Bone & Joint Open最新文献

{"title":"Femoral derotational osteotomies for version abnormalities: a mean ten-year follow-up.","authors":"Brian T Muffly, Zachary A Trotzky, Branden R Sosa, Olivia M Jochl, S Robert Rozbruch, Robert L Buly","doi":"10.1302/2633-1462.75.BJO-2026-0014.R1","DOIUrl":"10.1302/2633-1462.75.BJO-2026-0014.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to characterize long-term patient-reported outcomes and survivorship following femoral derotational osteotomy (FDO).</p><p><strong>Methods: </strong>A total of 77 hips (60 patients) between March 1997 and February 2019 who underwent FDO using an antegrade intramedullary device for excessive femoral anteversion or retroversion by a single-surgeon were retrospectively reviewed. Those with minimum five-year follow-up, with a mean of ten years (5.2 to 26.8), were included. Pre/postoperative modified Harris Hip Score (mHHS), postoperative patient global impression of change (PGIC), and patient acceptable symptomatic state (PASS) responses were collected. Survivorship free of conversion to arthroplasty was determined.</p><p><strong>Results: </strong>Overall, 90.0% of patients were female with a mean age of 29.6 years (14.4 to 60.9). A total of 52 hips had excessive anteversion with mean deformity of 38.3° (22° to 58°) and mean correction of 22.4° (15° to 40°); 25 hips had excessive retroversion with mean deformity of -8.7° (-24° to 2°) and mean correction of 21.7° (15° to 35°). Concomitant procedures included hip arthroscopy (32.5% of cases), periacetabular osteotomy (9.0%), and tibial derotational osteotomy (7.8%). Regardless of deformity, mean mHHS significantly improved (61.6 to 89.7, p < 0.001). The proportion of minimal clinically important difference (MCID), substantial clinical benefit (SCB), and PASS achievement was 94% (72 of 77), 84% (65 of 77), and 87% (67 of 77), respectively. For PGIC, 95.2% reported improvement, including 88.7% who reported themselves 'very much improved' or 'much improved'. Overall, 92.7% of anteverted and 85.7% of retroverted patients found their current symptomatic state satisfactory (p = 0.398). Three hips (two patients) underwent arthroplasty at mean 4.3 years. Survivorship free from conversion to arthroplasty was 95% at ten, 15, and 20 years.</p><p><strong>Conclusion: </strong>In appropriately selected patients, FDO for hip pain related to excessive femoral anteversion or retroversion provides significant improvements in pain and function at a mean ten-year follow-up. Most patients report postoperative improvement and find their current symptomatic state satisfactory. The procedure effectively preserves the native hip joint with 95% long-term survivorship free of conversion to arthroplasty.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 5","pages":"674-681"},"PeriodicalIF":3.3,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13186616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147975498","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":"Deep learning Algorithm for Wound assessment after total kNee (DAWN) arthroplasty : a prospective study protocol.","authors":"Sai Pendyala, Aditya Vijay, Nimra Akram, Andrew Coppola, Samantha Jones, Nick D Clement, Gustavo Carneiro, Deiary F Kader","doi":"10.1302/2633-1462.75.BJO-2025-0324.R1","DOIUrl":"10.1302/2633-1462.75.BJO-2025-0324.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study aims to develop and internally validate an AI approach based on a deep learning (DL) algorithm to classify wound photographs as either 'healing well' or 'requiring review' after a total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>A prospective cohort study will be conducted at a single, high-volume Elective Orthopaedic Centre. Adult patients who have undergone primary TKAs will be recruited either upon re-attendance at a wound review clinic or if they have a wound concern. Within the first two weeks postoperatively, an orthopaedic research fellow will obtain two standardized photographs of the wound, and the participant will complete a six-item symptom survey. Two blinded consultant orthopaedic surgeons will independently label each case (with the photographic and survey knowledge only) as 'healing well' or 'requires review'. The dataset of wound images will be split into an 80:20 ratio and a pre-trained DL algorithm will be fine-tuned using 80% of the data with five-fold cross-validation being employed. The folds will be generated using stratification not only by outcome labels but also by demographic variables in order to maintain similar distributions across folds. The remaining 20% will be the test set allowing for internal validation and assessment of the efficacy of the developed algorithm. Ethical approval has been granted by the NHS REC/HRA (IRAS 340642).</p><p><strong>Conclusion: </strong>This study will generate one of the first prospectively validated DL tools for orthopaedic wound triage. Embedding objective imaging and symptom data into a DL algorithm will allow for early detection of complications, timely intervention, streamlined follow-up, and support NHS digital-first pathways. This study's design directly mirrors NHS post-TKA pathways, supporting translatability into the current postoperative workflow for patients. The development of an early-detection system further enables patients to communicate concerns and receive timely assessment and treatment of any postoperative wound issues. The findings of this study will be disseminated through peer-reviewed publications and presentations at national and international conferences.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 5","pages":"659-666"},"PeriodicalIF":3.3,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13184645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147975552","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":"Negotiating research in the Emergency Department: a qualitative study of staff experience of the Distal Radius Acute Fracture Trial CAst versus SPlint (DRAFT3-CASP) RCT for distal radius fractures.","authors":"Emma E Phelps, Elizabeth Tutton, Jenny Gould, Liz Baird, Juul Achten, Matthew L Costa","doi":"10.1302/2633-1462.75.BJO-2025-0374.R1","DOIUrl":"10.1302/2633-1462.75.BJO-2025-0374.R1","url":null,"abstract":"<p><strong>Aims: </strong>We sought to explore staff experience of conducting an orthopaedic trauma randomized controlled trial (RCT) in the Emergency Department (ED). The Distal Radius Acute Fracture Trial: CAst versus SPlint (DRAFT3-CASP) RCT explores the effectiveness of two treatment pathways for patients with a fracture of the distal radius that does not require manipulation. These are, a plaster cast which is removed four to six weeks later in a fracture clinic, and discharge from emergency care with a wrist splint that patients remove themselves.</p><p><strong>Methods: </strong>A total of 20 multidisciplinary staff recruiting to the DRAFT3-CASP RCT from 14 NHS trusts across England took part in a telephone/online qualitative interview. Interviews were informed by Heideggerian Phenomenology and data were analyzed using thematic analysis.</p><p><strong>Results: </strong>The findings highlight the struggle to undertake research in emergency settings through the overarching theme 'negotiating research'. Staff identified three enablers of research: 1) fitting within clinical practice; 2) finding meaning; and 3) being supported. The fast pace of work and high service demand in emergency care prevented clinical staff from fully engaging with the study. Research delivery staff were vital and supported screening, recruitment, and data collection. Finding meaning in the research question by linking it to patient benefit helped staff to maintain enthusiasm despite the challenges encountered.</p><p><strong>Conclusion: </strong>Negotiating research in the ED is challenging. Protected time is essential for clinical staff to undertake research training and recruitment. Research delivery teams with research expertise are vital for successful recruitment. Increased investment in research delivery staff can ensure patients are given the opportunity to take part in research studies and can promote enthusiasm for research.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 5","pages":"667-673"},"PeriodicalIF":3.3,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13185654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147975527","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":"National survey of protocols for day-case hip and knee arthroplasty in the UK.","authors":"Tomos A Edwards, Jamie Large, Jonathan M R French, Jonathan T Evans, Mike R Reed, Michael R Whitehouse, Aaron B Y Ng, Abel Hosea, Akhilesh Pradhan, Akshay Date, Alexander Charalambous, Alexander Hunt, Amgad Nakhla, Amy M Firth, Arsany Metry, Benjamin J Bolland, Camille Aliker, Devaraj M Navaratnam, Dominic Waugh, Elizabeth Ojelade, Felix Morriss, Gautam Chadalavada, George Slade, Gordon Higgins, Gregory Neal-Smith, Hafiz Muhammad Umer, Hannah Noone, Iain Rankin, Ibrahim Muhammad, Issaq Ahmed, James Morris, Jayson Roberts, Jeremy Hill, Jonathan Quayle, Jonathan Topping, Joseph Heylen, Joshua Howard, Joshua Moreau, Julia Roope, Julian Cumberworth, Kartik Logishetty, Kathryn Hogan, Kerollos Khilla, Kevin Syam, Krunal Patel, Kumar Kaushik Dash, Laith Sinan, Lydia Jenner, Lyndsey Girling, Maria Choi, Mark Andrews, Mary Gibby, Michael Petrie, Michael Wilson, Muhammad Mubashir Siddiqui, Nagavaishnavi V Bhaskara, Oliver Flannery, Rakan Kabariti, Rami Ashour, Robert Sinnerton, Sadeeq Azeez, Samuel J Everett, Sarah Miller, Shady Hermena, Sonu Mehta, Sue Bannagham, Syed Mannan, Tahir Khaleeq, Theresa Maunganidze, Tim Petheram, Tristan Ross Fraser, Zhan Ng","doi":"10.1302/2633-1462.75.BJO-2025-0339.R1","DOIUrl":"10.1302/2633-1462.75.BJO-2025-0339.R1","url":null,"abstract":"<p><strong>Aims: </strong>Day-case joint arthroplasty, where patients are discharged on the day of surgery, is increasingly used to meet rising demand in a resource-efficient manner. NHS England guidance states that all patients should be placed on an ambulatory pathway (zero to one night stay). However, little is known about the prevalence, structure, and implementation of day-case protocols across the UK.</p><p><strong>Methods: </strong>An online survey was sent to all NHS institutions performing hip or knee arthroplasty. Respondents reported the presence of day-case, ambulatory (zero to one night stay), or generic enhanced recovery protocols. Data were collected across 21 questions covering key perioperative domains and analyzed descriptively, and model health system data was used to assess length of stay (LoS).</p><p><strong>Results: </strong>Overall, 63 responses were received covering 86 hospitals (56 trusts), of which 78 (91%) perform day-case surgery. In total, 41 (48%) had a dedicated day-case protocol, 23 (27%) had ambulatory protocols, and 15 (17%) used generic enhanced recovery pathways. Only 22% of hospitals with a day-case pathway placed all patients on it by default. Protocol content showed substantial variation, including the use of sedation as part of anaesthesia (49%), presence of therapy services beyond 17:00 (59%), and nurses competent in assessing day zero mobility (56%). One third of hospitals had no mechanism for patients to contact out-of-hours support. LoS was shorter in hospitals using day-case or ambulatory protocols when compared with those that did not, however, this did not reach statistical significance.</p><p><strong>Conclusion: </strong>While day-case joint arthroplasty is widely performed in the NHS, dedicated protocols are used in fewer than half of hospitals, and considerable variation exists. These results can be used collaboratively by hospitals that are trying to establish pathways, and to guide further research aiming to identify best practice and provide standardization for day-case protocols.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 5","pages":"651-658"},"PeriodicalIF":3.3,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13174002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943110","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":"Comparison of in-hospital complications following acute total hip arthroplasty versus open reduction and internal fixation in patients aged 50 years and older with acetabular fractures.","authors":"Geoffrey W Schemitsch, Graeme Hoit, Matthew Raleigh, Hans J Kreder, Aaron Nauth, Rob Fowler, Amir Khoshbin","doi":"10.1302/2633-1462.75.BJO-2026-0058.R1","DOIUrl":"10.1302/2633-1462.75.BJO-2026-0058.R1","url":null,"abstract":"<p><strong>Aims: </strong>To examine the relationship between surgical treatment type (acute total hip arthroplasty (THA) vs open reduction and internal fixation (ORIF)) and in-hospital medical complications in older adult trauma patients with operatively managed acetabulum fractures.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients aged ≥ 50 years who presented to institutions participating in the Trauma Quality Improvement Program between 1 January 2017 and 31 December 2022, and who underwent acetabulum fracture surgery within three weeks of admission. Our primary outcome was the development of in-hospital medical complications. Secondary outcomes included each medical complication alone, hospital length of stay, and discharge disposition. Acute THA patients were matched 1:1 without replacement to patients treated with ORIF on the logit of the propensity score using a greedy nearest-neighbour matching algorithm. Generalized estimating equations were used to calculate percent absolute risk differences with 95% CIs for categorical outcomes in the propensity score-matched sample. Wilcoxon signed-rank tests were used compare within pair differences in continuous outcomes.</p><p><strong>Results: </strong>A total of 10,213 patients were included in our study, of which 1,226 (12%) were treated with an acute THA and 8,987 (88%) were treated with ORIF. A total of 1,223 acute THA patients were matched to 1,223 ORIF patients. After matching, there were no meaningful differences in any baseline characteristics between the two treatment groups. There was no difference in the risk of in-hospital complications between patients treated with acute THA (216/1,223 (17.7%) vs patients who were treated with ORIF (201/1,223 (16.4%)) (absolute risk difference 1.23%, 95% CI -1.71 to 4.17, p = 0.414). There were no significant differences in the risk of each complication, length of stay, or discharge disposition.</p><p><strong>Conclusion: </strong>Our results suggest that acute THA and ORIF demonstrate similar risks of postoperative medical complications among older patients with acetabular fractures.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 5","pages":"643-650"},"PeriodicalIF":3.3,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13170500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934079","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 evolution of the control of airborne infection in operating rooms.","authors":"William Whyte, Cesira Pasquarella","doi":"10.1302/2633-1462.75.BJO-2025-0377.R1","DOIUrl":"10.1302/2633-1462.75.BJO-2025-0377.R1","url":null,"abstract":"<p><p>This article describes advances in the knowledge of airborne infection in operating rooms since 1867 when Joseph Lister first provided methods of controlling surgical site infection. However, it was not until the mid-20th century that evidence became available to show that airborne microbes were a cause of surgical site infection, and the design of operating rooms was improved to control this route of infection. The contributions from various researchers who investigated the importance of airborne infection and the design of operating rooms are discussed. It was concluded that further progress is still required to fully control airborne infection in operating rooms.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 5","pages":"636-642"},"PeriodicalIF":3.3,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13161790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147875921","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":"Unrestricted kinematic alignment for total knee arthroplasty : a mid- to long-term follow-up non-designer single surgeon study with survival analysis.","authors":"Francesco Mancuso, Khaled Al-Mohamadi, Christian Kleinert, Stijn Cornelissen, Hemant Pandit, Dragan Jeremic","doi":"10.1302/2633-1462.75.BJO-2025-0399.R1","DOIUrl":"10.1302/2633-1462.75.BJO-2025-0399.R1","url":null,"abstract":"<p><strong>Aims: </strong>Kinematic alignment (KA) offers a personalized approach by restoring each patient's pre-arthritic joint lines. Unrestricted KA (urKA) removes alignment boundaries defined by restricted KA concept, but concerns regarding reproducibility and clinical success persist. This study evaluates mid- to long-term survivorship and functional outcomes of urKA total knee arthroplasty (urKA-TKA) performed using a manual surgical technique by a single surgeon, with a minimum follow-up of three years.</p><p><strong>Methods: </strong>We prospectively reviewed 229 consecutive urKA-TKAs performed between March 2014 and October 2019 using a medial pivot design TKA and calipered measured resection (mean follow-up 87 months (36 to 136)). Patella was not routinely resurfaced. No restrictions were applied regarding preoperative limb alignment. Outcomes included survivorship (revision and reoperation), radiological alignment, and patient-reported outcomes: Knee Injury and Osteoarthritis Outcome Score (KOOS), Forgotten Joint Score (FJS), and Numerical Rating Scale (NRS) for pain. Survivorship was calculated using Kaplan-Meier analysis.</p><p><strong>Results: </strong>Preoperative and postoperative hip-knee-ankle (HKA) axis ranged respectively from -20.4° to 25.2° and -9.4° to 10.6°. The mean KOOS improved from 28.8 (SD 10.3) preoperatively to 75.8 (SD 16.6) postoperatively (p < 0.001). FJS was 87.6 (SD 17.7) at final follow-up, while NRS pain scores averaged 1.6 (SD 2.4), with 60% reporting no pain. At nine years (n = 32 at risk), implant survivorship was 97% free from revision for any reason and 96% free from reoperation, with no cases of aseptic loosening. Patients with preoperative alignment outliers (>± 5° HKA) demonstrated greater improvements in KOOS and FJS than neutral knees. Outcomes and implant survival were similar between knees within or outside restricted alignment boundaries. A trend towards higher rates of secondary patellar resurfacing was observed in valgus phenotypes, although this finding was not statistically significant.</p><p><strong>Conclusion: </strong>UrKA TKA provides excellent mid- to long-term survivorship and significant functional improvement without compromising safety in all knee phenotypes including patients with extreme preoperative alignment.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 5","pages":"627-635"},"PeriodicalIF":3.3,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13161791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147875897","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 effect of suturing techniques on aberrant wound recovery after total hip arthroplasty : study protocol for a prospective, randomized trial (HIP-STITCH).","authors":"Boudewijn W Miedema, Stephan B W Vehmeijer, Hans van der Linden, Brechtje Hesseling","doi":"10.1302/2633-1462.75.BJO-2025-0419.R1","DOIUrl":"10.1302/2633-1462.75.BJO-2025-0419.R1","url":null,"abstract":"<p><strong>Aims: </strong>The Netherlands is expected to see an increase in the annual number of primary total hip arthroplasties (THAs), as is the expectation in England, Wales, and Northern Ireland, according to the National Joint Registry (NJR). In 2023, the mean age for a patient receiving a primary THA was 69.3 years (SD 11.8) in the Netherlands, while the NJR documented a median age of 69 years. Wound recovery is impaired in elderly patients, and poor wound recovery could result in invasive and costly revision surgery. Currently, there is no consensus in the orthopaedic literature on which closure method is superior to prevent abnormal wound recovery.</p><p><strong>Methods: </strong>This prospective randomized trial will compare the effect of Monocryl, Vicryl Rapide with Indermil skin glue, Dermabond Prineo, and Stryker Zip on the amount of aberrant wound recovery within 14 days after primary THA via the direct anterior approach (DAA). Secondary outcomes include occurrence of superficial and deep wound infections within 90 days postoperatively, costs of the suturing techniques, number of visits to a healthcare professional for wound-related causes, and patient satisfaction scores. Photographs of the plaster (day three and day 11) and of the surgical wound (day seven and day 14) will be assessed with a self-developed classification model. Patient outcomes will be measured by a questionnaire at 14 and 90 days postoperatively.</p><p><strong>Discussion: </strong>This study will contribute to improving clinical care for patients undergoing DAA THA. Aberrant wound recovery was chosen as a proxy for periprosthetic joint infection since PJI as primary outcome measure would require an unfeasible number of patients for a prospective single-centre study. The classification model used is both a strength and a weakness. It has been developed specifically for this study, but its use has not yet been validated. Due to the nature of this study, full blinding is not possible. Only the assessors are partially blinded.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 5","pages":"619-626"},"PeriodicalIF":3.3,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13158625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147869742","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":"Pain control following total hip arthroplasty: a prospective randomized controlled trial comparing spinal anaesthesia without adjuncts versus fascia iliaca block versus pericapsular nerve group block versus local anaesthetic infiltration.","authors":"J Patrick Park, Kevin Yan Zhao, Tanya Cierson, Bardia Barimani, Eric Belzile, De Q Tran, Anthony Albers","doi":"10.1302/2633-1462.75.BJO-2026-0003.R1","DOIUrl":"10.1302/2633-1462.75.BJO-2026-0003.R1","url":null,"abstract":"<p><strong>Aims: </strong>Postoperative pain management for total hip arthroplasty (THA) remains an area for improvement. This study compared the impact of suprainguinal fascia iliaca block (FIB) versus local anaesthetic infiltration (LAI), versus pericapsular nerve group (PENG) block, and versus spinal anaesthesia alone, on early postoperative pain in patients who underwent inpatient primary THA.</p><p><strong>Methods: </strong>This was a single-centre, assessor- and participant-blinded randomized controlled trial. A total of 240 patients undergoing THA under spinal anaesthesia were randomized to LAI, FIB, PENG block, or control in a 1:1:1:1 ratio. The primary outcome was pain at four hours postoperatively (visual analogue scale (VAS)). Secondary outcomes included VAS at other timepoints, opioid consumption, patient satisfaction, and length of hospital stay (LOS). A VAS difference of 2 cm was considered clinically significant.</p><p><strong>Results: </strong>A total of 240 participants were randomized, with 222 in the final analysis. Only LAI (mean VAS 1.6 (SD 2.2)) significantly decreased postoperative pain compared with the control group (mean VAS 3.0 (SD 2.7); p = 0.004) at four hours. VAS at four hours was not significantly different between LAI, FIB, and PENG block groups in direct comparisons. FIB (23.3 mg morphine equivalents (MEQ) (SD 18.4), p = 0.001) and LAI (22.2 mg MEQ (SD 18.7), p = 0.001) significantly decreased opioid consumption compared with the control group (36.7 mg MEQ (SD 24.5)) at 24 hours postoperatively. The same was found at 48 hours postoperatively. LAI significantly improved patient satisfaction scores at four hours compared with the control group (1.3 (SD 0.6) vs 1.9 (SD 1.2), p = 0.043). There was no difference in LOS between study groups. One patient had femoral nerve motor deficit following PENG block, with full recovery at six months postoperatively.</p><p><strong>Conclusion: </strong>LAI combined with spinal anaesthesia reduced early postoperative pain and improved patient satisfaction with pain control compared with spinal anaesthesia alone. LAI and FIB both decreased opioid consumption in the first 24 and 48 hours.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 5","pages":"601-612"},"PeriodicalIF":3.3,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843689","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":"Prognostic factor research: why it matters in orthopaedics and how we do it better.","authors":"Zaid A Hamoodi, Richard D Riley, Gary S Collins, Lianne Kearsley-Fleet, Jamie C Sergeant, Adam C Watts","doi":"10.1302/2633-1462.75.BJO-2025-0385.R1","DOIUrl":"10.1302/2633-1462.75.BJO-2025-0385.R1","url":null,"abstract":"<p><p>By studying and predicting health outcomes, prognosis research can inform joint decision-making between a patient and clinician, and help to improve future health and care. The scope of prognosis research is broad. It can describe the natural history of a condition; identify prognostic factors (variables associated with future outcomes); develop and validate prediction models for estimating an individual's outcome risk; and identify intervention effects that vary by specified individual characteristics. Research on prognostic factors enables personalized treatment, as it helps identify patient risk profiles that guide clinical decisions, trial design, and resource allocation, and it is a stepping stone into developing prognostic models for individualized risk predictions. However, it is imperative for prognosis research to have high standards of study design, analysis, and reporting. Inadequately executed research can lead to misleading prognostic information, resulting in inappropriate treatment or advice for some patients. A better understanding of the fundamentals of modern prognosis research methods can empower clinicians to more accurately appraise research findings in this field. This will lead to the identification and implementation of high-quality prognostic research findings, to improve healthcare and patient outcomes. However, prognostic research in orthopaedics often exhibits poor methodology, inconsistent reporting, and over-reliance on statistical significance. Recent advances in methodological guidance have provided important recommendations for study design, analysis, and reporting. Accurate interpretation requires adjusted analyses that consider known prognostic factors to prevent misleading conclusions. Key components include study registration, sample size planning, clear protocols and transparent reporting. Following these principles can greatly enhance the quality and clinical relevance of trauma and orthopaedic research. This overview introduces types of prognosis studies and then focuses on prognostic factor research and its importance within the field of Trauma and Orthopaedics (T&O). It outlines the latest advances, identifies current limitations, and directs readers towards best practices that should be adopted by researchers.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 5","pages":"613-618"},"PeriodicalIF":3.3,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843701","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}