sayed-Noor: Greater trochanteric pain after total hip arthropasty. Dissertation 2008-11-14
  • Fatin Affas: Local infiltration analgesia in knee and hip arthropasty, efficacy and safety. Dissertation 2014-05-23
  • Anna-Klara Esbjörnsson: Gait analysis in Reumatoid Arthritis. Planned dissertation 15-04-17

Publications

Patient-reported outcome is influenced by surgical approach in total hip replacement: a study of the Swedish Hip Arthroplasty Register including 42,233 patients
Lindgren Jv, Wretenberg P, Kärrholm J, Garellick G, Rolfson O
The bone & joint journal 2014;96-B(5):590-6

Quantifying gait deviations in individuals with rheumatoid arthritis using the Gait Deviation Index
Esbjörnsson Ac, Rozumalski A, Iversen Md, Schwartz Mh, Wretenberg P, Broström Ew
Scandinavian journal of rheumatology 2014;43(2):124-31

Change in Gait Deviation Index after anti-tumour necrosis factor-α treatment in individuals with rheumatoid arthritis: a pilot study
Broström Ew, Esbjörnsson Ac, Von Heideken J, Larsson P, Wretenberg P, Iversen M
Scandinavian journal of rheumatology 2013;42(5):356-61

Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial
Agren Ph, Wretenberg P, Sayed-noor As
The Journal of bone and joint surgery. American volume 2013;95(15):1351-7

Epidemiology of adult ankle fractures in Sweden between 1987 and 2004 A population-based study of 91,410 Swedish inpatients
Thur Ck, Edgren G, Jansson Ka, Wretenberg P
ACTA ORTHOPAEDICA 2012;83(3):276-81

The type of surgical approach influences the risk of revision in total hip arthroplasty: a study from the Swedish Hip Arthroplasty Register of 90,662 total hipreplacements with 3 different cemented prostheses
Lindgren V, Garellick G, Kärrholm J, Wretenberg P
Acta orthopaedica 2012;83(6):559-65

Interobserver Reliability and Intraobserver Reproducibility of Three Radiological Classification Systems for Intra-articular Calcaneal Fractures
Sayed-noor As, Agren Ph, Wretenberg P
FOOT & ANKLE INTERNATIONAL 2011;32(9):861-6

Pain control after total knee arthroplasty: a randomized trial comparing local infiltration anesthesia and continuous femoral block
Affas F, Nygards Eb, Stiller Co, Wretenberg P, Olofsson C
ACTA ORTHOPAEDICA 2011;82(4):441-7

Changes in local species richness of farmland birds in relation to land-use changes and landscape structure
Wretenberg J, Part T, Berg A
BIOLOGICAL CONSERVATION 2010;143(2):375-381

One year follow-up after operative ankle fractures: A prospective gait analysis study with a multi-segment foot model
Wang Rl, Thur Ck, Gutierrez-farewik Em, Wretenberg P, Brostrom E
GAIT & POSTURE 2010;31(2):234-40

[Revision surgery in aseptic loosening of hip prosthesis. Mostly good clinical results also in extensive revisions]
Wretenberg P, Weidenhielm L
Lakartidningen 2010;107(35):2011-3

Comments on Pretell et al: Distal fascia lata lengthening: an alternative surgical technique for recalcitrant trochanteric bursitis
Sayed-noor As, Pedersen E, Wretenberg P, Sjoden Go
INTERNATIONAL ORTHOPAEDICS 2009;33(5):1467-

Distal lengthening of ilio-tibial band by Z-plasty for treating refractory greater trochanteric pain after total hip arthroplasty (Pedersen-Noor operation)
Sayed-noor As, Pedersen E, Wretenberg P, Sjoden Go
ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY 2009;129(5):597-602

[Hip resurfacing. An alternative for selected and informed patients]
Wretenberg P, Hedlund H, Lundberg A
Lakartidningen 2009;106(37):2282-4

Leg length discrepancy in total hip arthroplasty: comparison of two methods of measurement
Sayed-noor As, Hugo A, Sjoden Go, Wretenberg P
INTERNATIONAL ORTHOPAEDICS 2009;33(5):1189-93

Decrease of RA-related orthopaedic surgery of the upper limbs between 1998 and 2004: data from 54579 Swedish RA inpatients
Weiss Rj, Ehlin A, Montgomery Sm, Wick Mc, Stark A, Wretenberg P
RHEUMATOLOGY 2008;47(4):491-4

[Discussed--but mini-incision hip arthroplasty here to stay]
Wretenberg P
Lakartidningen 2008;105(10):737-40

Gait pattern in rheumatoid arthritis
Weiss Rj, Wretenberg P, Stark A, Palmblad K, Larsson P, Grondal L, et al
GAIT & POSTURE 2008;28(2):229-34

Good function but very high concentrations of cobalt and chromium ions in blood 37 years after metal-on-metal total hip arthroplasy
Wretenberg P
Medical devices (Auckland, N.Z.) 2008;1():31-2

Hip joint load in relation to leg length discrepancy
Wretenberg P, Hugo A, Broström E
Medical devices (Auckland, N.Z.) 2008;1():13-8

Pressure-pain threshold algometric measurement in patients with greater trochanteric pain after total hip arthroplasty
Sayed-noor As, Englund E, Wretenberg P, Sjoden Go
CLINICAL JOURNAL OF PAIN 2008;24(3):232-6

The foot: still the most important reason for walking incapacity in rheumatoid arthritis - Distribution of symptomatic joints in 1,000 RA patients
Grondal L, Tengstrand B, Nordmark B, Wretenberg P, Stark A
ACTA ORTHOPAEDICA 2008;79(2):257-61

Ankle/hindfoot arthrodesis in rheumatoid arthritis improves kinematics and kinetics of the knee and hip: a prospective gait analysis study
Weiss Rj, Brostrom E, Stark A, Wick Mc, Wretenberg P
RHEUMATOLOGY 2007;46(6):1024-8

In vivo knee kinematics during gait reveals new rotation profiles and smaller translations
Benoit Dl, Ramsey Dk, Lamontagne M, Xu L, Wretenberg P, Renstrom P
CLINICAL ORTHOPAEDICS AND RELATED RESEARCH 2007;:81-8

Arthrodesis versus Mayo resection: the management of the first metatarsophalangeal joint in reconstruction of the rheumatoid forefoot
Grondal L, Broström E, Wretenberg P, Stark A
The Journal of bone and joint surgery. British volume 2006;88(7):914-9

Arthrodesis versus Mayo resection - The management of the first metatarsophalangeal joint in reconstruction of the rheumatoid forefoot
Grondal L, Brostrom E, Wretenberg P, Stark A
JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME 2006;88B(7):914-919

Effect of skin movement artifact on knee kinematics during gait and cutting motions measured in vivo
Benoit Dl, Ramsey Dk, Lamontagne M, Xu Ly, Wretenberg P, Renstrom P
GAIT & POSTURE 2006;24(2):152-64

Orthopaedic surgery of the lower limbs in 49 802 rheumatoid arthritis patients: results from the Swedish National Inpatient Registry during 1987 to 2001
Weiss Rj, Stark A, Wick Mc, Ehlin A, Palmblad K, Wretenberg P
ANNALS OF THE RHEUMATIC DISEASES 2006;65(3):335-41

Radial head prosthesis after fracture of radial head with associated elbow instability
Wretenberg P, Ericson A, Stark A
ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY 2006;126(3):145-9

Direct activation of glucose transport in primary human myotubes after activation of peroxisome proliferator-activated receptor delta
Kramer Dk, Al-khalili L, Perrini S, Skogsberg J, Wretenberg P, Kannisto K, et al
DIABETES 2005;54(4):1157-63

Morphological characterization of receptor activator of NF kappa B ligand (RANKL) and IL-1 beta expression in rodent collagen-induced arthritis
Weiss Rj, Harris He, Wick Mc, Wretenberg P, Stark A, Palmblad K
SCANDINAVIAN JOURNAL OF IMMUNOLOGY 2005;62(1):55-62

Human skeletal muscle cell differentiation is associated with changes in myogenic markers and enhanced insulin-mediated MAPK and PKB phosphorylation
Al-khalili L, Kramer D, Wretenberg P, Krook A
ACTA PHYSIOLOGICA SCANDINAVICA 2004;180(4):395-403

Morphological studies of receptor activator of NF-KAPPA-B ligand (RANKL), IL-17, and IL-1-beta expression in rodent collagen-induced arthritis
Weiss Rj, Erlandsson-harris H, Wick Mc, Wretenberg Pf, Stark A, Palmblad K
ANNALS OF THE RHEUMATIC DISEASES 2004;:153-153

Electromyographic and biomechanic analysis of anterior cruciate ligament deficiency and functional knee bracing
Ramsey Dk, Wretenberg Pf, Lamontagne M, Nemeth G
CLINICAL BIOMECHANICS 2003;18(1):28-34

Methodological concerns using intra-cortical pins to measure tibiofemoral kinematics
Ramsey Dk, Wretenberg Pf, Benoit Dl, Lamontagne M, Nemeth G
KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY 2003;11(5):344-9

Variation in the position and orientation of the elbow flexion axis
Ericson A, Arndt A, Stark A, Wretenberg P, Lundberg A
JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME 2003;85B(4):538-44

Broken wings-common with the Hardinger plug
Svedmark P, Wretenberg P, Stark A
ACTA ORTHOPAEDICA SCANDINAVICA 2002;73(4):407-8

Tibiofemoral contact points relative to flexion angle measured with MRI
Wretenberg P, Ramsey Dk, Nemeth G
CLINICAL BIOMECHANICS 2002;17(6):477-85

Analysis of the retrieved hip after revision with impaction grafting
Weidenhielm Lra, Mikhail Wem, Wretenberg P, Fow J, Simpson J, Bauer Tw
ACTA ORTHOPAEDICA SCANDINAVICA 2001;72(6):609-14

Assessment of functional knee bracing: an in vivo three-dimensional kinematic analysis of the anterior cruciate deficient knee
Ramsey Dk, Lamontagne M, Wretenberg Pf, Valentin A, Engstrom B, Nemeth G
CLINICAL BIOMECHANICS 2001;16(1):61-70

The effect of bracing ACL deficient knees on skeletal 3-D kinematics
Ramsey Dk, Lamontagne M, Wretenberg Pf, Nemeth G
ARCHIVES OF PHYSIOLOGY AND BIOCHEMISTRY 2000;108(1-2):76-76

Biomechanics of the knee: methodological considerations in the in vivo kinematic analysis of the tibiofemoral and patellofemoral joint
Ramsey Dk, Wretenberg Pf
CLINICAL BIOMECHANICS 1999;14(9):595-611

Complex cemented revision using polished stem and morselized allograft - Minimum 5-years' follow-up
Mikhail Wem, Wretenberg Pf, Weidenhielm Lra, Mikhail Mn
ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY 1999;119(5-6):288-91

Effects of arm suspension in simulated assembly line work: muscular activity and posture angles
Feng Y, Grooten W, Wretenberg P, Arborelius Up
APPLIED ERGONOMICS 1999;30(3):247-53

Femoral bone regeneration subsequent to impaction grafting during hip revision - Histologic analysis of a human biopsy specimen
Mikhail Wem, Weidenhielm Lra, Wretenberg P, Mikhail Mn, Bauer Tw
JOURNAL OF ARTHROPLASTY 1999;14(7):849-53

Late dislocation after total elbow arthroplasty
Wretenberg Pf, Mikhail Wem
JOURNAL OF SHOULDER AND ELBOW SURGERY 1999;8(2):178-80

The Kessel total shoulder arthroplasty - A 13-to 16-year retrospective followup
Wretenberg Pf, Wallensten R
CLINICAL ORTHOPAEDICS AND RELATED RESEARCH 1999;:100-3

Acute hemiarthroplasty after proximal humerus fracture in old patients - A retrospective evaluation of 18 patients followed for 2-7 years
Wretenberg P, Ekelund A
ACTA ORTHOPAEDICA SCANDINAVICA 1997;68(2):121-3

Effects of arm support on shoulder and arm muscle activity during sedentary work
Feng Y, Grooten W, Wretenberg P, Arborelius Up
ERGONOMICS 1997;40(8):834-48

High- and low-bar squatting techniques during weight-training
Wretenberg P, Feng Y, Arborelius Up
MEDICINE AND SCIENCE IN SPORTS AND EXERCISE 1996;28(2):218-24

Passive knee muscle moment arms measured in vivo with MRI
Wretenberg P, Nemeth G, Lamontagne M, Lundin B
CLINICAL BIOMECHANICS 1996;11(8):439-446

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