Bone & Joint Open最新文献

{"title":"Risk factors influencing periprosthetic fracture and mortality following total hip arthroplasty with a cemented, collarless, polished taper femoral component : a minimum ten-year follow-up cohort study.","authors":"Bin Chen, Nick D Clement, Gareth S Turnbull, Chloe E H Scott, Paul Gaston, Gavin J Macpherson, James T Patton","doi":"10.1302/2633-1462.65.BJO-2025-0008.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.65.BJO-2025-0008.R1","url":null,"abstract":"<p><strong>Aims: </strong>The aims of this study were to evaluate the incidence of reoperation (all-cause and specifically for periprosthetic femoral fracture (PFF)) and mortality, and associated risk factors, following total hip arthroplasty (THA) incorporating a cemented collarless polished taper slip (PTS) femoral component.</p><p><strong>Methods: </strong>This study included a consecutive series of THAs performed with an Exeter PTS between January 2011 and December 2013 at a single centre. Patient demographics, diabetes, American Society of Anesthesiologists (ASA) grade, and admission type were collected. Co-primary outcomes were reoperation and death.</p><p><strong>Results: </strong>The cohort consisted of 2,177 patients (mean age 66.9 years (SD 11.8)). The median follow-up was 11 years (IQR 10.5 to 11.8). The indications for reoperation were PFF (n = 35, 1.6%), dislocation (n = 15, 0.7%), aseptic cup loosening (n = 13, 0.6%), and infection (n = 10, 0.5%). No femoral components were revised for aseptic loosening. The ten-year aseptic survival for the femoral components was 96.5% (95% CI 95.3 to 97.7). ASA grade III to IV was associated with a higher risk of both all-cause reoperation (hazard ratio (HR) 1.86, p = 0.017) and aseptic reoperation (HR 1.82, p = 0.031). The ten-year PFF-related femoral component survival was 97.7% (95% CI 96.9 to 98.5) and older age (HR 1.05, p = 0.004) and diabetes (HR 2.32, p = 0.048) were independently associated with the occurrence of PFF. Overall patient survival at ten years was 66.1% (95% CI 63.4 to 68.8), with male sex (HR 1.23, p = 0.010), older age (HR 1.08, p < 0.001), ASA grade II to IV (HR 2.22, 4.14 and 6.74, respectively, p ≤ 0.001), and THA undertaken for trauma (HR 1.79, p < 0.001) being independently associated with an increased mortality risk.</p><p><strong>Conclusion: </strong>The cemented PTS demonstrated excellent long-term survival in THA, but PFF was the most common reason for reoperation. Older age and diabetes were independently associated with PFFs. Higher ASA grade was linked to increased risk of both all-cause and aseptic reoperations. Mortality at ten years was influenced by male sex, older age, higher ASA grade, and trauma-related THA.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 5","pages":"544-552"},"PeriodicalIF":2.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037826","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":"Cost utility analysis of acute rehabilitation approaches in the management of traumatic anterior shoulder dislocation.","authors":"Henry Nwankwo, James Mason, Martin Underwood, Helen Parsons, Aminul Haque, David Torgerson, Chetan Modi, Rebecca S Kearney","doi":"10.1302/2633-1462.65.BJO-2024-0246.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.65.BJO-2024-0246.R1","url":null,"abstract":"<p><strong>Aims: </strong>We aimed to conduct a cost-utility analysis comparing one session of advice, supporting materials, and option to self-refer to physiotherapy with the same advice and materials, plus an additional programme of physiotherapy for people with a first-time, traumatic anterior shoulder dislocation.</p><p><strong>Methods: </strong>We conducted an economic evaluation within a randomized controlled trial from the UK NHS and personal social services (PSS) perspective. Resources used, and health-related quality of life information, were collected as part of the Acute Rehabilitation following Traumatic anterior shoulder dISlocAtioN (ARTISAN) randomized controlled trial over a 12-month period using patient-completed questionnaires. Incremental costs and quality-adjusted life-years (QALYs) accrued over the follow-up period were calculated and expressed as the incremental cost-effectiveness ratio (ICER). Estimate uncertainty was explored by bootstrapping and graphically displayed on the ICER plane. Net monetary benefits, probability of cost-effectiveness, and expected value of perfect information were explored at a range of willingness-to-pay thresholds and visualized graphically.</p><p><strong>Results: </strong>Over a 12-month time horizon, incremental costs were £64 (95% CI -61 to 191) and incremental QALYs were 0.019 (95% CI -0.0005 to 0.0375) for the additional programme of physiotherapy. The ICER was £3,373/QALY, suggesting that the programme is cost-effective, although the primary outcome (Oxford Shoulder Instability Score) found little difference six months after a shoulder dislocation. The probability of being cost-effective at a willingness-to-pay threshold of £30,000 per QALY is 95%. Findings need to interpreted with caution given the high rates of missing data at 12 months, due to the final 12-month follow-up being curtailed during the trial. However, the range of sensitivity analyses supports the base case findings.</p><p><strong>Conclusion: </strong>The within-trial economic evaluation found that the additional physiotherapy programme is likely to be cost-effective. However, given the small and imprecise health gains, the best use of scarce physiotherapy resources needs careful consideration given other current demands on services.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 5","pages":"535-543"},"PeriodicalIF":2.8,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12050136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030561","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":"Accuracy of posterosuperior iliac spine reference array placement in robot-navigated spine surgery.","authors":"Joseph J Y Wan, Qing H Tan, Dalun Leong, Zhihong Chew, Terry H L Teo","doi":"10.1302/2633-1462.65.BJO-2025-0006.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.65.BJO-2025-0006.R1","url":null,"abstract":"<p><strong>Aims: </strong>Computer-navigated spinal instrumentation requires placement of a dynamic reference base (DRB), typically intraosseously in the ilium via a percutaneous stab incision on the posterior superior iliac spine (PSIS) entry point. Data describing the accuracy and complications of DRB placement are limited in the literature. The aim of this study is to measure the accuracy of DRB placement in the PSIS, determine its exact placement trajectory, and determine the prevalence of related complications.</p><p><strong>Methods: </strong>This is a single-centre, institutional board approved, multisurgeon retrospective analysis of 69 included DRB placements from 51 robot-assisted lumbar posterior instrumentation procedures between May 2022 and April 2024. Pin entry point and trajectory were mapped out; the intraoperative O-arm CT scans and skin-to-PSIS depth were also measured, and patient demographics (age, sex, BMI), surgical outcomes, and postoperative complications were recorded.</p><p><strong>Results: </strong>Of the 69 PSIS pin placements, 47 (68.1%) had the correct entry point on the PSIS, and 35 (50.7%) of them were placed correctly within the ilium without breaching a second cortex. Skin-to-PSIS depth was significantly higher in patients with misplaced DRB placement, while age, sex, and BMI were similar. Of those with misplaced DRB (n = 34), one had delayed pin site wound healing.</p><p><strong>Conclusion: </strong>Percutaneous PSIS DRB placement has poor accuracy, with skin-to-PSIS depth being a significant factor. To avoid complications from misplaced DRB placement, the authors recommend the use of DRB placement on the iliac wing, or on the PSIS, following the trajectory used in pelvis posterior column fracture fixation, using fluoroscopy intraoperatively to ensure the DRB pin position.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 5","pages":"528-534"},"PeriodicalIF":2.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036938","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":"Cementless acetabular component without screw holes with immediate full weightbearing : a minimum 20-year follow-up study.","authors":"Lawrence C M Lau, Kin Y Wong, Hongjian Hu, Man H Cheung, Fu Y Ng, Henry Fu, Ping K Chan, Kwong Y Chiu","doi":"10.1302/2633-1462.65.BJO-2024-0197.R1","DOIUrl":"10.1302/2633-1462.65.BJO-2024-0197.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to evaluate the survival of a cementless component without screw holes in total hip arthroplasty (THA) at a minimum follow-up of 20 years. This design has the benefits of maximizing bone contact and reducing osteolysis by eliminating channels to backside wear. However, transacetabular screws cannot be used.</p><p><strong>Methods: </strong>A total of 71 hips in 58 patients receiving the same model of cementless component without screw holes (Depuy Duraloc 100 hydroxyapatite (HA) component) from June 1999 to March 2003 were prospectively followed up. All patients were allowed to have immediate full weightbearing. The mean age at THA was 53.7 years (28 to 74). Osteonecrosis was the leading cause of THA. Survival was assessed with any revision and component revision as the endpoint. Radiological parameters, including lateral opening angle, and the components' vertical and horizontal migration distances, were measured and compared between the early postoperative period and final follow-up.</p><p><strong>Results: </strong>Overall, 54 hips were assessed at a minimum 20-year follow-up. The mean follow-up was 22.9 years (20.9 to 24.5). Two component revisions occurred at 17.5 and 17.6 years later. Both components were well fixed but were revised, due to the need to upsize the articulation and component malpositioning, respectively. Conventional polyethylene (PE) was used in both hips, and 14 other hips were revised with the components well fixed and not revised. The estimated survival of the acetabular component and THA at 20 years was 96.4% and 74.5%, respectively. Mean changes in lateral opening angle and vertical and horizontal migration distances were 0.48° (SD 1.45°), -0.06 mm (SD 1.44), and -0.36 mm (SD 1.36), respectively, with no statistical significance.</p><p><strong>Conclusion: </strong>This study provides evidence of excellent long-term survival of cementless components without screw holes. Immediate postoperative weightbearing did not lead to component migration in the long term.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 5 Supple A","pages":"14-21"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12184716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039055","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 PROMIS scores after total hip and total ankle arthroplasty : a propensity score-matched study.","authors":"Justin Leal, Christopher T Holland, Mark E Easley, James A Nunley, Sean P Ryan, Michael P Bolognesi, Samuel S Wellman, William A Jiranek","doi":"10.1302/2633-1462.65.BJO-2024-0200.R1","DOIUrl":"10.1302/2633-1462.65.BJO-2024-0200.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study evaluated joint-specific and generic patient-reported outcome measures (PROMs) after total hip arthroplasty (THA) and total ankle arthroplasty (TAA) in matched cohorts, while evaluating implant survivorship and 90-day hospital use.</p><p><strong>Methods: </strong>Primary THA and TAA patients from 1 January 2015 to 1 January 2023 with minimum one-year follow-up were retrospectively reviewed. After applying exclusion criteria, 2,092 THAs and 478 TAAs were analyzed. Demographics, pre- and postoperative PROMs, revision surgeries, emergency department visits, and readmissions were collected. THA and TAA patients were then propensity score matched at a 2:1 ratio for age, sex, race, BMI, American Society of Anesthesiologists classification, and comorbidities, resulting in a final cohort of 844 THAs and 455 TAAs for comparison.</p><p><strong>Results: </strong>Median preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference (PI) scores between THA and TAA were calculated (66.0 (IQR 62.0 to 70.0) vs 65.0 (IQR 62.0 to 70.0); p = 0.276), and both showed improvement at six weeks. However, THA patients exhibited lower median PROMIS PI scores at one year (53.0 vs 54.0; p = 0.009), as well as a greater median decrease in PROMIS PI from preoperative to one year (-13.0 (IQR -20.0 to -8.0) vs -12.0 (IQR -18.0 to -7.0); p = 0.023). Median preoperative PROMIS physical function (PF) was worse in THA patients (36.0 (IQR 32.0 to 40.0) vs 37.0 (IQR 33.0 to 40.0); p = 0.031), but showed greater median improvement compared to TAA patients at both six weeks (7.0 (IQR 3.0 to 12.0) vs 3.0 (IQR -2.0 to 9.0); p < 0.001) and one year (11.0 (IQR 6.0 to 17.0) vs 8.0 (IQR 4.5 to 13.0); p < 0.001). Preoperative PROMIS depression scores were similar and improved similarly in both groups. Joint-specific PROMs improved in both cohorts.</p><p><strong>Conclusion: </strong>Patients undergoing THA or TAA experienced improvements in joint-specific PROMs postoperatively which translated to improved generic PROMs across both joints. Generic PROMs can be a useful tool to compare outcomes in THA and TAA. Results suggest that higher functional scores may be achieved sooner in THA.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 5 Supple A","pages":"1-13"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11688126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031499","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":"Primary total hip arthroplasty using custom-made acetabular implants in patients with high hip dislocation : surgical technique and results.","authors":"Rashid M Tikhilov, Rodion D Volykhin, Stanislav S Bilyk, Anton N Kovalenko, Alisagib A Dzhavadov, Igor I Shubnyakov","doi":"10.1302/2633-1462.65.BJO-2024-0255.R1","DOIUrl":"10.1302/2633-1462.65.BJO-2024-0255.R1","url":null,"abstract":"<p><strong>Aims: </strong>Despite good results of using uncemented press-fit cups in patients with high hip dislocations (type C as per the Hartofilakidis classification), there are reports of loosening of these components. To improve the results on the acetabular side in patients with high hip dislocations, we used custom-made acetabular implants (CMAIs). The aim of this study was to evaluate the outcomes after total hip arthroplasty (THA) using CMAIs in patients with high hip dislocation.</p><p><strong>Methods: </strong>We retrospectively analyzed the results of primary THA using the CMAIs in 58 hips (52 patients) from November 2017 to December 2019. All surgeries were performed using the femoral shortening osteotomy technique described by Paavilainen. Type C1 and C2 dislocations were observed in nine and 49 hips, respectively. The presence of various complications, functional results using the Oxford Hip Score (OHS), patient satisfaction, radiological parameters, and positioning of CMAIs were assessed.</p><p><strong>Results: </strong>The mean follow-up period, including radiological follow-up for all 58 hips, was 5.2 years (4.2 to 6.3; SD 0.71). Patients demonstrated statistically significant improved functional outcomes according to the OHS (preoperatively 16.9 and postoperatively 38.5; p < 0.001). Four hips were revised: two hips due to dislocations, the cause of which was impingement of the greater trochanter due to malposition of the distally advanced greater trochanter after osteotomy. One hip was due to nonunion of the distally advanced greater trochanter after osteotomy, and one hip due to pain resulting from iliopsoas impingement caused by contact of the CMAI flange with the iliopsoas muscle. There were no radiological signs of loosening of the CMAIs. Any deviation of the CMAIs from the planned position was noted.</p><p><strong>Conclusion: </strong>This preliminary study demonstrated that CMAIs may offer good bone fixation in patients with high hip dislocation; however, further biomechanical studies are needed to evaluate the use of CMAIs in terms of osseointegration, additional screw fixation, and to determine the effect of deviation of CMAIs from the planned position on clinically relevant complications.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 5 Supple A","pages":"41-50"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12184724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017264","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":"An overnight sensation: the effect of an acute introduction of a short-stay pathway on a previously compromised arthroplasty service.","authors":"Kevin Ilo, Bernard H van Duren, Mark A Higgins, Andrew R J Manktelow, Benjamin V Bloch","doi":"10.1302/2633-1462.65.BJO-2024-0238.R1","DOIUrl":"10.1302/2633-1462.65.BJO-2024-0238.R1","url":null,"abstract":"<p><strong>Aims: </strong>In this study, we report the impact of implementing a new short-stay hip and knee arthroplasty pathway in an NHS hospital. This was enacted due to existing concerns around long length of stay (LOS) and reduced elective operating capacity each winter due to bed pressures. The overnight introduction of this pathway was aimed to reduce LOS, alleviate bed pressures, minimize readmission rates, and generate financial savings, all combining to facilitate full elective activity during the winter.</p><p><strong>Methods: </strong>We conducted a prospective study at a regional tertiary arthroplasty centre. The new pathway was introduced across the service overnight. It included rigorous preoperative optimization, specific anaesthetic protocols, and uniform changes in surgical practice to allow a focus on early mobilization and discharge on the day of surgery where possible. Data collection spanned 17 months, encompassing the initial six months post-implementation of the short-stay pathway. LOS data were collected for the full period and data were compared pre- and post-implementation of the new pathway. Patient satisfaction and 30-day readmission data were also collected.</p><p><strong>Results: </strong>There was a significant decrease in median LOS from four days pre-implementation to one day post-implementation. Patient satisfaction was high and the 30-day readmission rate was unchanged (5.95%, n = 43), with no readmissions directly related to decreased inpatient stay. Financial analyses revealed substantial cost savings due to reduced LOS and the elimination of routine postoperative blood tests. Elective activity over winter was significantly higher (203 more arthroplasties, 79% increase) than in the same time period in the previous year.</p><p><strong>Conclusion: </strong>An acute introduction of a carefully planned and coordinated short-stay hip and knee pathway is safe, cost-effective, and popular with patients, but also contributes to increased efficiency in the delivery of elective healthcare in the context of increasing demand and financial constraints in the NHS.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 5 Supple A","pages":"22-29"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12184725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019160","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":"Clinical effectiveness of a child-specific dynamic stretching programme, compared to usual care, for ambulant children with spastic cerebral palsy (SPELL trial): a parallel group randomized controlled trial.","authors":"Tim Theologis, Daniel C Perry, Ines Rombach, David J Keene, Ioana R Marian, Morag Andrew, Catherine Barry, Loretta Davis, Gregory Firth, Heidi Fletcher, Beth Fordham, Vivi Gregory Osborne, Helen Gregory Osborne, Lesley Katchburian, Joanna O'Mahoney, Jeremy R Parr, Rachel Rapson, Jennifer Ryan, Fema Er, Megan Stone, Helen Wood, Sally Hopewell","doi":"10.1302/2633-1462.65.BJO-2024-0267","DOIUrl":"https://doi.org/10.1302/2633-1462.65.BJO-2024-0267","url":null,"abstract":"<p><strong>Aims: </strong>Dynamic muscle stretching exercises are one of the interventions frequently prescribed by physiotherapists for children with cerebral palsy (CP). However, there is wide variability in the exercise regimes used and limited evidence of their effectiveness. The SPELL trial will assess the clinical effectiveness of an individually tailored dynamic stretching programme, compared to usual care for ambulant children with spastic CP.</p><p><strong>Methods: </strong>We are conducting a multicentre, two-arm, parallel group, superiority randomized controlled trial. We will recruit children aged four to 11 years with a diagnosis of spastic CP (bilateral or unilateral) and Gross Motor Function Classification System (GMFCS) levels I to III who are able to comply with assessment procedures and exercise programme with or without support. Participants will be recruited from at least 12 UK NHS Trust physiotherapy and related services. Participants (n = 334) will be randomized (centralized computer-generated one:one allocation ratio) to either: 1) a dynamic stretching exercise programme, with six one-to-one physiotherapy sessions over 16 weeks; or 2) usual NHS care, with a single physiotherapy session and an assessment, and advice regarding self-management and exercise.</p><p><strong>Conclusion: </strong>The primary outcome is functional mobility measured using the child-/parent-reported Gait Outcomes Assessment List (GOAL) at six months. Secondary outcomes are: joint range of motion (Cerebral Palsy Integrated Pathway protocol) and motor function (timed up and go test) at six months; functional mobility (GOAL) at 12 months; independence (GOAL subdomain A); balance (GOAL subdomain A, B, D); pain and discomfort (GOAL subdomain C); health-related quality of life (youth version of the EuroQol five-dimension questionnaire (EQ-5D-Y)); educational attendance; exercise adherence; and additional physiotherapy treatment at six and 12 months. The primary analysis will be intention to treat.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 5","pages":"506-516"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986372","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":"Preservation of the lateral femoral circumflex artery in total hip arthroplasty using the bikini-type direct anterior approach : effect on muscle status and clinical outcomes.","authors":"Louisa Bell, Hannes A Rüdiger, Anika Stephan, Lukas Schwitter, Christian W A Pfirrmann, Vincent A Stadelmann, Michael Leunig","doi":"10.1302/2633-1462.65.BJO-2024-0193.R1","DOIUrl":"10.1302/2633-1462.65.BJO-2024-0193.R1","url":null,"abstract":"<p><strong>Aims: </strong>The direct anterior approach (DAA) is increasing in popularity as a minimally invasive technique for total hip arthroplasty (THA). DAA-THA involves ligation of the ascending branch of the lateral femoral circumflex artery (a-LFCA), considered to contribute to the blood supply of the tensor fasciae latae (TFL) muscle. To determine the morbidity of these surgical steps, periarticular muscle status and clinical outcomes were assessed after bikini-type DAA-THA with a-LFCA preservation versus ligation.</p><p><strong>Methods: </strong>We evaluated the surgical records of 140 patients undergoing DAA-THA with continuous attempt of a-LFCA preservation from May to October 2021. A total of 92 patients were eligible and 46 consented to study participation (n = 20 preservation, n = 26 ligation). Preoperative and six-week clinical and radiological data were retrospectively extracted from patient files, and patient-reported outcome measures (PROMs) from the institutional registry. Clinical and MRI examinations were performed two years postoperatively to analyze volume and fatty infiltration of the TFL, gluteus medius, and gluteus minimus relative to the contralateral hip. A total of 13 patients underwent contralateral THA and were excluded from the analysis of muscle status.</p><p><strong>Results: </strong>Coxa valga morphology and less muscular habitus were more frequent in a-LFCA preservation. After a-LFCA preservation, less anterolateral soft-tissue swelling was described at six weeks (p < 0.001) and TFL local pain at two years (p = 0.034) postoperatively. PROMs did not differ between groups. Mean TFL volume side-difference was not significantly different after a-LFCA preservation (p = 0.276), but it was significantly different after ligation (11.6% smaller (SD 15.5); p = 0.022). TFL fatty infiltration side-difference was larger after a-LFCA ligation (p = 0.010). Muscle status of the gluteus medius and minimus did not differ between sides and groups.</p><p><strong>Conclusion: </strong>a-LFCA preservation had a minor effect on TFL muscle status. Since preservation was primarily feasible in hips with simpler morphology, it remains uncertain whether differences were due to preserved vascularity or reduced TFL injury. Hence, a-LFCA preservation does not appear essential. However, until further evidence becomes available, attempting a-LFCA preservation may be advisable.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 5 Supple A","pages":"30-40"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12184720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040129","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":"Clinical effectiveness of an individually tailored strengthening programme, including progressive resistance exercises and advice, compared to usual care for ambulant adolescents with spastic cerebral palsy (ROBUST trial): a parallel group randomized controlled trial.","authors":"Sally Hopewell, David J Keene, Ioana Marian, Daniel C Perry, Ines Rombach, Morag Andrew, Catherine Barry, Loretta Davis, Gregory Firth, Heidi Fletcher, Beth Fordham, Vivi Gregory Osborne, Helen Gregory Osborne, Lesley Katchburian, Joanna O'Mahoney, Jeremy Parr, Rachel Rapson, Jennifer Ryan, Elnaz Saeedi, Megan Stone, Helen Wood, Tim Theologis","doi":"10.1302/2633-1462.65.BJO-2024-0268","DOIUrl":"https://doi.org/10.1302/2633-1462.65.BJO-2024-0268","url":null,"abstract":"<p><strong>Aims: </strong>Muscle strengthening exercises are one of the interventions frequently prescribed by physiotherapists for adolescents with cerebral palsy (CP). However, there is wide variability in the exercise regimes used and limited evidence of their effectiveness. The ROBUST trial will assess the clinical effectiveness of an individually tailored strengthening programme, including progressive resistance exercises and advice, compared to usual care for ambulant adolescents with spastic CP.</p><p><strong>Methods: </strong>We are conducting a multicentre, two-arm, parallel group, superiority randomized controlled trial. We will recruit adolescents aged 12 to 18 years with a diagnosis of spastic CP (bilateral or unilateral) Gross Motor Function Classification System (GMFCS) levels I to III who are able to comply with the assessment procedures and exercise programme with or without support. Participants will be recruited from at least 12 UK NHS Trust physiotherapy and related services. Participants (n = 334) will be randomized (centralized computer-generated 1:1 allocation ratio) to either: 1) a progressive resistance exercise programme, with six one-to-one physiotherapy sessions over 16 weeks; or 2) usual NHS care, with a single physiotherapy session and an assessment session, and advice regarding self-management and exercise.</p><p><strong>Conclusion: </strong>The primary outcome is functional mobility measured using the child-/parent-reported Gait Outcomes Assessment List (GOAL) at six months. Secondary outcomes are: clinician-assessed muscle strength (Five Times Sit-to-Stand Test) and motor function (timed up and go test) at six months; functional mobility (GOAL) at 12 months; independence (GOAL subdomain A), balance (GOAL subdomain A, B, D), pain and discomfort (GOAL subdomain C), health-related quality of life (youth version of the EuroQol five-dimension questionnaire; EQ-5D-Y), educational attendance, exercise adherence, and additional physiotherapy treatment (six and 12 months). The primary analysis will be intention to treat.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 5","pages":"517-527"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041938","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}