Bone & Joint Open最新文献

{"title":"Development of the rehabilitation interventions for people with an acute patellar dislocation in the Physiotherapy Rehabilitation Post Patellar Dislocation (PRePPeD) pilot randomized controlled trial.","authors":"Colin P Forde, Matthew L Costa, Elizabeth Tutton, Jonathan A Cook, David J Keene","doi":"10.1302/2633-1462.64.BJO-2024-0174","DOIUrl":"https://doi.org/10.1302/2633-1462.64.BJO-2024-0174","url":null,"abstract":"<p><strong>Aims: </strong>To develop the rehabilitation interventions for people with an acute patellar dislocation in the Physiotherapy Rehabilitation Post Patellar Dislocation (PRePPeD) pilot randomized controlled trial (RCT), and to describe how these interventions are delivered.</p><p><strong>Methods: </strong>We developed the interventions drawing on a range of established intervention development approaches and frameworks. We selected intervention components after reviewing the existing evidence, clinical guidelines, UK NHS practice, and relevant scientific theory. We then created early versions of the interventions, and discussed these with clinical experts and patient and public partners. We finalized the interventions considering their feedback, findings from our preliminary study, and what would be acceptable and deliverable in the UK NHS.</p><p><strong>Results: </strong>Upon randomization, all participants receive a workbook containing advice and initial exercises to implement before their first physiotherapy session. Self-managed rehabilitation then involves a single one-to-one session with a physiotherapist who provides advice, introduces a structured home exercise programme, and uses strategies to support exercise adherence. Participants then continue their recovery independently. Supervised rehabilitation involves four to six one-to-one physiotherapy sessions over a maximum of six months. Physiotherapists also provide advice, prescribe home exercise, and use exercise adherence strategies. Routine follow-up sessions enable physiotherapists to reassess participants and tailor the advice and exercises accordingly.</p><p><strong>Conclusion: </strong>The interventions were developed and are currently being assessed in the PRePPeD pilot RCT. This will determine whether a full-scale RCT comparing these interventions is feasible. Results are anticipated in Summer 2025.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 4","pages":"469-479"},"PeriodicalIF":2.8,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12011453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037598","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":"Assessment of applicability of Ganga Hospital Score in the management of open tibia fracture.","authors":"Innocent Kwizera, Jean C Byiringiro, J C A Ingabire, Emmanuel Murwanashyaka, Jean L Mwizerwa","doi":"10.1302/2633-1462.64.BJO-2024-0207.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.64.BJO-2024-0207.R1","url":null,"abstract":"<p><strong>Aims: </strong>Open fractures of the tibia encompass a wide spectrum of injuries, posing multiple challenges for treating surgeons. This study evaluates the Ganga Hospital Open Injury Severity Score (GHOISS) in predicting the outcomes of open tibia fractures in Rwanda, focusing on its ability to guide wound management choices and assist in decision-making between preservation and amputation.</p><p><strong>Methods: </strong>This was a prospective cohort study conducted between March and September 2022 in Kigali, Rwanda, involving patients aged 18 years and older with open tibial fractures. The GHOISS was calculated, and the patients were organized into three groups: Group I: score 1 to 13; Group II: score 14 to 16; and Group III: score ≥ 17. Outcome data were collected at one and six months of follow-up. The predictive validity of the GHOISS was determined through sensitivity, specificity, and predictive values. Correlation and analysis of variance (ANOVA) tests were also conducted to compare groups. Ethical considerations were respected, and institutional review board approval was obtained.</p><p><strong>Results: </strong>The study involved 111 participants, with a mean age of 34 years (18 to 80) and a male-to-female ratio of 3.44:1. The amputation rate was 10 (9.0%), with a mean hospital stay of 30.55 days (SD 34.09). The infection rate was 54.05%, and the need for soft-tissue reconstruction was 36.9%. The GHOISS in predicting the amputation showed high sensitivity of 100% and sensitivity of 96.03%, with a positive predictive value of 71.4% and negative predictive value of 100%. ANOVA revealed significant differences between the groups (F (2,108) = 21.12; p < 0.001), and a strong positive correlation was found between the covering tissue score and the need for soft-tissue reconstruction.</p><p><strong>Conclusion: </strong>The GHOISS demonstrated a remarkable ability to predict amputation and salvage in open tibia fractures and the potential for predicting related outcomes. The GHOISS subscore, which assesses skin and covering injuries, has shown a significant ability to predict the need for soft-tissue reconstruction.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 4","pages":"463-468"},"PeriodicalIF":2.8,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12009658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989395","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":"Altered motor function during daily activities in patients eligible for high tibial osteotomy is primarily driven by knee varus deformity.","authors":"Giordano Valente, Giulia Grenno, Maria G Benedetti, Giacomo Dal Fabbro, Alberto Grassi, Alberto Leardini, Fulvia Taddei, Stefano Zaffagnini","doi":"10.1302/2633-1462.64.BJO-2024-0189.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.64.BJO-2024-0189.R1","url":null,"abstract":"<p><strong>Aims: </strong>Patients with knee osteoarthritis (OA) and varus deformity present altered gait parameters, especially a large knee adduction moment that is predictive of OA progression. The distinct role of each coexisting parameter, such as OA grade, varus deformity, and previous meniscectomy, in the setting of high tibial osteotomy is not clear. Therefore, the aim of this study was to analyze the motor function parameters in patients eligible for high tibial osteotomy during walking, stair ascending, and stair descending, and to evaluate the effect of OA grade, varus deformity, and meniscectomy.</p><p><strong>Methods: </strong>A total of 52 patients with knee OA and varus deformity participated in this study, including 22 with previous partial meniscectomy, alongside 20 healthy controls. Imaging and motion-capture data during walking, stair ascending, and descending were acquired. Subject characteristics, joint kinematics, joint kinetics, and electromyography on-off activities were compared to evaluate statistically significant differences between the patients and healthy groups. Additionally, multiple linear regression evaluated the relationships between OA grade, varus deformity, and previous meniscectomy with motor function parameters.</p><p><strong>Results: </strong>The patients group showed significantly higher knee adduction and rotation moments, lower hip adduction and ankle inversion, and higher knee adduction and trunk flexion compared with the healthy group, as well as significantly increased biceps femoris activity. In addition, larger varus deformity showed a more marked effect on the major motor function parameters compared with OA grade and previous meniscectomy, especially during walking.</p><p><strong>Conclusion: </strong>Patients eligible for high tibial osteotomy move with altered motor function during daily activities, and the coexisting factors of OA grade, varus malalignment, and previous meniscectomy have different impacts, with varus deformity primarily affecting motor function. These findings help to detect the target that should be considered priority in the treatment of high tibial osteotomy, and highlight the importance of realigning the lower limb to possibly restore motor function.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 4","pages":"454-462"},"PeriodicalIF":2.8,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12005943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999518","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":"Morphology of occult posterior malleolus fractures associated with tibial shaft fractures.","authors":"Darren Myatt, Howard Stringer, James Chapman, Ben E Fischer, Lyndon Mason","doi":"10.1302/2633-1462.64.BJO-2024-0132.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.64.BJO-2024-0132.R1","url":null,"abstract":"<p><strong>Aims: </strong>Occult posterior malleolar fractures (PMFs) associated with tibial shaft fractures are thought to occur most commonly in spiral fracture types of the tibia. We hypothesize that tibial diaphyseal fracture patterns would be associated with certain PMFs, highlighting the pathomechanics of the injury.</p><p><strong>Methods: </strong>A retrospective review was performed on data collected between 1 January 2013 and 9 November 2020. The inclusion criteria were patients aged over 16 years with a diaphyseal tibial fracture who had undergone a CT of the affected lower limb. The Mason and Molloy posterior malleolar fracture classification system was used to describe the morphology of the PMFs.</p><p><strong>Results: </strong>There were 764 diaphyseal fractures identified. Of these, 442 met the inclusion criteria. A total of 107patients (24.21%) had PMF extensions. The classification of the PMFs according to Mason and Molloy revealed eight type 1 fractures (7.48%), 60 type 2A (56.07%), six type 2B (5.61%), and 33 type 3 fractures (30.84%). The most common PMF seen in this study was the minor rotational pilon (type 2A). PMFs generally occur in combination with spiral diaphyseal fractures (42A1, 42B1, 42C1, and 43A1). The majority of PMFs were undisplaced pre-surgical intervention. Only the 2B subtype (major rotational pilon) had a significant association with fracture displacement.</p><p><strong>Conclusion: </strong>This study highlighted an association between spiral tibial shaft fractures and type 2A posterior malleolus fractures. Unlike the PM fractures of the ankle, the majority of PM fractures associated with tibia fractures are undisplaced. We theorize that unlike the force transmission in ankle fractures, where the rotational force is in the axial plane in a distal-proximal direction, in the PM fractures related to tibia fractures, the rotational force in the axial plane progresses from proximal-distal. Therefore, the force transmission which exits posteriorly, finally dissipates the force and is thus unlikely to displace.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 4","pages":"446-453"},"PeriodicalIF":2.8,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12003030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050135","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":"From mobility to intimacy: assessing the effects of periacetabular osteotomy on sexual function in patients with hip dysplasia.","authors":"Vincent J Leopold, Sebastian Hardt, Susanne Bärtl, Carsten Perka, Luis A Becker","doi":"10.1302/2633-1462.64.BJO-2024-0254.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.64.BJO-2024-0254.R1","url":null,"abstract":"<p><strong>Aims: </strong>Developmental dysplasia of the hip (DDH) often leads to early osteoarthritis, causing pain and functional limitations that may impair sexual function. This study investigates the impact of periacetabular osteotomy (PAO) on sexual function in DDH patients, assessing changes from preoperative impairments to postoperative improvements.</p><p><strong>Methods: </strong>This retrospective study analyzed data from DDH patients treated with PAO between January 2015 and June 2017 at a single orthopaedic university centre. Data included radiological parameters and patient-reported outcome measures: International Hip Outcome Tool (iHOT-12), Subjective Hip Value, Hip disability and Osteoarthritis Outcome Score (HOOS) and its sub-scores, and Numeric Pain Scale. Sexual function was specifically assessed using iHOT-12 item nine, asking, \"How much trouble do you have with sexual activity because of your hip?\"</p><p><strong>Results: </strong>The study included 120 hips in 107 patients, predominantly female (85.1%). Radiological improvements post PAO were significant, with increases in the lateral centre-edge angle (LCEA) (16.6° (SD 6.0°) to 29.4° (SD 5.8°); p < 0.001) and reductions in the Tönnis angle (13.3° (SD 6.7°) to 1.2° (SD 7.4°); p < 0.001). Patient-reported outcomes demonstrated significant improvements postoperatively. Specifically, the iHOT-12 sexual function item showed substantial improvement from a mean preoperative score of 54.3 (SD 33.7) to a postoperative score of 75.0 (SD 27.1) (p < 0.001). Females reported significant enhancements in sexual function (p < 0.001), whereas improvements in males did not reach statistical significance (p = 0.181). Cases of under-correction (LCEA < 25°) demonstrated significantly higher impairments in sexual function postoperatively compared with adequately corrected cases, indicating the importance of achieving optimal anatomical correction.</p><p><strong>Conclusion: </strong>PAO significantly enhances sexual function and overall hip-related quality of life in patients with symptomatic DDH. The findings underscore the necessity of precise surgical techniques and highlight that outcomes may vary by sex, suggesting a need for a sex-sensitive approach in both clinical practice and research.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 4","pages":"440-445"},"PeriodicalIF":2.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11996260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Inaugural UK National Hallux Valgus Think Tank : identification of key issues and strategies to improve clinical care for patient benefit.","authors":"Thomas L Lewis, Abbas See, Martin Thomas, Linzy Houchen-Wolloff, Arash Angadji, Catriona McDaid, Seth O'Neill, Chris Nester, Jitendra Mangwani, Ali Abbasian, Arash Angadji, Ann Berger, Jodie Breach, Robert Clayton, Kartik Hariharan, Natasha Hossain, Thomas Lewis, Jitendra Mangwani, Catriona McDaid, Chris Nester, Seth O'Neill, Arul Ramasamy, Robbie Ray, Carrie Sandford, Abbas See, Andrea Sott, Martin Thomas, Madhu Tiruveedhula, Christopher Withey","doi":"10.1302/2633-1462.64.BJO-2024-0212.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.64.BJO-2024-0212.R1","url":null,"abstract":"<p><strong>Aims: </strong>Hallux valgus (also known as a bunion) is a common forefoot deformity impacting pain, function, quality of life, and mobility, with higher prevalence in females and increasing incidence with age. The high prevalence and rates of surgical treatment potentially have a major impact on the healthcare system. The aim of this stakeholder consultation was to identify current issues with provision of hallux valgus treatment, as well as identify achievable goals to improve understanding of hallux valgus and guide future assessment, treatment pathways, and research directions with the aim of improving clinical outcomes for patients.</p><p><strong>Methods: </strong>Scoping searches were undertaken to inform and identify relevant outcome sets and existing evidence relating to hallux valgus. A one-day think tank conference was held on 21 June 2024, involving stakeholders from various sectors, including patients, primary and secondary care professionals, researchers, and representatives of national societies. Key themes and issues related to hallux valgus were identified and used to develop structured action development plans.</p><p><strong>Results: </strong>Major issues identified include the absence of national policy recommendations, variability in treatment pathways, and gaps in research and patient education. Patient experiences highlighted the significant impact on quality of life and the need for standardized information and care pathways. Key priorities for research include developing a core outcome set and understanding the patient's lived experience, while policy priorities focus on creating national guidelines and raising awareness of the condition's socioeconomic and functional impacts.</p><p><strong>Conclusion: </strong>The inaugural UK National Hallux Valgus Think Tank identified critical issues in the management of hallux valgus and developed strategies to improve clinical outcomes through research and policy development. Establishing a working group and prioritizing both research and policy initiatives will be essential to advancing the understanding and treatment of hallux valgus.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 4","pages":"432-439"},"PeriodicalIF":2.8,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11994245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001295","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":"Global and regional disparities in access to specialist sarcoma services.","authors":"Tomas Zamora, Eduardo Botello, Thomas Jenkins, Charlotte Jeys, Minna Laitinen, Ajay Puri, Lee Jeys","doi":"10.1302/2633-1462.64.BJO-2024-0208.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.64.BJO-2024-0208.R1","url":null,"abstract":"<p><strong>Aims: </strong>Cancer care guidelines have been developed in many subspecialities, usually in advanced health systems. However, there are notable global disparities in healthcare access, which can impact sarcoma care. Unfortunately, there is a lack of global data on this subject. Our aim was to describe access to sarcoma care based on a comprehensive global survey among orthopaedic oncologists, and assess for global as well as regional differences.</p><p><strong>Methods: </strong>A 25-question survey was emailed to the attendees of the 2024 Birmingham Orthopaedic Oncology Meeting and included questions about the respondents' training and practice, access to sarcoma centres, and specific items for sarcoma diagnosis and treatment. For data analysis and comparison, countries were grouped geographically and per the World Bank's income classification.</p><p><strong>Results: </strong>A total of 192 specialists from 47 countries completed the survey (67%). Overall, 40% declared that most patients in their country were treated in a specialized sarcoma centre. Declared access to specific diagnostic technology ranged from 69% (translocation studies) to 86% (various immunohistochemistry). Only 31% stated having access to proton therapy and 82% to all possible reconstruction methods. Compromise of ideal surgical management because of prior treatments and financial constraints was declared to have happened regularly in 40% and 17% of practices, respectively. Regions with better-developed healthcare systems had improved access to all aspects surveyed. Similar results were observed when comparing high-income countries against low- to middle-income countries.</p><p><strong>Conclusion: </strong>Our study highlights substantial global and regional disparities in access to sarcoma services, which could potentially impact clinical outcomes. Further studies are needed to clarify this reality.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 4","pages":"425-431"},"PeriodicalIF":2.8,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11985170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030559","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 course of borderline dysplasia: a 26-year follow-up of nonoperative hips in patients undergoing unilateral acetabular rotational osteotomy.","authors":"Ayano Amagami, Hajime Sugiyama, Mitsuru Saito","doi":"10.1302/2633-1462.64.BJO-2024-0276.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.64.BJO-2024-0276.R1","url":null,"abstract":"<p><strong>Aims: </strong>We conducted a minimum 20-year follow-up of nonoperated hips that presented with borderline dysplasia (BD), defined as a lateral centre-edge angle (LCEA) of 18° to 25°, in cases of bilateral developmental dysplasia of the hip (DDH) where unilateral rotational acetabular osteotomy (RAO) was performed. The study aimed to identify risk factors for the development of hip osteoarthritis (OA), the timing of OA onset, and hip survival rate in BD. For the timing of OA onset and hip survival rate, we compared cases of BD with cases having LCEA < 18° (definite DDH).</p><p><strong>Methods: </strong>The cases were divided into two groups based on OA development in the nonoperated side. They were compared by age at surgery, LCEA, Sharp angle, acetabular head index, acetabular roof obliquity, pistol grip deformity, crossover sign, and OA progression in the RAO-treated side. OA onset timing and hip survival rate were calculated using the time of RAO as baseline.</p><p><strong>Results: </strong>This study enrolled 39 hips (39 patients) with a mean follow-up of 26.8 years (SD 3.38): nine in the progression group and 30 in the non-progression group. There were no significant differences in radiological indices between the groups. In the progression group, OA progression on the RAO-treated side was significantly more common (p = 0.002). The 20-year hip survival rate was 76.9%, with OA developing at a mean of 10.5 years (SD 5.3) after RAO. There were no significant differences in hip survival rate and OA onset timing compared with definite DDH.</p><p><strong>Conclusion: </strong>In BD, the condition of the contralateral hip may be a risk factor for OA development; however, radiological indices alone could not identify risk factors for OA onset. There were no differences in the time to OA onset or hip survival rate between BD and definite DDH, suggesting that LCEA alone may be insufficient to evaluate the long-term outcomes of BD.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 4","pages":"419-424"},"PeriodicalIF":2.8,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11981693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050841","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":"Birmingham Hip Resurfacing: a retrospective cohort study of clinical, biochemical, and radiological outcomes in a non-designer centre at minimum 15 years' follow-up.","authors":"Martin S Davey, Conor Farrell, Conor Kilkenny, Conor Medlar, Niall P McGoldrick, John F Quinlan","doi":"10.1302/2633-1462.64.BJO-2025-0003.R1","DOIUrl":"10.1302/2633-1462.64.BJO-2025-0003.R1","url":null,"abstract":"<p><strong>Aims: </strong>Although the use of metal-on-metal (MoM) implants in total hip arthroplasty (THA) remains a topic of controversy, prior literature has reported satisfactory ten-year clinical and radiological outcomes following Birmingham Hip Resurfacing (BHR), subsequently resulting in a recent Orthopaedic Data Evaluation Panel (ODEP) rating of 15 A*. Therefore, the purpose of this study was to evaluate the functional outcomes, radiological outcomes, and revision rates following BHR at a minimum of 15 years' follow-up in a non-designer centre.</p><p><strong>Methods: </strong>Two investigators performed a retrospective review to identify consecutive patients who underwent BHR in our institution over a seven-year period (2003 to 2009, at minimum 15 years' follow-up) in a non-designer centre. Evaluation of clinical (Oxford Hip Scores (OHS)), biochemical (cobalt and chromium levels), and radiological (plain film radiographs) outcomes was carried out. Survivorship analysis was performed using Kaplan-Meier curves, with all-cause surgical revision defined as a definitive endpoint for analysis. Descriptive statistical analysis was carried out.</p><p><strong>Results: </strong>Overall, 96 patients (86 males) at a mean age of 51.4 years (SD 9.9; 27 to 69) underwent 105 BHR procedures (nine bilateral) with at least 15 years' minimum follow-up. Mean OHS was 38.3 (SD 9.6; 17 to 48) at 15-year minimum follow-up. The overall survivorship was 94.3% at 15 years post BHR, with an all-cause revision rate of 5.7%. Only eight BHR prostheses (8.2%) had radiolucent lines on plain films, none of which were listed for revision at the time of latest follow-up, while 32 patients had undergone MRI at 170 months (SD 54.9; 6 to 249) post BHR, with evidence of fluid collection, aseptic lymphocyte-dominant vasculitis-associated lesion, and metallosis identified on the MRI of four patients, four patients, and one patient, respectively. For 98.4% (60/61) of patients, cobalt and chromium values were either within normal limits (68.9%, n = 42) or less than double the upper limit of normal (29.5%, n = 18).</p><p><strong>Conclusion: </strong>This study found that BHR demonstrates an acceptable survivorship of 94% at 15 years of minimum follow-up, with satisfactory clinical and radiological outcomes to reflect this low all-cause revision rate in a non-designer centre.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 4","pages":"413-418"},"PeriodicalIF":2.8,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative chronic opiate use associated with a worse joint-specific function and quality of life before and after total hip and knee arthroplasty.","authors":"Eliott S Martinson, Nick D Clement, Deborah J MacDonald, Chloe E H Scott, Colin R Howie","doi":"10.1302/2633-1462.64.BJO-2024-0250.R1","DOIUrl":"10.1302/2633-1462.64.BJO-2024-0250.R1","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to assess whether chronic pre-arthroplasty use of strong opiates impacted the pre- and postoperative joint-specific function, quality of life (QoL), pain scores, and satisfaction in those undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>This prospective study assessed 1,487 patients (THA n = 729; TKA n = 758). Preoperative opiate use of more than a month was used to define the opioid group. Patient demographics, comorbidities, Oxford Hip Score (OHS), Oxford Knee Score (OKS), and EuroQol five-dimension questionnaire (EQ-5D) scores were collected preoperatively and at six months postoperatively. Patient satisfaction with their joint was assessed at six months.</p><p><strong>Results: </strong>The opioid groups consisted of 95 patients in both the THA (13.0%) and TKA (12.5%) cohorts. Pre- and postoperative OHS, OKS, and EQ-5D were clinically (greater than the minimal clinically important difference) and statistically (p < 0.001) significantly worse for the opioid groups undergoing THA and TKA. The opioid group was independently associated with a significantly worse improvement in OHS (-3.0, 95% CI -4.8 to -1.2; p = 0.001) and EQ-5D (-0.089, 95% CI -0.132 to -0.041; p < 0.001) for those undergoing THA, but no significant (OKS, p = 0.650 and EQ-5D, p = 0.485) association was demonstrated in the TKA cohort. There was no difference in satisfaction with their arthroplasty between opioid and opiate-naive groups undergoing THA (p = 0.133) or TKA (p = 0.797).</p><p><strong>Conclusion: </strong>Preoperative opiate use was associated with clinically significantly worse pre- and postoperative joint-specific function and QoL. Those undergoing THA had a clinically worse improvement in their joint-specific function, but this was not observed in those undergoing TKA. However, patients were equally satisfied with outcomes.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 4","pages":"405-412"},"PeriodicalIF":2.8,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11972797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796623","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}