Bone & Joint Open最新文献

{"title":"Bridging the gap: enhancing orthopaedic outcomes through qualitative research integration.","authors":"Louise E Mew, Vanessa Heaslip, Tikki Immins, Arul Ramasamy, Thomas W Wainwright","doi":"10.1302/2633-1462.511.BJO-2024-0145.R1","DOIUrl":"10.1302/2633-1462.511.BJO-2024-0145.R1","url":null,"abstract":"<p><strong>Aims: </strong>The evidence base within trauma and orthopaedics has traditionally favoured quantitative research methodologies. Qualitative research can provide unique insights which illuminate patient experiences and perceptions of care. Qualitative methods reveal the subjective narratives of patients that are not captured by quantitative data, providing a more comprehensive understanding of patient-centred care. The aim of this study is to quantify the level of qualitative research within the orthopaedic literature.</p><p><strong>Methods: </strong>A bibliometric search of journals' online archives and multiple databases was undertaken in March 2024, to identify articles using qualitative research methods in the top 12 trauma and orthopaedic journals based on the 2023 impact factor and SCImago rating. The bibliometric search was conducted and reported in accordance with the preliminary guideline for reporting bibliometric reviews of the biomedical literature (BIBLIO).</p><p><strong>Results: </strong>Of the 7,201 papers reviewed, 136 included qualitative methods (0.1%). There was no significant difference between the journals, apart from <i>Bone & Joint Open</i>, which included 21 studies using qualitative methods, equalling 4% of its published articles.</p><p><strong>Conclusion: </strong>This study demonstrates that there is a very low number of qualitative research papers published within trauma and orthopaedic journals. Given the increasing focus on patient outcomes and improving the patient experience, it may be argued that there is a requirement to support both quantitative and qualitative approaches to orthopaedic research. Combining qualitative and quantitative methods may effectively address the complex and personal aspects of patients' care, ensuring that outcomes align with patient values and enhance overall care quality.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"5 11","pages":"953-961"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558995","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":"Association of MRI findings with intra-articular tumour extension.","authors":"Lorenzo Deveza, Mohammed A El Amine, Anton S Becker, John Nolan, Sinchun Hwang, Meera Hameed, Max Vaynrub","doi":"10.1302/2633-1462.510.BJO-2024-0047.R2","DOIUrl":"10.1302/2633-1462.510.BJO-2024-0047.R2","url":null,"abstract":"<p><strong>Aims: </strong>Treatment of high-grade limb bone sarcoma that invades a joint requires en bloc extra-articular excision. MRI can demonstrate joint invasion but is frequently inconclusive, and its predictive value is unknown. We evaluated the diagnostic accuracy of direct and indirect radiological signs of intra-articular tumour extension and the performance characteristics of MRI findings of intra-articular tumour extension.</p><p><strong>Methods: </strong>We performed a retrospective case-control study of patients who underwent extra-articular excision for sarcoma of the knee, hip, or shoulder from 1 June 2000 to 1 November 2020. Radiologists blinded to the pathology results evaluated preoperative MRI for three direct signs of joint invasion (capsular disruption, cortical breach, cartilage invasion) and indirect signs (e.g. joint effusion, synovial thickening). The discriminatory ability of MRI to detect intra-articular tumour extension was determined by receiver operating characteristic analysis.</p><p><strong>Results: </strong>Overall, 49 patients underwent extra-articular excision. The area under the curve (AUC) ranged from 0.65 to 0.76 for direct signs of joint invasion, and was 0.83 for all three combined. In all, 26 patients had only one to two direct signs of invasion, representing an equivocal result. In these patients, the AUC was 0.63 for joint effusion and 0.85 for synovial thickening. When direct signs and synovial thickening were combined, the AUC was 0.89.</p><p><strong>Conclusion: </strong>MRI provides excellent discrimination for determining intra-articular tumour extension when multiple direct signs of invasion are present. When MRI results are equivocal, assessment of synovial thickening increases MRI's discriminatory ability to predict intra-articular joint extension. These results should be interpreted in the context of the study's limitations. The inclusion of only extra-articular excisions enriched the sample for true positive cases. Direct signs likely varied with tumour histology and location. A larger, prospective study of periarticular bone sarcomas with spatial correlation of histological and radiological findings is needed to validate these results before their adoption in clinical practice.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"5 10","pages":"944-952"},"PeriodicalIF":2.8,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11503032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509480","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":"Five- and ten-year follow-up of medial unicompartmental knee arthroplasties in obese and non-obese patients.","authors":"Reinhold H Gregor, Gary J Hooper, Christopher Frampton","doi":"10.1302/2633-1462.510.BJO-2024-0124.R1","DOIUrl":"10.1302/2633-1462.510.BJO-2024-0124.R1","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to determine whether obesity had a detrimental effect on the long-term performance and survival of medial unicompartmental knee arthroplasties (UKAs).</p><p><strong>Methods: </strong>This study reviewed prospectively collected functional outcome scores and revision rates of all medial UKA patients with recorded BMI performed in Christchurch, New Zealand, from January 2011 to September 2021. Patient-reported outcome measures (PROMs) were the primary outcome of this study, with all-cause revision rate analyzed as a secondary outcome. PROMs were taken preoperatively, at six months, one year, five years, and ten years postoperatively. There were 873 patients who had functional scores recorded at five years and 164 patients had scores recorded at ten years. Further sub-group analysis was performed based on the patient's BMI. Revision data were available through the New Zealand Joint Registry for 2,323 UKAs performed during this time period.</p><p><strong>Results: </strong>Obese patients (BMI > 30 kg/m²) were 3.1 years younger than non-obese patients (BMI < 30 kg/m²) at the time of surgery (mean age of obese patients 65.5 years (SD 9.7) and mean age of non-obese patients 68.6 years (SD 10.1)). Preoperatively, obese patients tended to have significantly lower functional scores than non-obese patients, which continued at five and ten years postoperatively. At these timepoints, obese patients had significantly lower scores for most PROMs measured compared to non-obese patients. However, there was no significant difference in the improvement of any of these scores after surgery between obese and non-obese patients. There was no significant difference in revision rates between obese and non-obese patients at any time. All-cause revision rate for obese patients was 0.73 per 100 observed component years compared to 0.67 in non-obese patients at ten years. There was also no significant difference in the aseptic loosening rate between groups.</p><p><strong>Conclusion: </strong>Our study supports the use of UKAs in obese patients, with similar benefit and survival compared to non-obese patients at ten years.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"5 10","pages":"937-943"},"PeriodicalIF":2.8,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11495132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476449","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 greater tuberosity version angle: a novel method of acquiring humeral alignment during intramedullary nailing.","authors":"Jose M Gutierrez-Naranjo, Luis M Salazar, Vaibhav A Kanawade, Emam E Abdel Fatah, Mohamed Mahfouz, Nicholas W Brady, Anil K Dutta","doi":"10.1302/2633-1462.510.BJO-2024-0105","DOIUrl":"10.1302/2633-1462.510.BJO-2024-0105","url":null,"abstract":"<p><strong>Aims: </strong>This study aims to describe a new method that may be used as a supplement to evaluate humeral rotational alignment during intramedullary nail (IMN) insertion using the profile of the perpendicular peak of the greater tuberosity and its relation to the transepicondylar axis. We called this angle the greater tuberosity version angle (GTVA).</p><p><strong>Methods: </strong>This study analyzed 506 cadaveric humeri of adult patients. All humeri were CT scanned using 0.625 × 0.625 × 0.625 mm cubic voxels. The images acquired were used to generate 3D surface models of the humerus. Next, 3D landmarks were automatically calculated on each 3D bone using custom-written C++ software. The anatomical landmarks analyzed were the transepicondylar axis, the humerus anatomical axis, and the peak of the perpendicular axis of the greater tuberosity. Lastly, the angle between the transepicondylar axis and the greater tuberosity axis was calculated and defined as the GTVA.</p><p><strong>Results: </strong>The value of GTVA was 20.9° (SD 4.7°) (95% CI 20.47° to 21.3°). Results of analysis of variance revealed that females had a statistically significant larger angle of 21.95° (SD 4.49°) compared to males, which were found to be 20.49° (SD 4.8°) (p = 0.001).</p><p><strong>Conclusion: </strong>This study identified a consistent relationship between palpable anatomical landmarks, enhancing IMN accuracy by utilizing 3D CT scans and replicating a 20.9° angle from the greater tuberosity to the transepicondylar axis. Using this angle as a secondary reference may help mitigate the complications associated with malrotation of the humerus following IMN. However, future trials are needed for clinical validation.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"5 10","pages":"929-936"},"PeriodicalIF":2.8,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11493473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476464","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":"Implant design influences the joint-specific outcome after total knee arthroplasty.","authors":"Nick Clement, Deborah J MacDonald, David F Hamilton, Paul Gaston","doi":"10.1302/2633-1462.510.BJO-2024-0111.R1","DOIUrl":"10.1302/2633-1462.510.BJO-2024-0111.R1","url":null,"abstract":"<p><strong>Aims: </strong>The aims were to assess whether joint-specific outcome after total knee arthroplasty (TKA) was influenced by implant design over a 12-year follow-up period, and whether patient-related factors were associated with loss to follow-up and mortality risk.</p><p><strong>Methods: </strong>Long-term follow-up of a randomized controlled trial was undertaken. A total of 212 patients were allocated a Triathlon or a Kinemax TKA. Patients were assessed preoperatively, and one, three, eight, and 12 years postoperatively using the Oxford Knee Score (OKS). Reasons for patient lost to follow-up, mortality, and revision were recorded.</p><p><strong>Results: </strong>A total of 94 patients completed 12-year functional follow-up (62 females, mean age 66 years (43 to 82) at index surgery). There was a clinically significantly greater improvement in the OKS at one year (mean difference (MD) 3.0 (95% CI 0.4 to 5.7); p = 0.027) and three years (MD 4.7 (95% CI 1.9 to 7.5); p = 0.001) for the Triathlon group, but no differences were observed at eight (p = 0.331) or 12 years' (p = 0.181) follow-up. When assessing the OKS in the patients surviving to 12 years, the Triathlon group had a clinically significantly greater improvement in the OKS (marginal mean 3.8 (95% CI 0.2 to 7.4); p = 0.040). Loss to functional follow-up (53%, n = 109/204) was independently associated with older age (p = 0.001). Patient mortality was the major reason (56.4%, n = 62/110) for loss to follow-up. Older age (p < 0.001) and worse preoperative OKS (p = 0.043) were independently associated with increased mortality risk. An age at time of surgery of ≥ 72 years was 75% sensitive and 74% specific for predicting mortality with an area under the curve of 78.1% (95% CI 70.9 to 85.3; p < 0.001).</p><p><strong>Conclusion: </strong>The Triathlon TKA was associated with clinically meaningful greater improvement in knee-specific outcome when compared to the Kinemax TKA. Loss to follow-up at 12 years was a limitation, and studies planning longer-term functional assessment could limit their cohort to patients aged under 72 years.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"5 10","pages":"911-919"},"PeriodicalIF":2.8,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11491871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476450","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 a prospective randomized trial of surgical versus conservative management for unstable fractures of the distal radius in patients aged 65 years and older.","authors":"Katrina R Bell, William M Oliver, Timothy O White, Samuel G Molyneux, Catriona Graham, Nick D Clement, Andrew D Duckworth","doi":"10.1302/2633-1462.510.BJO-2024-0044","DOIUrl":"10.1302/2633-1462.510.BJO-2024-0044","url":null,"abstract":"<p><strong>Aims: </strong>The primary aim of this study is to quantify and compare outcomes following a dorsally displaced fracture of the distal radius in elderly patients (aged ≥ 65 years) who are managed conservatively versus with surgical fixation (open reduction and internal fixation). Secondary aims are to assess and compare upper limb-specific function, health-related quality of life, wrist pain, complications, grip strength, range of motion, radiological parameters, healthcare resource use, and cost-effectiveness between the groups.</p><p><strong>Methods: </strong>A prospectively registered (ISRCTN95922938) randomized parallel group trial will be conducted. Elderly patients meeting the inclusion criteria with a dorsally displaced distal radius facture will be randomized (1:1 ratio) to either conservative management (cast without further manipulation) or surgery. Patients will be assessed at six, 12, 26 weeks, and 52 weeks post intervention. The primary outcome measure and endpoint will be the Patient-Rated Wrist Evaluation (PRWE) at 52 weeks. In addition, the abbreviated version of the Disabilities of Arm, Shoulder and Hand questionnaire (QuickDASH), EuroQol five-dimension questionnaire, pain score (visual analogue scale 1 to 10), complications, grip strength (dynamometer), range of motion (goniometer), and radiological assessments will be undertaken. A cost-utility analysis will be performed to assess the cost-effectiveness of surgery. We aim to recruit 89 subjects per arm (total sample size 178).</p><p><strong>Discussion: </strong>The results of this study will help guide treatment of dorsally displaced distal radial fractures in the elderly and assess whether surgery offers functional benefit to patients. This is an important finding, as the number of elderly distal radial fractures is estimated to increase in the future due to the ageing population. Evidence-based management strategies are therefore required to ensure the best outcome for the patient and to optimize the use of increasingly scarce healthcare resources.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"5 10","pages":"920-928"},"PeriodicalIF":2.8,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11491869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476453","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":"Concurrent validity of the Single Assessment Numerical Evaluation and hip-specific patient-reported outcome measures.","authors":"Elizabeth M Bergman, Edward P Mulligan, Rupal M Patel, Joel Wells","doi":"10.1302/2633-1462.510.BJO-2024-0094.R1","DOIUrl":"10.1302/2633-1462.510.BJO-2024-0094.R1","url":null,"abstract":"<p><strong>Aims: </strong>The Single Assessment Numerical Evalution (SANE) score is a pragmatic alternative to longer patient-reported outcome measures (PROMs). The purpose of this study was to investigate the concurrent validity of the SANE and hip-specific PROMs in a generalized population of patients with hip pain at a single timepoint upon initial visit with an orthopaedic surgeon who is a hip preservation specialist. We hypothesized that SANE would have a strong correlation with the 12-question International Hip Outcome Tool (iHOT)-12, the Hip Outcome Score (HOS), and the Hip disability and Osteoarthritis Outcome Score (HOOS), providing evidence for concurrent validity of the SANE and hip-specific outcome measures in patients with hip pain.</p><p><strong>Methods: </strong>This study was a cross-sectional retrospective database analysis at a single timepoint. Data were collected from 2,782 patients at initial evaluation with a hip preservation specialist using the iHOT-12, HOS, HOOS, and SANE. Outcome scores were retrospectively analyzed using Pearson correlation coefficients.</p><p><strong>Results: </strong>Mean raw scores were iHOT-12 67.01 (SD 29.52), HOS 58.42 (SD 26.26), HOOS 86.85 (SD 32.94), and SANE 49.60 (SD 27.92). SANE was moderately correlated with the iHOT-12 (<i>r</i> = -0.4; 95% CI -0.35 to -0.44; p < 0.001), HOS (<i>r</i> = 0.57; 95% CI 0.53 to 0.60; p < 0.001), and HOOS (<i>r</i> = -0.55; 95% CI -0.51 to -0.58; p < 0.001). The iHOT-12 and HOOS were recorded as a lower score, indicating better function, which accounts for the negative r values.</p><p><strong>Conclusion: </strong>This study was the first to investigate the relationship between the SANE and the iHOT-12, HOS, and HOOS in a population of patients with hip pain at the initial evaluation with an orthopaedic surgeon, and found moderate correlation between SANE and the iHOT-12, HOS, and HOOS. The SANE may be a pragmatic alternative for clinical benchmarking in a general population of patients with hip pain. The construct validity of the SANE should be questioned compared to legacy measures whose content validity has been more rigorously investigated.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"5 10","pages":"904-910"},"PeriodicalIF":2.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11486539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476448","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":"Sensitivity and specificity of electrodiagnostic parameters in diagnosing carpal tunnel syndrome.","authors":"Shahir Mazaheri, Jalal Poorolajal, Alireza Mazaheri","doi":"10.1302/2633-1462.510.BJO-2024-0025.R1","DOIUrl":"10.1302/2633-1462.510.BJO-2024-0025.R1","url":null,"abstract":"<p><strong>Aims: </strong>The sensitivity and specificity of electrodiagnostic parameters in diagnosing carpal tunnel syndrome (CTS) have been reported differently, and this study aims to address this gap.</p><p><strong>Methods: </strong>This case-control study was conducted on 57 cases with CTS and 58 controls without complaints, such as pain or paresthesia on the median nerve. The main assessed electrodiagnostic parameters were terminal latency index (TLI), residual latency (RL), median ulnar F-wave latency difference (FdifMU), and median sensory latency-ulnar motor latency difference (MSUMLD).</p><p><strong>Results: </strong>The mean age in cases and controls were 50.7 years (SD 9.9) and 47.9 years (SD 12.1), respectively. The CTS severity was mild in 20 patients (34.4%), moderate in 19 patients (32.8%), and severe in 19 patients (32.8%). The sensitivity and specificity of the electrodiagnostic parameters in diagnosing CTS were as follows: TLI 75.4% and 87.8%; RL 85.9% and 82.5%; FdifMU 87.9% and 82.9%; and MSUMLD 94.8% and 60.0%, respectively.</p><p><strong>Conclusion: </strong>Our findings indicated that electrodiagnostic parameters are significantly associated with the clinical manifestation of CTS, and are associated with high diagnostic accuracy in CTS diagnosis. However, further studies are required to highlight the role of electrodiagnostic parameters and their combination in CTS detection.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"5 10","pages":"898-903"},"PeriodicalIF":2.8,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11485627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476463","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 'space suits' do not reduce periprosthetic joint infections in shoulder arthroplasty.","authors":"Adam Stoneham, Peter Poon, Marc Hirner, Christopher Frampton, Ryan Gao","doi":"10.1302/2633-1462.510.BJO-2024-0098.R1","DOIUrl":"10.1302/2633-1462.510.BJO-2024-0098.R1","url":null,"abstract":"<p><strong>Aims: </strong>Body exhaust suits or surgical helmet systems (colloquially, 'space suits') are frequently used in many forms of arthroplasty, with the aim of providing personal protection to surgeons and, perhaps, reducing periprosthetic joint infections, although this has not consistently been borne out in systematic reviews and registry studies. To date, no large-scale study has investigated whether this is applicable to shoulder arthroplasty. We used the New Zealand Joint Registry to assess whether the use of surgical helmet systems was associated with lower all-cause revision or revision for deep infection in primary shoulder arthroplasties.</p><p><strong>Methods: </strong>We analyzed 16,000 shoulder arthroplasties (hemiarthroplasties, anatomical, and reverse geometry prostheses) recorded on the New Zealand Joint Registry from its inception in 2000 to the present day. We assessed patient factors including age, BMI, sex, and American Society of Anesthesiologists (ASA) grade, as well as whether or not the operation took place in a laminar flow operating theatre.</p><p><strong>Results: </strong>A total of 2,728 operations (17%) took place using surgical helmet systems. Patient cohorts were broadly similar in terms of indication for surgery (osteoarthritis, rheumatoid arthritis, fractures) and medical comorbidities (age and sex). There were 842 revisions (5% of cases) with just 98 for deep infection (0.6% of all cases or 11.6% of the revisions). There were no differences in all-cause revisions or revision for deep infection between the surgical helmet systems and conventional gowns (p = 0.893 and p = 0.911, respectively).</p><p><strong>Conclusion: </strong>We found no evidence that wearing a surgical helmet system reduces the incidence of periprosthetic joint infection in any kind of primary shoulder arthroplasty. We acknowledge the limitations of this registry study and accept that there may be other benefits in terms of personal protection, comfort, or visibility. However, given their financial and ecological footprint, they should be used judiciously in shoulder surgery.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"5 10","pages":"894-897"},"PeriodicalIF":2.8,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11479769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476451","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":"Treatment of Andersson lesion-complicating ankylosing spondylitis via early minimally invasive surgery.","authors":"Chenggui Zhang, Yang Li, Guodong Wang, Jianmin Sun","doi":"10.1302/2633-1462.510.BJO-2024-0023.R1","DOIUrl":"10.1302/2633-1462.510.BJO-2024-0023.R1","url":null,"abstract":"<p><strong>Aims: </strong>A variety of surgical methods and strategies have been demonstrated for Andersson lesion (AL) therapy. In 2011, we proposed and identified the feasibility of stabilizing the spine without curettaging the vertebral or discovertebral lesion to cure non-kyphotic AL. Additionally, due to the excellent reunion ability of ankylosing spondylitis, we further came up with minimally invasive spinal surgery (MIS) to avoid the need for both bone graft and lesion curettage in AL surgery. However, there is a paucity of research into the comparison between open spinal fusion (OSF) and early MIS in the treatment of AL. The purpose of this study was to investigate and compare the clinical outcomes and radiological evaluation of our early MIS approach and OSF for AL.</p><p><strong>Methods: </strong>A total of 39 patients diagnosed with AL who underwent surgery from January 2004 to December 2022 were retrospectively screened for eligibility. Patients with AL were divided into an MIS group and an OSF group. The primary outcomes were union of the lesion on radiograph and CT, as well as the visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores immediately after surgery, and at the follow-up (mean 29 months (standard error (SE) 9)). The secondary outcomes were total blood loss during surgery, operating time, and improvement in the radiological parameters: global and local kyphosis, sagittal vertical axis, sagittal alignment, and chin-brow vertical angle immediately after surgery and at the follow-up.</p><p><strong>Results: </strong>Data for 30 patients with AL were evaluated: 14 in the MIS group and 16 in the OSF group. All patients were followed up after surgery; no nonunion complications or instrumentation failures were observed in either group. No significant differences in the VAS and ODI scores were identified between the two groups. Mean ODI improved from 51 (SE 5) to 17 (SE 5) in the MIS group and from 52 (SE 6) to 19 (SE 5) in the OSF group at the follow-up. There were significant improvements in total blood loss (p = 0.025) and operating time (p < 0.001) between the groups. There was also no significant difference in local kyphosis six months postoperatively (p = 0.119).</p><p><strong>Conclusion: </strong>Early MIS is an effective treatment for AL. MIS provides comparable clinical outcomes to those treated with OSF, with less total blood loss and shorter operating time. Our results support and identify the feasibility of solid immobilization achieved by posterior instrumentation without bone graft via MIS for the treatment of AL.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"5 10","pages":"886-893"},"PeriodicalIF":2.8,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11473168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476465","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}