Bone & Joint Open最新文献

{"title":"Rotator cuff surgery and semantics : definitions matter.","authors":"Lars E Adolfsson, Simon M Lambert, Hanna C Björnsson Hallgren","doi":"10.1302/2633-1462.611.BJO-2025-0205","DOIUrl":"10.1302/2633-1462.611.BJO-2025-0205","url":null,"abstract":"<p><p>The imprecise definition of terms used to describe pathological diagnosis in clinical medicine can lead to imprecise treatment concepts and inaccurate recording of outcomes. In this article, we explore the meaning of common terms applied to the pathology of the rotator cuff, and demonstrate how the imprecise use of words entails a risk of leading to a poor definition of the clinical condition being treated. We suggest improvements in the accuracy of the definition of what constitutes the rotator cuff. We suggest the use of 'defect' to describe the most common presentation of a degenerative lesion of the rotator cuff, rather than perpetuate the use of the term 'tear', which has a different, injurious aetiology. We suggest that the term 'repair' should be reserved for the condition in which an acutely injured tendon (with a 'tear') can be expected to heal, using the correct definition of the term 'to heal'. We recommend reserving the use of the term 'healed' for the condition of an acute lesion of the rotator cuff (a 'tear') to which the histological process of regenerating a near-normal enthesis can be reasonably applied. We further suggest that degenerative lesions ('defects') of the rotator cuff, which do not have the biological capacity to heal in the true sense when brought back to bone, should be described as having 'closure' of the defect.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 11","pages":"1475-1478"},"PeriodicalIF":3.1,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12620035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534114","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":"Congruence angle and medial ulnar translation: a novel measurement to assess the severity of ligament injury in simple elbow dislocation.","authors":"Sang-Pil So, Seung-Hun Lee, Hui Ben, Jae-Man Kwak, Kyoung Hwan Koh, In-Ho Jeon","doi":"10.1302/2633-1462.611.BJO-2025-0237.R1","DOIUrl":"10.1302/2633-1462.611.BJO-2025-0237.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study was to propose novel measurements to assess severity of ligament injury in simple elbow dislocation using axial imaging. This study assessed inter- and intraobserver reliability of the proposed novel measurements and compared their application as measures of severity of medial collateral ligament (MCL) and lateral collateral ligament (LCL) injuries.</p><p><strong>Methods: </strong>This retrospective study included patients diagnosed with simple elbow dislocations from January 2013 to December 2023. The degree of MCL and LCL injuries was assessed by four grades: (0 (normal); 1 (sprain); 2 (partial tear); and 3 (complete tear)) using MRI. Patients were classified into two groups according to the severity of MCL and LCL injuries (Group I (degree of MCL injury ≥ LCL injury); and Group II (degree of MCL injury < LCL injury)). The novel measurements were defined by measuring congruence angle (CA), medial ulnar translation (TRANS), and lateral ulnar tilt (TILT) as determined by axial MRI. Adjusted medial ulnar translation (ADJ-TRANS) was calculated. Two observers measured all parameters twice over four weeks.</p><p><strong>Results: </strong>A total of 21 patients were analyzed. Interobserver reliability was moderate to good for CA and good for TRANS. Both CA and TRANS showed excellent intraobserver reliability. Grade 2 MCL injury had significantly higher ADJ-TRANS than grade 1, while grade 2 LCL injury had significantly higher TRANS than grade 1. Meanwhile, grade 3 LCL injury had significantly higher CA and TRANS than grade 2, and significantly higher CA, TRANS, and ADJ-TRANS than grade 1. Group II also had significantly higher CA, TRANS, and ADJ-TRANS than Group I.</p><p><strong>Conclusion: </strong>Novel measurements using axial images of MRI scans achieved overall good inter- and intraobserver reliability. Higher grade LCL injury exhibited higher CA, TRANS, and ADJ-TRANS. Patients with LCL injury graded higher than that of MCL injury exhibited higher CA, TRANS, and ADJ-TRANS.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 11","pages":"1468-1474"},"PeriodicalIF":3.1,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12618108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145524493","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":"Rethinking SLIL classifications in the age of needle arthroscopy: do we need sub-grades?","authors":"Daniel Reiser, Sanjeev Kakar","doi":"10.1302/2633-1462.611.BJO-2025-0265.R1","DOIUrl":"10.1302/2633-1462.611.BJO-2025-0265.R1","url":null,"abstract":"","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 11","pages":"1466-1467"},"PeriodicalIF":3.1,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12615014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145514313","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":"Pain catastrophizing immediately after surgery predicts postoperative patient satisfaction one year after total knee arthroplasty.","authors":"Tomofumi Kinoshita, Tatsuhiko Kutsuna, Kunihiko Watamori, Takashi Tsuda, Yusuke Horita, Kazunori Hino, Masaki Takao","doi":"10.1302/2633-1462.611.BJO-2025-0076.R2","DOIUrl":"10.1302/2633-1462.611.BJO-2025-0076.R2","url":null,"abstract":"<p><strong>Aims: </strong>Patient satisfaction after total knee arthroplasty (TKA) is a key measure of clinical outcome. While preoperative pain catastrophizing is known to affect postoperative results, the impact of early postoperative catastrophizing remains unclear. This study aimed to evaluate whether early postoperative pain catastrophizing is associated with PS one year after TKA.</p><p><strong>Methods: </strong>We evaluated 254 knees in 254 patients undergoing TKA, assessing the Pain Catastrophizing Scale (PCS) and visual analogue scale (VAS) one day before, as well as one, three, and seven days after TKA. The 2011 Knee Society Score (KSS) was assessed preoperatively and one year postoperatively. Based on PS scores in the KSS, patients were classified into satisfaction (PS > 20) and dissatisfaction (PS ≤ 20) groups. PCS and VAS scores were compared between groups using the Mann-Whitney U test. Spearman's rank correlation coefficient and multiple regression analysis were used to evaluate relationships among factors.</p><p><strong>Results: </strong>Mean PCS scores were 22.8 (SD 12.6), 21.9 (SD 12.2), 18.3 (SD 10.8), and 15.2 (SD 10.5) one day before, as well as one, three, and seven days after TKA, respectively. PCS scores seven days after TKA were negatively correlated with patient satisfaction one year after TKA (ρ = -0.32, p < 0.001). The dissatisfaction group had significantly higher PCS scores at all postoperative timepoints (p = 0.010, p < 0.001, and p < 0.001, respectively.). There were no significant differences in VAS scores between groups at any timepoint. Multiple regression analysis revealed that the PCS score seven days after TKA was significantly associated with PS (<i>β</i> = -0.321, p < 0.001). The cutoff PCS score seven days post-TKA for the dissatisfaction group was 12 (area under the curve: 0.653).</p><p><strong>Conclusion: </strong>Patients who were dissatisfied with TKA outcomes persistently exhibited high PCS scores immediately after surgery. Surgeons should consider not only preoperative PCS and VAS scores, but also postoperative PCS scores in order to enhance postoperative patient satisfaction following TKA.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 11","pages":"1457-1465"},"PeriodicalIF":3.1,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12611442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145507556","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":"Rationale for preoperative planning in the supine position based on variability in the joint line convergence angle before and after open-wedge high tibial osteotomy.","authors":"Sayako Sakai, Shinichi Kuriyama, Takahiro Maeda, Yusuke Yamawaki, Yugo Morita, Kohei Nishitani, Shinichiro Nakamura, Shuichi Matsuda","doi":"10.1302/2633-1462.611.BJO-2025-0229.R1","DOIUrl":"10.1302/2633-1462.611.BJO-2025-0229.R1","url":null,"abstract":"<p><strong>Aims: </strong>In advanced medial knee osteoarthritis, lower limb alignment is assessed using weightbearing imaging, which reflects the joint line convergence angle (JLCA). However, successful lateral load transfer with open-wedge high tibial osteotomy (OWHTO) can reduce the JLCA by decreasing the lateral and increasing the medial joint space on weightbearing imaging, making the correction less predictable. This study aimed to demonstrate that OWHTO planning using preoperative supine imaging yields more reproducible correction than weightbearing imaging and to identify radiological predictors of excessive JLCA change (> 2°).</p><p><strong>Methods: </strong>We retrospectively analyzed 115 knees of 96 patients who underwent OWHTO planned using supine imaging. Radiological parameters, including the hip-knee-ankle angle (HKAA) and arithmetic HKAA, were measured using preoperative and postoperative long-leg weightbearing radiographs. Knees were categorized into three groups by ΔJLCA: ΔJLCA < -2° (decreased); -2° ≤ ΔJLCA ≤ 2° (unchanged), and ΔJLCA > 2° (increased). Logistic regression and receiver operating characteristic curve analysis were used to determine radiological factors associated with ΔJLCA.</p><p><strong>Results: </strong>The unchanged JLCA group comprised 84.3% of knees, with similar preoperative weightbearing and supine JLCAs (2.6° and 2.5°, respectively). The postoperative weightbearing JLCA was 2.5°. The decreased JLCA group included 11.3% of knees, and the postoperative weightbearing JLCA (mean 2.6°) was closer to the preoperative supine (mean 4.1°) than the weightbearing JLCA (mean 5.5°). Preoperative arithmetic HKAAs were identical in the unchanged and decreased JLCA groups (3.9° varus). The increased JLCA group comprised only 4.3% of knees. Preoperative weightbearing JLCA > 4.9° and varus HKAA > 8.8° were significantly associated with decreased JLCA, with areas under the curve of 0.86 and 0.72, respectively.</p><p><strong>Conclusion: </strong>Postoperative weightbearing alignment following OWHTO is better predicted by preoperative supine than weightbearing imaging. Furthermore, large preoperative weightbearing JLCA (> 4.9°) and severe varus HKAA (> 8.8°) are associated with decreased postoperative JLCA.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 11","pages":"1446-1455"},"PeriodicalIF":3.1,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12614650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145496246","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":"Corrigendum.","authors":"Khalid Al-Hourani, Saran Singh Gill, Bhargava Ram Govardhana, Eoghan Hurley, Shehzaad Khan, Alastair Davidson, Xinning Li, Iain R Murray, Fares S Haddad","doi":"10.1302/2633-1462.611.BJO-2025-00006","DOIUrl":"10.1302/2633-1462.611.BJO-2025-00006","url":null,"abstract":"","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 11","pages":"1456"},"PeriodicalIF":3.1,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12614649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145496265","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":"Interobserver reliability of Coronal Plane Alignment of the Knee (CPAK) phenotype classification : external validation using data from the Osteoarthritis Initiative.","authors":"William Wynell-Mayow, Thomas A G Hall, Abhinav Singh, Richard J van Arkel, Gareth G Jones","doi":"10.1302/2633-1462.611.BJO-2025-0153.R1","DOIUrl":"10.1302/2633-1462.611.BJO-2025-0153.R1","url":null,"abstract":"<p><strong>Aims: </strong>Coronal Plane Alignment of the Knee (CPAK) phenotyping is gaining momentum in research and clinical practice to understand individualized knee alignments and predict knee balance in total knee arthroplasty (TKA). The nine CPAK classes are based on joint line obliquity (JLO) and arithmetic hip-knee-ankle angle (aHKA), which are calculated using the medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA). This study aims to assess CPAK classification reproducibility, and analyze what level of angular error is associated with CPAK misclassification.</p><p><strong>Methods: </strong>Two readers labelled 75 long-leg radiographs (LLRs) from the Osteoarthritis Initiative database for analyses of CPAK inter-reader reproducibility. A single reader then labelled and classified phenotypes for an aggregate total of 1,128 LLRs. Finally, Monte Carlo simulations were run based on 1,128-patient phenotype distribution and the inter-reader reproducibility statistics to understand how CPAK agreement rates were affected by the reproducibility of MPTA and LDFA measurements.</p><p><strong>Results: </strong>There was excellent reproducibility in MPTA and LDFA measurements (mean absolute error: 0.41°/0.71°; and intraclass correlation coefficient: 0.96°/0.91°, respectively). These small angular deviations led to one-in-five disagreement in CPAK classification (20.0%; 95% CI 10.9% to 29.1%). An aHKA mean absolute error of < 0.1°, which is potentially unattainable, would be required to reduce inter-reader CPAK disagreement to below 95%.</p><p><strong>Conclusion: </strong>CPAK phenotyping from long-leg radiographs may result in clinically significant rates of misclassification. CT imaging may improve reliability, particularly in cases where aHKA and JLO are near to discriminatory values.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 11","pages":"1425-1435"},"PeriodicalIF":3.1,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12602010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490260","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 new classification for heterotopic ossification following periacetabular osteotomy with and without concomitant hip arthroscopy.","authors":"Ta-Wei Tai, Diego J Restrepo, Sergio F Guarin Perez, Adrian E Gonzalez-Bravo, Onur Hapa, Rafael J Sierra","doi":"10.1302/2633-1462.611.BJO-2025-0222.R1","DOIUrl":"10.1302/2633-1462.611.BJO-2025-0222.R1","url":null,"abstract":"<p><strong>Aims: </strong>Heterotopic ossification (HO) is a recognized complication following periacetabular osteotomy (PAO), but its patterns, incidence, and clinical relevance remain poorly defined. The commonly used Brooker classification, developed for total hip arthroplasty, is not fully applicable to HO after PAO. This study aimed to propose a new classification system specific to HO after PAO, evaluate its clinical relevance, and report the cumulative probabilities of radiological and symptomatic HO.</p><p><strong>Methods: </strong>This retrospective study included 643 patients who underwent PAO between January 2006 and July 2024. A total of 308 patients (47.9%) had concomitant arthroscopic procedures. Radiographs were analyzed to identify HO using both the Brooker classification and a newly developed system. The cumulative probabilities of radiological and symptomatic HO were calculated using Kaplan-Meier analysis. Difference of variables between patients with and without HO was analyzed. Receiver operating characteristic (ROC) curve analysis was used to compare the predictive performance of the two classification systems.</p><p><strong>Results: </strong>The cumulative probabilities of radiological and symptomatic HO at five years post-PAO were 30.4% and 3.8%, respectively. The probabilities were 41.9% in males and 29.2% in females. Four patients (2.8%) required surgical excision of HO, all classified as type 3 or 4 under the new system. The ROC analysis demonstrated superior predictive performance for the new classification system (AUC = 0.928) compared to the Brooker classification (AUC = 0.697; p = 0.007). No significant differences were found between the patients with and without HO in terms of age, sex, concomitant arthroscopic procedures, or receiving prophylaxis in addition to low-dose aspirin.</p><p><strong>Conclusion: </strong>This study highlighted the cumulative probabilities of HO following PAO and introduced a new classification system that improved clinical relevance and predictive accuracy. These findings have provided insights into the incidence and management of HO after PAO, and laid the groundwork for standardized reporting and future research.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 11","pages":"1436-1445"},"PeriodicalIF":3.1,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12602009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490285","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 Ankle Recovery Trial (ART): clinical outcomes and patient experience of a pragmatic multicentre RCT comparing cast with removable boot for early mobilization after ankle fracture surgical fixation.","authors":"Rachel Martin, Sharon Docherty, Vanessa Heaslip, Helen Allen, Lee W Tbaily, Christopher J Hayward, Elsa M R Marques, Anuraag Sangar","doi":"10.1302/2633-1462.611.BJO-2025-0108.R1","DOIUrl":"10.1302/2633-1462.611.BJO-2025-0108.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study compares functional outcomes and patient experience between cast immobilization and early mobilization in a removable boot after ankle fracture fixation, with early weightbearing encouraged in both groups.</p><p><strong>Methods: </strong>This pragmatic multicentre randomized controlled trial with qualitative component and economic evaluation was conducted across eight UK NHS hospitals. Adults with acute ankle fractures were randomized to receive a plaster cast or removable support boot two weeks post-surgery. The primary outcome was ankle function measured by the Olerud and Molander Ankle Symptom Score (OMAS) seven weeks post-surgery. Secondary outcomes included function at 12 weeks, mechanistic measures, quality of life, complications, and resource use. Subgroup analyses included fracture complexity and age. Patients' views on both treatments were collected through semi-structured telephone interviews.</p><p><strong>Results: </strong>In total, 243 participants consented to be randomized (120 cast; 123 boot), of whom 173 (71.2%) completed the primary outcome. The mean difference in OMAS at seven weeks between groups was 4.9 points favouring the boot (95% CI -1.0 to 10.7), which is below the minimal clinically important difference, and failed to detect a difference between groups. Boot participants had better dorsiflexion, particularly those with comminuted fractures, and better plantarflexion, particularly older patients. Complication rates were low, albeit higher in the boot group (cast eight/112; boot 18/117); all were minor, except one case of deep vein thrombosis in the boot group. Overall, we found low wound complication rates (7%). There were no differences for all other secondary measures. Patients expressed preference for boots at randomization, point of withdrawal from the trial, and during interviews.</p><p><strong>Conclusion: </strong>Patients managed in casts and boots had similar functional outcomes following ankle fracture fixation. Boots provided improved dorsiflexion and plantarflexion for some subgroups, but higher complication rates. Treatment modality decisions could therefore be informed by individual patient preference.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 11","pages":"1416-1424"},"PeriodicalIF":3.1,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12598652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483121","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":"Periprosthetic joint infection after hemiarthroplasty for hip fracture is a distinct clinical entity associated with high mortality.","authors":"Daniel P Lewis, Seth M Tarrant, David Dewar, Zsolt J Balogh","doi":"10.1302/2633-1462.611.BJO-2025-0120.R1","DOIUrl":"10.1302/2633-1462.611.BJO-2025-0120.R1","url":null,"abstract":"<p><strong>Aims: </strong>Periprosthetic joint infections (PJIs) are devastating complications. Our knowledge of hip fracture-associated hemiarthroplasty PJI (HHA-PJI) is limited compared to elective arthroplasty. The goal of this study was to describe the epidemiology, risk factors, management, and outcomes for HHA-PJI.</p><p><strong>Methods: </strong>A population-based (465,000 patients) multicentre, retrospective analysis of hip hemiarthroplasty (HHA) between January 2006 to December 2018 was conducted. PJI was defined by international consensus and treatment success as no return to operating room and survival to 90 days after the initial surgical management of the infection. Univariate, survival, and competing risk regression analyses were performed.</p><p><strong>Results: </strong>In total, 1,852 HHAs were identified (74% female; mean age 84 years (SD 7); 90-day mortality 16.7%). A total of 43 patients (2.3%) developed PJI at aged 77 years (SD 10) (56% female; 90-day-mortality 20.9%; hazard ratio (HR) 1.6; 95% CI 1.1 to 2.3; p = 0.023). The incidence of HHA-PJI was 0.77/100,000 population/year and 193/100,000 HHAs/year. The median time to PJI was 26 days (IQR 20 to 97), with 53% polymicrobial growth and 41% multidrug-resistant organisms (MDRO). Competing risk regression identified younger age (subdistribution hazard ratio (SHR) 0.86; 95% CI 0.8 to 0.92; p < 0.001), chronic kidney disease (SHR 3.41; 95% CI 1.36 to 8.56; p = 0.013), BMI > 35 kg/m² (SHR 6.81; 95% CI 2.25 to 20.65; p < 0.001), perioperative urinary tract infection (SHR 1.89; 95% CI 1.02 to 3.5; p = 0.042), and dementia (SHR 9.4; 95% CI 2.89 to 30.58; p < 0.001) as significant risk factors for developing HHA-PJI. When infection treatment was successful (n = 15, 38%), median survival was 1,632 days (IQR 829 to 2,084), as opposed to 215 days (IQR 20 to 1,245) in those who failed, with a 90-day mortality of 30% (n = 12). There was no significant difference in treatment success between debridement, excision arthroplasty, or revision arthroplasty.</p><p><strong>Conclusion: </strong>HHA-PJI is an uncommon complication, but is significantly associated with mortality. All currently identified predictors are nonmodifiable. Due to the common polymicrobial and MDRO infections, our standard antibiotic prophylaxis may not be adequate. HHA-PJI is a different disease compared to elective PJI with distinct epidemiology, pathogens, risk factors, and outcomes, which require targeted research specific to this unique population.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 11","pages":"1409-1415"},"PeriodicalIF":3.1,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12598510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472174","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}