Bone & Joint Open最新文献

{"title":"Fixation versus revision arthroplasty for Unified Classification System type B periprosthetic fractures around cemented polished tapered femoral components : a systematic review and meta-analysis.","authors":"Samuel Walters, Borna Guevel, Peter Bates, Homa Arshad, Xavier L Griffin","doi":"10.1302/2633-1462.68.BJO-2025-0123","DOIUrl":"10.1302/2633-1462.68.BJO-2025-0123","url":null,"abstract":"<p><strong>Aims: </strong>Periprosthetic femoral fractures (PFF) around hip arthroplasty implants are increasingly common, often occurring in frail elderly patients. Polished taper-slip (PTS) cemented femoral components are commonly used and have been associated with increased PFF rates compared with other cemented femoral component types. In managing Unified Classification System (UCS) type B fractures around PTS stems, surgical treatment options include open reduction and internal fixation (ORIF) and revision arthroplasty (RA), but there is limited evidence comparing these.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was undertaken. Results from database searching were screened and data were extracted by two authors independently. Reoperation was the primary outcome measure, and the secondary outcome measures included mortality, blood transfusion requirements, and length of stay.</p><p><strong>Results: </strong>There were 4,640 unique results, and four comparative studies were included in the final analysis. These were published between 2015 to 2023, totalling 539 patients, with 339 treated with ORIF and 200 treated with RA. There was a signal for a clinically large, but not statistically significant, benefit of ORIF compared with RA in reoperation risk (risk ratio (RR) 0.444; 95% CI 0.162 to 1.218; p = 0.115), with an absolute risk reduction of 9.15%. There was also a non-significant signal for increased mortality in the ORIF group at both 90 days and one year. ORIF was associated with a significant decrease in blood transfusion requirements (RR 0.65; 95% CI 0.482 to 0.876; p = 0.005), with an absolute risk reduction of 14.07%. There was also a significant decrease in length of stay following ORIF (mean reduction 2.45 days; 95% CI 0.09 to 4.82; p = 0.042).</p><p><strong>Conclusion: </strong>Fixation alone is associated with significantly reduced length of stay and blood transfusion, and also with a trend towards reduced reoperation and increased mortality, which may reflect a frailer patient group that receive this treatment, but neither of these findings reached statistical significance. Fixation may have benefits when applied in suitable cases.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 8","pages":"944-953"},"PeriodicalIF":3.1,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875576","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":"Long-term functional and quality of life outcomes after cementless minimally invasive extendable endoprosthesis replacement in skeletally immature patients with bone sarcomas at the lower limb : a Japanese Musculoskeletal Oncology Group (JMOG) study.","authors":"Yusuke Tsuda, Yoshihiro Nishida, Akio Sakamoto, Koichi Ogura, Tomohiro Fujiwara, Tetsuya Sekita, Hirotaka Kawano, Hiroshi Kobayashi","doi":"10.1302/2633-1462.68.BJO-2025-0062.R1","DOIUrl":"10.1302/2633-1462.68.BJO-2025-0062.R1","url":null,"abstract":"<p><strong>Aims: </strong>Extendable endoprostheses are utilized to reconstruct segmental defects following resection of bone sarcomas in skeletally immature children. However, there remains a paucity of data regarding long-term functional and quality of life outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective, multicentre study and reviewed 45 children who underwent cementless minimally invasive extendable endoprosthetic replacement. Anatomical sites included the distal femur (n = 29), proximal femur (n = 4), proximal tibia (n = 11), and total femur (n = 1). The mean follow-up period was 12 years. The mean age at extendable endoprosthetic replacement was ten years (5 to 15). Most patients (96%, 43/45) had reached skeletal maturity at the final follow-up.</p><p><strong>Results: </strong>The ten-year endoprosthetic failure-free survival rate was 60%. Of the 45 patients, 25 (56%) had 42 complications which were frequently related to structural failure (45%, 19/42), with extension mechanism jamming being the most common (n = 7, 17%). Excluding lengthening procedures, 20 patients (44%) underwent additional surgery with a mean of two surgeries per patient. The mean limb-length discrepancy at the final follow-up was 2.3 cm. Limb salvage was achieved in 44 (98%) patients. The mean Musculoskeletal Tumor Society (MSTS) scores, Toronto Extremity Salvage Score (TESS), and EuroQol five-dimension five-level questionnaire (EQ-5D-5L) were 78%, 92%, and 92% at the last follow-up, respectively. Multiple additional surgeries (≥ 2 times) for complications were associated with worse MSTS scores compared with those without multiple additional surgeries (p = 0.009). Moreover, limb-length discrepancy > 3 cm showed significantly worse MSTS scores compared with those ≤ 3 cm (p = 0.019).</p><p><strong>Conclusion: </strong>Extendable endoprostheses were associated with a high complication rate and need for additional surgeries over time, especially for structural-related complications. Despite this, successful limb salvage with reasonable function/quality of life and small limb-length discrepancy were achievable in the long term. Patients' function in the long term depended on the experience of postoperative complications and limb-length discrepancy.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 8","pages":"954-963"},"PeriodicalIF":3.1,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12363372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875577","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":"Allografts in primary anterior cruciate ligament reconstruction : a scoping review of the literature highlighting reporting standards.","authors":"Khalid Al-Hourani, Saran Singh Gill, Bhargava Ram Govardhana, Eoghan Hurley, Shehzaad Khan, Alastair Davidson, Xinning Li, Iain R Murray, Fares S Haddad","doi":"10.1302/2633-1462.68.BJO-2025-0080.R1","DOIUrl":"10.1302/2633-1462.68.BJO-2025-0080.R1","url":null,"abstract":"<p><strong>Aims: </strong>To conduct a scoping review into the use of allograft in primary anterior cruciate ligament (ACL) reconstruction, and to ascertain the variability in reporting outcomes in the literature.</p><p><strong>Methods: </strong>The study was conducted in line with the Preferred Reporting Items for Systematic reviews and Meta-Analayses (PRISMA), and also used Arksey and O'Malley's established five-stage process for scoping reviews in order to map the literature for allograft use in primary ACL reconstruction. Following screening to identify eligible studies, data were extracted and mapped to provide a descriptive and thematic analysis.</p><p><strong>Results: </strong>A total of 421 studies were identified from the initial search, with 77 studies eligible for final scoping review published from January 1993 to December 2024. The majority of studies were published from the USA and China (56/77, 72.3%). Nine studies (9/77, 11.7%) were level1 evidence. Key variables such as graft diameter (27/77, 33.8%), graft processing (27/77, 35.1%), and cost of graft (3/77, 3.9%) were significantly under-reported. For clinical outcomes, the Lachman score (45/77, 57.1%), pivot shift grade (45/77, 58.4%), and graft re-rupture rate (42/77, 54.5%) were highest reported. For functional outcomes, two predominant scores were recorded, the International Knee Documentation Committee score (52/77, 67.5%) and the Tegner-Lysholm knee score (48/77, 62.3%). A total of 30 functional outcomes were recorded, spanning all studies.</p><p><strong>Conclusion: </strong>This scoping review identified 77 studies which analyzed allografts in primary ACL reconstruction. There is great variability in the reporting standards, with significant under-reporting of important variables. Further research is required to develop standardized reporting criteria in order to accurately reflect the outcomes of allografts in primary ACL reconstruction.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 8","pages":"933-943"},"PeriodicalIF":3.1,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12343146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838037","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":"Civilian gunshot fractures of the acetabulum.","authors":"Anna Antoni, Kirsty Berry, Kim Laubscher, Benjamin H Blankson, Rebecca Wagner, Stefan Swanepoel, Maritz Laubscher, Sithombo Maqungo","doi":"10.1302/2633-1462.68.BJO-2025-0097.R1","DOIUrl":"10.1302/2633-1462.68.BJO-2025-0097.R1","url":null,"abstract":"<p><strong>Aims: </strong>Sparse literature is available for gunshot fractures of the acetabulum. Based on the high risk of hip septic arthritis following bowel content contamination in small case series, most authors recommend washout of the hip. Due to a lack of clear injury definition and differentiation between high- and low-energy fractures in the literature, the aim of the study was to increase the body of knowledge by describing the characteristics, management, and complications of civilian gunshot fractures of the acetabulum. The main research questions were: what is the rate of early infection, and are infection rates increased by associated injuries?</p><p><strong>Methods: </strong>Data of all adult patients with civilian acetabulum gunshot fractures treated at a high-volume tertiary hospital betweenJanuary 2009 and December 2022 were retrospectively analyzed.</p><p><strong>Results: </strong>We treated 52 patients in the study period. A total of 30 patients (58%) had associated intra-abdominal or urological injuries. Fracture patterns were stable in 96%. Orthopaedic surgical interventions were performed in 15 patients (29%) with removal of bullets as the most frequent procedure (13, 25%). Infections were noted in four patients (8%) with two cases of septic arthritis (4%). Among the patients with infections, there were more trajectories crossing the midline, more blood products used, and more bowel before bone trajectories, statistically non-significant. Displaced fractures had a 50% rate of septic arthritis and large bowel before bone trajectories a 20% rate.</p><p><strong>Conclusion: </strong>We could identify characteristics and complications of mostly low-energy civilian acetabulum gunshot fractures, which is novel in the literature. Displaced fractures and large bowel before bone trajectories had the highest rate of septic arthritis, but infection rates were markedly lower than in the literature on bowel content-contaminated hip gunshots. Despite the mainly descriptive nature of the study, the findings could have implications for the surgical management of civilian acetabulum gunshot fractures.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 8","pages":"924-932"},"PeriodicalIF":3.1,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12339083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822759","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 prior osteotomy and osteosynthesis on long-term outcomes after total hip arthroplasty : a 1:1 Mahalanobis distance-matched registry study of 5,392 patients.","authors":"Nele Wagener, Yinan Wu, Alexander Grimberg, Christian Hipfl, Sebastian Hardt","doi":"10.1302/2633-1462.68.BJO-2025-0067","DOIUrl":"10.1302/2633-1462.68.BJO-2025-0067","url":null,"abstract":"<p><strong>Aims: </strong>Patients with a history of osteotomy or osteosynthesis pose distinct challenges in total hip arthroplasty (THA) due to altered anatomy and biomechanics. Although THA is an established intervention for degenerative hip disease, limited evidence exists on its long-term outcomes in this cohort, especially regarding revision rates, mortality, and complications. This registry study aimed to determine these outcomes using data from a large national registry.</p><p><strong>Methods: </strong>This registry study analyzed data from the German Arthroplasty Registry (EPRD), which captures approximately 70% of all hip arthroplasties in Germany. Among 418,409 patients undergoing THA between November 2012 and March 2024, 5,392 were included after 1:1 Mahalanobis distance matching for age, sex, BMI, and comorbidities: 2,696 patients with a history of osteotomy or osteosynthesis compared with 2,696 patients without. Kaplan-Meier survival curves estimated revision and mortality risks over an eight-year follow-up.</p><p><strong>Results: </strong>Over eight years, patients with prior osteotomy or osteosynthesis had significantly higher revision (6.8%, n = 183/2,696 vs 3.9%, n = 105/2,696, p = 0.002) and mortality (25.2%, n = 679/2,696 vs 20.4%, n = 550/2,696, p < 0.001) rates than those without prior hip surgery. Infection (17%, n = 22/131 vs 16%, n = 15/94), periprosthetic fracture (14%, n = 18/131 vs 12%, n = 11/94), and dislocation (14%, n = 18/131 vs 8.5%, n=8/94) were leading causes of revision. For cementless femoral components, prior-surgery patients had an eight-year revision rate of 7.3%, n = 143/1,957 compared with 3.6%, n = 71/1,958 (p = 0.003) and a mortality rate of 17.3%, n = 339/1,957 compared with 10.9%, n = 213/1,958 (p < 0.001). For cemented femoral components, revision rates were 4.9%, n = 36/739, compared with 4.7%, n = 35/738 (p = 0.330), and mortality 46.3%, n = 342/739, compared with 43.0%, n = 317/738 (p < 0.001). At one year, the revision rate in the prior-surgery group was already elevated at 3.7% (95% CI 3.1 to 4.5; n = 100/2,696) compared with 2.6% (95% CI 2.0 to 3.3; n = 70/2,696) in controls, diverging further over time.</p><p><strong>Conclusion: </strong>Patients with prior osteotomy or osteosynthesis undergoing THA face higher long-term revision and mortality risks, particularly with cementless stem fixation. Infection, periprosthetic fracture, and dislocation are key causes of revision.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 8","pages":"915-923"},"PeriodicalIF":3.1,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12335900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817726","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":"Paediatric type I open tibia fractures: are antibiotics alone sufficient?","authors":"Rory F L Hammond, Nikhil Manoj, Anna Bridgens, Fergal Monsell, Abhinav Singh, Yael Gelfer","doi":"10.1302/2633-1462.68.BJO-2025-0060.R1","DOIUrl":"10.1302/2633-1462.68.BJO-2025-0060.R1","url":null,"abstract":"<p><strong>Aims: </strong>The conventional management of the soft-tissue component of an open fracture involves emergent debridement. There is, however, evidence that questions this approach in the management of Gustilo-Anderson type I open fractures in paediatric patients. This systematic review aims to explore differences in infection rates between nonoperative management with antibiotics and operative debridement in children with type I open lower limb tibial fractures that do not require surgical fixation.</p><p><strong>Methods: </strong>A systematic review following the PRISMA guidelines was conducted. Patients aged under 18 years with Gustilo-Anderson type I open tibia fractures treated with either antibiotics alone or operative debridement were included. Polytrauma patients and those requiring operative fracture stabilization were excluded. Study bias was assessed with the ROBINS-I (Risk of Bias in Non-randomized Studies of Interventions) tool.</p><p><strong>Results: </strong>Ten retrospective studies of 123 patients with Gustilo-Anderson type I open tibial fractures were included. Nonoperative management in the emergency department with antibiotics was used in 41 patients, with two infections reported (4.87%). Operative debridement was performed in 82 patients, with two infections reported (2.33%).</p><p><strong>Conclusion: </strong>The optimum management for paediatric Gustilo-Anderson type I open tibia fractures remains unclear. There may be selected cases, with true low-energy injury without operative fixation requirements, which can be managed in the emergency department. However, there is not sufficient high-quality evidence to advocate for regular deviation from current guidelines in open tibia fractures in paediatric patients. Decision-making must take into account the energy absorbed, as this factor can be misleading within the current classification system.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 8","pages":"905-914"},"PeriodicalIF":3.1,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800448","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":"Grading medial compartment tightness among varus osteoarthritic knees during image-free robot-assisted total knee arthroplasty for optimized pre-resection gap balancing.","authors":"Krishna Kiran Eachempati, Apurve Parameswaran, Vinay Kishore Ponnala, Sunil Apsingi, Roshna Prem Kumar, Neil Perry Sheth","doi":"10.1302/2633-1462.68.BJO-2025-0041.R1","DOIUrl":"10.1302/2633-1462.68.BJO-2025-0041.R1","url":null,"abstract":"<p><strong>Aims: </strong>Robot-assisted total knee arthroplasty (RA-TKA) allows for calibrated pre-resection gap balancing (PRGB). Complete PRGB is considered inappropriate as some gap tightness resolves spontaneously during surgery. The aims of this study were to 1) assess the degree of medial tightness that spontaneously resolves during the course of surgery; 2) assess the magnitude of medial tightness beyond which extensive soft-tissue releases (STRs) can be anticipated; and 3) develop a grading system for preoperative medial tightness based on anticipated STRs to optimize PRGB, among varus osteoarthritic knees during image-free RA-TKA.</p><p><strong>Methods: </strong>Overall, 300 patients who underwent mechanically aligned image-free RA-TKA for varus osteoarthritis were studied. In part 1 of the study, 100 patients were assessed with the aim of developing a grading system for medial compartment tightness. Grades 1, 2, and 3 of medial compartment tightness were planned such that they represented patient sub-groups who required the highest proportions of routine-only, moderate, and extensive STRs, respectively. In part 2 of the study, the grading system was applied to 200 patients to evaluate its ability to predict the extent of STRs required.</p><p><strong>Results: </strong>Medial compartment tightness of < 4 mm (grade 1), 4 to 7 mm (grade 2), or ≥ 7 mm (grade 3) in extension or flexion was associated with routine-only, moderate, or extensive STRs, respectively, in ≥ 80% of patients in both parts of the study (p < 0.001). Almost perfect agreement was noted between grades of preoperative medial tightness and STRs in part 1 (weighted <i>ƙ</i> = 0.843 and 0.874, for extension and flexion tightness, respectively) and part 2 of the study (weighted <i>ƙ</i> = 0.815 and 0.866, for extension and flexion tightness, respectively).</p><p><strong>Conclusion: </strong>The proposed grading system for medial compartment tightness is easily applicable and optimizes PRGB. Further research is required on its applicability to alternative alignment strategies.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 8","pages":"894-904"},"PeriodicalIF":3.1,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12328037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144795703","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":"Knee arthroplasty compared with joint distraction for osteoarthritis: a phase III randomized controlled trial.","authors":"Thomas W Hamilton, Beth Lineham, Deborah D Stocken, Hemant Pandit, A Muli, R Kelly, H Collier, R Mujica-Mota, A Metcalfe, H Simpson, D W Murray, H Sharma, D McGonagle, D R Ellard, J Croft, J Stokes, P Harwood","doi":"10.1302/2633-1462.68.BJO-2024-0120.R2","DOIUrl":"10.1302/2633-1462.68.BJO-2024-0120.R2","url":null,"abstract":"<p><strong>Aims: </strong>Knee joint distraction (KJD) has been proposed as a joint-preserving alternative to arthroplasty. The objective of this study was to evaluate the clinical and cost-effectiveness of KJD compared to arthroplasty for knee osteoarthritis.</p><p><strong>Methods: </strong>This phase III multicentre, pragmatic, randomized controlled non-inferiority trial recruited adults aged ≤ 65 years with symptomatic osteoarthritis refractory to non-surgical treatment and suitable for knee arthroplasty. Patients were randomized to static, linear, KJD of 5 mm, produced with an external fixator construct for six-week duration, or total knee arthroplasty. The primary outcome measure was the Knee injury and Osteoarthritis Outcomes Score (KOOS) pain subscale 12 months post-surgery. The trial was terminated early due to failure to recruit following cessation of elective orthopaedic surgery during the COVID-19 pandemic.</p><p><strong>Results: </strong>A total of 24 participants were randomized with baseline characteristics balanced between groups. Improved median KOOS pain scores at 12 months postoperatively were observed in both treatment groups. The median KOOS pain score in the KJD group improved from 38.9 (IQR 30.6 to 41.7) at baseline to 55.6 (IQR 41.7 to 94.4) at 12 months, while corresponding scores in the arthroplasty group improved from 30.6 (IQR 11.1 to 36.1) to 75.0 (IQR 66.7 to 88.9). Similar improvements following KJD were seen across other KOOS subdomains and pain VAS, range of motion, or timed up-and-go test. The small sample size does not provide sufficient information to make meaningful comparisons between treatment groups. Pin site infection was seen in two patients, and a fracture through a pin site after frame removal following trauma in one patient.</p><p><strong>Conclusion: </strong>KJD appears to be associated with improved pain and function compared to baseline. The clinical and cost-effectiveness of KJD compared to arthroplasty remains uncertain.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 8","pages":"886-893"},"PeriodicalIF":3.1,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12324894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790150","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":"Avoidable and unavoidable delays in hip fracture surgery : a prospective observational study of who, what, and why?","authors":"Mitchell Sarkies, Nicholas Murphy, Ramya Kunnath, Seth Tarrant, Erica Epstein, Natasha Weaver, Cameron R Hemmert, Zsolt J Balogh","doi":"10.1302/2633-1462.68.BJO-2025-0083.R1","DOIUrl":"10.1302/2633-1462.68.BJO-2025-0083.R1","url":null,"abstract":"<p><strong>Aims: </strong>Surgical management of hip fracture is often delayed, which is associated with increased mortality. We aimed to prospectively determine the proportion of potentially avoidable delay to surgery beyond 48 hours, and its causes, as clinically relevant margins for quality improvement.</p><p><strong>Methods: </strong>A 12-month prospective cohort study from September 2022 to September 2023 was conducted on all 427 hip fracture surgery patients aged ≥ 50 years who were admitted to a trauma centre in New South Wales, Australia. The reasons for delay, medical speciality, and level of seniority initiating the decision, and what response was taken after the delay, were recorded for each case delayed beyond 48 hours from hospital admission. Surgical delays were categorized as either avoidable or unavoidable independently by surgical and medical experts.</p><p><strong>Results: </strong>From 427 hip fractures, 37% (160/427) had surgery beyond 48 hours, with 29% (124/427) considered avoidable, 6% (27/427) unavoidable, and 2% (9/427) unable to be categorized. Patients experienced a median 43-hour time to surgery (IQR 27 to 63): 30 hours (IQR 24 to 41) for non-delayed, 69 hours (IQR 55 to 93) for avoidable, and 75 hours (IQR 59 to 135) for unavoidable delays. Patients with unavoidable delays had higher American Society of Anesthesiologists grades and acute ward length of stay. Limited operating theatre availability was responsible for 60% of delays (96/160), of which 92% (88/96) were considered avoidable. Orthopaedic trauma operating theatre access was compromised (operating theatre unavailable) for 86% of hip fracture surgery delays that were due to limited operating theatre availability. Reasons unrelated to operating theatre availability accounted for 35% of delays (56/160). It was not possible to categorize 5% of delays (8/160).</p><p><strong>Conclusion: </strong>Most hip fracture surgery delays are due to limited operating theatre availability. Of the delays, 78% were considered avoidable, representing a margin for improvement of 55% for operating theatre availability, and 23% unrelated to operating theatre availability.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 8","pages":"876-885"},"PeriodicalIF":3.1,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12321406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144785500","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":"Dual-mobIlity verSus conventional Total hip arthroplasty In femoral Neck fractures, a registry-nested, open-label, Cluster-randomized crossover Trial (DISTINCT) : statistical analysis plan.","authors":"John E Farey, Tania Alland, Justine M Naylor, Thu-Lan Kelly, Kara Cashman, Michelle Lorimer, Carl Holder, Adriane M Lewin, Frances Garden, Chi Kin Law, Jacqueline C T Close, Stephen E Graves, Richard de Steiger, Peter L Lewis, Sam Adie, Sanja Lujic, Ian A Harris","doi":"10.1302/2633-1462.68.BJO-2025-0042","DOIUrl":"10.1302/2633-1462.68.BJO-2025-0042","url":null,"abstract":"<p><strong>Aims: </strong>A statistical analysis plan for analysis of DISTINCT (Dual-mobIlity verSus conventional Total hip arthroplasty In femoral Neck fractures, a registry-nested, open-label, Cluster-randomized crossover Trial) is outlined to aid transparency in analytical procedures.</p><p><strong>Methods: </strong>DISTINCT aims to determine whether dual-mobility total hip arthroplasty (THA) is superior to conventional THA in reducing postoperative prosthetic hip dislocations in patients undergoing surgery for femoral neck fractures. The trial is nested within the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). The clusters comprised hospitals that perform at least 12 THAs for femoral neck fracture per annum. Each hospital was randomized to two sequential periods of dual-mobility THA and conventional THA, with the order randomly allocated. Crossover occurred once sites had recruited an average of 16 patients eligible for the primary analysis in the initial allocation, to provide an average of 32 patients per cluster. The primary outcome is the incidence of prosthetic hip dislocation in the first postoperative year. Secondary outcomes are the rate of revision for dislocation, all-cause revision, mortality at one, two, and five years, and complication rates at one year. All analyses will use cluster summary methods, weighted by cluster size to account for unequal cluster sizes. Participants will be analyzed in the groups to which they were randomized (intention-to-treat). Sensitivity analyses will be performed to analyze the unadjusted primary outcome based on treatment received (as-treated) and per-protocol groupings.</p><p><strong>Conclusion: </strong>This statistical analysis plan describes the detailed analysis of the DISTINCT study, a registry-nested, open-label, cluster-randomized crossover trial that will provide supporting evidence for prosthesis choice in the common clinical problem of femoral neck fracture.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 8","pages":"866-875"},"PeriodicalIF":3.1,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776369","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}