Bone & Joint Open最新文献

{"title":"Developing a new CT-based bone defect classification in revision knee arthroplasty : a Delphi consensus study.","authors":"Maaike R de Bondt, Simon N van Laarhoven, Gijs G van Hellemondt, Andrew Porteous, Gabriëlle J M Tuijthof, Petra J C Heesterbeek, Paolo Adravanti, Abtin Alvand, Michele d'Amato, Andrea Baldini, Cecile Batailler, Johan Bellemans, Friedrich Boettner, Stefano Campi, Sebastiaan van de Groes, Andreas Halder, Michael Hirschmann, Siegfried Hofmann, William Jackson, Gareth Jones, Lucien Keijser, Robin van Kempen, Wolfgang Klauser, Peter Koch, Vicente J León-Muñoz, Nick London, Sébastien Lustig, Thomas Luyckx, Sam Oussedik, Jonathan Phillips, Stefano Rossi, Federica Rosso, Emmanuel Thienpont, Hilde Vandenneucker, Ben Waterson, Frank-Christiaan Wagenaar, Remco van Wensen, Tommy de Windt, Francesco Zambianchi","doi":"10.1302/2633-1462.710.BJO-2026-0188.R1","DOIUrl":"10.1302/2633-1462.710.BJO-2026-0188.R1","url":null,"abstract":"<p><strong>Aims: </strong>To seek consensus on the principles and criteria necessary to develop a CT-based bone defect classification (BDC) for revision knee arthroplasty.</p><p><strong>Methods: </strong>A three-round structured Delphi study was conducted. First, five interviews were held with international knee revision experts to support the development of 29 statements. Two consecutive rounds of Delphi survey statements were distributed among 56 international knee revision experts in the first round, and to 37 in the second round. Consensus (≥ 80% agreement) was sought on the statements covering bone defect definitions, imaging, and zonal assessment.</p><p><strong>Results: </strong>A total of 37 experts responded to the first survey round, and 34 also completed the second round. Consensus was reached on 93% of the statements after both survey rounds. Experts agreed that a BDC should guide both surgical planning and implant selection, and that CT imaging improves knee revision bone defect assessment. Consensus was also reached on the definition of a bone defect. While anatomical zones (epiphysis, metaphysis, diaphysis) were considered important for inclusion in a BDC, the results showed no consensus on which landmarks define these anatomical zones.</p><p><strong>Conclusion: </strong>The expert panel indicated that CT evaluation and distinct assessment of anatomical zones are essential in a (new) BDC, although no consensus was reached on the definition of those anatomical zones. Moreover, a CT-based BDC should be useful for guiding surgical planning and implant selection.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 10","pages":"1272-1279"},"PeriodicalIF":3.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138525","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":"Pelvic tilt, impingement simulation, and the limits of static planning in robotic total hip arthroplasty.","authors":"Sayf Faraj, Andreas Fontalis, James Li, Fares S Haddad","doi":"10.1302/2633-1462.710.BJO-2026-0228","DOIUrl":"10.1302/2633-1462.710.BJO-2026-0228","url":null,"abstract":"","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 10","pages":"1269-1271"},"PeriodicalIF":3.3,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138539","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 rate of total hip arthroplasty after closed reduction of late-detected hip dislocation : 147 hips followed to patient age 70 years.","authors":"Terje Terjesen, Anders Wensaas","doi":"10.1302/2633-1462.710.BJO-2026-0171.R1","DOIUrl":"10.1302/2633-1462.710.BJO-2026-0171.R1","url":null,"abstract":"<p><strong>Aims: </strong>The outcome of late-detected developmental dysplasia and dislocation of the hip (DDH) deteriorates with the length of follow-up. The aims of this study were to explore the rate of total hip arthroplasty (THA) with follow-up to patient age 60 to 76 years, and to define risk factors for THA.</p><p><strong>Methods: </strong>Inclusion criteria were patient age at diagnosis < three years, closed reduction, and no acetabular procedures. A total of 114 patients (147 hips) met these criteria: 98 females and 16 males with a mean age of 1.4 years (0.4 to 2.7). Residual acetabular dysplasia was defined as centre-edge (CE) angle < 20° at skeletal maturity. Information on THA was obtained from the Norwegian Arthroplasty Register.</p><p><strong>Results: </strong>Overall, 39% of the hips (n = 54) had residual dysplasia at skeletal maturity, with a mean CE angle of 14.9° (7° to 19°). In total, 52 hips (35%) had undergone THA at a mean patient age of 53.2 years (33 to 71). Risk factors for THA were residual acetabular dysplasia and severe degree of avascular necrosis. Kaplan-Meier survival analysis, with THA as the endpoint, showed survival rates of 95% in hips without residual acetabular dysplasia at patient age 50 years and 76% at 70 years. In hips with residual dysplasia, the survival rate was 83% at age 50 years and 41% at 70 years. The estimated mean survival time was significantly lower in hips with residual dysplasia than in hips without dysplasia (62.6 years vs 71.4 years; p < 0.001).</p><p><strong>Conclusion: </strong>The long-term outcome was very good in hips with no residual dysplasia at skeletal maturity. Only 24% of such hips had undergone THA at patient age 70 years. Dysplastic hips showed markedly worse outcomes, with a THA rate of 59% at 70 years. Routine concurrent pelvic osteotomy at the time of reduction in children < three years at diagnosis is hardly indicated.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 10","pages":"1261-1268"},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138528","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":"Efficacy of topical vancomycin in preventing surgical site infection following fracture surgery : a systematic review and meta-analysis.","authors":"Neel Badhe, Amelia Hutton, Abbas See, Benjamin J Ollivere, Ben Arthur Marson","doi":"10.1302/2633-1462.710.BJO-2026-0126.R1","DOIUrl":"10.1302/2633-1462.710.BJO-2026-0126.R1","url":null,"abstract":"<p><strong>Aims: </strong>Fracture-related infection (FRI) is a major cause of morbidity following limb fracture surgery. Topical vancomycin has gained popularity as an adjunct to systemic prophylaxis; however, concerns regarding nephrotoxicity, impaired bone healing, and wound complications remain. This review aims to evaluate the efficacy and safety of intraoperative topical vancomycin powder in preventing FRI in patients undergoing surgical management of upper or lower limb fractures.</p><p><strong>Methods: </strong>A systematic review of randomized controlled trials (RCTs) was conducted in February 2026. Comprehensive searches of Medline, EMBASE, and Cochrane CENTRAL were performed. Trials were included if they randomized patients with limb fractures between intraoperative topical vancomycin powder and no vancomycin, placebo, or standard care. The primary outcome was FRI or deep surgical site infection (SSI). Secondary outcomes included time to FRI, organism profile, antimicrobial resistance, superficial SSI, nonunion, revision surgery, wound healing problems, renal impairment, and other reported complications.</p><p><strong>Results: </strong>Five studies involving 1,373 patients were included. Topical vancomycin significantly reduced FRI rates compared with controls (risk ratio (RR) 0.64 (95% CI 0.43 to 0.96); p = 0.030). A significant reduction in FRIs caused by gram-positive organisms was identified in patients given topical vancomycin (RR 0.41 (95% CI 0.24 to 0.71); p = 0.001). No differences in FRIs caused by gram-negative or resistant organisms were identified. There were no significant differences in superficial SSI, nonunion rates, wound healing, or other complications. Topical vancomycin was not associated with a significant risk of nephrotoxicity.</p><p><strong>Conclusion: </strong>Topical vancomycin powder may be a safe and effective adjunct to standard systemic prophylaxis for preventing FRI, particularly in reducing gram-positive infections. However, current evidence is limited by a lack of high-quality RCTs and small sample sizes. A large, definitive RCT is needed to determine the efficacy, safety, and cost-effectiveness of topical vancomycin in limb fracture surgery.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 10","pages":"1253-1260"},"PeriodicalIF":3.3,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138491","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":"To scan or not to scan? The image debate in robotic joint arthroplasty.","authors":"Warran Wignadasan, Andreas Fontalis, Fares S Haddad","doi":"10.1302/2633-1462.710.BJO-2026-0223","DOIUrl":"10.1302/2633-1462.710.BJO-2026-0223","url":null,"abstract":"","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 10","pages":"1248-1252"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138482","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":"Tibial migration of a novel cementless total knee arthroplasty : a multicentre radiostereometric analysis study.","authors":"Douglas D R Naudie, Brent A Lanting, Eric Bohm, Matthew Teeter, Christiaan Righolt, Thomas Robert Turgeon, Trevor Gascoyne","doi":"10.1302/2633-1462.79.BJO-2026-0178.R1","DOIUrl":"10.1302/2633-1462.79.BJO-2026-0178.R1","url":null,"abstract":"<p><strong>Aims: </strong>The search for enhanced fixation and longevity in total knee arthroplasty (TKA) continues. Radiostereometric analysis (RSA) allows early detection of implant migration predictive of future aseptic loosening and is the recommended method for evaluating new implants. This multicentre RSA study evaluated early fixation and migration stability of a novel cementless tibial baseplate used in primary TKA.</p><p><strong>Methods: </strong>A total of 30 patients undergoing primary TKA were enrolled at two academic centres. All patients received a porous cementless tibial baseplate combined with either a cementless or cemented femoral component. The patella was selectively resurfaced based on surgeon preference and was resurfaced using either a cementless onlay or a cemented inset biconvex design. During surgery, RSA beads were inserted into the tibia, femur, and patella. RSA examinations were performed at six weeks (baseline), six months, 12 months, and 24 months postoperatively. The primary outcome was change in maximum total point motion (MTPM) of the tibial baseplate over 24 months. Secondary outcomes included component migration patterns and patient-reported outcome measures (PROMs).</p><p><strong>Results: </strong>In total, 29 patients completed minimum 24-month follow-up. Mean tibial baseplate MTPM was 1.018 mm (SD 0.742) at six months and 1.210 mm (SD 0.571) at 24 months. The change in MTPM between six and 12 months was -0.096 mm (SD 0.551) and between 12 and 24 months was 0.095 mm (SD 0.603), remaining below accepted RSA thresholds associated with increased risk of aseptic loosening. Translational and rotational migration stabilized by six months. Patients reported substantial improvement in functional (Oxford Knee Score, Forgotten Joint Score) and health-related (EuroQol five-dimension questionnaire) PROMs and high satisfaction at 12 and 24 months.</p><p><strong>Conclusion: </strong>This novel cementless tibial baseplate demonstrated early stabilization with no evidence of continuous migration over two years. These RSA findings suggest a low risk of future aseptic loosening, and support the early fixation performance of this implant design.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 9","pages":"1239-1247"},"PeriodicalIF":3.3,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991413","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":"Radiological pattern of hip osteoarthritis is associated with one-year patient-reported outcomes but not long-term mortality or revision after total hip arthroplasty : a retrospective case series.","authors":"Conor J McCann, Nick D Clement, John M Bayram, Gillian Leitch, Chloe E H Scott","doi":"10.1302/2633-1462.79.BJO-2025-0332.R3","DOIUrl":"10.1302/2633-1462.79.BJO-2025-0332.R3","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to determine the effect of the radiological patterns of hip osteoarthritis (OA) on patient-reported outcome measures (PROMs) at one year following total hip arthroplasty (THA) and their impact on long-term mortality and survivorship.</p><p><strong>Methods: </strong>This retrospective study assessed the outcomes of 445 patients with primary hip OA undergoing THA. Plain radiographs were assessed to determine the Kellgren-Lawrence grading, the radiological pattern of arthritis (hypertrophic, atrophic, or mixed) and the predominant location of wear. PROMs assessed included the EQ-5D-3L and Oxford Hip Score (OHS) preoperatively and at 12 months postoperatively. The minimum follow-up for surviving patients was 14.7 years. Across the cohort, including patients who died during follow-up, the mean follow-up was 12.3 years (1.0 to 15.6), with patients censored at death. Multivariable linear regression models were used to evaluate independent predictors of postoperative PROM scores, mortality, and revision.</p><p><strong>Results: </strong>In all, 284 females (63.5%) and 161 males (36.5%) were included. Females were more likely to have atrophic OA (n = 120; (42.3%) vs n = 47; (29.2%); p < 0.001). Males were more likely to have hypertrophic OA (n = 52; (32.3%) vs n = 47; (16.5%); p < 0.001). One-year PROM improvement differed by OA pattern: hypertrophic OA had the greatest mean improvement in OHS (+22.6 (SD 7.4)) and EQ-5D-3L (+0.45 (SD 0.32)), compared with mixed (+18.6 (SD 9.5), +0.35 (SD 0.32)) and atrophic OA (+17.3 (SD 11.3), +0.33 (SD 0.32)) OHS (p < 0.001) and EQ-5D-3L (p = 0.005). After adjustment for covariates, atrophic OA remained independently associated with lower postoperative OHS and EQ-5D-3L scores compared with hypertrophic OA. Mortality and revision rates did not differ between OA pattern groups.</p><p><strong>Conclusion: </strong>Radiological pattern of hip OA was associated with differences in one-year PROMs following THA. Patients with atrophic OA had smaller improvements following surgery compared with counterparts with hypertrophic OA. No differences were observed in long-term mortality or revision. Radiological pattern may represent a clinically relevant marker of postoperative functional improvement.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 9","pages":"1226-1238"},"PeriodicalIF":3.3,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983569","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":"'Waiting poorly' for hip and knee arthroplasty - unmet needs and lack of support while waiting for surgery : findings of the multicentre WAIT-DATA study.","authors":"Conor J McCann, Nick D Clement, Christopher Gee, Jon Clarke, Phil Walmsley, Nicholas E Ohly, David Deehan, Deiary F Kader, Ciara Stevenson, Andrew J Hall, Nimra Akram, Fareed Al Qusous, Almigdad Ali, Danielle Archer, Dheeraj Attarde, Megan Bates, Stuart Bell, Pragya Bhatt, Louise Bluck, Andrew Blythe, Alexander Boucher, Tracy Broadbent, Justine Burt, Ethan Caruana, Jon Clarke, Nick Clement, Andrew Coppola, Andrew Crone, Angelo David, David Deehan, Ha Phuong Do Le, Fraser EwenFraser, Christopher Gee, Catherine Gilmore, Christopher Goodland, Dariusz Gunia, Andrew Hall, Shady Hermena, George Holland, Nicholas Holloway, Lauren Hutchinson, Azka Ikram, Stuart Irvine, Andrea Jimenez, Deiary Kader, Roberty Kay, Ronan Kearney, Matt Kennedy, Elizabeth Lindsay, Harrison Loader, Emma Lunan, Panos Mastorakos, Daryl Mcauley, Carolyn McCafferty, Conor McCann, Heidi McColm, Joshua McIntyre, Nicole McLaughlin, David Munn, Jagdesh Nijjher, Esther Nyobendo, Henry O'Brien, Nicholas Ohly, Jeya Palan, Joshua Patton, Sai Pendyala, Jane Peters, Patrick Porter, Bilal Qaddoura, Muhammad Humza Qadri, Conor Rankin, Ahmed Sanalla, Sobha Singh, Karen Smith, Lauren Smith, Ciara Stevenson, Gemma Toland, Phil Walmsley","doi":"10.1302/2633-1462.79.BJO-2026-0132.R1","DOIUrl":"10.1302/2633-1462.79.BJO-2026-0132.R1","url":null,"abstract":"<p><strong>Aims: </strong>In socialized health systems, prolonged waiting times for hip and knee arthroplasty lead to progressive decline in patients' health-related quality of life. This multicentre study aimed to evaluate patients' experience of the information, advice, and support received during the waiting period, and to identify which groups feel least supported.</p><p><strong>Methods: </strong>This study was a multicentre prospective observational audit including 851 patients undergoing elective hip or knee arthroplasty across 14 hospitals in the UK. Participants completed a standardized questionnaire assessing satisfaction with nine domains of preoperative information and support, each rated on a five-point Likert scale. Composite scores for information and advice and support were generated, and associations with demographic, clinical, and psychosocial variables were examined using multivariable linear regression.</p><p><strong>Results: </strong>Overall satisfaction was moderate. Patients were generally well informed about their condition (mean 4.14 (SD 0.92)) and operation (mean 4.34 (SD 0.88)), but less satisfied with support for weight management (mean 3.49 (SD 0.98)), general health (mean 3.54 (SD 1.01)), and mental wellbeing (mean 3.46 (SD 1.02), p < 0.001). Older age, obesity, socioeconomic deprivation, and new physical or mental health diagnoses were associated with lower satisfaction, though most effects were small. Larger effects were seen between self-reported deterioration in health and quality of life and dissatisfaction with waiting time. Almost half of the patients reported opioid use, and most described worsening function and activity while waiting.</p><p><strong>Conclusion: </strong>Patients awaiting hip or knee arthroplasty experience substantial physical and psychological decline, compounded by limited holistic support. While procedural information is generally adequate, guidance on lifestyle, wellbeing, and self-management is lacking. The waiting period should be reframed as an active phase of care, with coordinated, multidisciplinary input and clearer responsibility among care providers to ensure patients receive appropriate support.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 9","pages":"1215-1225"},"PeriodicalIF":3.3,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148971620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative outcomes of Bernese periacetabular osteotomy in adolescents, young adults, and middle-aged adults : a minimum two-year follow-up.","authors":"Yu-Hung Chen, Chia-Che Lee, Kuan-Wen Wu, Yu-Han Chen, Shu-Hsin Yao, Tsung-Lin Lee, Ken N Kuo, Ting-Ming Wang","doi":"10.1302/2633-1462.79.BJO-2025-0361.R1","DOIUrl":"10.1302/2633-1462.79.BJO-2025-0361.R1","url":null,"abstract":"<p><strong>Aims: </strong>Bernese periacetabular osteotomy (PAO) is a well-established procedure for symptomatic hip dysplasia in adolescents and young adults. Its application in middle-aged patients remains debated due to concerns regarding complications and uncertain outcomes. This study evaluated the safety and effectiveness of PAO in middle-aged patients by comparing minimum two-year outcomes with those of younger cohorts.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients who underwent PAO between June 2015 and December 2021 with a minimum two-year follow-up. Patients with previous hip surgery or systemic conditions affecting outcomes were excluded. The final cohort comprised 27 hips in 16 adolescents (Group A, 11 to 19 years), 24 hips in 18 young adults (Group B, 20 to 39 years), and 17 hips in 14 middle-aged adults (Group C, 40 to 57 years). Radiological parameters, complications, and patient-reported outcomes (PROs), including visual analogue scale (VAS) pain scores, and modified Harris Hip Score (mHHS), were compared among groups.</p><p><strong>Results: </strong>All age groups demonstrated significant improvements in radiological parameters and PROs. Median mHHS improved from 84.7 (IQR 84.7 to 84.7) to 95.7 (IQR 95.7 to 100) in Group A, 81.4 (IQR 75.9 to 84.7) to 95.7 (95.7 to 100) in Group B, and 73.7 (66.0 to 75.9) to 95.7 (90.2 to 100) in Group C. No significant between-group differences in radiological parameters or PROs were observed at final follow-up. Complication rates were comparable across groups except for osteotomy site healing. The middle-aged group demonstrated longer osteotomy union times than the adolescent and young adult groups (median 13 months (IQR 10 to 14) vs six months (IQR 6 to 11) vs six months (IQR 5 to 7); (p < 0.001). Delayed union did not adversely affect functional outcomes or rehabilitation.</p><p><strong>Conclusion: </strong>Carefully selected middle-aged patients with hip dysplasia demonstrated favourable radiological and functional outcomes after PAO despite longer osteotomy union times, with complication rates comparable with younger cohorts. These findings support the safety and effectiveness of PAO in selected middle-aged patients with dysplasia-associated Tönnis grade I to II osteoarthritis.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 9","pages":"1204-1214"},"PeriodicalIF":3.3,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963703","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":"Clinical characteristics and risk factors of recurrence for Pseudomonas aeruginosa-associated fracture-related infection following surgical treatment : a 12-year retrospective cohort study.","authors":"Hongri Wu, Shengpeng Yu, Dong Sun, Shuling Wang, Xiaohua Wang, Jing Fu, Zhao Xie, Jie Shen","doi":"10.1302/2633-1462.79.BJO-2026-0015.R1","DOIUrl":"10.1302/2633-1462.79.BJO-2026-0015.R1","url":null,"abstract":"<p><strong>Aims: </strong><i>Pseudomonas aeruginosa</i> (PA), a prevalent Gram-negative pathogen in fracture-related infections (FRIs), presents huge therapeutic challenges due to biofilm formation and multidrug resistance (MDR). Evidence-based guidelines for PA-associated FRI (PA-FRI) remain limited. The aim of the present study was to delineate the clinical characteristics of PA-FRI and associated risk factors of recurrence, and to provide actionable insights for optimizing antibiotic stewardship, refining surgical protocols, and reducing the burden of PA-FRI recurrence.</p><p><strong>Methods: </strong>This retrospective cohort study examined 147 cases of PA-FRI involving limb fractures treated at our centre from January 2012 to December 2023. Demographic, microbiological, and clinical parameters were evaluated with ≥ 24-month follow-up. Multivariate regression analysis was conducted to identify risk factors for recurrence.</p><p><strong>Results: </strong>The cohort (mean age 45.06 years (SD 13.83)) showed a predominance of tibial fractures (69.4%; 102 out of 147). MDR-PA prevalence increased from 33.3% (2012 to 2014) to 58.6% (2021 to 2023), accounting for 44.9% (n = 66) of isolates. Coinfection with <i>Staphylococcus aureus</i> occurred in 17 cases (11.6%). Initial debridement and antibiotic therapy achieved infection control in 132 cases (89.8%), with persistence in 10.2% (n = 15). At a median 36-month follow-up (IQR 30 to 48), recurrence occurred in 15.6% (n = 23) after documented resolution of infection. Nine patients (6.1%) required amputation, while the remaining 14 achieved infection-free union. Multivariate logistic regression identified the following risk factors for recurrence: post-debridement internal fixation (odds ratio (OR) 4.85 (95% CI 1.00 to 23.36)); multiple prior debridements (two or more) (OR 6.00 (95% CI 1.02 to 35.37)); MDR-PA infection (OR 11.33 (95% CI 1.95 to 65.91)); long-term polymethylmethacrylate spacer retention (OR 9.32 (95% CI 2.08 to 41.80)); and shorter duration (less than four weeks) of systemic antibiotics (including intravenous and oral) (OR 7.84 (95% CI 2.02 to 30.40)). Delayed surgical intervention (more than ten weeks from the time of initial injury to the index debridement surgery) was associated with a reduced risk of recurrence compared with acute/sub-acute interventions (OR 0.16 (95% CI 0.04 to 0.63)).</p><p><strong>Conclusion: </strong>The high MDR prevalence and recurrence rates underscore persistent challenges in PA-FRI. This study identifies key modifiable risk factors and establishes a risk-stratified framework to guide preoperative optimization, antimicrobial stewardship, and surgical decision-making.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 9","pages":"1194-1203"},"PeriodicalIF":3.3,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148930758","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}