Bone & Joint Open最新文献

{"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}

{"title":"Machine learning in shoulder arthroplasty : a systematic review of predictive analytics applications.","authors":"Tim Schneller, Moritz Kraus, Jan Schätz, Philipp Moroder, Markus Scheibel, Asimina Lazaridou","doi":"10.1302/2633-1462.62.BJO-2024-0234.R1","DOIUrl":"10.1302/2633-1462.62.BJO-2024-0234.R1","url":null,"abstract":"<p><strong>Aims: </strong>Machine learning (ML) holds significant promise in optimizing various aspects of total shoulder arthroplasty (TSA), potentially improving patient outcomes and enhancing surgical decision-making. The aim of this systematic review was to identify ML algorithms and evaluate their effectiveness, including those for predicting clinical outcomes and those used in image analysis.</p><p><strong>Methods: </strong>We searched the PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases for studies applying ML algorithms in TSA. The analysis focused on dataset characteristics, relevant subspecialties, specific ML algorithms used, and their performance outcomes.</p><p><strong>Results: </strong>Following the final screening process, 25 articles satisfied the eligibility criteria for our review. Of these, 60% focused on tabular data while the remaining 40% analyzed image data. Among them, 16 studies were dedicated to developing new models and nine used transfer learning to leverage existing pretrained models. Additionally, three of these models underwent external validation to confirm their reliability and effectiveness.</p><p><strong>Conclusion: </strong>ML algorithms used in TSA demonstrated fair to good performance, as evidenced by the reported metrics. Integrating these models into daily clinical practice could revolutionize TSA, enhancing both surgical precision and patient outcome predictions. Despite their potential, the lack of transparency and generalizability in many current models poses a significant challenge, limiting their clinical utility. Future research should prioritize addressing these limitations to truly propel the field forward and maximize the benefits of ML in enhancing patient care.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 2","pages":"126-134"},"PeriodicalIF":2.8,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11790313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123795","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":"Age-optimized cut-off values for pubofemoral distances in screening for hip dysplasia.","authors":"Hans-Christen Husum, Michel B Hellfritzsch, Rikke D Maimburg, Bjarne Møller-Madsen, Mads Henriksen, Natallia Lapitskaya, Søren Kold, Ole Rahbek","doi":"10.1302/2633-1462.62.BJO-2024-0181.R1","DOIUrl":"10.1302/2633-1462.62.BJO-2024-0181.R1","url":null,"abstract":"<p><strong>Aims: </strong>To establish cut-off values for lateral pubofemoral distance (PFD) measurements for detecting hip dysplasia in early (four days) and standard care (six weeks) screening for developmental dysplasia of the hip (DDH).</p><p><strong>Methods: </strong>All newborns, during a one-year period (October 2021 to October 2022), were offered a PFD ultrasound (US) examination in addition to the existing screening programme for DDH. Newborns who were referred for standard care hip US, suspected for DDH, received a secondary PFD US examination in conjunction with the standard care Graf/Harcke hip US examination. Receiver operating characteristic curves and empirically optimal cut-off values were calculated with a true positive defined as a Graf type ≥ IIc hip.</p><p><strong>Results: </strong>We included 2,735 newborns, of whom 758 received both early PFD hip US and standard care Graf/Harcke hip US. For early (four days) PFD screening, the optimal cut-off point was calculated to be 6.2 mm (95% CI 4.7 to 7.7) producing a sensitivity of 80% (95% CI 55% to 100%) and a specificity of 87% (86% to 89%). For PFD screening performed at standard care (six weeks) hip US, the optimal cut-off point was calculated to be 5.6 mm (95% CI 4.9 to 6.3) producing a sensitivity of 100% (95% CI 100% to 100%) and a specificity of 96% (95% CI 95% to 97%).</p><p><strong>Conclusion: </strong>PFD US screening produces a high degree of both sensitivity and specificity for detecting DDH. Age-specific cut-off values should be used to heighten the accuracy of PFD US screening.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 2","pages":"119-125"},"PeriodicalIF":2.8,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081278","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 malignant bone and soft-tissue tumours of the spine and appendicular sacrum.","authors":"Eleonora Schneider, Thomas M Tiefenboeck, Christoph Böhler, Iris-Melanie Noebauer-Huhmann, Susanna Lang, Petra Krepler, Philipp T Funovics, Reinhard Windhager","doi":"10.1302/2633-1462.62.BJO-2024-0169.R1","DOIUrl":"10.1302/2633-1462.62.BJO-2024-0169.R1","url":null,"abstract":"<p><strong>Aims: </strong>The aim of the present study was to analyze the oncological and neurological outcome of patients undergoing interdisciplinary treatment for primary malignant bone and soft-tissue tumours of the spine within the last seven decades, and changes over time.</p><p><strong>Methods: </strong>We retrospectively analyzed our single-centre experience of prospectively collected data by querying our tumour registry (Medical University of Vienna). Therapeutic, pathological, and demographic variables were examined. Descriptive data are reported for the entire cohort. Kaplan-Meier analysis and multivariate Cox regression analysis were applied to evaluate survival rates and the influence of potential risk factors.</p><p><strong>Results: </strong>A total of 119 consecutive patients (mean age 38 years (SD 37; 1 to 83), mean follow-up 66 months (SD 26; 0 to 505) were investigated. Histological entities included Ewing's sarcoma (EWS; 33), chondrosarcoma (CSA; 20), osteosarcoma (OSA; 22), and soft-tissue sarcoma (STS; 44). Surgery was performed in 88 patients (74%). Neurological parameters improved in 18 patients (20%) after surgery. Overall, 32 patients (36%) suffered from surgical complications requiring revision. The median survival was 42 months (IQR 10 to 204). The one-, five-, and ten-year survival rates were 73%, 47%, and 39%, respectively. Corresponding five-year survival rates for EWS, CSA, OSA, and STS were 63%, 61%, 40%, and 32%, respectively. The decade of diagnosis, histological entity, surgical intervention, resection margin, and the presence of metastases had significant influence on survival. (Neo-)adjuvant therapies alone had no significant influence on overall survival.</p><p><strong>Conclusion: </strong>Our study clearly demonstrates the positive impact of improved surgical techniques, as well as refined imaging methods and evolved adjuvant therapy options, on survival rate in all tumour entities. However, despite a multimodal treatment plan, the long-term mortality of these tumours remains high.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 2","pages":"109-118"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11785419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075688","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}