Bone & Joint Journal最新文献

{"title":"Functional alignment restores native kinematics more consistently than mechanical axis alignment in total knee arthroplasty.","authors":"Jonathan R Manara, Rick Steer, Sarah L Whitehouse, Dermot Collopy, Gavin W Clark","doi":"10.1302/0301-620X.107B4.BJJ-2024-0956.R1","DOIUrl":"10.1302/0301-620X.107B4.BJJ-2024-0956.R1","url":null,"abstract":"<p><strong>Aims: </strong>Functional alignment (FA) and adjusted mechanical alignment (aMA) are recognized techniques for performing total knee arthroplasty (TKA). The native femur rolls back further on the lateral tibial plateau than the medial side during flexion, resulting in a medial pivot pattern of movement. We have assessed whether an individualized alignment technique affects the kinematic pattern observed and the clinical outcomes, when compared to a systematic alignment technique in TKA.</p><p><strong>Methods: </strong>A total of 60 consecutive patients were randomized to a robotically assisted TKA with either FA (n = 29) or aMA (n = 31), using a cruciate-retaining (CR) implant. After definitive implantation of the prostheses, a trial pressure monitor was inserted recording contact points between the femoral component and monitor in the medial and lateral compartments as the knee was taken through a range of motion. The kinematic pattern was observed, contact pressures measured, and patient-reported outcome measures (PROMs) assessed at 12 months.</p><p><strong>Results: </strong>The FA-TKA group produced a medial pivot in 58.6% of cases (17/29), symmetrical rollback in 37.9% (11/29), and a lateral pivot in 3.4% (1/29). The aMA-TKA group produced a medial pivot in 19.4% of cases (6/31), symmetrical rollback in 45.2% (14/31), and a lateral pivot in 35.5% (11/31) (p < 0.001). No differences in knee balance were recorded between the two alignment groups at any flexion point. Patients with a medial pivot kinematic pattern had superior one-year PROMs in some measures. Patients producing a lateral pivot had lower Kujala scores.</p><p><strong>Conclusion: </strong>FA CR-TKA generates an intraoperative medial pivot kinematic pattern through soft-tissue balance more often than those that use aMA. Lateral pivot kinematic patterns are more commonly found with aMA. These intraoperative kinematic patterns are related to clinical outcomes, with knees producing a medial pivot performing better than those with lateral pivot.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 4","pages":"423-431"},"PeriodicalIF":4.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic arm-assisted acetabular reconstruction in revision total hip arthroplasty : a clinical study with minimum two-year follow-up.","authors":"Wang Deng, Xiangdong Wu, Hongyi Shao, Hao Tang, Yong Huang, Zhaolun Wang, Dejin Yang, Yixin Zhou","doi":"10.1302/0301-620X.107B4.BJJ-2024-0982.R1","DOIUrl":"10.1302/0301-620X.107B4.BJJ-2024-0982.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to report the surgical techniques and early clinical results of robotic arm-assisted acetabular reconstruction in revision total hip arthroplasty (THA).</p><p><strong>Methods: </strong>Between October 2019 and May 2021, we used the Mako robotic system to perform 62 revision THAs at our hospital. This study included 54 patients who underwent robotic arm-assisted revision THA for acetabular reconstruction. Surgical techniques using the robotic system to reconstruct the acetabulum, including preoperative planning, intraoperative registration, and the accuracy of different registration methods, are reported. The accuracy between the target acetabular component orientation and final orientation was evaluated. The latest follow-up Harris Hip Score (HHS) and radiographs were analyzed.</p><p><strong>Results: </strong>Among the 54 hips included, four types of intraoperative registration methods with different surfaces were developed and registered 65 times. The overall success rate of the registration process was 98.5%. The mean accuracy of successful registration was 0.38 mm (0.2 to 0.5). The median difference between the target and final acetabular component orientations assessed by Mako was 1.0° (-2.0° to 0.0°) for inclination and 0.0° (-1.0° to 1.0°) for anteversion. Four hips were classified as outliers for acetabular component orientation. The reconstructed centres of rotation (CORs) were slightly lower than the anatomical CORs by a mean 4.72 mm (SD 4.71), and shifted laterally by 3.92 mm (SD 4.62) on postoperative radiographs. The median HHS improved significantly from 46.0 (IQR 33.0 to 58.3) preoperatively to 89.0 (IQR 78.3 to 93.0) postoperatively (p < 0.001). The overall satisfaction rate was 86.0% (n = 50). There were no radiological failures at the latest follow-up.</p><p><strong>Conclusion: </strong>Robotic arm-assisted revision THA provides valuable information for the analysis of bone defects to guide reconstructive strategies. Robotic arm-assisted reaming and acetabular component or augment positioning facilitates accurate component position and orientation. The radiological and preliminary clinical results of this cohort were satisfactory.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 4","pages":"404-412"},"PeriodicalIF":4.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and characteristics of noise generation in total hip arthroplasty with ceramic-on-ceramic bearings : a comparison between robotic-assisted surgery and conventional methods.","authors":"Xianzuo Zhang, Mo Chen, Tao Zhang, Haining Zhang, Bo Yang, Chen Zhu","doi":"10.1302/0301-620X.107B4.BJJ-2024-0506.R2","DOIUrl":"10.1302/0301-620X.107B4.BJJ-2024-0506.R2","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate the impact and risk factors of robotic-assisted surgery (RAS) on noise generation in total hip arthroplasty (THA) with ceramic-on-ceramic (CoC) bearings in comparison to conventional (CON) manual methods.</p><p><strong>Methods: </strong>A secondary analysis of a prospective multicentre randomized controlled trial - conducted from June 2021 to July 2022 - included 74 patients with CoC bearings, equally divided between RAS and CON groups. Noise incidence, characteristics, and duration were documented. Radiological assessments and logistic regression analysis were performed to identify predictors of noise or squeaking.</p><p><strong>Results: </strong>The incidence of overall noise complaints was higher in the CON group compared to the RAS group, with a statistically significant difference observed at the early postoperative stage. Specifically, at 14 days post-surgery, 5.4% of patients in the RAS group and 32.4% in the CON group reported noises (p = 0.008), while at 24 weeks, the rates were 5.4% and 21.6%, respectively, with no statistically significant difference (p = 0.089). RAS showed superior alignment and precision in component placement. Logistic regression analysis identified conventional surgery as a significant predictor of noise complaints (odds ratio 7.10 (95% CI 1.51 to 33.33); p = 0.013). Additionally, the probability distributions of different acetabular alignment and abduction angles were plotted and analyzed. No differences in functional status or patient-reported outcomes were found between groups.</p><p><strong>Conclusion: </strong>RAS in THA with CoC bearings reduces the incidence and severity of noise-related complications, and is likely due to more precise and appropriate component placement, which may improve outcomes.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 4","pages":"391-403"},"PeriodicalIF":4.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kinematic alignment achieves a tibial joint line angle that is more parallel to the floor in single-leg stance than mechanical alignment : a radiological analysis of a randomized controlled trial.","authors":"Benjamin J Leong, James Corbett, Darren B Chen, George Kirsh, Anthony K L Leong, Jil A Wood, Ashish D Diwan, Gregory C Wernecke, Ian A Harris, Samuel J MacDessi","doi":"10.1302/0301-620X.107B4.BJJ-2024-0204.R3","DOIUrl":"10.1302/0301-620X.107B4.BJJ-2024-0204.R3","url":null,"abstract":"<p><strong>Aims: </strong>Previous research on knee kinematics has demonstrated that achieving a tibial joint line angle (TJLA) parallel to the floor in the single-leg stance phase of gait may restore native knee kinematics and optimize compartmental compressive loads in total knee arthroplasty (TKA). However, it is currently unclear which surgical alignment strategy best achieves this. Therefore, this study sought to determine whether kinematically aligned (KA) or mechanically aligned (MA) TKAs produce a TJLA closer to parallel.</p><p><strong>Methods: </strong>A total of 95 patients were randomized to KA (n = 46) or MA (n = 49). Constitutional joint line obliquity (JLO) was measured from preoperative radiographs; TJLA was measured from postoperative radiographs. The primary outcome was the mean difference in TJLA between KA and MA in single-leg stance. Secondary outcomes included differences in TJLA between apex distal and neutral JLO knees, the proportion of patients with TJLA within approximately 2° of neutral, and changes in constitutional JLO between alignment groups.</p><p><strong>Results: </strong>In single-leg stance, the mean TJLA was closer to parallel with KA (-2.0° (SD 2.6°)) than MA (-4.5° (SD 1.9°); p < 0.001). Similar mean differences were observed in patients with apex distal JLO (KA -1.4° (SD 2.1°); MA -4.9° (SD 1.8°); p < 0.001) but not neutral JLO (KA -3.7° (SD 2.8°); MA -3.7° (SD 1.9°); p = 0.776). More patients had a TJLA within 2° of parallel with KA (n = 24; 52.2%) than MA (n = 4; 8.2%; p < 0.001), and KA resulted in significantly less change to constitutional JLO.</p><p><strong>Conclusion: </strong>A TJLA parallel to the floor in single-leg stance is achieved more readily with KA than MA, but is dependent on constitutional JLO. A parallel TJLA during this phase of gait is more likely achieved when alignment is individualized to the patient's native anatomy.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 4","pages":"413-422"},"PeriodicalIF":4.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mid-term outcomes of the fixed-bearing lateral Oxford unicompartmental knee arthroplasty.","authors":"Lachlan W Arthur, Cathy Jenkins, Christopher A F Dodd, Andrew J Price, William F M Jackson, Nicholas Bottomley, Abtin Alvand, David W Murray","doi":"10.1302/0301-620X.107B4.BJJ-2024-0977.R1","DOIUrl":"10.1302/0301-620X.107B4.BJJ-2024-0977.R1","url":null,"abstract":"<p><strong>Aims: </strong>Mixed clinical results have been reported following the use of lateral unicompartmental knee arthroplasty (UKA) in patients with isolated lateral compartment osteoarthritis (OA) of the knee. Although this procedure may be appropriate for use in about 10% of knees needing arthroplasty, it is only used in about 1%. The aim of this study was to determine the medium-term results for the Fixed Lateral Oxford (FLO) UKA.</p><p><strong>Methods: </strong>We report the clinical results and survival for 305 consecutive FLO UKAs implanted in 279 patients between July 2015 and August 2022. A total of 283 knees (93%) satisfied the recommended surgical indications. The mean age of the patients was 70.8 years (SD 11), their mean BMI was 28.4 kg/m² (SD 5.4), and 219 (72%) were female. Isolated lateral compartment OA was the indication for 298 operations (98%). The mean follow-up was 4.3 years (1 to 8). The Oxford Knee Score (OKS) was recorded pre- and postoperatively. The revision status of all knees was known.</p><p><strong>Results: </strong>There were four revisions (1%): two were conversions to a total knee arthroplasty (TKA) for instability and progressive OA and two had the addition of a medial UKA for medial compartment OA. Three other UKAs required a reoperation. At the last follow-up, the mean OKS was 40.9 (SD 7.8), a mean increase of 20 points from the preoperative score. The cumulative rate of survival with any reoperation, including revision, as the endpoint, at seven years, was 96% (95% CI 91 to 100), with revision as the endpoint was 98% (95% CI 94 to 100) and with revision to a TKA as the endpoint was 99% (95% CI 96 to 100). No revisions required revision TKA components. When those who underwent surgery for indications which were outside the recommended indications were excluded, there were only two revisions, both with the addition of a medial UKA for progressive OA, resulting in a seven-year cumulative survival with revision as the endpoint of 99% (95% CI 93 to 100).</p><p><strong>Conclusion: </strong>This study involved the largest published cohort of fixed-bearing lateral UKAs. The good clinical outcomes and medium-term survival of the FLO UKA, particularly in patients satisfying the recommended indications, suggest that it is an excellent alternative to TKA for the treatment of patients with isolated OA of the lateral compartment of the knee.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 4","pages":"432-439"},"PeriodicalIF":4.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Periprosthetic joint infection : development of a core outcome set.","authors":"Ian W Kennedy, Fares S Haddad, Matthew P Abdel, Donald S Garbuz, Vanya Gant, R M D Meek, Carsten Perka, Chloe E H Scott, Bryan D Springer, Sam Oussedik, Michael R Whitehouse","doi":"10.1302/0301-620X.107B4.BJJ-2024-1727","DOIUrl":"10.1302/0301-620X.107B4.BJJ-2024-1727","url":null,"abstract":"<p><strong>Aims: </strong>Periprosthetic joint infection (PJI) is a devastating complication of arthroplasty, with substantial morbidity, mortality, and healthcare costs. Despite advances in diagnosis and treatment, inconsistencies in outcome reporting have hindered evidence synthesis, limiting progress in understanding and management. This study aimed to develop a core outcome set (COS) for PJI to standardize outcome reporting in the literature.</p><p><strong>Methods: </strong>A two-stage modified Delphi process was conducted to establish consensus across a range of domains. Stage 1 involved the identification of core outcomes in PJI research by an international expert panel. A patient group was also consulted to ensure that the domains were relevant to patient priorities. Stage 2 included a broader group of 55 stakeholders in an online consensus process to finalize the COS. Quantitative and qualitative data were collated to redefine the outcomes throughout the Delphi process.</p><p><strong>Results: </strong>Following the modified two-stage Delphi process, a high level of consensus was achieved for all outcomes. The final COS included 23 outcomes across the following four domains: patient demographics and baseline characteristics; infection characteristics; surgical and treatment details; and outcomes and follow-up.</p><p><strong>Conclusion: </strong>The developed COS provides a standardized framework for reporting outcomes in PJI research. By addressing variability and inconsistency in the literature, this COS aims to enhance comparability across studies, support robust evidence synthesis, and ultimately guide clinical decision-making.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 4","pages":"455-460"},"PeriodicalIF":4.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How are adults who had Perthes' disease functioning after total hip arthroplasty? : patient-reported outcome results from an international web-based survey.","authors":"Michael B Millis, Bella Vakulenko-Lagun, Harry K W Kim","doi":"10.1302/0301-620X.107B4.BJJ-2024-1019.R1","DOIUrl":"10.1302/0301-620X.107B4.BJJ-2024-1019.R1","url":null,"abstract":"<p><strong>Aims: </strong>Perthes' disease is a hip disorder that presents in childhood but can lead to diminished quality of life (QoL) in adulthood from hip deformities and secondary arthritis. Little is known about adult outcomes following total hip arthroplasty (THA) from the patient's perspective. We employed a web-based survey to gather data on treatment history, demographic details, and patient-reported outcome measures (PROMs) from adults with Perthes' disease who underwent THA. We then compared these PROMs to those of age- and sex-matched normative cohorts, and a Perthes' disease cohort not treated with THA.</p><p><strong>Methods: </strong>We used an English REDCap-based survey on a Perthes' disease study group website, which included Perthes' disease history, University of California, Los Angeles Activity Scale scores, the 36-Item Short-Form Health Survey (SF-36), and the Hip disability and Osteoarthritis Outcome Score (HOOS). A total of 261 THA participants were analyzed (mean age at survey 44.6 years (SD 12.4); mean time since THA 7.2 yrs (SD 8.0)).</p><p><strong>Results: </strong>Compared to normative cohorts, THA participants had significantly lower HOOS QoL and Sports & Recreation scores across all age groups (p < 0.001). Female THA participants aged under 45 years reported worse HOOS Pain, Symptom, and Activities of Daily Living scores, as well as SF-36 Physical and Social scales (all p < 0.001) compared to normative cohorts. Hip dysplasia and number of years from THA were significantly associated with poorer outcome. In comparison to a Perthes' disease cohort without THA, female THA participants aged 35 to 54 years reported significantly better outcomes across all scores except for sports. Females aged 18 to 34 years had significantly better symptom and pain scores in the THA cohort.</p><p><strong>Conclusion: </strong>The Perthes' disease cohort who had THA had better pain and symptom scores than the Perthes' disease non-THA cohort, but reported substantially lower QoL scores compared to a normative population. These results highlight the symptom improvements that THA can offer, while suggesting the need for research to improve treatments which will reduce persisting impairments of QoL.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 4","pages":"380-390"},"PeriodicalIF":4.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early aseptic loosening and inferior patient-reported outcomes of a cementless tibial baseplate in a modern total knee arthroplasty design.","authors":"Octavian Andronic, Yue H Yang, Moreica Pabbruwe, Chris W Jones, Piers J Yates","doi":"10.1302/0301-620X.107B4.BJJ-2024-0704.R1","DOIUrl":"10.1302/0301-620X.107B4.BJJ-2024-0704.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study reports the outcome of a modern total knee arthroplasty design using a cementless tibial baseplate compared to the full-cemented version.</p><p><strong>Methods: </strong>Consecutive cohorts with 12-month follow-up were evaluated. Patients receiving a cementless tibial baseplate were compared to those who received a cemented tibial component. Endpoints included revision rates and reason for revision, patient-reported outcome measures (PROMs) using the Oxford Knee Score (OKS), and progressive radiolucency. Retrieval analysis was performed for the revised cases. Pearson correlation analysis and multiple regression analysis were used.</p><p><strong>Results: </strong>A total of nine knees (7%) from the cementless cohort were revised, all due to aseptic loosened baseplate at a mean follow-up of 10.4 months (3 to 19), whereas the incidence of aseptic loosening of the cemented tibial baseplate was significantly lower at 0.5% (3/534; p < 0.001). The cemented cohort PROMs outperformed the cementless baseplate group at both 12 months' follow-up and the improvement from baseline (mean OKS 40.4 (SD 6.8) vs 38.5 (SD 8.1); p = 0.006; mean ΔOKS 18.8 (SD 9.0) vs 15.5 (SD 12.8); p < 0.001). There were no significant differences between the groups in the occurrence of new radiolucency at 12 months (p = 0.325). An elevated BMI was the only factor to correlate (<i>r</i> = -0.195) with worse values of ΔOKS (p = 0.048) in the cementless cohort. The multiple regression analysis determined that an increased BMI was the single independent predictor for aseptic loosening (p = 0.024) for the knees with a cementless tibial baseplate. Retrieval analysis suggested failed osseointegration.</p><p><strong>Conclusion: </strong>In our cohort, there was a significantly higher incidence of aseptic loosening and worse PROMs at one year for the cementless tibial baseplate. An increased BMI may be an independent risk factor for aseptic loosening and inferior PROMs.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 4","pages":"440-448"},"PeriodicalIF":4.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delirium on presentation with a hip fracture is associated with adverse outcomes : a multicentre observational study of 18,040 patients using national clinical registry data.","authors":"Rose S Penfold, Luke Farrow, Andrew J Hall, Nick D Clement, Kirsty Ward, Lorraine Donaldson, Antony Johansen, Andrew D Duckworth, Atul Anand, Daniel E Hall, Bruce Guthrie, Alasdair M J MacLullich","doi":"10.1302/0301-620X.107B4.BJJ-2024-1164.R1","DOIUrl":"10.1302/0301-620X.107B4.BJJ-2024-1164.R1","url":null,"abstract":"<p><strong>Aims: </strong>Delirium is common in hip fracture patients, but large-scale routine data studies examining the prevalence and associations of delirium at the time of initial presentation with a hip fracture are rare. This study aimed to describe the prevalence and outcomes of delirium on initial presentation with a hip fracture in a large national population sample.</p><p><strong>Methods: </strong>This study analyzed routinely collected national clinical registry data for all people in Scotland aged 50 years and over presenting with a hip fracture between 1 July 2019 and 31 December 2021. Delirium was assessed prospectively by clinicians as part of routine care using the 4AT, a validated two-minute assessment tool. Associations of 4AT score with mortality and return home within 30 days were analyzed using logistic regression models, adjusted for confounders.</p><p><strong>Results: </strong>Of 18,040 patients (mean age 80 years (SD 10); 70% female (n = 12,594)), 16,476 (91%) had a 4AT assessment on presentation and of these, 3,386 (21%) had a score ≥ 4, suggestive of delirium. Patients with delirium were older, more likely residing in care homes, and had higher American Society of Anesthesiologists grades (all p < 0.001). Delirium was independently associated with a twofold increased risk of inpatient mortality (adjusted odds ratio (aOR) 2.26 (95% CI 1.79 to 2.84)) and one-year mortality (aOR 2.05 (95% CI 1.83 to 2.29)), and a lower likelihood of returning home within 30 days (aOR 0.27 (95% CI 0.24 to 0.30)).</p><p><strong>Conclusion: </strong>Delirium affects around 20% of patients presenting with a hip fracture, and is associated with important adverse outcomes. Integrating delirium assessment into the initial clinical assessment of hip fracture patients is feasible at national scale, and should be considered as part of care for all hip fracture patients.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 4","pages":"470-478"},"PeriodicalIF":4.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and performance of contemporary press-fit titanium osseointegration implants in lower extremity amputation : a five-year follow-up study.","authors":"Robin Atallah, Elmer Rutjes, Jan P M Frölke, Ruud A Leijendekkers","doi":"10.1302/0301-620X.107B4.BJJ-2024-0754.R1","DOIUrl":"10.1302/0301-620X.107B4.BJJ-2024-0754.R1","url":null,"abstract":"<p><strong>Aims: </strong>Treatment using bone-anchored prostheses (BAPs) with press-fit femoral osseointegration implants (OIs) has been used in patients with lower limb amputations for more than two decades. The development of these OIs has enabled treatment in patients with a short transfemoral and a transtibial amputation. The aim of this follow-up study was to report the safety of this treatment at five years postoperatively, the prosthesis wearing time (PWT), and health-related quality of life (HRQoL).</p><p><strong>Methods: </strong>All consecutive patients undergoing treatment between March 2015 and June 2018 using one of three different OIs were eligible for inclusion. A total of 90 patients were included, of whom 14 were lost to follow-up, leaving 76 available for analysis. The curved- or gamma-osseointegration femoral implant (OFI-C, OFI-Y) was used in patients with a mid-diaphyseal or short transfemoral amputation, respectively. The osseointegration tibial implant (OTI) was used in those with a transtibial amputation. The adverse events which were evaluated included infection (soft-tissue, bone, implant), stoma-related complications, aseptic loosening, implant breakage, periprosthetic fracture, and complications between surgical stages. The functional outcomes which were assessed included the Questionnaire for Persons with a Transfemoral Amputation (Q-TFA)-Prosthetic Use Score (PUS) and the Global Score (GS), for PWT and HRQoL, respectively.</p><p><strong>Results: </strong>A 94.2% implant survival was achieved at five years (OFI-C = 93.8%, OFI-Y = 93.3%, OTI = 95.5%); five implants were removed. Overall, 27 patients (36%) had a total of 56 infections, 53 (95%) of which were infections of the soft-tissues. Septic loosening occurred in three patients (4%, OFI-C = 2, OTI = 1), resulting in removal of the implant in two. The infection/implant-year ratio was 0.09, 0.16, and 0.24 for OFI-C, OFI-Y and OTI, respectively. Periprosthetic fracture occurred in four patients (5%, all OFI-C); all were treated surgically, three with fixation, one with removal. One patient had asymptomatic radiological evidence of partial aseptic loosening; this was managed conservatively. Stoma-related problems required surgery on 26 occasions, mostly in patients treated with an OFI-Y. The implant was removed in two patients (2.6%) due to unexplained pain. Complications between surgical stages were mostly surgical site infections, requiring bringing forward stage 2 on seven occasions. Baseline Q-TFA-PUS and GS scores increased significantly in all patients, and also when stratified per type of implant with the passage of time.</p><p><strong>Conclusion: </strong>Contemporary press-fit titanium OIs, when used in lower limb amputations, result in acceptable rates of survival and safety, with considerable improvements in functional outcomes.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 4","pages":"486-494"},"PeriodicalIF":4.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}