Bone & Joint Open最新文献

{"title":"How reliable are surgeons at assessing soft-tissue laxities in robotic arm-assisted total knee arthroplasty? : a prospective, multicentre surgeon-blinded study.","authors":"James A Corbett, Darren B Chen, Price Gallie, Anthony Leong, Jonathan S Mulford, David Penn, Jil A Wood, Samuel J MacDessi","doi":"10.1302/2633-1462.69.BJO-2025-0073.R1","DOIUrl":"10.1302/2633-1462.69.BJO-2025-0073.R1","url":null,"abstract":"<p><strong>Aims: </strong>Regardless of one's alignment philosophy and belief in ligament releases, the precise estimation of soft-tissue laxities is crucial in total knee arthroplasty (TKA). This study prospectively assessed the reliability of surgeons' and assistants' measurements of ligament tension during robotic arm-assisted TKA.</p><p><strong>Methods: </strong>A prospective, surgeon-blinded study was performed in 123 patients undergoing TKA by six surgeon/assistant pairs. Ligament tensions were captured using manual stress and instrumented distraction techniques for four gaps: medial extension, lateral extension, medial flexion, and lateral flexion. Assessors were blinded during gap measurements. The primary outcome was intrarater and inter-rater reliability using intraclass correlation coefficients (ICCs). Secondary outcomes were the reliability of manual compared with instrumented distraction measures and comparison of planned pre-resection virtual gaps against actual post-implantation laxities.</p><p><strong>Results: </strong>The intrarater mean ICC for surgeons' measurements of gap laxities was 0.95 (0.90 to 0.97) and 0.94 (0.91 to 0.96) for assistants' measurements. These results indicate excellent reliability for all four gaps for both surgeons and assistants. For inter-rater reliability, both extension gaps returned an ICC > 0.90, indicating excellent reliability between surgeons and assistants. Lateral flexion ICC was 0.75 and medial flexion 0.86, indicating good reliability. Comparing manual with instrumented distraction techniques, the mean ICC was 0.72, indicating moderate reliability (0.55 to 0.88). The mean difference between planned and final gap measures was 0.5 mm (-1.5 to 3.0, SD 0.71).</p><p><strong>Conclusion: </strong>Surgeons' ability to assess knee laxities using manual stressing during robotic arm-assisted TKA has excellent intrarater and good-to-excellent inter-rater reliability. Distraction values for the medial side were more reliable than the lateral side, where constitutional laxity and the technical challenge of assessment may increase variability. High reliability of manual stressed gap assessment in robotic arm-assisted TKA should give surgeons confidence in using this information for measuring and achieving soft-tissue balance.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 9","pages":"1044-1052"},"PeriodicalIF":3.1,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12411016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001489","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":"Loading of the artificial knee during early rehabilitation and physiotherapy : an in vivo study.","authors":"Nike Schulle, Tobias Winkler, Alwina Bender, Srdan Popovic, Clemens Gwinner, Carsten Perka, Georg Duda, Philipp Damm","doi":"10.1302/2633-1462.69.BJO-2025-0071.R1","DOIUrl":"10.1302/2633-1462.69.BJO-2025-0071.R1","url":null,"abstract":"<p><strong>Aims: </strong>This retrospective observational study aimed to determine the in vivo joint loads in the knee after total knee arthroplasty during early postoperative rehabilitation involving different physiotherapy exercises and to analyze how these loads change over the first three weeks postoperatively.</p><p><strong>Methods: </strong>Nine patients (six males, three females) with a primary instrumented total knee replacement participated in the study. A total of 19 selected physical therapy exercises of varying load levels were performed on the ninth (SD 3) and 21st (SD 6) postoperative day. During these sessions, the peak resultant knee contact force (F_{res max}) and loading patterns were measured to assess joint loading dynamics.</p><p><strong>Results: </strong>F_{res max} varied across different exercises, ranging from a minimum of 15% body weight (% BW) during seated leg swings to a maximum of 195% BW during stair ascent. Joint loads increased from the ninth to the 21st postoperative day for all activities, except for a few relaxed status exercises where a decrease was observed. Load-bearing activities with crutches had the highest knee joint loads.</p><p><strong>Conclusion: </strong>All exercises remained below the forces of walking on ground level indicating safety for the postoperative rehabilitation. Physical therapists should consider these loads in relation to daily activities when designing treatment plans also referring to the different loads in different exercises.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 9","pages":"1053-1064"},"PeriodicalIF":3.1,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12411017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001573","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":"A systematic review of outcomes reported in randomized controlled trials involving people with patellar dislocations.","authors":"Colin P Forde, Crispin Mortimer, Toby O Smith, Matthew L Costa, Jonathan A Cook, Elizabeth Tutton, Georgina Wistow, Paul Minty, David J Keene","doi":"10.1302/2633-1462.69.BJO-2025-0045.R1","DOIUrl":"10.1302/2633-1462.69.BJO-2025-0045.R1","url":null,"abstract":"<p><strong>Aims: </strong>The primary aims were to determine what outcome domains, outcome measurement instruments, and outcome measurement timepoints are reported in randomized controlled trials (RCTs) involving people with patellar dislocations. The secondary aims were to determine what primary outcomes were used and how a recurrent patellar dislocation was defined when this was used as an outcome.</p><p><strong>Methods: </strong>We searched MEDLINE, Embase, CINAHL, the Cochrane Database of Controlled Trials, and trial registries (last search: January 2024) for RCTs evaluating treatments for people with a patellar dislocation irrespective of age or sex. We identified the unique outcomes in included studies and mapped these onto the World Health Organization's International Classification of Functioning, Disability and Health (WHO ICF) framework to identify the measured domains. We synthesized results into tables, figures, and text. A critical appraisal of included studies was not required for this systematic review.</p><p><strong>Results: </strong>From the 70 included studies, we identified 141 unique outcomes. The most commonly used unique outcome was a recurrent ipsilateral patellar dislocation (used in 55 studies), but only 17/55 studies (31%) reported how this was defined (i.e. the criteria required for a recurrent ipsilateral patellar dislocation event to be recorded). Unique outcomes mapped onto 66 second-level domains of the WHO ICF framework, and 56% (593/1,052) in the 'activities and participation' domain. Included studies used 42 different patient-reported outcome measures (PROMs), most commonly the Kujala Patellofemoral Score (71%, 50/70 studies), but 28 PROMs (60%) were used only once. In all, 31 different primary outcomes were identified from 47 included studies, with 14 primary outcomes (45%) used only once among included studies. The Kujala Patellofemoral Score was also the most common primary outcome (38%, 18/47 studies). Outcome measurement timepoints varied, but the most common timeframe for primary outcome measurement was > one to three years (46%, 16/35 studies that provided data).</p><p><strong>Conclusion: </strong>The variability in the outcome domains, PROMs, and primary outcomes measured in RCTs evaluating patellar dislocation treatments highlights that a core outcome set is needed. This process is underway and is being informed by this systematic review's findings.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 9","pages":"1031-1043"},"PeriodicalIF":3.1,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993738","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":"Prior hip arthroscopy impacts long-term outcomes of total hip arthroplasty : a propensity-matched study with a minimum ten-year follow-up.","authors":"Roger Quesada-Jimenez, Elizabeth G Walsh, Ady H Kahana-Rojkind, Drashti Sikligar, Krishi Rana, Benjamin G Domb","doi":"10.1302/2633-1462.69.BJO-2025-0064","DOIUrl":"10.1302/2633-1462.69.BJO-2025-0064","url":null,"abstract":"<p><strong>Aims: </strong>The objective of this study was to perform a long-term comparative analysis of patients who underwent total hip arthroplasty (THA) with a history of previous ipsilateral hip arthroscopy (PA) to a propensity-score matched control group of primary THA with no prior hip arthroscopy (NPA).</p><p><strong>Methods: </strong>Data were analyzed from patients who underwent primary THA for symptomatic hip osteoarthritis between November 2010 and November 2013. Patients included had completed a minimum of ten years of patient-reported outcome measure questionnaires. The PA group was propensity-score matched 1:1 based on age at THA, BMI, sex, robotic assistance, approach, and laterality to the NPA group. Clinical hip arthroplasty outcome thresholds, complications, and revision surgery rates were compared between cohorts. A Kaplan-Meier analysis was performed to assess survivorship.</p><p><strong>Results: </strong>A total of 108 patients were included, 54 in each group. The groups displayed comparable outcomes at minimum ten-year follow-up, for modified Harris Hip Score (mHHS) (p = 0.370), Harris Hip Score (HHS) (p = 0.370), Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR) (p = 0.380), Forgotten Joint Score (FJS) (p = 0.250), visual analogue scale (VAS; p = 0.150), and patient satisfaction (p = 0.310). The two groups reached Patient Acceptable Symptom State (PASS) for FJS, HHS, and HOOS-JR at similar rates (p > 0.05). The PA group exhibited a significantly higher complication rate, with 11 major complications compared to two in the NPA group, translating to a relative risk of 2.8 (p < 0.033). Among the major complications in the PA group, nine required revision surgery, resulting in a relative risk of 4.5 (p < 0.047).</p><p><strong>Conclusion: </strong>Patients undergoing primary THA with a history of prior hip arthroscopy achieve similar long-term functional outcomes compared to a propensity-matched control group. However, they face a 2.8-fold increased risk of complications and a 4.5-fold higher risk of major complications requiring revision THA.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 9","pages":"1022-1030"},"PeriodicalIF":3.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972093","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":"Between-hospital variability in the management and outcomes of postoperative periprosthetic femoral fractures.","authors":"Mohammad Aryaie, Jonathan T Evans, Mike Reed, Cliff Shelton, Antony Johansen, Toby O Smith, Jonathan Benn, Mark Baxter, Paul Aylin, Dawn Goodwin, Choon Key Chekar, Alex Bottle","doi":"10.1302/2633-1462.69.BJO-2025-0050.R1","DOIUrl":"10.1302/2633-1462.69.BJO-2025-0050.R1","url":null,"abstract":"<p><strong>Aims: </strong>Postoperative periprosthetic femoral fractures (POPFFs) following hip arthroplasty pose complex challenges, with differences in management and outcomes across healthcare facilities. However, there is limited published literature on such variability to inform improvement initiatives. This study aims to quantify the between-hospital variations in surgical management and short-term outcomes.</p><p><strong>Methods: </strong>Administrative hospitalizations data from all 177 NHS hospital Trusts in England were analyzed for patients aged 18 years and above with a primary diagnosis of POPFF between April 2016 and December 2022. Patient demographic characteristics, comorbidities, procedures, length of stay, in-hospital mortality, 30-day total mortality (in or out of hospital), and emergency 30-day all-cause readmissions were extracted. Multilevel models with random intercepts for hospitals and funnel plots assessed the non-random variations between hospitals in procedures and outcomes.</p><p><strong>Results: </strong>Among 39,035 hospitalized patients, 66% were female (n = 25,720), with a median age of 82 years (IQR 73 to 88). Hospital variation existed in treatment outcomes, with adjusted intraclass correlation coefficients for fixation without revision, revision, and no surgical procedure of 4.0%, 3.8%, and 2.4%, respectively. Funnel plots revealed hospital outliers for procedure choice after adjusting for age, sex, and number of comorbidities - among 177 hospitals, nine (5.1%) exceeded the upper 95% control limit for fixation and 17 (9.6%) did so for revision; outlier proportions were 14.1% for length of stay, 3.9% for emergency 30-day readmission, and 1.1% for mortality.</p><p><strong>Conclusion: </strong>Inter-hospital variation exists for the management and short-term outcomes following POPFFs in England. This warrants further explanation to better understand the reasons for this.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 9","pages":"1013-1021"},"PeriodicalIF":3.1,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12401591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971592","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":"No obvious time trend in proximal humeral fracture complexity : a cohort study from 1944 to 2020 in Malmö, Sweden.","authors":"Anton Cederwall, Anders Nordqvist, Magnus K Karlsson, Björn E Rosengren","doi":"10.1302/2633-1462.69.BJO-2025-0210","DOIUrl":"10.1302/2633-1462.69.BJO-2025-0210","url":null,"abstract":"<p><strong>Aims: </strong>The epidemiology of proximal humerus fractures (PHFs) has been described in terms of incidence, fracture complexity, and general time trends, but current literature on time trends in PHF complexity is limited. This study aims to explore possible time trends in PHF complexity and report the distribution of different types of PHF from January 1944 to December 2020.</p><p><strong>Methods: </strong>The city of Malmö, Sweden, has one emergency hospital where acute fractures are treated, and radiographs have been saved for almost a century. One author reviewed and classified relevant radiological examinations in individuals aged ≥ 18 years with a PHF during 17 sample years from 1944 to 2020 in Malmö using the Neer and AO classifications.</p><p><strong>Results: </strong>Of the 3,031 identified PHFs, 2,216 (73%) were sustained by women (mean age 69 years (SD 14)) and 815 (27%) by men (mean age 59 years (SD 17)). We saw no obvious time trend in fracture complexity overall, for men and women separately, or for different age groups. Fracture complexity according to AO was higher in older than younger age groups, which was true also with the Neer classification for women. However, for men, according to the Neer classification, the fracture complexity was higher in younger than older age groups.</p><p><strong>Conclusion: </strong>We found no obvious time trend in fracture complexity with the Neer or AO classification systems from 1944 to 2020.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 9","pages":"1006-1012"},"PeriodicalIF":3.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12399329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971623","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":"HIP Surgical Techniques to Enhance Rehabilitation (HIPSTER) : a single-centre, double-blind, parallel three-arm, randomized-controlled, superiority trial.","authors":"Holly Whitmore, Alison Smeatham, Siobhan Creanor, Fiona C Warren, Sarah L Whitehouse, Elizabeth Gordon, Timothy P Holsgrove, A M Kassam, A John Timperley, Chris Hayward, Heather Cook, Lucy Clarke, Paul Winspear, Peter Greenstreet, Peter Tippett, Phoebe Dawe, Rebecca Barnard, Rebeka Sultana","doi":"10.1302/2633-1462.68.BJO-2025-0065","DOIUrl":"10.1302/2633-1462.68.BJO-2025-0065","url":null,"abstract":"<p><strong>Aims: </strong>The primary aim of this trial is to investigate whether two novel robotic-assisted tendon-sparing posterior approaches to total hip arthroplasty (THA) surgery, the piriformis-sparing posterior approach (PSPA) and the spare piriformis and internus, repair externus technique (SPAIRE), improve early patient outcomes in THA compared with a robotic-assisted standard posterior approach (PA).</p><p><strong>Methods: </strong>HIP Surgical Techniques to Enhance Rehabilitation (HIPSTER) is a single-centre, double-blind, parallel three-arm, individually randomized, controlled, superiority trial. A total of 309 participants aged over 18 years who have been listed for an elective THA will be recruited. Participants will be randomized in a 1:1:1 ratio to SPAIRE:PSPA:PA, using minimization (with a random element) on sex (males; females), age (< 50 years; ≥ 50 years), and BMI (< 30 kg/m²; ≥ 30 kg/m²). The primary outcome is the patient-reported outcome of Oxford Arthroplasty Early Recovery Score (OARS), assessed six weeks after surgery. Secondary outcome measures include blood biomarkers, activity monitoring, and patient-reported outcome measures.</p><p><strong>Conclusion: </strong>The trial will assess whether the two novel robotic-assisted tendon-sparing posterior approaches to THA surgery, the PSPA and SPAIRE, improve patient outcomes in THA compared with a robotic-assisted standard PA. If successful, it is anticipated that the results of this trial will provide the evidence necessary to plan a future multicentre, randomized-controlled trial to compare the best-performing tendon-sparing approach (PSPA or SPAIRE) identified in this efficacy trial with the gold standard PA, to assess whether the efficacy results are generalizable across the NHS. At the time of the submission, the trial is currently completing recruitment, and the follow-up will be completed in 2026.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 8","pages":"991-1005"},"PeriodicalIF":3.1,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12381592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972269","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":"Improvement in six of the 12 Oxford Knee Score questions is independently associated with patient satisfaction following knee arthroplasty.","authors":"Eliott Sophie Martinson, Nick D Clement, Gillian Leitch, Chloe E H Scott","doi":"10.1302/2633-1462.68.BJO-2025-0105.R1","DOIUrl":"10.1302/2633-1462.68.BJO-2025-0105.R1","url":null,"abstract":"<p><strong>Aims: </strong>The Oxford Knee Score (OKS) is an established and validated outcome measure of knee arthroplasty (KA), but it is not clear how responses to each of the 12 questions relate to satisfaction. The aim was to assess which of 12 OKS questions were associated with patient satisfaction after KA.</p><p><strong>Methods: </strong>This single-centre retrospective cohort study was conducted over an eight-year period from January 2014 to December 2021. A total of 3,361 patients completed preoperative and six months postoperative OKS. The mean age was 69.9 years (34 to 94, SD 9.3), and 1,792 were female (55.0%). Patient satisfaction with their KA was assessed at six months, which was categorized into satisfied (satisfied, very satisfied) and dissatisfied (neutral, dissatisfied, very dissatisfied).</p><p><strong>Results: </strong>All 12 questions demonstrated significant improvements postoperatively (p < 0.001), with moderate (q2/3/7) to large (q1/4/5/6/8/9/10/11/12) effect sizes. There were 2,704 patients (82.9%) who were satisfied with their KA at six months. Satisfied patients had significantly greater improvements (p < 0.001) in each of the OKS questions, with the greatest differences found in questions 6 (limping; mean difference (MD) 1.41 (95% CI 1.29 to 1.53)) and 1 (pain; MD 1.32 (95% CI 1.22 to 1.42)). Preoperative responses to each of the OKS questions demonstrated poor discriminatory ability to predict patient satisfaction (area under the curve < 0.70). Improvement in questions 1 (pain; odds ratio (OR) 1.72 (95% CI 1.51 to 1.96), p < 0.001), 6 (limping; OR 1.28 (95% CI 1.16 to 1.41), p < 0.001), 7 (kneeling; OR 1.20 (95% CI 1.06 to 1.35), p = 0.003), 8 (night pain; OR 1.11 (95% CI 1.01 to 1.23), p = 0.038), 9 (working; OR 1.21 (95% CI 1.05 to 1.39), p = 0.015), and 12 (stairs; OR 1.42 (95% CI 1.25 to 1.63), p < 0.001) were independently associated with satisfaction.</p><p><strong>Conclusion: </strong>Improvements in six of the 12 OKS questions were independently associated with patient satisfaction; these could be prioritized as areas to be addressed following KA, and modification of related patient expectations may improve satisfaction with surgery.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 8","pages":"983-990"},"PeriodicalIF":3.1,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12368461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972332","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":"Leg-length discrepancy in revision total hip arthroplasty : computer-assisted navigation improves the discrepancy when compared with manual techniques.","authors":"Troy D Bornes, Sebastian B Braun, Christopher G Anderson, Young Dong Song, Isaiah Selkridge, Allina A Nocon, Kathleen Tam, Peter K Sculco","doi":"10.1302/2633-1462.68.BJO-2024-0149.R3","DOIUrl":"10.1302/2633-1462.68.BJO-2024-0149.R3","url":null,"abstract":"<p><strong>Aims: </strong>Leg-length discrepancy (LLD) following total hip arthroplasty (THA) is a source of patient dissatisfaction and morbidity. The objectives of this study were to characterize LLD following revision THA (rTHA) and evaluate the difference in LLD between navigated and non-navigated rTHA.</p><p><strong>Methods: </strong>This retrospective cohort study included 202 patients treated with rTHA performed between 2017 and 2021. An a priori power analysis determined that 101 patients in each group were required. Navigated and non-navigated rTHA were compared with regard to LLD (absolute value), re-revision rate, and patient-reported outcome measures (PROMs).</p><p><strong>Results: </strong>Mean postoperative LLD was 4.3 mm (SD 4.6) in all patients. In navigated rTHA, mean postoperative LLD of 3.7 mm (SD 4.7) was lower than preoperative LLD (7.5 mm (SD 6.1); p < 0.001). In non-navigated rTHA, postoperative LLD of 4.9 mm (SD 4.3) was lower than preoperative LLD (7.8 mm (SD 6.6); p < 0.001). Postoperative LLD was significantly lower in navigated compared with non-navigated rTHA in all patients and in sub-groups with preoperative LLD < 5 mm (1.7 mm vs 3.5 mm), < 10 mm (2.8 mm vs 3.9 mm), < 15 mm (3.0 mm vs 4.1 mm), and < 20 mm (3.3 mm vs 4.7 mm), respectively (p < 0.05). Based on revision type, postoperative LLD was significantly lower in navigated rTHA compared to non-navigated rTHA in those with both-component and acetabular component-only revisions (p < 0.05). Subsequent re-revision was required in three navigated rTHAs (3%) and eight non-navigated rTHAs (8%, p = 0.121). Changes in patient-reported Hip injury and Osteoarthritis Outcome Score Joint Replacement, Lower Extremity Activity Scale, and pain were not significantly different between navigated and non-navigated patients.</p><p><strong>Conclusion: </strong>Postoperative LLD was improved relative to preoperative LLD in rTHA with and without the use of navigation. Postoperative LLD was significantly lower in navigated rTHA compared with non-navigated rTHA. There was no significant difference in PROMs between groups. Based on these results, computer-assisted navigation seems to optimize leg-length correction and should be considered for use in rTHA involving the acetabular component, including both-component and acetabular component-only revisions. Of note, the present study was not designed to validate all aspects of all parameters of computer navigation; rather, it was specifically designed to assess LLDs when using navigation. Therefore, the present results only cover the topic of LLD when using navigation in comparison with manual techniques.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 8","pages":"964-970"},"PeriodicalIF":3.1,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12368460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes reported in trials of children and adolescent knee injuries : a systematic review.","authors":"Ignatius Liew, Wen Xian Low, Adeel Ikram, Stephen McDonnell, Ben Arthur Marson, Adeel Ikram, Arman Memarzadeh, Ben A Marson, Benjamin Gompels, Caroline Hing, Dimitrios Manoukian, Faye Grace, Ignatius Liew, Jay Ebert, Jimmy Ng, Joanna Thomas, Neeraj M Patel, Nicolas Nicolaou, Peter D'Alessandro, Pranai Buddhdev, Sheba Basheer, Stephen McDonnell, Toby Smith, Wen Xian Low, Hannah Boddy","doi":"10.1302/2633-1462.68.BJO-2025-0005.R1","DOIUrl":"10.1302/2633-1462.68.BJO-2025-0005.R1","url":null,"abstract":"<p><strong>Aims: </strong>To systematically review published evidence of outcomes reported in trials of knee injuries in children and adolescents.</p><p><strong>Methods: </strong>We searched the following databases from inception to 29 July 2024: OVID MEDLINE, Embase, Cochrane CENTRAL, Clinicaltrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). In total, 13,146 studies were identified; after removing duplicates, 9,796 studies were yielded for screening following PRISMA guidelines. Data extraction was performed by two researchers, and 15 trials were included in the final analysis. Outcomes reported by trials were mapped to the domains within the WHO International Classification of Function framework (ICF), comprising four main categories: Body functions (b), Activities and participation (d), Environmental factors (e), and Body structure (s).</p><p><strong>Results: </strong>A total of 83 outcomes were identified from 15 trials, representing 35 WHO domains. The most common domain reported mapped to the ICF framework was structure of the lower limb (s750; 93.3%), followed by sensation of pain (b280; 86.7%), mobility of joint function (b710; 86.7%), and function of the joints and bones (b729; 86.7%). Patient satisfaction was reported in two trials (13.3%) trials. Primary outcomes were not reported in seven trials (46.6%). Pedi-International Knee Documentation Committee (IKDC) was the most common patient-reported outcome measure in seven trials (46.6%).</p><p><strong>Conclusion: </strong>Outcome measure tools reported in children and adolescent knee injuries are highly variable and inconsistent. Currently, there are no core outcome sets (COS) for these injuries, highlighting an urgent need to improve standardization and consistency in trial reporting. A key recommendation for the COS development is accounting for pathology-specific subcategories, given the difference in emphasis on WHO ICF domains across various knee injuries. In the future, these approaches will ensure the COS has comprehensive yet unique priorities for each condition.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 8","pages":"971-982"},"PeriodicalIF":3.1,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12368462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971582","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}