Bone & Joint Open最新文献

{"title":"Adverse events in paediatric spinal deformity surgery - 12-year review of specialist spinal deformity practice.","authors":"Edward J Bayley, Shreya Srinivas, Matthew Bellamy, Adya Ranjan, Dominic M Luttrell, Michael Athanassacopoulos, Anthony L R Michael, Lee M Breakwell, Ashley A Cole","doi":"10.1302/2633-1462.710.BJO-2026-0057.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.710.BJO-2026-0057.R1","url":null,"abstract":"<p><strong>Aims: </strong>Adverse events following paediatric spinal deformity surgery in the UK suffers from significant reporting gaps, as current data relies predominantly on voluntary incident submissions. This retrospective study aims to comprehensively assess the incidence of all surgical adverse events at a specialized paediatric spinal orthopaedic centre.</p><p><strong>Methods: </strong>A retrospective review of prospectively collected data from January 2010 to December 2022 systematically evaluated perioperative and postoperative adverse events. Patients were analyzed by scoliosis aetiology and adverse events were stratified according to the Clavien-Dindo classification system. Adverse events were further grouped by common themes including implant-related, infection-related, and neurological events.</p><p><strong>Results: </strong>A total of 871 paediatric spinal deformity patients undergoing 1,020 operations with at least two years follow-up were identified. Adolescent idiopathic scoliosis was the most common primary pathology with 545 patients (62.6%). Overall, 324 patients (37.2%) experienced an adverse event. Adverse events were categorized by severity: 14.8% grade 1, 5.3% grade 2, 1.1% grade 3A, 14.6% grade 3B, 1.1% grade 4, and 0.1% grade 5. Implant-related issues were most frequent (n = 113, 13.0%), followed by curve progression (n = 33, 3.8%) and persistent pain (n = 33, 3.8%). Neurological events included four complete cord injuries (0.5%) and four incomplete cord injuries which fully recovered (0.5%). One perioperative death occurred.</p><p><strong>Conclusion: </strong>In this cohort of paediatric spinal deformity surgeries, over one-third of patients experienced adverse events, predominantly of low severity requiring minimal or no further intervention. Implant-related adverse events were most frequent, while the incidence of both complete and incomplete spinal cord injury, as well as mortality, remained reassuringly low across all procedures.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 10","pages":"1365-1374"},"PeriodicalIF":3.3,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228797","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":"Development of a therapist-supervised flexibility and resistance exercise intervention for adults aged 50 years and over with a distal radius fracture in the Wrist Injury Strengthening Exercise (WISE) trial.","authors":"Warren Sheehan, Sarah E Lamb, Colin P Forde, Cynthia Srikesavan, Phillipa J A Nicolson, Elizabeth Tutton, Jenny Gould, Richard Grant, Juul Achten, Duncan Appelbe, Matthew L Costa, David J Keene","doi":"10.1302/2633-1462.710.BJO-2026-0101.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.710.BJO-2026-0101.R1","url":null,"abstract":"<p><strong>Aims: </strong>The definitive Wrist Injury Strengthening Exercise (WISE) trial is a multicentre superiority randomized controlled trial (RCT) evaluating usual care advice plus a therapist-supervised flexibility and resistance exercise intervention versus usual care advice alone for adults aged ≥ 50 years with a distal radius fracture (DRF). This paper describes the development and delivery of the therapist-supervised exercise intervention evaluated in the definitive WISE RCT.</p><p><strong>Methods: </strong>The intervention was developed iteratively in accordance with Medical Research Council (MRC) guidance for complex interventions. UK DRF clinical guidelines, published rehabilitation RCTs, UK NHS patient information leaflets, common post-injury impairments, and exercise and behavioural theory were reviewed to inform candidate intervention components. Feedback from UK therapists and patient and public involvement partners then informed the design of the initial intervention. Two methods of intervention delivery were then evaluated in a multicentre feasibility RCT and embedded qualitative study involving 117 participants aged ≥ 50 years with a distal radius fracture.</p><p><strong>Results: </strong>Review of guidelines and previous research highlighted uncertainty regarding the optimal rehabilitation after DRF and limited reporting of progressive exercise interventions. NHS patient information leaflets largely focused on flexibility exercises and self-management advice. Therapist and patient feedback informed the intervention content, progression, and participant materials. Findings from the feasibility RCT and embedded qualitative study supported a therapist-supervised delivery model with three sessions, rather than a single-session independent exercise approach. The final intervention comprised usual care advice plus up to three one-to-one sessions with a physiotherapist or occupational therapist over 12 weeks. Participants also received a workbook containing self-management advice, progressive flexibility and resistance exercises with resistance bands and therapeutic putty, and behaviour change strategies to support exercise adherence.</p><p><strong>Conclusion: </strong>Using an iterative MRC-informed process, a therapist-supervised rehabilitation intervention was developed and refined prior to definitive evaluation. Transparent reporting of intervention development and content should support interpretation, replication, and implementation.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 10","pages":"1352-1364"},"PeriodicalIF":3.3,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224960","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":"RESULT-Hip. The impact of restrictive compared with liberal transfusion strategy on cardiac injury and death in patients undergoing surgery for hip fracture : protocol for a multicentre, randomized controlled trial of two blood transfusion strategies.","authors":"Rhona C F Sinclair, Gayle Beveridge, Andrew D Duckworth, Annabel Giddings, Stephanie Cholbi, George V Guy, Sophie Birch, David A Hope, Joanne Singleton, Lucy Macdonald, Catriona Keerie, Julia Boyd, Alixe H M Kilgour, Alasdair MacLullich, Annemarie B Docherty, Carol Porteous, Matthew L Costa, Nicholas L Mills, Iain K Moppett, Rupert M Pearse, Simon J Stanworth, Andrew Stoddart, Steff Lewis, Timothy S Walsh, Michael A Gillies","doi":"10.1302/2633-1462.710.BJO-2026-0131.R1","DOIUrl":"10.1302/2633-1462.710.BJO-2026-0131.R1","url":null,"abstract":"<p><strong>Aims: </strong>Hip fracture is a global health issue. Complications are common, leading to reduced quality of life or death. These occur more frequently if anaemia is present. We hypothesize that correcting anaemia in the perioperative period may decrease major adverse cardiac events (MACE) and death after hip fracture.</p><p><strong>Methods: </strong>This multicentre prospective randomized trial compares transfusion strategies after hip fracture in patients aged ≥ 60 years. We initially planned to randomize 1,984 participants with anaemia, defined as haemoglobin ≤ 90 g l^-1, to one of two transfusion strategies: liberal transfusion (aim haemoglobin 90 g l^-1 to 110 g l^-1), or restrictive transfusion (aim 75 g l^-1 to 90 g l^-1). The intervention lasts from randomization to hospital discharge or 30 days post randomization, whichever is soonest. The primary outcome measure was a composite of death or MACE adjudicated by blinded clinical experts. Secondary outcomes included all-cause mortality and quality of life, evaluated at 120 days. Cost-effectiveness and health economic evaluation will also be reported.</p><p><strong>Results: </strong>This trial was funded by the National Institute for Health and Care Research, HTA award (National Institute for Health and Care Research (NIHR) 130875) and registered at ISRCTN 28818784. Ethical approval was obtained to recruit patients in the UK. As recruitment fell short of the initial target, and following consultation with the funder, we refined our primary outcome to include myocardial injury after non-cardiac surgery (MINS), and reduced the required sample size to 842.</p><p><strong>Conclusion: </strong>Recruitment commenced on 10 June 2022. The first participant was recruited on 16 June 2022. We will engage clinicians and healthcare planners to implement the findings. We plan to recruit until 31 October 2026. Results will be disseminated to clinicians, policymakers, patients, and the public.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 10","pages":"1342-1351"},"PeriodicalIF":3.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220769","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":"Comparison of CT-based migration analysis against radiostereometric analysis for assessing two-year migration in an uncemented medial pivot tibial knee implant : clinical implications from a prospective safety study.","authors":"Lars Harald William Engseth, Charles Jahren Conrad, Frank-David Øhrn, Anselm Schulz, Stephan Maximillian Herbert Röhrl","doi":"10.1302/2633-1462.710.BJO-2026-0123.R1","DOIUrl":"10.1302/2633-1462.710.BJO-2026-0123.R1","url":null,"abstract":"<p><strong>Aims: </strong>Radiostereometric analysis (RSA) is the gold standard for migration analysis of orthopaedic implants, but CT-based RSA has shown comparable results in an increasing number of joints. In this study, we compared the method in an uncemented medial pivot tibial implant. Our primary outcome measure was maximum total point motion (MTPM). Secondary measures were segmental and feature point migration parameters, range of motion (ROM), Forgotten Joint Score (FJS-12), Knee Injury and Osteoarthritis Score (KOOS), effective radiation doses, and time usage.</p><p><strong>Methods: </strong>A total of 31 patients were prospectively included to receive an uncemented medial pivot knee implant using mechanical alignment (MA) with conventional instruments. Migrations were measured up to 24 months with marker-based RSA, model-based RSA, and CT-based RSA. Clinical data were measured using a goniometer and patient-reported outcome measures ((PROMs); FJS-12 and KOOS).</p><p><strong>Results: </strong>Migrations at 24 months for MTPM showed a mean of 1.09 mm (95% CI 0.78 to 1.40) for marker-based RSA, 1.17 mm (95% CI 0.85 to 1.49) for model-based RSA, and 0.74 mm (95% CI 0.45 to 1.04) for CT-based RSA. MTPM for CT-based RSA was lower than both RSA methods (p < 0.001). Differences increased between the methods at all timepoints, but migrations stabilized for all methods. Time usage (min:sec) for performing RSA radiographs was 17:02 and 4:10 for CT. FJS-12 score increased from 12.3 at baseline to 70.4 at 24 months; and KOOS increased for all sub-scales. ROM increased by 12.4° (95% CI 5.6 to 19.3).</p><p><strong>Conclusion: </strong>For clinical importance, the uncemented GMK Sphere shows a stable migration pattern using all methods and can therefore be considered safe. CT-based RSA shows lower migration values of an uncemented medial pivot tibial implant up to 24 months compared with conventional RSA.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 10","pages":"1330-1341"},"PeriodicalIF":3.3,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196945","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 Stanmore Limb Reconstruction Score : validation of a novel patient-reported outcome measure.","authors":"Gagori Bandopadhyay, Peter Calder, Anna Timms, Elizabeth K Tissingh, William David Goodier, Jonathan Wright","doi":"10.1302/2633-1462.710.BJO-2026-0186.R1","DOIUrl":"10.1302/2633-1462.710.BJO-2026-0186.R1","url":null,"abstract":"<p><strong>Aims: </strong>The Stanmore Limb Reconstruction Score (SLRS) has been developed to capture the unique perspective of patients undergoing deformity correction. In this multiphase mixed method approach, face validity has previously been established. This study presents the next stage of validation and illustrates the evolution of this novel patient-reported outcome measure (PROM).</p><p><strong>Methods: </strong>All patients aged ≥ 18 years, undergoing deformity correction, who met the inclusion criteria were recruited, between March 2021 and January 2025. Data were collected at significant timepoints over the patients' treatment journey. In accordance with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidance, construct validity, reliability, and responsiveness of the SLRS was investigated.</p><p><strong>Results: </strong>A total of 62 patients were included in the analysis. Diverse demographic background, with heterogenous pathologies and varied surgical interventions, made this a representative population of limb reconstruction patients. Convergent validity was established with statistically significant correlations between American Academy of Orthopaedic Surgeons (AAOS)-lower-limb (<i>r</i> = 0.77, p < 0.001) and 36-Item Short-Form Health Survey (SF-36) questionnaire scales (pain and function, p < 0.001). Notably there was sufficient variability, ensuring this new tool is not entirely identical in scope. Divergent validity was confirmed, with no correlations between SLRS and sex, anatomical location, laterality, deformity, and implant. The scale was demonstrated to be reliable (intraclass correlation coefficient (ICC) > 0.9 for pain, and combined ICC 0.78), indicated high internal consistency (Cronbach α score 0.89) and negligible floor-ceiling effects were noted. Responsiveness was established, confirming the instrument's sensitivity to accurately reflect clinically meaningful change in all domains, consistent with expected outcomes following deformity correction surgery (p < 0.001).</p><p><strong>Conclusion: </strong>This study provides evidence of construct validity, reliability, and responsiveness for the SLRS. Field-test, through collaborative work, is necessary for further validation. This has the potential to deliver a unified outcome assessment tool in adult limb reconstruction surgery, to inform evidence-based clinical care.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 10","pages":"1322-1329"},"PeriodicalIF":3.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184805","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 15-year evaluation of two total knee arthroplasty designs : similar patient-reported outcomes and survivorship but divergent patellofemoral and radiological outcomes.","authors":"Nick D Clement, Thomas R Williamson, Gillian L Leitch, Chloe E H Scott, Paul Gaston","doi":"10.1302/2633-1462.710.BJO-2026-0115.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.710.BJO-2026-0115.R1","url":null,"abstract":"<p><strong>Aims: </strong>To compare 15-year patient-reported outcomes measure (PROMs), pain characteristics, implant survivorship, and radiological findings between two total knee arthroplasty (TKA) systems to determine whether modern implant design influenced outcomes.</p><p><strong>Methods: </strong>A minimum 15-year follow-up of a randomised controlled trial was undertaken of patients undergoing primary TKA with either the Kinemax or Triathlon implant. We compared 15-year survivorship, mortality, patient-reported outcome measures (PROMs: Oxford Knee Score (OKS), Forgotten Joint Score (FJS), EuroQol five-dimension questionnaire (EQ-5D), and EQ visual analogue scale (VAS)), pain and location, and radiological assessments between groups.</p><p><strong>Results: </strong>There were nine revisions during the follow-up period (six aseptic and three septic), and there was no difference between the groups (p = 0.721, log-rank). A total of 108 deaths occurred, corresponding to 50.7% (95% CI 44.1 to 57.3) patient mortality at 15 years, with no difference between groups (p = 0.603, log-rank). Overall, 61 patients completed functional assessment at 15 years (mean age 80 years (SD 8.5); 41 female (67%)). There were no statistical (p ≥ 0.170) or clinically meaningful differences between groups in OKS, FJS, EQ-5D, EQ VAS, or satisfaction. Longitudinal analysis demonstrated no between-group differences in postoperative OKS or EQ-5D. However, both declined significantly over the study period (p < 0.001), but remained clinically meaningfully better than those observed preoperatively. Pain VAS scores were comparable, although anterior knee pain was more frequent in the Kinemax group (OR 3.2, p = 0.037). Radiological assessment showed no loosening. Tibial zone 1 radiolucent lines (OR 12.1, 95% CI 2.6 to 57.6, p < 0.001) and severe patellofemoral osteoarthritis (OR 5.1, 95% CI 1.4 to 18.4, p = 0.010) were more prevalent in the Kinemax group.</p><p><strong>Conclusion: </strong>Both implants were associated with comparable PROMs, and despite deterioration with increasing follow-up, they remained superior to preoperative scores. The Kinemax group demonstrated higher rates of anterior knee pain, though this difference did not result in clinically meaningful outcome disparities.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 10","pages":"1312-1321"},"PeriodicalIF":3.3,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184736","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":"Substantial improvement in short-term survivorship in patients receiving robotic arm-assisted medial unicompartmental knee arthroplasty : a retrospective cohort study.","authors":"Tim Cheok, Kristopher Law, Julie F Vermeir, Ruurd L Jaarsma, Job N Doornberg, Anthony M Silva","doi":"10.1302/2633-1462.710.BJO-2026-0104.R1","DOIUrl":"10.1302/2633-1462.710.BJO-2026-0104.R1","url":null,"abstract":"<p><strong>Aims: </strong>Robotic arm-assisted unicompartmental knee arthroplasty (R-UKA) has been shown to improve alignment and accuracy of component placement compared with conventional unicompartmental knee arthroplasty (C-UKA). Despite this, there is conflicting evidence for whether this has an impact on revision rates.</p><p><strong>Methods: </strong>We performed a retrospective analysis of a prospective database, comparing patients who underwent R-UKA using the Stryker Restoris MCK implant with those who underwent C-UKA using the cemented Oxford Partial Knee implant, between January 2002 and December 2024 at The Prince Charles Hospital (Brisbane, Australia), with a minimum six-month follow-up. Patient selection for UKA mirrored the recommendations by Kozinn and Scott. The primary outcome of interest was to compare the all-cause revision rate between these two groups. Secondary outcomes of interest were to compare hospital length of stay (HLOS), surgical duration, the odds of superficial surgical site infection, and the odds of periprosthetic joint infection (PJI) between the same groups. The analysis of individual outcomes were adjusted for age, sex, BMI, American Society of Anesthesiologists grade, Charlson Comorbidity Index, and primary surgeon grade.</p><p><strong>Results: </strong>The hazard of all-cause revision significantly decreased by 78% in the R-UKA group as compared with the C-UKA group (p = 0.046). HLOS was also significantly shorter by 2.2 days (95% CI 1.0 to 3.3) in the R-UKA group (p < 0.001). There was no significant difference in the surgical duration (p = 0.733), odds of superficial surgical site infection (p = 0.845), nor in the odds of PJI (p = 0.415) between the two groups.</p><p><strong>Conclusion: </strong>The substantial improvement in revision outcomes suggests that R-UKA is the option of choice for managing symptomatic unicompartmental knee arthritis in carefully selected patients with isolated medial compartmental osteoarthritis, especially in the hands of low-volume surgeons. Decreased HLOS should be interpreted with caution, given the non-contemporaneous nature of the two cohorts.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 10","pages":"1304-1311"},"PeriodicalIF":3.3,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168622","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":"Long-term results of the modified Dunn procedure in slipped capital femoral epiphysis : a minimum of ten-year follow-up.","authors":"Alessandro Aprato, Andrea Audisio, Samuele Grilli, Matteo Giachino, Virginia Reinaudo, Salvatore Risitano, Reinhold Ganz, Alessandro Masse'","doi":"10.1302/2633-1462.710.BJO-2026-0076.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.710.BJO-2026-0076.R1","url":null,"abstract":"<p><strong>Aims: </strong>In situ fixation for slipped capital femoral epiphysis (SCFE) prevents further displacement, but fails to correct the proximal femoral deformity, which may lead to femoroacetabular impingement (FAI) and early osteoarthritis (OA). The modified Dunn procedure (MDP) restores proximal femoral anatomy with the aim of improving long-term joint preservation. However, evidence beyond mid-term follow-up remains limited. This study evaluates the ten-year survivorship, functional outcomes, and radiological correction following MDP.</p><p><strong>Methods: </strong>A retrospective single-centre review was performed of patients treated with the MDP between 2007 and 2014 for stable or unstable SCFE of any severity. Patients with preoperative avascular necrosis (AVN) were excluded. Primary outcomes were ten-year survivorship free from conversion to total hip arthroplasty (THA) and from radiological OA progression (≥ 1 Tönnis grade). Secondary outcomes included patient-reported outcome measures, hip range of motion, clinical signs of FAI, and correction of the Southwick and α angles. Kaplan-Meier survival analyses were performed and stratified by slip severity.</p><p><strong>Results: </strong>A total of 35 hips (34 patients) completed ≥ ten years of follow-up (163 months (SD 34)). Ten-year THA conversion-free survivorship was 88.6%, decreasing from 100% in mild slips to 86.4% in moderate and 83.3% in severe slips. Ten-year OA progression-free survivorship was 82.9%, with rates of 100%, 81.8%, and 66.7% for mild, moderate, and severe slips, respectively. The mean ten-year functional scores were high (modified Harris Hip Score 88.9 (SD 4.4); University of California, Los Angeles Activity Scale 8.9 (SD 1.6); and Merle d'Aubigné-Postel 17.7 (SD 0.9)). Substantial radiological correction was observed, with the Southwick angle improving from 45.0° to 13.1° and the α angle from 85.8° to 50.9°. No postoperative AVN occurred.</p><p><strong>Conclusion: </strong>At ten-year follow-up, the MDP achieved excellent functional outcomes and effective deformity correction in SCFE, with high survivorship in mild and moderate slips. However, progression of hip OA was less favourable in severe slips.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 10","pages":"1295-1303"},"PeriodicalIF":3.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170019","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":"Temporary screw epiphysiodesis for correction of ankle valgus in children with multiple hereditary exostoses : a case-control study.","authors":"Sarah I Schmitz, Moritz Broja, Anne Andresen, Alexandra Doerell, Luisa Saegebrecht, Martin Rupprecht, Kiril Mladenov, Alexander S Spiro","doi":"10.1302/2633-1462.710.BJO-2026-0157.R1","DOIUrl":"10.1302/2633-1462.710.BJO-2026-0157.R1","url":null,"abstract":"<p><strong>Aims: </strong>In patients with multiple hereditary exostosis (MHE), the development of ankle valgus is a common deformity. The aim of this study was to evaluate whether temporary screw epiphysiodesis of the medial distal tibia leads to a correction of the deformity and to provide further information on the timing and duration of the operative treatment, considering sex-specific differences and a concomitant fibular shortening or relevant exostoses.</p><p><strong>Methods: </strong>The data of 37 MHE patients with a total of 68 ankles, and 35 patients with idiopathic ankle valgus with a total of 56 ankles, were analyzed retrospectively. The lateral distal tibia angle was measured before and after treatment. We also assessed complications, relevant exostoses, and a fibular shortening, as well as sex-specific differences in the correction rate.</p><p><strong>Results: </strong>Ankle valgus improved in all but one patient of the MHE group with a mean valgus correction of 9.6° (control group: 9.9°). The correction rate was significantly lower in the MHE group than in the control group (0.5° vs. 0.8° per month, p < 0.001), resulting in a significantly higher wearing time in the MHE group (20.12 vs. 14.59 months, p = 0.002). No significant sex-specific differences were found neither in the MHE group nor in the control group. Complications were observed in five ankles of the MHE group (screw breakage during explantation) and none in the control group. Concomitant exostoses or fibular shortening did not affect the correction of ankle valgus.</p><p><strong>Conclusion: </strong>Temporary screw epiphysiodesis is an effective method for the treatment of ankle valgus in MHE patients. As the correction rate per month is lower in MHE patients, operative treatment should be performed earlier to achieve satisfactory correction.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 10","pages":"1288-1294"},"PeriodicalIF":3.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13649346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138456","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":"Estimating within-patient sagittal pelvic tilt change from routine anteroposterior hip radiographs in patients undergoing total hip arthroplasty : development and temporal validation.","authors":"Kyosuke Kobayashi, Kenichi Kidera, Syuta Yamada, Tatsuya Fukushima, Akira Hozumi","doi":"10.1302/2633-1462.710.BJO-2026-0113.R1","DOIUrl":"10.1302/2633-1462.710.BJO-2026-0113.R1","url":null,"abstract":"<p><strong>Aims: </strong>Changes in sagittal pelvic tilt influence functional cup orientation in total hip arthroplasty (THA). Although lateral spinopelvic radiographs are the reference standard, they are not routinely obtained, whereas anteroposterior (AP) hip radiographs are widely used. This study evaluated whether within-patient pelvic tilt changes can be accurately estimated using AP radiographs.</p><p><strong>Methods: </strong>This retrospective observational study included 116 patients who underwent primary THA (derivation cohort). Supine and standing AP radiographs and CT data were acquired preoperatively. CT-derived synthetic radiographs were generated and adjusted to match the pelvic foramen ratio (PFR) measured on AP radiographs, yielding adjusted synthetic (AS) radiographs. For the supine-to-standing transition, the change in anterior pelvic plane tilt (ΔAPPt) measured on AS radiographs was used as the reference outcome, and the change in pubic symphysis-to-transischial line distance (ΔPSTI, mm) on AP radiographs was used as the predictor. A linear regression model was developed to estimate ΔAPPt from ΔPSTI. Internal validation was performed using fivefold cross-validation. Independent temporal validation was performed in a separate cohort (n = 80).</p><p><strong>Results: </strong>The derived equation was (ΔAPPt = -0.74 × ΔPSTI + 1.2). Fivefold cross-validation showed a mean error of 0.01° (root mean square error (RMSE) 1.4°, mean absolute error (MAE) 1.0°; 95% limits of agreement (LoA) -2.6° to 2.7°). Absolute error was ≤ 3° in 112 out of 116 (96.6%) cases and ≤ 5° in 116 out of 116 (100%). Independent temporal validation showed a mean error of 0.2° (RMSE 1.3°, MAE 0.9°; 95% LoA -2.4° to 2.8°). Absolute error was ≤ 3° in 75 out of 80 cases (93.8%) and ≤ 5° in 80 out of 80 (100%), within an observed ΔAPPt range of -15.3° to 8.0°.</p><p><strong>Conclusion: </strong>A regression equation based on ΔPSTI estimated supine-to-standing within-patient ΔAPPt from routine AP hip radiographs with a clinically acceptable agreement (95% LoA approximately ± 3°).</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 10","pages":"1280-1287"},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138486","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}