Bone & Joint Open最新文献

{"title":"Periprosthetic fractures after hip and knee arthroplasty in France : national trends and future projections.","authors":"Bernard de Geofroy, Julie Bulsei, Pierre-Alban Bouché, Lolita Micicoi, Eric Fontas, Jean-François Gonzalez, Louis Dagneaux, Grégoire Micicoi","doi":"10.1302/2633-1462.77.BJO-2026-0027.R1","DOIUrl":"10.1302/2633-1462.77.BJO-2026-0027.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to provide a nationwide assessment of the incidence, risk factors, morbidity, and mortality of hip and knee periprosthetic fractures in France over the past decade, and to project their future burden up to 2070 under different epidemiological scenarios.</p><p><strong>Methods: </strong>This nationwide retrospective study used the French National Health Data System to identify all patients who underwent reoperation for hip or knee periprosthetic fracture in France between January 2015 and December 2024. Fracture episodes occurring within three months of each other were considered a single event. Annual incidence rates were calculated per 100,000 inhabitants, and cumulative incidences of complications and mortality were assessed at three months and one year. Long-term projections were generated for 2030 to 2070 using two scenarios: a static model assuming stable incidence, and a dynamic model extrapolating the 2015 to 2024 linear trend adjusted for demographic forecasts.</p><p><strong>Results: </strong>Over the ten-year period, 15,029 periprosthetic fractures were identified. The mean age was 81 years (SD 11) and 70% (10,571) of patients were female. The incidence doubled from 1.73 to 3.94 per 100,000 inhabitants between 2015 and 2024. Mortality reached 8% at three months and 16% at one year, primarily associated with older age (HR 1.1) and higher comorbidity burden (HR 1.2). Postoperative complications occurred in 16% of patients within three months, including pressure ulcers, procedure-related complications, and cardiovascular events. Projections indicated a 33% and 248% increase in periprosthetic fractures by 2070 under the static and dynamic incidence scenarios, respectively.</p><p><strong>Conclusion: </strong>The incidence of periprosthetic fractures in France has risen steadily and is expected to increase substantially in the coming decades, driven by demographic ageing. Given their high morbidity and mortality, optimizing perioperative and post-fracture care, along with implementing measures to prevent both fractures and related complications, should be considered a public health priority.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 7","pages":"934-943"},"PeriodicalIF":3.3,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13368401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449655","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":"Forecasting knee arthroplasty surgery with deep learning : an integrated approach using routine clinical data and radiographs.","authors":"Omar Musbahi, Thomas A G Hall, Alexis Alibert, Gareth G Jones, Justin Cobb, Richard J van Arkel","doi":"10.1302/2633-1462.77.BJO-2025-0268.R1","DOIUrl":"10.1302/2633-1462.77.BJO-2025-0268.R1","url":null,"abstract":"<p><strong>Aims: </strong>We aimed to develop and validate a practical deep learning model integrating commonly collected clinical data and knee radiographs to predict the need for knee arthroplasty (total or partial) in patients with, or at risk of, knee osteoarthritis, as well as the time to surgery.</p><p><strong>Methods: </strong>Data from the Multicentre Osteoarthritis Study (MOST) and the Osteoarthritis Initiative (OAI) were used. The MOST dataset, comprising 3,026 patients, was the primary training and testing cohort, while the OAI dataset provided external validation. The final architecture was based on DenseNet-201, with a head that combined outputs from the radiological analysis with commonly collected clinical data. Model evaluation used the area under the receiver operating characteristic curve (AUROC) and precision-recall curve (AUPRC).</p><p><strong>Results: </strong>The integration of clinical and radiological data significantly improved predictive accuracy. The combined model achieved an AUROC of 0.85 and AUPRC of 0.62, outperforming models using either data source alone. External validation with the OAI dataset yielded an AUROC of 0.79, confirming the model's generalizability. The AUROC and AUPRC for surgical interventions within 40 months was 0.83 and 0.26, respectively, on the validation dataset, demonstrating higher predictive accuracy for earlier surgical needs.</p><p><strong>Conclusion: </strong>This study highlights the potential of deep learning models, which integrate clinical and radiological data, to predict the need for knee arthroplasty. The robust performance and generalizability of the developed model could streamline clinical pathways and predict local demand for surgery during the next three years. This will facilitate resource planning for providers and accurate and timely access to surgical interventions for patients.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 7","pages":"926-933"},"PeriodicalIF":3.3,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13364347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438398","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":"Validation of a standardized question and a numerical rating scale for assessment of patient satisfaction after knee arthroplasty at one and two years.","authors":"Nick D Clement, Donia Karimaghaei, Irrum Afzal, Fares S Haddad, Deiary F Kader","doi":"10.1302/2633-1462.77.BJO-2026-0105","DOIUrl":"10.1302/2633-1462.77.BJO-2026-0105","url":null,"abstract":"<p><strong>Aims: </strong>The aim was to validate the use of a standardized satisfaction question with a numerical rating scale (NRS) response following knee arthroplasty (KA) at one and two years.</p><p><strong>Methods: </strong>A retrospective study was conducted over six years and included 7,644 KAs in 6,690 patients. Patient demographic details, American Society of Anesthesiologists (ASA) grade, and preoperative and postoperative Oxford Knee Scores (OKS), and EQ-5D-3L) scores were obtained from a local arthroplasty register. Patient satisfaction was assessed at one and two years postoperatively using a standardized questionnaire with possible responses ranging from 0 (not satisfied) to 100 (very satisfied) on a NRS.</p><p><strong>Results: </strong>During the study period, 5,893 and 4,879 KA had completed outcomes at one and two years' follow-up, respectively. The median satisfaction score was 90 (IQR 80 to 100). There were moderate correlations between the postoperative OKS at one year (<i>r</i> = 0.554) and two years (<i>r</i> = 0.441) with satisfaction, supporting construct validity. Responses to the satisfaction question were skewed, with a 34.1% ceiling effect. The test-retest analysis showed an intraclass coefficient of 0.934 (95% CI 0.886 to 0.962) for single measures and 0.966 (95% CI 0.940 to 0.981) for average measures, suggesting good to excellent reliability. Longitudinal agreement between one and two years showed an intraclass coefficient of 0.71 (95% CI 0.68 to 0.74, p < 0.001). Level of satisfaction was not influenced by preoperative variables or had a negligible to weak influence on satisfaction. Suggested thresholds in satisfaction score were very satisfied ≥ 90, satisfied as 80 to 89, neutral 60 to 79, dissatisfied 40 to 59, and very dissatisfied < 40.</p><p><strong>Conclusion: </strong>The NRS was a valid, reliable, and universally applicable measure of satisfaction following KA, with a smaller ceiling effect than Likert scales. One year appears optimal for assessing satisfaction, as no further improvement occured beyond this, and follow-up rates decline. The defined thresholds will help identify satisfied and unsatisfied patients.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 7","pages":"916-925"},"PeriodicalIF":3.3,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13356975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430811","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":"Super-acute massive osteolysis of the femoral head after acetabular fracture fixation : a comparative study with conventional post-traumatic osteonecrosis requiring total hip arthroplasty.","authors":"Yi-Hsun Yu, Chih-Yang Lai, I-Jung Chen, Yung-Heng Hsu, Ying-Chao Chou","doi":"10.1302/2633-1462.77.BJO-2026-0106.R1","DOIUrl":"10.1302/2633-1462.77.BJO-2026-0106.R1","url":null,"abstract":"<p><strong>Aims: </strong>Super-acute massive osteolysis of the femoral head (MOFH) is a rare but devastating complication following acetabular fracture, characterized by rapid femoral head destruction within weeks. This study aimed to characterize and compare the clinical and radiological features of super-acute MOFH with those of conventional post-traumatic osteonecrosis of the femoral head (ONFH) requiring total hip arthroplasty (THA).</p><p><strong>Methods: </strong>This retrospective study included adult patients who underwent acetabular fracture osteosynthesis at a single Level I trauma centre between January 2021 and December 2025 and subsequently required THA. Patients were classified into super-acute MOFH or conventional ONFH groups. Demographic data, injury patterns, surgical variables, and radiological findings were reviewed. Reduction quality was assessed using postoperative radiographs and CT-based articular gap and stepoff measurements. Groups were compared using non-parametric and exact tests; Firth penalized logistic regression identified factors independently associated with super-acute MOFH.</p><p><strong>Results: </strong>Overall, 31 patients met the inclusion criteria: 12 with super-acute MOFH and 19 with conventional ONFH. Patients with super-acute MOFH were significantly older (p = 0.010). Fracture pattern, hip dislocation, recurrent dislocation, time to reduction, time to fixation, surgical approach, revision fixation, and overall reduction quality showed no association with super-acute MOFH. CT-based articular gap measurements were similar between groups. Greater postoperative axial stepoff in posterior wall fractures occurred in the super-acute MOFH group but were not independently predictive. Multivariable analysis showed increasing age was independently associated with super-acute MOFH (odds ratio 1.14 per year; 95% CI 1.01 to 1.29; p = 0.037).</p><p><strong>Conclusion: </strong>Super-acute MOFH is a distinct, aggressive post-traumatic entity that can occur despite satisfactory acetabular reduction and fixation. Its development is unrelated to fracture morphology or surgical factors, but associated with older age in middle-aged trauma patients, suggesting host-related biological vulnerability. Early recognition, close postoperative imaging surveillance, and timely THA preparation are recommended for at-risk patients.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 7","pages":"907-915"},"PeriodicalIF":3.3,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13349589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424625","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":"Weaning in INfant hip DYsplasia (WINDY) study: weaning of brace treatment versus immediate cessation for developmental dysplasia of the hip : study protocol for a randomized multicentre feasibility study.","authors":"Joanna Craven, Richard Kirk, Xavier L Griffin, Elizabeth Conroy, Eleanor C Carpenter, Lucy Llewellyn-Stanton, Alexander Aarvold, Daniel C Perry","doi":"10.1302/2633-1462.77.BJO-2026-0074.R1","DOIUrl":"10.1302/2633-1462.77.BJO-2026-0074.R1","url":null,"abstract":"<p><strong>Aims: </strong>Pavlik harness (brace) treatment is the cornerstone of management for infants with developmental dysplasia of the hip (DDH). However, there is wide variation in how the harness is discontinued, with some clinicians stopping immediately and others using gradual reduction ('weaning'), reflecting the absence of high-quality comparative evidence. WINDY (Weaning in INfant hip Dysplasia) is a multicentre randomized feasibility trial comparing a standardized weaning regimen with immediate cessation. The primary aim is to determine whether a definitive multicentre randomized controlled trial (RCT) is feasible. Secondary aims are to assess parental engagement, evaluate the acceptability and measurement properties of the Evaluation Measure for BRACe Experience (EMBRACE), and explore whether routinely collected Smart4NIPE data can be used for trial outcomes.</p><p><strong>Methods: </strong>WINDY is a multicentre, parallel-group feasibility RCT with 1:1 allocation, stratified by site. Infants treated with a Pavlik harness who demonstrate ultrasound normalization (hip centred; α angle ≥ 60°) are eligible. Following consent, infants are randomized to either four weeks of night-time-only harness wear (minimum 10 hours per night) or immediate cessation. Follow-up is 12 weeks and aligned with routine care. Parents complete electronic questionnaires, including EMBRACE, at baseline, two, four, and six weeks post-randomization. Feasibility outcomes include recruitment, proportion randomized, parental engagement, and compliance. EMBRACE measurement properties and the feasibility of using routinely collected national data will also be assessed.</p><p><strong>Discussion: </strong>This study will determine key feasibility parameters for a definitive multicentre RCT comparing harness weaning with immediate cessation in DDH, including recruitment, intervention acceptability, and parent-reported data completion. It will also provide further evaluation of the EMBRACE measure to support family-centred outcomes and assess whether routinely collected Smart4NIPE data can be used for trial outcome capture. As a feasibility study, analyses will be descriptive and will inform the design and delivery of a future definitive trial.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 7","pages":"900-906"},"PeriodicalIF":3.3,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13345714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413321","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":"Watchful waiting versus methylprednisolone or polidocanol injections as treatment of simple bone cysts.","authors":"Thomas P G van Geloven, Annebel M J Soffers, Marta Fiocco, Lizz van der Heijden, Hilde W van Kouswijk, Pieter Bas de Witte, Michiel A J van de Sande","doi":"10.1302/2633-1462.77.BJO-2026-0062.R1","DOIUrl":"10.1302/2633-1462.77.BJO-2026-0062.R1","url":null,"abstract":"<p><strong>Aims: </strong>Simple bone cysts (SBCs) are among the most prevalent benign cystic bone lesions in children. The use of watchful waiting as management is debated, as are the type and timing of injection therapy. This study aims to compare clinical outcomes of watchful waiting and delayed and immediate percutaneous procedures in children with SBCs, together with the effectiveness of methylprednisolone and polidocanol.</p><p><strong>Methods: </strong>All eligible paediatric patients with SBCs and minimal one year of follow-up were included from our tertiary musculoskeletal oncology referral centre (January 2000 to December 2024). Outcomes of interest were cumulative incidence of (partial) healing (CI-Healing), cumulative incidence of failure (CI-Failure), and prognostic factors for healing and failure. For CI-Healing, competing risk analysis was performed with failure as the competing event. For CI-Healing and CI-Failure of methylprednisolone and polidocanol, landmark analysis was performed. Prognostic factors were estimated using a multivariate cause-specific hazard model.</p><p><strong>Results: </strong>In total, 160 paediatric patients with SBCs were included (mean age 8.7 years (SD 3.6); 128 (80%) males). Management consisted of watchful waiting (n = 41) and delayed (n = 86) or immediate (n = 33) percutaneous procedure. The median follow-up was 3.4 years (IQR 2.2 to 5.4). CI-Healing was significantly higher in immediate percutaneous procedures than in watchful waiting and delayed percutaneous procedures. Additionally, polidocanol performed significantly better than methylprednisolone regarding CI-Healing and CI-Failure. Lower limb localization was a significant negative prognostic factor for healing (cause-specific hazard ratio 0.38; 95% CI 0.18 to 0.82).</p><p><strong>Conclusion: </strong>For treatment of SBCs, watchful waiting showed high chances of necessitating subsequent treatment, leading to lower CI-Healing and prolonged exposure to risk of failure. If treatment is required, polidocanol is a superior injectable compared with methylprednisolone, in terms of both healing and failure prevention.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 7","pages":"890-899"},"PeriodicalIF":3.3,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13345715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413266","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":"Revision periacetabular osteotomy enhances joint function and activity level after failure of redirectional pelvic osteotomy at skeletal maturity.","authors":"Maximilian Fischer, Andreas Nitsch, Jens Goronzy, Feras Kasabji, Andre Hofer, Georgi I Wassilew","doi":"10.1302/2633-1462.77.BJO-2025-0406.R1","DOIUrl":"10.1302/2633-1462.77.BJO-2025-0406.R1","url":null,"abstract":"<p><strong>Aims: </strong>There is a paucity in the literature regarding functional outcomes of revision periacetabular osteotomy (R-PAO) after failure of previous redirectional pelvic osteotomy in a mature skeleton. This study aimed to compare the surgical and patient-reported outcome measures (PROM) between R-PAO and primary PAO.</p><p><strong>Methods: </strong>Patients undergoing R-PAO (n = 13) and primary PAO (n = 39) were matched in a 1:3 ratio for age, sex, and surgical date with a minimum follow-up of one year. PROM assessment included scores for pain, joint function (Modified Harris Hip Score -mHHS; International Hip outcome tool-12 -iHOT12), and activity level (University of California Los Angeles activity scale -UCLA). Postoperative outcomes were compared between the groups using independent-samples <i>t</i>-tests and Mann-Whitney U test. Multivariable linear regression was used to identify predictors of postoperative outcome improvement.</p><p><strong>Results: </strong>Patients undergoing R-PAO had significantly worse preoperative joint function (mHHS 34.91 to 57.28, p < 0.001; iHot-12 33.17 to 46.22, p = 0.005) and activity level (UCLA 4.38 to 6.34, p = 0.004) compared to primary PAO. While achieving similar functional improvement (Δpre - post, p > 0.05) comparing both groups, postoperative mHHS (70.21 to 86.81, p = 0.002) and pain score (3.46 to 1.92, p = 0.010) remained significantly worse after R-PAO. Multivariable linear regression analysis revealed that preserved preoperative joint function (iHot-12 ß = 0.795, p < 0.001; mHHS ß = 0.696, p < 0.001) and activity level (UCLA ß = 0.360, p < 0.001), a lower BMI (iHot-12 ß = -2.011, p = 0.002; UCLA ß = -0.120, p = 0.041), and a sufficient postoperative anterior wall coverage (iHot-12 ß = 0.849, p < 0.001) are predictors of improved postoperative outcomes in both R-PAO and primary PAO.</p><p><strong>Conclusion: </strong>The failure of hip-preserving pelvic osteotomies in skeletally mature patients results in a substantial symptom burden and functional impairment. R-PAO represents a considerable treatment strategy that preserves the native hip joint and function, but postoperative outcomes after R-PAO remain inferior to those of primary PAO, due to the worse preoperative joint function.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 7","pages":"882-889"},"PeriodicalIF":3.3,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406078","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 Reconstructive Pelvic Anatomy classification system : a valid and reliable classification system for pelvic reconstruction.","authors":"William J J Collins, Daniel Franks, Ian A Harris, Verinder S Sidhu, Maurice Guzman, Paul D Stalley, Joshua Zadro, Kate Alexander, Philip Hay, Kai Cheng, Scott Sommerville, Luke Johnson, Richard Carey Smith, Demien Broekhuis, Matthew Broadhead, Richard Boyle","doi":"10.1302/2633-1462.77.BJO-2026-0041.R1","DOIUrl":"10.1302/2633-1462.77.BJO-2026-0041.R1","url":null,"abstract":"<p><strong>Aims: </strong>Pelvic reconstruction in the setting of significant bone loss has become increasingly complex, with advancements such as custom 3D-printed prostheses now used in both large oncological resections and revision total hip arthroplasty (rTHA) with massive bone loss. Surgeons must consider how to best reconstruct the pelvis to optimize patient outcomes. The Reconstructive Pelvic Anatomy (RPA) classification system is proposed to aid in communication, reconstructive planning, and developing research cohorts suitable for modern pelvic reconstructions. This study aimed to 1) describe the development of the RPA classification as a novel classification system for pelvic reconstruction; 2) demonstrate the content and construct validity of the system; and 3) investigate its interobserver and intraobserver agreement.</p><p><strong>Methods: </strong>A group of orthopaedic surgeons and researchers, based in Sydney, Australia, developed the system's four domains, which together form the overall classification. A total of 23 pelvic reconstruction surgeons provided an assessment of each domain's clarity and relevance, producing an Item-Content Validity Index (I-CVI). They then applied the classification to the surgical plan and postoperative radiograph of 20 pelvic reconstructions twice, at a minimum of two weeks apart. Construct validity was assessed by agreement between observers and authors. Interobserver and intraobserver agreement was assessed using the kappa statistic.</p><p><strong>Results: </strong>A total of 23 surgeons completed the assessment of content validity, and 18 surgeons completed both surveys. Each domain demonstrated content validity for both relevance and clarity (I-CVI > 0.78). Authors and observers had moderate agreement on the classification supporting construct validity (k = 0.6) with a median agreement of 90% for individual domains. Interobserver agreement was moderate overall (k = 0.54), with individual domains having substantial or better agreement (k = 0.73 to 0.82) except for anterior fixation (k = 0.57). Intraobserver agreement of individual domains was substantial or almost perfect (k = 0.76 to 0.84) with moderate agreement for the overall classification (k = 0.6).</p><p><strong>Conclusion: </strong>This study establishes the content and construct validity of the RPA classification system as a novel classification system for pelvic reconstruction, and its reliability to support its use as a communicative tool, and in research and surgical planning.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 7","pages":"871-881"},"PeriodicalIF":3.3,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13337304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148399516","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":"Protocol for Novel Perioperative Optimization of Obese Osteoarthritic Patients pending Total Knee Replacement with glucagon-like peptide-1 receptor agonist (NPO-OOPS-TKR) : a pilot randomized controlled trial.","authors":"Lawrence C M Lau, Tak W D Lui, Chunyi Wen, Lin Zhu, Sien Lin, Thomas K C Leung, Michelle H Luk, Ping Keung Chan, Amy Cheung, Kwong Yuen Chiu, Henry Fu","doi":"10.1302/2633-1462.77.BJO-2025-0359.R1","DOIUrl":"10.1302/2633-1462.77.BJO-2025-0359.R1","url":null,"abstract":"<p><strong>Aims: </strong>Obesity is associated with higher rates of perioperative complications and worse pain and functional outcomes after total knee arthroplasty (TKA). Preoperative optimization through weight management is therefore clinically appealing, but the current evidence base is mixed. No randomized controlled trial (RCT) has evaluated glucagon-like peptide-1 receptor agonists (GLP-1RAs) as a perioperative optimization strategy before TKA, and no such trial has focused on an Asian population. This pilot randomized trial therefore aims to determine the feasibility, tolerability, and acceptability of semaglutide-based optimization before and after TKA in older Asian adults with obesity.</p><p><strong>Methods: </strong>This is a two-arm pilot RCT that will recruit 54 adults aged 40 to 80 years with obesity (BMI ≥ 27 kg/m²) listed for primary TKA. Participants will be randomized 1:1 to semaglutide plus standard TKA care or to usual care alone. The intervention group will receive semaglutide for 48 weeks before and 48 weeks after TKA, with a planned four-week washout period before and after surgery. The control group will receive current standard care, including routine orthopaedic management and standardized general advice on diet and physical activity. Primary outcomes are feasibility outcomes (recruitment, adherence, tolerability, and retention), while pain, body weight, patient-reported outcomes, and perioperative complications are exploratory clinical outcomes intended to inform a future definitive trial.</p><p><strong>Conclusion: </strong>This pilot trial will determine whether a definitive randomized trial is feasible in older Asian adults with obesity awaiting TKA. The study is designed to estimate recruitment, adherence, tolerability, and retention, and to generate preliminary effect-size estimates for a future fully powered trial. Because semaglutide may influence perioperative outcomes through mechanisms beyond weight loss alone, including metabolic and anti-inflammatory pathways, these pathways will be considered when interpreting the findings.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 7","pages":"861-870"},"PeriodicalIF":3.3,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13333214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391495","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":"Fast fix or false hope? Polyethylene exchange in unstable primary unconstrained total knee arthroplasty.","authors":"Yannik Hanusrichter, Carsten Gebert, Marcel Dudda, Jendrik Hardes, Alexander Grimberg, Daniela Koller, Martin Wessling","doi":"10.1302/2633-1462.77.BJO-2026-0024.R1","DOIUrl":"10.1302/2633-1462.77.BJO-2026-0024.R1","url":null,"abstract":"<p><strong>Aims: </strong>Instability is a leading cause of revision after primary total knee arthroplasty (TKA). Isolated polyethylene exchange (IPE), typically involving increased insert thickness, is considered a fast and low-risk treatment option. However, evidence supporting its effectiveness remains limited. This study assesses outcomes and risk factors of IPE for secondary instability in unconstrained primary TKAs using data from the German Arthroplasty Registry (EPRD).</p><p><strong>Methods: </strong>Patients with unconstrained primary TKA and subsequent IPE due to presumed instability were included. Polyethylene height increase served as a surrogate for instability severity. Cases with infection were excluded. Secondary patellar resurfacing (SPR) was analyzed as a potential influencing factor. Multivariate Cox regression and time-dependent analyses were used to identify predictors for re-revision, defined as any subsequent revision procedure.</p><p><strong>Results: </strong>The study included 1,890 patients. IPE was performed on at a mean of 639 days (SD 521; 1 to 3343) after primary TKA, with a mean height increase of 3 mm (SD 2.2). The overall re-revision rate was 13.5%; 2.4% were due to periprosthetic joint infection. SPR was associated with lower revision risk (hazard ratio (HR) 0.50; 95% CI 0.37 to 0.68; p < 0.001). IPE one and two years after the index operation was associated with a decreased risk of subsequent revision (HR 0.33, 95% CI 0.20 to 0.55; HR 0.36, 95% CI 0.21 to 0.60). Polyethylene height increase > 3 mm was not associated with worse outcomes (< 3 mm HR 0.87, 95% CI 0.65 to 1.17; p = 0.358).</p><p><strong>Conclusion: </strong>IPE can be a viable treatment for mild secondary instability following primary TKA, particularly with careful patient selection. SPR appears to improve implant survival and should be considered in cases with patellar pathology. Early-onset instability warrants critical evaluation, as it may indicate deeper underlying issues requiring component revision. These findings highlight the importance of an individualized surgical approach and underscore the need for thorough preoperative counselling to align treatment strategy with patient-specific risk factors and expectations.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 7","pages":"852-860"},"PeriodicalIF":3.3,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148383074","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}