Bone & Joint Open最新文献

{"title":"Protocol for the ACTIVE trial: a multicentre, open-label, cluster-randomized controlled trial of a quality improvement programme for older adults with hip fracture in resource-limited hospitals in China.","authors":"Minghui Yang, Tingzhuo Liu, Gang Liu, Ning Tang, Xinyi Zhang, Rebecca Ivers, Yongchen Wang, Maoyi Tian, Zhenghua Sun, Jiarong Shen, Boya Nan, Wei Tian, Qiang Li, Lei Si, Ronald Man Yeung Wong, Jing Zhang, Shangzhi Xiong, Pengpeng Ye, Lei Yang, Liming Li, Matthew Costa, Jianyu Liu, Chenguang Hao, Tingting Zhou, Baorui Xing, Wenming Luo, Xuecheng Sun, Haibin Sun, Shuyuan Wang, Xuefei Wu, Honghua Dong, Fuhong Cheng, Dongsheng Wu, Bihui Song, Kangquan Shou, Yang Li, Zhengqiang Liu, Jun Li, Shangmin Chen, Zhigang Zhong, Zhichao Zhu, Wenbo Yang, Jianbang Yan, Chunlei Shi, Zhuhui Xi, Baozhu Wen, Jinbao Guo, Chengyu Feng, Desheng Wu, Sheng Guo, Xiaowei Zhang, Xingke Chi, Yongli Peng, Tianliang Li, Qingzheng Fan, Zhiwen An, Yue Guan, Zhichang Lv, Jianbing Wang, Yanguang Yuan, Xuehao Cheng, Haipeng Liu, Fei Du, Ruiyong Tan, Liangquan Ji, Zhaoyong Liu, Fengquan Dou, Yuzhu Guo, Qifu Liu, Shuwei Wang, Fuwei Zhao, Hongchao Sun, Xingyan Wang, Yu Cao, Yuhu Zhang, Hao Wang, Dongfeng An, Wenfeng Jia, Heng Yang, Xiaohui Ni, Shunbing Wang, Xiang Chen, Cheng Li, Yuehua Zhu, Haitao Zhu, Fuwen Zhao, Tongwei Ni, Xia Guo, Wanqing Lu, Junping Shan, Wenpeng Jia, Yongle Bai, Xiqing Wang, Pingzhou Jiao, Guoliang Chen, Kai Sun, Junfeng Zhao, Yupeng Xie, Minzhi Tan, Shaoping Liu, Wei Lu, Jianbo Zhou, Quanchuan Huang, Jing Tu, Xingchun Long, Yuanchun Liu, Yonghua Chen, Demeng Tan, Qiqi Peng, Xiaolin Zhang, Yiguang Mou, Lunhua Peng, Yinzhi Tang, Yanyang Hou, Zilong Wang, Han Zhao, Gang Wei, Zhen Xu, Senping Feng, Ping Ouyang, Jie Xiao, Jianhua Zhang, Feng Wu, Fengcai Wu, Yuandong Xiao, Hongji Xing, Zhanpeng Wu, Liehao Lin, Jie Lin, Jianbiao Xu, Chubiao Lin, Zijian Zhao, Zhaoxiong Wu, Ruizhong Lin","doi":"10.1302/2633-1462.78.BJO-2026-0136.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.78.BJO-2026-0136.R1","url":null,"abstract":"<p><strong>Aims: </strong>The primary aim of the Action on Hip Fracture Management Quality Improvement (ACTIVE) trial is to evaluate whether a context-tailored quality improvement programme improves health-related quality of life at 120 days after hospital admission, among adults aged 65 years or older with a hip fracture, in less-resourced hospitals in China. Secondary aims are to compare health-related quality of life at 30 days, complication and morbidity at 30 and 120 days, proportion of patients receiving surgery, proportion of patients on full weightbearing at one week after surgery, time from admission to surgery, length of hospital stay, 120-day mortality, and inpatient costs between the two groups, and to evaluate the implementation and cost-effectiveness of the intervention.</p><p><strong>Methods: </strong>This is a multicentre, open-label, pragmatic, parallel-group, cluster-randomized controlled trial conducted in 80 less-resourced county- or district-level public general hospitals across ten provinces in China (all hospitals are graded 3B or below; 3A is considered the most high-ranking or well-resourced hospital). Hospitals are randomized 1:1 within each province to either intervention or the control group. Eligible participants are adults aged 65 years or older with acute unilateral hip fracture confirmed by radiography or CT. The intervention consists of optimization of in-hospital management processes, empowerment of surgeons and physicians, and health education for patients and their family members. Hospitals allocated to the control group continue usual orthopaedic-led care. Participants are followed up at 30 and 120 days after admission. The primary outcome is health-related quality of life at 120 days after admission. A total of 8,800 participants will be recruited.</p><p><strong>Conclusion: </strong>The results of the ACTIVE trial will inform whether a context-tailored quality improvement programme, consisting of interventions on health administrators, health providers, and patients, can improve outcomes for older adults with hip fracture in less-resourced hospitals in China, and many countries beyond with emerging burden of ageing population.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 8","pages":"1101-1109"},"PeriodicalIF":3.3,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13485398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798813","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":"Maximizing stem body size may reduce the risk of postoperative periprosthetic fractures : an analysis of 2,757 CPT femoral components.","authors":"Bernard H van Duren, Amy M Firth, Jonathan France, Jessica Nightingale, Benjamin V Bloch, Andrew R Manktelow, Mark Higgins","doi":"10.1302/2633-1462.78.BJO-2025-0386.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.78.BJO-2025-0386.R1","url":null,"abstract":"<p><strong>Aims: </strong>There is concern around an increased risk of postoperative periprosthetic fracture (POPPF) with cemented polished taper slip (PTS) femoral components. We hypothesized that femoral constructs resulting in increased load on the cement mantle would be associated with higher POPPF risk. The aim of this study, based on our hypothesis, was to undertake an analysis of a large cohort of PTS femoral components to understand the role of implant construct variations on the incidence of POPPF.</p><p><strong>Methods: </strong>We retrospectively reviewed 2,757 patients undergoing THA with a PTS femoral component between January 2009 and December 2021. POPPFs were identified using a combination of linked Hospital Episode Statistic, National Joint Registry data, and local records. All fractures were confirmed with review of radiographs and documentation. Demographic data and implant details were collected. Associations between POPPF and potential contributory variables were assessed using univariate and multivariate regression analyses.</p><p><strong>Results: </strong>In total, 40 POPPFs (1.45%) were identified at a mean of 6.4 years (SD 2.9; 0.2 to 10.1) from index procedure. Patients with POPPFs were older (mean age 74.5 years; SD 8.6) than the overall cohort (p < 0.001). BMI, height, weight, and American Society of Anesthesiologists grade were not different. Most fractures were type B (B1 65%, B2 17.5%, B3 5%). One fracture (B1) was managed conservatively, seven (17.5%) were revised, and 32 (80%) fixed. Multivariate analysis showed increased POPPF risk with age (odds ratio (OR) 1.076), but no other patient factors were significant. Offset (OR 1.13, 95% CI 1.04 to 1.22) and construct ratio (head + neck offset/femoral component-size) (OR 3.92; 95% CI 1.31 to 11.79) were strongly predictive.</p><p><strong>Conclusion: </strong>The findings show that, for a given offset, a larger femoral component (reducing the construct ratio) was associated with a lower risk of POPPF. Surgeons should aim to maximize the size of the femoral component to optimize the 'torsional resistance' of the femoral component relative to their reconstructed offset to reduce the risk of POPPF.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 8","pages":"1093-1100"},"PeriodicalIF":3.3,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13481126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798751","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":"Coronal Plane Alignment of the Knee (CPAK) in children and adolescents : an analysis of 655 knees according to the CPAK classification.","authors":"Hendrik Pott, Peter Savov, Ricarda Stauss, Darren B Chen, Samuel J MacDessi, Max Ettinger","doi":"10.1302/2633-1462.78.BJO-2026-0152","DOIUrl":"10.1302/2633-1462.78.BJO-2026-0152","url":null,"abstract":"<p><strong>Aims: </strong>The Coronal Plane Alignment of the Knee classification (CPAK) describes nine knee phenotypes by defining arithmetic hip-knee-ankle angle (aHKA) and joint line obliquity (JLO). In this study, the CPAK classification was used to analyze the development of lower-limb alignment in children and adolescents, providing reference values and allowing insights into the morphogenesis of the knee joint during skeletal maturation.</p><p><strong>Methods: </strong>Angular measurements of 655 knees taken on CT scans of 333 children aged between four and 18 years from a publicly available radiological database were analyzed, applying the CPAK classification by calculating the aHKA and JLO.</p><p><strong>Results: </strong>The mean aHKA was 3.4° (SD 3.1°). JLO became more pronounced with age, decreasing from a mean of 176.8° (SD 4.2°) at the age of four years to 172.8° (SD 3.1°) at the age of 18 years. The most common CPAK type between four and 18 years was CPAK III (58.2%), the second most common type was CPAK II (24.7%), and the third most prevalent type was CPAK IV (10.1%).</p><p><strong>Conclusion: </strong>This is the first study analyzing lower-limb alignment in children and adolescents using the CPAK classification. By simultaneously developing a distal femoral valgus and a counteracting proximal tibial varus morphology, overall constitutional alignment as represented by the aHKA remains almost constant between the age of four and 18 years. Conversely, joint line obliquity changes significantly with age towards an apex distal phenotype. We provide a comprehensive explanation for the physiological development of lower-limb alignment during skeletal growth.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 8","pages":"1084-1092"},"PeriodicalIF":3.3,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13477816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766426","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":"Erratum.","authors":"Kimberly Zambito, Yevgeniya Kushchayeva, Andrew Bush, Paola Pisani, Sergiy Kushchayeva, Mary Peters, Nick Birch","doi":"10.1302/2633-1462.78.BJO-2026-00011","DOIUrl":"https://doi.org/10.1302/2633-1462.78.BJO-2026-00011","url":null,"abstract":"","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 8","pages":"1075"},"PeriodicalIF":3.3,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13472736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761794","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":"Challenges and barriers to musculoskeletal injury research in sub-Saharan Africa : a modified Delphi study.","authors":"Robyn Waters, Maritz Laubscher, Sithombo Maqungo, Linda Chokotho, Nyengo Mkandawire, Billy Haonga, George Njambilo, William J Harrison, Matthew L Costa, Simon Matthew Graham, Vincent Mkochi, Chikumbutso Clara Mpanga, Marc Henrion, Chipiliro Moffat, Bruce M Biccard, Richard Matzopoulos, Tracey Smythe, Nosipho Mncwabe, Kirsty Berry, Elizabeth Mumba, Wonderful Khumalo, Patrick Ngunyale, Obedi Emmanuel, John Mbanga, Dorkasi L Mwakawanga, David G Lalloo, Jonathan Cook, Stavros Petrou, Daniel C Perry, Sarah Drew, Duncan Appelbe, Juul Achten, Molly Glaze, Abigail Shaw, Claude Martin, David Shearer, Grace Drury, James Masters, Saima Sheikh, Annabel Morley, Jimmy Olomi, Nathaniel Scherer, Sumayyah Rashan, Chantelle Mbugua, Lacey Smith, Madeline Mackechnie","doi":"10.1302/2633-1462.78.BJO-2025-0409.R1","DOIUrl":"10.1302/2633-1462.78.BJO-2025-0409.R1","url":null,"abstract":"<p><strong>Aims: </strong>Musculoskeletal (MSK) injuries are a major cause of morbidity and mortality worldwide. However, research into MSK injuries is hampered by significant challenges and barriers, particularly in low-and middle-income countries (LMICs). Our aim was to identify the most important challenges and barriers to MSK injury care research across Malawi, South Africa, and Tanzania.</p><p><strong>Methods: </strong>We conducted a three-stage modified Delphi study. In Stage 1, healthcare professionals and researchers involved in MSK injury care listed challenges and barriers to conducting MSK injury research, which were consolidated in 25 themes. In Stage 2, participants rated each theme on a five-point Likert scale. In Stage 3, to drive consensus, participants re-rated the themes after viewing group and country-specific feedback from the previous stage. Challenges and barriers were ranked by mean score. Consensus was defined as ≥ 75% of respondents rating a theme as 4 or 5 ('important' and 'most important' on the Likert Scale).</p><p><strong>Results: </strong>A total of 396 participants completed Stage 1, 424 completed Stage 2, and 434 completed Stage 3. Across all participants, consensus (≥ 75%) was reached on nine key challenges and barriers to MSK injury research, including: lack of funding, high clinical workloads, limited training and mentorship, poor-quality data collection practices, healthcare facility resource constraints, patient loss to follow-up, limited research opportunities outside academic institutions, poverty and financial barriers, and healthcare delays. At the country level, the challenges of lack of funding, high clinical workload, and inconsistent data collection practices consistently achieved consensus in Malawi, South Africa, and Tanzania.</p><p><strong>Conclusion: </strong>MSK injuries impose a substantial burden in sub-Saharan Africa, yet research remains limited by funding shortages, high clinical workloads, and inconsistent data collection practices. These challenges, consistently identified across Malawi, South Africa, and Tanzania, highlight the need for targeted investment and regional collaboration to strengthen research capacity and improve patient outcomes.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 8","pages":"1076-1083"},"PeriodicalIF":3.3,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13472737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763431","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":"Fracture laterality as an independent prognostic factor for clinical outcomes after hip fracture surgery : an analysis of 72,008 patients.","authors":"Yasuhiko Takegami, Takahiro Imaizumi, Kikue Sato, Yusuke Osawa, Hiroto Funahashi, Shiro Imagama","doi":"10.1302/2633-1462.78.BJO-2026-0088.R1","DOIUrl":"10.1302/2633-1462.78.BJO-2026-0088.R1","url":null,"abstract":"<p><strong>Aims: </strong>Fracture laterality is routinely recorded in large hip fracture registries for administrative purposes, yet rarely evaluated as a prognostic variable. We aimed to test whether laterality is independently associated with short-term outcomes after hip fracture surgery.</p><p><strong>Methods: </strong>This retrospective cohort study used a regional, prefecture-wide administrative database based on Japan's Diagnosis Procedure Combination system. We identified 72,008 patients who underwent primary surgery for hip fracture between 2015 and 2023. The primary outcome was in-hospital mortality. The secondary outcome was impaired independence in activities of daily living (ADL) at discharge, defined as a Barthel index (BI) score < 60. We used multivariable logistic regression to assess the association between fracture laterality and outcomes, adjusting for age, sex, BMI, smoking history, fracture type, admission BI, diabetes mellitus, and the Charlson Comorbidity Index (CCI).</p><p><strong>Results: </strong>Left-sided fractures were significantly more frequent than right-sided fractures (51.5% vs 48.5%, p < 0.001). In-hospital mortality did not differ significantly between right- and left-sided fractures in either unadjusted (2.0% vs 2.0%, p = 0.093) or adjusted analyses (adjusted odds ratio (aOR), 1.10; 95% CI 0.99 to 1.22; p = 0.075). In contrast, right-sided fracture was independently associated with impaired ADL at discharge (aOR 1.09; 95% CI 1.05 to 1.13; p < 0.001). In a prespecified sub-group analysis, right-sided fracture was associated with higher mortality among patients with high comorbidity burden (CCI ≥ 2; aOR 1.29; 95% CI 1.09 to 1.53; p = 0.004; p for interaction = 0.022). A sensitivity analysis using double-selection lasso logistic regression yielded materially unchanged estimates.</p><p><strong>Conclusion: </strong>In our cohort, right-sided hip fractures were independently associated with impaired ADL at discharge, and with higher in-hospital mortality among patients with substantial comorbidity. These associations persisted across sensitivity analyses but, given the observational design and the inability of administrative data to capture limb dominance, require confirmation in independent cohorts. Fracture laterality, which is a variable routinely captured at presentation but seldom analyzed, nonetheless merits consistent reporting and consideration in registry-based prognostic research.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 8","pages":"1064-1074"},"PeriodicalIF":3.3,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13467364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148721976","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":"Anatomical versus reverse total shoulder arthroplasty for primary glenohumeral osteoarthritis with an intact rotator cuff : a systematic review.","authors":"Paras P Shah, Rashini Jayawardena, Ryan Wong, Charles Poff, Nicholas H Maassen, Lewis Shi","doi":"10.1302/2633-1462.78.BJO-2025-0297.R2","DOIUrl":"10.1302/2633-1462.78.BJO-2025-0297.R2","url":null,"abstract":"<p><strong>Aims: </strong>Anatomical total shoulder arthroplasty (aTSA) has been the traditional treatment for glenohumeral osteoarthritis (OA) with an intact rotator cuff. However, reverse total shoulder arthroplasty (rTSA) is now being more frequently performed, with its utility in consistent fixation and severe bony deformity. This study systematically reviews available literature comparing aTSA and rTSA in patients with OA with an intact rotator cuff.</p><p><strong>Methods: </strong>A literature review was conducted to identify studies comparing aTSA and rTSA in patients with glenohumeral OA and intact rotator cuffs. Primary postoperative outcomes were analyzed, including range of motion, patient-reported outcomes, complications, revisions, cost, radiological changes, and satisfaction.</p><p><strong>Results: </strong>In all, 18 articles met the inclusion criteria. aTSA demonstrated better range of motion with no difference in American Shoulder and Elbow Surgeons scores and pain outcomes. While complication and revision reasons varied slightly, there was no difference in overall complication and revision rates. Of four studies reporting patient satisfaction, two favoured aTSA.</p><p><strong>Conclusion: </strong>In our population, aTSA and rTSA yield comparable postoperative outcomes. While aTSA may offer a superior range of motion, its clinical value remains uncertain. These findings support the growing consideration of rTSA as a viable alternative to aTSA in this population, although longer follow-up time is required.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 8","pages":"1056-1063"},"PeriodicalIF":3.3,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713720","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":"Incidence and risk factors for postoperative myocardial infarction following hip and knee arthroplasty.","authors":"Ahmed Al-Saadawi, Saran Singh Gill, Sara Sousi, Gareth G Jones, Alex Bottle, Justin P Cobb, Omar Musbahi","doi":"10.1302/2633-1462.78.BJO-2026-0065.R1","DOIUrl":"10.1302/2633-1462.78.BJO-2026-0065.R1","url":null,"abstract":"<p><strong>Aims: </strong>Hip and knee arthroplasty are among the most commonly performed surgical procedures worldwide but carry a risk of cardiovascular complications, including myocardial infarction (MI). Therefore, this study aimed to assess the long-term incidence of MI following hip and knee arthroplasty, and subsequent mortality, in a UK-based cohort.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using linked Hospital Episode Statistics (HES), Office for National Statistics (ONS) mortality data, and Clinical Practice Research Datalink (CPRD) records. Patients undergoing total hip arthroplasty (THA), hip resurfacing arthroplasty (HRA), total knee arthroplasty (TKA), or unicompartmental knee arthroplasty (UKA) between 2 January 1998 and 29 March 2021 were identified. An inverse probability weighting approach based on propensity scores was used, and outcomes were assessed using weighted logistic regression for MI incidence at 30, 90, and 365 days postoperatively, and multiple Cox proportional hazards models for MI-related mortality.</p><p><strong>Results: </strong>In total, 1,148,298 procedures were included in the final analysis. Of those undergoing hip arthroplasty, 713 (0.13%) patients experienced a MI within 30 days postoperatively, rising to 947 (0.17%) at 90 days and 1,989 (0.38%) patients at one year. In the knee arthroplasty cohort, the number of patients experiencing a MI was 656 (0.11%) at 30 days, 890 (0.15%) at 90 days, and 1,853 (0.32%) at one year postoperatively. Factors associated with increased MI incidence included age, male sex, non-white ethnicities, geographical region, higher deprivation status, and elevated comorbidity scores. Weighted logistic regression demonstrated significantly lower odds of MI, and MI-related mortality in patients undergoing UKA and HRA compared with TKA and THA, respectively.</p><p><strong>Conclusion: </strong>In England, post-arthroplasty MI remains uncommon but carries significant mortality risk. Bone-preserving procedures are associated with a significantly reduced incidence of MI and subsequent mortality. These findings emphasize the importance of careful patient and treatment selection, and targeted cardiovascular risk mitigation, to optimize postarthroplasty outcomes.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 8","pages":"1046-1055"},"PeriodicalIF":3.3,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707652","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":"Occupational hazards in hip and knee adult reconstruction surgery : a systematic review of physical and psychological stressors.","authors":"Matteo Innocenti, Roberto Civinini, Filippo Leggieri, Sébastien Lustig, Cécile Batailler, Simon N van Laarhoven, Gijs van Hellemondt","doi":"10.1302/2633-1462.78.BJO-2025-0310.R1","DOIUrl":"10.1302/2633-1462.78.BJO-2025-0310.R1","url":null,"abstract":"<p><strong>Aims: </strong>Adult reconstruction surgeons face unique occupational challenges during joint arthroplasty procedures, including sustained physical demands, ergonomic strain, noise exposure, and psychological pressure from high patient expectations. This systematic review aimed to synthesize existing evidence regarding physical and psychological stressors encountered by surgeons performing hip and knee arthroplasty.</p><p><strong>Methods: </strong>Following PRISMA guidelines, we searched PubMed, EMBASE, Web of Science, and Cochrane Library through to December 2024. Studies evaluating occupational hazards during adult hip and knee arthroplasty were included, focusing on noise exposure, ergonomic challenges, musculoskeletal strain, and robotic-assisted platforms' impact on surgeon performance. Risk of bias was assessed using Appraisal tool for Cross-Sectional Studies (AXIS) and Methodological Index for Non-Randomized Studies (MINORS) tools.</p><p><strong>Results: </strong>In total, 38 studies were included, revealing five key hazard categories. Work-related injury prevalence ranged from 66% to 96.5%, predominantly affecting spine (28% to 34.2%), shoulders, and upper limbs. Risk factors included age > 55 years, high surgical volume (> 100 procedures annually), and > 20 years' practice. CO₂ accumulation in helmet systems exceeded safety limits in 10/11 configurations tested. Joint arthroplasties generated the highest noise levels (77 dBA to 88.2 dBA) among orthopaedic procedures, with arthroplasty surgeons showing nearly triple the hearing loss rate compared with non-surgical clinicians (31% vs 11%, odds ratio 3.63). Total hip arthroplasty demonstrated higher physiological demands than total knee arthroplasty (heart rate: 95.7 vs 90.2 bpm; energy: 290.2 vs 189.4 kcal). Revision surgeries imposed doubled mental demand scores compared with primary procedures. Robotic assistance improved ergonomics through reduced neck and lumbar flexion, but increased operating times and generated higher noise levels.</p><p><strong>Conclusion: </strong>Arthroplasty surgeons face substantial occupational hazards with high musculoskeletal injury rates, significant noise-induced hearing loss, and considerable physiological demands. While emerging technologies show promise in reducing some physical demands, they introduce new ergonomic considerations, highlighting the need for comprehensive occupational health strategies to ensure sustainable surgical careers.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 8","pages":"1037-1045"},"PeriodicalIF":3.3,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702455","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":"Patellofemoral outcomes after kinematic versus mechanical alignment in primary total knee arthroplasty : a focused scoping review of head-to-head comparative studies.","authors":"Seikai Toyooka, Yutoshi Osaki, Noriaki Arai, Hirotaka Kawano, Takumi Nakagawa","doi":"10.1302/2633-1462.78.BJO-2026-0079.R1","DOIUrl":"10.1302/2633-1462.78.BJO-2026-0079.R1","url":null,"abstract":"<p><strong>Aims: </strong>Concerns persist that kinematic alignment (KA) in primary total knee arthroplasty (TKA) may adversely affect the patellofemoral (PF) joint, because most contemporary components were developed under mechanical alignment (MA) principles. This focused scoping review mapped head-to-head comparative clinical evidence on PF outcomes after KA versus MA TKA, and identified key evidence gaps relevant to clinical decision-making.</p><p><strong>Methods: </strong>A focused scoping review was conducted. PubMed/MEDLINE, the Cochrane Library, and CINAHL were searched from inception to 15 January 2026. We included head-to-head comparative studies directly comparing KA and MA in primary TKA that reported at least one PF-related outcome. PF outcomes were mapped into three domains: 1) PF symptoms and PF-specific patient-reported outcome measures (PROMs); 2) PF-related interventions and complications; and 3) PF imaging/radiological measures. Findings were synthesized descriptively.</p><p><strong>Results: </strong>A total of 12 studies met the inclusion criteria. Domain A was addressed by only one study and was insufficient for definitive conclusions. Domain B was addressed by six studies; no consistent signal of higher PF-related interventions/complications with KA was identified, and several studies reported numerically fewer PF-related procedures with KA, including lateral retinacular release. Domain C was addressed by ten studies and showed heterogeneous imaging findings; when PF radiological differences were observed, they were not consistently accompanied by worse symptoms or higher PF-related intervention rates. Postoperative rotational alignment was inconsistently assessed.</p><p><strong>Conclusion: </strong>Current head-to-head comparative evidence is insufficient to determine the definitive PF-specific clinical impact of KA versus MA, mainly because PF-specific PROMs are rarely reported. Although no consistent harm signal was identified, this should not be interpreted as evidence of equivalence. This review primarily defines current evidence gaps, including the need for prespecified PF-specific PROMs, systematic rotational verification, consistent reporting of PF-related interventions/complications, and longer follow-up.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 8","pages":"1026-1036"},"PeriodicalIF":3.3,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13447007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686332","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}