Bone & Joint Open最新文献

{"title":"Young Hip: an exploration into young patients' (aged < 50 years) expectations following primary total hip arthroplasty : a qualitative study.","authors":"Louise E Mew, Vanessa Heaslip, Tikki Immins, Thomas W Wainwright","doi":"10.1302/2633-1462.67.BJO-2025-0013.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.67.BJO-2025-0013.R1","url":null,"abstract":"<p><strong>Aims: </strong>Total hip arthroplasties (THAs) are common operations performed in orthopaedics. Though initially developed to address hip conditions in older patients, demand in younger patients is increasing. Research in older populations informs current practice, and it is unclear if outcome priorities are the same in younger patients. The study's aim was to explore the expectations and priorities of younger patients' (aged < 50 years) undergoing THA.</p><p><strong>Methods: </strong>Using interpretive phenomenological analysis (IPA) methodology, ten patients were recruited from one UK hospital. Semistructured interviews occurred at three timepoints (pre-surgery, six weeks, and six months post-surgery). This study has been reported using the COnsolidated criteria for REporting Qualitative research (COREQ).</p><p><strong>Results: </strong>Six themes were identified: 'I'm just constantly in pain', 'Giving up hope', 'Living a process that does not reflect me', 'This is not who I'm meant to be', 'My family didn't sign up for this', and 'I can't do anything'. Some themes were independent of patient age, such as pain, and experiences of healthcare. However, other findings may be more imperative to the younger patient than the older patient.</p><p><strong>Conclusion: </strong>The Young Hip study highlighted aspects currently overlooked in younger THA patients. Participants were aware that they were not the accepted patient profile for THA, and expressed having to fight to be heard. Function was considered in terms of responsibilities and roles in society, rather than traditional clinical perceptions of mobility. The findings demonstrated that current care pathways are not fully addressing the needs of younger THA patients. Further development of a personalized THA pathway, allowing for more focus on person-centred care, could address issues raised by this study, more effectively supporting younger patients.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 7","pages":"807-815"},"PeriodicalIF":2.8,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From theory to practice: insights into intervention development of the NON-STOP app for children with Perthes' disease.","authors":"Adam M Galloway, Anna M Anderson, Emma Casimir, Colin Holton, David J Keene, Anthony C Redmond, Heidi J Siddle, Suzanne Richards, Daniel C Perry","doi":"10.1302/2633-1462.67.BJO-2025-0082","DOIUrl":"https://doi.org/10.1302/2633-1462.67.BJO-2025-0082","url":null,"abstract":"<p><p>The development of interventions in healthcare often lacks a robust theoretical basis, which may contribute to suboptimal engagement and effectiveness. This paper provides insights into and practical guidance on the development of complex interventions in healthcare, using the example of a digital self-management tool for children with Perthes' disease, called the Non-Surgical Treatment of Perthes' (NON-STOP) app. We applied the Medical Research Council framework, used psychological theory, and integrated stakeholder engagement to develop the intervention. The lessons learned and considerations for the developments of other complex interventions provide practical actions for clinicians and researchers in orthopaedics.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 7","pages":"822-827"},"PeriodicalIF":2.8,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of the hexapod frame in 111 'high risk' tibial fractures.","authors":"Jonathan France, Adam Tucker, Jessica Nightingale, Andrew Taylor, Simon Craxford, Benjamin Ollivere","doi":"10.1302/2633-1462.67.BJO-2025-0023.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.67.BJO-2025-0023.R1","url":null,"abstract":"<p><strong>Aims: </strong>The use of circular frames in the management of tibia fractures and deformity correction is well established in the literature. The Taylor Spatial Frame (TSF) is the most widely used hexapod device globally. However, the majority of published papers are small in patient numbers, contain primary and revision cases, and outcomes are therefore unclear. In this study we evaluate the clinical and radiological outcomes of patients with tibial fractures treated primarily with a TSF.</p><p><strong>Methods: </strong>Patients were identified from a prospective trauma database at a UK major trauma centre. An analysis of patient records and radiographs was performed for the study. Patient demographics, comorbidities, frame construct, time in frame, union rates, and complications of treatment were analyzed.</p><p><strong>Results: </strong>Between September 2009 and January 2020, 111 patients with tibial fractures managed primarily with a TSF were included. The majority of patients (86, 77.5%) sustained fractures to the tibial shaft, leaving nine plateau (8.1%) and 16 pilon fractures (14.4%). Of these, 55 (49.6%) were open and 56 (50.4%) were closed. Of the open fractures, seven were classified as Gustilo and Anderson grade 3A and 41 (74.5%) were classified as grade 3B. The overall union rate for primary TSF was 85%, with a mean time to union of 191 days (SD 90). A total of 15 patients (13.5%) required either open reduction and internal fixation (n = 6, 5.4%) or intramedullary nail (n = 9, 8.2%) to achieve bony union. Five patients (4.5%) developed a deep infection requiring invasive treatment. Two patients (1.8%) required an eventual amputation for an infected nonunion; both of these patients sustained an initially closed fracture. Overall limb salvage at two years was 98.2%.</p><p><strong>Conclusion: </strong>The TSF remains an established option in the surgical management of patients with complex injuries to the tibia, with good rates of limb salvage within this challenging patient subgroup.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 7","pages":"816-821"},"PeriodicalIF":2.8,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of indocyanine green fluorescence-based near-infrared angiography in assessing intraoperative wound perfusion for bone and soft-tissue surgery.","authors":"Han Wang, Xiaodong Tang, Tao Ji, Dasen Li, Huayi Qu, Zhiye Du, Wei Guo","doi":"10.1302/2633-1462.67.BJO-2024-0248.R1","DOIUrl":"10.1302/2633-1462.67.BJO-2024-0248.R1","url":null,"abstract":"<p><strong>Aims: </strong>Wound complication is common in bone and soft-tissue tumour surgery. Proper wound healing requires robust blood perfusion. However, intraoperative assessment of perfusion is difficult, and lacks methods with good accuracy. This study aimed to explore the efficacy of indocyanine green fluorescence angiography (ICGA) in intraoperatively assessing wound perfusion and predicting postoperative wound necrosis and clinical outcomes.</p><p><strong>Methods: </strong>A total of 22 patients with orthopaedic oncological diseases were enrolled in this study from August 2021 to December 2022. All patients were deemed to have high risk of postoperative necrosis but normal wound appearance during surgery. ICGA was performed intraoperatively to assess the perfusion status of the wound. A novel system, called the Fluorescence Perfusion Scale (FPS), was proposed, consisting of three types of fluorescence angiography features corresponding to different perfusion statuses. Patient- and provider-related risk factors were analyzed. The relationship between clinical outcomes and FPS types was analyzed.</p><p><strong>Results: </strong>Wound necrosis occurred in ten of 22 patients (46%). According to the FPS, seven patients (32%) showed type 1, seven patients (32%) showed type 2, and eight patients (36%) showed type 3 angiography, respectively. The uni- and multivariate analysis indicated that FPS type 1 or 2 is the only independent risk factor for wound necrosis. The necrosis rate showed a significant difference between FPS types (p＜0.001). The rate of reoperation of patients of type 1 was significantly higher than that of type 2 (85% compared 0%, p = 0.005).</p><p><strong>Conclusion: </strong>Wound perfusion in bone and soft-tissue surgery can be assessed by ICGA and graded by the FPS system, which can predict postoperative necrosis and clinical outcomes.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 7","pages":"796-806"},"PeriodicalIF":2.8,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12246870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609798","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":"Does weightbearing status impact mortality and other complications in hip fracture patients when accounting for frailty?","authors":"Makoa Mau, Tyler Thorne, Kai Rossbach, Eleanor H Sato, Chong Zhang, Angela P Presson, Justin M Haller","doi":"10.1302/2633-1462.67.BJO-2025-0059.R1","DOIUrl":"10.1302/2633-1462.67.BJO-2025-0059.R1","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to analyze the risk of mortality and other postoperative complications following restricted weightbearing in geriatric patients who undergo fixation of a hip fracture, while accurately controlling for patient frailty.</p><p><strong>Methods: </strong>The National Surgical Quality Improvement Program (NSQIP) database January 2016 to December 2020 was queried for operatively treated hip fractures in patients aged ≥ 60 years using Current Procedural Terminology (CPT) codes (n = 53,959). Logistic regressions and receiver operating characteristic (ROC) curve analysis were conducted to determine the frailty measure which best predicts 30-day mortality among American Society of Anesthesiologists grade (ASA), five-factor modified Fraility Index (mFI-5), and Risk Analysis Index Recalibrated Version (RAI-Rev). The effect of weightbearing on 30-day mortality, and severe (SAE) and minor (MAE) adverse events, was assessed using logistic regressions while controlling for the selected frailty measure and other relevant patient characteristics.</p><p><strong>Results: </strong>A total of 53,959 patients met the inclusion criteria, and 36,177 patients (67%) were weightbearing as tolerated postoperatively. Under ROC curve, the only discriminatory performance was by RAI-Rev in 30-day mortality. Controlling for RAI-Rev, age, sex, BMI, functional status, and CPT, weightbearing patients had a 42% lower odds of 30-day mortality (p < 0.001), a 31% lower odds of a SAE (p < 0.001), and a 24% lower odds of a MAE (p < 0.001) in comparison to non-weightbearing patients.</p><p><strong>Conclusion: </strong>Geriatric hip fractures are prevalent in patients with varying degrees of health. RAI-Rev is a better predictor of postoperative mortality than ASA grade and mFI-5, and should be used in evaluating the risk of geriatric hip fractures. Postoperative weightbearing is associated with significant reductions in complications for geriatric hip fracture patients, even while controlling for frailty. Our findings suggest that postoperative weightbearing after surgical fixation of geriatric hip fractures should be encouraged for able patients.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 7","pages":"785-795"},"PeriodicalIF":2.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12235488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585060","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":"Progressive resistance and flexibility exercises versus usual care advice for improving pain and function after distal radius fracture in adults aged 50 years or over : protocol for the WISE randomized superiority trial.","authors":"David J Keene, Juul Achten, Ioana Marian, Marloes Franssen, Elizabeth Tutton, Warren Sheehan, Colin Forde, Hannah Crook, Jenny Gould, Richard Grant, Duncan Appelbe, Sarah E Lamb, Matthew L Costa","doi":"10.1302/2633-1462.67.BJO-2024-0227","DOIUrl":"10.1302/2633-1462.67.BJO-2024-0227","url":null,"abstract":"<p><strong>Aims: </strong>Distal radius fractures are very common injuries; the majority affect females aged 50 years or over. Most patients experience pain and stiffness in their wrist and upper limb weakness, making activities of daily living difficult. The aim of the WISE (Wrist Injury Strengthening Exercise) trial is to assess the effectiveness of a flexibility and resistance exercise programme for the upper limb compared with usual care advice after distal radius fracture.</p><p><strong>Methods: </strong>This is a multicentre, parallel-group, superiority, individually randomized controlled trial. We aim to recruit 588 participants aged 50 years and older with a distal radius fracture treated surgically or non-surgically from at least 15 UK NHS hospitals. Participants will be randomized 1:1 using a web-based service to usual care advice plus a therapist-supervised exercise programme (three one-to-one therapy sessions of tailored advice and prescribed home exercise over 12 weeks) or usual care advice only. The primary outcome is participant-reported wrist-related pain and function six months after randomization, measured by the Patient-Rated Wrist Evaluation. Secondary outcomes at three and six months measure health-related quality of life, pain, physical function, self-efficacy, exercise adherence, grip strength, complications, and resource use.</p><p><strong>Conclusion: </strong>This study will assess whether a therapist-supervised exercise programme is more clinically effective than usual care advice for people aged 50 years and older after distal radius fracture. At the time of submission, the trial is currently completing recruitment; follow-up will be completed in 2025 (ISRCTN registry identifier: ISRCTN78953418).</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 7","pages":"764-784"},"PeriodicalIF":2.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12235327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585061","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":"Catastrophism and anxiety are risk factors of chronic pain after total knee arthroplasty : a prospective cohort study.","authors":"Clara Croppi, Fanny Delaigue, Violaine Guinebertière, Flore Devriese, Pascal Bizot, Jules Descamps, Rémy Nizard, Pierre-Alban Bouché","doi":"10.1302/2633-1462.67.BJO-2024-0270.R1","DOIUrl":"10.1302/2633-1462.67.BJO-2024-0270.R1","url":null,"abstract":"<p><strong>Aims: </strong>After a total knee arthroplasty (TKA), up to 40% of patients suffer from chronic pain. Few studies have focused specifically on psychosocial factors as predictors of chronic pain after TKA. Our study aims to identify psychosocial risk factors of chronic pain after TKA and to identify an optimal threshold for significant scores in the multivariate analysis, using a receiver operating characteristic (ROC) curve.</p><p><strong>Methods: </strong>This was a single-centre prospective study conducted from September 2022 to September 2023, involving 204 patients. The mean age was 70 years (SD 8.59), the mean BMI was 30.49 kg/m² (SD 5.29), and 70.60% of patients were female (144/204). A form was administered before surgery to collect: Hospital Anxiety and Depression Scale (HADS), anxiety scale State-Trait Anxiety Inventory (STAI)-Y, Amsterdam Preoperative Anxiety and Information Scale (APAIS), Pain Catastrophizing Scale (PCS), and visual analogue scale (VAS). Univariate and multivariate logistic regression was used to determine the risk factors associated with chronic pain. To determine a threshold in the psychological scores associated with chronic pain, ROC curves were performed.</p><p><strong>Results: </strong>A total of 36 patients (17.60%) met the definition of chronic pain, defined as VAS ≥ 4/10 at six months postoperatively. In the multivariate analysis, to be an employee or worker (<i>β</i> = 1.10, 95% CI 0.20 to 2.10, p = 0.018), anxiety STAI-YB (<i>β</i> = 0.03, 95% CI 0.01 to 0.06, p = 0.013), and catastrophism PCS (<i>β</i> = 0.04, 95% CI 0.02 to 0.06, p < 0.001) were associated with chronic pain after TKA. Using ROC analysis, we identified a threshold value of 44.5 for anxiety STAI-YB (sensitivity 57.58%, specificity 74.51%) and of 21.5 for catastrophism PCS (sensitivity 56,25 %, specificity 71.90%) of developing chronic pain after TKA.</p><p><strong>Conclusion: </strong>This study shows that the psychosocial profile of patients can be linked to the occurrence of chronic pain, and underlines the importance of a multidimensional approach to patient assessment and management.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 7","pages":"755-763"},"PeriodicalIF":2.8,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12226953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585059","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 pubic cut position on pubic root displacement in periacetabular osteotomy : a 3D CT simulation study.","authors":"Sufian S Ahmad, Gaia Giudici, Justus Stamp, Quentin Karisch, Henning Windhagen, Marco Haertlé","doi":"10.1302/2633-1462.67.BJO-2024-0223.R1","DOIUrl":"10.1302/2633-1462.67.BJO-2024-0223.R1","url":null,"abstract":"<p><strong>Aims: </strong>Periacetabular osteotomy (PAO) has become widely recognized as the gold standard for the correction of acetabular pathomorphologies. However, the pubic cut has raised concerns due to complications such as delayed union and its association with anterior hip syndrome. The aim of this study was to examine the impact of the position of the pubic cut on the displacement of the pubic root during PAO surgery.</p><p><strong>Methods: </strong>The study included thin-sliced CT scans of 58 hips with symptomatic hip dysplasia. Overall, 3D simulations of PAO were performed in triplicate, incorporating three variations of the pubic cut, specifically positioned 5, 10, or 15 mm medial to the iliopectineal eminence. Full displacement of the pubic osteotomy was noted by two independent investigators. Analysis of variance was used for comparison between means. Logistic regression was used to determine factors influencing displacement of the pubic root.</p><p><strong>Results: </strong>The incidence of complete pubic bone displacement increased with the medial position of the cut, with rates of 17.24% for a 5 mm cut, 36.21% for a 10 mm cut, and the highest at 82.76% for a 15 mm cut medial to the iliopectineal eminence (p < 0.001). The odds of complete displacement were reduced ten-fold with a lateral 5 mm pubic cut (odds ratio 0.1, 95% CI 0.04 to 0.20, p < 0.001).</p><p><strong>Conclusion: </strong>The position of the pubic cut is the most significant determinant of pubic root displacement in PAO surgery. Loss of contact at the pubic osteotomy is likely associated with delayed union and postoperative anterior hip syndrome. Choosing a lateral pubic cut positioned 5 mm medial to the iliopectineal eminence is expected to result in a ten-fold reduction in the risk of complete pubic bone displacement. Appreciating the results of this study when performing the pubic cut may help mitigate the risk of post-PAO anterior hip syndrome.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 7","pages":"748-754"},"PeriodicalIF":2.8,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12221529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555180","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":"A systematic review of evidence regarding the association between time to mobilization following hip fracture surgery and patient outcomes.","authors":"Veena Mazarello Paes, Andrew Ting, James Masters, Mahalia V I Paes, Simon Mathew Graham, Matthew L Costa","doi":"10.1302/2633-1462.67.BJO-2024-0243.R1","DOIUrl":"10.1302/2633-1462.67.BJO-2024-0243.R1","url":null,"abstract":"<p><strong>Aims: </strong>Performance indicators are increasingly used to evaluate the quality of healthcare provided to patients following a hip fracture. In this systematic review, we investigated the association between 'early mobilization' after surgery and patient outcomes.</p><p><strong>Methods: </strong>Evidence was searched through 12 electronic databases and other sources. The methodological quality of studies meeting the inclusion criteria was assessed. The protocol for this suite of related systematic reviews was registered at PROSPERO: ID = CRD42023417515.</p><p><strong>Results: </strong>A total of 24,507 articles were reviewed, and 20 studies met the inclusion criteria for the review, involving a total of 317,173 patients aged over 60 years with a hip fracture. There were two randomized clinical trials, five prospective studies, and 13 retrospective cohort studies, conducted between January 1981 and June 2022. All but two studies came from high-income healthcare systems. The definition of early mobilization varied across studies and health systems; and weightbearing status was often not reported or ambiguously defined, making formal meta-analysis of the data impossible. Early mobilization (within 48 hours of surgery) was associated with improved outcomes in 29 of the 33 patient-reported outcomes, including improved mobility scores and improved assessments of daily activities of living. A total of 45 out of 51 clinical outcomes derived from hospital records showed a positive association with early mobilization, including reduced rates of postoperative complications, reduced length of acute hospital stay, and lower mortality.</p><p><strong>Conclusion: </strong>Early mobilization after surgery for hip fracture in older people is associated with improved patient-reported outcomes and reduced length of hospital stay. Standardization of the definition of early mobilization and consistent reporting of weightbearing status would improve future evidence synthesis.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 7","pages":"741-747"},"PeriodicalIF":2.8,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12221528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555179","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":"Staging growing rod insertion results in increased postoperative complications than the equivalent unstaged procedure.","authors":"Lily S Switzer, Emma B Nadler, Jennifer A Dermott, Karim Aboelmagd, Alison Anthony, Dorothy J Kim, Mark Camp, David E Lebel","doi":"10.1302/2633-1462.67.BJO-2025-0047.R1","DOIUrl":"10.1302/2633-1462.67.BJO-2025-0047.R1","url":null,"abstract":"<p><strong>Aims: </strong>Anchor-related complications are the leading cause for unplanned surgery in early-onset scoliosis (EOS). One strategy to reduce unplanned surgery is staging implant insertion. This study compares the outcomes of staged versus unstaged growing rod (GR) insertion, focusing on complication rates.</p><p><strong>Methods: </strong>This retrospective cohort study examined 48 EOS patients who received GR surgery at a single institution (Hospital for Sick Children, Toronto, Canada) between January 2006 and July 2023. Patients were grouped according to staged and unstaged GR insertion. Radiological measurements were obtained preoperatively, post-insertion, and one-year follow-up to determine radiological change between and within each group. Complications were recorded until posterior spinal fusion (PSF) or most recent follow-up if no PSF was performed, and compared between groups.</p><p><strong>Results: </strong>Overall, 24 patients received staged and 24 patients received unstaged dual GR insertion. The mean follow-up time for patients was 53.1 months (SD 33.1). Patients who underwent unstaged insertion had greater Cobb angle correction (46.6% (SD 15.9%) vs 31.5% (SD 13.3%), p < 0.001). There were no significant differences in kyphosis correction (p = 0.118) or thoracic height growth (p = 0.348) between groups. Staged patients experienced a higher complication rate compared to unstaged patients within the first year following insertion (38% vs 12%). Differences in proximal junctional kyphosis (PJK) development between staged (17%) and unstaged (29%) patients were not significant (p = 0.303). The mean insertion-associated length of stay was longer in staged patients (10.7 days (SD 4.2)) compared to unstaged patients (5.8 days (SD 4.0), p < 0.001).</p><p><strong>Conclusion: </strong>Staged and unstaged GR insertion results in acceptable coronal correction and comparable radiological parameters. However, staged insertion may not be superior to unstaged insertion given the increased length of stay and rate of complications associated with the procedure.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 7","pages":"733-740"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529964","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}