Bone & Joint Journal最新文献

{"title":"Assessment of the plane of maximum curvature in adolescent idiopathic scoliosis using 3D ultrasound : an exploratory study.","authors":"Zi-Qi Yang, Chonglin Wu, Yihao Zhou, Tom P C Schlösser, Adrian Gardner, Rene M Castelein, Winnie Chiu-Wing Chu, Jack Chun-Yiu Cheng, Tsz-Ping Lam, Yong-Ping Zheng, Timothy Tin-Yan Lee","doi":"10.1302/0301-620X.108B9.BJJ-2025-1594.R3","DOIUrl":"https://doi.org/10.1302/0301-620X.108B9.BJJ-2025-1594.R3","url":null,"abstract":"<p><strong>Aims: </strong>The size of the curves in patients with adolescent idiopathic scoliosis (AIS) is traditionally assessed using 2D Cobb angles, which may underestimate the extent of this complex 3D deformity. The plane of maximum curvature, measured using 3D reconstructions of the spine, including 3D ultrasound, offers more accurate 3D representation. However, the optimal 3D ultrasound-based method of measuring the plane of maximum curvature remains unknown. We evaluated the reliability and agreement of three methods of measuring the plane of maximum curvature (the maximum-curvature, endplate-apex-endplate, and maximum-axial-rotation methods) to provide radiation-free and severity-specific clinical recommendations for 3D ultrasound measurements of the plane of maximum curvature using the SRS-Lenke-Aubin 3D classification.</p><p><strong>Methods: </strong>A total of 88 patients with right major thoracic AIS, stratified by the severity of the curve (mild 29; moderate 34; severe 25), underwent 3D ultrasound. Conventional 2D parameters were quantified from the 3D ultrasound reconstructions. For each method of measurement of the plane of maximum curvature, we recorded the ultrasound curve angle (UCA) on the plane, its orientation, and the difference between it and the coronal UCA (ΔUCA). The reliability of all variables, the agreement between the three methods of measurement, comparisons between the severity groups, and correlations between the parameters of the deformity were analyzed.</p><p><strong>Results: </strong>All parameters showed excellent intraobserver reliability. The maximum-curvature and endplate-apex-endplate methods showed high agreement in the UCA measurements of the plane of maximum curvature and were consistent across the different severities of curve. For both methods, the orientation of the plane of maximum curvature was positively correlated with the coronal curvature and negatively correlated with the thoracic kyphosis. The mean ΔUCA exceeded the clinically relevant threshold of 5° in mild curves. In contrast, measurements using the maximum-axial-rotation method showed greater bias in the UCA measurement of the plane of maximum curvature and inverse associations; the orientation of the plane of maximum curvature showed negative correlations with the coronal and sagittal curvatures as well as with the apical and maximum axial vertebral rotations. The ΔUCA obtained by the three methods did not differ significantly across severity groups.</p><p><strong>Conclusion: </strong>3D ultrasound-based measurements of the plane of maximum curvature are reliable for the evaluation of the deformity in patients with AIS. The endplate-apex-endplate method is recommended for routine assessment of the plane of maximum curvature in moderate and severe curves, offering an automatic, reliable, and radiation-free alternative for the 3D monitoring of the scoliotic spine.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 9","pages":"1169-1181"},"PeriodicalIF":4.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867356","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":"Hip arthroplasty following proximal femoral tumour resection in children : the impact of age and articulation on implant survival and the outcomes following acetabular revision.","authors":"Charles A E Baird, Natalie Green, Scott Evans, Vineet Kurisunkal, Michael C Parry, Jonathan Stevenson","doi":"10.1302/0301-620X.108B9.BJJ-2025-1473.R2","DOIUrl":"https://doi.org/10.1302/0301-620X.108B9.BJJ-2025-1473.R2","url":null,"abstract":"<p><strong>Aims: </strong>Hip arthroplasty is rarely required before skeletal maturity. However, it is appropriate after resection of a proximal femoral bone tumour. This retrospective single-centre cohort study was conducted to evaluate how age and choice of articulation affects modes of implant failure and revision-free survival, and to understand the longer-term outcomes following inevitable revision.</p><p><strong>Methods: </strong>Between January 1982 and April 2023, 60 patients aged between two and 16 years underwent excision of a malignant bone tumour and proximal femoral endoprosthetic reconstruction (PFEPR) combined with either a hemiarthroplasty (HA) or total hip arthroplasty (THA) articulation. The median follow-up was 12.6 years (IQR 4 to 21).</p><p><strong>Results: </strong>There were 41 HAs and 19 THAs. Revision-free survival was poor in pre-adolescent patients (age ≤ 12 years) regardless of articulation (54% at five years (95% CI 38 to 77) and 21% at ten years (95% CI 8 to 54)). Adolescent patients (age > 12 years) undergoing THA (n = 12) had better median, five-year, and ten-year revision-free implant survival (21.9 years (IQR 11.9 to 22.7), 89% (95% CI 71 to 100), and 78% (55 to 100), respectively) than similarly aged patients undergoing HA (n = 15); (7.1 years (IQR 4.9 to 13.5), 68% (95% CI 46 to 100), 39% (18 to 82); p = 0.048), respectively). The leading indication for revision across all ages was an acetabular complication. HA subluxation occurred exclusively in the pre-adolescent cohort (14/26) at a median 2.8 years (IQR 2 to 8). Chondrolysis occurred in the adolescent cohort (8/27) at a median 7.1 years (IQR 2 to 12). Revision THA after failed HA (n = 35) survived well (85% (95% CI 71 to 100) and 77% (60 to 100) at five and ten years) although an early postoperative dislocation rate of 12% (n = 4) was observed, all of which were managed by closed reduction.</p><p><strong>Conclusion: </strong>Very young patients continue have a high risk of further surgery in the first decade after PFEPR. THA combined with PFEPR appears to improve revision-free implant survival in adolescent patients when compared with HA; however, it may introduce a risk of early postoperative dislocation. Following HA, there is a different mode of failure in pre-adolescent compared with adolescent patients, and revision to THA in either circumstance is durable.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 9","pages":"1190-1198"},"PeriodicalIF":4.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867391","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":"Patient-evaluated functional outcome is systematically different from physician-evaluated outcome after proximal humerus fracture fixation.","authors":"Dipit Sahu, Aditya Chaubey, Darshil Shah","doi":"10.1302/0301-620X.108B9.BJJ-2026-0044.R2","DOIUrl":"https://doi.org/10.1302/0301-620X.108B9.BJJ-2026-0044.R2","url":null,"abstract":"<p><strong>Aims: </strong>The study aimed to investigate the agreement between Constant-Murley score (CMS) and the shoulder subjective value (SSV); and the association of poor self-evaluated outcome with shoulder pain, range of motion (ROM) limitation, and shoulder strength after fixation of proximal humerus fractures.</p><p><strong>Methods: </strong>The study included 74 shoulders in 72 patients (mean age 56 years (SD 14), 40 male (56%)) who underwent locking plate fixation of displaced proximal humerus fractures between January 2015 and January 2024. We evaluated CMS, SSV, pain scores (visual analogue scale), and ROM measurements at the most recent (minimum one-year) follow-up. Agreement statistics between CMS and SSV were used descriptively, rather than to test true substitutability, because CMS and SSV are nonequivalent constructs.</p><p><strong>Results: </strong>The Bland-Altman analysis showed differences between CMS and SSV, as the mean difference between CMS and SSV (-14.21 (95% CI -17.25 to -11.18)) did not include the zero-difference line. The Pitman's test suggested that the variances were significantly different (p = 0.029). Firth's penalized method of logistic regression revealed that only the presence of shoulder pain was associated with an increased likelihood of a poor functional outcome (SSV ≤ 69.4) (coefficient 3.5 (95% CI 1.53 to 6.47); p < 0.001). The SSV threshold (69.4) was derived from the CMS ≤ 55 threshold on the same dataset and therefore may have nonindependence. However, a sensitivity analysis using a priori SSV threshold (75) of patient-acceptable symptom state (PASS) also showed that presence of pain was associated with increased likelihood of a lower SSV. Limitations in ROM (elevation, external rotation, and internal rotation) and lower shoulder strength were not independently associated with a poor SSV. In shoulders that did not develop avascular necrosis (n = 66), the bivariate exploratory analysis between presence of pain and predefined injury and radiological factors showed that malreduction (χ² (1, n = 66) = 6.8; p = 0.009) and absent postoperative medial hinge (χ² (1, n = 66) = 4.6; p = 0.032) were significantly associated with more frequent presence of shoulder pain.</p><p><strong>Conclusion: </strong>Physician-evaluated outcomes (as measured by the CMS) and patient self-evaluated outcomes (as measured by the SSV) are likely to differ systematically after internal fixation of proximal humerus fractures. Additionally, shoulder pain is independently associated with a poor self-evaluated functional outcome.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 9","pages":"1162-1168"},"PeriodicalIF":4.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867519","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 prospective double-blinded randomized controlled trial comparing conventional jig-based versus robotic arm-assisted medial unicompartmental knee arthroplasty.","authors":"Babar Kayani, Andreas Fontalis, Jenni Tahmassebi, Sujith Konan, Ricci Plastow, Usman Wazir, Munuzza Shah, Sam Oussedik, Fares S Haddad","doi":"10.1302/0301-620X.108B9.BJJ-2025-1481.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.108B9.BJJ-2025-1481.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study reports the interim outcomes of a randomized controlled trial comparing the accuracy of component positions, early functional outcomes, patient-reported outcome measures, and complications in conventional jig-based unicompartmental knee arthroplasty with navigational control (CO UKA) with robotic arm-assisted unicompartmental knee arthroplasty (RO UKA) for patients who have medial compartment knee osteoarthritis (OA).</p><p><strong>Methods: </strong>In total, 107 patients with symptomatic medial compartment OA were prospectively randomized to undergo CO UKA (n = 52) or RO UKA (n = 55), representing the currently available recruited cohort. Patients in both treatment groups had CT-based surgical planning. All procedures were completed using the medial parapatellar approach, and all patients received a standardized postoperative rehabilitation programme. Predefined study outcomes were recorded at regular intervals for two years after surgery.</p><p><strong>Results: </strong>RO UKA was associated with increased accuracy in executing the planned femoral (p < 0.001) and tibial (p < 0.001) component positions compared with CO UKA. RO UKA was associated with reduced inpatient pain scores (p < 0.001), decreased inpatient opioid analgesia consumption (p = 0.008), and shorter length of hospital stay (p = 0.004) compared with CO UKA. There were no differences between the treatment groups in the Oxford Knee Score (p = 0.299), Knee Injury and Osteoarthritis Outcome Score (p = 0.261), and Western Ontario and McMaster Universities Arthritis Index (p = 0.281) at two-year follow-up. RO UKA was associated with improved Forgotten Joint Score (FJS) at six-month (p = 0.002) and two-year (p = 0.021) follow-up. Patient recruitment declined during the trial as an increasing proportion of eligible patients expressed a preference for RO UKA, and operating surgeons experienced reduced clinical equipoise between the treatment groups.</p><p><strong>Conclusion: </strong>The interim results of this study show that RO UKA was associated with increased accuracy in achieving the planned femoral and tibial component positions, improved early functional recovery, and decreased length of hospital stay compared with CO UKA. RO UKA was associated with higher FJSs compared with CO UKA at short- to mid-term follow-up.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 9","pages":"1113-1120"},"PeriodicalIF":4.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867296","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":"Poor mental health in patients with symptomatic osteochondral lesions of the talus.","authors":"Juliëtte H M Pijnacker, Nathanael O Agyeman-Prempeh, Inger N Sierevelt, Kaj S Emanuel, Birit Broekman, Gino M M J Kerkhoffs, Sjoerd A S Stufkens, Jari Dahmen, Julian J Hollander, Quinten G H Rikken, Jason A H Steman","doi":"10.1302/0301-620X.108B9.BJJ-2025-1851.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.108B9.BJJ-2025-1851.R1","url":null,"abstract":"<p><strong>Aims: </strong>Osteochondral lesions of the talus (OLT) can cause pain and functional limitations, potentially affecting mental health. This study aimed to compare mental health in patients with OLT to the general Dutch population and individuals with mood or anxiety disorders, and to identify factors associated with mental health in OLT patients.</p><p><strong>Methods: </strong>This prospective study included patients with symptomatic OLT prior to treatment. Data for the general population and individuals with mood or anxiety disorders were obtained from the Netherlands Mental Health Survey and Incidence Study-3. Mental health was assessed using the Mental Health Inventory-5 (MHI-5). The primary outcome was the mean difference in MHI-5 between OLT patients and the general population. Multivariate linear regression examined associations between mental health and age, sex, BMI, smoking, lesion characteristics, laterality, and Foot and Ankle Outcome Score (FAOS) pain.</p><p><strong>Results: </strong>Among the 358 included OLT patients, 87% (311 of 358) scored ≤ 76 on the MHI-5. OLT patients scored significantly lower than the general population (mean difference 20.2 (95% CI 18.9 to 21.5)) and showed similar scores to individuals with a mood or anxiety disorder (mean difference 2.0 (95% CI -0.3 to 4.3)). One and two years after treatment, 79% (170/214) and 78% (134/173) of patients, respectively, scored ≤ 76 on the MHI-5. Multivariate analysis identified smoking (β = -2.6 (95% CI -4.7 to -0.4)) and FAOS pain (β = 0.3 (95% CI 0.1 to 0.3)) significantly associated with MHI-5 scores.</p><p><strong>Conclusion: </strong>Poor mental health is highly prevalent in patients with OLT, with scores substantially lower than the general population and comparable with individuals with mood or anxiety disorders. Smoking and ankle pain were associated with worse mental health. Despite successful long-term clinical outcomes of treatment of OLT, mental health remained poor. These findings underscore the importance of integrating mental health interventions alongside orthopaedic care for patients with OLT.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 9","pages":"1147-1153"},"PeriodicalIF":4.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867489","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":"Total ankle arthroplasty via lateral transfibular approach with and without concomitant subtalar arthrodesis : radiological alignment, patient-reported outcomes, and range of motion at ≥ five-year follow-up.","authors":"Serban A Constantinescu, Agustin Barbero, Carla Carfi, Nicholas Crippa Orlandi, Chiara Bonzano, Cristian Indino, Camilla Maccario, Federico G Usuelli","doi":"10.1302/0301-620X.108B9.BJJ-2026-0244.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.108B9.BJJ-2026-0244.R1","url":null,"abstract":"<p><strong>Aims: </strong>Concomitant subtalar pathology may require arthrodesis at the time of total ankle arthoplasty (TAA), yet direct comparisons of isolated TAA versus TAA + subtalar joint arthrodesis (STJA) via a lateral transfibular approach, using the same implant, remain limited. We compared ≥ five-year radiological, functional, and range of motion (ROM) outcomes.</p><p><strong>Methods: </strong>This retrospective single-centre cohort included 119 patients from January 2015 to December 2020 with ≥ five-year follow-up: 50 underwent TAA with concomitant subtalar arthrodesis and 69 underwent isolated TAA. Outcomes were Foot and Ankle Outcome Score (FAOS), visual analogue pain scale (VAS), 12-Item Short-Form Health Survey questionnaire physical component/mental component summary (SF-12 PCS/MCS), ankle ROM, radiological alignment (lateral distal tibial angle, α, tibiotalar surface (TTS), and Saltzman alignment), and complications. Analyses were performed using Welch's <i>t</i>-test or the Mann-Whitney U test for continuous variables and the chi-squared test or Fisher's exact test for categorical variables, together with multivariable regression, using a two-sided significance level of α = 0.05 with Holm correction across angles. Post hoc minimum detectable effect (MDE) analysis at 80% power used observed SDs and group sizes.</p><p><strong>Results: </strong>Ankle osteoarthritis (OA) + STJ OA had worse baseline FAOS (24.8 (7.0) vs 42.6 (8.8); p < 0.001), higher VAS (8.4 vs 7.2; p < 0.001), and lower ROM; there was no difference in SF-12 scores. At five years, both cohorts improved; between-group differences in PROMs and ROM were not significant. Radiologically, α and Saltzman alignment were similar; TTS differed modestly (-0.83° (95% CI -1.44 to -0.22); p = 0.048). Subtalar arthrodesis showed radiological bridging in 96% of patients (n = 48). Adjusted models showed no independent STJ effect and no smoking effect. MDE at 80% power was ~4.5 FAOS points (d = 0.52); the observed -3.4-point difference was below the threshold.</p><p><strong>Conclusion: </strong>TAA + STJ achieved comparable five-year functional, pain, and radiological outcomes to isolated TAA via the transfibular approach, supporting the safety of this combined approach in selected patients.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 9","pages":"1154-1161"},"PeriodicalIF":4.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867543","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":"Five-year survival and complications of more than 300 articulating high-dose antibiotic spacers in two-stage revision total hip arthroplasties for infection.","authors":"Matthew T Weintraub, William R Midthun, Mark W Pagnano, Michael J Taunton, Rafael J Sierra, Tad M Mabry, Kevin I Perry, Daniel J Berry, Matthew P Abdel","doi":"10.1302/0301-620X.108B9.BJJ-2026-0551.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.108B9.BJJ-2026-0551.R1","url":null,"abstract":"<p><strong>Aims: </strong>Two-stage exchange arthroplasty with an antibiotic-eluting cement spacer remains the predominant strategy in the USA for managing chronic periprosthetic joint infection (PJI) following total hip arthroplasty (THA). The aim of this study was to evaluate a commercially available, partially intraoperatively fabricated articulating high-dose antibiotic cement spacer, focusing on survival, complications, and patient-reported outcomes.</p><p><strong>Methods: </strong>A total of 298 patients (302 THAs) underwent two-stage exchange arthroplasty for PJI using a specific articulating antibiotic spacer between August 2005 and May 2022. Patients with a previous failed two-stage exchange were excluded, although 121 THAs (302, 40%) had undergone previous PJI-related procedures. The mean age of the patients was 65 years (SD 11), the mean BMI was 32 kg/m² (SD 7), and 116 (38%) were female. Most patients were classified as McPherson host B (158; 52%) and limb grade 2 (165; 55%), and 265 (88%) met the 2011 Musculoskeletal Infection Society criteria. The mean follow-up was six years (2 to 16). .</p><p><strong>Results: </strong>At five years after reimplantation, survival free of reinfection, aseptic rerevision, any rerevision, or any reoperation were 89% (95% CI 85.2 to 93.1), 93% (95% CI 89.3 to 96.1), 86% (95% CI 81.3 to 90.3), and 80% (95% CI 74.7 to 84.9), respectively. Dislocation accounted for most aseptic rerevisions (15/20). McPherson host C (HR 3.7 (95% CI 1.4 to 9.6); p = 0.007) and limb grade 3 (HR 3.3 (95% CI 1.0 to 11.1); p = 0.049) were significantly associated with an increased risk of reinfection. The mean Harris Hip Score at the latest follow-up was 76 (29 to 100). A total of 17 patients underwent revision or removal of a spacer for concerns about persistent infection and two for dislocation of the spacer. Eight patients underwent a non-rerevision reoperation during the spacer interval for wound drainage (n = 5), dislocation of the spacer (n = 2), and perispacer fracture (n = 1). A total of 26 spacer-related complications were treated nonoperatively (15 perispacer fractures, 11 dislocations). Dislocation of the spacer was strongly associated with dislocation after reimplantation (HR 6.2 (95% CI 2.3 to 16.9); p < 0.001).</p><p><strong>Conclusion: </strong>This commercially available, partially intraoperatively fabricated articulating spacer showed excellent reinfection-free five-year survival (89%). Spacer-related fracture and dislocation each occurred in 5% of patients. Dislocation of the spacer significantly increased the risk of dislocation following reimplantation, supporting the use of higher-stability bearings in these high-risk patients.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 9","pages":"1104-1112"},"PeriodicalIF":4.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867393","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":"Locking plate fixation compared with tension-band wiring for patellar fractures: a multicentre randomized controlled trial.","authors":"Peter Larsen, Rikke Thorninger, Rasmus Pind Severinsen, Jens-Christian Beuke, Steffen Skov Jensen, Morten Kerri Rasmussen, Juozas Petruskevicius, Jeppe Barckman, Niels Henrik Bruun, Rasmus Elsoe, Jan Duedal Rölfing, Rasmus Jorgensen, Jens Traerup, Anne Mette Kold Stausholm, Luis Ferreira, Mohammed Adel Al-Bayati, Mette Rosenstand, Rikke Serritslev","doi":"10.1302/0301-620X.108B9.BJJ-2026-0517.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.108B9.BJJ-2026-0517.R1","url":null,"abstract":"<p><strong>Aims: </strong>Patellar fractures are associated with considerable postoperative morbidity, and tension-band wiring has high complication rates and suboptimal outcomes. Locking plate fixation is a recent surgical innovation which confers superior biomechanical stability. However, there is little information about the clinical outcomes of this method of treatment. The aim of this study was to compare locking plate fixation with tension-band wiring in patients requiring surgical treatment for a patellar fracture.</p><p><strong>Methods: </strong>In this patient- and assessor-blinded, multicentre randomized trial, 122 adults with a displaced patellar fracture were assigned 1:1 to locking plate fixation or tension-band wiring. The primary outcome was patient-reported knee function measured by the five sub-scales of the Knee Injury and Osteoarthritis Outcome Score (KOOS) at 12 months. Superiority was predefined as a statistically significant difference in at least three KOOS sub-scales exceeding the minimal clinically important difference (pain 10, symptoms 9, activities of daily living 6, sport and recreation 10, quality of life 10). Secondary outcomes included additional clinical and functional outcomes. Analyses were performed according to the intention-to-treat principle.</p><p><strong>Results: </strong>A total of 63 patients were assigned to locking plate fixation and 59 to tension-band wiring; 57 (90.5%) and 52 (88.1%), respectively, completed 12-month follow-up. Locking plate fixation resulted in statistically significant and clinically meaningful improvements in three KOOS sub-scales at this time: symptoms (mean difference -10.4 (95% CI -16.4 to -4.4)), sport and recreation (-14.1 (95% CI -24.7 to -3.4)), and quality of life (-10.9 (95% CI -19.0 to -2.7)). Removal of hardware, failure of fixation, and reoperation occurred more frequently after tension-band wiring.</p><p><strong>Conclusion: </strong>Locking plate fixation yielded superior patient-reported outcomes compared with tension-band wiring at 12 months, providing high-level evidence supporting the use of plate fixation as a preferred surgical technique for patients with a displaced patellar fracture.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 9","pages":"1182-1189"},"PeriodicalIF":4.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867441","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":"Does transposition osteotomy of the acetabulum alter the natural history of developmental dysplasia of the hip?","authors":"Shiori Tanaka, Masanori Fujii, Shunsuke Kawano, Masaya Ueno, Yosuke Oba, Tadatsugu Morimoto","doi":"10.1302/0301-620X.108B9.BJJ-2026-0223.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.108B9.BJJ-2026-0223.R1","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to clarify the natural history of developmental dysplasia of the hip (DDH), borderline DDH (BDDH), and normal hips, and to determine whether transposition osteotomy of the acetabulum (TOA) alters the long-term joint survival in DDH and BDDH.</p><p><strong>Methods: </strong>We retrospectively reviewed 683 hips treated with TOA and 353 contralateral native hips. Hips were classified by the lateral centre-edge angle (LCEA) as DDH (< 20°), BDDH (20° to < 25°), or normal (≥ 25°). The median follow-up was 11 years (IQR 5.8 to 16) for contralateral native hips and 9.6 years (IQR 5.3 to 15) for TOA-treated hips. The cumulative probability of failure (progression to Tönnis grade 3, or conversion to total hip arthroplasty) was estimated using the Kaplan-Meier method. Cox proportional hazards models with patient-level cluster-robust standard errors identified predictors for failure.</p><p><strong>Results: </strong>In native hips, the 20-year survival was significantly lower in DDH than in BDDH and normal hips (69% (95% CI 55 to 80) vs 96% (95% CI 83 to 99) vs 100%, respectively; p < 0.010), with no significant difference between BDDH and normal hips. Increased BMI and decreased LCEA were independent predictors for failure. In DDH, TOA-treated hips had significantly increased 20-year survival compared with native hips (88% (95% CI 80 to 93) vs 69% (95% CI 55 to 80); p < 0.001), and native hip status, older age, and increased BMI were independent predictors of failure. In BDDH, failure-free survival at 20 years did not differ significantly between native hips and TOA-treated hips (96% (95% CI 83 to 99) vs 100%; p = 0.394); however, TOA-treated hips had significantly less progression of osteoarthritis (OA) than native hips (20-year survival: 79% (95% CI 22 to 96) vs 52% (95% CI 30 to 71); p = 0.039). Older age and decreased LCEA were independent predictors of progression of OA.</p><p><strong>Conclusion: </strong>In DDH, the increased long-term survival after TOA supports a potential disease-modifying effect of acetabular reorientation. BDDH showed a low long-term risk of failure and TOA was not significantly associated with improved failure-free survival in this sub-group. These findings indicate that the severity of dysplasia determines distinct long-term outcomes and support the careful selection of patients for TOA in those with BDDH, with the need for further longitudinal evaluation.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 9","pages":"1087-1096"},"PeriodicalIF":4.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867328","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":"Patient, surgeon, and institutional variation in dual-mobility component use in primary total hip arthroplasty : a retrospective cohort study using data from the National Joint Registry Study.","authors":"Benjamin E Zucker, Joshua T Howard, Michael R Whitehouse, Andrew Judge","doi":"10.1302/0301-620X.108B9.BJJ-2026-0389.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.108B9.BJJ-2026-0389.R1","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to quantify the contribution of patient-, surgeon-, and institution-level factors to variation in dual-mobility component use in primary total hip arthroplasty (DM-THA) in England. We sought to determine whether current patterns reflect appropriate patient selection or unwarranted practice variation. We hypothesized that surgeon- and institution-level factors account for a greater proportion of variation in DM-THA use than patient-level characteristics.</p><p><strong>Methods: </strong>We analyzed 238,455 primary THAs recorded in the National Joint Registry which were linked with Hospital Episode Statistics for England between 1 January 2018 and 31 December 2022. Using cross-classified multilevel logistic regression modelling, we partitioned variation in DM-THA use attributable to patient, surgeon, and institutional factors. Patient risk factors were included as fixed effects, with random effects specified for surgeons and hospitals to account for clustering.</p><p><strong>Results: </strong>Of the total cohort, 7,032 underwent DM-THA. These patients were older, more frail, and more frequently treated for neck of femur fractures. Surgeon-level factors explained 32.4% and institutional factors 22.9% of variation in DM-THA use. Patient-level factors accounted for approximately 10% of the variance (marginal R² = 0.10), while the full model explained 59.8% of variation (conditional R² = 0.598). Findings were consistent in analyses restricted to high-volume surgeons.</p><p><strong>Conclusion: </strong>Variation in DM-THA use is predominantly driven by surgeon and institutional practice rather than patient characteristics. Prognostic tools which can identify patients at high dislocation risk, to guide inclusion criteria for targeted randomized trials, are needed to establish evidence-based guidance for DM implant selection and reduce unwarranted practice variation.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 9","pages":"1097-1103"},"PeriodicalIF":4.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867554","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}