Bone & Joint Open最新文献

{"title":"Communication when bone and joint infection in children is suspected : a qualitative study of patients, families, and health professionals.","authors":"Andrew Kirkcaldy, C V E Carpenter, Nicolas Magrane, Marie-Caroline Nogaro, Anjali Shah, Daniel C Perry, Tim Theologis, Bridget Young","doi":"10.1302/2633-1462.72.BJO-2025-0179.R1","DOIUrl":"10.1302/2633-1462.72.BJO-2025-0179.R1","url":null,"abstract":"<p><strong>Aims: </strong>Bone and joint infection in children can result in bone and joint damage, sepsis, and even death. Diagnosis is informed by the history, examination, and a suite of tests, including blood markers, radiographs, ultrasound, and MRI. This study aimed to identify the communication needs of families during diagnostic assessment of bone and joint infection.</p><p><strong>Methods: </strong>This was a qualitative study involving semi-structured interviews with children and families who had experienced diagnostic tests for bone and joint infection, and health professionals experienced in the care of affected children. A total of 21 families (four children; 21 parents) and 11 health professionals from 11 English and Welsh hospitals were interviewed. Data analysis was informed by thematic analysis.</p><p><strong>Results: </strong>Families often felt highly anxious during diagnosis. Some described a disorderly diagnosis process, gaps or inconsistencies in information, and insensitive communication that contributed to their anxiety. Other families described more positive experiences, indicating how health professionals helped them feel prepared by providing an outline of timelines, the rationale for tests, and the potential need to adjust plans as new information became available. Participants recognized the importance of age-appropriate communication with children, and the involvement of play specialists in this process.</p><p><strong>Conclusion: </strong>The findings demonstrate the intense anxiety families experience during assessment of bone and joint infection, particularly when they are left to make sense of uncertainties by themselves, or when communication is unclear. Health professionals can support families during diagnosis by attending to both the information they provide and how it is provided, while acknowledging the uncertainties of the diagnosis process. Specifically, families valued explanations of the rationale for different clinical investigations and their timing, and advance discussion of the next steps and possible outcomes of diagnostic testing. When test results became available, families were also helped by clear follow-up plans, including in situations when the results were inconclusive.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 2","pages":"259-265"},"PeriodicalIF":3.1,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12920024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146228977","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":"Dynamic changes to the tibiofemoral joint line with increasing osteoarthritis severity and its relationship to constitutional alignment : a radiological analysis of 3,320 knees.","authors":"John E Farey, Benjamin J Leong, Jil A Wood, Do W Lee, Seyun Kim, Darren B Chen, Du H Ro, Samuel J MacDessi","doi":"10.1302/2633-1462.72.BJO-2025-0370.R1","DOIUrl":"10.1302/2633-1462.72.BJO-2025-0370.R1","url":null,"abstract":"<p><strong>Aims: </strong>Changes in both native and dynamic joint line obliquity may influence the pathogenesis of osteoarthritis (OA) and subsequent development of coronal limb alignment deformity. This study aimed to characterize joint line alterations relative to OA severity and constitutional alignment.</p><p><strong>Methods: </strong>A retrospective, cross-sectional analysis of 3,320 preoperative weightbearing long-leg radiographs from patients undergoing total knee arthroplasty was performed using deep learning software. OA severity was assessed using the Kellgren-Lawrence (KL) grading system. Constitutional alignment parameters included lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), arithmetic hip-knee-ankle (aHKA) angle, and arithmetic joint line obliquity (aJLO). Tibiofemoral joint line alterations were assessed using the mechanical hip-knee-ankle (mHKA) angle, tibial joint line angle (TJLA), femoral joint line angle (FJLA), and joint line congruence angle (JLCA). The primary outcome was the difference in the TJLA relative to the aJLO across KL grades, stratified for the presence of medial or lateral compartment OA.</p><p><strong>Results: </strong>Alterations in TJLA were observed in moderate (KL Grade 3) and severe (Grade 4) OA for medial and lateral compartment OA (both p < 0.001). In medial OA, the TJLA reversed orientation at Grade 3 from medially declined to medially inclined relative to aJLO. The aJLO maintained its constitutional orientation until Grade 4, when non-clinically significant changes (< 1°) were observed (p < 0.001). In lateral OA, the TJLA became more medially inclined in moderate and severe OA, while the aJLO remained stable. Significant changes in aHKA were observed in moderate and severe OA, indicating an apparent change in constitutional limb alignment (p < 0.001 for both medial and lateral OA).</p><p><strong>Conclusion: </strong>The tibiofemoral joint line angle changes dynamically with OA progression, while the constitutional aJLO remains stable until advanced disease occurs. Understanding this distinction between constitutional and dynamic joint line orientation is important when communicating and studying outcomes related to knee alignment.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 2","pages":"249-258"},"PeriodicalIF":3.1,"publicationDate":"2026-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12916168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146221390","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 modified Care and Comfort Questionnaire score in children with severe cerebral palsy : reference values and the associated floor and ceiling effects.","authors":"Katie Hughes, Navnit S Makaram, Callum Hughes, Nick D Clement, Mark S Gaston","doi":"10.1302/2633-1462.72.BJO-2025-0225.R1","DOIUrl":"10.1302/2633-1462.72.BJO-2025-0225.R1","url":null,"abstract":"<p><strong>Aims: </strong>The modified Care and Comfort Hypertonicity Questionnaire (mCCHQ) is a validated caregiver-reported outcome measure for children with Gross Motor Function Classification System (GMFCS) IV/V cerebral palsy (CP). This study aimed to establish reference values for the mCCHQ and determine if a floor or ceiling effect exists.</p><p><strong>Methods: </strong>This was a population-based cross-sectional study of GMFCS IV/V children enrolled in the CP Integrated Pathway Scotland (CPIPS) national surveillance programme. At each CPIPS assessment, age, sex, GMFCS and CP subtype were recorded, and caregivers were asked to complete the mCCHQ. The Scottish Index of Multiple Deprivation (SIMD) was calculated according to the child's home address.</p><p><strong>Results: </strong>The mCCHQ scores were available from 685 clinical assessments of 405 GMFCS IV/V children across four years (2017 to 2020). The mean age at assessment was 8.3 years (2 to 16). Overall, 40% (n = 163) were GMFCS IV and 60% (n = 242) GMFCS V. The mean total mCCHQ score was 52.1 (SD 12.7; 15 to 92). The mean scores for the personal care, positioning/transferring, comfort, and interaction/communication subdomains were 17.2 (SD 5.9; 6 to 36), 11.4 (SD 4.0; 1 to 24), 8.7 (SD 3.2; 0 to 20), and 14.9 (SD 4.5; 0 to 25), respectively. Although no notable floor or ceiling effect was observed for the total mCCHQ score, 13% and 15% of respondents gave the minimum possible score for the positioning/transferring and comfort subdomains, respectively, demonstrating a moderate/significant floor effect. There was no discernible trend in total mCCHQ scores across different ages. Demographic variables had limited influence on the mCCHQ score.</p><p><strong>Conclusion: </strong>The mCCHQ provides a valuable outcome score for quantifying the experience of caring for a child with GMFCS level IV/V CP. While it demonstrates good sensitivity and reliability, the observed floor effects in the positioning/transferring and comfort subdomains highlight areas for potential refinement.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 2","pages":"241-248"},"PeriodicalIF":3.1,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12914213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146214395","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":"Luton cauda equina syndrome pathway: a pragmatic approach to achieve a national target of time to scan in UK district general hospitals.","authors":"Aarjav Naik, Ghulam Abbas, Oran Roche, Preena Patel, Nofil Mulla, Dario Prudencio, Dimpu Bhagawati","doi":"10.1302/2633-1462.72.BJO-2025-0234.R1","DOIUrl":"10.1302/2633-1462.72.BJO-2025-0234.R1","url":null,"abstract":"<p><strong>Aims: </strong>Cauda equina syndrome (CES) is a rare neurosurgical emergency where diagnosis and treatment by emergency spinal decompression is time critical. A national CES pathway from Getting It Right First Time (GIRFT) suggested development of 24/7 MRI services at district general hospitals (DGHs). It gave a national target of time to scan time between MRI scan request and actual scan of less than four hours. The Luton CES pathway was introduced in 2021 at Luton and Dunstable University Hospital, UK, to improve the time (in hours) to a MRI service, as well as to streamline patient care for suspected CES. It aimed to improve time to scan and reduce need of out-of-hours transfer to tertiary centre for urgent MRI scan.</p><p><strong>Methods: </strong>A retrospective review of patients who presented with suspected CES before (2018) and after (2024) the introduction of the pathway in Luton and Dunstable University Hospital. The time to scan was the primary outcome measure. Secondary outcome measures were number of patients scanned, scan positive rate (patients with actual CES who underwent emergency spinal decompression), patients meeting the national target of time to scan, and the number of patients needing out-of-hours transfer to tertiary centre for urgent MRI scan.</p><p><strong>Results: </strong>The median time to scan improved from 8 hours 48 minutes to 34 minutes (p < 0.001). The number of patients scanned increased more than two-fold from 280 to 688. Patients meeting the national target increased from 66% to 90%. The number of patients also needing out-of-hours transfer reduced more than 50% from 17 to six.</p><p><strong>Conclusion: </strong>A local dedicated pathway can achieve national targets, and reduce need for out-of-hours transfer to a tertiary centre for urgent MRI scan. This is achieved by efficient use of an existing in-hours MRI service, already available in every DGH of UK. This can be the pragmatic way forward for most DGHs until they establish a 24/7 MRI service.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 2","pages":"235-240"},"PeriodicalIF":3.1,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12908994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146207924","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":"Corrigendum.","authors":"Tomofumi Kinoshita, Tatsuhiko Kutsuna, Kunihiko Watamori, Takashi Tsuda, Yusuke Horita, Kazunori Hino, Masaki Takao","doi":"10.1302/2633-1462.72.BJO-2026-00010","DOIUrl":"10.1302/2633-1462.72.BJO-2026-00010","url":null,"abstract":"","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 2","pages":"234"},"PeriodicalIF":3.1,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12906948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203063","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":"Artificial intelligence to support ultrasound in the detection of developmental dysplasia of the hip : a scoping review.","authors":"Rusul Yonis, Laurence Still, Mohammed Khattak, Natalie Hall, James S Bowness, Daniel C Perry","doi":"10.1302/2633-1462.72.BJO-2025-0029.R1","DOIUrl":"10.1302/2633-1462.72.BJO-2025-0029.R1","url":null,"abstract":"<p><strong>Aims: </strong>Ultrasound is a highly sensitive method to detect developmental dysplasia of the hip (DDH). However, the cost of expert sonographers performing the tests is an important factor preventing wider adoption of this technique. AI has been used to enable non-specialists to undertake imaging in other disciplines, lowering costs and improving patient access. This scoping review aims to assess and map the available evidence pertaining to AI-assisted ultrasound for DDH detection.</p><p><strong>Methods: </strong>The Association for Computing Machinery (ACM) Digital Library, EMBASE, OVID MEDLINE, PubMed, COCHRANE library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Australian New Zealand Clinical Trials Registry (ANZCTR), and Institute of Electrical and Electronics Engineers (IEEE) Xplore databases were searched. Additionally, we searched clinical trial registries from International Committee of Medical Journal Editors (ICMJE) and the World Health Organization (WHO), as well as publicly available commercial material from Exo.AI.</p><p><strong>Results: </strong>A total of 600 records were identified, of which 41 discussed the use of AI-assisted ultrasound for DDH. The search of commercial sources revealed one FDA-approved device, which featured in two of the records scrutinized in the review. Common challenges across studies included limited access to large, high-quality imaging datasets, resulting in poor generalizability due to the small sample sizes used in model training and testing. There was poor transparency in the patient population selected, insufficient reporting on model inference time, and no cost-effectiveness analyses.</p><p><strong>Conclusion: </strong>AI-based assistance for ultrasound detection of DDH shows promise, but the evidence base is incomplete. Future research should focus on standardizing development processes, improving transparency in study reporting, considering the varied perspectives of multidisciplinary teams, and prioritize comprehensive health economic evaluations. Addressing these challenges will be critical for successful development and integration of AI into this area of clinical practice.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 2","pages":"223-233"},"PeriodicalIF":3.1,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12906950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203025","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 injuries in the treatment of developmental dysplasia of the hip: a 34-year retrospective analysis of compensation claims in Finland.","authors":"Emma-Sofia Luoto, Jenni Jalkanen, Yrjänä Nietosvaara","doi":"10.1302/2633-1462.72.BJO-2025-0362.R1","DOIUrl":"10.1302/2633-1462.72.BJO-2025-0362.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to evaluate all compensation claims related to the management of developmental dysplasia of the hip (DDH) in Finland between 1 January 1987 and 31 December 2020, with a particular focus on cases compensated as avoidable treatment injuries. A secondary aim was to identify the underlying causes of these adverse events to support the prevention of similar incidents in the future.</p><p><strong>Methods: </strong>We conducted a retrospective review of all compensation claims and decisions made by the Finnish Patient Insurance Centre (PIC) concerning management of DDH over a 34-year study period. We used data from the national care register (HILMO) to extrapolate the number of children aged under 15 years who received treatment for DDH in Finland between 1 January 1987 and 31 December 2020. We then assessed the nationwide risk of compensated treatment injuries of DDH.</p><p><strong>Results: </strong>During the study period, 55 patients filed compensation claims related to the management of DDH, of whom 43 received compensation as an avoidable treatment injury, with a calculated incidence of 2.4 per 1,000 DDH patients (95% CI 1.7 to 3.2). Delayed diagnosis was the most common reason for compensation (35/43): 23 cases were missed in hospitals; 21 in child welfare clinics; and nine were missed in both a hospital and a child welfare clinic. The most common reason for delayed diagnosis (20/35) was the failure to recognize typical clinical findings associated with DDH.</p><p><strong>Conclusion: </strong>The number of compensated treatment injuries in the management of DDH was low in Finland, with most cases resulting from delayed diagnosis.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 2","pages":"216-222"},"PeriodicalIF":3.1,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12893806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146166906","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":"Acetabular component placement accuracy and short-term outcomes in total hip arthroplasty : comparison of robotic arm-assisted surgery system and an augmented reality-based portable navigation.","authors":"Tatsuroh Suzuki, Norio Yamamoto, Takanori Miura, Yuto Otaira, Shuji Fujiwara, Takeshi Yamashita, Takayuki Nakajima","doi":"10.1302/2633-1462.72.BJO-2025-0352.R1","DOIUrl":"10.1302/2633-1462.72.BJO-2025-0352.R1","url":null,"abstract":"<p><strong>Aims: </strong>Precise acetabular component positioning is critical to the success of total hip arthroplasty (THA). Mako uses CT-based robotic assistance, whereas AR-hip is an augmented reality-based portable navigation system operating without preoperative CT and at lower costs. Although both systems improve accuracy, direct comparative data are scarce. We compared cup placement accuracy and short-term outcomes between Mako robotic arm and AR navigation systems.</p><p><strong>Methods: </strong>This single-centre retrospective cohort study included 192 primary THAs (Mako, 147; AR navigation, 45). Cup placement accuracy was assessed three-dimensionally using postoperative CT, evaluating cup alignment (radiological inclination (RI) and anteversion (RA)) and position (centre of rotation (COR)). Short-term outcomes were evaluated using the Harris Hip Score (HHS), Japanese Orthopaedic Association hip score (JOA), Japanese Hip-disease Evaluation Questionnaire (JHEQ), Timed Up and Go (TUG), and 10 m walk test (10MWT). Baseline differences were adjusted using propensity score overlap weighting.</p><p><strong>Results: </strong>Mako demonstrated significantly superior accuracy than AR navigation, with smaller absolute errors in cup angles (RI 2.0° vs 3.0°, p = 0.045; RA 1.7° vs 2.4°, p = 0.005) and COR errors in the superior-inferior direction (1.5 mm vs 3.7 mm, p < 0.001). More cases were within 5° of planned angles with Mako (92.3% vs 77.7%, p = 0.030), while Lewinnek safe zone rates were high in both groups (99.5% vs 95.2%, p = 0.202). Short-term clinical scores and functional recovery at discharge were similar between groups. Operating time and blood loss were greater with Mako (122.6 vs 103.5 mins; 242.5 vs 171.5 ml; both p < 0.001). Subgroup analyses showed greater advantages of Mako in complex cases, such as obesity and developmental dysplasia of the hip, although interactions were insignificant.</p><p><strong>Conclusion: </strong>Mako demonstrated superior cup placement accuracy and COR reconstruction compared with AR navigation, with comparable short-term clinical outcomes, potentially offering advantages in complex cases. However, further research is warranted to clarify its long-term outcomes and cost-effectiveness.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 2","pages":"203-215"},"PeriodicalIF":3.1,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12890357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158791","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":"Comparable revision outcomes after unicompartmental knee arthroplasty in rheumatoid arthritis and osteoarthritis : results from the German Arthroplasty Registry.","authors":"Joost Adriaan Burger, Lorenz Pichler, Alexander Grimberg, Yinan Wu, Carsten Perka, Bernd Kladny, Sebastian Benedict Braun","doi":"10.1302/2633-1462.72.BJO-2025-0282.R1","DOIUrl":"10.1302/2633-1462.72.BJO-2025-0282.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to compare the risk of revision surgery between patients with rheumatoid arthritis (RA) who underwent primary unicompartmental knee arthroplasty (UKA) and those with osteoarthritis (OA).</p><p><strong>Methods: </strong>Data from the German Endoprosthesis Registry (EPRD) were used to compare 796 cases of primary UKA in RA patients with 67,653 cases in patients with OA. Revisions were classified into major (revision of at least the femoral or tibial component) and minor (no bony component revision, including only insert exchange), based on the surgical and procedural codes recorded in the register and further stratified by aseptic or septic revision. Mahalanobis matching was performed with a 1 RA to 5 OA ratio. The crude and matched cumulative risk of these procedures was analyzed using the Kaplan-Meier estimator. Statistical significance of differences was assessed using the log-rank test.</p><p><strong>Results: </strong>At two years, the crude cumulative risk of major revision was similar between RA (3.5%) and OA patients (3.3% p = 0.860). Matched analysis showed no significant difference with patients with OA (3.1%; p = 0.650). When stratified by cause, septic and aseptic major revisions did not differ between groups. For minor revisions, the crude risk was not different between patients with RA (2.2%) and in OA (1.3%; p = 0.071); matched analysis also showed no significant difference with patients with OA (1.5%; p = 0.236). When stratified by cause, no differences were observed in septic or aseptic minor revisions. Comparable patterns persisted through nine years.</p><p><strong>Conclusion: </strong>RA does not appear to impact the risk of revision surgery compared with OA. However, the limited sample size and relatively short follow-up necessitate ongoing monitoring to determine the risk for long-term outcomes.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 2","pages":"195-202"},"PeriodicalIF":3.1,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12885603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146150873","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":"Comparing the express and enhanced workflows for restoration of hip length and combined offset using the Mako robotic arm-assisted total hip arthroplasty.","authors":"Tim Cheok, Veronica Pajnic, Julie F Vermeir, Yvana Toh, William J Donnelly, Anthony M Silva","doi":"10.1302/2633-1462.72.BJO-2025-0288.R1","DOIUrl":"10.1302/2633-1462.72.BJO-2025-0288.R1","url":null,"abstract":"<p><strong>Aims: </strong>The Mako system is one of the most widely used systems for robotic arm-assisted total hip arthroplasty (THA). Two workflows for femoral preparation exists for this system - the enhanced and the express workflow.</p><p><strong>Methods: </strong>We performed a retrospective cohort study comparing the accuracy of each workflow in restoring the patient's combined offset and correcting the hip length discrepancy. The Mako derived values were compared against measured values and assessed with Bland-Altman plots and Theil's median slope. Secondary outcomes of interest included comparison of the measured combined offset and hip length discrepancy, surgical time, incidence of postoperative instability/dislocation, as well as pin-site related complications between the two groups.</p><p><strong>Results: </strong>A total of 81 patients were identified from our database: 61 in the enhanced group and 20 in the express workflow group. Bland-Altman plots demonstrated agreement between the measurements for both hip length discrepancy and combined offset. There was no significant difference in the measurement of hip length discrepancy or combined offset difference between the two groups; however, the magnitude of the latter was better in the enhanced (median 1.50 mm) compared with the express workflow group (median 3.13 mm). There was no significant difference in measured combined offset (p = 0.254), hip length discrepancy (p = 0.425), or surgical time (p = 0.548). Lastly, there were no patients with postoperative instability/dislocation nor pin-site related complications in either group.</p><p><strong>Conclusion: </strong>Both techniques provide excellent outcomes with minimal risk of complications when performing a Mako robotic arm-assisted THA.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 2","pages":"185-194"},"PeriodicalIF":3.1,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12883281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146143651","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}