Bone & Joint Open最新文献

{"title":"Establishing the UK clubfoot research priorities : a multiple-stakeholder consensus study.","authors":"Amanda Trees, Emily Jane Baird, Dawn Lockey, Christine Douglas, Elizabeth Ashby, Donald M Campbell, Yael Gelfer","doi":"10.1302/2633-1462.77.BJO-2026-0108.R1","DOIUrl":"10.1302/2633-1462.77.BJO-2026-0108.R1","url":null,"abstract":"<p><strong>Aims: </strong>Clubfoot is the most common congenital foot deformity. Although the overall effectiveness of the Ponseti method is well established, it has traditionally been taught as a unified doctrine, and individual components, particularly those related to the maintenance of correction, have not been evaluated with the same level of rigour. Consequently, high-quality evidence to support clinical decision-making remains limited. This study used a consensus-based approach to identify research priorities for clinical trials in clubfoot management.</p><p><strong>Methods: </strong>This study followed a previously published protocol. A modified Delphi technique was used, which involved an initial scoping survey, a two-round modified Delphi consensus survey, and consensus meetings that included the UK Clubfoot Network Research Committee. The survey was distributed among key stakeholders in the management of clubfoot as well as patients and carers in the UK. Reporting followed the ACCORD checklist.</p><p><strong>Results: </strong>A total of 103 and 93 participants contributed to rounds one and two of the Delphi process, respectively, scoring research priorities from one (low priority) to five (high priority). Stakeholders identified nine priorities in research across four themes of Primary Treatment, Bracing, Relapse, and Physiotherapy. The highest scoring themes were Relapse and Bracing, and the highest scoring priority was regarding the effectiveness of unilateral versus bilateral bracing.</p><p><strong>Conclusion: </strong>Identification of research priorities in clubfoot through this study will guide multicentre clinical trials to improve evidence-based clubfoot treatment.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 7","pages":"845-851"},"PeriodicalIF":3.3,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13327791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377112","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":"Automated impaction in uncemented total hip arthroplasty : a systematic review and meta-analysis.","authors":"Milos Brkljac, Eliseu Bandeira, Shrey Sharma, Borna Guevel, Justin Cobb, Kartik Logishetty","doi":"10.1302/2633-1462.77.BJO-2026-0090.R1","DOIUrl":"10.1302/2633-1462.77.BJO-2026-0090.R1","url":null,"abstract":"<p><strong>Aims: </strong>Intraoperative periprosthetic femoral fractures (IPFs) are a serious complication of total hip arthroplasty (THA), typically attributed to surgical technique. Manual impaction provides tactile feedback but varies with surgeon fatigue and experience. Automated impaction systems offer consistent energy delivery, potentially improving safety and efficiency. This study aimed, through a systematic review and meta-analysis, to compare the risk of IPF and operating times between automated and manual impaction during primary uncemented THA.</p><p><strong>Methods: </strong>We performed a systematic review and random-effects meta-analysis of primary uncemented THA studies comparing automated and manual impaction techniques. Outcomes included IPFs and operating time. Pooled odds ratios (ORs) were calculated for IPF risk, and differences in mean operating time between techniques were analyzed using mean differences with 95% CIs.</p><p><strong>Results: </strong>Comparative data were available from five studies (n = 2,607 THAs). Meta-analysis included three studies (n = 2,377), with 1,408 hips in the automated group (14 IPFs) and 969 hips in the manual group (three IPFs). There was no significant difference in IPF risk between techniques (pooled OR 1.29; 95% CI 0.52 to 3.21; p = 0.59). Operating time was reported in three studies. The pooled mean difference suggested a shorter operating time with automated impaction (-1.34 minutes; 95% CI -15.60 to 12.92; p = 0.72).</p><p><strong>Conclusion: </strong>Automated impaction was not associated with a lower risk of IPF or operating time compared with manual techniques in primary uncemented THA. Fracture risk and efficiency may instead depend on femoral component-femur compatibility and implant sizing. Further randomized studies incorporating diverse femoral component designs and automated impaction systems, alongside formal economic evaluation, are required.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 7","pages":"838-844"},"PeriodicalIF":3.3,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13322771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370139","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":"Postoperative best practice for thumb carpometacarpal joint replacement : a Delphi consensus study.","authors":"Nicole Leah Lyons, Shannon Halmkan, Victoria Jansen, Nick A Johnson, Emma Reay, Ellie Fitzmaurice, Maisie Wilding, Antonina Yakimova, Joy Adamson","doi":"10.1302/2633-1462.77.BJO-2026-0013.R1","DOIUrl":"10.1302/2633-1462.77.BJO-2026-0013.R1","url":null,"abstract":"<p><strong>Aims: </strong>Thumb carpometacarpal joint replacement (CMCJR) is gaining popularity for the surgical management of thumb base osteoarthritis. However, there is considerable variability in the literature regarding postoperative management, with limited information on timescales for return to normal function. This study aims to develop consensus-based guidance for postoperative best practice.</p><p><strong>Methods: </strong>A three-round modified Delphi process was undertaken with 16 experienced hand surgeons and hand therapists from the UK and mainland Europe. The initial survey was developed following a comprehensive review of the literature and consultation with a patient and public involvement group. The second round was an iteration of the first, including refinement of themes into statements. The third round presented the guidance for overall agreement and comment. Consensus throughout was defined as ≥ 70% agreement.</p><p><strong>Results: </strong>In round one, consensus was reached on postoperative immediate protection duration of ten to 14 days and the need for a postoperative radiograph. In round two, agreement was achieved for seven out of ten statements that included the type of immediate postoperative protection to be a bulky bandage allowing restricted thumb movement, splinting practices, thumb full range of motion commencement, and a return to driving timescale of four weeks. Return to timescales of light (two weeks), moderate (four weeks), and heavy tasks (six to eight weeks) were further defined in round three and accepted by the panellists.</p><p><strong>Conclusion: </strong>This Delphi study established consensus-based guidance for best practice in the postoperative management of thumb CMCJR, with specific inclusion of timescales for return to normal function. This will be beneficial for clinics, particularly in the UK, which are newly adopting this technique. Recommendations regarding the timing and frequency of postoperative radiographs remain to be clearly defined.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 7","pages":"825-837"},"PeriodicalIF":3.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13318481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148362727","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":"Contraindications of femoral implants in primary total hip arthroplasty : legal implications and strategies for orthopaedic surgeons.","authors":"Marc A Manzo, Veronica Pentland, Amir Khoshbin, Amit Atrey","doi":"10.1302/2633-1462.76.BJO-2025-0384.R1","DOIUrl":"10.1302/2633-1462.76.BJO-2025-0384.R1","url":null,"abstract":"<p><strong>Aims: </strong>Litigation related to total hip arthroplasty (THA) is a growing concern. Manufacturer-specified contraindications for femoral implants may influence legal outcomes, particularly when common patient characteristics such as obesity are listed. This study identified manufacturer-listed contraindications for femoral implants used in primary THA and evaluated their medicolegal implications within the frameworks of medical negligence and informed consent law in England and Wales.</p><p><strong>Methods: </strong>The 11 most commonly used femoral implants were identified from the National Joint Registry of England, Wales, and Northern Ireland. For each implant, manufacturer surgical technique guides were reviewed to extract contraindications, relative contraindications, and warnings. A structured medicolegal analysis was conducted within the frameworks of medical negligence and informed consent law, drawing on landmark case law and peer-reviewed medicolegal scholarship, supplemented by consultation with legal professionals who specialize in orthopaedic device litigation.</p><p><strong>Results: </strong>Two implants cited obesity or morbid obesity as a contraindication; four reported obesity as a warning. Nine implants listed inadequate bone quality as a contraindication, and two as a relative contraindication. Neuromuscular disease was contraindicated in nine implants, and a relative contraindication in two. Infection was contraindicated in all eleven implants. Vascular deficiency was a contraindication in six implants, and a relative contraindication in two. Deficient musculature was contraindicated in five implants and a relative contraindication in two.</p><p><strong>Conclusion: </strong>Many manufacturer-listed contraindications correspond to clinical characteristics commonly found in THA patients. These contraindications do not preclude implant use when supported by evidence and sound clinical judgement, but carry significant medicolegal implications under negligence and informed consent law. Once a manufacturer has communicated a contraindication, medicolegal scrutiny may shift to the surgeon's decision-making under two distinct frameworks, namely the standard of care and informed consent. Surgeons should know their implant-specific contraindications, ensure decisions are evidence-based and documented, and explicitly disclose elevated risks to patients.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 6","pages":"818-824"},"PeriodicalIF":3.3,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13291786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148309563","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":"Distal femur fractures: a comparison of hybrid and non-hybrid fixation of standard locking plates.","authors":"Yanin Plumarom, Tanachot Singsuwit, Lawrence Marsh, Ong-Art Phruetthiphat","doi":"10.1302/2633-1462.76.BJO-2025-0302.R1","DOIUrl":"10.1302/2633-1462.76.BJO-2025-0302.R1","url":null,"abstract":"<p><strong>Aims: </strong>The aim of the study was to assess progression of fracture healing after locking plate osteosynthesis with hybrid fixation compared with non-hybrid fixation in the distal femur, using the modified Radiological Union Scale for Tibia (mRUST) fracture score.</p><p><strong>Methods: </strong>A retrospective review was performed to identify patients who had operative fixation of distal femur fractures with a distal femoral locking plate. A total of 90 patients with 90 fractures (26 hybrid and 64 non-hybrid) were included for analysis. The primary outcome was to compare two constructs using mRUST score assessed on anteroposterior (AP) and lateral radiographs at six, 12, and 24 weeks, and final follow-up.</p><p><strong>Results: </strong>Overall, 90 patients with distal femur fractures with a mean age of 53 years (SD 24.4) met the inclusion criteria. Statistically significant differences in mean mRUST scores were noted at six weeks (p < 0.001), 12 weeks (p < 0.001), and 24 weeks (p < 0.001) postoperatively, with higher mean scores in the hybrid group. However, there was no significant difference in the union rate or other complication rates between the two groups. The union rate was 100% and 97% for the hybrid and non-hybrid groups, respectively, at final follow-up.</p><p><strong>Conclusion: </strong>This study suggests that standard locking plates with hybrid fixation form earlier bridging callus than locking plates with non-hybrid fixation. However, there were no differences in final follow-up including healing rates or complications between the two groups. Further prospective study designs are needed to compare the two constructs in distal femur fracture, which is necessary to improve the results and provide the optimal healing environment for distal femur fractures.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 6","pages":"809-817"},"PeriodicalIF":3.3,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13284912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148296669","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":"Patient experiences of Dupuytren's contracture and its treatment : a qualitative investigation.","authors":"Paul Leighton, Maria Armaou, Catherine Arundel, Puvan Tharmanathan, Joseph Dias","doi":"10.1302/2633-1462.76.BJO-2026-0002.R1","DOIUrl":"10.1302/2633-1462.76.BJO-2026-0002.R1","url":null,"abstract":"<p><strong>Aims: </strong>Our aim was to investigate patient experiences of Dupuytren's contracture and its treatment.</p><p><strong>Methods: </strong>A purposive sample of 45 participants enrolled in the Dupuytren's Interventions Surgery vs Collagenase (DISC) trial. Participants were interviewed three to six months after treatment. Interviews were semistructured and analyzed using an inductive, thematic approach, with data collection and analysis integrated iteratively.</p><p><strong>Results: </strong>Participants reported living for extended periods with contracture and seeking medical advice only when they had trouble doing practical tasks or when self-conscious about their appearance. Most participants reported improvement irrespective of treatment modality. Some participants who were treated with collagenase noted that while the outcome was not perfect, it was acceptable. More participants who were treated with collagenase reported preferring collagenase in the future, compared with the proportion preferring further surgery.</p><p><strong>Conclusion: </strong>This research contributes to our knowledge of how treatments for Dupuytren's contracture are understood and experienced. It demonstrates that treatment experience is important to patients, and that they are often willing to accept a compromise in outcome for an easier treatment experience. Patients may be willing to accept multiple, repeated treatments. As a result, non-surgical or noninvasive treatment options, such as collagenase, are likely to be popular and could reduce delay in seeking treatment.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 6","pages":"802-808"},"PeriodicalIF":3.3,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266205","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":"What hip and spinopelvic characteristics are associated with ischiofemoral impingement?","authors":"Vincent J Leopold, Alberto Telias, Dyan V Flores, Jeroen Verhaegen, Zoe Kerhoulas, Andrew Speirs, Paul E Beaulé, George Grammatopoulos","doi":"10.1302/2633-1462.76.BJO-2025-0360.R1","DOIUrl":"10.1302/2633-1462.76.BJO-2025-0360.R1","url":null,"abstract":"<p><strong>Aims: </strong>To determine the prevalence of MRI-confirmed ischiofemoral impingement (IFI) in young patients with nonarthritic hip pain, and to evaluate the associations of femoral, acetabular, pelvic, and spinopelvic parameters with IFI.</p><p><strong>Methods: </strong>We included 250 patients with nonarthritic hip pain who underwent standardized imaging (MRI and CT, lateral standing and deep-seated spinopelvic radiographs). IFI was diagnosed by quadratus femoris oedema/atrophy. IFI-positive/negative hips were compared for morphological and spinopelvic parameters. Underlying pathologies (e.g. femoroacetabular impingement, dysplasia) were documented. Multivariate regression identified independent predictors of IFI and determinants of quadratus femoris space (QFS).</p><p><strong>Results: </strong>IFI was identified in 14/250 patients (5.6%), all female. IFI cases had significantly reduced ischiofemoral space (24.8 mm (SD 6.7) vs 34.9 mm (SD 10.2); p < 0.001) and QFS (9.2 mm (SD 3.4) vs 20.7 mm (SD 7.0); p < 0.001). IFI cases demonstrated larger ischial angle (135.7° (SD 3.0°) vs 132.2° (SD 4.0°); p = 0.002), higher femoral version (16.5° (SD 10.3°) vs 10.4° (SD 12.3°); p = 0.031), and reduced femoral (34.2 mm (SD 5.6) vs 37.7 mm (SD 5.9); p = 0.016) and acetabular offset (29.4 mm (SD 3.5) vs 32.0 mm (SD 4.8); p = 0.036). In standing, IFI cases tended to have lower lumbar lordosis (LL) (55.31° (SD 7.95°) vs 59.91° (SD 10.50°); p = 0.077), higher pelvic tilt (15.68° (SD 4.73°) vs 12.39° (SD 6.20°); p = 0.047), and smaller mismatch between pelvic incidence and LL (-2.39° (SD 7.18°) vs -7.82° (SD 10.00°); p = 0.034). The change in LL across standing to deep-flexed sitting transition (ΔLL) was lower in IFI cases (50.31° (SD 10.89°) vs 56.89° (SD 10.64°); p = 0.020). Multivariate regression identified reduced QFS (odds ratio (OR) 1.92, 95% CI 1.30 to 2.89; p < 0.001) and greater LL (OR 1.16, 95% CI 1.00 to 1.33; p = 0.047) as independent predictors of IFI. Size of QFS was associated positively with femoral offset (<i>β</i> = 0.35; p < 0.001) and mismatch between pelvic incidence and LL (<i>β</i> = 0.18; p = 0.028), and negatively with ischial angle (<i>β</i> = -0.34; p < 0.001), femoral version (<i>β</i> = -0.14; p = 0.016), and standing pelvic tilt (<i>β</i> = -0.16; p = 0.026).</p><p><strong>Conclusion: </strong>IFI occurred in 5.6% of patients and was characterized by a distinct morphometric and sagittal alignment profile, including increased femoral version, reduced offset, greater ischial angle, reduced LL, increased pelvic tilt, and diminished spinal motion. These findings support a multifactorial model in which hip morphology and spinopelvic alignment jointly influence posterior hip clearance in IFI.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 6","pages":"792-801"},"PeriodicalIF":3.3,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13270448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148259775","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":"Reliability and clinical utility of paediatric ankle fracture classifications : a systematic review.","authors":"Le Shang Teo, Liyang Xiao, Bryan Kyi Kia Yeo, Rishi Rayapati, Andrew Kean Seng Lim, James Hoipo Hui, Si Heng Sharon Tan","doi":"10.1302/2633-1462.76.BJO-2025-0250.R1","DOIUrl":"10.1302/2633-1462.76.BJO-2025-0250.R1","url":null,"abstract":"<p><strong>Aims: </strong>Despite the availability of various classification systems for paediatric ankle fractures, there is a lack of consensus regarding the reliability and utility of each classification, and the corresponding impact on clinical practice. This systematic review aimed to investigate current paediatric ankle fracture classification systems, by assessing their inter- and intraobserver reliability, and their clinical utility in guiding clinical decisions and outcomes.</p><p><strong>Methods: </strong>A systematic search was performed on PubMed, Embase, and Cochrane Library from inception until 31 October 2025. The inclusion criteria were studies which evaluated the reliability and clinical utility of different paediatric ankle fracture classification systems. Exclusion criteria were adult fractures, paediatric non-ankle fractures, and lack of classification usage.</p><p><strong>Results: </strong>There were 42 studies covering 11 classification systems, including Salter-Harris, AO, Dias-Tachdjian, Lauge-Hansen, Gerner-Smidt, Ashhurst-Bromer, Carothers-Crenshaw, transitional fractures, atypical triplane fractures, Li-La, and Nenopoulos, in this systematic review. Salter-Harris, AO, Dias-Tachdjian, and transitional fracture classifications are among the more widely used systems in the current field of paediatric orthopaedic surgery. In terms of interobserver reliability, both the AO classification and the Dias-Tachdjian demonstrated substantial to almost perfect agreement for paediatric ankle fractures, followed by the Salter-Harris classification, which showed substantial agreement. Anatomical classification such as the Salter-Harris classification is better at predicting the rate of premature physeal closure. Mechanistic classification such as the Dias-Tachdjian classification is preferred for predicting the rate of angular deformity.</p><p><strong>Conclusion: </strong>Dias-Tachdjian classification demonstrated the greatest interobserver and intraobserver reliability among paediatric orthopaedic surgeons, while the Salter-Harris classification was the most commonly used and provided the highest predictive value for premature physeal closure. Combining anatomical (e.g. Salter-Harris) and mechanistic (e.g. Dias-Tachdjian or Carothers-Crenshaw) systems may improve prognostic accuracy and treatment planning.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 6","pages":"777-791"},"PeriodicalIF":3.3,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13253023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148219999","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":"Intraoperative hypotension and short-term outcomes after primary total hip arthroplasty : a retrospective cohort study.","authors":"Alexander Burbelo, Trace Clark, Andrew Blake Huffman, Nicholas Scarl, Stephanie O'Palko, Brian Ferguson, Jay Shepherd, Matthew Bullock","doi":"10.1302/2633-1462.76.BJO-2026-0009.R1","DOIUrl":"10.1302/2633-1462.76.BJO-2026-0009.R1","url":null,"abstract":"<p><strong>Aims: </strong>Intraoperative hypotension (IOH) has been associated with adverse outcomes in non-cardiac surgery, but its effect during total hip arthroplasty (THA) remains unclear. This study aimed to investigate whether absolute (AIOH) or relative (RIOH) IOH is a risk factor for adverse short-term outcomes following primary THA.</p><p><strong>Methods: </strong>A retrospective review of 394 THAs (394 patients) performed at a single academic institution between September 2020 and April 2025 was conducted. AIOH was defined as any intraoperative mean arterial pressure (MAP) < 65 mmHg, and RIOH as a ≥ 20% decrease from preoperative baseline MAP. Primary outcomes included all-cause 30- and 90-day readmissions and postoperative length of stay (LOS). Multivariable logistic regression was used to identify predictors of readmission and LOS > one day.</p><p><strong>Results: </strong>Overall, 112 patients (28.4%) experienced AIOH during their THA. Neither the presence nor duration of AIOH was associated with readmission or LOS. RIOH occurred in 74 patients (22.5%), and was not associated with readmission or LOS, but was associated with higher rates of reoperation within 90 days (12.2% vs 2.4%, p = 0.001). Estimated blood loss independently predicted prolonged LOS across all models (odds ratio 1.75 per 50 ml, 95% CI 1.33 to 2.31, p < 0.001).</p><p><strong>Conclusion: </strong>AIOH was not associated with an increased risk of adverse short-term outcomes following primary THA when defined by a fixed MAP threshold. RIOH and intraoperative blood loss demonstrated stronger associations with postoperative complications, but these findings require further evaluation. This study supports a more individualized approach to haemodynamic monitoring in primary THA.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 6","pages":"766-776"},"PeriodicalIF":3.3,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206474","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 a 32 mm glenosphere optimal in reverse shoulder arthroplasty for patients with small glenoid anatomy? : a range of motion simulation study in petite Asian females.","authors":"Hiroshi Kiyomatsu, Taketsugu Fujibuchi, Tatsuhiko Kutsuna, Tomofumi Kinoshita, Takashi Tsuda, Mizuaki Hayashi, Katsuhiro Shimono, Masaki Takao","doi":"10.1302/2633-1462.76.BJO-2025-0355.R1","DOIUrl":"10.1302/2633-1462.76.BJO-2025-0355.R1","url":null,"abstract":"<p><strong>Aims: </strong>In reverse shoulder arthroplasty (RSA), the diameter and position of the glenosphere have a significant effect on impingement-free range of motion (ROM). This effect may be more pronounced in patients with small glenoid anatomy. We tested whether a 32 mm glenosphere provides greater ROM than 36 mm and 39 mm glenospheres across three inferior overhangs (IOs).</p><p><strong>Methods: </strong>Asian female patients undergoing RSA (mean age 75.5 years (SD 5.6; range 66 to 89); mean height 145.9 cm (SD 3.3; range 137.6 to 153.0)) were evaluated using 3D CT planning. Three diameters (32 mm, 36 mm, and 39 mm) and three IOs (1.5 mm, 3.0 mm, and 4.5 mm) were combined (nine simulations per patient). We recorded impingement-free ROM arcs from neutral (0°) to bony impingement (bone-to-bone contact) for extension-flexion (EF), abduction-adduction (AA), and external-internal rotation (RO). Postoperative outcomes were described for the 32 mm subset (n = 11). Repeated-measures analysis of variance assessed the main effects and interactions of diameter and overhang.</p><p><strong>Results: </strong>Both glenosphere diameter and inferior overhang had significant independent effects in each plane (all p < 0.001) without consistent interactions. The 32 mm glenosphere conferred broader arcs of motion in EF, AA, and RO, whereas the 39 mm diameter consistently restricted ROM. A higher IO (≥ 3.0 mm) further expanded motion.</p><p><strong>Conclusion: </strong>In this cohort with small glenoid anatomy, a 32 mm glenosphere and IO ≥ 3.0 mm maximized predicted bony impingement-free ROM, suggesting that downsizing with adequate inferior overhang may be advantageous in a small glenoid vault. Clinical validation accounting for soft-tissue constraints and implant stability is required.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 6","pages":"759-765"},"PeriodicalIF":3.3,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13242967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200200","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}