Bone & Joint Open最新文献

{"title":"Good outcomes of bipolar radial head arthroplasty for comminuted radial head fractures : a cohort study of 64 patients with an average 5.2-year follow-up.","authors":"Saga Byman, Oskari Oikarinen, Mikko Salmela, Ville Haapamäki, Thomas Ibounig, Tuomas Lähdeoja","doi":"10.1302/2633-1462.66.BJO-2024-0202.R2","DOIUrl":"10.1302/2633-1462.66.BJO-2024-0202.R2","url":null,"abstract":"<p><strong>Aims: </strong>Radial head fractures are among the most common upper limb fractures, constituting up to 30% of all elbow fractures. While many can be managed non-surgically with favourable outcomes, approximately one-third require surgical intervention, typically involving open reduction and internal fixation or radial head arthroplasty. This study aimed to assess the functional and radiological outcomes of elbow injuries involving comminuted radial head fractures treated with bipolar radial head arthroplasty.</p><p><strong>Methods: </strong>We retrospectively analyzed 64 patients, of whom 55 participated in the follow-up, with acute radial head fractures who underwent radial head arthroplasty within two weeks of the injury between March 2009 and June 2015 at a tertiary trauma centre. The primary outcome measure was the Oxford Elbow Score (OES). Secondary outcomes were the short version of Disabilities of Arm, Shoulder and Hand questionnaire, the Mayo Elbow Performance Score, range of motion (ROM), subjective satisfaction, and radiological assessment.</p><p><strong>Results: </strong>In our study, patient-reported outcome measures indicated good function, minimal pain, and high subjective satisfaction scores. The mean total OES score was 88 (33 to 100; SD 17). In general, patients exhibited good ROM (128° extension-flexion arc), with only minor deficits compared to the unaffected side. Radiological findings commonly included osteolysis around the stem (29 out of 48 patients with available radiographs) and osteoarthritis of the elbow joint (mild in 23 out of 48 patients, severe in nine out of 48).</p><p><strong>Conclusion: </strong>Comminuted radial head fractures in elbow injuries involving a comminuted radial head fracture can be successfully treated with bipolar radial head arthroplasty. Although radiological changes are frequently observed during follow-up, they do not seem to impact clinical outcomes, and therefore should not be the primary indication for revision surgeries.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6","pages":"724-733"},"PeriodicalIF":2.8,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12173526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proximal humeral endoprosthetic reconstruction for tumour defects : clinical outcomes of 165 patients from the MUTARS Orthopedic Registry Orthopedic Registry Europe (MORE).","authors":"Richard Evenhuis, Michaël P A Bus, Simen Sellevold, Edwin F Dierselhuis, Ioannis G Trikoupis, Maurizio Scorianz, Sebastian Walter, Jorge Cabrolier, Marta Fiocco, Michiel A J van de Sande","doi":"10.1302/2633-1462.66.BJO-2025-0018","DOIUrl":"10.1302/2633-1462.66.BJO-2025-0018","url":null,"abstract":"<p><strong>Aims: </strong>Tumour defects of the proximal humerus can be reconstructed using hemiarthroplasty, reverse shoulder arthroplasty (RSA), or anatomical total shoulder arthroplasty (TSA). This study aimed to evaluate clinical and functional outcomes of reconstructions of proximal humeral tumour defects with MUTARS endoprostheses.</p><p><strong>Methods: </strong>A total of 165 reconstructions were included: 98 (59%) hemiarthroplasties, 61 (37%) RSAs, and six (4%) TSAs. Median age was 54 years (IQR 31 to 68). Median follow-up time was 5.9 years (IQR 2.83 to 10.50). Competing risks models were employed to estimate the cumulative incidence of revision (CIR) for mechanical reasons and infection with local recurrence and mortality as competing events. The range of motion was reported using descriptive statistics.</p><p><strong>Results: </strong>Axillary nerve preservation and deltoid muscle reattachment were observed in 89% and 96% of cases, respectively, without significant differences between implant types. Rotator cuff refixation was less frequent in RSA (78%) compared to hemiarthroplasty (91%). Overall, 26 implants (16%) were revised for mechanical complications (dislocation n = 11, loosening n = 2, periprosthetic fracture n = 3) and infection (n = 10). Patients with previous surgery at the same site had a higher revision risk due to instability (cause-specific hazard ratio 3.7; 95% CI 1.3 to 10.8). The CIRs for mechanical reasons (Henderson 1 to 3) in the entire population at two, five, and ten years were 7% (95% CI 3 to 11), 11% (95% CI 6 to 17), and 13% (95% CI 7 to 20), respectively. For periprosthetic joint infection (Henderson 4), the CIRs were 5% (95% CI 2 to 10), 7% (95% CI 3 to 12), and 7% (95% CI 3 to 12). Compared with hemiarthroplasty, RSA offered superior median anteflexion (73° (IQR 40 to 90) vs 30° (IQR 5 to 45)), abduction (70° (IQR 38 to 90) vs 30° (IQR 5 to 45)), and external rotation (15° (IQR 0 to 28) vs 5° (0 to 19)).</p><p><strong>Conclusion: </strong>MUTARS proximal humerus reconstruction outcomes are satisfying, particularly in terms of mechanical failure. RSA and hemiarthroplasty exhibit comparable revision risks, with previous surgery at same site as a prognostic factor for revision due to dislocation. RSA appears to provide the best functional outcome.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6","pages":"715-723"},"PeriodicalIF":2.8,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12167655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of early radiolucencies in cementless versus cemented total knee arthroplasty.","authors":"Vadim Benkovich, Artsiom Abialevich, Vladislav Osinsky, Guy Benkovich","doi":"10.1302/2633-1462.66.BJO-2024-0281.R1","DOIUrl":"10.1302/2633-1462.66.BJO-2024-0281.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to compare early outcomes of cemented and cementless total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>We analyzed 593 patients who underwent cemented or cementless TKA between January 2017 and December 2022. Data collected included demographics, BMI, comorbidities, surgical variables, follow-up duration, and outcomes such as implant survivorship, radiolucencies (assessed using the Modern Knee Society Radiographic Evaluation System (MKSRES)), short-term complications, revision rates, periprosthetic fractures, hospital length of stay, and readmissions.</p><p><strong>Results: </strong>The study included 593 patients, equally divided into cemented and cementless groups. Age (p = 0.354) and sex (p = 0.342) were similar, though BMI was higher in the cementless group (p < 0.001). Comorbidities were comparable. Radiolucencies and osteolysis occurred in 12 cemented and ten cementless cases, with no significant differences across femoral and tibial zones (p ≥ 0.479). All radiolucencies were stable, partial, and non-progressive. No cases of aseptic loosening required revision. Revisions for periprosthetic fractures were rare (p = 0.218). Hospital length of stay (p = 0.623) and readmissions (p = 0.216) were similar between groups. The mean follow-up time postoperatively was slightly longer in the cementless group (4.22 years (SD 0.84)) compared to the cemented group (4.01 years (SD 1.03)) (p < 0.001).</p><p><strong>Conclusion: </strong>Cemented fixation remains the gold standard in TKA due to its reliability, yet advancements in implant design and indications support increasing adoption of cementless TKA. This study found comparable early outcomes for both methods, with stable radiolucent lines and no aseptic loosening during follow-up. The MKSRES facilitates standard radiological assessment, enabling precise implant monitoring and improving TKA outcome evaluation. These findings support the equivalence of cemented and cementless fixation in early survivorship.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6","pages":"707-714"},"PeriodicalIF":2.8,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144294987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is it safe to use ceramic on polyethylene bearings in revision hip arthroplasty for ceramic fracture?","authors":"Christopher Gunn, Vivek Thakker, Sophie Williams, Timothy N Board, Henry Wynn-Jones, Jonathan Barrow","doi":"10.1302/2633-1462.66.BJO-2025-0030.R1","DOIUrl":"10.1302/2633-1462.66.BJO-2025-0030.R1","url":null,"abstract":"<p><strong>Aims: </strong>Ceramic bearing fracture is a rare complication following implantation using modern ceramic bearing materials. The ideal revision bearing option in such cases is debated. We aimed to investigate the safety of a hard on soft bearing following ceramic fracture in total hip arthroplasty.</p><p><strong>Methods: </strong>Data on all patients undergoing revision following ceramic fracture between January 2016 and January 2019 were collected retrospectively. Templating software was used to determine linear wear between the first post-revision radiograph and latest available follow-up. Univariate analysis was used to examine patient demographics and the wear rates of the polyethylene components. The intra- and inter-rater reliability of wear measurements was calculated. Additionally, in vitro testing was undertaken to assess the effects on bearing surfaces of residual ceramic particles.</p><p><strong>Results: </strong>A total of 12 patients underwent revision for ceramic fracture in the study period. The mean age at revision was 62 years (54 to 72). There were six liner and six head fractures revised to delta ceramic heads and cross-linked polyethylene acetabular components. At mean follow-up of 3.8 years (0.5 to 6.1), median 4.4 years (IQR 2.0 to 5.1), linear wear rate was calculated at 0.08 mm/year (SD 0.06). Both intra- and inter-rater reliability was excellent with intraclass correlation coefficient (ICC) scores of 0.99 at all timepoints. In vitro testing showed an increase in head roughness in metal on polyethylene bearings after ceramic particles were embedded, but no increase in ceramic on polyethylene (CoP) or ceramic on ceramic bearings.</p><p><strong>Conclusion: </strong>Revision to CoP bearings following ceramic fracture does not cause early catastrophic wear at early follow-up, aligning with the in vitro study observations. It appears safe to use this hard on soft bearing combination, given that wear rates are comparable to what is expected in a primary hip arthroplasty setting. Longer follow-up is required to establish if this trend persists.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6","pages":"700-706"},"PeriodicalIF":2.8,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12162154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revision of reverse shoulder arthroplasty by indication : a National Joint Registry study.","authors":"Olivia O'Malley, Andrew Davies, Mansour T A Sharabani, Amar Rangan, Sanjeeve Sabharwal, Peter Reilly","doi":"10.1302/2633-1462.66.BJO-2025-0017.R1","DOIUrl":"10.1302/2633-1462.66.BJO-2025-0017.R1","url":null,"abstract":"<p><strong>Aims: </strong>Reverse shoulder arthroplasty (RSA), initially designed for cuff tear arthropathy (CTA), is now the most common choice of shoulder arthroplasty in both elective and trauma settings in the UK. Its use has rapidly increased for several indications, including osteoarthritis (OA) with an intact rotator cuff, acute trauma, and trauma sequalae. This study aims to review the revision rates of RSA by indication to assess how the implant is performing for indications for which it was not primarily designed.</p><p><strong>Methods: </strong>Data from the National Joint Registry were obtained from 1 April 2012 to 31 March 2022. Data were linked to Hospital Episode Statistics for England and National Mortality Data. RSAs were identified and sorted into mutually exclusive groups by indication. The primary outcome was first revision and the secondary outcome was non-revision reoperation.</p><p><strong>Results: </strong>The revision rates for RSA for CTA were 1.53% (95% CI 1.31 to 1.78) at one year, 3.21% (95% CI 2.86 to 3.60) at five years, and 4.97% (95% CI 4.23 to 5.84) at nine years. For primary OA, they were 1.21% (95% CI 0.95 to 1.54) at one year, 2.71% (95% CI 2.25 to 3.37) at five years, and 5.00% (95% CI 3.62 to 6.88) at nine years. For trauma, they were 1.51% (95% CI 1.15 to 1.99) at one year and 2.67% (95% CI 2.07 to 3.43) at five years. For trauma sequalae, they were 4.25% (95% CI 3.4 to 5.29) at one year and 7.12% (95% CI 5.90 to 8.59) at five years. Between indications, the revision rates were not statistically different except for trauma sequalae, which had a significantly increased risk of revision (p ≤ 0.001). Incidence of non-revision reoperation across the cohort was 1.1% (n = 283 patients), with the most common being manipulation under anaesthesia with or without capsular release (42.03%, n = 124) followed by subacromial decompression (21.02%, n = 62).</p><p><strong>Conclusion: </strong>This study reports on the range of indications for which RSA is being used in the UK. It demonstrated that, based on the largest analysis of RSA across a range of indications, the revision rates and secondary surgery rates are broadly similar except for trauma sequalae.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6","pages":"691-699"},"PeriodicalIF":2.8,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12158565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of weaning in brace treatment for developmental dysplasia of the hip : time to define best practice?","authors":"Joanna Craven, Ioan Davies, Daniel C Perry","doi":"10.1302/2633-1462.66.BJO-2025-0053.R1","DOIUrl":"10.1302/2633-1462.66.BJO-2025-0053.R1","url":null,"abstract":"<p><strong>Aims: </strong>In infants aged under six months with developmental dysplasia of the hip (DDH), the use of a removable brace is considered the gold-standard treatment. However, considerable variation exists for brace removal after 'successful' treatment. Some clinicians support immediate cessation, while others prefer weaning of the brace. This study aimed to explore clinicians' understanding of weaning, and to identify current practices and the rationale behind different approaches, in order to inform the design of a future randomized controlled trial (RCT).</p><p><strong>Methods: </strong>A survey was developed using Google Forms and disseminated via professional networks, social media, and the British Society of Children's Orthopaedic Surgery mailing list. It targeted clinicians involved in DDH care, gathering information on demographics, treatment protocols, criteria for removal, and weaning practices. Quantitative and qualitative data were analyzed to identify patterns and variability.</p><p><strong>Results: </strong>In total, 139 clinicians from 25 countries responded, with 50% from the UK. Most respondents (87.8%) followed a protocol for brace treatment, with considerable variation in definition and implementation of weaning. 'Weaning' was most commonly defined as a gradual reduction in brace wear over time (n = 103, 74.1%). Overall, 47.4% of respondents (n = 65) reported never weaning, 39.4% (n = 54) always wean, and 13.1% (n = 18) varied their approach. Among clinicians who always wean, the most common approach involved gradually reducing the hours per day over several weeks (n = 28, 51.9%). However, for those who sometimes wean, the most frequent practice was night-time only wear (n = 8, 44.4%). Durations of weaning differed, although the majority of clinicians reported weaning periods from two to six weeks. There is broad support for a future RCT, with 75.9% (n = 105) expressing a willingness to participate.</p><p><strong>Conclusion: </strong>This survey highlights considerable variability in weaning practices for brace treatment in DDH, and underscores the need for standardized terminology and protocols. These findings provide a foundation for designing a RCT to evaluate weaning compared with immediate brace cessation, ultimately informing evidence-based guidelines.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6","pages":"685-690"},"PeriodicalIF":2.8,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a multicentre cohort study to understand the role of MRI and ultrasound in the diagnosis of acute haematogenous bone and joint infection in children (the PIC Bone study) : a study protocol.","authors":"Marie-Caroline Nogaro, Stuart Hartshorn, Mariea Brady, Amaka Offiah, Saul Faust, Gregory Firth, Jie Ma, Paula Dhiman, Joanna O'Mahoney, Loretta Davies, Catherine Spowart, Amy Moscrop, Bridget Young, Catrin Tudur-Smith, Gary Collins, Daniel C Perry, Tim Theologis","doi":"10.1302/2633-1462.66.BJO-2024-0277","DOIUrl":"10.1302/2633-1462.66.BJO-2024-0277","url":null,"abstract":"<p><strong>Aims: </strong>Bone and joint infections (BJI) in children are rare but can be serious. Differentiating BJI from other conditions with similar symptoms is critical. Advanced imaging (ultrasound scans (USS) and MRI) is often required to confirm the diagnosis. The differing merits of imaging type and regional variation in access to advanced imaging can lead to diagnostic uncertainty and treatment variation. The aim of this study is to evaluate the diagnostic accuracy of MRI and USS for the investigation of BJI in children, and develop and validate prediction models to aid the diagnosis of BJI in children. A nested qualitative sub-study will explore acceptability of the imaging to children, parents, and health practitioners.</p><p><strong>Methods: </strong>A multicentre retrospective cohort of children (aged < 16 years) with suspected diagnosis of BJI will be used to estimate the diagnostic accuracy of the two imaging methods and develop the prediction models. The models will be evaluated in a second cohort of prospectively recruited children. Diagnostic test accuracy will be estimated overall, and separately for children aged under and over five years. The prediction models will be fit using logistic regression, with candidate predictors chosen based on clinical plausibility and from a review of the literature. Continuous predictors will be examined for non-linearity with confirmed BJI using fractional polynomials. Multiple imputation will be used to replace missing values. Internal validation will be carried out using bootstrapping. Model performance will be assessed with discrimination and calibration.</p><p><strong>Discussion: </strong>Ethical approval for this study (registration: ISRCTN15471635) was granted (REC reference 23/WM/0027). Informed consent is being obtained from participants in the prospective cohort and the qualitative sub-study. Study findings will be published in an open access journal and presented at relevant national and international conferences. Relevant charities and associations are being engaged to promote awareness of the project.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6","pages":"677-684"},"PeriodicalIF":2.8,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12148504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of preoperative nutritional impairment on physical function early after total hip arthroplasty.","authors":"Tsutomu Fujita, Satoshi Hamai, Toshimi Konishi, Kazuya Okazawa, Yuki Nasu, Daisuke Hara, Shinya Kawahara, Ryosuke Yamaguchi, Taishi Sato, Ken Utsunomiya, Goro Motomura, Kenichi Kawaguchi, Yasuharu Nakashima","doi":"10.1302/2633-1462.66.BJO-2024-0261.R1","DOIUrl":"10.1302/2633-1462.66.BJO-2024-0261.R1","url":null,"abstract":"<p><strong>Aims: </strong>To investigate whether preoperative nutritional status, assessed by the Geriatric Nutritional Risk Index (GNRI), predicts postoperative physical function following total hip arthroplasty (THA).</p><p><strong>Methods: </strong>A total of 681 patients (87 males, 594 females; mean age 65.3 years (SD 10.2)) who underwent unilateral primary THA for hip osteoarthritis were included. GNRI was calculated from preoperative serum albumin levels, categorizing patients into three groups: normal nutrition (GNRI ≥ 98), moderate malnutrition (92 ≤ GNRI < 98), and severe malnutrition (GNRI < 92). Physical function, including hip joint range of motion, muscle strength (hip abduction, knee extension), leg length difference, and comfortable walking speed, was assessed preoperatively and at discharge. Group comparisons were made based on GNRI scores, and a multiple regression analysis was conducted using preoperative muscle strength ratio and postoperative comfortable walking speed as outcome variables. Receiver operating characteristic curves determined a preoperative GNRI cut-off value for achieving a postoperative comfortable walking speed of 0.8 m/s.</p><p><strong>Results: </strong>The moderate and severe malnutrition comprised 68 (10%) and 19 (3%) patients with GNRI: 92 ≤ GNRI < 98 and < 92, respectively, whereas 594 (87%) were in the normal nutrition (GNRI ≥ 98). Patients with malnutrition demonstrated significantly lower preoperative muscle strength and pre- and postoperative muscle strength ratios (p < 0.001). Preoperative GNRI was a significant predictor of hip abductor muscle strength (p = 0.031) and postoperative comfortable walking speed (p < 0.001). The determined preoperative GNRI cut-off score for achieving a postoperative comfortable walking speed of 0.8 m/s was 98.</p><p><strong>Conclusion: </strong>Preoperative GNRI serves as a valuable indicator for improving postoperative muscle strength and comfortable walking speed.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6","pages":"667-676"},"PeriodicalIF":2.8,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness analysis of robotic-arm assisted versus manual total knee arthroplasty in the UK.","authors":"Gurdeep S Sagoo, Nick D Clement, Yaneth Gil-Rojas, Nawaraj Bhattarai, Steven Galloway, Jenny B Baron, Karen Smith, David J Weir, David J Deehan","doi":"10.1302/2633-1462.66.BJO-2024-0274","DOIUrl":"10.1302/2633-1462.66.BJO-2024-0274","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to estimate the additional cost per quality-adjusted life-year (QALY) of robotic-assisted total knee arthroplasty (rTKA) compared to manually performed total knee arthroplasty (mTKA).</p><p><strong>Methods: </strong>An economic evaluation was undertaken from the UK NHS and personal social services perspective, alongside a randomized controlled trial comparing rTKA and mTKA. Costs were estimated individually using a top-down approach and included all healthcare resources incurred during the trial. Costs were presented in 2021 GBP sterling (£). Responses to the EuroQol five-dimension three-level questionnaire were used to estimate QALYs for each participant. The incremental cost-effectiveness ratio (ICER) was evaluated against the current willingness-to-pay threshold recommended by the National Institute for Health and Care Excellence. Stochastic sensitivity analysis was performed using bootstrapping techniques, and results were shown through the cost-effectiveness acceptability curve and cost-effectiveness plane. Cost-effectiveness over one- and ten-year time horizons were explored using a decision model.</p><p><strong>Results: </strong>There were 100 participants randomized: 50 rTKA and 50 mTKA. Overall, 37 participants (39.4%) had some missing data on either costs or utilities, or on both. Multiple imputation was used for the base case results. The intervention was associated with incremental mean per-patient costs of £1,829 (95% CI 421 to 3,238) and an incremental QALY gain of 0.015 (95% CI -0.05 to 0.0796) at one year. The ICER at one year was £123,770. However, rTKA was likely to be cost-effective over a ten-year time horizon, with an ICER of £11,109. All except one of the scenarios (QALY gain reduction to 0.005) explored supported the cost-effectiveness of rTKA over a ten-year time horizon with an ICER below a £20,000 threshold.</p><p><strong>Conclusion: </strong>Over a short one-year time horizon, rTKA was not a cost-effective procedure compared to mTKA. However, when results were extrapolated out to a ten-year time horizon, which would need to be confirmed in future research, rTKA was likely to be cost-effective.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6","pages":"658-666"},"PeriodicalIF":2.8,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12143939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional pelvic tilt frequently differs from the anterior pelvic plane in non-arthritic hip disorders : implications for 3D motion analysis.","authors":"Mark R J Jenkinson, Calvin Cheung, Alastair G Dick, Johan Witt, Jonathan Hutt","doi":"10.1302/2633-1462.66.BJO-2024-0265.R1","DOIUrl":"10.1302/2633-1462.66.BJO-2024-0265.R1","url":null,"abstract":"<p><strong>Aims: </strong>Hip preservation surgeons are increasingly using commercially available 3D motion analysis software to investigate areas of impingement and quantify femoral head coverage. Variations in functional pelvic tilt will affect the position of the acetabular rim and projected femoral head coverage, but currently the majority of available software standardizes sagittal rotation to the anterior pelvic plane (APP). The study hypothesis was that the APP does not correlate well with patient-specific pelvic position.</p><p><strong>Methods: </strong>In total, 60 patients were selected from an institutional database: 20 with acetabular retroversion (AR), 20 with developmental dysplasia of the hip (DDH), and 20 with cam-type femoroacetabular impingement (FAI). Multiplanar CT reformats were created and the sagittal rotation was aligned to the APP. The sagittal pelvic orientation was then corrected until the anteroposterior (AP) projection mirrored that of their preoperative supine and standing plain radiographs. The change in sagittal pelvic tilt angle required was measured.</p><p><strong>Results: </strong>The mean deviation from the APP in the AR group was 11.55° (SD 4.96°) for supine radiographs and 3.28° (SD 8.66°) for standing radiographs. The mean deviation from the APP in the DDH group was 12.2° (SD 4.26°) for supine radiographs and 6.96° (SD 3.43°) for standing radiographs. The main deviation from the APP in the FAI group was 8.63° (SD 5.21°) for supine radiographs and -1.28° (SD 7.31°) for standing.</p><p><strong>Conclusion: </strong>There is a wide variation in patients' functional pelvic positioning in both supine and standing radiographs, in all different subgroups, which rarely correlates with the APP. Commercial 3D motion analysis may therefore give misleading results for both the extent and location of hip impingement as well as femoral head coverage, which may affect surgical decision-making. Consideration should be given to incorporating this into the software algorithms.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6","pages":"651-657"},"PeriodicalIF":2.8,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}