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Per Wretenberg

Anknuten

Besöksadress : Karolinska Universitetssjukhuset, Solna, A2:07 171 76 Stockholm
Postadress : Institutionen för molekylär medicin och kirurgi (MMK), K1, Ortopedi , Ortopedkliniken och ; Institutionen för hälsovetenskap och medicin, 701 85 Örebro
Leveransadress : Karolinska Universitetssjukhuset, Solna, A2:07 171 76 Stockholm

Forskningsbeskrivning

Adjungerad professor i ortopedi vid Karolinska Institutet med placering vid Institutionen för molekylär medicin och kirurgi, forskargruppen Ortopedi. Anknytningen omfattar 20 procent, och är förenad med överläkartjänst och tjänst. 

Per Wretenberg ansvarar för proteskirurgin vid Karolinska Solna och bedriver i huvudsak protes relaterad forskning. Med biomekaniska gånganalys studeras hur gångförmågan kan förbättras med korrigerande operationer och höft- och knäproteskirurgi. Han bedriver även forskning i relation till komplikationer vid proteskirurgi. I en omfattande rikstäckande studie har den faktiska incidensen av protesrelaterade infektioner kartlagts som ett viktigt led i hur detta problem ska kunna reduceras på sikt.

Per Wretenberg forskar också kring effektiviserad smärtlindring. Lokalbedövning och anti-inflammatorisk medicin ges i form av injektioner i direkt anslutning till operationsstället. Det är effektivt, men kan leda till för höga koncentrationer av läkemedlen i blodet, vilket i sin tur kan leda till njurskador och njursvikt. Det är därför viktigt att inte ge för höga doser till riskpatienter.

Ett problem är att många ortopedpatienter som kommer för en planerad operation stryks, beroende på att mer akuta fall tillkommit. I samarbete med stressforskare studeras patienternas stressfaktorer i blodet och hur utfallet av operationen blir då den senare genomförs. Preliminära data visar att resultatet för dessa patienter inte blir lika bra som för de patienter som opereras på utsatt tid.

Per Wretenberg handleder också doktorander i traumarelaterad forskning. I en nyligen publicerad artikel har forskargruppen publicerat den hittills största randomiserade studien i världen på hälbensfrakturer med 10 års uppföljning.

Per Wretenberg är mycket aktiv kursledare och har under många år varit ansvarig för en kurs i grundläggande proteskirurgi för ST läkare, en kurs i avancerad rekonstruktiv revisionskirurgi för specialister samt forskarutbildningskursen; Rörelseapparaten - klinik utvärdering av funktion och behandling.  

Per Wretenberg har varit handledare till följande doktorander

Huvudhandledare

Bihandledare

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

Per Wretenberg arrangerar ett flertal årliga kurser tillsammans med prof. Lars Weidenhielm.

Rörelseapparaten – utvärdering av funktion och behandling

Forskarutbildningskurs KI, Karolinska Institutet 15-10-12 – 16

Grundläggande proteskirurgi höft och knä

ST kurs för ortopeder, Skåvsjöholm 15-09-23 – 25, se vidare LIPUS

Höftprotes revision; teori och praktik

Kurs för specialister i ortopedi, Skåvsjöholm 15-04-15 – 15-04-17

Knee Replacment Academy

Avancerad knäprotes-kurs för specialister, Karolinska Sjukhuset  15-11-04 - 06

Publikationer

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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