Bone & Joint Open最新文献

{"title":"Patient-reported outcomes three months after treatment of metacarpal and phalangeal fractures or dislocations : a multicentre snapshot study.","authors":"Louise E M de Haas, Veronique A P van de Lücht, Bastiaan T van Hoorn, Dorien A Salentijn, Rolf H H Groenwold, Niels W L Schep, Mark van Heijl, Elke Arts, Said Bachiri, Reinier Beks, Leonie Blom, Doeke Boersma, Jan T Bosch, Floor Ter Brugge, Niels Bruggeman, Brigitte van der Heijden, Priscilla Jawahier, Pieter Joosse, Siegrid de Meer, Amanda Nijhuis, Jan Siert Reinders, Luke van Rossenberg, Friso Schonk, David Tas, Michiel Teijgeler, Tim Timmers, Ruben van Veen, Detlef van der Velde, Stephanie Zielinski","doi":"10.1302/2633-1462.62.BJO-2024-0146.R1","DOIUrl":"10.1302/2633-1462.62.BJO-2024-0146.R1","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate patient-reported outcomes three months after treatment of metacarpal and phalangeal fractures or dislocations, and to identify factors that are associated with worse patient-reported outcomes.</p><p><strong>Methods: </strong>This cross-sectional, multicentre snapshot study included all adult patients with metacarpal and phalangeal fractures or dislocations during a three-month period between August and October 2020. The primary outcome was the Michigan Hand Outcomes Questionnaire (MHQ) three months after injury. The MHQ scores were compared to normative MHQ scores of 90 points of the affected hand of patients who sustained unilateral trauma derived from a previous study. Subgroup analyses were performed for the most common injury types. Multivariable linear regression was used to study associations between patient characteristics and worse MHQ scores.</p><p><strong>Results: </strong>The MHQ scores of 512 patients were analyzed. The median MHQ score was 80 (IQR 65 to 91) for nonoperatively treated patients (n = 398) and 78 (IQR 66 to 85) for operatively treated patients (n = 114). After nonoperative treatment, 104/398 patients (26%) reached a MHQ score equal to or better than the normative MHQ score, ranging between 11% (1/9) and 42% (13/31) among the nine most common injury types. After operative treatment, this was 11% (13/114), ranging between 10% (3/29) and 31% (5/16) among the three most common injury types. No significant differences in MHQ scores were found between common injury types. Older age, the presence of hand comorbidities, and referral to hand therapy were associated with a worse MHQ score after nonoperative treatment.</p><p><strong>Conclusion: </strong>These results suggest that most patients have not returned to a normal hand function within three months following metacarpal and phalangeal fractures or dislocations. Older age, the presence of hand comorbidities, and referral for hand therapy were associated with worse hand functioning after nonoperative treatment. The findings are relevant for clinicians to evaluate recovery and for patients to manage their expectations.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 2","pages":"227-236"},"PeriodicalIF":2.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11863288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does composite bone resection for soft-tissue sarcoma with cortical contact result in better local control and survival compared to sub-periosteal dissection? : a comparative retrospective cohort study.","authors":"Hao Qu, Keyi Wang, Cangyi Shi, Hengyuan Li, Xiumao Li, Peng Lin, Nong Lin, Zhaoming Ye","doi":"10.1302/2633-1462.62.BJO-2024-0057.R2","DOIUrl":"10.1302/2633-1462.62.BJO-2024-0057.R2","url":null,"abstract":"<p><strong>Aims: </strong>Osseous invasion exhibited in soft-tissue sarcoma (STS) is recognized as a prognostic risk factor. Achieving a wide margin is the default surgical approach for local control. However, for STSs where the tumour is in contact with the adjacent cortex but without clear evidence of osseous invasion, such as medullary invasion, the question of whether bone resection can provide better local control or survival than more conservative sub-periosteal excision remains controversial. The aim of this study was to assess whether bone resection for thigh STS with cortical contact of the adjacent bone results in better local control and survival compared to sub-periosteal dissection, and to investigate the prognostic factors for clinical outcomes in STS.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on 142 patients with thigh STS exhibiting cortical contact but without medullary invasion, from May 2000 to May 2020. Patients underwent either composite bone resection or sub-periosteal excision. Demographics, clinical outcomes, and functional outcomes were compared between the two groups. Additionally, Cox regression analysis was used to analyze risk factors for local recurrence.</p><p><strong>Results: </strong>The five-year overall survival, local recurrence-free survival, and metastasis-free survival among patients with bone resection was 74.0%, 65.9%, and 74.1%, respectively, compared to 72.9%, 68.3%, and 72.0%, respectively, among patients with sub-periosteal excision. The cumulative incidence of recurrence was 33.1% for patients who underwent bone and 36.4% for those with sub-periosteal excision (p = 0.681). In multivariate analysis, STS with high Fédération Nationale des Centres de Lutte Contre Le Cancer (FNCLCC) grade, invasion involving posterior intermuscular septum, medial intermuscular septum, and adductor brevis were found to be associated with poorer prognosis. The mean Musculoskeletal Tumor Society (MSTS) score in the bone resection group was 24.7, significantly lower than the 28.3 in the sub-periosteal group (p < 0.001).</p><p><strong>Conclusion: </strong>Routine bone resection failed to improve local control or survival in STS patients with cortical bone contact, but resulted in significantly impaired postoperative function. A more conservative sub-periosteal excision approach may be preferable for these cases.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 2","pages":"215-226"},"PeriodicalIF":2.8,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11866206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493880","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":"Prioritizing orthopaedic evidence uncertainties : expert consensus based on a modified DELPHI study and a focus group.","authors":"Annabelle R Iken, Maaike G J Gademan, Barbara A M Snoeker, Thea P M Vliet Vlieland, Rudolf W Poolman, T Gosens, S A W van de Groes, M C van der Steen, P C Jutte, Y V Kleinlugtenbelt, M E Major, B J E de Lange-Brokaar, A F Lenssen, W O Zimmermann, G A W Bruijn, J Zwerver, R J Derksen, E G M Pels","doi":"10.1302/2633-1462.62.BJO-2024-0053.R1","DOIUrl":"10.1302/2633-1462.62.BJO-2024-0053.R1","url":null,"abstract":"<p><strong>Aims: </strong>To develop a multidisciplinary health research agenda (HRA) utilizing expertise from various disciplines to identify and prioritize evidence uncertainties in orthopaedics, thereby reducing research waste.</p><p><strong>Methods: </strong>We employed a novel, structured framework to develop a HRA. We started by systematically collecting all evidence uncertainties from stakeholders with an interest in orthopaedic care, categorizing them into 13 sub-themes defined by the Dutch Orthopaedic Association (NOV). Subsequently, a modified two-phased Delphi study (two rounds per phase), adhering to the Conducting and REporting DElphi Studies (CREDES) guideline, was conducted. In Phase 1, board members assessed the collected evidence uncertainties on a three-point Likert scale to confirm knowledge gaps. In Phase 2, diverse stakeholders, including orthopaedic surgeons, rated the confirmed knowledge gaps on a seven-point Likert scale. Panel members rated one self-selected sub-theme and two randomly assigned sub-themes. The results from Phase 2 were ranked based on the overall average score for each uncertainty. Finally, a focus group discussion with patient associations' representatives identified their top-ranked uncertainty from a predefined consensus process, leading to the final HRA. An advisory board, the Federation of Medical Specialists, and the NOV research coordinator oversaw the process.</p><p><strong>Results: </strong>Of the 687 collected evidence uncertainties, 160 (zero to 33 per theme) were confirmed by 41 panel members (three to five per theme). In Phase 2, 124 panel members prioritized 41 evidence uncertainties (zero to five per theme). The focus group members identified 12 key evidence uncertainties leading to the final HRA. The remaining 29 evidence uncertainties will be addressed after research on the HRA's prioritized evidence uncertainty is completed.</p><p><strong>Conclusion: </strong>Our framework resulted in a multidisciplinary HRA, enabling an inclusive approach to consensus-building among healthcare professionals and patients on future research priorities within orthopaedic care. We anticipate this innovative framework will enhance inclusivity and transparency, leading to broader acceptance and optimized resource allocation, ultimately reducing research waste.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 2","pages":"206-214"},"PeriodicalIF":2.8,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442117","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":"Outcomes of conversion total hip arthroplasty following previous hip fracture surgery.","authors":"Amr Selim, Debashis Dass, Siddharth Govilkar, Ashley J Brown, Saket Bonde, Benjamin Burston, Geraint Thomas","doi":"10.1302/2633-1462.62.BJO-2024-0188.R1","DOIUrl":"10.1302/2633-1462.62.BJO-2024-0188.R1","url":null,"abstract":"<p><strong>Aims: </strong>The conversion of previous hip fracture surgery to total hip arthroplasty (CTHA) can be surgically challenging with unpredictable outcomes; reported complication rates vary significantly. This study aimed to establish the medium-term survival and outcomes of CTHA performed following a previous hip fracture surgery.</p><p><strong>Methods: </strong>All CTHAs performed at our tertiary orthopaedic institution between January 2008 and January 2020 following previous ipsilateral hip fracture surgery were included. Patients were followed up clinically using Oxford Hip Scores (OHS), and radiologically until death or revision surgery. Postoperative complications, radiological implant failure, and indications for revision surgery were reviewed.</p><p><strong>Results: </strong>A total of 166 patients (167 hips) were included in the study, with a mean age of 71 years (42 to 99). Of these, 113 patients (67.7%) were female. CTHA followed cannulated screw fixation in 75 cases, hemiarthroplasty in 18, dynamic hip screw fixation in 47, and cephalomedullary nail in 27 cases. Patients were followed up for a mean of four years (0.1 to 9.3). During the follow-up period, 32 patients (19.2%) died. Overall, 14 patients (8.4%) suffered a complication of surgery, with intraoperative fractures (4.2%) and dislocations (3.6%) predominating. The survival probability was 96% at 9.53 years in the cemented group and 88% at 9.42 years in the uncemented group (p = 0.317). The median OHS improved from 13 (IQR 7.75 to 21.25) preoperatively to 39 (IQR 31 to 45) postoperatively in the uncemented group, and from 14 (IQR 10.5 to 22) to 38 (IQR 27 to 45) in the cemented group.</p><p><strong>Conclusion: </strong>This study highlights that CTHA from hip fracture surgery is associated with higher complication rates than conventional THA, but good medium-term results can be achieved. Their classification within the NJR requires review, acknowledging the increased potential for complications.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 2","pages":"195-205"},"PeriodicalIF":2.8,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415413","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 Zweymüller primary stem is a reliable, effective, and less invasive implant in revision hip arthroplasty for Paprosky type I and II defects.","authors":"Antonino G Battaglia, Rocco D'Apolito, Benjamin T K Ding, Stefano Tonolini, Joil Ramazzotti, Luigi Zagra","doi":"10.1302/2633-1462.62.BJO-2024-0182.R1","DOIUrl":"10.1302/2633-1462.62.BJO-2024-0182.R1","url":null,"abstract":"<p><strong>Aims: </strong>Revision hip arthroplasty for femoral stem loosening remains challenging due to significant bone loss and deformities requiring specialized revision stems. The aim of this study was to evaluate the clinical and radiological outcomes, and survival, of a consecutive series of femoral revisions performed using a primary cementless stem with tapered geometry and rectangular cross-section at medium-term follow-up.</p><p><strong>Methods: </strong>We retrospectively evaluated 113 patients (115 hips) with intraoperative Paprosky type I (n = 86) or II (n = 29) defects, who underwent femoral revision with Alloclassic Zweymüller SL stem for one-stage aseptic revision or two-stage septic revision from January 2011 to December 2020. The mean follow-up was 77.9 months (SD 33.8). Nine patients were lost to follow-up (deceased or not available), leaving 104 patients (106 hips) for the clinical and radiological analysis. Clinical assessment was performed with Harris Hip Score (HHS) and visual analogue scale (VAS) before surgery and at final follow-up.</p><p><strong>Results: </strong>There were 60 males and 53 females with a mean age at time of surgery of 71.2 years (SD 12.6). The mean HHS and VAS significantly improved at final follow-up, from 33.7 (SD 13.0) and 5.8 (SD 1.8) preoperatively to 66.4 (SD 16.8) and 2.1 (SD 1.8) postoperatively, respectively (p = 0.001 and p = 0.001). Overall, 28 patients (25%) showed non-progressive radiolucent lines at the level of proximal femur without radiological or clinical signs of loosening. One patient had a recurrence of periprosthetic joint infection after a two-stage procedure requiring re-revision surgery. One patient underwent exchange of modular components for recurrent dislocation, and another case of dislocation was treated conservatively. The survival with aseptic loosening as endpoint was 100%, while stem revision for any reason was 99.1% at up to 152 months' follow-up.</p><p><strong>Conclusion: </strong>Alloclassic Zweymüller SL primary stem showed favourable medium-term results and survival for revision total hip arthroplasty in Paprosky type I and II defects.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 2","pages":"186-194"},"PeriodicalIF":2.8,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411077","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":"Risk factors for valgus subsidence in uncemented medial unicompartimental knee arthroplasty.","authors":"Alexander Gallant, Pieter-Jan Vandekerckhove, Lucas Beckers, Arne De Smet, Cedric Depuydt, Jan Victor, François Hardeman","doi":"10.1302/2633-1462.62.BJO-2024-0161.R1","DOIUrl":"10.1302/2633-1462.62.BJO-2024-0161.R1","url":null,"abstract":"<p><strong>Aims: </strong>Valgus subsidence of uncemented tibial components following medial unicompartmental knee arthroplasty (UKA) poses a challenge in the early postoperative phase, necessitating a comprehensive understanding of its prevalence, risk factors, and impact on patient outcomes.</p><p><strong>Methods: </strong>This prospective multicentre study analyzed 97 knees from 90 patients undergoing UKA across four participating hospitals. A standardized surgical technique was employed uniformly by all participating surgeons. Postoperative evaluations were conducted preoperatively, and one day, four weeks, three months, and one year postoperative, encompassing weightbearing radiographs, bone mineral density assessments, and clinical outcome reports using the Forgotten Joint Score and Oxford Knee Score. Statistical analyses, including non-parametric correlation analysis using the Kendall correlation coefficient and Mann-Whitney U test, were performed to explore associations between subsidence and various patient-related or radiological parameters.</p><p><strong>Results: </strong>A total of eight patients showed more than 2° valgus subsidence (8.2%), higher than previously reported rates. There were significant correlations between subsidence and higher preoperative varus alignment of the tibia, larger adaptation of the preoperative varus to a postoperative neutral or valgus alignment, mediolateral undersizing of the tibial component, excessive lateral load of tibial component by more lateral position of femoral component relative to tibial component, a lower T-score, and female sex. Our study found no significant difference in pain scores between subsidence and non-subsidence groups at various postoperative milestones.</p><p><strong>Conclusion: </strong>These findings corroborate earlier suggested risk factors based on biomechanical models. Further research might provide the opportunity to identify high-risk groups preoperatively and adapt treatment strategies for these patients.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 2","pages":"178-185"},"PeriodicalIF":2.8,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392124","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":"Total versus robotic-assisted unicompartmental knee replacement (TRAKER) for medial compartment osteorthritis: a randomized controlled trial.","authors":"Nick D Clement, Chloe E H Scott, Gavin J Macpherson, Philip M Simpson, Gillian Leitch, James T Patton, Issaq Ahmed, Anish K Amin, Paul Gaston, Ewan Goudie, Stuart Goudie, Deborah M Macdonald, Eliott Martinson, Matthew Moran, Fazer Wade","doi":"10.1302/2633-1462.62.BJO-2024-0155.R1","DOIUrl":"10.1302/2633-1462.62.BJO-2024-0155.R1","url":null,"abstract":"<p><strong>Aims: </strong>Unicompartmental knee arthroplasty (UKA) is associated with an accelerated recovery, improved functional outcomes, and retention of anatomical knee kinematics when compared to manual total knee arthroplasty (mTKA). UKA is not universally employed by all surgeons as there is a higher revision risk when compared to mTKA. Robotic arm-assisted (ra) UKA enables the surgeon to position the prosthesis more accurately when compared to manual UKA, and is associated with improved functional outcomes and a lower early revision risk. Non-randomized data suggests that, when compared to mTKA, raUKA has a clinically meaningful greater functional benefit. This protocol describes a randomized controlled trial that aims to evaluate the clinical and cost-effectiveness of raUKA compared to mTKA for individuals with isolated medial compartment osteoarthritis (OA).</p><p><strong>Methods: </strong>The total versus robotic-assisted unicompartmental knee arthroplasty (TRAKER) trial is a patient- and assessor-blinded, pragmatic parallel two-arm randomized superiority trial of adults undergoing elective primary knee arthroplasty for primary medial compartment OA at a single NHS hospital (ClinicalTrials.gov NCT05290818). Participants will be randomly allocated on a 1:2 basis to either raUKA or mTKA, respectively. The primary analysis will compare the Oxford Knee Score (OKS) six months after surgery. Secondary outcomes measured at three, six, and 12 months include the OKS, Forgotten Joint Score, patient expectations, EuroQol five-dimension questionnaire (EQ-5D), and EQ-visual analogue scale (EQ-VAS), patient satisfaction, range of motion, postoperative complications, need for further surgery, resource use, and financial costs. Cost-effectiveness will be measured over a ten-year time span. A total of 159 patients will be randomized (n = 53 raUKA vs n = 106 mTKA) to obtain 80% power to detect a five-point difference in OKS between the groups six months after surgery.</p><p><strong>Conclusion: </strong>The trial findings will provide evidence about the clinical and cost-effectiveness of raUKA compared to mTKA in patients with isolated medial compartment OA. This will inform future National Institute for Health and Care Excellence guidelines on primary knee arthroplasty in the UK.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 2","pages":"164-177"},"PeriodicalIF":2.8,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of CT-based navigation, large femoral head, and dual-mobility liner on achieving the required range of motion in total hip arthroplasty.","authors":"Toshiki Konishi, Satoshi Hamai, Shinya Kawahara, Daisuke Hara, Taishi Sato, Goro Motomura, Takeshi Utsunomiya, Yasuharu Nakashima","doi":"10.1302/2633-1462.62.BJO-2024-0084.R1","DOIUrl":"10.1302/2633-1462.62.BJO-2024-0084.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to investigate whether the use of CT-based navigation enhances: 1) the accuracy of cup placement; and 2) the achievement rate of required range of motion (ROM). Additionally, we investigated the impact of using a large femoral head and dual-mobility liner on the achievement rates.</p><p><strong>Methods: </strong>This retrospective study analyzed 60 manual and 51 CT-based navigated primary total hip arthroplasties performed at a single facility. Postoperative CT scans and CT-based simulation software were employed to measure the cup orientation and to simulate the ROM. We compared the absolute errors for radiological inclination (RI) and radiological anteversion (RA) between the two groups. We also examined whether the simulated ROM met the required ROM criteria, defined as flexion > 110°, internal rotation > 30°, extension > 30°, and external rotation > 30°. Furthermore, we performed simulations with 36 mm femoral head and dual-mobility liner.</p><p><strong>Results: </strong>The absolute errors of RI and RA from the preoperative plan were significantly smaller in the CT-based navigation group (3.7° (SD 3.5°) vs 5.1° (SD 3.5°); p = 0.022, and 3.9° (SD 3.5°) vs 6.8° (SD 5.0°); p = 0.001, respectively). The proportion of cases achieving the required ROM in all directions was significantly higher in the CT-based navigation group (42% vs 63%; p = 0.036). The achievement rates of the required ROM were significantly higher with the use of a 36 mm ball or dual-mobility liner compared to the use of a 32 mm ball (65% vs 51%; p = 0.040 and 77% vs 51%; p ≤ 0.001, respectively).</p><p><strong>Conclusion: </strong>CT-based navigation enhanced required ROM achievement rates by > 20%, regardless of the ball diameter. The improved accuracy of cup placement through CT-based navigation likely contributed to the enhancement. Furthermore, the use of large femoral heads and dual-mobility liners also improved the required ROM achievement rates. In cases with a high risk of dislocation, use of these devices is preferred.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 2","pages":"155-163"},"PeriodicalIF":2.8,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11805587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371210","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":"Preoperative peripheral nerve blocks are not independently associated with improved functional outcome, patient satisfaction, or risk of chronic pain at one year following knee arthroplasty.","authors":"Nick D Clement, Bilal Qaddoura, Andrew Coppola, Nimra Akram, Sai Pendyala, Samantha Jones, Irrum Afzal, Deiary F Kader","doi":"10.1302/2633-1462.62.BJO-2024-0185.R1","DOIUrl":"10.1302/2633-1462.62.BJO-2024-0185.R1","url":null,"abstract":"<p><strong>Aims: </strong>Control of acute pain following knee arthroplasty (KA) with a perioperative peripheral nerve block (PNB) may improve functional outcomes and reduce the risk of chronic postoperative knee pain (CPKP). The aims of this study were to assess whether a PNB influences patient-reported outcomes and risk of CPKP at one year following KA.</p><p><strong>Methods: </strong>A retrospective study was conducted over a two-year period and included 3,338 patients who underwent KA, of whom 1,434 (43.0%) had a lower limb PNB. A total of 2,588 patients (77.6%) completed and returned their one-year follow-up questionnaire. The Oxford Knee Score (OKS) and pain component (OKS-PS), EuroQol five-dimension questionnaire (EQ-5D), and EQ-visual analogue scale (VAS) were collected preoperatively and at one year postoperatively. Patient satisfaction was also recorded at one year. The OKS-PS was used to define CPKP at one year.</p><p><strong>Results: </strong>The PNB group were younger (mean difference (MD) 0.7 years, 95% CI 0.0 to 1.3; p = 0.039), had a worse OKS (MD 0.7, 95% CI 0.1 to 1.3; p = 0.027), and were more likely to have had a spinal anaesthesia relative to a general anaesthetic (odds ratio 4.2, 95% CI 3.23 to 5.45; p < 0.001). When adjusting for confounding factors, patients in the PNB group had a significantly reduced improvement in their OKS (MD -0.9, 95% CI -1.6 to -0.1; p = 0.022), which may not be clinically meaningful. There were no significant differences in the OKS-PS (p = 0.068), EQ-5D (p = 0.313), or EQ-VAS (0.855) between the groups when adjusting for confounding factors. When adjusting for confounding factors using binary regression analysis, there were no differences in patient satisfaction (p = 0.132) or in the risk of CPKP (p = 0.794) according to PNB group.</p><p><strong>Conclusion: </strong>PNBs were independently associated with worse knee-specific outcomes, but whether these are clinically meaningful is not clear, as the difference was less than the minimal clinically important difference. Furthermore, PNBs were not independently associated with differences in health-related quality of life, patient satisfaction, or risk of CPKP.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 2","pages":"147-154"},"PeriodicalIF":2.8,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11802191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365881","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":"Patient and parent perspectives on being invited to join a trial of night-time only versus full-time bracing for adolescent idiopathic scoliosis : a qualitative study.","authors":"Frances C Sherratt, Lizzie Swaby, Kerry Walker, Raveen Jayasuriya, Laura Campbell, Andrew J Mills, Adrian C Gardner, Daniel C Perry, Ashley Cole, Bridget Young","doi":"10.1302/2633-1462.62.BJO-2024-0078.R1","DOIUrl":"10.1302/2633-1462.62.BJO-2024-0078.R1","url":null,"abstract":"<p><strong>Aims: </strong>The Bracing Adolescent Idiopathic Scoliosis (BASIS) study is a randomized controlled non-inferiority pragmatic trial of 'full-time bracing' (FTB) compared to 'night-time bracing' (NTB) for the treatment of adolescent idiopathic scoliosis (AIS). We anticipated that recruiting patients to BASIS would be challenging, as it is a paediatric trial comparing two markedly different bracing pathways. No previous studies have compared the experiences of AIS patients treated with FTB to those treated with NTB. This qualitative study was embedded in BASIS to explore families' perspectives of BASIS, to inform trial communication, and to identify strategies to support patients treated in a brace.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted with parents (n = 26) and young people (n = 21) who had been invited to participate in BASIS at ten of the 22 UK paediatric spine services in hospitals recruiting to BASIS. Audio-recorded interviews were transcribed and analyzed thematically.</p><p><strong>Results: </strong>Families viewed their interactions with BASIS recruiters positively, but were often confused about core aspects of BASIS, such as the aims, expectations of bracing, and the process of randomization. Participants typically expressed a preference for NTB, but recruiters may have framed NTB more favourably. Patients and parents reported challenges wearing a brace, such as physical discomfort, feelings of self-consciousness, difficulty participating in physical activities, and strain on financial resources to support brace use. Patients in FTB reported more pronounced challenges. While families valued health professional support, they felt there was a lack of social, emotional, and school support, and relied on online resources, as well private counselling services to address this need.</p><p><strong>Conclusion: </strong>The findings informed the development of resources and strategies, including guidance for schools and the recommendations in this paper, to support patients to wear NTB and FTB as prescribed. The results indicated opportunities for recruiters to enhance trial communication in ways that could improve informed consent and recruitment to BASIS, and inform future trials of bracing.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 2","pages":"135-146"},"PeriodicalIF":2.8,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256908","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}