Bone & Joint Journal最新文献

{"title":"Corrigendum.","authors":"Sjur Børsheim, Torbjørn Berge Kristensen, Geir Hallan, Jan-Erik Gjertsen, Ove Furnes, Eva Dybvik, Stein Atle Lie, Håvard Dale","doi":"10.1302/0301-620X.107B10.BJJ-2025-00058","DOIUrl":"https://doi.org/10.1302/0301-620X.107B10.BJJ-2025-00058","url":null,"abstract":"","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 10","pages":"1131"},"PeriodicalIF":4.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201551","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":"The false economy of increased waiting times for hip and knee arthroplasty : a cost consequence analysis.","authors":"Chloe E H Scott, Liam Zen Yapp, Navnit S Makaram, Paul Nicholas Karayiannis, Nicholas D Clement","doi":"10.1302/0301-620X.107B9.BJJ-2024-0974.R2","DOIUrl":"https://doi.org/10.1302/0301-620X.107B9.BJJ-2024-0974.R2","url":null,"abstract":"<p><strong>Aims: </strong>Cost per quality-adjusted life-year (QALY) can be used to estimate the financial consequences of delayed surgery. QALYs are determined by health-related quality of life (HRQoL) and the duration of the time spent in that state. Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are cost-effective procedures, but it is not known whether prolonged waiting times have an impact on costs and QALYs associated with them. The aim of this study was to investigate how the time waiting for surgery can influence the overall cost and gains in QALYs over a ten-year period following THA or TKA.</p><p><strong>Methods: </strong>Public data sources, including the National Joint Registry (NJR), NHS Digital patient-reported outcome measures (PROMs) and previously published studies were used to model HRQoL gains following THA and TKA. Using EuroQol five-dimension questionnaire (EQ-5D) index scores, the net QALY was simulated for waiting times of three months, one year and three years. Expected EQ-5D scores up to ten years postoperatively were plotted for THA and TKA. The trjectories of QALYs were modelled using probabilistic sensitivity analysis. Shortfalls in QALYs were calculated as the area under the curve (AUC).</p><p><strong>Results: </strong>When the costs of additional prescriptions and unscheduled care were included, the excess cost incurred per patient by waiting three years compared to three months was £1,756 (£796 with disutility) for THA, and £2,116 (£1,068 with disutility) for TKA. Waiting one year resulted in a ten-year shortfall of QALYs of 9% for both THA and TKA, increasing to 45.5% (THA) and 57.1% (TKA) after a three-year wait. Three-year waits increased the cost/QALY by 2.00 to 2.44 times for THA (1.14 to 1.23 for one year) and 2.45 to 2.93 times (1.10 to 1.19 for one year) for TKA. If improvements in EQ-5D (as opposed to absolute values) were equal between the waiting times, waiting three years for TKA resulted in a net loss of QALYs over ten years.</p><p><strong>Conclusion: </strong>This analysis suggests that waiting beyond three months for THA/TKA resulted in excess costs and diminished HRQoL. Increasing waiting times in the NHS, thus, appear to be a false economy.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 9","pages":"905-914"},"PeriodicalIF":4.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975587","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":"Much higher re-revision rates and mortality following septic revision total knee arthroplasty compared to meta-analyses : a registry study.","authors":"Luis Becker, Martin Resl, Alexander Grimberg, Yinan Wu, Clemens Gwinner, Carsten Perka","doi":"10.1302/0301-620X.107B9.BJJ-2024-1440.R1","DOIUrl":"10.1302/0301-620X.107B9.BJJ-2024-1440.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study investigates re-revision and mortality rates following septic revision of total knee arthroplasty (TKA) using registry data from Germany.</p><p><strong>Methods: </strong>An observational cohort study was conducted using data from the German Arthroplasty Registry (EPRD), consisting of 15,372 revision TKAs. Cumulative incidences of re-revision and mortality for septic and aseptic revision-TKAs were analyzed over a seven-year follow-up (2015 to 2022). Kaplan-Meier estimates were employed to determine re-revision rates and cumulative mortality probabilities after revision TKA.</p><p><strong>Results: </strong>The re-revision rate within the first year following septic revision TKA was 21.7% (95% CI 20.3 to 23.1), compared to only 7.1% (95% CI 6.6 to 7.6) for aseptic revisions. Notably, 74% of all re-revisions for septic revision TKA occurred within the first year. Cumulative mortality within the first year after septic revision TKA was 4.9% (95% CI 4.2 to 5.7), rising to 28.5% (95% CI 24.2 to 33.2) after seven years. In contrast, aseptic revision TKA had lower mortality rates, with 2% within the first year and 16% within seven years. After multiple previous knee revisions, re-revision rates increased to over 47%, and mortality to 30% for septic revisions.</p><p><strong>Conclusion: </strong>Registry data revealed nearly twice the re-revision rates for septic revision TKA compared to single-centre studies, reflecting real-world outcomes in Germany. Septic revision TKA has a threefold higher re-revision rate in the first year and double the mortality rate compared to aseptic revisions. Given the high risk in the first postoperative year, optimizing perioperative procedures is crucial to reducing the burden of septic revision TKA.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 9","pages":"896-904"},"PeriodicalIF":4.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975472","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":"A family-centred core outcome set for infants with developmental dysplasia of the hip undergoing brace treatment.","authors":"Joanna Craven, Wesley W E S Theunissen, Olivia O'Malley, Daniel M G Winson, Emma Morley, Miranda Asher, Clare Carpenter, Daniel C Perry","doi":"10.1302/0301-620X.107B9.BJJ-2025-0059.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.107B9.BJJ-2025-0059.R1","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to identify a minimum set of family-centred outcomes that should be collected in research involving infants with developmental dysplasia of the hip (DDH) undergoing brace treatment.</p><p><strong>Methods: </strong>A comprehensive list of potential outcomes was developed through a literature review and survey of key stakeholders including caregivers, clinicians, and researchers. Potential outcomes were evaluated in a two-round Delphi consensus process, which included a UK-led group with international involvement comprising orthopaedic surgeons, physiotherapists, nurse practitioners, researchers, parents, and charity representatives. Outcomes that did not reach consensus were discussed during a final consensus meeting, where a broad group of stakeholders voted on the inclusion or exclusion of these outcomes.</p><p><strong>Results: </strong>A total of 14 family-centred outcomes were identified for inclusion in the Delphi process. Of these, 12 were derived from the comprehensive literature review and two additional outcomes were added following the initial stakeholder survey. No additional outcomes were identified during the Delphi process. Of the 14 outcomes, eight achieved 'consensus in' during the Delphi rounds and none were excluded. Six outcomes were further discussed at the final consensus meeting, resulting in one being added to the final core outcome set (COS). The final COS includes nine outcomes: infant cleanliness, sleep, comfort, development, skin irritation, and feeding; along with parental wellbeing, bonding, and the availability of information and resources.</p><p><strong>Conclusion: </strong>This family-centred COS is recommended as the minimum set of outcomes that should be collected in trials involving infants undergoing brace treatment for DDH. Further work is required to identify or develop an appropriate tool for collecting data on these outcomes.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 9","pages":"973-978"},"PeriodicalIF":4.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975461","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":"Satisfactory return to work rates after reverse total shoulder arthroplasty.","authors":"Alberto Pedrazzini, Flamur Zendeli, Bettina Hochreiter, Samy Bouaicha, Karl Wieser, Philipp Kriechling","doi":"10.1302/0301-620X.107B9.BJJ-2024-1587.R2","DOIUrl":"https://doi.org/10.1302/0301-620X.107B9.BJJ-2024-1587.R2","url":null,"abstract":"<p><strong>Aims: </strong>The aim was to analyze the ability to return to work (RTW) after implantation of reverse total shoulder arthroplasty (RTSA) with special attention to heavy labourers.</p><p><strong>Methods: </strong>All working patients younger than 60 years of age who underwent RTSA between September 2005 and October 2021 were retrospectively evaluated for their ability to RTW. Basic demographic information, job intensity, change of work, and preoperative sick leave were collected. Constant-Murley score (CS) and Subjective Shoulder Value (SSV) preoperatively and at two years' follow-up, complications, and revision surgeries were used to evaluate the outcome. Logistic regression analysis was used to predict RTW.</p><p><strong>Results: </strong>A total of 167 of 209 eligible patients were employed at the time of surgery (median age 55 years (IQR 50.3 to 57.8), 34.1% (n = 57) female), of whom 75 (44.9%), 61 (36.5%), and 31 (18.6%) were classified to have light, medium, or heavy work intensity, respectively. Postoperatively, 73.7% (123/167) of them RTW at a median time of four months (IQR 2 to 7). Of those who RTW, 9.8% of patients (12/123) had to change occupation to less demanding jobs. Patients with high-intensity jobs had a lower RTW rate (19/31; 61.3%) compared with those with light (59/75; 78.7%) and medium-intensity jobs (45/61; 73.8%). Patients who RTW had better pre- and postoperative outcomes as well as greater improvement in relative CS (76% vs 34%; p < 0.001), CS for pain (14 vs 7 with 15 as best value; p < 0.001), and SSV (75% vs 20%; p < 0.001). Logistic regression analysis showed that absence of preoperative sick leave (OR 6.81 (95% CI 2.63 to 19.4); p < 0.001) was associated with higher RTW rates.</p><p><strong>Conclusion: </strong>More than two-thirds of preoperatively working patients were able to RTW after RTSA, depending on work intensity. Higher RTW rates were seen in patients who were not on sick leave preoperatively. This information is highly relevant for the surgeon to counsel patients accordingly and possibly limit expectations, especially in heavy workers.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 9","pages":"915-923"},"PeriodicalIF":4.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975525","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":"Risk factors associated with the development of complications after a hip fracture.","authors":"En Lin Goh, May Ee Png, David Metcalfe, Juul Achten, Duncan Appelbe, Xavier L Griffin, Jonathan A Cook, Matthew L Costa, Michael Barrett, Peter Hull, David Melling, Jonathan Kosy, Charalambos P Charalambous, Oliver Keast- Butler, Paul Magill, Rathan Yarlagadda, Girish Vashista, Terence Savaridas, Seb Sturridge, Graham Smith, Kishore Dasari, Deepu Bhaskar, Stefan Bajada, Ewan Bigsby, Ansar Mahmood, Mark Dunbar, Andrea Jimenez, Ryan Wood, James Penny, William Eardley, Robert Handley, Suresh Srinivasan, Matt Gee, Ashwin Kulkarni, John Davison, Mohammad Maqsood, Amit Sharma, Chris Peach, Ahsan Sheeraz, Piers Page, Andrew Kelly, Iain McNamara, Lee Longstaff, Mike Reed, Iain Moppett, Ayman Sorial, Theophilus Joachim, Aaron Ng, Kieran Gallagher, Mark Farrar, Ad Ghande, Jonathan Bird, Shyam Rajagopalan, Andrew McAndrew, Andrew Sloan, Rory Middleton, Ian Dos Remedios, Damian McClelland, Benedict Rogers, James Berstock, Sharad Bhatnagar, Owen Diamond, Paul Fearon, Inder Gill, Doug Dunlop, Tim Chesser, Mehool Acharya, Deepak Sree, Johnathan Craik, David Hutchinson, David Johnson, Mosab Elgalli, Paul Dixon, Pregash Ellapparadja, Guy Slater, Jakub Kozdryk, Jonathan Young, Khitish Mohanty Ben Ollivere, Mohammad Faisal, Callum Clark, Baljinder Dhinsa, Ibrahim Malek, Sam Heaton, Oliver Blocker, Kanthan Theivendran","doi":"10.1302/0301-620X.107B9.BJJ-2024-0981.R2","DOIUrl":"10.1302/0301-620X.107B9.BJJ-2024-0981.R2","url":null,"abstract":"<p><strong>Aims: </strong>Mortality after a hip fracture has declined in recent years, but the risk of complications remains high. The aim of this study was to identify non-modifiable and, specifically, modifiable factors associated with the development of complications after hip fracture.</p><p><strong>Methods: </strong>This was a multicentre, prospective cohort study of adults aged ≥ 60 years with a hip fracture who were treated in 77 hospitals in England, Wales, and Northern Ireland between July 2014 and November 2021. A total of 24,523 patients were enrolled into the study. Cox proportional hazards regression models were used to assess associations between prespecified (a priori) covariates and the development of surgery-specific and general complications at 120 days, postoperatively.</p><p><strong>Results: </strong>For surgery-specific complications, male sex was associated with reoperation (hazard ratio (HR) 1.23 (95% CI 1.01 to 1.51)) and surgical site infection (SSI) (HR 1.20 (95% CI 1.00 to 1.43)); American Society of Anesthesiologists (ASA) grade ≥ III with prosthetic dislocation (HR 2.19 (95% CI 1.40 to 3.41)), reoperation (HR 1.35 (95% CI 1.06 to 1.72)), and surgical site infection (SSI) (HR 1.26 (95% CI 1.02 to 1.56)); treatment with a cephalomedullary nail with periprosthetic or peri-implant fracture (HR 4.09 (95% CI 1.62 to 10.32)) and reoperation (HR 1.94 (95% CI 1.29 to 2.92)); and treatment with total hip arthroplasty (THA) with prosthetic dislocation (HR 2.43 (95% CI 1.54 to 3.82)). For general complications, age was associated with acute kidney injury (AKI) (HR 1.04 (95% CI 1.03 to 1.05)), the requirement of a blood transfusion (HR 1.02 (95% CI 1.01 to 1.02)), lower respiratory tract infection (LRTI) (HR 1.02 (95% CI 1.01 to 1.03)), and urinary tract infection (UTI) (HR 1.02 (95% CI 1.01 to 1.02)); ASA grade ≥ III with AKI (HR 1.52 (95% CI 1.18 to 1.95)), the requirement of a blood transfusion (HR 1.35 (95% CI 1.16 to 1.58)), LRTI (HR 2.02 (95% CI 1.72 to 2.37)), and UTI (HR 1.33 (95% CI 1.13 to 1.56)); male sex with AKI (HR 1.30 (95% CI 1.09 to 1.55)) and LRTI (HR 1.33 (95% CI 1.20 to 1.48)); delayed mobilization with AKI (HR 1.68 (95% CI 1.13 to 2.44)), LRTI (HR 1.96 (95% CI 1.75 to 2.19)), UTI (HR 1.52 (95% CI 1.32 to 1.74)), myocardial infarction (MI) (HR 2.05 (95% CI 1.35 to 3.10)), and pulmonary embolism (HR 1.70 (95% CI 1.05 to 2.74)); and delayed surgery with MI (HR 1.66 (95% CI 1.13 to 2.44)).</p><p><strong>Conclusion: </strong>Patient-related factors such as increasing age, male sex, and higher comorbidity were associated with a number of complications, which may explain the higher mortality and worse recovery seen in these groups. We also identified a number of potentially modifiable treatment-related factors which may influence the development of complications and which warrant further investigation.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 9","pages":"950-956"},"PeriodicalIF":4.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975527","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":"High-dose dual antibiotic cement for hip hemiarthroplasty : a post-hoc Bayesian analysis of a randomized controlled trial.","authors":"Luke Farrow, Jemma Hudson, Alan George, Mike R Reed, Marion K Campbell","doi":"10.1302/0301-620X.107B9.BJJ-2024-1364.R1","DOIUrl":"10.1302/0301-620X.107B9.BJJ-2024-1364.R1","url":null,"abstract":"<p><strong>Aims: </strong>In this study we aimed to evaluate how a post-hoc Bayesian analysis of results from the large multicentre World Hip Trauma Evaluation (WHiTE) 8 (High-dose dual-antibiotic-loaded cement for hip hemiarthroplasty) trial might aid clinical interpretation.</p><p><strong>Methods: </strong>Using anonymized data, a post-hoc Bayesian Poisson regression adjusting for age, sex, and centre (random effects), with 200,000 iterations, was undertaken to compare high-dose dual-antibiotic cement versus single-antibiotic cement for the primary outcome reduction of deep surgical site infection (dSSI) at 90 days. Two set of priors were used: reference priors and a data-derived prior. We assessed the posterior probabilities (PP) of relative risk (RR) (for any benefit (RR > 1), modest benefit (> 1.25), and large benefit (> 1/5)) and risk difference (RD).</p><p><strong>Results: </strong>There were 38/2,187 (1.7%) and 27/2,219 (1.2%) dSSIs identified at 90 days in the single-antibiotic and high-dose dual-antibiotic cement groups, respectively (original analysis (OR) 1.44 (95% CI 0.88 to 2.37)). With a minimally informative reference prior there was a posterior median (PM) RR for dSSI of 1.42 (95% credible interval (CrI) 0.87 to 2.36), with a 92% PP of a RR > 1 and an 81% PP of a RD > 0.25 in favour of high-dose dual-antibiotic cement. When utilizing the data-driven prior without downweighting, there was a PM RR for dSSI of 1.62 (95% CrI 1.03 to 2.59), with a 98% PP of a RR > 1 and a 93% PP of a RD > 0.25.</p><p><strong>Conclusion: </strong>This Bayesian re-analysis demonstrates that it is highly probable (> 90%) that there is at least some reduction of dSSI related to high-dose dual-antibiotic cement use when performing hemiarthroplasty; adding useful clinical nuance to the original trial findings in context of the noteworthy detrimental impact of dSSI in the study population. This study also highlights the potential benefits of a Bayesian approach to analysis due to improved interpretability of trial outcomes.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 9","pages":"957-964"},"PeriodicalIF":4.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975451","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":"Clinical trials in Trauma and Orthopaedics : time to think Bayesian?","authors":"Luke Farrow, Jemma Hudson, Alan George, Mike R Reed, Marion K Campbell","doi":"10.1302/0301-620X.107B9.BJJ-2025-0548.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.107B9.BJJ-2025-0548.R1","url":null,"abstract":"<p><p>This aim of this annotation is to provide greater knowledge about Bayesian methodology when used in the design of clinical trials and in the analysis of the findings, including the potential benefits and limitations of this approach in Trauma and Orthopaedic surgery. We outline how adopting Bayesian methodology could serve as a feasible and potentially more relevant basis for the design and conduct of future randomized controlled trials in our specialty. It also provides background methodological context for the paper 'High-dose dual-antibiotic cement for hip hemiarthroplasty: a post-hoc Bayesian analysis of a randomized controlled trial', which is published in this issue.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 9","pages":"862-864"},"PeriodicalIF":4.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975458","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":"Grade 2 central chondrosarcoma treated by intralesional curettage: observation or surgery? : a multicentre retrospective study.","authors":"Andrea Sambri, Domenico Andrea Campanacci, Minna K Laitinen, Maria Anna Smolle, Michiel A J van de Sande, Jonathan Perera, Davide Maria Donati, Andreas Leithner, Lee Jeys, Massimiliano De Paolis, Eric Staals, David Biau, Vania Oliveira, Rob Pollock, Alessandro Bruschi, Michele Fiore, Andrea Montanari, Renato Zunarelli, Roberto Scanferla, Osman Emre Aycan, Berkay Dogan, Adyb-Adrian Khal, Laura Trullols Tarragó, Ingrid van der Geest, Remco Doodkorte, Michal Mahdal, Min Wook Joo, Lorenzo Andreani, Luca Cevolani, Nischalan Pillay, Ankur Gupta, Julian Maier, Hagen Schmal","doi":"10.1302/0301-620X.107B9.BJJ-2024-1378.R1","DOIUrl":"10.1302/0301-620X.107B9.BJJ-2024-1378.R1","url":null,"abstract":"<p><strong>Aims: </strong>The most appropriate management of patients who have undergone curettage for a suspected low-grade chondrosarcoma (CS), which has subsequently been found to be of grade 2, remains unknown. We aimed to assess whether these patients have an increased risk of local recurrence and distant metastasis if followed up over time, compared to those who undergo further treatment soon after the diagnosis has been established.</p><p><strong>Methods: </strong>A retrospective study was undertaken which included 71 patients treated between January 2010 and December 2022 by intralesional curettage for a supposed low-grade CS, but who subsequently proved to have a histological grade 2 CS. Thereafter, patients either underwent further surgery (resection group) or follow-up (follow-up group).</p><p><strong>Results: </strong>The estimated local recurrence rate was 36.8% at five (95% CI 35.6 to 38.0) and 48.1% at ten years (95% CI 46.4 to 49.8), and was significantly higher in the follow-up group (48.4%, 95% CI 45.4 to 51.4) than in the resection group (9.6%, 95% CI 8.1 to 11.1) at five years (p = 0.005). Locally recurrent CS, considered as a time-dependent covariate, had an increased risk of metastasis (36.8% vs 2.5% at five years; p < 0.001) and a worse disease-specific survival (81.3% vs 100% at five years; p = 0.007).</p><p><strong>Conclusion: </strong>The optimal treatment strategy should be individualized based on the histological features of the tumour, tumour location, morbidity of resection, and patient-specific factors. We recommend that patients who have undergone unplanned surgery be treated in the standard manner. Observation may be appropriate in specific cases with a properly informed patient.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 9","pages":"965-972"},"PeriodicalIF":4.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975474","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":"Combining four patient-reported outcome measurement instruments to develop a common metric computerized adaptive test to measure outcome after total knee arthroplasty.","authors":"Chetan Khatri, Nick D Clement, Deborah J MacDonald, Chloe E H Scott, Andrew J Metcalfe, Jeremy N Rodrigues, Conrad J Harrison","doi":"10.1302/0301-620X.107B9.BJJ-2024-0993.R2","DOIUrl":"https://doi.org/10.1302/0301-620X.107B9.BJJ-2024-0993.R2","url":null,"abstract":"<p><strong>Aims: </strong>To map the Oxford Knee Score (OKS), OKS Activity & Participation Questionnaire, Forgotten Joint Score (FJS), and High Activity Arthroplasty Score to a common scale using principles of modern test theory. Using the common scale, we then aimed to build a computerized adaptive test (CAT) to reduce item burden.</p><p><strong>Methods: </strong>Participants undergoing total knee arthroplasty provided preoperative and postoperative (six and 12 months) paired responses for four patient-reported outcome measure (PROM) instruments, with the OKS being the common linking instrument. After meeting assumptions (unidimensionality, monotonicity, local independence, and measurement invariance), a graded response model was fitted to the data. A CAT algorithm was developed.</p><p><strong>Results: </strong>There were 6,301 paired responses included. Confirmatory factor analysis demonstrated that the four PROM instruments measured a similar or very similar latent construct, which we describe as 'knee health'. The combination of all four instruments resulted in higher test-level information than any individual instrument. The CAT reduced 36 items to a median of eight items, while maintaining high measurement precision (standard error of measurement 0.29).</p><p><strong>Conclusion: </strong>The common metric provides a more precise measurement of knee health than any of the individual instruments, and avoids floor and ceiling effects inherent in individual scores. The CAT algorithm reduced the item burden to a median of eight items, which is lower than the FJS or OKS, when used as individual instruments. It will also allow for standardization of outcome reporting and pooling of results across databases that use any of the four instruments to facilitate individual and meta-analyses across different scores.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 9","pages":"885-895"},"PeriodicalIF":4.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975499","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}