Bone & Joint Open最新文献

{"title":"Progressive resistance and flexibility exercises versus usual care advice for improving pain and function after distal radius fracture in adults aged 50 years or over : protocol for the WISE randomized superiority trial.","authors":"David J Keene, Juul Achten, Ioana Marian, Marloes Franssen, Elizabeth Tutton, Warren Sheehan, Colin Forde, Hannah Crook, Jenny Gould, Richard Grant, Duncan Appelbe, Sarah E Lamb, Matthew L Costa","doi":"10.1302/2633-1462.67.BJO-2024-0227","DOIUrl":"10.1302/2633-1462.67.BJO-2024-0227","url":null,"abstract":"<p><strong>Aims: </strong>Distal radius fractures are very common injuries; the majority affect females aged 50 years or over. Most patients experience pain and stiffness in their wrist and upper limb weakness, making activities of daily living difficult. The aim of the WISE (Wrist Injury Strengthening Exercise) trial is to assess the effectiveness of a flexibility and resistance exercise programme for the upper limb compared with usual care advice after distal radius fracture.</p><p><strong>Methods: </strong>This is a multicentre, parallel-group, superiority, individually randomized controlled trial. We aim to recruit 588 participants aged 50 years and older with a distal radius fracture treated surgically or non-surgically from at least 15 UK NHS hospitals. Participants will be randomized 1:1 using a web-based service to usual care advice plus a therapist-supervised exercise programme (three one-to-one therapy sessions of tailored advice and prescribed home exercise over 12 weeks) or usual care advice only. The primary outcome is participant-reported wrist-related pain and function six months after randomization, measured by the Patient-Rated Wrist Evaluation. Secondary outcomes at three and six months measure health-related quality of life, pain, physical function, self-efficacy, exercise adherence, grip strength, complications, and resource use.</p><p><strong>Conclusion: </strong>This study will assess whether a therapist-supervised exercise programme is more clinically effective than usual care advice for people aged 50 years and older after distal radius fracture. At the time of submission, the trial is currently completing recruitment; follow-up will be completed in 2025 (ISRCTN registry identifier: ISRCTN78953418).</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 7","pages":"764-784"},"PeriodicalIF":2.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12235327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585061","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":"Catastrophism and anxiety are risk factors of chronic pain after total knee arthroplasty : a prospective cohort study.","authors":"Clara Croppi, Fanny Delaigue, Violaine Guinebertière, Flore Devriese, Pascal Bizot, Jules Descamps, Rémy Nizard, Pierre-Alban Bouché","doi":"10.1302/2633-1462.67.BJO-2024-0270.R1","DOIUrl":"10.1302/2633-1462.67.BJO-2024-0270.R1","url":null,"abstract":"<p><strong>Aims: </strong>After a total knee arthroplasty (TKA), up to 40% of patients suffer from chronic pain. Few studies have focused specifically on psychosocial factors as predictors of chronic pain after TKA. Our study aims to identify psychosocial risk factors of chronic pain after TKA and to identify an optimal threshold for significant scores in the multivariate analysis, using a receiver operating characteristic (ROC) curve.</p><p><strong>Methods: </strong>This was a single-centre prospective study conducted from September 2022 to September 2023, involving 204 patients. The mean age was 70 years (SD 8.59), the mean BMI was 30.49 kg/m² (SD 5.29), and 70.60% of patients were female (144/204). A form was administered before surgery to collect: Hospital Anxiety and Depression Scale (HADS), anxiety scale State-Trait Anxiety Inventory (STAI)-Y, Amsterdam Preoperative Anxiety and Information Scale (APAIS), Pain Catastrophizing Scale (PCS), and visual analogue scale (VAS). Univariate and multivariate logistic regression was used to determine the risk factors associated with chronic pain. To determine a threshold in the psychological scores associated with chronic pain, ROC curves were performed.</p><p><strong>Results: </strong>A total of 36 patients (17.60%) met the definition of chronic pain, defined as VAS ≥ 4/10 at six months postoperatively. In the multivariate analysis, to be an employee or worker (<i>β</i> = 1.10, 95% CI 0.20 to 2.10, p = 0.018), anxiety STAI-YB (<i>β</i> = 0.03, 95% CI 0.01 to 0.06, p = 0.013), and catastrophism PCS (<i>β</i> = 0.04, 95% CI 0.02 to 0.06, p < 0.001) were associated with chronic pain after TKA. Using ROC analysis, we identified a threshold value of 44.5 for anxiety STAI-YB (sensitivity 57.58%, specificity 74.51%) and of 21.5 for catastrophism PCS (sensitivity 56,25 %, specificity 71.90%) of developing chronic pain after TKA.</p><p><strong>Conclusion: </strong>This study shows that the psychosocial profile of patients can be linked to the occurrence of chronic pain, and underlines the importance of a multidimensional approach to patient assessment and management.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 7","pages":"755-763"},"PeriodicalIF":2.8,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12226953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of pubic cut position on pubic root displacement in periacetabular osteotomy : a 3D CT simulation study.","authors":"Sufian S Ahmad, Gaia Giudici, Justus Stamp, Quentin Karisch, Henning Windhagen, Marco Haertlé","doi":"10.1302/2633-1462.67.BJO-2024-0223.R1","DOIUrl":"10.1302/2633-1462.67.BJO-2024-0223.R1","url":null,"abstract":"<p><strong>Aims: </strong>Periacetabular osteotomy (PAO) has become widely recognized as the gold standard for the correction of acetabular pathomorphologies. However, the pubic cut has raised concerns due to complications such as delayed union and its association with anterior hip syndrome. The aim of this study was to examine the impact of the position of the pubic cut on the displacement of the pubic root during PAO surgery.</p><p><strong>Methods: </strong>The study included thin-sliced CT scans of 58 hips with symptomatic hip dysplasia. Overall, 3D simulations of PAO were performed in triplicate, incorporating three variations of the pubic cut, specifically positioned 5, 10, or 15 mm medial to the iliopectineal eminence. Full displacement of the pubic osteotomy was noted by two independent investigators. Analysis of variance was used for comparison between means. Logistic regression was used to determine factors influencing displacement of the pubic root.</p><p><strong>Results: </strong>The incidence of complete pubic bone displacement increased with the medial position of the cut, with rates of 17.24% for a 5 mm cut, 36.21% for a 10 mm cut, and the highest at 82.76% for a 15 mm cut medial to the iliopectineal eminence (p < 0.001). The odds of complete displacement were reduced ten-fold with a lateral 5 mm pubic cut (odds ratio 0.1, 95% CI 0.04 to 0.20, p < 0.001).</p><p><strong>Conclusion: </strong>The position of the pubic cut is the most significant determinant of pubic root displacement in PAO surgery. Loss of contact at the pubic osteotomy is likely associated with delayed union and postoperative anterior hip syndrome. Choosing a lateral pubic cut positioned 5 mm medial to the iliopectineal eminence is expected to result in a ten-fold reduction in the risk of complete pubic bone displacement. Appreciating the results of this study when performing the pubic cut may help mitigate the risk of post-PAO anterior hip syndrome.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 7","pages":"748-754"},"PeriodicalIF":2.8,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12221529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555180","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":"A systematic review of evidence regarding the association between time to mobilization following hip fracture surgery and patient outcomes.","authors":"Veena Mazarello Paes, Andrew Ting, James Masters, Mahalia V I Paes, Simon Mathew Graham, Matthew L Costa","doi":"10.1302/2633-1462.67.BJO-2024-0243.R1","DOIUrl":"10.1302/2633-1462.67.BJO-2024-0243.R1","url":null,"abstract":"<p><strong>Aims: </strong>Performance indicators are increasingly used to evaluate the quality of healthcare provided to patients following a hip fracture. In this systematic review, we investigated the association between 'early mobilization' after surgery and patient outcomes.</p><p><strong>Methods: </strong>Evidence was searched through 12 electronic databases and other sources. The methodological quality of studies meeting the inclusion criteria was assessed. The protocol for this suite of related systematic reviews was registered at PROSPERO: ID = CRD42023417515.</p><p><strong>Results: </strong>A total of 24,507 articles were reviewed, and 20 studies met the inclusion criteria for the review, involving a total of 317,173 patients aged over 60 years with a hip fracture. There were two randomized clinical trials, five prospective studies, and 13 retrospective cohort studies, conducted between January 1981 and June 2022. All but two studies came from high-income healthcare systems. The definition of early mobilization varied across studies and health systems; and weightbearing status was often not reported or ambiguously defined, making formal meta-analysis of the data impossible. Early mobilization (within 48 hours of surgery) was associated with improved outcomes in 29 of the 33 patient-reported outcomes, including improved mobility scores and improved assessments of daily activities of living. A total of 45 out of 51 clinical outcomes derived from hospital records showed a positive association with early mobilization, including reduced rates of postoperative complications, reduced length of acute hospital stay, and lower mortality.</p><p><strong>Conclusion: </strong>Early mobilization after surgery for hip fracture in older people is associated with improved patient-reported outcomes and reduced length of hospital stay. Standardization of the definition of early mobilization and consistent reporting of weightbearing status would improve future evidence synthesis.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 7","pages":"741-747"},"PeriodicalIF":2.8,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12221528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555179","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":"Staging growing rod insertion results in increased postoperative complications than the equivalent unstaged procedure.","authors":"Lily S Switzer, Emma B Nadler, Jennifer A Dermott, Karim Aboelmagd, Alison Anthony, Dorothy J Kim, Mark Camp, David E Lebel","doi":"10.1302/2633-1462.67.BJO-2025-0047.R1","DOIUrl":"10.1302/2633-1462.67.BJO-2025-0047.R1","url":null,"abstract":"<p><strong>Aims: </strong>Anchor-related complications are the leading cause for unplanned surgery in early-onset scoliosis (EOS). One strategy to reduce unplanned surgery is staging implant insertion. This study compares the outcomes of staged versus unstaged growing rod (GR) insertion, focusing on complication rates.</p><p><strong>Methods: </strong>This retrospective cohort study examined 48 EOS patients who received GR surgery at a single institution (Hospital for Sick Children, Toronto, Canada) between January 2006 and July 2023. Patients were grouped according to staged and unstaged GR insertion. Radiological measurements were obtained preoperatively, post-insertion, and one-year follow-up to determine radiological change between and within each group. Complications were recorded until posterior spinal fusion (PSF) or most recent follow-up if no PSF was performed, and compared between groups.</p><p><strong>Results: </strong>Overall, 24 patients received staged and 24 patients received unstaged dual GR insertion. The mean follow-up time for patients was 53.1 months (SD 33.1). Patients who underwent unstaged insertion had greater Cobb angle correction (46.6% (SD 15.9%) vs 31.5% (SD 13.3%), p < 0.001). There were no significant differences in kyphosis correction (p = 0.118) or thoracic height growth (p = 0.348) between groups. Staged patients experienced a higher complication rate compared to unstaged patients within the first year following insertion (38% vs 12%). Differences in proximal junctional kyphosis (PJK) development between staged (17%) and unstaged (29%) patients were not significant (p = 0.303). The mean insertion-associated length of stay was longer in staged patients (10.7 days (SD 4.2)) compared to unstaged patients (5.8 days (SD 4.0), p < 0.001).</p><p><strong>Conclusion: </strong>Staged and unstaged GR insertion results in acceptable coronal correction and comparable radiological parameters. However, staged insertion may not be superior to unstaged insertion given the increased length of stay and rate of complications associated with the procedure.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 7","pages":"733-740"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529964","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":"Good outcomes of bipolar radial head arthroplasty for comminuted radial head fractures : a cohort study of 64 patients with an average 5.2-year follow-up.","authors":"Saga Byman, Oskari Oikarinen, Mikko Salmela, Ville Haapamäki, Thomas Ibounig, Tuomas Lähdeoja","doi":"10.1302/2633-1462.66.BJO-2024-0202.R2","DOIUrl":"10.1302/2633-1462.66.BJO-2024-0202.R2","url":null,"abstract":"<p><strong>Aims: </strong>Radial head fractures are among the most common upper limb fractures, constituting up to 30% of all elbow fractures. While many can be managed non-surgically with favourable outcomes, approximately one-third require surgical intervention, typically involving open reduction and internal fixation or radial head arthroplasty. This study aimed to assess the functional and radiological outcomes of elbow injuries involving comminuted radial head fractures treated with bipolar radial head arthroplasty.</p><p><strong>Methods: </strong>We retrospectively analyzed 64 patients, of whom 55 participated in the follow-up, with acute radial head fractures who underwent radial head arthroplasty within two weeks of the injury between March 2009 and June 2015 at a tertiary trauma centre. The primary outcome measure was the Oxford Elbow Score (OES). Secondary outcomes were the short version of Disabilities of Arm, Shoulder and Hand questionnaire, the Mayo Elbow Performance Score, range of motion (ROM), subjective satisfaction, and radiological assessment.</p><p><strong>Results: </strong>In our study, patient-reported outcome measures indicated good function, minimal pain, and high subjective satisfaction scores. The mean total OES score was 88 (33 to 100; SD 17). In general, patients exhibited good ROM (128° extension-flexion arc), with only minor deficits compared to the unaffected side. Radiological findings commonly included osteolysis around the stem (29 out of 48 patients with available radiographs) and osteoarthritis of the elbow joint (mild in 23 out of 48 patients, severe in nine out of 48).</p><p><strong>Conclusion: </strong>Comminuted radial head fractures in elbow injuries involving a comminuted radial head fracture can be successfully treated with bipolar radial head arthroplasty. Although radiological changes are frequently observed during follow-up, they do not seem to impact clinical outcomes, and therefore should not be the primary indication for revision surgeries.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6","pages":"724-733"},"PeriodicalIF":2.8,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12173526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318171","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":"Proximal humeral endoprosthetic reconstruction for tumour defects : clinical outcomes of 165 patients from the MUTARS Orthopedic Registry Orthopedic Registry Europe (MORE).","authors":"Richard Evenhuis, Michaël P A Bus, Simen Sellevold, Edwin F Dierselhuis, Ioannis G Trikoupis, Maurizio Scorianz, Sebastian Walter, Jorge Cabrolier, Marta Fiocco, Michiel A J van de Sande","doi":"10.1302/2633-1462.66.BJO-2025-0018","DOIUrl":"10.1302/2633-1462.66.BJO-2025-0018","url":null,"abstract":"<p><strong>Aims: </strong>Tumour defects of the proximal humerus can be reconstructed using hemiarthroplasty, reverse shoulder arthroplasty (RSA), or anatomical total shoulder arthroplasty (TSA). This study aimed to evaluate clinical and functional outcomes of reconstructions of proximal humeral tumour defects with MUTARS endoprostheses.</p><p><strong>Methods: </strong>A total of 165 reconstructions were included: 98 (59%) hemiarthroplasties, 61 (37%) RSAs, and six (4%) TSAs. Median age was 54 years (IQR 31 to 68). Median follow-up time was 5.9 years (IQR 2.83 to 10.50). Competing risks models were employed to estimate the cumulative incidence of revision (CIR) for mechanical reasons and infection with local recurrence and mortality as competing events. The range of motion was reported using descriptive statistics.</p><p><strong>Results: </strong>Axillary nerve preservation and deltoid muscle reattachment were observed in 89% and 96% of cases, respectively, without significant differences between implant types. Rotator cuff refixation was less frequent in RSA (78%) compared to hemiarthroplasty (91%). Overall, 26 implants (16%) were revised for mechanical complications (dislocation n = 11, loosening n = 2, periprosthetic fracture n = 3) and infection (n = 10). Patients with previous surgery at the same site had a higher revision risk due to instability (cause-specific hazard ratio 3.7; 95% CI 1.3 to 10.8). The CIRs for mechanical reasons (Henderson 1 to 3) in the entire population at two, five, and ten years were 7% (95% CI 3 to 11), 11% (95% CI 6 to 17), and 13% (95% CI 7 to 20), respectively. For periprosthetic joint infection (Henderson 4), the CIRs were 5% (95% CI 2 to 10), 7% (95% CI 3 to 12), and 7% (95% CI 3 to 12). Compared with hemiarthroplasty, RSA offered superior median anteflexion (73° (IQR 40 to 90) vs 30° (IQR 5 to 45)), abduction (70° (IQR 38 to 90) vs 30° (IQR 5 to 45)), and external rotation (15° (IQR 0 to 28) vs 5° (0 to 19)).</p><p><strong>Conclusion: </strong>MUTARS proximal humerus reconstruction outcomes are satisfying, particularly in terms of mechanical failure. RSA and hemiarthroplasty exhibit comparable revision risks, with previous surgery at same site as a prognostic factor for revision due to dislocation. RSA appears to provide the best functional outcome.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6","pages":"715-723"},"PeriodicalIF":2.8,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12167655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303027","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":"Comparative analysis of early radiolucencies in cementless versus cemented total knee arthroplasty.","authors":"Vadim Benkovich, Artsiom Abialevich, Vladislav Osinsky, Guy Benkovich","doi":"10.1302/2633-1462.66.BJO-2024-0281.R1","DOIUrl":"10.1302/2633-1462.66.BJO-2024-0281.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to compare early outcomes of cemented and cementless total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>We analyzed 593 patients who underwent cemented or cementless TKA between January 2017 and December 2022. Data collected included demographics, BMI, comorbidities, surgical variables, follow-up duration, and outcomes such as implant survivorship, radiolucencies (assessed using the Modern Knee Society Radiographic Evaluation System (MKSRES)), short-term complications, revision rates, periprosthetic fractures, hospital length of stay, and readmissions.</p><p><strong>Results: </strong>The study included 593 patients, equally divided into cemented and cementless groups. Age (p = 0.354) and sex (p = 0.342) were similar, though BMI was higher in the cementless group (p < 0.001). Comorbidities were comparable. Radiolucencies and osteolysis occurred in 12 cemented and ten cementless cases, with no significant differences across femoral and tibial zones (p ≥ 0.479). All radiolucencies were stable, partial, and non-progressive. No cases of aseptic loosening required revision. Revisions for periprosthetic fractures were rare (p = 0.218). Hospital length of stay (p = 0.623) and readmissions (p = 0.216) were similar between groups. The mean follow-up time postoperatively was slightly longer in the cementless group (4.22 years (SD 0.84)) compared to the cemented group (4.01 years (SD 1.03)) (p < 0.001).</p><p><strong>Conclusion: </strong>Cemented fixation remains the gold standard in TKA due to its reliability, yet advancements in implant design and indications support increasing adoption of cementless TKA. This study found comparable early outcomes for both methods, with stable radiolucent lines and no aseptic loosening during follow-up. The MKSRES facilitates standard radiological assessment, enabling precise implant monitoring and improving TKA outcome evaluation. These findings support the equivalence of cemented and cementless fixation in early survivorship.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6","pages":"707-714"},"PeriodicalIF":2.8,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144294987","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":"Is it safe to use ceramic on polyethylene bearings in revision hip arthroplasty for ceramic fracture?","authors":"Christopher Gunn, Vivek Thakker, Sophie Williams, Timothy N Board, Henry Wynn-Jones, Jonathan Barrow","doi":"10.1302/2633-1462.66.BJO-2025-0030.R1","DOIUrl":"10.1302/2633-1462.66.BJO-2025-0030.R1","url":null,"abstract":"<p><strong>Aims: </strong>Ceramic bearing fracture is a rare complication following implantation using modern ceramic bearing materials. The ideal revision bearing option in such cases is debated. We aimed to investigate the safety of a hard on soft bearing following ceramic fracture in total hip arthroplasty.</p><p><strong>Methods: </strong>Data on all patients undergoing revision following ceramic fracture between January 2016 and January 2019 were collected retrospectively. Templating software was used to determine linear wear between the first post-revision radiograph and latest available follow-up. Univariate analysis was used to examine patient demographics and the wear rates of the polyethylene components. The intra- and inter-rater reliability of wear measurements was calculated. Additionally, in vitro testing was undertaken to assess the effects on bearing surfaces of residual ceramic particles.</p><p><strong>Results: </strong>A total of 12 patients underwent revision for ceramic fracture in the study period. The mean age at revision was 62 years (54 to 72). There were six liner and six head fractures revised to delta ceramic heads and cross-linked polyethylene acetabular components. At mean follow-up of 3.8 years (0.5 to 6.1), median 4.4 years (IQR 2.0 to 5.1), linear wear rate was calculated at 0.08 mm/year (SD 0.06). Both intra- and inter-rater reliability was excellent with intraclass correlation coefficient (ICC) scores of 0.99 at all timepoints. In vitro testing showed an increase in head roughness in metal on polyethylene bearings after ceramic particles were embedded, but no increase in ceramic on polyethylene (CoP) or ceramic on ceramic bearings.</p><p><strong>Conclusion: </strong>Revision to CoP bearings following ceramic fracture does not cause early catastrophic wear at early follow-up, aligning with the in vitro study observations. It appears safe to use this hard on soft bearing combination, given that wear rates are comparable to what is expected in a primary hip arthroplasty setting. Longer follow-up is required to establish if this trend persists.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6","pages":"700-706"},"PeriodicalIF":2.8,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12162154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286654","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 of reverse shoulder arthroplasty by indication : a National Joint Registry study.","authors":"Olivia O'Malley, Andrew Davies, Mansour T A Sharabani, Amar Rangan, Sanjeeve Sabharwal, Peter Reilly","doi":"10.1302/2633-1462.66.BJO-2025-0017.R1","DOIUrl":"10.1302/2633-1462.66.BJO-2025-0017.R1","url":null,"abstract":"<p><strong>Aims: </strong>Reverse shoulder arthroplasty (RSA), initially designed for cuff tear arthropathy (CTA), is now the most common choice of shoulder arthroplasty in both elective and trauma settings in the UK. Its use has rapidly increased for several indications, including osteoarthritis (OA) with an intact rotator cuff, acute trauma, and trauma sequalae. This study aims to review the revision rates of RSA by indication to assess how the implant is performing for indications for which it was not primarily designed.</p><p><strong>Methods: </strong>Data from the National Joint Registry were obtained from 1 April 2012 to 31 March 2022. Data were linked to Hospital Episode Statistics for England and National Mortality Data. RSAs were identified and sorted into mutually exclusive groups by indication. The primary outcome was first revision and the secondary outcome was non-revision reoperation.</p><p><strong>Results: </strong>The revision rates for RSA for CTA were 1.53% (95% CI 1.31 to 1.78) at one year, 3.21% (95% CI 2.86 to 3.60) at five years, and 4.97% (95% CI 4.23 to 5.84) at nine years. For primary OA, they were 1.21% (95% CI 0.95 to 1.54) at one year, 2.71% (95% CI 2.25 to 3.37) at five years, and 5.00% (95% CI 3.62 to 6.88) at nine years. For trauma, they were 1.51% (95% CI 1.15 to 1.99) at one year and 2.67% (95% CI 2.07 to 3.43) at five years. For trauma sequalae, they were 4.25% (95% CI 3.4 to 5.29) at one year and 7.12% (95% CI 5.90 to 8.59) at five years. Between indications, the revision rates were not statistically different except for trauma sequalae, which had a significantly increased risk of revision (p ≤ 0.001). Incidence of non-revision reoperation across the cohort was 1.1% (n = 283 patients), with the most common being manipulation under anaesthesia with or without capsular release (42.03%, n = 124) followed by subacromial decompression (21.02%, n = 62).</p><p><strong>Conclusion: </strong>This study reports on the range of indications for which RSA is being used in the UK. It demonstrated that, based on the largest analysis of RSA across a range of indications, the revision rates and secondary surgery rates are broadly similar except for trauma sequalae.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6","pages":"691-699"},"PeriodicalIF":2.8,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12158565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276157","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}