Bone & Joint Open最新文献

{"title":"An overnight sensation: the effect of an acute introduction of a short-stay pathway on a previously compromised arthroplasty service.","authors":"Kevin Ilo, Bernard H van Duren, Mark A Higgins, Andrew R J Manktelow, Benjamin V Bloch","doi":"10.1302/2633-1462.65.BJO-2024-0238.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.65.BJO-2024-0238.R1","url":null,"abstract":"<p><strong>Aims: </strong>In this study, we report the impact of implementing a new short-stay hip and knee arthroplasty pathway in an NHS hospital. This was enacted due to existing concerns around long length of stay (LOS) and reduced elective operating capacity each winter due to bed pressures. The overnight introduction of this pathway was aimed to reduce LOS, alleviate bed pressures, minimize readmission rates, and generate financial savings, all combining to facilitate full elective activity during the winter.</p><p><strong>Methods: </strong>We conducted a prospective study at a regional tertiary arthroplasty centre. The new pathway was introduced across the service overnight. It included rigorous preoperative optimization, specific anaesthetic protocols, and uniform changes in surgical practice to allow a focus on early mobilization and discharge on the day of surgery where possible. Data collection spanned 17 months, encompassing the initial six months post-implementation of the short-stay pathway. LOS data were collected for the full period and data were compared pre- and post-implementation of the new pathway. Patient satisfaction and 30-day readmission data were also collected.</p><p><strong>Results: </strong>There was a significant decrease in median LOS from four days pre-implementation to one day post-implementation. Patient satisfaction was high and the 30-day readmission rate was unchanged (5.95%, n = 43), with no readmissions directly related to decreased inpatient stay. Financial analyses revealed substantial cost savings due to reduced LOS and the elimination of routine postoperative blood tests. Elective activity over winter was significantly higher (203 more arthroplasties, 79% increase) than in the same time period in the previous year.</p><p><strong>Conclusion: </strong>An acute introduction of a carefully planned and coordinated short-stay hip and knee pathway is safe, cost-effective, and popular with patients, but also contributes to increased efficiency in the delivery of elective healthcare in the context of increasing demand and financial constraints in the NHS.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 5 Supple A","pages":"22-29"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019160","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":"Primary total hip arthroplasty using custom-made acetabular implants in patients with high hip dislocation : surgical technique and results.","authors":"Rashid M Tikhilov, Rodion D Volykhin, Stanislav S Bilyk, Anton N Kovalenko, Alisagib A Dzhavadov, Igor I Shubnyakov","doi":"10.1302/2633-1462.65.BJO-2024-0255.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.65.BJO-2024-0255.R1","url":null,"abstract":"<p><strong>Aims: </strong>Despite good results of using uncemented press-fit cups in patients with high hip dislocations (type C as per the Hartofilakidis classification), there are reports of loosening of these components. To improve the results on the acetabular side in patients with high hip dislocations, we used custom-made acetabular implants (CMAIs). The aim of this study was to evaluate the outcomes after total hip arthroplasty (THA) using CMAIs in patients with high hip dislocation.</p><p><strong>Methods: </strong>We retrospectively analyzed the results of primary THA using the CMAIs in 58 hips (52 patients) from November 2017 to December 2019. All surgeries were performed using the femoral shortening osteotomy technique described by Paavilainen. Type C1 and C2 dislocations were observed in nine and 49 hips, respectively. The presence of various complications, functional results using the Oxford Hip Score (OHS), patient satisfaction, radiological parameters, and positioning of CMAIs were assessed.</p><p><strong>Results: </strong>The mean follow-up period, including radiological follow-up for all 58 hips, was 5.2 years (4.2 to 6.3; SD 0.71). Patients demonstrated statistically significant improved functional outcomes according to the OHS (preoperatively 16.9 and postoperatively 38.5; p < 0.001). Four hips were revised: two hips due to dislocations, the cause of which was impingement of the greater trochanter due to malposition of the distally advanced greater trochanter after osteotomy. One hip was due to nonunion of the distally advanced greater trochanter after osteotomy, and one hip due to pain resulting from iliopsoas impingement caused by contact of the CMAI flange with the iliopsoas muscle. There were no radiological signs of loosening of the CMAIs. Any deviation of the CMAIs from the planned position was noted.</p><p><strong>Conclusion: </strong>This preliminary study demonstrated that CMAIs may offer good bone fixation in patients with high hip dislocation; however, further biomechanical studies are needed to evaluate the use of CMAIs in terms of osseointegration, additional screw fixation, and to determine the effect of deviation of CMAIs from the planned position on clinically relevant complications.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 5 Supple A","pages":"41-50"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017264","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":"Clinical effectiveness of a child-specific dynamic stretching programme, compared to usual care, for ambulant children with spastic cerebral palsy (SPELL trial): a parallel group randomized controlled trial.","authors":"Tim Theologis, Daniel C Perry, Ines Rombach, David J Keene, Ioana R Marian, Morag Andrew, Catherine Barry, Loretta Davis, Gregory Firth, Heidi Fletcher, Beth Fordham, Vivi Gregory Osborne, Helen Gregory Osborne, Lesley Katchburian, Joanna O'Mahoney, Jeremy R Parr, Rachel Rapson, Jennifer Ryan, Fema Er, Megan Stone, Helen Wood, Sally Hopewell","doi":"10.1302/2633-1462.65.BJO-2024-0267","DOIUrl":"https://doi.org/10.1302/2633-1462.65.BJO-2024-0267","url":null,"abstract":"<p><strong>Aims: </strong>Dynamic muscle stretching exercises are one of the interventions frequently prescribed by physiotherapists for children with cerebral palsy (CP). However, there is wide variability in the exercise regimes used and limited evidence of their effectiveness. The SPELL trial will assess the clinical effectiveness of an individually tailored dynamic stretching programme, compared to usual care for ambulant children with spastic CP.</p><p><strong>Methods: </strong>We are conducting a multicentre, two-arm, parallel group, superiority randomized controlled trial. We will recruit children aged four to 11 years with a diagnosis of spastic CP (bilateral or unilateral) and Gross Motor Function Classification System (GMFCS) levels I to III who are able to comply with assessment procedures and exercise programme with or without support. Participants will be recruited from at least 12 UK NHS Trust physiotherapy and related services. Participants (n = 334) will be randomized (centralized computer-generated one:one allocation ratio) to either: 1) a dynamic stretching exercise programme, with six one-to-one physiotherapy sessions over 16 weeks; or 2) usual NHS care, with a single physiotherapy session and an assessment, and advice regarding self-management and exercise.</p><p><strong>Conclusion: </strong>The primary outcome is functional mobility measured using the child-/parent-reported Gait Outcomes Assessment List (GOAL) at six months. Secondary outcomes are: joint range of motion (Cerebral Palsy Integrated Pathway protocol) and motor function (timed up and go test) at six months; functional mobility (GOAL) at 12 months; independence (GOAL subdomain A); balance (GOAL subdomain A, B, D); pain and discomfort (GOAL subdomain C); health-related quality of life (youth version of the EuroQol five-dimension questionnaire (EQ-5D-Y)); educational attendance; exercise adherence; and additional physiotherapy treatment at six and 12 months. The primary analysis will be intention to treat.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 5","pages":"506-516"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986372","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":"Preservation of the lateral femoral circumflex artery in total hip arthroplasty using the bikini-type direct anterior approach : effect on muscle status and clinical outcomes.","authors":"Louisa Bell, Hannes A Rüdiger, Anika Stephan, Lukas Schwitter, Christian W A Pfirrmann, Vincent A Stadelmann, Michael Leunig","doi":"10.1302/2633-1462.65.BJO-2024-0193.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.65.BJO-2024-0193.R1","url":null,"abstract":"<p><strong>Aims: </strong>The direct anterior approach (DAA) is increasing in popularity as a minimally invasive technique for total hip arthroplasty (THA). DAA-THA involves ligation of the ascending branch of the lateral femoral circumflex artery (a-LFCA), considered to contribute to the blood supply of the tensor fasciae latae (TFL) muscle. To determine the morbidity of these surgical steps, periarticular muscle status and clinical outcomes were assessed after bikini-type DAA-THA with a-LFCA preservation versus ligation.</p><p><strong>Methods: </strong>We evaluated the surgical records of 140 patients undergoing DAA-THA with continuous attempt of a-LFCA preservation from May to October 2021. A total of 92 patients were eligible and 46 consented to study participation (n = 20 preservation, n = 26 ligation). Preoperative and six-week clinical and radiological data were retrospectively extracted from patient files, and patient-reported outcome measures (PROMs) from the institutional registry. Clinical and MRI examinations were performed two years postoperatively to analyze volume and fatty infiltration of the TFL, gluteus medius, and gluteus minimus relative to the contralateral hip. A total of 13 patients underwent contralateral THA and were excluded from the analysis of muscle status.</p><p><strong>Results: </strong>Coxa valga morphology and less muscular habitus were more frequent in a-LFCA preservation. After a-LFCA preservation, less anterolateral soft-tissue swelling was described at six weeks (p < 0.001) and TFL local pain at two years (p = 0.034) postoperatively. PROMs did not differ between groups. Mean TFL volume side-difference was not significantly different after a-LFCA preservation (p = 0.276), but it was significantly different after ligation (11.6% smaller (SD 15.5); p = 0.022). TFL fatty infiltration side-difference was larger after a-LFCA ligation (p = 0.010). Muscle status of the gluteus medius and minimus did not differ between sides and groups.</p><p><strong>Conclusion: </strong>a-LFCA preservation had a minor effect on TFL muscle status. Since preservation was primarily feasible in hips with simpler morphology, it remains uncertain whether differences were due to preserved vascularity or reduced TFL injury. Hence, a-LFCA preservation does not appear essential. However, until further evidence becomes available, attempting a-LFCA preservation may be advisable.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 5 Supple A","pages":"30-40"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040129","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":"Clinical effectiveness of an individually tailored strengthening programme, including progressive resistance exercises and advice, compared to usual care for ambulant adolescents with spastic cerebral palsy (ROBUST trial): a parallel group randomized controlled trial.","authors":"Sally Hopewell, David J Keene, Ioana Marian, Daniel C Perry, Ines Rombach, Morag Andrew, Catherine Barry, Loretta Davis, Gregory Firth, Heidi Fletcher, Beth Fordham, Vivi Gregory Osborne, Helen Gregory Osborne, Lesley Katchburian, Joanna O'Mahoney, Jeremy Parr, Rachel Rapson, Jennifer Ryan, Elnaz Saeedi, Megan Stone, Helen Wood, Tim Theologis","doi":"10.1302/2633-1462.65.BJO-2024-0268","DOIUrl":"https://doi.org/10.1302/2633-1462.65.BJO-2024-0268","url":null,"abstract":"<p><strong>Aims: </strong>Muscle strengthening exercises are one of the interventions frequently prescribed by physiotherapists for adolescents with cerebral palsy (CP). However, there is wide variability in the exercise regimes used and limited evidence of their effectiveness. The ROBUST trial will assess the clinical effectiveness of an individually tailored strengthening programme, including progressive resistance exercises and advice, compared to usual care for ambulant adolescents with spastic CP.</p><p><strong>Methods: </strong>We are conducting a multicentre, two-arm, parallel group, superiority randomized controlled trial. We will recruit adolescents aged 12 to 18 years with a diagnosis of spastic CP (bilateral or unilateral) Gross Motor Function Classification System (GMFCS) levels I to III who are able to comply with the assessment procedures and exercise programme with or without support. Participants will be recruited from at least 12 UK NHS Trust physiotherapy and related services. Participants (n = 334) will be randomized (centralized computer-generated 1:1 allocation ratio) to either: 1) a progressive resistance exercise programme, with six one-to-one physiotherapy sessions over 16 weeks; or 2) usual NHS care, with a single physiotherapy session and an assessment session, and advice regarding self-management and exercise.</p><p><strong>Conclusion: </strong>The primary outcome is functional mobility measured using the child-/parent-reported Gait Outcomes Assessment List (GOAL) at six months. Secondary outcomes are: clinician-assessed muscle strength (Five Times Sit-to-Stand Test) and motor function (timed up and go test) at six months; functional mobility (GOAL) at 12 months; independence (GOAL subdomain A), balance (GOAL subdomain A, B, D), pain and discomfort (GOAL subdomain C), health-related quality of life (youth version of the EuroQol five-dimension questionnaire; EQ-5D-Y), educational attendance, exercise adherence, and additional physiotherapy treatment (six and 12 months). The primary analysis will be intention to treat.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 5","pages":"517-527"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041938","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":"Diagnostic injections are predictive of similar improvements following total hip arthroplasty in patients with radiologically mild osteoarthritis.","authors":"Jamil S Kendall, Enrico M Forlenza, Daniel Shinn, Anne DeBenedetti, Aditya Yadav, Scott M Sporer","doi":"10.1302/2633-1462.65.BJO-2024-0239.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.65.BJO-2024-0239.R1","url":null,"abstract":"<p><strong>Aims: </strong>Intra-articular (IA) injections are a useful diagnostic tool in patients presenting with debilitating hip pain but radiologically mild osteoarthritis (OA). We aim to explore the clinical and patient-reported outcomes (PROs) associated with patients who have radiologically mild OA and undergo total hip arthroplasty (THA) after an IA injection.</p><p><strong>Methods: </strong>Patients undergoing primary, elective THA at a single centre between January 2017 and December 2023 were identified. Only those patients who underwent an IA injection into the operative hip within one year of surgery were included. Patients were divided into two cohorts based on the severity of their OA: those with Kellgren-Lawrence (KL) grade I to II arthritis were classified as 'mild', whereas those with KL grade III to IV arthritis were classified as 'severe'. Clinical outcomes and PROs, including the Hip disability and Osteoarthritis Outcome score for Joint Replacement, the Harris Hip Score, Single Assessment Numeric Evaluation, and Veterans Rand 12-Item Health Survey Mental and Physical subscales were compared between cohorts.</p><p><strong>Results: </strong>The final cohorts included 25 and 225 patients with radiologically mild and severe OA, respectively. There were no baseline differences in age, sex, or time between IA injection and THA between cohorts. There were no significant differences in the preoperative or postoperative PRO values between patients with mild or severe arthritis (all p > 0.05). There were no significant differences in the change in PRO scores from the preoperative to final follow-up, or the percentage of patients who achieved the minimal clinically important difference on any of the PROs between cohorts. There were also no significant differences in the studied complications between groups.</p><p><strong>Conclusion: </strong>Patients with radiologically mild OA who feel relief of their hip pain following an IA injection report similar preoperative debility and postoperative improvements in PROs following THA compared with patients with radiologically severe OA.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 5 Supple A","pages":"51-56"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017263","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":"The use of porous titanium acetabular augments in primary total hip arthroplasty for hip dysplasia or rapidly destructive coxopathy.","authors":"Nobuhiko Sugano, Wataru Ando, Kazunori Tamura, Yuki Maeda, Keisuke Uemura, Kazuma Takashima, Hidetoshi Hamada","doi":"10.1302/2633-1462.65.BJO-2024-0221.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.65.BJO-2024-0221.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to evaluate the efficacy of porous titanium acetabular augments in primary total hip arthroplasty (THA) for reconstruction of superolateral acetabular bone defects in patients with Crowe II or higher classes of developmental dysplasia of the hip (DDH) or rapidly destructive coxopathy (RDC).</p><p><strong>Methods: </strong>We conducted a retrospective evaluation of 27 patients (30 hips) who underwent primary THA using cementless cups and porous titanium acetabular augments. The follow-up periods ranged from two to 11 years, with a mean of 5.0 years. The cohort included 22 females (24 hips) and five males (six hips), with a mean age of 67 years (45 to 83) at the time of surgery.</p><p><strong>Results: </strong>At the final follow-up, there was no radiological evidence of loosening or radiolucency around the cups and augments, indicating successful biological fixation in all cases. Clinically, there was a significant improvement in the Western Ontario and McMaster Universities Osteoarthritis Index score, which improved from a mean of 39.1 (SD 14.7) preoperatively to 5.1 (SD 6.4) postoperatively.</p><p><strong>Conclusion: </strong>The use of cementless cups and porous acetabular titanium augments in primary THA for patients with DDH and RDC can lead to considerable clinical improvements and reliable biological fixation, suggesting their potential as a viable solution for managing challenging acetabular defects in these conditions.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 5 Supple A","pages":"57-64"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046191","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":"Deployment of real-time particle detection monitoring system in operating theatres for airborne contamination assessments : a methodological evaluation.","authors":"Frans Stålfelt, Johan Tenghamn, Henrik Malchau, Karin Svensson Malchau","doi":"10.1302/2633-1462.64.BJO-2025-0002","DOIUrl":"https://doi.org/10.1302/2633-1462.64.BJO-2025-0002","url":null,"abstract":"<p><strong>Aims: </strong>Surgical site infections (SSIs) are a major complication of orthopaedic implant surgeries, causing patient morbidity and reduced quality of life, and represent a substantial economic burden. Current methods for monitoring airborne contamination in operating theatres (OTs) are labour-intensive and delayed, limiting timely preventive actions. Advanced real-time monitoring technologies offer potential for improving infection control in surgical settings. This study evaluated real-time monitoring for airborne contamination; two scenarios were analyzed with the developed system: 1) the use of reusable non-disposable versus disposable surgical sheets; and 2) surgical team shift changes. SSI outcomes were also evaluated in relation to elevated particle levels.</p><p><strong>Methods: </strong>This study was conducted in four OTs at Sahlgrenska University Hospital, Sweden. Particle counters were employed in each OT for detection of airborne contamination for continuous surveillance. SSIs leading to reoperations were extracted from national registries and integrated into the analysis.</p><p><strong>Results: </strong>The use of reusable surgical sheets significantly reduced airborne particle concentrations across all sizes (0.5, 1, 5, and 10 µm; p = 0.022, p = 0.004, p = 0.009, and p = 0.015, respectively) compared with single-use sheets. Team shift changes were associated with increased airborne particle levels for 0.5, 1, and 5.0 µm (p = 0.001, p = 0.004, and p = 0.009, respectively). While smaller particle concentrations showed no consistent association with SSIs, larger particles (10 µm) were significantly elevated in SSI cases (p = 0.005 for maximum values and p = 0.009 for mean values).</p><p><strong>Conclusion: </strong>Real-time monitoring systems proved effective in identifying factors influencing airborne contamination in OTs. Notably, non-disposable sheets outperformed disposable sheets in minimizing particulate dispersion, and surgical events with team shift changes showed an increase in maximum particle levels. Although the system shows promise for infection prevention and workflow optimization, its direct impact on SSI rates requires validation in larger cohorts. Future research should focus on integrating predictive algorithms and machine-learning to enhance clinical utility and drive improvements in surgical safety.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 4","pages":"499-505"},"PeriodicalIF":2.8,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12017936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027369","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":"Conservative treatment versus hip arthroscopy in patients with femoroacetabular impingement : a multilevel meta-analysis of randomized controlled trials.","authors":"Nikolai Ramadanov, Jonathan Lettner, Maximilian Voss, Robert Hable, Robert Prill, Dobromir Dimitrov, Roland Becker","doi":"10.1302/2633-1462.64.BJO-2024-0198.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.64.BJO-2024-0198.R1","url":null,"abstract":"<p><strong>Aims: </strong>Femoroacetabular impingement (FAI) is a serious cause of hip pain with loss of function, and development of osteoarthritis of the hip. The aim of this multilevel meta-analysis of randomized controlled trials (RCTs) was to evaluate the outcomes of FAI patients treated conservatively compared with those treated with hip arthroscopy (HAS).</p><p><strong>Methods: </strong>A systematic literature search of PubMed, CENTRAL of the Cochrane Library, Epistemonikos, and Embase databases was conducted up to 30 June 2024. In a frequentist multilevel meta-analysis with random effects model, means with 95% CIs were calculated separately in the conservative treatment subgroup and the HAS subgroup. A test for subgroup differences in meta-analysis was then performed to determine whether there was a statistically significant difference between the means of the two subgroups. Clinical assessment was based on Harris Hip Score (HHS), the International Hip Outcome Tool (iHOT), the Hip disability and Osteoarthritis Outcome Score (HOOS), the Hip Outcome Score Activities of Daily Living (HOS-ADL), and visual analogue scale (VAS) for pain.</p><p><strong>Results: </strong>A total of 21 RCTs, including 674 patients in the conservative treatment subgroup and 1,125 patients in the HAS subgroup, met the inclusion criteria. The test for subgroup differences showed that the HAS subgroup had a statistically significant 6.5-point higher HHS ≤ 12 months post-intervention (<i>F</i> = 12.8; df = 1.5; p = 0.016) and a statistically significant 9.8-point higher iHOT ≤ 24 months post-intervention (<i>F</i> = 5.3; df = 1.1; p = 0.035) than the conservative treatment subgroup. Other functional (HOOS, HOS) and pain (VAS, NRS) outcome parameters analyzed did not show statistically significant differences.</p><p><strong>Conclusion: </strong>This multilevel meta-analysis of 21 RCTs with a total of 1,799 FAI patients showed a statistically significant higher HHS ≤ 12 months post-intervention and iHOT ≤ 24 months post-intervention, favouring the HAS subgroup compared to the conservative treatment subgroup, without reaching minimal clinically important differences (MCIDs).</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 4","pages":"480-498"},"PeriodicalIF":2.8,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12014245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064950","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 the rehabilitation interventions for people with an acute patellar dislocation in the Physiotherapy Rehabilitation Post Patellar Dislocation (PRePPeD) pilot randomized controlled trial.","authors":"Colin P Forde, Matthew L Costa, Elizabeth Tutton, Jonathan A Cook, David J Keene","doi":"10.1302/2633-1462.64.BJO-2024-0174","DOIUrl":"https://doi.org/10.1302/2633-1462.64.BJO-2024-0174","url":null,"abstract":"<p><strong>Aims: </strong>To develop the rehabilitation interventions for people with an acute patellar dislocation in the Physiotherapy Rehabilitation Post Patellar Dislocation (PRePPeD) pilot randomized controlled trial (RCT), and to describe how these interventions are delivered.</p><p><strong>Methods: </strong>We developed the interventions drawing on a range of established intervention development approaches and frameworks. We selected intervention components after reviewing the existing evidence, clinical guidelines, UK NHS practice, and relevant scientific theory. We then created early versions of the interventions, and discussed these with clinical experts and patient and public partners. We finalized the interventions considering their feedback, findings from our preliminary study, and what would be acceptable and deliverable in the UK NHS.</p><p><strong>Results: </strong>Upon randomization, all participants receive a workbook containing advice and initial exercises to implement before their first physiotherapy session. Self-managed rehabilitation then involves a single one-to-one session with a physiotherapist who provides advice, introduces a structured home exercise programme, and uses strategies to support exercise adherence. Participants then continue their recovery independently. Supervised rehabilitation involves four to six one-to-one physiotherapy sessions over a maximum of six months. Physiotherapists also provide advice, prescribe home exercise, and use exercise adherence strategies. Routine follow-up sessions enable physiotherapists to reassess participants and tailor the advice and exercises accordingly.</p><p><strong>Conclusion: </strong>The interventions were developed and are currently being assessed in the PRePPeD pilot RCT. This will determine whether a full-scale RCT comparing these interventions is feasible. Results are anticipated in Summer 2025.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 4","pages":"469-479"},"PeriodicalIF":2.8,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12011453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037598","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}