Bone & Joint Open最新文献

{"title":"Osteoarthritis with an intact rotator cuff, reverse shoulder arthroplasty, or total shoulder arthroplasty? : a qualitative study of surgeon decision-making.","authors":"Olivia O'Malley, Alex Abouharb, Harry Beale, Joanna Craven, Sanjeeve Sabharwal, Peter Reilly","doi":"10.1302/2633-1462.73.BJO-2025-0306.R1","DOIUrl":"10.1302/2633-1462.73.BJO-2025-0306.R1","url":null,"abstract":"<p><strong>Aims: </strong>The indications for reverse shoulder arthroplasty (RSA) have expanded beyond the primary design philosophy of an implant used to deal with rotator cuff deficiency. Its application in the cuff intact shoulder is growing in clinical practice. Despite this, there is little understanding of how surgeons decide between implants, specifically RSA and total shoulder arthroplasty (TSA) in this clinical scenario.</p><p><strong>Methods: </strong>Trauma & Orthopaedic Consultants specializing in shoulder surgery were recruited to participate in semistructured interviews by the research team. Using grounded theory methodology, the transcribed interviews were analyzed to generate themes and theories on factors affecting the decision-making between RSA and TSA. Collection and analysis was concluded when data saturation had been reached.</p><p><strong>Results: </strong>Patients characteristics, specifically 'physiological age', a term incorporating age, comorbid status, and preoperative function played a key role in decision-making. Anatomical factors specifically glenoid morphology and retroversion angle significantly contributed to implant choice; however, specific cut-offs for determining implants were not universal. Other themes identified included revision profiles of the implants, functional outcomes, and surgical training and experience.</p><p><strong>Conclusion: </strong>The decision-making between RSA and TSA for osteoarthritis and cuff intact patients is complex and multifactorial. The main factors surgeons consider are physiological age, patient anatomy, and functional outcomes. Within these factors however, there is no uniform agreement on which implant is best for which patients.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 3","pages":"433-441"},"PeriodicalIF":3.1,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13012813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515222","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":"Revision rates following total shoulder arthroplasty in rural and urban hospitals : an Australian Orthopaedic Association National Joint Replacement Registry analysis of high-volume surgeons.","authors":"Zac Dragan, Ryan J Campbell, Madeleine Tropman, Peiyao Du, David R J Gill, Cameron Handford, Benjamin Cass, Allan Young","doi":"10.1302/2633-1462.73.BJO-2025-0299.R1","DOIUrl":"10.1302/2633-1462.73.BJO-2025-0299.R1","url":null,"abstract":"<p><strong>Aims: </strong>Total shoulder arthroplasty (TSA) outcomes may be affected in rural settings where resources can differ from urban hospitals.</p><p><strong>Methods: </strong>This study compared revision rates of primary TSA performed in rural and urban hospitals analyzed from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) between 1 January 2008 and 31 December 2023. Rural and urban hospital location was defined by nationally accepted criteria. We included high-volume surgeons (upper two quartiles and undertook TSA in both settings) stratified for anatomical or reverse shoulder arthroplasty, and glenoid morphology. The cumulative percent revision (CPR) was determined using Kaplan-Meier estimates of survivorship and hazard ratios (HRs) from Cox proportional hazard models adjusted for age and sex.</p><p><strong>Results: </strong>A total of 16,179 TSA procedures were performed; 3,456 (21%) in rural and 12,723 (79%) in urban hospitals. CPR at five years was 4.1% (95% CI 3.4 to 4.9) for rural TSA and 5.5% (95% CI 5.0 to 6.0) for urban hospitals. Rural hospitals had lower overall revision rates compared with urban hospitals (entire period, HR 0.81 (95% CI 0.66 to 0.99); p = 0.037). There was a higher rate of revision for primary anatomical TSA in rural centres for the first six months, followed by lower rates of revision (rural vs urban 0.6 months, HR 2.04, p = 0.011; six months to 1.5 years, HR 0.52, p 0.008; 1.5 years +, HR 0.36, p < 0.001). The revision rate for primary reverse TSA did not differ between rural and urban hospitals (entire period, HR 0.87, p = 0.233). Patients aged < 65 years had a lower revision risk in a rural hospital, but there was no difference in patients aged > 65 years. Sex did not change TSA revision rates in rural and urban hospitals.</p><p><strong>Conclusion: </strong>Revision rates for TSA procedures performed in rural hospitals were equivalent to urban hospitals. Our study supports the provision of TSA services in rural hospitals when undertaken by high-volume surgeons.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 3","pages":"425-432"},"PeriodicalIF":3.1,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13014324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515190","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":"How accurate are arthroplasty surgeons in visually estimating extension and flexion gaps in total knee arthroplasty?","authors":"Shady S Elmasry, Scott LaValva, Cynthia A Kahlenberg, David J Mayman, Michael B Cross, Andrew D Pearle, Timothy M Wright, Geoffrey H Westrich, Carl W Imhauser, Peter K Sculco","doi":"10.1302/2633-1462.73.BJO-2025-0420.R1","DOIUrl":"10.1302/2633-1462.73.BJO-2025-0420.R1","url":null,"abstract":"<p><strong>Aims: </strong>The ability of a surgeon to provide accurate visual estimates of intraoperative gaps during total knee arthroplasty (TKA) is not well understood. This study evaluated: 1) the accuracy of gap estimation in extension and in flexion; 2) the accuracy of gap estimation in the medial and lateral compartments, also in extension and flexion; 3) the differences in accuracy among surgeons; and 4) the frequency of clinically significant errors in gap estimation, defined as greater than 1 mm.</p><p><strong>Methods: </strong>A posterior stabilized TKA was performed on seven cadaveric knees. Five fellowship-trained arthroplasty surgeons and one orthopaedic resident manually stressed each knee, and visually assessed the medial and lateral gaps in full extension and 90° of flexion. Gaps were objectively measured via a motion capture system. Gap estimation error was calculated as the difference between the surgeons' visual assessment and the measured gaps.</p><p><strong>Results: </strong>Across all surgeons and knees, the mean gap estimation error was -0.4 mm (SD 0.7), with the majority (72%) of gaps being underestimated. Errors were greater in extension (-0.7 mm (SD 0.8)) than in flexion (-0.2 mm (SD 1.0)) (p < 0.001). Lateral gap error was less in flexion (-0.1 mm (SD 1.0)) than extension (-0.7 mm (SD 0.8)). Gap estimation error pooled for all assessments differed between surgeons, ranging from a mean error of -0.8 mm (SD 0.8) to 0.2 mm (SD 1.2) (p < 0.001). Clinically significant gap estimation errors (> 1 mm) occurred in 33% of assessments in extension and 26% in flexion (p = 0.315, not statistically different). The frequency of such errors varied by surgeon ranging from 18% to 42% (p = 0.370).</p><p><strong>Conclusion: </strong>Surgeons tend to underestimate intraoperative gaps during TKA, particularly in extension. Clinically meaningful gap estimation errors (> 1 mm) occurred in up to 33% (26/78) of exams, supporting the need to enhance gap assessment accuracy.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 3","pages":"417-424"},"PeriodicalIF":3.1,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13011599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147504095","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":"Differences in characteristic morphological variability among distal femurs based on sex and ethnicity.","authors":"Nadim Ammoury, Michael J Dunbar, Jerry D'Alessio, Janie Astephen Wilson","doi":"10.1302/2633-1462.73.BJO-2025-0380.R1","DOIUrl":"10.1302/2633-1462.73.BJO-2025-0380.R1","url":null,"abstract":"<p><strong>Aims: </strong>The morphology of the distal femur varies widely among individuals and has a direct impact on knee joint mechanics and function. Understanding this variability is essential in improving surgical planning and implant design, especially as current tools and approaches move toward more anatomically informed and personalized technique. This study sought to characterize the major modes of morphological variability in the adult human distal femur and to examine morphometric differences based on sex and ethnicity.</p><p><strong>Methods: </strong>A dataset of 1,686 distal femurs from a CT scan-based database was analyzed. A total of 15 morphometric dimensional and angular variables were assessed, and principal component analysis (PCA) was employed to identify key modes of variability. Morphological differences were examined between male and female femurs and among self-identified Caucasian and Asian ethnic groups.</p><p><strong>Results: </strong>Five principal components (PCs) explained over 90% of the total variance in the original morphometric variables. Male and Caucasian femurs were significantly larger than female and Asian femora respectively (PC1; 58.3% variability explained). There were characteristic variations in the trochlear anatomy, with female and Asian femurs exhibiting more elevated anterior distal femora (PC2; 13.6%). Variability in the intercondylar notch (PC3 11%) and femoral aspect ratio (PC5; 4.9%) were sex-specific, with female femora having relatively less anteriorly elevated medial condyles, larger AP height, and relatively narrower in the AP direction than male femora. However, variability in the condylar twist angles (PC4; 6.2%) was not different based on sex or ethnicity.</p><p><strong>Conclusion: </strong>This study characterized morphological variability in a large sample of distal femora, with key differences noted based on sex and ethnicity. The results support further consideration of this variability in knee arthroplasty implant design options and surgical approaches.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 3","pages":"407-416"},"PeriodicalIF":3.1,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13007267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147499990","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":"Antibiotic duration in native and periprosthetic joint infections : a systematic review and meta-analysis of randomized controlled trials.","authors":"Freddy M Bombah, Randy Buzisa Mbuku, Cédric Dongmo Mayopa, Gaspary Fodjeu, Loïc Fonkoue, Thomas Van den Wyngaert, Hervé Poilvache, Thomas Schubert, Christine Detrembleur, Jean-Cyr Yombi, Olivier Cornu","doi":"10.1302/2633-1462.73.BJO-2025-0227.R2","DOIUrl":"10.1302/2633-1462.73.BJO-2025-0227.R2","url":null,"abstract":"<p><strong>Aims: </strong>The optimal duration of antibiotic therapy in joint infection remains controversial, particularly as native joint septic arthritis and periprosthetic joint infection (PJI) differ substantially in pathophysiology, surgical management, and prognosis. While short antibiotic courses have been advocated for native joints after adequate drainage, prolonged therapy is often recommended for PJIs due to biofilm-related infection. This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to compare short- with long-course antibiotic strategies in both native and prosthetic joint infections.</p><p><strong>Methods: </strong>Following PRISMA guidelines, a systematic search was performed across PubMed, Embase, Web of Science, and the Cochrane Library. Only RCTs were included. Studies were assessed for inclusion using predefined population, intervention, comparison, outcomes, and study (PICOS) criteria. Meta-analyses were conducted using MedCalc, and treatment failures were analyzed using odds ratios (ORs) with 95% CIs.</p><p><strong>Results: </strong>A total of 12 RCTs involving 1,414 patients (native 577; periprosthetic 837) were included, with six eligible for meta-analysis. For PJIs, long-course therapy (≥ 12 weeks) significantly reduced treatment failure compared with short courses (OR 2.04, 95% CI 1.18 to 3.54; p = 0.011), while complication and mortality rates were similar. In contrast, for native joints, short-course therapy (≤ four weeks) achieved comparable infection control with prolonged regimens (OR 1.347; p = 0.565) when combined with adequate surgical drainage, particularly in paediatric populations. Surgical strategy (e.g. debridement, antibiotics, and implant retention vs one- or two-stage exchange) influenced outcomes more than antibiotic duration alone.</p><p><strong>Conclusion: </strong>Optimal antibiotic duration should be individualized based on joint type and surgical approach. Short courses are effective for native septic arthritis with proper drainage, whereas PJIs generally require extended therapy due to biofilm-related complexity. We propose the Age-Joint-Immunity-Surgery-Sensitivity (AJISS) score as a decision-making tool to guide treatment duration, warranting prospective validation.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 3","pages":"394-406"},"PeriodicalIF":3.1,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12995424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147475655","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":"Surgical algorithms for ankylosing spondylitis-related pseudarthrosis : adapting to radiological and clinical variations.","authors":"Mu Qiao, Bang-Ping Qian, Kaiyang Wang, Chen-Yu Song, Jing-Shun Lu, Yong Qiu","doi":"10.1302/2633-1462.73.BJO-2025-0293.R1","DOIUrl":"10.1302/2633-1462.73.BJO-2025-0293.R1","url":null,"abstract":"<p><strong>Aims: </strong>To propose feasible and systematic surgical therapeutic algorithms for treatment of spinal pseudarthrosis caused by ankylosing spondylitis (AS) with diverse radiological patterns and clinical manifestations.</p><p><strong>Methods: </strong>Retrospective analysis of AS patients with pre-existing pseudarthrosis was performed. All the patients were divided into six groups according to surgical procedures: anterior debridement and fixation (ADF), posterior fixation (PF), posterior laminectomy and fixation (PLF), osteotomy through pseudarthrosis (OTP), osteotomy skipping pseudarthrosis (OSP), and osteotomy skipping pseudarthrosis with laminectomy (OSPL). Sagittal parameters, pseudarthrosis characteristics, kyphosis apex location, and neurological status were assessed.</p><p><strong>Results: </strong>Overall, 87 patients were evaluated (mean follow-up of 42.02 months (24 to 180)). Three cases with pseudarthrosis involving anterior-to-middle column and absence of local kyphosis underwent ADF. Conversely, PF was selected for eight cases with mild regional kyphosis and three-column involving lesions. For cases with pre-existing neurological deficit but without global kyphotic deformity, PLF was used (six cases). OTP was adopted in 16 cases with global kyphosis and identical location of apex and lesions. An additional five patients also underwent osteotomy at pseudarthrotic site with lesions located below the apex and severe spinal stenosis. Regarding 45 cases with global kyphosis, normal neurological function and absence of spinal stenosis, OSP was performed. Addtionally, if neurological deficit was complicated in the aforementioned situation, OSPL was chosen (four cases). Radiological assessment confirmed solid bony union at pseudarthrotic sites in all cases.</p><p><strong>Conclusion: </strong>Developing a reliable therapeutic algorithm for AS-associated pseudarthrosis depended on its distinct radiological features and clinical manifestations. Key factors including presence of local and/or global kyphosis, extent of lesions, anatomical relationship between kyphosis apex and pseudarthrosis, and preoperative neurological status should be thoroughly evaluated to provide personalized treatment strategies.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 3","pages":"381-393"},"PeriodicalIF":3.1,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12993691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147469551","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":"Can surgeons accurately estimate loss of threshold alignment (instability) of distal radius fractures? : the influence of imaging diagnostic accuracy of radiographs compared with CT.","authors":"Lente H M Dankelman, Koen D Oude Nijhuis, Melle M Broekman, Frank F A IJpma, Britt Barvelink, Ruurd L Jaarsma, Joost W Colaris, Michael H J Verhofstad, Job N Doornberg, David Ring, Mathieu Wijffels","doi":"10.1302/2633-1462.73.BJO-2025-0330.R1","DOIUrl":"10.1302/2633-1462.73.BJO-2025-0330.R1","url":null,"abstract":"<p><strong>Aims: </strong>Almost half of distal radius fractures (DRFs) lose threshold alignment (i.e. instability) after closed reduction and immobilization. This study aimed to investigate surgeons' ability to estimate secondary displacement by addressing three questions: 1) What is the diagnostic accuracy of surgeons to estimate instability of DRFs on pre- and post-reduction radiographs?; 2) What is the diagnostic accuracy of surgeons to estimate instability of DRFs on post-reduction CT imaging?; and 3) What patient factors are associated with estimating instability?</p><p><strong>Methods: </strong>We performed a scenario-based, randomized experiment with two distinct online surveys. In Part I, 116 members of the Science of Variation Group assessed radiographs of 20 initially displaced DRFs (11 'stable', nine 'unstable'), and estimated the loss of threshold alignment after closed reduction. Half viewed pre- and post-reduction radiographs, while half viewed only post-reduction radiographs. In Part II, 115 participants assessed 15 DRFs cases (six 'stable', nine 'unstable') to estimate loss of alignment. Half of the participants evaluated pre- and post-reduction radiographs, and half also received post-reduction CT imaging.</p><p><strong>Results: </strong>In Part I, diagnostic accuracy for estimating loss of threshold alignment on pre- and post-reduction radiographs was 54% (95% CI 51% to 57%), similar to 55% (95% CI 46% to 62%) when only viewing post-reduction radiographs (p = 0.063). In Part II, the accuracy was 70% (95% CI 64% to 77%) with both radiographs and CT, compared with 67% (95% CI 61 to 67) with radiographs alone (p = 0.240). Patient factors associated with estimating instability were female sex and higher age.</p><p><strong>Conclusion: </strong>Surgeons' ability to detect DRF instability on both pre- and post-reduction radiographs, as well as post-reduction CT-scans, was limited, reflecting a restricted value of probability estimates for clinical decision-making. Given suboptimal estimations of alignment loss, it seems prudent to monitor adequately reduced fractures during initial immobilization. Future studies should focus on aids that can overcome this limited accuracy.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 3","pages":"373-380"},"PeriodicalIF":3.1,"publicationDate":"2026-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12987694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147460404","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":"Multicentre outcomes of total hip arthroplasty using a novel collared cementless femoral stem.","authors":"John Mahon, Carl Keogh, Behnazir Mohamed, Victoria Byrne, Fergal Moran, Fiachra Rowan, Gerard A Sheridan, James P Cashman","doi":"10.1302/2633-1462.73.BJO-2025-0233.R1","DOIUrl":"10.1302/2633-1462.73.BJO-2025-0233.R1","url":null,"abstract":"<p><strong>Aims: </strong>Recent years have seen increased interest in tissue-sparing approaches for total hip arthroplasty (THA), which has led to innovations in implant design. Short cementless femoral components have gained traction, and the inclusion of a medial calcar collar to improve stability may offset the risk of fracture. The aim of this current study is to report short-term outcomes and survivorship for a novel design of femoral component across four non-designer centres.</p><p><strong>Methods: </strong>All patients undergoing primary THA across four centres from July 2020 to January 2025 were eligible for inclusion. Data were collected prospectively in a national arthroplasty register, with planned routine follow-up at six months and two years. Patient-reported outcome measures were assessed using the Oxford Hip Score (OHS) and EuroQol five-dimension questionnaire (EQ-5D) score.</p><p><strong>Results: </strong>A total of 517 components in 489 patients were included in the dataset: three patients (0.6%) died by final follow-up, and of the remaining 514 components, 512 components (99.6%) remain in situ. For the two patients (0.4%) undergoing revision surgery, indications for revision were periprosthetic fracture (PPF) and large postoperative haematoma. PPF affected four patients (0.8%) in total: two intraoperative events were managed with cables, and one Vancouver C fracture was managed with plate and screw fixation. The mean preoperative OHS was 17 (95% CI 16.3 to 17.7) with a mean postoperative score of 40.7 (95% CI 39.7 to 41.5), and mean preoperative EQ-5D score was 0.36 (95% CI 0.34 to 0.38), with a mean postoperative score of 0.80 (95% CI 0.78 to 0.82).</p><p><strong>Conclusion: </strong>This novel femoral component demonstrates excellent functional outcomes which are reproducible across multiple surgeons in non-designer centres, with low rates of revision surgery and PPF.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 3","pages":"366-372"},"PeriodicalIF":3.1,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12981940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445186","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":"Pain-induced sleep disturbances fully mediate the association between symptomatic hip and knee osteoarthritis and poor sleep quality : a cross-sectional study.","authors":"Juliette C Sorel, Bowien H W Korterink, Raymond Noordam, Frits R Rosendaal, Magreet Kloppenburg, Rob G H H Nelissen, Saskia le Cessie, Rudolf W Poolman, Birit F P Broekman, Maaike G J Gademan","doi":"10.1302/2633-1462.73.BJO-2025-0325.R1","DOIUrl":"10.1302/2633-1462.73.BJO-2025-0325.R1","url":null,"abstract":"<p><strong>Aims: </strong>We assessed whether symptomatic end-stage hip and knee osteoarthritis (OA) are associated with poorer sleep quality and to what extent pain mediates these associations.</p><p><strong>Methods: </strong>We included symptomatic end-stage hip- and knee OA participants from the Longitudinal Leiden Orthopaedics Outcomes of Osteo-arthritis Study (LOAS) and participants without OA from the Netherlands Epidemiology of Obesity (NEO) study. We assessed sleep with the Pittsburgh Sleep Quality Index (PSQI) and performed linear regression analyses to investigate the associations between OA and sleep and the potential mediating effects of pain-related sleep disturbances.</p><p><strong>Results: </strong>Overall, 54% of the 922 hip OA and 48% of the 870 knee OA patients reported poor sleep (total PSQI > 5), compared with 21% of the 1,165 participants without OA. Both hip and knee OA were associated with worse subjective sleep quality (adjusted difference: 0.37 points (95% CI 0.29 to 0.44) and 0.23 points (95% CI 0.15 to 0.32), respectively) and pain-related sleep disturbances (adjusted difference: 1.75 points (95% CI 1.64 to 1.86) and 1.50 points (95% CI 1.38 to 1.62), respectively). The association of hip and knee OA and worse subjective sleep quality was fully mediated by pain-related sleep disturbances (112% (95% CI 90 to 145) and 123% (95% CI 90 to 191), respectively).</p><p><strong>Conclusion: </strong>Symptomatic end-stage hip and knee OA are strongly associated with worse sleep quality, which is fully mediated by pain-related sleep disturbances. While the cross-sectional design limits causal inferences, these findings underscore the importance of improving both sleep quality and pain management strategies in symptomatic end-stage OA patients. Addressing sleep disturbances, which are often overlooked in clinical practice, could significantly enhance overall health and quality of life of patients with end-stage hip- or knee OA.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 3","pages":"348-356"},"PeriodicalIF":3.1,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12978874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436247","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":"Automated deep-learning quantification of nine patellofemoral instability parameters on multislice CT images : development and validation of the GU2Net model.","authors":"Qin Ye, Yingying Ying, Jiake Hua, Junfen Ye, Chengxin Zhu, Bowen Zheng","doi":"10.1302/2633-1462.73.BJO-2025-0326.R1","DOIUrl":"10.1302/2633-1462.73.BJO-2025-0326.R1","url":null,"abstract":"<p><strong>Aims: </strong>Objective and precise measurement of patellar instability (PI) parameters on CT images is essential for accurate diagnosis and treatment planning. However, manual assessment is tedious, time-consuming, and prone to error. This study aimed to develop and validate a deep learning model that automatically quantifies PI parameters on axial knee CT images.</p><p><strong>Methods: </strong>CT scans of 1,125 knees were randomly divided into training, validation, internal test, and hold-out test sets. A deep learning-based model was trained to localize anatomical landmarks and calculate nine PI parameters: lateral patellar tilt (LPT), bisect offset ratio (BSO), congruence angle (CA), sulcus angle (SA), trochlear groove depth (TGD), lateral trochlear inclination (LTI), trochlear groove-transepicondylar axis (TG-TEA) distance, tibial tubercle-trochlear groove (TT-TG) distance, and tibial tubercle-Roman arch (TT-RA) distance. Model performance was compared with manual measurements using the successful detection rate, mean absolute error (MAE), intraclass correlation coefficient (ICC), and Pearson correlation coefficient.</p><p><strong>Results: </strong>The model accurately predicted landmark locations (MAE 0.84 to 2.72 mm) and PI parameters (ICC 0.826 to 0.997, <i>r</i> 0.705 to -0.994, p < 0.001) except for SA (ICC 0.701 to 0.862, <i>r</i> 0.542 to 0.744, p < 0.001). On the hold-out test set, the model outperformed inexperienced radiologists for LPT, CA, SA, LTI, and TGD (model: ICC 0.701 to 0.996, r 0.542 to 0.992, p < 0.001; radiologists: ICC 0.413 to 0.959, r 0.281 to 0.923, p<i> </i>< 0.05).</p><p><strong>Conclusion: </strong>The proposed deep learning model reliably automates PI measurement, reducing the time and variability associated with manual assessment and mitigating dependence on examiner experience.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 3","pages":"357-365"},"PeriodicalIF":3.1,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12978875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436316","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}