Bone & Joint Open最新文献

{"title":"Facilitating translation of trial findings into NHS practice : case study of the Support and Treatment After Replacement (STAR) care pathway.","authors":"Wendy Bertram, Vikki Wylde, Tom Woodward, Rachael Gooberman-Hill, Michael R Whitehouse, Nick Howells","doi":"10.1302/2633-1462.66.BJO-2024-0043.R1","DOIUrl":"10.1302/2633-1462.66.BJO-2024-0043.R1","url":null,"abstract":"<p><strong>Aims: </strong>The Support and Treatment After Replacement (STAR) care pathway is a clinically important, cost-effective treatment to improve pain outcomes over one year for people with chronic pain three months after total knee arthroplasty. This work describes the implementation of trial findings in practice at one NHS hospital and the further work undertaken to support national implementation.</p><p><strong>Methods: </strong>Trial findings were presented to NHS managers with a business case for a pilot embedded in usual care. Trial documentation was adapted using the capability, opportunity, motivation, and behaviour (COM-B) model for behaviour change and evidence-based approaches to increase questionnaire responses. Trial sites were contacted to understand their capacity to pilot the intervention.</p><p><strong>Results: </strong>The STAR care pathway was successfully implemented into NHS practice with a screening response rate of 89%. It is now permanently part of usual care at North Bristol NHS Trust. Trial centres indicated that lack of trained extended scope practitioners was a barrier to implementation. The trial manual and training sessions were adapted into an online training package.</p><p><strong>Conclusion: </strong>The STAR care pathway has been successfully embedded into NHS care at one hospital. A toolkit and online clinician training package supports wider implementation.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6","pages":"644-650"},"PeriodicalIF":2.8,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226960","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":"Physiotherapy and physical activity in children with Perthes' disease : an international survey of recommendations from paediatric orthopaedic surgeons.","authors":"Yasmin D Hailer, Daniel C Perry, Emily Schaeffer, Jacqueline Li, Kishore Mulpuri","doi":"10.1302/2633-1462.66.BJO-2024-0219.R1","DOIUrl":"10.1302/2633-1462.66.BJO-2024-0219.R1","url":null,"abstract":"<p><strong>Aims: </strong>In the absence of clear and consistent clinical guidelines, this study aims to survey the current international consensus on recommendations for physiotherapy (PT), physical activity (PA), and weightbearing in patients with Perthes' disease. Additionally, the study seeks to identify factors influencing these recommendations, and to determine at which stage possible restrictions on physical activity are typically lifted.</p><p><strong>Methods: </strong>An online international cross-sectional survey using a purpose-designed questionnaire with a general section, and three cases of Perthes' disease, was distributed to surgeons through paediatric orthopaedic societies and research groups.</p><p><strong>Results: </strong>A total of 160 paediatric orthopaedic surgeons from 43 different countries (seven continents) participated. There was general agreement that impaired range of motion (ROM) and pain were important when prescribing PT, while the child's sex was not important. There was disagreement on whether age and Waldenström or Lateral Pillar classification were important factors in determining the need for PT. There was widespread agreement that stretching in the early stages of Perthes' disease was important, although Western and Southern Europe and the British Isles differed. There was considerable disagreement about strengthening exercises. 'Weightbearing as tolerated' in the early and fragmentation stages was generally recommended in the British Isles and Scandinavia (both > 90%), whereas other regions showed large variation. Regarding PA, there was broad agreement in allowing swimming and cycling, and discouraging high-impact activities including school sports in all stages.</p><p><strong>Conclusion: </strong>Maintaining ROM was crucial for most participants, with strong consensus to discourage high-impact activities during initial and fragmentation stages. Swimming and cycling were often allowed, but no clear consensus emerged on weightbearing restrictions or when to resume full activities. Consensus within the British Isles, Scandinavia, and Eastern Europe was high for both for PT and PA, but recommendations differed between countries. Recommendations from the British Isles and Scandinavia were less restrictive than their Eastern European counterparts.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6","pages":"635-643"},"PeriodicalIF":2.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217123","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":"Striving to recover - wrist splint or plaster cast : a qualitative study of patients' experience of recovery after a distal radius fracture.","authors":"Emma Elizabeth Phelps, Elizabeth Tutton, Jenny Gould, Liz Baird, Juul Achten, Matthew L Costa","doi":"10.1302/2633-1462.66.BJO-2025-0033","DOIUrl":"10.1302/2633-1462.66.BJO-2025-0033","url":null,"abstract":"<p><strong>Aims: </strong>We sought to explore patients' experience of early recovery from a fracture of the wrist (distal radius). This study was nested in the DRAFT-CASP randomized controlled trial (RCT), which explores the effectiveness of two treatment pathways for patients with a fracture of the distal radius that does not require manipulation: a plaster cast which is removed in fracture clinic, versus a wrist splint that patients remove themselves without returning to hospital.</p><p><strong>Methods: </strong>Qualitative interviews were undertaken with 21 adults (mean age 58.2 years (SD 13.96), six male), from eight NHS hospitals, four to ten weeks post injury. Interviews were informed by phenomenology and analyzed using reflexive thematic analysis.</p><p><strong>Results: </strong>We identified the overarching theme 'striving to recover', which conveys patients' determination to get back to normal after a wrist fracture. To recover, patients needed to be comfortable, to adapt, and to be certain that their wrist was healing. Early in their recovery, they were unable to complete their daily activities, experienced pain, loss of strength, worry, and were cautious about using their wrist. Overall, both treatments were considered acceptable. The splint was advantageous for the freedom and control it provided. The cast was valued for the protection and safety it provided. Both groups required more information and reassurance, but had varied views on the need for follow-up appointments.</p><p><strong>Conclusion: </strong>The splint made life easier for patients and was an acceptable treatment. Patients wanted reassurance that their wrist was healing, but they felt this could be achieved in a variety of ways. Most patients coped without a follow-up appointment. Innovative ways to maximize recovery are required. These include support for patients to, manage their pain and provide comfort, be able to adapt, and feel certain of healing. Sharing patients' experiences may help future patients to make informed treatment and recovery decisions.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6","pages":"626-634"},"PeriodicalIF":2.8,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209679","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":"Tunnel combinations that should be avoided in anterior cruciate ligament reconstruction : a biomechanical assessment of 15 different combinations of femoral and tibial graft tunnels.","authors":"Salameh Eljaja, Jørgen Tranum-Jensen, Mette Tavlo, Volkert Siersma, Michael Rindom Krogsgaard","doi":"10.1302/2633-1462.66.BJO-2025-0011.R1","DOIUrl":"10.1302/2633-1462.66.BJO-2025-0011.R1","url":null,"abstract":"<p><strong>Aims: </strong>Structured knowledge on the combined effect of various positions of femoral and tibial tunnels in reconstruction of the anterior cruciate ligament (ACL) on knee range of motion, rotatory stability, and anterior translatory laxity is limited. The aim was to test this for 15 regularly used tunnel combinations and identify combinations that should be avoided.</p><p><strong>Methods: </strong>A total of 60 cadaveric knees had the ACL removed and reconstructed. Flexion/extension, tibial rotation, and anterior tibial translation were measured with intact ACL, after ACL resection, and after ACL reconstructions with 15 tunnel combinations, based on five different femoral tunnels and three different tibial tunnels.</p><p><strong>Results: </strong>With a posterior tibial tunnel, the anterior tibial translation and tibial rotation increased when combined with most femoral tunnels. A transtibially positioned femoral tunnel when combined with any tibial tunnel caused flexion deficiency. Any femoral tunnel positioned by anteromedial technique combined with anterior or posterior tibia tunnels caused flexion deficiency. Severe extension deficiency was observed with an anterior tibial tunnel, in particular combined with a transtibially positioned femoral tunnel or an anterior femoral tunnel by anteromedial technique. Least anterior tibial translation combined with normal extension was achieved with a femoral tunnel by anteromedial technique as far posterior as possible, and an anatomically positioned tibial tunnel.</p><p><strong>Conclusion: </strong>In conclusion, tunnel combinations with the steepest (sagittal plane) and/or least oblique (frontal plane) grafts resulted in increased anterior tibial translation and tibial rotation, and should therefore be avoided. Anterior positioning of the graft caused extension deficiency, and there was flexion deficit with most grafts. A femoral tunnel as far posterior as possible by anteromedial technique is preferable in combination with an anatomically positioned tibial tunnel.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6","pages":"618-625"},"PeriodicalIF":2.8,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12127053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200254","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":"Primary nerve exploration is required in more than 10% of complete motor nerve paralysis cases associated with Gartland type III paediatric supracondylar humerus fractures : a multicentre retrospective study.","authors":"Rina Ito, Katsuhiro Tokutake, Yasuhiko Takegami, Nobuyuki Okui, Tadahiro Natsume, Shukuki Koh, Masahiro Tatebe, Michiro Yamamoto","doi":"10.1302/2633-1462.66.BJO-2025-0020.R1","DOIUrl":"10.1302/2633-1462.66.BJO-2025-0020.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study aims to determine the prevalence, prognosis, and outcome of complete motor paralysis associated with Gartland type III paediatric supracondylar humerus fractures (SCHFs) and identify when primary nerve exploration is indicated.</p><p><strong>Methods: </strong>In this multicentre retrospective study, we investigated complete motor paralysis associated with Gartland type III paediatric SCHFs. Iatrogenic paralysis was excluded. Radiographs were used to determine a fascial penetration sign. Findings from nerve explorations were recorded. Notable cases were defined as those with the following nerve conditions: 1) complete or partial laceration; 2) tethering/entrapment; 3) formation of a neuroma; or 4) entrapment at the fracture site or callus. The frequency with which ultrasound was used was documented and its findings were examined.</p><p><strong>Results: </strong>Among 691 patients with Gartland type III SCHFs, 45 (7%) had complete motor paralysis. Of these, 20 (44%) were managed without primary nerve exploration. Overall, 18 (90%) spontaneously recovered and two (10%) required neurorrhaphy and nerve grafting during a secondary exploration. Of the other 25 (56%) who underwent primary nerve exploration, one had a complete radial nerve laceration, and five had tethered/entrapped nerves. The fascial penetration sign was positive in each of the eight notable cases (18%), a rate that was substantially higher than in the others (19 of 37; p = 0.014, sensitivity 100%, specificity 49%). Ultrasound was used preoperatively in 14 cases (31%) to investigate the condition of the nerve, possible contact with the proximal fragment, and its changes after traction.</p><p><strong>Conclusion: </strong>For Gartland type III paediatric SCHF patients with complete motor paralysis, we estimate that more than 10% require primary nerve exploration due to tethered/entrapped or lacerated nerves. A positive fascial penetration sign on radiography provided early evidence that primary nerve exploration was warranted. In addition, preoperative ultrasound under general anaesthesia to assess the condition of the nerves can play a crucial role.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6","pages":"609-617"},"PeriodicalIF":2.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12127776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192349","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":"Antibacterial hydrogel coating is associated with lower complication risks after complex high-risk primary and cementless hip revision arthroplasty : a retrospective matched cohort study.","authors":"Benjamin T K Ding, Rocco D'Apolito, Lucia Sciamanna, Luigi Zagra","doi":"10.1302/2633-1462.66.BJO-2025-0004.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.66.BJO-2025-0004.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to verify the hypothesis that an antibiotic-loaded hydrogel, defensive antimicrobial coating (DAC), reduces overall complication and infection rates when used for high-risk primary and revision total hip arthroplasty (THA).</p><p><strong>Methods: </strong>This was a retrospective, 1:1 matched cohort study of 238 patients, treated with cementless implants coated with and without DAC. A subgroup analysis was also conducted of patients undergoing second-stage revision THA for periprosthetic joint infection (PJI). Reinfection rates within two years, complications necessitating surgical intervention, and radiological analysis for aseptic loosening were assessed.</p><p><strong>Results: </strong>Overall, the mean age of the patients was 68.3 years (SD 11.5), with 39 (32.8%) McPherson class A, 64 (53.8%) class B, and 16 (13.4%) class C. Four (3.4%) patients in the DAC group developed complications including one PJI and one delayed wound healing, while 13 (10.9%) patients in the control group developed complications, including five PJIs and three delayed wound healing (p = 0.032). PJI rates (p = 0.136) and delayed wound healing rates (p = 0.337) were not statistically significant. For second-stage revision THA, for PJI there were 86 patients in the DAC group and 45 in the control group. One patient (1.2%) in the DAC group developed complications with no recurrences of infection or delayed wound healing, while ten patients (22.2%) in the control group developed complications including four recurrent PJI and one delayed wound healing (p = 0.003). Recurrent PJI rates were statistically significant (p = 0.005), while delayed wound healing rates were not (p = 0.165). Patients treated with DAC also had lower rates of aseptic loosening (0% compared with 6.7%; p = 0.015). No local or systemic side effects related to the DAC hydrogel coating were observed.</p><p><strong>Conclusion: </strong>Antibiotic-impregnated hydrogel coatings on cementless implants appear to be associated with decreased complication rates after complex primary or revision THA. For second-stage revision THA for PJI, it is also associated with reduced risk of reinfection and aseptic loosening.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6 Supple B","pages":"15-23"},"PeriodicalIF":2.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192350","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":"Radiological results of the Bernese periacetabular osteotomy performed before closure of the triradiate cartilage.","authors":"Reinhold Ganz, Stefan Blümel, Alisa Schleicher, Felix Öttl, Vincent A Stadelmann, Michael Leunig","doi":"10.1302/2633-1462.66.BJO-2024-0204.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.66.BJO-2024-0204.R1","url":null,"abstract":"<p><strong>Aims: </strong>The Bernese periacetabular osteotomy (PAO) is typically not performed until after the growth plates have closed in late adolescence, as the osteotomy crosses the posterior branch of the triradiate cartilage, which could potentially cause deformities similar to post-traumatic dysplasia, a condition observed following pelvic fractures in childhood. The aim of this study was to retrospectively analyze on radiographs whether the PAO, when performed in children with open growth plates, affects acetabular development.</p><p><strong>Methods: </strong>We retrospectively reviewed the radiological outcomes of 23 hips (20 patients) with a mean age of 10.7 years (SD 1.8; 5.7 to 12.7). Preoperative, three-months postoperative, and latest follow-up measurements (after growth plate closure) were assessed for the following parameters: lateral centre-edge angle (LCE), acetabular index (AI), head extrusion (HE) index, femoral head (FH) lateralization, and teardrop thickness. We also compared the age at triradiate cartilage closure between the operated and nonoperated hips.</p><p><strong>Results: </strong>The mean follow-up was 5.2 years (SD 3.7; 0.6 to 12.7). Preoperatively, over 80% of the hips showed pathological measurements, which improved significantly post-PAO. None of the hips had pathological measurements after surgery. All acetabular angles showed significant improvement post-PAO (LCE from 14° (SD 8°) to 38° (SD 11°); AI from 20° (SD 8°) to 7° (SD 4°); and HE index from 32° (SD 9°) to 8° (SD 8°)). Acetabular moulding was physiological with little FH lateralization (from 9° (SD 9°) to 11.7° (SD 4.8°)), and a small increase in teardrop width (4.7 mm (SD 1) to 8.2 mm (SD 4.4)). Few complications were observed: one case of osteoarthritis (OA); one case of transient sciatic nerve irritation that resolved; one case of interfering osteosynthesis material that was removed; and one case requiring an additional valgus intertrochanteric osteotomy. All complications resolved without further issues.</p><p><strong>Conclusion: </strong>Our data on the use of PAO in patients with an open growth plate are encouraging with normalization of acetabular coverage parameters and only minor alterations of acetabular development, and may support its use in children six years old and older.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6 Supple B","pages":"24-32"},"PeriodicalIF":2.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192353","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":"Re-revision risk of modular and monobloc revision stems after revision hip arthroplasty.","authors":"Michael Morlock, Yinan Wu, Alexander Grimberg, Klaus-Peter Günther, Carsten Perka","doi":"10.1302/2633-1462.66.BJO-2024-0201.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.66.BJO-2024-0201.R1","url":null,"abstract":"<p><strong>Aims: </strong>Modular revision stem fracture is a rare but difficult complication after hip arthroplasty revision. The purpose of this German Arthroplasty Registry (EPRD)-based study was to investigate whether the overall re-revision rate and the re-revision reasons of modular revision stems compared with monobloc stems are different.</p><p><strong>Methods: </strong>A total of 291 re-revisions occurring within five years after implantation of a revision stem (n = 2,039) documented in the EPRD were analyzed using Kaplan-Meier survival analysis and Cox regression. Stem type (modular: n = 1,026, monobloc: n = 1,013) and revision reason were investigated as independent variables, while BMI, sex, age, hospitals' annual revision volume, and Elixhauser score were treated as confounding variables. Cases with an infection at index surgery were analyzed separately.</p><p><strong>Results: </strong>Re-revision risk after five years was similar for either stem type (modular: 18.7% ( 95% CI 15.9 to 21.9); monobloc: 15.6% (95% CI 13.2 to 18.4); p = 0.200). One stem fracture of a modular revision stem was reported. The main reasons for re-revision were infection (modular/monobloc: 50%/60% of all revisions; p = 0.200), dislocation (19.8%/9.6%; p = 0.045), and loosening (12.2%/11.4%; p > 0.999). An Elixhauser score of 4 and above was associated with a higher hazard ratio (HR) for re-revision for either stem type (modular/monobloc: HR 2.01; p = 0.026/HR 2.44; p = 0.004), as well as a BMI category above 25/40 (modular/monobloc: HR 1.73 to 3.25; all p < 0.025/HR 3.61; p < 0.001). An infected index surgery increased the re-revision risk after one year to 26.0% (95% CI 22.2% to 30.3%) compared with 8.3% for noninfected cases (95% CI 7.0% to 9.8%) (p < 0.001) independent of stem type.</p><p><strong>Conclusion: </strong>A high BMI increases the HR for revision for either stem design but not due to mechanical implant failure. Infection at the index operation increases re-revision risk significantly, and is also the dominant reason for re-revision independent of stem type.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6 Supple B","pages":"1-6"},"PeriodicalIF":2.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192354","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":"Management of chronic pelvic discontinuity during revision hip arthroplasty using the 'acetabular distraction technique' : clinical and radiological outcomes from a two-centre study with a minimum two-year follow-up.","authors":"Rajesh Malhotra, Apurve Parameswaran, Deepak Gautam, Sahil Batra, Sunil Apsingi, Vinay K Ponnala, Krishna K Eachempati","doi":"10.1302/2633-1462.66.BJO-2024-0199.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.66.BJO-2024-0199.R1","url":null,"abstract":"<p><strong>Aims: </strong>Chronic pelvic discontinuity (CPD) during revision hip arthroplasty is a challenging entity to address. The aim of this study was to evaluate the clinical and radiological outcomes and complications of the 'acetabular distraction technique' for the management of CPD during revision hip arthroplasty.</p><p><strong>Methods: </strong>Patients with CPD, who underwent acetabular revision between January 2014 and April 2022 at two tertiary care centres, using an identical distraction technique, were evaluated. Demographic parameters, preoperative acetabular bone loss, duration of follow-up, clinical and radiological outcomes, and survivorship were evaluated.</p><p><strong>Results: </strong>In all, 46 patients with a mean follow-up of 34.4 months (24 to 120) were available for evaluation. There were 25 male (54.3%) and 21 female (45.7%) patients, with a mean age of 58.1 years (40 to 81) at the time of revision surgery. Based on the Paprosky classification for acetabular bone loss, 19 (41.3%), 12 (26.1%), and 15 (32.6%) patients had type IIIB, IIIA, and IIC defects, respectively. All patients were managed using the Trabecular Metal Acetabular Revision System; 16 patients required additional Trabecular Metal augments. The mean Harris Hip Score improved from 50.1 (34.3 to 59.8) preoperatively to 86.6 (74.8 to 91.8) at the last follow-up (p < 0.001). Of the 46 patients studied, 34 were able to walk unaided, whereas 12 required a walking stick. Two patients (4.3 %) developed partial sciatic nerve palsy, two (4.3%) had posterior dislocation, and one (2.2%) required re-revision for aseptic loosening. Radiologically, 36 patients (78.3%) showed healing of the pelvic discontinuity through bony bridging. The overall cup survivorship was 97.8%, while the three-year survivorship free from any re-revision was 94.1% based on a Kaplan-Meier survival plot.</p><p><strong>Conclusion: </strong>The acetabular distraction technique results in good clinical and radiological outcomes in the management of CPD during revision hip arthroplasty.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6 Supple B","pages":"7-14"},"PeriodicalIF":2.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192351","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":"Predicting early return to sport after periacetabular osteotomy : a machine-learning approach.","authors":"Lars Nonnenmacher, Maximilian Fischer, Lars Kaderali, Georgi I Wassilew","doi":"10.1302/2633-1462.66.BJO-2024-0257.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.66.BJO-2024-0257.R1","url":null,"abstract":"<p><strong>Aims: </strong>Periacetabular osteotomy (PAO) is the primary surgical treatment for developmental dysplasia of the hip (DDH), providing considerable pain relief and improved joint function. Return to sport (RTS) is a key outcome for young, active patients. This study aimed to identify preoperative predictors of RTS timing and develop a machine-learning-based prediction model to optimize patient counselling.</p><p><strong>Methods: </strong>This retrospective analysis of prospectively collected data included 235 patients who underwent PAO between January 2019 and December 2023. Preoperative variables, including demographic, functional, and psychological assessments, were analyzed. RTS was assessed at three, six, and 12 months postoperatively. Logistic regression with recursive feature elimination and a conditional inference tree (ctree) model were used to identify predictors of RTS.</p><p><strong>Results: </strong>At three months, 102 patients (43%) had returned to sports, increasing to 182 (77%) at six months and 223 (95%) at 12 months. Key predictors of early RTS included the minimally invasive surgical approach, higher preoperative physical activity (≥ two sessions/week), lower anxiety scores, and higher Hip disability and Osteoarthritis Outcome Score (HOOS) pain scores. Male sex and older age were associated with delayed RTS. The ctree model stratified patients based on their likelihood of early RTS, providing an individualized prognosis.</p><p><strong>Conclusion: </strong>PAO enables early RTS in over 90% of patients within the first year. The use of a minimally invasive approach allowing immediate active hip flexion, higher preoperative activity levels, and lower anxiety scores significantly improves RTS timing. The machine-learning model provides precise, individualized RTS predictions, offering a valuable tool for patient counselling and rehabilitation planning.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6 Supple B","pages":"33-42"},"PeriodicalIF":2.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192352","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}